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This report outlines interventions for tackling hepatitis C in IDU populations in Europe. These approaches are detailed in the context of the major common challenges faced across the region in addressing hepatitis C in IDU populations, such as insufficient political will and leadership, low levels of understanding of hepatitis C, marginalization and stigmatization of drug using communities and of hepatitis C and inadequate access to hepatitis C prevention, diagnosis, treatment and care services.  This publication includes examples of interventions focused on awareness, prevention, treatment and care. They illustrate a range of approaches to tackling hepatitis C among IDUs, particularly in the context of the major common challenges facing the region today.  The report ends with a set of recommendations for governments, civil society actors and donor agencies.

Recent years have seen some progress in the development of harm reduction in Eastern Europe and Central Asia, but policies and services rarely account for the specific needs of women who use drugs.  Drug user registries, the illegal status of drug use and sex work, lack of access to evidence-based drug treatment, stigma and discrimination are among the factors that hinder women drug users’ access to medical care while exposing them to a range of human rights abuses.  Using input from national experts, this paper explores issues of drug policy and discrimination on the basis of gender in Georgia, Kyrgyzstan, Lithuania, the Russian Federation, and Ukraine.

When it comes to drug policy, EHRN’s overall goal is to achieve a balanced and a human rights-based policy that does not criminalize people who use drugs; that is conducive to providing them with adequate access to drug treatment, including OST, services for the prevention of blood-borne diseases and other health problems; and that protects their rights and reduces stigmatization and discrimination.  This position paper outlines EHRN’s priorities, which are rooted in 5 key principles: that the drug policy be balanced, evidence-based, respectful of human rights, focused on public health, as well as transparent and inclusive.  

Five years ago, governments in South East and Eastern Europe and Central Asia committed to move towards universal access to HIV prevention, treatment, care and support by 2010. With UNAIDS support, in 2006 most of the countries of these regions set targets and now, in 2010-2011, are reviewing their achievements, seeking ways to overcome challenges, and setting objectives and targets beyond 2010. The report provides recommendations to civil society and service providers, UNAIDS family and technical support providers, national policy makers and other stakeholders, donor community including the Global Fund and the European Community.

This 2011 report was prepared by members of the Public Mechanism for the Monitoring of Drug Policy Reform in the Russian Federation (hereafter, Public Monitoring Mechanism), together with the Eurasian Harm Reduction Network and the Canadian HIV/AIDS Legal Network. Thе report identifies the gaps in Russia's implementation of the 2009 Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem.  The analysis shows that the drug demand reduction policy of the Russian Federation does not comply with the 2009 Political Declaration and that the country's Anti-Drug Policy Strategy is poised to result in the loss of human life, further criminalization of people who use drugs and a spike in HIV infections.  Urgent action is needed to shift the focus of Russia's drug policy from repressive approaches to those grounded in human rights, public health and meaningful participation of people who use drugs.

Young people and injecting drug use in Eastern Europe and Central Asia synthesizes a wide body of evidence about young people and injecting drug use, reviews the national responses in Eastern Europe and Central Asia, and offers guidance on building a more enabling environment for effective action. The report provides vital information for several audiences: policymakers and legislators, people providing young people with drug-related services (harm reduction services as well as services in areas such as youth justice and sexual health), researchers, non-government organizations, and international agencies.  It will equip the reader with an excellent understanding of how injecting drug problems affect young people in Central and Eastern Europe—and how to respond appropriately. 

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.