Harm Reduction Drug Project Uzbekistan - Contact Netz

Harm Reduction Drug Project
Uzbekistan
Contact Net Bern/Swiss Federal Office of Public Health
(SFOPH)
Interim Report – Autumn 2004
Two-year Harm Reduction Project in Uzbekistan
Authors
Jakob Huber, Contact Net Project Manager
Steffi Wirth, Project Leader for Phase I
© 2004 Contact Net/by order of the Swiss Federal Office of Public Health (SFOPH),
Order No. 01.001043

TABLE OF CONTENTS
PREFACE ................................................................................................................ 3
1. ABSTRACT ...................................................................................................... 4
2. INTRODUCTION............................................................................................... 5
3. SWITZERLAND-UZBEKISTAN HARM REDUCTION PROJECT.................... 7
3.1 BACKGROUND: SWITZERLAND’S DRUG POLICY .............................................. 7
3.2 KEY PROJECT DATA ................................................................................... 10
3.3 PROJECT OBJECTIVES................................................................................ 11
3.3.1 Harm reduction, and ensuring the survival of injecting heroin users
and their circle .................................................................................. 11
3.3.2 Improving know-how with regard to cessation of drug use, substitution
and the rehabilitation of heroin addicts, with the help of government
institutions......................................................................................... 11
3.4 OTHER PROJECT AIMS................................................................................ 11
3.5 PROJECT COSTS........................................................................................ 12
3.6 SWITZERLAND-UZBEKISTAN PROJECT AGREEMENT ..................................... 12
4. PROJECT ORGANISATIONAL CHART........................................................ 13
5. THE PROJECT LAUNCH: DEFINING OBJECTIVES AND STAFFING
REQUIREMENTS .................................................................................................. 15
5.1 PROJECT CONTENT AND STAFFING ............................................................. 15
5.2 CALL FOR INTERNATIONAL PROJECT LEADERSHIP........................................ 15
6. PROJECT IMPLEMENTATION...................................................................... 16
6.1 PHASE ONE - OCTOBER 2002 – JULY 2003 ................................................ 16
6.1.1 Successful search for partner organisations..................................... 16
6.1.2 Creating Contact Centres in Tashkent and Samarkand: objectives .17
6.1.3 Capacity building .............................................................................. 18
6.2 PHASE TWO - AUGUST 2003 – OCTOBER 2004........................................... 20
6.2.1 Opening the Contact Centres in Tashkent and Samarkand ............. 20
6.2.2 The project teams in Tashkent and Samarkand ............................... 20
6.2.3 Facts and figures from the Contact Centres ..................................... 21
6.3 CO-OPERATION WITH UZBEK PARTNERS ..................................................... 23
6.3.1 Co-operation with government officials............................................. 23
6.3.2 Co-operation , trust and key network partners.................................. 23
6.3.3 Switzerland has something to offer and should continue.................. 23
6.3.4 NGOs and their contribution to a process of democratisation .......... 24
6.3.5 Drug policy and efforts to combat drug abuse: a difficult learning
process ............................................................................................. 24
6.3.6 Risks and opportunities in relation to staff and the social context .... 24
6.3.7 The project leader – strategic integration ......................................... 25
7. PROJECT DEVELOPMENT........................................................................... 26
7.1 THE STRENGTHS OF THE PROJECT.............................................................. 26
7.2 WEAKNESSES OF THE PROJECT.................................................................. 26
8. CHALLENGES TO BE FACED FOR EFFICIENT PREVENTION OF HIV/AIDS
AND DRUG ADDICTION IN CENTRAL ASIA IN THE YEARS AHEAD............... 28
8.1 REACHING A LARGE NUMBER OF ADDICTS IN UZBEKISTAN............................ 28
8.1.1 Efficient distribution structures, and the affordability of HIV/AIDS and
drug prevention................................................................................. 28
1

8.2 NEED TO DEVELOP TREATMENT OPPORTUNITIES FOR DRUG ADDICTS........... 32
9. FIRST HARM REDUCTION CONFERENCE IN CENTRAL ASIA ................. 32
9.1 HARM REDUCTION NETWORK FOR NGOS IN CENTRAL ASIA ........................ 32
10. CONCLUSIONS AND NEW CHALLENGES .............................................. 34
11. A LEARNING EXPERIENCE ...................................................................... 36
12. .......................................................................................................................... 36
13. APPENDIX .................................................................................................. 37
14. GLOSSARY ................................................................................................ 41
2

