2018

Day of Action 2018

City: Astana

Organisations: The Kazakhstan Union of People Living with HIV

The Kazakhstan Union of People Living with HIV held a series of pickets and other events dedicated to the global campaign “Support Don’t Punish” in Astana, Kazakhstan.

The official opening of the photo exhibition “Everyone is important: stories of Kazakhstan people about the world drug problem in photos”, was held in Astana on June 26, 2018 and organized by the UN Office on Drugs and Crime in partnership with USAID. The opening ceremony was attended by the author, a well-known photographer Nick Danziger, representatives of UNODC and USAID, as well as the patients of substitution therapy programs from various regions of Kazakhstan. The patients later joined civil activist in a campaign to support OST.

The actions in support of substitution therapy programs were necessary because the program had stopped accepting new patients since December 20, 2017 in Kazakhstan. This verdict on the results of the government inspection caused concern among public and medical workers, the patients of the substitution therapy program were panicking themselves.  Moreover, a special interdepartmental commission was to be held on June 27, 2018 to decide the fate of the program! All the data showed that OST program was going to shut down on the entire territory of Kazakhstan.

The Kazakhstan Union of People Living with HIV launched an awareness campaign to attract the attention of decision-makers, so they could make the right and deliberate choice, and issued the following appeal together with the participants of OST programs:

“We, the citizens of Kazakhstan, the participants of opioid substitution therapy and those who stand in queues waiting for treatment, need access to treatment of drug dependence in our country. The right to life and the right to the highest level of health are guaranteed to us by the Declarations of Human Rights and the Constitution of the Republic of Kazakhstan.

The substitution maintenance therapy medicine is included to the WHO list of vital medicines. 320 people receive treatment in 13 cities in Kazakhstan today, the main purpose of which, like any other type of treatment, is to stabilize or improve the physical condition of a person. Drug dependence is a chronic disease and substitution therapy is an effective form of treatment.

The situation in Kazakhstan is currently threatening for the program and it might be closed. Meanwhile, this therapy is recognized all over the world as one of the most effective practices for drug dependence treatment. It is successfully implemented in 106 countries. The results of numerous studies indicate that OST positively contributes to reducing the use of illegal drugs and reduces mortality and the risk of HIV infection.

We ask you to protect and exercise our right to receive effective, evidence-based treatment.

The Kazakhstan Union of People Living with HIV has always supported drug users, because even the closest people turned away from many of them, and they could once again become clients of the illegal drug market, end up in prison or die. Everyone should have a chance to live!

We call on decision makers to protect and realize the right of these people to receive effective, evidence-based treatment for substitution therapy!

We ask community activists and all those who understand the importance of the program to support us! We ask you to publish videos, photos and stories on social networks so that this program could be saved, and people would have a chance to change and save their lives.

We will not be silent and afraid! We can change the situation!  On June 26, Astana will host an action to defend OST”

Representatives of communities, non-governmental organizations from Astana, Almaty, and Temirtau, and other citizens held a picket to support OST on June 26, one day before the decision on the further existence of substitution therapy programs was to be made.

The activists spoke, proved, called and hoped that they would be heard by the decision makers. Hundreds of those who were already involved in the program hoped with us but those who wanted to be included to the program and stay alive were even more worried. After all, OST is a really last chance for a lot of people. 34 appeals and complaints from patients were sent to the Commissioner for Human Rights of Kazakhstan. A flash mob “Substitution therapy is my chance” aimed at drawing attention to the problem became very popular in social networks. A report was prepared together with the Eurasian Harm Reduction Association and the Canadian HIV / AIDS Legal Network and later presented at the 62nd pre-sessional working group of the UN Committee on Economic, Social and Cultural Rights (CESCR) in Geneva.

The document contains 30 questions, but the question № 26 is of particular importance: “Please indicate the success of the measures taken by the state party to combat the flow of illicit drugs, such as cannabis and opiates, and to prevent their consumption. Please also provide information on measures taken to improve the quality of drug addiction treatment and rehabilitation services, including the provision of opioid substitution therapy.”

Addressing the government of Kazakhstan, the activists hoped that they would be heard and hundreds of people would not lose faith in the future and the programs of substitution therapy would upgrade from the pilot projects to the official form of treatment of drug dependence in Kazakhstan.  Every patient should have the right to choose their treatment.

And we won!!! It was decided to continue the programs of substitution therapy in Kazakhstan on June 27! Take action!

