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Background
Since 2009, we provide harm reduction services to people who use drugs in Moscow. The political and financial climate as well as the epidemiologic situation are not very supportive for our work – Russia still has one of the fastest growing HIV epidemics in the world with more than 1 million cases being registered and more then 50 000 HIV positive people living in Moscow. Officially registered number of people who use drugs living in Moscow is over 30 000 people. Unsafe injection of drugs is still the major cause of HIV transmission in Russia (more than 60% of all new cases), HIV epidemic is escalating in the country and its capital, but the government still denies the effectiveness of harm reduction measures and provides zero support to NGOs working on HIV prevention among key affected populations. Russian drug policy is still known as one of the most conservative and repressive among those around the world – it continues to declare a zero tolerance towards drug use inflaming the stigma and discrimination towards people who use drugs because of their drug dependence and primarily they are considered not as patients who need proper treatment and support but as criminals. It restricts the access for drug users to vitally important for them information on health issues and to the health services needed such as needle exchange programs and opioid substitution treatment.
About our harm reduction project and its participants
Unfortunately, our harm reduction project is still the only one working in Moscow providing harm reduction services and particularly doing needle, syringe and naloxone distribution among people who use drugs on the streets of the city.
Our project is targeted mostly on people who use such drugs as heroin, methadone, tropicamid (eye drops) etc. And to the less extent on those who use stimulants but recently the synthetic drugs became very popular. Mostly we work with those people who go to the pharmacies to get legal drugs (they mix and use them together with other stuff) and syringes. Most of our participants are poor people, marginalizes, with limited social opportunities. Some of them are homeless, other don’t have any documents, and many of them are immigrants. Being highly stigmatized and discriminated due to all these life conditions and behavior their rights and dignity are being constantly violated which affects greatly on their access to health, legal and other services. The average age of our participants is about 30. About 30% of them are women. In most cases they need help related to the complications and side effects of the injections like wounds, thrombosis, ulcers, infections. Also, our HR project is the only opportunity for many of them to get tested for HIV, HCV and become redirected for treatment.
We do the outreach work on the streets of Moscow 5 days a week. Since 2016 we have an outreach mobile unit to support our street work which is especially useful during long and cold Russian winters.
About our project activities in 2017
Our work helps our project participants to prevent overdoses, address HIV, hepatitis, and other health issues, and offer social and legal assistance to those who need it. In 2017, our harm reduction services had 7 300 contacts with people who use drugs. Overall number of individual client covered in 2017 – 3727 persons of whom 2396 were the new clients.
Our outreach workers distributed 20 642 needles and 74 419 alcohol swabs. We also continued to offer testing and counseling on HIV. Here are some other numbers showing our work in 2017:
| 2017 | ||
| Syringes | 301 286 | |
| Condoms | 111 225 | |
| HIV tests | 214 | |
| Of them positive | 26 |
We distributed informational materials on legal matters, HIV, hepatitis, etc. Some of our most popular materials include a brochure about Naloxone which discusses overdose management, as well as our newspaper for people who use drugs, Shlyapa i Bayan, which provides a lot of useful tips on legal issues, human rights and harm reduction.
Finally, we refer and accompany clients to health services, assist with their shelter and hospital access, and help them restore their documents. Counseling is an important part of our activities. The main demand of our clients is for consultations on post injection complications and bacterial infections. Sometimes we have a certified surgeon working with us, offering advice to our project participants during outreach.
| 2017 | ||
| Counseling on overdoses | 1233 | |
| Counseling on post-injection complications | 914 | |
| Counseling on drug treatment | 423 | |
| Counseling on HIV, TB and hepatitis | 879 | |
| Counseling on STIs | 374 |
When our project participants require more substantive assistance, our case managers provide accompaniment. The key principles of case management include participant centered approach, respect, equity and empowerment. We help our project participants obtain and keep receiving the medical and social assistance they are entitled to. We consider each case individually and aim to offer carefully tailored solutions.
The main difficulty with case management is the inability of medical and social institutions to adapt to the needs of people who use drugs (e.g. lack of substitution treatment, stigma and discrimination) and consequent human rights violations (e.g. denial of HIV treatment). When visiting medical facilities, drug users face restrictions of their right to health services and are subjected to moral condemnation. Recently there have been more and more such cases because the state has failed to ensure an uninterrupted supply of therapy. That is why we are helping people who use drugs and living with HIV to obtain medical assistance and access to ARV therapy.
This year our case managers documented 107 cases of human rights abuse and also helped project participants to submit 58 complaints to different government structures on violation of their rights. 651 participants received legal support, in 79 cases we provided support to the participants in restoring their official documents.
One of the most significant achievement of our harm reduction project is the fact that from January till the middle of December 2017 we managed to save 423 lives from overdose with the help of naloxone we distribute among people who use drugs during our outreach work. We do this work for more than 3 years, and almost all our visits to the streets bring us with new reports on the number of lives rescued with the help of our naloxone. We also do overdose counselling during the outreach work. Number of distributed ampules of naloxone in 2017 – 3 573.
Finally, we implemented a number of small “projects” helping make the lives of our project participants a tiny bit happier. These small good deeds included:
- Collecting and distributing second hand clothes among our project participants.
- Continued the organization of actions once per quartal to collect and utilize the used syringes and needles on the streets of Moscow to make our city cleaner and safer.
- Organizing social events for children from the families of people who use drugs
