Category: Новости

Text me on Telegram: online peer-to-peer consultations in Kazakhstan

Posted on by Igor Gordon

Forum of people who use drugs (PWUD) Kazakhstan

Forum of people who use drugs (PWUD) Kazakhstan is a civil forum, a community of people who use drugs and their supporters, activists and experts in the field of drug policy, who areunited by  common goals and interests. The mission of the Forum is to mobilize people who use drugs for joint action and structural changes in Kazakhstan drug policy in accordance with the interests and needs of the PWUD, based on standards of human rights and fundamental freedoms, as well as standards of medical care and social support for the PWUD recommended by the World Health Organization (WHO). Currently, the Forum has 21 people - these are activists from 7 regions of Kazakhstan.

How did you decide to focus on the topic of peer-to-peer consultants? Why is this topic relevant in Kazakhstan?

Starting from 2014, there is a growth of the NPS market in Kazakhstan. Compared to other Central Asia countries, Kazakhstan has the highest number of NPS reported. More about NPSs in Kazakhstan can be found in the report “New psychoactive substance use in the Republic of Kazakhstan: Research results.

Most harm reduction services in Kazakhstan are oriented at opiate users, although the drug scene is changing: the opiate market is slowly disappearing. As a result, fewer people with opioid dependence are registered each year, while NPS appear on the market. With the changing drug scene, outreach work to support people with opioid dependence has become less effective.  Activists from the community of PWUD in their 30s are those who have been clients of harm reduction programs and started to use synthetics. Young people aged 12-30 who have never tried opiates now snort and smoke, prefer to smoke NPS, and mix substances with tramadol and stimulants (part of this group are directly related to darknet advertising, distribution, etc.) and then switch to injecting.

No one in Kazakhstan has previously implemented projects aimed at supporting people who use NPS in the online platforms. This topic was also new for us, but we already had little experience in consulting people who use NPS on social networks (Telegram) as volunteers in darknet. The project became an opportunity for us to do it more professionally and qualitatively with the ability to pilot its results to all interested parties to expand the package of services and subsequent implementation of the online consultation componentfor PWUD at the country level.

What is an online peer-to-peer consultation? How does it work? Tell us more about how you do these consultations.

Online peer consultation is the work in a variety of online formats:
-publications, posts with information on safe drug use that we collect and prepare ourselves (types of NPS, characteristics, effects, consequences of use; poly-drug use);
– thematic photos, GIFs, videos;
– trip-reports (when people share their personals stories related to substance use). It is a great  material, and it is always interesting to read it. It can also inform people about the negative consequences of using a substance they are trying for the first time;
– peer-to-peer psychological support is a support without shaming or blaming person, with the opportunity to share personal experience;
– referral to specialized professionals (psychologist, addictologist, infectious diseases specialist);
– online lawyer of the Forum of PWUD Kazakhstan;
– consultations on HIV/ AIDS, hepatitis, STIs;
– HIV testing;
– consultations on access to social and medical services;
– informing about the activities of PWUD Kazakhstan Forum, ENPUD, EHRA – organizations that support PWUD in the region;
– invitations to participate in open discussions, online webinars for PWUD;
– invitation to participate in the campaigns with the international community of PWUD;
– referrals, accompanying, personal face-to-face meetings;
– thematic surveys (HIV, hepatitis, on the content of the channel).

What problems did you face, when you started to provide online consultations?

The difficulties that we faced, when we started to provide online consultations are the distrust and closeness of users of Telegram channels. Even now for people who use NPS it is difficult to trust and understand that there are people in Kazakhstan, who are providing harm reduction services, who are openly speaking at one’s own risk about themselves, their experience of drug use, and support you psychologically. The difficulty is in the communication and personal contacts because some help implies private meetings, for example, social accompanying, and this kind of activity is excluded by the rules of Telegram users.

Only few people contacted the project lawyer. According to the results of a face-to-face survey, we realized that people simply do not trust such a service. It is something new for them, and it is difficult for people who use drugs to talk to a person with a legal background about personal use or to solve similar issues.

Please share your achievements in this small grant.

One of the most significant achievements of the project was the launch of three Telegram channels, where around 400 people subscribed. These are people who receive information on harm reduction,, what to do in case of overdose, receiving social, medical and legal assistance. The most important thing is that in case of any problems they know where and whom they can ask for help or advice.The audience also participated in two campaigns: on August 31 in the World Overdose Awareness Day and Support Don’t Punish (World Drug Day).

Users have also noted the value and necessity of the publications in the channels, as well as the existence of such content and the service in general.

