1. Washington D.C., USA, 22-27 July 2012www.aids2012.org Alternatives to NSEPs: community-based initiatives Providing access to syringes in the politically hostile environment in Moscow, Russia Anya Sarang, Andrey Rylkov Foundation for Health and Social Justice

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org Moscow background: epi Estimated drug users: 1.5 mln (chief narcologist of russia), 70- 100K – IDUs 65% - opioids (heroin, street methadone, pharmacy opioids, poppy seeds preparations) 41.000 official HIV, 7 new registered infections per day (2011), epidemic growing BUT 25% IDUs don’t know their diagnosis HIV prevalence growing: 2004 – 14%, 2011 – 18%. Hep C incidence increased by 7.5 times in 98-2010 Hep C prevalence in IDUs – 69% (2011) TB – 4700 new cases in 2010

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org Background: politics Federal “government” opposes Harm reduction interventions: –Opioid substitution illegal –NSPs = thread to the national drug control strategy However, several NSP programs work in Russia, with support of GF and IHRD. –Grey legal zone –unsustainable

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org Background: politics Resolution of the Moscow Department of Health prohibits realization of HR programs on the basis of municipal medical institution Several aggressive statements from ex-mayor However, technically NSP is not illegal in moscow. -- just nobody wants to mess with it! Myth of “HR illegality” inhibited development of services in the city eg our application for funding from the Global Fund grant has been refused on the basis that we don’t have established relations with the health authorities.

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org ARF, what do we do: Small grass-root NGO fighting for health and human rights of people who use drugs in Russia. mission is to promote and develop humane drug policy based on tolerance, protection of health, dignity and human rights. advocacy, human rights watchdog, service provision and capacity-building of affected communities and individuals.

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org Community based outreach: Daily on-foot outreach – provision of syringes, condoms, HIV rapid tests, ointments, bandages, naloxone counseling and referral Drug users ‘spots’ Medical specialist 1-2 times a week Case management of clients Legal counseling available on request Training for drug users

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org Numbers 2011 Ovrerall clients – 774 Of them women – 312 Syringes and needles provided – 40 K Condoms ~ 3K HIV tests – 41 HIV Counseling / referral - 61 Counseling / referral to drug treatment etc - 60 Most burning issue: –post injection complications - 76

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org Challenges No problems with police or municipal authority No office or convenient storage of materials Not possible to carry enough materials to one outreach No regular spaces for trainings Seasonal challenges: one month of -40C and 4 month below -10C Lack of services for IDUs or homeless people in the city, including OST Unsustainable funding

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org Pluses: No office!! No unnecessary conditions to our participants including NO TORTURE BY CODING and etc !!! No work ‘discipline’ -Horizontal self management -We love each other No overregulation or unnessasary bureaucracy –Flexible system of reporting = minimizes burn out

12. Washington D.C., USA, 22-27 July 2012www.aids2012.org Funding Intermittent funding, long periods of volunteer work Not included into the GF program Application for the presidential funds declined 2 years funded by UNODC 2011-12 funding from Crystal of Hope Award No perspective of funding in the near future

13. Washington D.C., USA, 22-27 July 2012www.aids2012.org Funding Mocro-donation campaign to buy a mobile unit www.en.rylkov-fond.org Successful in terms of awareness but not actual fundraising

14. Washington D.C., USA, 22-27 July 2012www.aids2012.org The ‘government’ is going nuts Censorship of Internet, ARF site illegally shut down, but soon it will be legal Crack down on the NGOs (all NGOs who do some advocacy = Foreign Agents Just say no to HIV prevention Its illegal to protest all that