 

 

 

City: Temirtau

Organisations: “Bridge to the Future”

The activists of the youth volunteer club “Bridge to the Future” and Center for development and social assistance to the population “My House” joined the international campaign “Support. Don’t Punish” in Temirtau, Kazakhstan. Its purpose is to show that punishment can’t be an effective measure to solve the problem of drug use, but on the contrary it only aggravates the situation!

 

2018

Preserving substitution maintenance therapy in Kazakhstan: the history of advocacy

Article written by the Eurasian Harm Reduction Association (EHRA)

In the middle of 2017 there was an alarming situation with methadone opioid therapy (OST) in Kazakhstan, which had been initiated there earlier in 2008 in accordance with the recommendations of various international organizations such as WHO, UNAIDS and UNODC. The program couldn’t get unanimous support from politicians, law enforcement and health agencies and was under the threat of closure.

In the summer of 2017, one of EHRA partners in Kazakhstan, the Kazakhstan Union of People Living with HIV, expressed serious concern about the threat of closing the supporting substitution therapy program (this is what OST is officially called in Kazakhstan, it’s usually abbreviated as “SMT” – “substitution maintenance therapy”) and revealed the facts of pressuring program participants by law enforcement agencies.

In June 2017, the Ministry of Internal Affairs with the support of seven MPs has demanded to close OST programs immediately. The Office of the Prime Minister soon ordered the evaluation of OST programs for opioid dependent people, which was launched at the end of September by a specially created Intersectoral Working Group consisting of 17 people. On October 30, 2017, the Working Group prepared a resolution concluding that the program was effective and should continue after some improvements to accessibility and quality of services.

However, some members of Intersectoral Working Group were not satisfied with the positive recommendations and initiated the “alternative research” that was performed without appropriate methodology and with the assistance of the police, which consequently led to serious violations of the rights of OST clients. This study resulted in the document named “Special opinion” of four members of the working group, which said that the program was not effective and should be closed.

From November 27 till December 1, 2017, the team of the Eurasian Harm Reduction Association held three meetings with OST program participants in Pavlodar and Temirtau during its visit to Kazakhstan. The meetings were held in the office of NGO “Ty ne odin” (“You are not alone”), at OST site in Pavlodar and at the crisis center for women in Temirtau. 30 people attended the meetings. During the meetings, EHRA conducted the interviews to find out how an “alternative study” of the effectiveness of OST programs was really conducted. The interviews with the participants of OST programs in Pavlodar and Temirtau revealed numerous violations in the work of the commission during their visits: most of the interviewed patients were not informed about the purpose of the study, they were threatened and accused of not being able to stop using drugs without medical support, were forced to participate in the survey and provide urine samples for drug testing without their informed consent. The police visited some OST clients at their homes and demanded to share their experience of participating in the program.

Despite the serious violations recorded by the civil society in the work of the members of the Intersectoral Commission and the false data indicated in the Special Opinion, the document was attached to the main report of the Intersectoral Working Group, which led to the decision to stop the recruitment of new participants in the OST program starting from January 2018.  On June 27, 2018, the new commission, with the participation of the National Security Committee and the Foreign Intelligence Service, had to decide the future of people receiving methadone treatment in the Republic of Kazakhstan.

At that point it became obvious that the situation at the national level should be viewed from the international perspective, so the Eurasian Harm Reduction Association in cooperation with the Kazakhstan Union of People Living with HIV and in partnership with several international organizations, held a series of advocacy activities. It was decided to draw the attention of journalists, international human rights organizations, representatives of the embassies of the Republic of Kazakhstan in foreign countries to most serious violations of human rights, including the right to access scientifically proven life-saving treatment in the Republic of Kazakhstan

Advocacy actions of EHRA and its partners

  • January – April, 2018: EHRA, together with the Canadian HIV / AIDS Legal Network, filed a complaint based on the documented cases of violations to the UN Committee on Economic, Cultural and Social Rights.
  • The threat of closure of substitution treatment programs was announced by EHRA at the April meeting of the Committee’s Working Group. As a result, the questions were asked to the government of Kazakhstan (Question 26) about the plans for the expansion of the program.
  • EHRA experts analyzed the arguments of the opposition with respect to their scientific validity, interpretation, and evidence. Based on the analysis, EHRA published the explanatory note “Why you shouldn’t rely on the special opinion of a group of committee members on the continuation of OST“. This document includes the facts which the leaders of the civil society in Kazakhstan have used in their advocacy actions.

On 26 June 2018 the International Campaign “Support, Don’t Punish!” defended OST in Kazakhstan.

