By Maxim Malyshev – outreach coordinator
A team of experienced and passionate outreach workers works with street drug users since 2009. Outreach workers regularly distribute syringes, condoms, naloxone, alcohol swabs, needles, pregnancy tests, and other materials and test participants for HIV and hepatitis. Outreach workers actively distribute brochures on hepatitis, HIV, overdose, medical services in Moscow, etc. We continued cooperation with “Narcotics Anonymous”, which provided us with community newspapers and business cards and support groups’ schedule. Project participants can use our telephone “hot line” service to learn about changes in our schedule, request necessary materials and testing for HIV and hepatitis and receive consultations. A medical consultant participated in the outreach work regularly and a surgeon sees our participants upon request.
We have established productive relations with the drug users community. Some of our participants enthusiastically share our values and beliefs and actively involve their friends and acquaintances in the project activities. They distribute prevention materials, syringes and carry out secondary outreach activities.
With the support from Eurasian Harm Reduction Network/European Commission we started to provide targeted services to women who use drugs. This helped strengthen the project’s social support component, which includes referring and accompanying women in various medical facilities, referring them to medical specialists for consultations, providing support and distributing personal hygiene and sanitary products.
Also in 2012 the project had many contacts with the media. We worked with correspondents from Big City, Moskovsky Komsomolets, Independent, Guardian, internet portal Open Space, Philanthropist, Belgian National Radio, and the Moscow State University student radio. We are always pleased to work with the media that cover our work and contribute to our mission – to develop humane drug policy in Russia.
Project results in 2012:
The number of participants/of them woman – 657/178
The number of contacts/with woman – 1726/373
The number of new participants in 2012/woman – 377/82
Number of syringes/needles – 56484/4130
Number of condoms – 2258
The number of HIV tests/ of them positive – 43/3
Number of referrals / consultations on drug dependence – 50
Number of referrals / consultations on HIV testing/ treatment – 42
Number of referrals / consultations post-injection complications – 96
Number of given vials of naloxone – 282
We provide social support to our participants including telephone consultations for participants seeking drug treatment and medical care, information about medical facilities’ schedules, required documents and requirements for admission to treatment programs.
We accompany our participants to various medical facilities, when they undergo in-patient treatment we provide them with food and other necessities and visit them regularly. With support of our outreach worker several participants received detoxification and rehabilitation services. Other participants, including participants from other cities, received medical support in relevant medical facilities including very serious surgeries.
Our social worker and medical consultant participate in the outreach activities every week; our participants can ask questions and receive advice and support directly from them. The project’s medical consultant educates participants on wound care including wound redressing skills training.
A new activity we added in this reporting period is the support of a psychologist – a trained member of our team- who carries out brief consultations during outreach and provides in-depth consultations and motivational interviews with our participants and their families.
Networking with institutions that provide medical and social services
We have established working relations with the Moscow Drug Treatment Clinic # 19. Until November 2011 we referred our participants seeking detoxification and rehabilitation services to the clinic. Outreach workers provided support to the participants undergoing treatment, visited and supplied food for these participants during their stay in the clinic. Unfortunately, “pink stubs” for hospitalizing our participants from other cities were cancelled in November 2011. Consequently, we can no longer refer our participants from other cities for detoxification, rehabilitation or other medical services and they have no place where they can receive rehabilitation as in other cities it is unavailable.
Successful cooperation was also established with the TB clinic #11, where several participants were undergoing treatment. We provide psychological and material support (food parcels, second hand clothes) to our participants and maintain contact with medical specialists.
The project established co-operation with the following organizations/specialists:
- regional STI clinic: outreach workers refer project participants for anonymous STI testing;
- “Salvation Army” Surgeon who consults us and works with our participants;
- Epidemiological Research Institute of the Rospotrebnadzor; we referred people to their “school of patients” for people with hepatitis C and distributed their materials.
- human rights organization “Agora”: their Moscow-based lawyer several times provided legal advice to our participants and organized a seminar “How to behave during police detention”.
Educational activities for the project participants and employees
In 2012, the project organized four training sessions. Two trainings were organized for the project staff. Psychologist Viktor Bogomolov provided a session on team building, developing and implementing a common vision. The second training on using narrative approaches in the street outreach work, communication with participants and motivating them for positive changes was very helpful for professional development.
The other two trainings were organized for project participants. Together with Ilnur Sharipov a lawyer from the organization “Agora” we discussed what our participants should do if they are being detained. We discussed various models of behavior and avoiding conflicts with law enforcement representatives. The other training was on HIV, ways of transmission, minimizing risks, and the importance of knowing test results.
The main challenges and steps taken to address them
The main challenge in the work stems from the failure and unwillingness of healthcare services to work with drug dependent patients. Often, people who live on the street and use pharmacy drugs and homemade opiates have no chance to get medical care. Even if they have all the necessary identification papers, they still cannot get comprehensive care that would help solve their problems, such as injuries and post-injection complications. We try to help participants on a case by case basis – referring them to medical specialists who work with us for consultations.
Most of our participants cannot access medical services because they either do not have all necessary identification papers or came to Moscow from other cities. A system of “pink stubs” allowed us to refer these participants for detoxification, rehabilitation and other medical services. After the cancellation of these “pink stubs” in November 2012 we can no longer refer these participants to the Moscow medical facilities. We appealed this decision of the Moscow Health Department with support of volunteers – community defenders and pro-bono lawyers but so far there was no decision by the court.
A similar situation has been observed with pregnant participants of the project. They cannot receive drug treatment because due to pregnancy they cannot be admitted to drug treatment clinics (according to existing drug treatment standards, drug treatment is contraindicated for pregnant women as drugs used in drug treatment are toxic). Thus, pregnant women have no way of getting adequate medical assistance in connection with drug dependence. ARF is also involved in strategic litigation around lack of access to opioid substitution treatment for drug dependent women in Russia.
The project does not have an office or a room where people who use drugs and their friends could come to visit our outreach workers, receive information or meet for trainings and discussions, including discussions about our current repressive drug policies.
Changing weather conditions (seasonal factor) also create challenges for meeting new participants. We tried to collect money for the outreach bus but did not reach the goal by the winter of 2013 and this winter we experience the same problems.
Another challenge is changing drug scene. We solve this problem by organizing outreach to investigate new sites and learn about new sites from our participants.
Our participants have multiple legal problems which present a priority in their lives over their health and well-being. In 2012 we started to work with several lawyers groups such as pro-bono firm Second Opinion, the Canadian HIV/AIDS Legal Network, a legal clinic of the Russia Legal Academy, Legal Association Agora, web-resource hand-help.ru. Our outreach workers represented clients interests in courts and provided counceling and referral in cases where legal consultation is needed. We decided that in 2013 we will dedicate more attention to legal services and had a consultation with a group of Moscow lawyers in January 2013 on how to improve our cooperation.
The 2012 years activities were funded through the Crystal of Hope Award received by ARF for its outstanding contribution to HIV advocacy. 25% time of our case manager and some prevention materials was also funded through the Eurasian Harm Reduction Network/EC grant for developing services for women. We have also received some targeted donations for support of particular individuals, travel to Moscow etc. We started a campaign on Global Giving to fundraise for the bus, which was accompanied by a number of advocacy activities in Moscow. One of the brightest activities – an auction of contemporary art work in support of the fundraising organized by our friends from the Creative Bureau “How does it work” which sold several artwork to support our fundraising. However, we were not able to reach our goal to buy a minibus by winter of 2013.
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