Preface
A Fact Finding Mission 1 into drug abuse in Uzbekistan which was carried out more
than three years ago made one thing absolutely clear: Uzbekistan faces an
enormous challenge with regard to injecting heroin use and HIV/AIDS. It is for this
reason that we decided to focus the Switzerland-Uzbekistan Harm Reduction Drug
Project on HIV prevention.
Contact Net, with the help of its Uzbek partners and the two Contact Centres in
Tashkent and Samarkand, has been involved in implementing the ambitious Harm
Reduction Drug Project for a period of two years. The “grass roots” approach of this
project is unique. For a period of one week in June 2003, an Uzbek delegation
made up of all the representatives on the project Steering Committee was given an
insight into the theory and practice of Switzerland’s drug policy and the work done
in the field in Switzerland. The Uzbek delegation visited the Federal Office of Public
Health (SFOPH), the premises of Contact Net, and Suchthilfe Region Basel (Drug
Addiction Assistance Programme for the Basel Region).
The Switzerland-Uzbekistan Drug Conference which Contact Net organised in
Tashkent in July 2003, and the Harm Reduction Conference of Central Asia which
took place in October of the following year, have been important milestones in
efforts to develop meaningful co-operation. Thanks to a more interactive concept
and setting, participants at both conferences were able to engage in active
dialogue. Both conferences included a presentation of theoretical and practical
knowledge from Switzerland, as well as comparisons between our project in
Uzbekistan and the experiences of other harm reduction projects in Kyrgyzstan and
Tajikistan. The learning process and the dynamics thus created have proven
particularly useful in creating awareness and building capacity in Uzbekistan and
Central Asia. The results of the discussion on comprehensive access to drug
addicts, and the transfer of knowledge which took place between harm-reduction
organisations at the October conference are particularly encouraging. The whole
process has led to new approaches that hold out great promise for the future.
Particularly worth mentioning in this context is the Harm Reduction Network of
Central Asia, which was created as a result of this conference.
One result of our efforts in Uzbekistan has been an increase in the commitment to
harm reduction in Central Asia and in the corresponding know-how, as well as an
increase in the readiness for dialogue among the various players. It is already clear
that there has been a fundamental shift in attitudes with regard to drug-dependent
individuals and related problems in the past three years. In particular, the focus has
shifted from seeing drug addiction as a criminal activity to seeing it as an illness.
There is a growing awareness that although it will never be possible totally to
eradicate the drug problem as a social phenomenon, there is nonetheless a need
for radical action. As in the story of the iceberg and the Titanic, it is important to
become aware of, and be on guard against, the major problems associated with
HIV/AIDS that are presented by the high risk group of injecting heroin users in
Central Asia. The most important task is to provide information about HIV and
Hepatitis C, as well as clean syringes and condoms, to the 95 per cent of injecting
drug users who are not being reached by current assistance programmes. The
drug projects in Tashkent and Samarkand enable us to provide a clear example of
how concrete results can be obtained through a “snowball” system which involves
volunteers and the drug addicts themselves. A major challenge in this context is the
need for a new kind of collaboration between professional harm reduction groups,
the police, and law enforcement bodies in general.
1 Conducted in March 2001 by Jakob Huber
3

