– We, people who use drugs, today are in a situation where government services and donors are trying to provide services for us, not taking into account the peculiarities of our lifestyle and understanding that the source of emerging problems is often not substances, but the actions of the state system itself, based on repression , intimidation, blackmail and deception. Therefore, we need to convince the system to change its approach to a humane, educational and supportive one, with the possibility of realizing human rights, maintaining individual and public health and well-being. Our world – our rules – this is when we, as a community of people who use drugs, have an effective participation in the formation and implementation of state and international programs in our country.
Valya Mankieva, Secretary of the LUN Forum Kazakhstan
From the fourth to the fifth February 2020, the first Kazakhstani forum of people who use drugs (PUD) was held in Almaty. Forum members – 38 people from 11 cities of the country and invited experts from the Kyrgyz Republic, Lithuania and Russia, united to protect the rights to life, health and social well-being of people who use drugs.
The mission of the PUD Kazakhstan Forum is to mobilize the community, achieve structural changes in drug policy in accordance with interests and needs, based on human rights and fundamental freedoms standards, as well as standards of medical care and social support recommended by the World Health Organization.
In the Republic of Kazakhstan, the government pays attention to HIV issues, providing access to treatment by introducing new approaches and reducing bureaucratic and other barriers. However, extremely insufficient is being done to realize the rights of PWUD to access medical and social services.
- Today HIV infection in Kazakhstan is at a concentrated stage, i.e. spreads among key populations and is:- 7.9% among people who use drugs;
– 1.9%, among sex workers;
– 6.2% among men who have sex with men.
In the country, the implementation of comprehensive harm reduction, HIV prevention and treatment services, including syringes and needles programs for people who inject drugs (PWID), are included in the HIV prevention roadmap and approved by the Ministry of Health in 2018.
Resource support to the community in preparing the forum was provided by the ALE “Central Asian Association of People Living with HIV” within the framework of the grant of the International Charitable Foundation “Alliance for Public Health” – “Sustainability of Services for Key Communities in the EECA Region” and the Eurasian Harm Reduction Association (EHRA).
Participant’s opinion. Natalia, Taraz
– I went to talk, to see people with similar life situations. What a surprise it was when, after two days, my emotions went off scale. These are not just people, but amazing people, my views have changed dramatically. To carry so much good, benefit, to do a huge number of vital matters. I am moved to the depths of my soul, because these people save others. I am grateful to fate that I am now a part of this community.
The forum participants were informed about the international practices of implementing programs to increase the benefits and reduce risks in the use of psychoactive substances (PAS), HIV prevention among people who use PAS. It was presented by international experts from the Eurasian Harm Reduction Association, the UN Office on Drugs and Crime, UNAIDS, CCM and others.
The right information from reliable sources … How often it is not enough to defend your rights and support community members. The Forum has become an active platform for free information exchange.
Participant’s opinion. Pavel, Karaganda
-The LUN Forum provided me with a lot of useful information. The most important issues were discussed at the event. Such as the problem with access to substitution therapy treatment in the territory of the Republic of Kazakhstan. What to do and how to achieve risk reduction programs for people using new psychoactive substances? Also, how to mobilize the community and how to reach out to decision-makers? It’s great that the forum was held at a good pace and very productive.
Information – an opportunity to show an action plan. Through disputes, discussions, learning from experience, and only then to common solutions. This algorithm worked effectively on the forum. The energy of exchange of experience, with the skillful facilitation of Viktor Malchikov, the forum moderator, united and allowed to choose arguments and make decisions in a balanced and responsible manner.
Participant’s opinion. Svetlana, Pavlodar
– The Forum has become a platform for uniting people, resources and ideas aimed at results, and not at an endless process of discussion. The participants formed an algorithm for interaction and unification of the community to solve the identified problems. It was very important for me to identify the needs of the community and the possibility of solving some of the problems associated with participation in the program of maintenance substitution therapy.
For more than 10 years, the country has been implementing a maintenance substitution therapy (RST) program. Special offices were opened in 13 cities. 300 people are being treated with a life-saving drug. Access to “one-stop shop” services has been created, when it is possible to make tests for HIV, hepatitis and receive drugs for the treatment of HIV and tuberculosis. But having the opportunity to identify the disease, program participants cannot receive RRT medication if they need inpatient treatment in hospitals and at home, or when they are forced to leave the city. For several years, the initiative group of the Kazakhstan Harm Reduction Network and the Kazakhstan Union of People Living with HIV has been making every effort to change the situation.
The members of the forum decided to look for resources and opportunities for advocacy and provision of regulatory regulation and supply of drugs to hospitals during hospitalization, in a home hospital, to places of detention, starting from the moment of detention. RRT drugs are included in the WHO list of essential drugs, which means that access to them should be provided to all those in need.
Participant’s opinion. Natalia, Taldykorgan
-Our forum is an opportunity for people from the community to speak openly about problems, access to harm reduction services, declare their intentions to change drug policy and make it more humane. This is a dialogue platform for the exchange of experience between countries, partners, the opportunity to offer ideas for solving issues related to the punishment for the use of psychoactive substances. It is a pity that decision-makers do not respond to such a significant event – the LUN Forum in Kazakhstan. It was important to meet and discuss the accumulated issues.
Forum participants in working groups discussed the problems of access to civil administration of public programs and resources and prepared a plan of joint actions to reduce barriers to participation in decision-making.
The result of the meeting, which determines further actions – the PUD Kazakhstan Forum has emerged as a mechanism for public monitoring of drug policy reform. It bases its activities on the principles of horizontal democracy in decision-making that are consistent with community values on the principles of meaningful participation of people who use psychoactive substances in the development, resource provision, implementation and monitoring of IDUIT services.
Directly at the forum, proposals were formulated for inclusion in the country application of the Global Fund to Fight AIDS, Tuberculosis and Malaria for 2021-2023 in the direction of HIV prevention and reducing legal barriers among people who inject drugs. Namely, to create opportunities for real protection of the rights of community members: to a fair trial commensurate with the violation of the system’s response and to access to necessary medical and social services.
The changing drug scene and the collected evidence confirm the need to rethink approaches to risk reduction and prevention of HIV and hepatitis:
– keeping people away from non-injecting use for as long as possible and developing skills for safe or less risky injecting use;
– inclusion of measures to preserve the mental health of people using new psychoactive substances;
– the need to take urgent measures to preserve the sexual and reproductive health of people using new psychoactive substances, paying quality attention to women who practice sexual intercourse with the use of new psychoactive substances;
– maintaining, expanding access, improving the quality of OST and improving information systems for monitoring and control of services, including monitoring by the community of people’s satisfaction with the services received.
To support community advocacy, forum members described activities whose resource support will strengthen the community’s capacity to implement plans and achieve change.
Participant’s opinion. Olga, Temirtau
– For me, the LUN forum is hope. The hope is that by joint efforts we will be able to confront the terrible reality, namely, the fascination of the young generation with readily available and deadly synthetic drugs. Children whose life is just beginning perish from ignorance and ignorance; irreversible changes destroy families and cripple destinies. We can stop this. Of course, the forum is necessary, it is an opportunity for legal, legal and civil protection for us and our loved ones.