Harm Reduction in the Russian Federation: Achievements and Challenges

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Harm Reduction in the Russian Federation
Achievements and Challenges

• Vitaly Djuma, Anya Sarang
• Russian Harm Reduction Network
• GFATM Partnership Forum
• Durban, South Africa, 1 July 2006

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Country Context

• Population - 144 mln
• 2-5 mln drug users 2.5 or more adult pop.
• Drug use is administrative offense harsh drug
  policy
• HIV/AIDS 342,000 officially registered case,
  estimated 1 mln Federal AIDS Centre, May 2006
• 87 IDU related
• 90,000 needed ART in 2005 Ladnaya, 2005 only
  2,000 were receiving it treatment started in 2006

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Harm Reduction Activities in Russia

• Harm reduction in Russia mainly needle exchange
  and outreach (plus education and info primary
  health care referrals).
• Substitution treatment illegal
• 1996 First projects in 3 cities
• 1997-98 Harm reduction dissemination
• 1999 - Informal HR network 26 projects
• 2003 a survey identified 75 needle exchange
  projects run by NGOs and GOs (40/60)
• 2004 RHRN formalised
• 2004-2005 HR in crisis (financial gap)

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Russian Harm Reduction Network

• Unites 20 organisations and 15 individual
  activists
• Activities advocacy, support to HR interventions
  in Russia incl. information exchange and
  training, fundraising
• Due to 2004-2005 funding gap main energy
• went to fundraising, financial management

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2004-2005 Financial Gap

• Harm reduction previously funded by OSI/DFID
• (bridging to WB/GFATM), cease in the end of
  2004
• WB loan - turns out to provide practically no
  support to HR projects
• 3 GFATM-funded projects (a) R3, started August
  04 but covered 15 out of 40 projects at that
  time (b) R4, started 06, focus on treatment, HR
  component insignificant (c) R3, TB no HR
• RHRN managed to find financial support (OSI,
  Ford) for 2005-2006 (18 projects), but no
  perspectives for further funding
• ?? GFATM Round 5 application
• Non-CCM CCM didnt approve
• Approved by GFATM Board October 05 LFA
  assessment finished May 06
• June 06 preparing for the grant agreement
  signing

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RHRN GFATM-R5-supported Project

• Support to 33 harm reduction programmes (needle
  exchange outreach)
• Training and technical assistance
• Capacity building in treatment preparedness work
• Community development (drug users, PLHIV)
• Advocacy

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Challenges for the project

• Strong opposition to HR
• explicit Federal Drug Control Service, media,
  projects regularly under attack
• implicit The proposal was not supported by the
  CCM, formal bureaucracy based refusal
• Most HR projects are not community-based
• Communities seen as clients (or outreach-workers,
  at best), not decision-makers
• Ambitious coverage targets (60 IDUs in covered
  cities)
• Currently
• Coverage of existing projects is very limited
  (10-12) only a few small cities reach 30,
  rarely60 IDUs.
• Needle exchange in its current form has a limited
  effect!
• 11 exchange political, but not effective
• Programmes not attractive for drug users
• Focus on fixed sites not effective

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Challenges for the project (contd)

• Monitoring of HR activities
• Lack of research (quantitative and qualitative)
  to evaluate HR effectiveness and drug situation
  in regions
• No common approach to ME of HR activities, incl.
  indicators difficult to estimate achievements
  and gaps
• Poor ME and research skills of the projects
• No common database
• Substitution pilot projects not included
• in the proposal
• Impediment for prevention
• Crucial for adherence

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Main problems already encountered

• CCM eligibility
• CCM members from NGOs and affected communities
  not selected in an open process but appointed by
  CCM
• LFA
• LFA team not familiar with the HR field demanded
  non-anonymous registration of clients products
  (syringes) coding ineffective data verification
  system
• Suggestion an expert in the programme field
  should to be included in the team
• Budget re-allocation funding from activities to
  org. support
• Our capacity was not found efficient had to move
  a large amount from operations to TA consultancy
  not planned earlier.
• Suggestion GFATM to develop clear
  recommendations on TA
• GFATM demands centralized procurement of syringes
  
• Although our application specified the crucial
  need for a decentralized procurement, different
  needs and preferences of drug users in all the
  regions

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Achievements

• 10 years of harm reduction in Russia,
• and still alive
• National governmental funding for HR in 2006
• Inter-sectoral cooperation within HR movement
  GOs/NGOs
• compare approaches, gain and exchange different
  experience, complement each other
• HR programmes involved in ART
• Drug users and PLHIV community development
  supported by HR programmes
• RHRN capacity is being built when prepared for
  GFATM grant

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Thank you! ???????!
Vitaly Djuma vitaly_at_harmreduction.ru