1. Do we need to be effective in HIV response?

2. HIV response without DRUG POLICY issues?
Expenses without effect
Most affected group is marginalized from getting health and medical care
Is it possible to talk about HIV and Law not mentioning issues connected with drug use? What happen with ART drugs in AIDS Centre if drug user is afraid of doctor who need to report to police every drug user.
It is expenses without effect.
It is also more marginalasing and trying to keep one of the most affected groups out of the medical and social services.

3. Repressions in EECA region is a barrier to HIV response
HIV epidemic is still growing (Russia, Ukraine, Belarus, Georgia, Central Asia);
Access of people using drugs (PUD) to ART – less then 10%;
Access of PUD to other medical
services is the lowest one.
IN our region HIV epidemic is still growing. In the same time in most of the countries of the region the drug policy is becoming more and more repressive toward the human rights of PUD. Repressive law lead to the lack of access to HIV related services for the key population which is the most affected by the epidemic.
Georgia, Russia, Ukraine, Belarus, Central Asia – countries where repressive measures are used are used to punish drug users for the usage. They are the same where HIV epidemic is still growing
Do you know why PUD in Georgia were protesting with posters “We will increase the number of HIV infected”, “Better HIV then 25 years imprisonment”
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The region of Central and Eastern Europe and Central Asia (CEECA) remains the one with high burden of injection drug use and related HIV and HCV epidemics. In vast, national drug legislations and law enforcement practices in the region have remained disproportionately repressive and have neglected human rights and public health perspectives of the response to drugs issues.
Legal environment and policy implementation in many countries is far from what can be called a balanced approach. Drug use and/or possession for personal use are criminalized throughout the region. Majority of people incarcerated for possession of controlled substances serve prison terms for possession of drugs for personal use. Most country legislations do not contain provisions for alternative measures for drug offenders and/or people with substance use problems. Where such provisions exist they are very rarely applied. Police resources are vastly devoted to targeting drug users and law scale dealers. International experience suggests that countries with best results in reducing drug related harms are those where law enforcement focuses on reducing violence and capacity of criminal groups, and where policies are inclusive and treat people with substance use related problems as members of society/community.
Alternative approaches include establishing police partnership with communities and addressing complex social issues. Collaboration between law enforcement agencies and civil society sector in the region is at the embryonic stage. Few examples of project-driven initiatives were presented.

4. Higher OST cost is also consequence of repressive drug policy
OST from the state budget costs about $1,400 in Georgia vs $ 553 Tajikistan (for 1 client per year)
In Georgia drug use per se is a criminal offence (when committed two or more times during a year) and can be punished by monetary fine or prison term.
Not only in the streets, but also in the harm reduction programs police dictates the rules. Five guards for three OST cabinets and video cameras – it is extra 500 dollars per years for 1 client.
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The region of Central and Eastern Europe and Central Asia (CEECA) remains the one with high burden of injection drug use and related HIV and HCV epidemics. In vast, national drug legislations and law enforcement practices in the region have remained disproportionately repressive and have neglected human rights and public health perspectives of the response to drugs issues.
Legal environment and policy implementation in many countries is far from what can be called a balanced approach. Drug use and/or possession for personal use are criminalized throughout the region. Majority of people incarcerated for possession of controlled substances serve prison terms for possession of drugs for personal use. Most country legislations do not contain provisions for alternative measures for drug offenders and/or people with substance use problems. Where such provisions exist they are very rarely applied. Police resources are vastly devoted to targeting drug users and law scale dealers. International experience suggests that countries with best results in reducing drug related harms are those where law enforcement focuses on reducing violence and capacity of criminal groups, and where policies are inclusive and treat people with substance use related problems as members of society/community.
Alternative approaches include establishing police partnership with communities and addressing complex social issues. Collaboration between law enforcement agencies and civil society sector in the region is at the embryonic stage. Few examples of project-driven initiatives were presented.

