Harm Reduction in Central Asia: A Global Perspective Shona Schonning, Program Director Eurasian Harm Reduction Network Secretariat (EHRN) October, 2008, Almaty

Eurasian Harm Reduction Network (EHRN) Founded in 1997 Founded in 1997 Secretariat in Vilnius, Lithuania Secretariat in Vilnius, Lithuania 260 members: GOs, NGOs, drug user organizations 260 members: GOs, NGOs, drug user organizations Democratic decision making mechanism Democratic decision making mechanism Any organization or individual committed to HR can become a member Any organization or individual committed to HR can become a member

Networking to: Exchange news, information, skills (over 700 people get listserve) Exchange news, information, skills (over 700 people get listserve) Generate, identify new knowledge (research) Generate, identify new knowledge (research) Build partnerships Build partnerships Support advocacy initiatives Support advocacy initiatives Provide technical assistance (through the Harm Reduction Knowledge Hub and through the Civil Society Action Team (CSAT) Provide technical assistance (through the Harm Reduction Knowledge Hub and through the Civil Society Action Team (CSAT)

Priority topics for EHRN in the coming year Overdose Overdose Stigma and discrimination Stigma and discrimination OST OST Drug Policy Drug Policy

Overdose OD is the No. 1 cause of death of IDU where data is collected systematically EHRN overview in 7 Eurasian countries showed: Most countries had very poor data Most countries had very poor data Few countries engaged in prevention of OD and OD death Few countries engaged in prevention of OD and OD death What does OD have to do with HIV? It is probably a major cause of death among PLHIV It is probably a major cause of death among PLHIV

The good news about OD: OD death is preventable through relatively cheap and easy interventions OD death is preventable through relatively cheap and easy interventions Nalaxone, a relatively cheap drug reverses overdose Nalaxone, a relatively cheap drug reverses overdose Distributing it to emergency services and directly to drug users and their family and friends saves lives Distributing it to emergency services and directly to drug users and their family and friends saves lives Good practice right here in CA: Khrog Tadjikistan Good practice right here in CA: Khrog Tadjikistan

The NGO Volunter in Khorog, Tajikistan a good practice example right here in CA NGO Volunter distributes nalaxone to Hospitals Hospitals Emergency services Emergency services Drug users and their family & friends Drug users and their family & friends Overdose related death down from 27 in 2006 to 0 so far in 2008

Stigma & Discrimination Common problem globally & in Eurasia Common problem globally & in Eurasia In Central Asia too (major cause of non-adherence to ARV in Kyrgizstan In Central Asia too (major cause of non-adherence to ARV in Kyrgizstan Internal stigma, external stigma Internal stigma, external stigma External: External: – among health professionals – in the general populations

Opiate Substitution Therapy Globally OST is growing in acceptance Globally OST is growing in acceptance Included in WHO Model Essential Drugs List Included in WHO Model Essential Drugs List Practiced in 23 of 29 Eurasian Countries (not in: Armenia, Russia, Kosovo, Kazakhstan, Tajikistan & Turkmenistan) Practiced in 23 of 29 Eurasian Countries (not in: Armenia, Russia, Kosovo, Kazakhstan, Tajikistan & Turkmenistan) Soon to be practiced in Kazakhstan Soon to be practiced in Kazakhstan Good practice model in Kyrgyzstan Good practice model in Kyrgyzstan Scale still low 102 sites in region with clients (of 3.4 mil IDU) Scale still low 102 sites in region with clients (of 3.4 mil IDU)

Legislation and policy on drugs International drug conventions were invented before the HIV and HCV epidemics International drug conventions were invented before the HIV and HCV epidemics –Demand reduction is not as emphasized as supply reduction –Harm reduction is not mentioned at all This blocks institutionalizeation and mainstreaming of harm reduction locally and nationally This blocks institutionalizeation and mainstreaming of harm reduction locally and nationally The UNGASS review on Drugs is coming up (March 2009) The UNGASS review on Drugs is coming up (March 2009) The time is now to highlight HIV-related challenges, need for harm reduction and human rights protection, as well as involvement of people who are directly affected by drugs in the Political Declaration, summarizing the progress and future challenges after UN General Assembly Special Session on Drugs 1998 which is currently being prepared. The time is now to highlight HIV-related challenges, need for harm reduction and human rights protection, as well as involvement of people who are directly affected by drugs in the Political Declaration, summarizing the progress and future challenges after UN General Assembly Special Session on Drugs 1998 which is currently being prepared.

General Observations Policy change still needed Policy change still needed Scope of services provided is good but not yet fully comprehensive Scope of services provided is good but not yet fully comprehensive Scale improving but still not adequate Scale improving but still not adequate Sustainability Sustainability –Financial (advocacy for national resources needed) –Methodological (effective technical assistance and instutionalization)

Central Asian Information and Training Center on Harm Reduction To maximize use of CA knowledge, skills and human resources within CA To maximize use of CA knowledge, skills and human resources within CA To make Eurasian knowledge accessible in CA (through HR Knowledge Hub) To make Eurasian knowledge accessible in CA (through HR Knowledge Hub) Make CA knowledge accessible in Eurasia (through HR Knowledge Hub) Make CA knowledge accessible in Eurasia (through HR Knowledge Hub) Networking (national and regional) for cooperation on policy change efforts Networking (national and regional) for cooperation on policy change efforts

Thank you and good luck! For more information contact: