SUMMARY OF FACT FINDING MISSION TO KYRGYZSTAN
Maitland J. "Aaron" Peak – Peak Options Consulting
For Soros Foundation – Open Society Institute,
International Harm Reduction Development Program
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Hepatitis B and C has steadily increased in the 1990s, especially among drug users. This is true in Osh as well, where it is calculated that the route of infection is caused by injection (35-40%) and not through sexual contact. It is difficult to detect hepatitis B and C because test kits are not always available. Two cases of necrotizing fascialitis have occurred and many patients have abscesses. Free treatment rarely exists and all medication must be purchased by the patient. Soon a law will be passed to require prescriptions for many of the medications presently on the open market, including antibiotics. (Ref. 8)

The Osh Oblast center is the primary testing site for half of the Oblast for HIV, hepatitis B and C, and STDs. The ELISA method is used. Two cases of HIV have been detected in this center – one in 1998 and one in 1999. Both were drug users, one of whom came from prison. Both shared syringes and had sexual relationships for an extended period of time with local drug users. The number of HIV infected people is low but there is great concern about a pending epidemic. The Osh trust point only has the capacity to provide services to 200 out of the 5,000 drug users, which means that only 3-4% are being tested for HIV. UNDCP’s preliminary survey of HIV rates among IDUs in Osh show that 20% are infected. Some people who have tested positive have paid to have their tests changed to negative. The vast majority of tests are not voluntary and some do not even know they are being tested.

STDs are on the rise. Sixty percent of those with STDs are between the ages of 20 and 40 years. Eighty percent of the patients are unemployed. (Ref. 20) MSF/F has a center for STDs in Osh with medications provided by MSF/F. At present there are approximately 4,000 cases of gonorrhea per year and 2,000 cases of syphilis. Lack of compliance has caused resistant strains of STDs to appear, necessitating ever more expensive medications. Compliance in taking medications on schedule and for the full course is poor. No STDs in prison initiatives exist, but police are informed of current events and trends. The STD clinic generally does not get involved in drug treatment. (Ref. 23)

How Service Providers and International Aid Meet the Needs of the Drug Users

UNDP is working on HIV/AIDS within the framework given by the UNAIDS Theme Group and has discussed with the Minister of Health decentralizing finances and activities to the oblasts. The National AIDS Program should be evaluated, as should work at the oblast level, and it should be done by donor agencies, including the Soros Foundation.

At a meeting with a representative from UN Volunteers it was stated that UNVs are not yet active in HIV/AIDS but want to know more about the TAPAS Initiative which utilizes UNVs in promoting harm reduction. Support for an international UNV is about USD $40,000; for a national UNV USD $4,800; and for the field worker UNV, about USD $520 a year.

UNFPA does not work directly in the HIV or drug use fields, but it has worked with high risk families with a history of drug use, HIV infection, and issues surrounding family planning and reproductive health. Most of UNFPA’s work concerns, naturally, contraception analyses, building national capacity in family planning, working with professionals who provide primary health care, and producing IEC materials on reproductive health. Information will be distributed on drug use and HIV vulnerability will be sub-contracted to the National AIDS Center. (Ref. 14)

The National AIDS Program’s first project, in 1997, targeted safe sex in Bishkek with USD $850,000 from the UN. The second project targeted the entire country at a cost of USD $285,000. UNFPA has continued support for the National AIDS Program with USD $5,000, which is insufficient to continue to project. UNDP’s contributions likewise have decreased in the last few years. The rest of the international donor community, aside from the UN, has not supported the National AIDS Program, in spite of efforts to engage the international and national NGOs and volunteers. The Program’s priority is prevention of drug use and HIV and only secondarily needle exchange. (Ref. 13)

The Program’s multi-sectorial initiative, including the Ministries of Health, Labor and Social Services, Education, Internal Affairs, and Defense will produce and distribute IEC materials and focus on medical services. New strategic planning will focus on drug users, youth, and commercial sex workers. There is also an initiative on prisoners, refugees, and special groups of youth. Four NGOs have joined to work in these areas: Oasis, which works with MSM; Tais Plus, which was developed and is operated by commercial sex workers; Sanistas, a harm reduction group; and Parents Against Drugs.