1. Abstract
BACKGROUND The number of injecting heroin addicts has risen sharply in
Uzbekistan in the past few years in all sections of society. This has gone hand in
hand with the spread of HIV/AIDS and Hepatitis C. Since Uzbek drug policy and
efforts to combat drug abuse are to a great extent inadequate and overstretched
there is little likelihood of dealing with the massive problem of heroin addiction
without international support. A model project focusing on harm reduction and on
helping drug addicts to survive, was developed with support from the Swiss
government, inspired by the four-pillar model on which Switzerland’s own drug
policy is based. The dissemination of information about HIV/AIDS and Hepatitis C,
and the provision of clean syringes and condoms and related counselling services,
should help to reduce the frequency of HIV and Hepatitis C infections in
Uzbekistan.
METHODS Co-operation with NGOs in Tashkent and Samarkand, creating Contact
Centres, confidence-building with drug addicts, the “snowball” system, supplying
syringes with the help of volunteers, involving the community and drug addicts
themselves, strategic integration through the co-operation between Uzbekistan and
Switzerland, and between the Tashkent Steering Committee, the Swiss Embassy
and higher-level Uzbek officials in the Public Health, Justice and Police
Departments.
INDICATORS OF SUCCESS The number of syringes distributed and returned, the
number of condoms distributed, the take-up of services offered by the Samarkand
and Tashkent Contact Centres, adoption of the model project as part of the normal
services provided by the healthcare systems in Uzbekistan and Central Asia, a
Central Asian drug policy focused on harm reduction, and a drug strategy based on
the Swiss four-pillar model.
RESULTS Greater understanding of and support for harm reduction among
government representatives, distribution of 300,000 syringes in six months, 1,200-
1,500 heroin addicts supplied with syringes, condoms and information. Access to
drug addicts’ is far greater via Contact Centres than via government-run Trust
Points.
CONCLUSIONS The difficulty of implementing a harm reduction approach within
the context of Uzbek drug policy, a trailblazing project that makes sense, lasting
prospects, endangered by financial problems, the limitations of an institutionalised
harm reduction strategy, the need for changes in attitudes , confidence, long-term
prospects and financing, and also for cultural change.
4

2. Introduction
Uzbekistan, one of the five Central Asian republics, has a surface area of 172,700
square miles (447,000km 2 ) and a population of around 24 million, of whom 2.5m
live in the capital Tashkent. Nearly half the population is below the age of 16.
Despite the massive socio-economic crisis that resulted from the collapse of the
Soviet Union, Uzbekistan managed to stave off its own collapse. In general, the
rapid pace of social change and the deterioration in the living conditions of most
people created a situation in which, among other things, the heroin problem soon
became rampant. This had negative secondary effects such as HIV, the disruption
of families and communities, drug smuggling and dealing, and the spread of crime.
Uzbekistan, which borders Afghanistan, is one of Central Asia’s transit points for
trafficking in heroin. The quantities of heroin and raw opium seized each year are
constantly increasing and Uzbekistan is in ever greater danger of itself becoming a
drug producer. The use and consumption of opium for medicinal purposes is still
deeply rooted in local culture, and people still have the knowledge and experience
necessary to produce opium. The use of injecting heroin, on the other hand, is an
entirely new phenomenon.
The number of injecting heroin addicts has increased remarkably in Uzbekistan in
the past 2–3 years, and the trend is still upwards. In the summer of 2003, the
number of registered heroin consumers was 19,000, of whom 13,000 were injecting
heroin users. Experts put the actual number at 10 to 15 times higher. While the
injection of heroin has become the “in“ thing at all levels of society and in all
regions including rural areas, it is especially widespread among upper class youth.
This has led to a dramatic rise in the number of HIV/AIDS cases and presumably
also in the number of Hepatitis C cases.
According to the UNODC (United Nations Office on Drugs and Crime), there are
three main reasons for the sharp rise in the consumption of heroin by injection.
Firstly, the cost of heroin is very low. The price of a dose varies between 2000 –
5000 som, about SFr2.50 (US$2.15) and CHF 7.50 (US$6.50). Secondly, the
“heroin mafia“ sometimes finances the smuggling of heroin through Uzbekistan
through payments in kind, ie, in heroin. And last but not least, much of the
population is unaware of the risks involved in injecting heroin and heroin is easy to
obtain. The transmission of HIV through unclean syringes and unprotected sexual
activity is already at a dramatically high level and is certain to worsen in the near
future.
As yet, Uzbekistan has no national drug policy and there are no coordinated efforts
to combat drug abuse. The present healthcare system does not have the
equipment, the knowledge or the expertise needed to cope with the new situation.
The treatment of injecting heroin users is currently in the hands of physicians and
psychiatrists. There are virtually no social workers working in this area. The
Ministry of Health relies on the old structures that are intended for people who wish
to seek help. This does not work, however, in the field of drug addiction, due to the
great fear and mistrust of government services that exists among injecting heroin
users. The situation is not helped by the close and rather unclear collaboration that
exists between the security forces and health officials.
The Uzbek Ministry of Health recognises that the heroin problem is increasingly
serious and demands its immediate attention. The Ministry’s readiness to consider
almost any strategy for dealing with the drug problem, be it prevention or harm
reduction, and a certain general bewilderment have resulted in a national drug
5
Social change
Heroin problem
Heroin
smuggling
Traditional
consumption vs.
injecting
Rise in number
of injecting
heroin users
Negative
secondary
effects
Reasons for
heroin
consumption
Lack of or
ineffectiveness
of drug policy
and related
activities
Open to new
drug strategies

policy that is undifferentiated and incoherent. There are in reality no practical or
effective measures to combat drug abuse. Apart from its lack of expertise,
Uzbekistan suffers above all from a lack of the necessary resources.
There is an urgent need to develop solutions that will reach a wide circle of
injecting heroin users and ensure their survival. In particular, this means
demonstrating that it is possible to establish community-oriented HIV prevention
and to provide the necessary treatment. A clear and practical example is urgently
needed that will show how to achieve effective harm reduction for injecting heroin
users using minimal resources. Part of the strategy must be a change of attitudes
with regard to injecting heroin users which offers integration rather than exclusion,
and cure instead of criminalisation. Health-related and social risks for addicts must
be reduced, and the resources of families and neighbourhoods mobilised.
Past efforts to provide “low-threshold“ facilities in Uzbekistan have produced the
anonymous approach of the Trust Points. B etween 2001 and 2003, the UN
Development Programme (UNDP), working with the Ministry of Health, created
three pilot Trust Points (health centres) 2 . To date, the government has
redesignated a total of 206 health centres as Trust Points and given them official
recognition. Trust Points should be located where the drug addicts are, should
provide anonymous procedures for exchanging syringes, and should offer
condoms, information about the risks associated with injecting heroin, and
opportunities for treatment. The Trust Point approach is good, but the threshold
remains too high for heroin addicts. People’s fear of becoming known in the
neighbourhood and to the police is too great. The Trust Points that the authors
visited also have inflexible structures based on the expectation that people will
seek assistance for themselves. They cannot truly be described as low-threshold.
They are also unsuitable as contact points due to their organisation and their size.
The number of syringes exchanged at Trust Points is thus very small.
In view of all this, an effort was made to collaborate with two carefully chosen
NGOs in the regions of Tashkent and Samarkand. These NGOs are well
recognised in the community, have effective networking systems, and are both
implementing a model project under the name “Contact Centre“. Each centre is
located at a strategic point. Thanks to the fact that they offer exchanges of
syringes and provide information and counselling as well as basic medical care,
the centres have become popular meeting places for drug addicts. They also
serve as ”base camps” for groups of volunteers. It is here that outreach work, the
real focus of the model projects in Tashkent and Samarkand, is planned and
carried out. In order to reach as many injecting heroin users as possible,
volunteers, parents and associates work together in a “snowball” system for
exchanging syringes, supplying condoms and disseminating information material.
The advantages of working with NGOs are obvious: they are recognised as
independent by both the general public and the drug addicts. Furthermore
collaboration with local NGOs makes a not insignificant contribution to the
democratisation of the country. State institutions are also brought into the picture
at the strategic level and co-operation takes place mainly at the level of the
Steering Committee. It will only be possible to achieve sustainable results through
strong networking with the Ministries of Justice and Health.
2 Subsequently Japan took over the financing and management of the Trust Points
6
Urgent need to
reach heroin
users
Low-threshold
facilities not
realised with
Trust Points
Advantages of
local NGOs
Importance of
strong
networking

3. Switzerland-Uzbekistan Harm Reduction Project
3.1 Background: Switzerland’s drug policy
Switzerland cannot claim, any more than any other country, to have “solved” or
“eliminated” the drug problem, and is therefore in no position to lecture others.
However, since we are convinced that an exchange of experiences can help all
concerned to make progress in this onerous struggle we would like to take this
opportunity to explain our drug policy to a wider audience.
Despite being a prosperous nation with a reputation for health and order
Switzerland has been shaken to the core by the misery and desperation of those of
its citizens who have become drug dependent. The problem grew out of all
proportion with the spread of the deadly HIV virus, making it necessary for a
fundamental rethink of the situation as a whole. One of the major factors that had to
be considered was the extent of organised, drug-related crime. The political
authorities of our cities and those involved at the grass-roots level were the first to
realise that a new policy reflecting the reality of the drug problem was urgently
needed. They developed an “outreach” strategy, i.e. reaching out to the most
seriously addicted individuals.
Since 1991 the Swiss federal government has provided support for this realignment
of policy by adopting a strategy based on the “four-pillar model”: prevention,
therapy and rehabilitation, harm reduction, and law enforcement.
Figure 1 Swiss drug policy is based on a four-pillar model
Prevention
Treatment
and
therapy
Harm
reduction
Law
enforcement
Prevention: prevention must be an everyday activity. Intervention therefore has to
be directed at the “settings” in which people live, i.e. the family, school, workplace,
community or neighbourhood. The primary aim of prevention is to avoid damage to
health, rather than focusing solely on drug abuse.
Therapy and rehabilitation: a wide range of options are available, including both
hospital and outpatient treatment. About half the opiate addicts in Switzerland are
receiving methadone treatment. Heroin-assisted therapy has been recognised
since 1999.
Harm reduction: this means providing medical help in an effort to prevent the
spread of Aids and Hepatitis, including substitution therapy and centres in which
drugs can be injected under hygienic conditions. It also means helping subjects to
7
Drug policy in
Switzerland
A policy
reflecting the
drug problem
The four-pillar
model:
Prevention
Treatment and
therapy
Harm reduction

find employment and accommodation, and helping to structure their daily routine
and their leisure activities.
Maintaining and promoting health
The fundamental objective in working with addicts is to reintegrate them into
society. This means maintaining and improving their physical heath as well as their
social situation, helping with employment, training and housing needs.
The direct action of the substances drug users take is often a serious threat to their
health. They are, for instance, exposed to the risk of overdose and to the side
effects of the many substances used to “cut” or dilute the drugs. Many are also at
risk from the conditions in which they live including inadequate food, poor hygiene,
homelessness and a high risk of HIV infection.
Low-threshold assistance
The pioneering institutions in this field offered drug addicts shelters, and continue
to do so. These shelters provide a refuge from the stress of the streets. The focal
point is often a cafeteria. Many centres also offer laundry and shower facilities, as
well as a sympathetic ear.
The Swiss Federal Office of Public Health (SFOPH) provided support for a large
number of harm reduction projects in the framework of the first national drugs
programme. These included the following measures:
- distribution of syringes to addicts at large
- distribution of syringes in prisons
- drug injecting facilities
- employment and housing projects
- projects for drug-dependent women engaged in prostitution
- an advisory centre for children with drug-dependent parents
Since 1991 harm reduction services have also been provided by the cantons, local
authorities and private organisations.
Medical services
Fortunately the incidence of HIV infection among drug users has declined in recent
years. This is partly due to a widespread campaign of awareness resulting in a
significant decline in needle sharing. There has also been a vast improvement in
the distribution of syringes and the means of obtaining them in recent years in
Switzerland.
Social care
In 1995 the SFOPH created a central agency for facilities and services designed to
foster social stabilisation. This agency provides support for low-threshold social
facilities, particularly employment and housing schemes, as well as for day centres.
Acceptance and the legal situation
Addicts often resort to criminal behaviour such as illegal drug dealing to finance
their habit. This worsens their social situation and increases the burden on society.
Though harm reduction measures are well accepted by the general public they
regularly meet with initial criticism in the immediate neighbourhood. This can put
harm reduction projects at risk, or at least delay their implementation. It is therefore
important to provide the public directly affected with the necessary information. The
legal situation of each project also needs to be checked. Before injecting rooms
were set up for example, expert legal opinion was sought to ensure that this would
not violate Swiss law.
Law enforcement: the primary objectives of drug-related law enforcement are to
restrict the drug supply, combat illegal dealing and the associated illegal financial
transactions, and eliminate organised crime from the circle.
8
Reintegration in
society
Low-threshold
facilities are
important
Support from
SFPOH
Decline in
incidence of HIV
Agency for social
stabilisation
Harm Reduction:
Acceptance and
legal situation
Law enforcement
against organized
crime