Medical workers, the expert community, GFATM, representatives of international organizations in Kazakhstan also share this opinion. At the moment the information about piloting the service online – consultations were presented on two platforms, where all interested state parties (Kazakh scientific center of dermatology and infectious diseases, Republican Scientific and practical center of mental health,, CCM, etc.) and international organizations (UNAIDS, UNODC, GFATM, etc.) were present.

We mastered the skills of running Telegram channels, learned how to work through bot-support, and learned a lot of useful information while compiling and selecting material for publications. We gained experience in creating promotional materials focused on the needs of the community of people who use NPS.

Consultations and support for people who use NPS is also a new experience for us, and we are pleased with the result we got. Acceptance and trust is the most important thing.

Now that the project is over, people from other regions have joined the channels, and one of them asked us for support. Our consultant helped us to create a channel, and now we have another additional resource where we can talk about harm reduction.

Your recommendations for donors/government to promote this approach. What are the next steps?

  1. The Forum has planned further steps to improve and expand online services. For example, attracting funds to provide services of addictologist, psychologist, distribution of informational material on harm reduction. We submitted one grant application, now we are waiting for the results.

-Technical support (laptops, software to work with video, create promotional materials, etc.) is needed for the implementation of such projects;
– educational pieces of training, offline seminars;
– capacity building of the team, psychological support for online consultants;
– development of a security plan with the involvement of specialists as NPS attracts the attention of the police;
– organizational and personal security;
– IT security
– contacts of friendly lawyers, psychologists

  1. There is a need for intensive outreach work with NPS users. Access to prevention programs for new people will become more effective if information about services will be disseminated through Internet resources, pharmacies, mobile sites, nightclubs.
  1. It is not known precisely how many people are members of groups where sexual contacts are connected with the use of NPS. It is worth noting that offers of substance use in exchange for sexual services for girls are common in Тelegram channels. This type of “leisure” is popular.

The risks of HIV infection and other STIs are increasing significantly. Therefore, it is necessary to develop services aimed at the sexual and reproductive health of women who use synthetic substances, involving medical specialists (gynecologists, dermatovenerologists). It is essential to educate project consultants on specific topics of counseling, to provide lubricants, female condoms, etc. in larger quantities.

  1. Creation of an international online platform for communication on harm reduction for NPS users:

– Implementation of projects towards online consultation on NPS (sharing experience)
– Mobilization and support for people working with NPS issues
– trainings
– development of new concepts, plans, materials on NPS

Harm Reduction in Eurasia 2020 published in Russian

Posted on by Igor Gordon

November 27, 2020, Vilnius

The Eurasian chapter of the Global State of Harm Reduction 2020 was presented and published today in Russian language.

This is the seventh edition of the Global State of Harm Reduction Report 2020, prepared by the Harm Reduction International, now in the year when public health took a leading position in the world news. COVID-19 and response measures introduced around the world continue to disrupt our lives. The report provides the most up-to-date information on existing programs, the situation with HIV, viral hepatitis and tuberculosis among people who use drugs, as well as analysis of harm reduction programs in the context of the COVID-19 epidemic. The parts of the report describing the situation in the Central, Eastern Europe and Central Asia region were gathered and summarized by the Eurasian Harm Reduction Association (EHRA).

A short summary of the report is presented to the public during an online discussion today. In total, the region is home to approximately 3 million people who inject drugs, 66% of whom are living in Russia and 77% in Russia and Ukraine together.

Syringe exchange programs operate in 27 of the 29 countries in the region, except Turkmenistan and Bulgaria. Unfortunately, the programs experience problems in many countries, particularly with sustainable funding, especially in transitioning from donor to domestic funding sources. The report shows challenges in unit cost, scope and quality of harm reduction services over the past two years.

Opioid Agonist Treatment (OAT) programs are implemented in 26 of the 29 countries in the region, except Russia, Uzbekistan and Turkmenistan. Unfortunately, we can state that most people who use drugs in the region live in countries where OAT programs are prohibited. In the transition of OAT programs from donor support to domestic funding, the biggest challenges are the availability and coverage, quality, and sustainability of program funding.

The key problem areas for harm reduction implementation in the CEECA region are as follows:

  • Criminalization
  • Decrease in funding
  • Lack of political support
  • Pressure on civil society

As a result, we see low coverage of harm reduction services and poor quality of programs.

The report provides detailed information on the situation with HIV, TB, hepatitis, and COVID-19 response programs for people who use drugs in the CEECA region. It provides an analysis of the programs, as well as challenges in accessing services.

The report provides an opportunity to learn about innovative harm reduction practices being implemented in the countries of the region. Substitution therapy for amphetamine users, kits for smoking and oral use, drug checking, safe consumption rooms, harm reduction for women who use drugs and for new psychoactive substance users, as well as for those who use drugs in Chemsex practices (LGBTQI, sex workers) are all being actively implemented in the region by the community- and harm reduction organizations.