The National AIDS Program produces a quarterly magazine on HIV-related activities and issues. A newsletter in English is sponsored by UNAIDS and UNESCO. This UN/government project has received the Jonathan Mann Award. (Ref. 2)

WHO, USAID, and CDC Atlanta sponsored a project for hepatitis testing in the Infectious Disease Hospital. (Ref. 8)

The labor market policy and employment projects of GTZ in Bishkek will come to a completion at the end of 2001. The government began collaboration with GTZ in 1991. One of the pilot projects, Reconstruction Industrial Enterprise, renovates derelict industrial buildings for the use of small medical-based work enterprises. Another pilot program, Employment Promotion Company, has been so successful that 11 have been opened in the country. (Ref. 6)

GTZ’s job club initiative was launched in 1997 in Takmak and Karabolta. Job clubs provide trainings and discussion groups for the unemployed and people who have had difficulty with lack of work in the transition period. Job placement is higher among members of the job clubs than in regular employment facilities. In an area of a large population of single mothers, in the Osh Oblast, a project specific to women has been set up. These women who are discriminated against are trained to operate their own businesses, many of which have been bakeries. Since one must present a passport and labor book to receive unemployment services, which is sometimes a tall order, training for the unemployed is offered. A mobile employment service initiated in 1997 and funded by GTZ is geared toward the country’s population of internal migrants. The service helps verify the residence of people and issue residency papers, as well as provide employment services. (Ref. 6)

The Narcology Center in Bishkek was created three years ago to bring together agencies and organizations concerned with drug addiction and its consequences. It has an in-patient component, a dispensary for detoxification, and a department for teenagers for drug use prevention issues. The government has not stepped in to help the Center’s lack of finances. The Center considers counseling an integral part of harm reduction and so defines harm reduction as skills + knowledge + means. (Ref. 3)

Drug users who have overdosed are admitted to the First Aid Hospital Toxicology Unit – the only one in the country. An increase in overdoses has made the working environment more difficult and increased mortality rates. (Ref. 12)

The NGO Sotsium, opened in Bishkek in 1998, is one of the most promising harm reduction initiatives. So far, 823 injecting drug users have requested Sotsium’s services, but over 200 users have been turned away because of lack of funds for an adequate supply of syringes and needles. Sotsium uses one room for what have turned out to be very successful meetings of AA, NA, ALATEEN, and ALANON. (Ref. 4) It has two full-time staff and an average of 20 paid volunteers, mostly drug users, who attend regular meetings. It opened a second site across town, the October District Trust Point, so that clients would have services closer to them. Meetings are also held in this location. (Ref. 16) The staff, drug users, and their spouses are all frustrated by police harassment, which they consider a barrier to their work, but the NGO does not have funds for a lawyer to address the corruption. Another barrier is the lack of appropriate IEC materials. The literature by the Center of Information and Enlightenment is medically based and needs to be re-developed, produced, and distributed. This need has been discussed many times but there is still a lack of funding. The NGO photocopies materials on HIV/AIDS. (Ref. 10)

The NGO Tais Plus, that aims to prevent HIV and STDs among commercial sex workers, has had many obstacles and setbacks but nevertheless covers 20 areas in Bishkek. It would like to start similar programs in Karabalt and Takmak. It works closely with the NGO that works with the gay community, Oasis. (Ref. 9)

The Children’s Welfare Foundation helps create a better environment for children of alcoholics, drug users, and incarcerated parents. It aims to prevent drug addiction, alcoholism, HIV/AIDS, STDs, and negative behavior in youth from seven to 18 years of age. The NGO currently helps 34 children and does not have the funds to help all 800 who have been identified for assistance. Its office space is becoming too small and the Foundation will have to look for new space, for which financial support is needed. The Foundation and Sotsium have initiated plans to open a temporary boarding school for children while parents are in treatment. The school will offer medical attention, counseling, training, and schooling. (Ref. 15)

