Side Event: Improving health and social inclusion of people who use drugs in Eastern Europe and Central Asia. Regional input for the upcoming UNGASS on Drugs

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): Gathered to discuss considerations in developing drug policies in our countries and preparations for UNGASS. We see that there are many discussions around the outcome document. It will contain very important messages for the region. We do not expect radical changes. The declaration contains many messages concerning drugs, and promotes idea that health indicators play a major role in drug policy issues. The main topic for today’s event is how countries define their progress in drug policy in the field in health. How will they succeed in improving health indicators, such as hepatitis C, HIV/AIDS, TB?

Zhannat Kosmukhamedova, UNODC: Global situation over the past ten years achieved big successes in HIV treatment. Data from UNAIDS shows new HIV cases decreased by 35%. Many people received antiviral therapy. For key populations, including people who use drugs, people in detention centres, men who have sex with men, and sex workers, there is no success. According to UNODC data, 12% of people who use drugs are living with HIV. Now there are cases of HIV among NPS users and people who use drugs through means other than injection. Very challenging. Must think of a response to that situation. The prevalence of hepatitis C among people who use drugs is much higher than the general population. Mainly because of high level of stigma and discrimination, and a lack of access to package of evidence-based services. In 2015, the new strategy strives to reduce HIV to 0 cases. In relation to that, UNODC also elaborated a strategy to reduce new cases of HIV among people who use drugs and in detention centres by 25%. We need to eliminate barriers that exist to accessing services. We need to build partnerships with civil society to respond to needs. Financial barriers. In our region, programs are mainly financed by donors and the Global Fund. Next year, situation may be even worse. Need to think about priorities and reallocation of existing funding. Need to speak about the transition to finance life saving programs for people who use drugs.

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): This meeting is important to understand our region and to define what kind of experiences we want to take from other countries. Have today’s meeting to discuss next steps for after UNGASS. In 2000, Ukraine had the worse HIV epidemic in the region. Most funding went to Ukraine from Global Fund. Good collaboration with civil society made major achievements in regard to health indicators.

Oleg Dzisyak, Ukraine: Our language is Russian, which is uniting us in the region. Speaking about results from our common position. Strategy implemented in Ukraine was evaluated as one of the best in the region. Success in development of that strategy was because of cooperation with academics, experts, and civil society and taking good practices from other countries. Important that this strategy is valid to people to which it is devoted. Strategy is embedded in legal act. Drug control department is coordinating structure. Government should provide opportunities to get good practices. Help should be accessible and of high quality. All people who are in need of help must understand that this is their constitution right to health from the state. This is for the people who are in need. Cooperation with international organizations. Religious communities providing support for people in need.

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): OST is one of the evidence-based policies. According to the number of people who are getting OST, Ukraine is a leading country in the region. Do you think this experience could be provided as good practice in other countries?

Oleg Dzisyak, Ukraine: Positive experience. OST is recognized in the world as effective. Even if it helps some people, it is meaningful and needs to be promoted so people who need that help can get it. Main achievement is that we could stabilize the HIV epidemic and other infectious diseases with OST programs. System of providing services to control the situation. People can count on governmental support if they need it.

Vasiliy Loshich, Belarus: Starting from 2008, NPS and increasing drug-related crime is a huge issue in Belarus. 47% increase in crime. Scary number. Drug control department took coordinating role. Task was to develop a plan and strategy to stabilize the situation. We involved all stakeholders in that, including civil society. This plan is already working. Results include saving the lives and health of society. Key criteria for the government was to reduce the number of deaths in relation to misuse of drugs, to reduce overdose, to increase percent of people who use drugs that are employed, and to increase people who use drugs that are cured. In 2016, we succeeded in stabilizing the situation in regard to drug crime. Crime decreased 7%. In 2015, reduced overdose by 20% and 37% among young people. Harm reduction services integral.

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): How can people who use drugs become employed, given that this is a key indicator?

Vasiliy Loshich, Belarus: Medical help in governmental institutions. We have qualification courses for people. Not always possible to do so quickly. Government puts in all efforts to employ people. Cooperating with volunteer organizations and civil society.

