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All Eastern European countries have ratified the three UN conventions on drugs; in the wake of the UN General Assembly Special Session (UNGASS) and the Declaration of the Guiding Principles of Drug Demand Reduction, they also adopted the 1998 UN Political Declaration, which committed them to improving relevant national and international mechanisms.  The Eurasian Harm Reduction Network (EHRN) and its national partners conducted this review to assess the 10-year progress in Eastern Europe following the 1998 UNGASS on the World Drug Problem. The review looks at the developments – in the levels of drug consumption and access to health services, particularly, to HIV, hepatitis C, overdose and drug treatment; in the legislation and policy; and in human rights  .  Four countries—Georgia, Lithuania, Russia and Ukraine were selected for this review.  The sources used for this report include official national reports, a review of statistical data, as well as qualitative semi-structured interviews with drug users, law enforcement agents, public health specialists and other experts from each country. 

All the authors of this book have been working in harm reduction for the past ten years and have observed various developments on the drug scene, but as long as ignorance and fear of the unknown persist, we all will have work to do. In order to understand how deeply rooted prejudice is in society, we can look at statements like "marijuana is a springboard to heroin, and heroin users are incurable and live a maximum of five years" – which are often pronounced publicly by politicians, reported in the media, and expressed by medical doctors, sociologists, teachers, and others. Once drug users realize that no one but themselves can solve these problems, once we begin to see other people around us facing the same problems, then and only then the problems may be solved. The battle has just started and victory is far away, but the first steps have been taken, and the effort will not be wasted. 

Though the number of countries in Eastern Europe and Central Asia providing OST increased up to 25 in 2010 (out of total 29), treatment remains to be hardly accessible for those who need it. The new research provided by EHRN in countries of the Central Asia, shows that in Kazakhstan, Kyrgyzstan and Tajikistan less than 5% of the estimated IDU population has got access to the OST. The report concludes that existing drug policies are the key constrain to the access to medical care for drug users and calls the countries upon ensuring the availability of essential medicines as a core obligation of governments under the right to the highest attainable standard of health.

For most drug users and people who work with them, overdose is an urgent issue. Many AIDS, harm reduction, and other drug service organizations have created programs to educate people who use drugs about overdose prevention and response techniques, to distribute naloxone and to document the extent of overdose and the success of responses. But funding has been limited. Recently, the Global Fund to Fight AIDS, Tuberculosis and Malaria issued guidance that they will support these kinds of overdose prevention activities. Other AIDS funders are beginning to follow the lead, and service providers should ensure that overdose services are available to their drug-using clients directly or through local referral networks. This document presents arguments that organizations can make to AIDS funders to show that overdose prevention and response matter for HIV programming.

The aim of this report is to provide insight into the ways to improve civil society participation in country-level planning and evaluation of the national response to HIV.  The report explores the nature of civil society involvement in the process of establishing national targets as well as the impact this involvement had on the targets established.  The target setting process is examined in 15 countries in the region of South-Eastern and Eastern Europe and Central Asia.

The HIV epidemic in Russia continues to grow. Groups most affected by the HIV epidemic are injecting drug users (IDUs), also sex workers, men who have sex with men and inmates as well as their sexual partners. Russia has a steadily increasing number of patients in need of antiretroviral therapy as well. Though much progress has been made to move towards established Universal Access Targets for 2008, there are many barriers to be overcome for Universal Access to be reached by 2010. Report provides thirteen issues raised by civil society representatives in the process of the Country Report preparation for UNGASS 2008 and recommendations.

This paper written by EHRN in 2008 examines the introduction of opioid substitution therapy (OST) in selected post-Soviet countries: Belarus, Ukraine, Lithuania, Georgia, Kyrgyzstan, Kazakhstan, Russia, Tajikistan and Uzbekistan. As of 2008, less than 2% of injecting drug users in the region had access to this life-saving treatment, with many OST programs still remaining in the perpetual pilot phase. The findings point to an urgent need to develop better epidemiological surveillance of injecting drug use in the EECA region; to improve availability of evidence-based treatment of injecting drug users including opioid substitution therapy; and to disseminate the information more broadly to policy makers, the medical community, and civil society organizations in order to move from policy to action.

Hepatitis C Among Injecting Drug Users in the New EU Member States and Neighboring Countries: Situation, Guidelines and Recommendations

To assess the situation with IDU access to HCV treatment in the region, the Central and Eastern European Harm Reduction Network (CEEHRN) carried out a survey in 13 countries of the European Union (EU) and the neighboring countries, looking at the availability of HCV prevention, treatment, care and support for IDUs.  The findings show that in most countries access to HCV care for injecting drug users remains limited. Stigmatization of drug use means that those with the greatest need for HCV support, treatment and care are often denied these lifesaving services. The current level of policy and advocacy efforts is not sufficient to achieve progress, meaning that more needs to be done in order to raise the profile of the issue with the policymakers. The report provides guidelines and recommendations for further action.

Hepatitis C virus (HCV) presents an important public health problem globally and particularly in the region of Central and Eastern Europe. The infection spreads rapidly among injecting drug users (IDUs) due to its high infectivity. Availability of HCV prevention, treatment, care and support for IDUs is often not satisfactory. The key finding of the fact sheet, based on a survey in 13 countries of the European Union (EU) and neighboring countries, is that in most countries HCV among IDUs is a neglected problem.

Working with vulnerable populations—injecting drug users (IDU’s), sex workers, people living with HIV, men who have sex with men, and prisoners—is associated with high levels of stress and burnout. This is particularly so for those working on the “frontlines”—harm reduction service providers, medical staff, social workers. This manual explores best practices in burnout prevention and management based on the experience of harm reduction projects in the region of Eastern Europe and Central Asia. The manual also includes a training module, strategies for stress management, as well as a suggested reading list.