East to East Satellite Meeting

1
Harm Reduction in the Russian Federation

• East to East Satellite Meeting
• Advocacy as a Key Component
• of Harm Reduction
• 13 May, Warsaw
• Natalya Korzhaeva, Russian Harm Reduction Network

2

• First harm reduction (HR) programs started to
  work in Russia in 1996
• - a needle exchange bus in St Petersburg,
• - a peer driven intervention in Yaroslavl,
• - an outreach program in Moscow.
• All the activities were NGO driven and funded by
  international organizations.

3

• Later on, in 1998 a strategic initiative RAPID
  (Russia AIDS Prevention Initiative Drugs) which
  united several international NGOs (MDM, MSF, OSI
  with the Ministry of Health) helped to
  significantly increase the number of HR services
  in the RF.
• The main problem addressed by the services and HR
  advocacy was rapid spread of HIV among IDUs in
  the country.

4
Donors line Needle exchange needs to be
institutionalised and accepted by the government

• The main strategy of international donors was
  based on an assumption that after evaluating the
  positive effects of HR programs, the government
  will decide to allocate its own funding for
  support of HR services in the country. Hence,
  most of the projects in Russia were designed as
  short-term initiatives (3-5 years) and have
  always operated in the context of uncertain
  sustainability.

5
Government line non-doing

• The support of the governmental bodies such as
  the Ministry of Health was never explicit and
  strong. Although several official documents were
  issued by the ministry, which supported HR
  strategy, these documents were mostly declarative
  and didnt bring about any real support neither
  on political or financial levels.

6
Policy of Non-Doing

• 2003 Criminal Code amended
• Inclination to use of narcotic or psychotropic
  substances
• not valid in case of needle exchange for HIV
  prevention, if the actions are agreed upon with
  public health and drug control agencies
• Need to develop protocols for HR
• 4 years since then protocols not approved,
  threat of unfavourable requirements
• Harm reduction is not a part of national HIV
  strategy

7
The Case of Substitution Prevention of (an
Essential Medical) Drug Use

• Much stronger resistance than that to NX
• Aggressive rejection by the narcology
  psychiatry elite, drug control service
• Strong anti-substitution position at intl level
• Russia at CND, CIS ministerial mtg, UNAIDS PCB,
  Eastern European and Central Asian AIDS
  Conference 2006

8

• There were good and bad times in terms of
  number of HR programs in Russia
• Peak in 2003 75 projects identified
• 2006 63 projects
• (15 projects were supported by Government)

9
(No Transcript)
10
Harm Reduction in RF (Y 2006)
11

• In terms of state support, the situation
  reversed
• in 2006 15 programs were supported exclusively
  from the federal budget (in the framework of the
  National Priority Project called Health") and
• in 2007, due to several political and
  organizational reasons this number has decreased
  to 3

12
As a Result

• Needle exchange carried out on a local (not
  national) level
• No adequate official (legal) support from the
  national government
• No adequate financial support from the national
  government
• Political ambiguity and absence of the clear
  strategy misleading for local administrations
• No substitution therapy

13
Participation in the decision-making

• Participation of NGOs representatives in a
  number of
• high-level advisory bodies
• the National Coordination Council on HIV/AIDS,
• the Coordination Council on MTCT Prevention,
• the UN Theme Group on HIV/AIDS in the Russian
  Federation,
• the Country Coordination Mechanism (CCM)
• The Expert Group on ME and others.
• GLOBUS leader was selected to participate in the
  new Government Commission on HIV established in
  2006 by the President Putins order.