EHRA sincerely thanks its colleagues who helped us prepare this report through individual interviews and verification of data from countries and the region.

Loader Loading...
EAD Logo Taking too long?

Reload Reload document
| Open Open in new tab

Download

Review of harm reduction programs in the situation of the COVID-19 crisis in 22 CEECA countries is published

Posted on by EHRA

In most countries of the CEECA region, opioid substitution therapy (OST) and sterile needle/syringe programmes (NSP) – key components of an evidence-based and comprehensive harm reduction (HR) programme – continue to operate under COVID-19 quarantine measures. Such work requires flexibility, readiness for mutual partnerships and strong advocacy by community and harm reduction activists. Unfortunately, the practice of amnesty of prisoners for drug-related crimes because of COVID-19 quarantine requirements has not been implemented in the region.

Key changes in harm reduction services include the following:

Provision of take–home OST. For many countries of the region, OST medications have been made available to take home for the first time, for periods of 5 to 14 days and sometimes up to one month. The opportunity to get take-home OST (both buprenorphine and methadone) became available to all clients in every country of the region except for Azerbaijan, Belarus and Kazakhstan. Initially, there were difficulties in some countries in enrolling new clients onto such programmes. Some countries developed partnerships, such as mobile outpatient clinics, to deliver OST medications and, often, together with antiretroviral therapy (ART) drugs to clients in remote locations.

Harm reduction works remotely. In all countries of the region, organisations have managed to deliver a range of commodities such as– sterile needles and syringes, masks, disinfectant, hygiene materials, naloxone, tests, and information materials for people who use drugs (PWUD). As a result of the restriction in movement caused by COVID-19, such service providers have found it necessary to deliver sufficient supplies at one time to cover the needs of an individual for 1-2 weeks. Often, materials are provided by mobile outpatient clinics, including social workers delivering such assistance by use of their own car or through use of a courier. Organisations have arranged online counselling for clients and, wherever possible, HIV testing through self-test kits delivered to clients. In providing such remote services, social workers and psychologists have needed to urgently develop additional skills and the management of organisations have had to introduce a flexible system of monitoring for the new service modalities.

Providing the essentials – food and shelter. For a large number of problematic users of psychoactive substances, quarantine restrictions and curfews have restricted access to temporary accommodation and made it impossible for them to earn money to find drugs. Responding to such basic needs, some organisations have re-planned budgets (as has been the case, for example, for EHRA members in Czechia, Kazakhstan, Montenegro, and Slovakia), or organised crowdfunding campaigns to be able to feed those in need (as undertaken by the Pink House in Bulgaria). In some countries, partnerships have been established to make it possible to provide shelter to PWUD and women who are victims of violence. In Azerbaijan and Kazakhstan, harm reduction organisations have helped their clients to receive specific assistance for unemployed people in connection with COVID-19.

Partnership in the integration of services. In most countries, the crisis situation has prompted medical centres and non-governmental organisations (NGOs) of various types to partner in the daily provision and delivery of necessary preventive materials, substitution therapy and ART drugs, and food supplies to clients, especially in remote areas.

Flexibility of services in response to changes in the drug scene. Due to the closure of international borders as a result of COVID-19, the drug scene has changed in many countries, with access to some drugs becoming more difficult, resulting in people having to use everything that they can find, including various prescription drugs mixed with alcohol. Many clients need advice to reduce harm in using new psychoactive substances (NPS), as well as help to prevent overdose. In some countries, such as Kazakhstan, Lithuania, and Serbia, such consultations are already under development. In Prague, because crystal methamphetamine is less available, community organisations have pushed for the introduction of substitution therapy for stimulant users.

Risk of service interruption due to deficiencies in the supply chain. The closure of international borders has also led to a disruption in the supply of substitution therapy medications in Moldova; similar risks exist in other countries. In addition, government authorities responsible for OST and other harm reduction programmes in several countries have not issued a tender for the purchase of medications from public organisations providing harm reduction services; this is particularly critical in Bulgaria and Montenegro.

As Ala Iatco, the EHRA Steering Committee member from Moldova, has noted: “Now we need to transform the harm reduction system. In different countries, the situation is different and depends on many factors, but the pandemic is not only a crisis but also a chance to move new services forward.” Online discussions organised by the Steering Committee of the Eurasian Harm Reduction Association (EHRA) were held between April 14 and April 23, 2020[1], with 51 members of the Association in seven sub-regional groups concerning the state of harm reduction programmes during the COVID-19 pandemic in 22 countries of the Central and Eastern Europe and Central Asia (CEECA) region. During discussions, members of the Association identified the main tasks of national and regional advocacy to overcome the crisis at the national and regional levels.

[1] Information was also updated as of 19 May 2020.

Download the Report