Based on the appeal of the participants of the substitution therapy program and the Kazakhstan Union of PLWH to decision-makers in Kazakhstan, the Eurasian Harm Reduction Association appealed to the international community and civil society in the countries of Eastern Europe and Central Asia to support the following initiatives:

  • Sign an appeal to the President of the Republic of Kazakhstan to sustain the substitution therapy in the country.  As a result, 64 international and national organizations have signed the appeal. This appeal was circulated to journalists and announced at a press conference by Oksana Ibragimova on June 26 in Astana, on behalf of the Kazakhstan Union of People Living with HIV.
  •  On the International Day Against Drug Abuse and Illicit Trafficking – June 26 – come to the embassies of the Republic of Kazakhstan, send the appeal to the President of Kazakhstan and post photos near the embassy on Facebook with hashtags #KazOST, #EHRA, #SupportDontPunish.
  • On June 26, 2018, participants of substitution therapy programs, along with harm reduction organizations in Lithuania, Estonia, the UK, Ukraine, Moldova, Belarus, Russia, held rallies near the embassies of the Republic of Kazakhstan and published photo and video messages calling to save the OST program in Kazakhstan.  A community of people who use drugs and people living with HIV in Kazakhstan, our friends and partners held the event in Astana to support the program.
  • On June 27, 2018 the Joint Commission for the Study of the Effectiveness of Opioid Substitution Treatment was held in Astana, chaired by Elzhan Birtanov, the Minister of Health; the event was attended by Gerra Gilberto, Head of the Department for Drug Use Prevention and Care at UNODC, Oleg Chestnov, WHO Permanent Representative to the Republic of Kazakhstan, Zhanat Suleimenov, First Deputy Minister of Internal Affairs of the Republic of Kazakhstan, representatives of the General Prosecutor’s Office, Nikolai Negai, Director General of the Republican Scientific and Practical Center for Mental Health, Bauyrzhan Bayserkin, General Director of the Republican Center for AIDS Prevention and Control, and other law enforcement and public health agencies, Department of Organization of Medical Assistance, representatives of the Global Fund for HIV, Tuberculosis and Malaria and the human rights organization “Aman-Saulik”.
  • As a result of the meeting, the representatives of the Ministry of Internal Affairs signed the protocol of the Joint Commission on the continuation of the program of substitution therapy in Kazakhstan. A roadmap for improving and implementing the program of substitution therapy with opioid agonists in the Republic of Kazakhstan for 2018-2019 was developed. Within the framework of this Roadmap, it is planned to include methadone into the list of medicine for outpatient mental health treatment in 2019 (amending the Order No. 666 of August 29, 2017).
  • As a result of advocacy work, intersectoral cooperation with international organizations and specialized NGOs has intensified in terms of improving the quality of service delivery and monitoring the quality of OST. Also, UNAIDS will redirect previously allocated funds for UNODC to continue advocacy through public hearings for the advocacy of the OST program among general public.
  • The final decision on the continued support of substitution therapy hasn’t been made yet. A new joint meeting of the Intersectoral Working Group and the Intersectoral Commission will take place in November 2018, which will decide the future of the methadone treatment program in Kazakhstan. Also within the framework of the Roadmap it is planned to carry out the analysis of economic effectiveness of SMT in comparison with traditional methods of drug dependence treatment with the involvement of an independent accredited expert, the Republican Scientific and Practical Center for Mental Health, the Republican AIDS Center, UNODC and UNAIDS in December 2018.
  • The team of the Kazakhstan Union of People Living with HIV constantly monitors the processes affecting the sustainability of the program in the country through advocacy at the national level, documenting the positive results of treatment on human life and family, as well as organizes and actively participates in public hearings at the national and local advocacy venues, saving the opportunity to receive vital treatment for people in need.
  • According to the experts of the Kazakhstan Union of People Living with HIV and other civil society organizations and the data available as of 17 September 2018, the methadone program available in 13 cities has started recruitment of new clients to the substitution treatment program. However, in most cases, doctors refuse to include new people to the program, even taking into account the referrals from medical commissions to methadone treatment.
  • We will continue protecting the right of access to scientifically based treatment by methadone, which is included to the list of vital medicines of the World Health Organization. #KazOST

2017

Day of Action 2017

In Almaty, a flash mob was organised by the “Kazakhstan Union of People Living with HIV”. LUN also provided training on motivational interviewing to representatives of the community of people who use drugs from different cities in the country.