5. Georgia: OST is provided for free to HIV-positive people
To HIV-negative patients, OST is provided at $50 per month (average pension per month)
In Georgia, a person convicted of possession of 0.96g of heroine for personal use is liable to imprisonment for 7+ years
In Georgia, OST covered by the government money is available for HIV positive people. For others, it is necessary to pay the inflated cost of the program. With total unemployment and the crisis, to find a $ 50 per month is not possible for all. Therefore, people are facing a choice - either get infected and a treatment access to treatment, or jail for a longer period.
The region of Central and Eastern Europe and Central Asia (CEECA) remains the one with high burden of injection drug use and related HIV and HCV epidemics. In vast, national drug legislations and law enforcement practices in the region have remained disproportionately repressive and have neglected human rights and public health perspectives of the response to drugs issues.
Legal environment and policy implementation in many countries is far from what can be called a balanced approach. Drug use and/or possession for personal use are criminalized throughout the region. Majority of people incarcerated for possession of controlled substances serve prison terms for possession of drugs for personal use. Most country legislations do not contain provisions for alternative measures for drug offenders and/or people with substance use problems. Where such provisions exist they are very rarely applied. Police resources are vastly devoted to targeting drug users and law scale dealers. International experience suggests that countries with best results in reducing drug related harms are those where law enforcement focuses on reducing violence and capacity of criminal groups, and where policies are inclusive and treat people with substance use related problems as members of society/community.
Alternative approaches include establishing police partnership with communities and addressing complex social issues. Collaboration between law enforcement agencies and civil society sector in the region is at the embryonic stage. Few examples of project-driven initiatives were presented.

6. Alternatives to imprisonment
Portugal - the country really changed the approach from the repressive drug policy to decriminalization and public health and have received impressive results by reducing infected by HIV.

7. Kazakhstan
A couple days before the conference, I received a table - a comparison of the costs of treatment for one drug user per year in Kazakhstan. Dark yellow line – cost of OST - $ per year per person. Green - almost $ the maintenance of the PUD in prison for a year. At the end of 2015 Kazakhstan, under the pressure of PUD community, NGOs, EHRN and the UN agencies, registered methadone. We know that needle exchange and OST treatment – is a political issue. Therefore, Kazakhstan‘s moving towards state support of OST programs is extremely important for Uzbekistan, Tajikistan and other countries.