The Soros Foundation has never funded the Ministry of Internal Affairs and it is unlikely to do so in the future. The Ministry’s mission is to arrest people for drug use, including clients of Soros’s needle exchange program. According to the Deputy Director, if the Soros Foundation launches a comprehensive harm reduction initiative – encompassing primary prevention, harm reduction, and drug treatment that includes detoxification, rehabilitation, and reintegration into society – the Ministry will cooperate with it fully. Other branches of the law enforcement community should also be included in harm reduction training. The Ministry is willing to help administrate post-rehabilitation training if funding is supplied by the Soros Foundation. (Ref. 18)

The only available drug treatment is the Osh oblast narcology dispensary. Rural areas have consultation rooms. The two toxicologists in Osh need up-dated training on overdose. (Ref. 22)

Risk of HIV infection is high since only 4% of Osh’s estimated drug users are reached by the Soros and UNDCP program. Funding for an initiative to reach at least 1,000 more IDUs should be granted. Other cities in the region need harm reduction programs, especially since drug users are mobile and can infect users in other areas. (Ref. 20)

There is a growing concern about the spread of STDs in the Osh oblast. Medecins Sans Frontieres/France operates the leading STD treatment center which also provides general information and special information for CSWs engaged in drug use. Another detoxification center in Osh, called Musada, is a rival and not spoken of much. MSF/F provides medication for their programs whereas UNDP does not. The MSF/F director feels that the UN is not doing enough to fight the spread of HIV and that their support is only just enough to make them look good and give them political clout. Regardless, one collaborative effort that is needed concerns the incineration of medical waste. UNDP, MSF/F, and Soros Foundation should support this initiative. (Ref. 23)

The Osh narcology dispensary has an in-patient division with 60 beds, and an out-patient department that follows up on those who have completed detoxification. The dispensary also has a consultation and prevention center for teenagers. Some attempts at AA and NA groups have not been successful. (Ref. 19) Because government funding for the dispensary is insufficient the NGO Parents Against Drugs has been located within the dispensary. The NGO’s needle exchange is off the premises, however, to maintain its independence from the government.

The Soros Foundation is the only organization in Osh working in HIV prevention for drug users even though other international agencies are there: MSF/F, SCF/UK, GTZ, OBSCE, ACCELS, UNESCO, and inter-Bilium. The view of the Soros Foundation focus is that it is too narrow and should be broadened to include education of the general public with assistance from the Ministries of Health and Internal Affairs. The funding that Soros Foundation provides means that coverage of its project is limited and drug users are being turned away.

Since there is no law prohibiting needle exchange the law enforcement community allows the program to continue. While they are neutral, it would help drug using clients if the top officials were actually in favor of harm reduction. If methadone treatment is initiated, however, the clients and volunteers will be arrested. (Ref. 17)

The Osh trust point, located in the First Aid Hospital, believes that drug users who come to the program are sick rather than criminals and should be left alone by the police. At one point 30 drug users were arrested, and after this scandal few drug users came to the program. The NGO appealed to UNDCP to help educate the police about the uselessness of incarcerating drug users. The situation improved considerably as a result.

Volunteers cover the city but not all drug users are willing to admit their use since there is still not a great amount of trust. The families of drug users, however, are eager for the NGO’s help. While doctors are obligated to promote abstinence, volunteers promote harm reduction instead. If users agree they can be sent to the narcology dispensary for treatment. It is said that 90% are willing to have treatment but have no money to pay for it. The volunteers are trained in primary health care and are able to treat abscesses and other infections, but they do not have the equipment or materials. Volunteers receive in-service training once a week on primary health care, overdose, and referral service management. The site doctor, however, provides most health services. (Ref. 21) PAGE 3

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Posted March 1, 2001 © Eurasianet
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