14

• To increase multi-sector local participation in
  the development of advocacy campaigns local
  programs in 5 regions organized multi-sector
  consultations.
• Novorossiysk, South Federal Okrug.
• Voronezh, Central Federal Okrug.
• Balakovo, Privolzhsky Federal Okrug.
• Ekaterinburg, Ural federal Okrug.
• Tomsk, Siberian Federal Okrug.
• Participants of each round-table developed
  written drafts of local regional advocacy
  strategies for year 2007

15

• National Harm Reduction Conference
• 10 years of Harm Reduction in Russia keep
  moving on
• (Moscow, 14 - 15 December 2006)
• The results of the discussion served as
  foundation for the advocacy strategy developed by
  RHRN Board.
• Implementation of the strategy on the national
  and regional levels is planned for year
  2007-2008.
• (10 advocacy projects were supported this year
  by RHRN)

16
Development of Position Paper on Harm Reduction

• PP on HR was prepared by RHRN members and was
  approved by RHRN Board.
• Later UNAIDS propounded to develop PPs on the
  most important HIV-related issues like ARV
  treatment, care and support, prevention among
  young people and harm reduction as well.
• Now RHRN Position Paper on HR is reviewed by
  other two main Russian NGOs networks working in
  HIV area (e.g. Network of People Living with HIV
  and Forum of Non-commercial Organisations working
  in HIV-Prevention Area) in order to adopt it as
  the joint position of NGOs on HR in Russia.

17

• GLOBUS has developed an HIV treatment program
  focused on vulnerable populations which is unique
  for the country. Its essential features are
  sustainable supply of antiretroviral (ARV)
  medications, multidisciplinary approach to
  patient, adherence promotion program tailored for
  PLWH - IDUs, and software for ART clinical
  monitoring.
• By the end of 2006, 2000 PLWHA have been
  receiving highly active antiretroviral therapy
  (HAART) from GLOBUS. 65 of the GLOBUS patients
  on HAART have a history of intravenous drugs
  use.
• __________________________________________________
  _____
• Source Stimulating an Effective National
  Response to HIV/AIDS in the Russian Federation
  (GLOBUS Project). Annual Report. January 1, 2006
  December 31, 2006

18

• GLOBUS provided training programs on HIV-related
  issues for journalists and editors, business and
  trade union leaders from regional enterprises.
• _____________________________________________
• Source Stimulating an Effective National
  Response to HIV/AIDS in the Russian Federation
  (GLOBUS Project). Annual Report. January 1, 2006
  December 31, 2006

19

• In 2006, to draw attention of the Russian
  business elite to HIV/AIDS issues the Consortium
  launched an initiative called Partnership
  against AIDS. GLOBUS .
• The initiative fully supported by the Russian
  federal legislative authorities (State Duma) and
  the Ministry of Health and Social Development
  will allow to disseminate widely experience
  gained by the GLOBUS Consortium (including
  experience in HR) and to develop a model of
  successful socially oriented partnership between
  the state, non-governmental organizations and
  business community.
• __________________________________________________
  ___
• Source Stimulating an Effective National
  Response to HIV/AIDS in the Russian Federation
  (GLOBUS Project). Annual Report. January 1, 2006
  December 31, 2006

20

• As part of a legislative initiative, GLOBUS
  developed and issued a number of policy briefs,
  conducted meetings and round table discussions on
  HIV-related policy for the legislators on a
  federal and regional level.
• Among the most outstanding events was the
  Inter-Parliamentary Conference HIV/AIDS in
  Eurasia and the Role of the G8 in the Fight
  against the Epidemic that brought together
  legislators from G8 states and a number of NIS
  countries. It took place in Moscow before the G8
  summit in St. Petersburg, July 2006.
• ______________________________________________
• Source Stimulating an Effective National
  Response to HIV/AIDS in the Russian Federation
  (GLOBUS Project). Annual Report. January 1, 2006
  December 31, 2006

21

• In spite of numerous advocacy efforts we still
  have a lot to do from official recognition and
  legalisation of needle exchange to equal access
  to ARV therapy and access to substitution
  treatment

22
Thank you for your attention!
Russian Harm Reduction Network www.harmreduction.
ru Natalya Korzhaeva nata_at_harmreduction.ru