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): What about access to OST?

Vasiliy Loshich, Belarus: Everything is free of charge. We have a lot of rehabilitation centres. Run using private donations, and in some cases absolutely free of charge. Range of services quite high. More than 5 rehabilitation centres. Even not traditional. Controlling some of them, but not interrupting their work. For OST, we have enough centres.

Pulod Dzamolov, Tajikistan: Role of civil society and community in these events is important so policymakers can hear us. Practice within the countries differs from official documents. Theoretical documents which are discussed in high-level events are maybe about diplomacy, threat, or protecting image. Important to emphasize that this is about the lives of people. Harm reduction programs reflected in all documents. Standards and guidelines for how to implement those programs. Since 2009, there is OST, guidelines in accordance with WHO, protocols for how to treat drug addiction, and addiction protocols for using OST. Today, OST programs will be implemented. In 2016, plan to support two sites of OST in detention centres. In 2020, plan to expand this number to five. In each region of Tajikistan, there will be OST programs. National program between 2016 and 2020 reflects harm reduction, development, expansion of OST coverage, and also, naloxone and how community organizations and medical staff can use it. Besides those documents and programs that work within the health structure, there are documents that provide enabling environment to work for hospital programs, instructions for law enforcement representatives and ministry of internal affairs. Law enforcement undergoing training. For community people, people who use drugs, and people living with HIV, those institutions explain how law enforcement representatives should treat, and how representatives of internal affairs should approach, people in OST programs. Law enforcement should help involve people in those programs by making referrals. Explains how to behave during encounters with people who use drugs, shouldn’t do raids close to harm reduction sites, do not detain people close to OST and harm reduction sites, all in order not to make them fear to approach those places.

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): Can you sum up what other programs can be initiated in the upcoming period of three years?

Pulod Dzamolov, Tajikistan: I want to link that to plans of UN. What is important now is what will be discussed. Within this event at CND, spoken a lot about supply reduction. What about the question of treatment instead of punishment? We have OST and this is evidence-based. Very important now that OST meets the demand. OST could be approached as supply reduction strategy.

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): Tajikistan could in the future talk about experiences with alternatives to incarceration and referrals to OST. Kazakhstan is the leading country in the region in terms of coverage of OST and harm reduction programs. What is the situation?

Elena Kuznetsova, Kazakhstan: In Kazakhstan, there is HIV prophylaxis programs among people who use drugs, men who have sex with men, and sex workers. Realized through trust bonds. From 2006 to 2013, harm reduction programs financed by donors, mainly Global Fund. As Kazakhstan is a high level income country, the Global Fund moved and international donors moved. Currently 80% of harm reduction programs are financed by government. Starting from 2008, we have OST and now we plan that OST will be financed by government. Pilot project went very well. I participated in this project. It is the right approach. Government was correct to introduce this program.

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): What needs to be improved in Kazakhstan?

Elena Kuznetsova,Kazakhstan: We are not perfect. Drug scene is changing. Those things that we need today may change tomorrow. We still do not have naloxone. This is life saving and very important for overdose protection. Government should finance those programs in order for them to be developed.

Question: I am from the Latvia delegation, When do you think your governments would be ready to introduce safe injection sites?

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): Room for safe injection sites so people can come and use drugs in a safe place. None in our region.

Vasiliy Loshich, Belarus: We are studying this experience. For now, our society is not ready for that. I hope that we will be ready someday.

Oleg Dzisyak, Ukraine: This is a serious decision that needs to be taken at the governmental level.

Daria Matyushina-Ocheret, Eurasian Harm Reduction Network (EHRN): Promote the document of UNODC that was translated into Russian explaining how UN drug conventions concern stigmatization, and how OST and NSP fit within those conventions. Also explain relationship between criminal punishment and conventions. Gives formal position of UN in regard to that question. In Central Europe and Central Asia region, new reality causes new challenges. We should review harm reduction approaches, including social elements. Forum will take place in Kiev in April on law enforcement and civil society participation.

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