8. Are there any alternatives?
Maybe you use vizualization board for personal purposes? We also decided to make the visualization of an approach to public health in drug policy in EECA region.
We are not only crying about repressive drug policy, we are developing alternatives together with national ministries of internal affairs. On the recent meeting in Kiev with national authorities from 11 countries of the region we found out that there are several key measures which could save money and effort for the effective HIV response. They are following:
To not to run after the drug users who are just experimenting and using in the small amount
To not to plan and report on the cases of drug use
To suggest to drug users the harm reduction services such as OST instead of imprisonment.
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1. Decriminalize use and possession of small amounts of drugs for personal use and reform tables of quantities of psychoactive drugs seized from illegal turnover and introduce realistic and adequate quantities
In most countries drug use per se is not a criminal offence (with the exception of Georgia and Latvia). However, possession for personal use (with different thresholds for quantities) is criminalized throughout the region. As a result, significant share of people sentenced for drug possession serve their prison terms due to possession of drugs for personal use. Historically country legislations include tables that set thresholds for considering amounts of seized substances as “small”, “large”, and “extremely large”. Criminal laws refer to these amounts and establish punishment measures – the larger amount of the drug, the longer the prison term. Common issue is extremely low thresholds defined in these tables and resulting disproportionately harsh punishment for the vast majority of drug offenders. Therefore, the goal of the legal reform should be to develop (and introduce) amendments to the legislation that would abolish criminal liability for per se drug consumption (where applicable), abolish criminal liability for possession of small quantities of drugs for personal use, and revise tables of quantities of psychoactive substances. In addition, it is necessary to make sure tables and relevant articles speak of, and consider, pure (active) substances, but not the often adulterated mixture that was seized.
2. Improve the effectiveness of police work through abolishing plans/targets for criminal statistics
In a number of countries effectiveness of police historically has been assessed based on a number of criminal cases registered and solved. This encourages police officers to accomplish those plans at the cost of drug related offences. Existing regulations provide easy options for that – for example, criminal case related to drug use (in Georgia) or drug possession would be opened only in case the use and/or possession has been confirmed, and will be immediately reported as solved. Both the criminalization of drugs use and possession for personal use and plans/targets for criminal statistics encourage police officers to focus on chasing drug users and/or low profile drug sellers. As a result significant share of police resources are wasted towards dealing with people and behaviors that do not represent tangible threat to public security, which diverts law enforcement resources from tackling serious drug-related and other crimes. The Warsaw declaration ( provides following recommendation in this regard:
“Police and other law enforcement agencies should not target people who use drugs for simple possession of small amounts of drugs intended for personal use. Indicators of policing success should be reviewed in order to deprioritise the policing of low-level drug offenders, and to improve public health outcomes, recognising that this in turn will improve public safety. This should be clearly defined through guidelines on policing best practice for law enforcement agencies, and effective cooperation mechanisms should be established between law enforcement agencies and health and social service providers. Law enforcement officials should be adequately trained and sensitised as to how best to respond to drug use and/or drug dependence and addiction, and be properly informed as to the availability of prevention and education programmes, harm reduction services, treatment and social services for people who use drugs, should they be required.”
Therefore, indicators of effectiveness of police work should be linked to fighting organized drug crime and improving public health outcomes (linking individuals with drug related problems with relevant health and social services). At the level of legislation this would require both changing laws (i.e. decriminalization) and police internal regulations. At the level of implementation this will require establishing close partnerships with service providers and training police staff.
Introduce legislative changes that would allow the implementation of alternatives to punishment measures
Legislation of the vast majority of countries does not include options for providing non -criminal measures (education, treatment, rehabilitation) as an alternative to punishment for drug related offenders and/or offenders with drug problems. Moreover, in those countries where such options are available they are largely ignored and not utilized – often due to both the lack of motivation from the side of law enforcement and criminal justice institutions, and the absence of implementation mechanisms. Criminal sanctions (largely imprisonment) remain as a major (often the only) intervention applied by the state while fulfilling its often-declarative aim to reduce demand for illicit drugs.
Develop practical mechanisms to implement alternative measures
Existence of alternative (to punishment) options in the legislation is not sufficient for their implementation. At least three other elements of the system should be developed in order it to function effectively. Relevant operational protocols (manuals) and/or guidelines should provide clear and detailed description of specific steps to be followed by the staff of partnering institutions/facilities (for example police and NGOs, probation services and NGOs, courts and NGOs and addiction clinics). Staff of partner organizations needs to be trained on the implementation of the guidelines and should have good understanding of the rationale for the intervention (who benefits and how, including benefits to law enforcement and criminal justice systems). And finally, where needed, financial resources should be available to cover the cost of alternative measures (meaning supporting available in each city continuum of services from harm reduction, OST to rehabilitation).

9. Steps forward
Safe state and money through decriminalization and alternatives to punishment for the drug use
Develop system of harm reduction services on local level and alternatives for punishment
Implement system of legal and para-legal support to PUD in case of human rights violation
PUD community leadership development
All this alternatives will save state‘s money. Only for the keeping one drug user in prison is 10 times more then helping him/her with OST. Cost of street drug testing in Georgia is four fold of government’s expenditures on drug treatment and rehabilitation.
Alternatives in comparison to imprisonments improving not only state of governmental budget, but also the social adaptation of the people.
In addition to the services we need to provide legal and para-legal support to PUD especially in case of rights violation from police. We have huge experience of the street lawers work which help not only in protection of the concrete victim, but also help to change situation systematically on legislative level.
Actually, this systematic changes are possible if work is done by PUD community leaders.

10. The fact that HIV is spreading among people who inject drugs and their partners does not require an evidence. You see 51% and 33%, respectively. There is an obvious need for affordable sterile equipment and condoms. Enough to recommend, it's time to negotiate and together change the conditions, to ensure that people who use drugs would like to take advantage of HIV prevention and treatment services.

11. Punishment does not work! Harm reduction works!
Eurasian Harm Reduction Network (EHRN) is a regional network of harm reduction programs and their allies from across 29 countries in the region of Central and Eastern Europe and Central Asia. Together, we work to advocate for the universal human rights of people who use drugs, and to protect their lives and health.