These four key elements are viewed as an integral part of a strategy approved by
the Swiss government and parliament, and also supported by the population in
several referenda. Switzerland is aware that the need for law enforcement must be
reconciled with the need to help drug addicts. Our aim is to continue developing
and adapting Swiss drug policy to changing circumstances, learning from the
experience of those on the front line.
Excerpt from: Swiss Federal Office of Public Health (SFOPH) (2000). Swiss Drug
policy. SFHOPH, Bern.
9
Overcoming
contradictions
between law
enforcement
and harm
reduction
Source

3.2 Key project data
Harm Reduction Drug Project CONTACT CENTRE
Donor Swiss Federal Office of Public Health (SFOPH), Bern, Switzerland
Project partner Ministry of Health, Tashkent, Uzbekistan
Implementing agencies
Contact Net Bern; Switzerland and local NGOs (SABOR in Tashkent and Ayol
in Samarkand)
Project duration September 2002 – December 2005
Beneficiaries
Overall project goal
Injecting drug users (IDUs); drug prevention and harm reduction service
providers
Harm reduction: helping IDUs to survive, mobilising the community in their immediate social environment,
stimulating dialogue on drug prevention and harm reduction policies
Capacity building: improving know-how in the areas of therapy, substitution and rehabilitation of IDUs for
the benefit of the institutions involved
Objective of current phase
HIV prevention: providing easy access to clean syringes and condoms, informing IDUs about the risk of
infectious diseases.
Outreach work: social work reaching out to the environment of the IDUs and working with groups at risk.
Access to medical treatment: providing medical counselling and treatment as well as access to
specialised treatment.
Capacity building: know-how transfer to relevant Institutions (GOs and NGOs) on therapy and
rehabilitation (including exit strategies for addicts, and social integration), substitution (methadone or
buprenorphine).
Policy and coordination: creating opportunities for dialogue between GOs and NGOs on governmental
and social policies and strategies in the field, as well as raising public awareness about HIV and other drug
abuse related infections (including about prevention).
Project description CONTACT CENTRE
• Creation of facilities for the target group in Tashkent and Samarkand
• Establishing meeting points for IDUs where they can be supplied with syringes and condoms, as
well as social and medical counselling and information
• Introducing an “outreach” approach (“snowball” system) for the dissemination of needles, condoms,
information
• Training professionals in harm reduction and health promotion through seminars, on-the-job
training, coaching and methods of multiplication (training of trainers).
• Improving the coordination in the field of professionals and policymakers through regular meetings,
working groups and seminars.
Project organisation
The project organisation is based on a Steering Committee (SC) that includes members of the Swiss
Embassy in Tashkent [1], the Swiss Agency for Development and Co-operation (SDC) [1], the Uzbek
Ministry of Health [1], the Uzbek Ministry of the Interior [1], the Uzbek National Centre for Drug Control [1]. The
project is implemented by the Contact Net Bern (NGO) with an international project manager based in
Tashkent)
Revised October 2004
10

3.3 Project objectives
3.3.1 Harm reduction, and ensuring the survival of injecting heroin users
and their circle
• Ensuring the survival of injecting heroin users
• HIV prevention, low-threshold, comprehensive access to clean syringes and
condoms at key points
• Proactive visits by social workers, community work, work with at-risk
groups, volunteers and their associates
• Providing information with a view to creating motivation to give up drugs
• Achieving mental, physical and social stability
• Involving and mobilising the community/environment in which the drug
addicts live
• Drug policy and the general public
• Nationwide involvement and training of mediators capable of setting up
more projects or increasing the existing ones in their localities
• Ensuring that efforts to ensure the survival of addicts, together with harm
reduction strategies, become an established part of social policy,
particularly for the Ministry of Health (MoH) and other organisations
involved in health and social work in Uzbekistan
• Creating awareness among the general public and the authorities about HIV
prevention policy in relation to drug abuse.
These project objectives have received national and international attention and
recognition in other Central Asian states.
3.3.2 Improving know-how with regard to cessation of drug use,
substitution and the rehabilitation of heroin addicts, with the help
of government institutions
• Transferring knowledge about cessation of drug use and rehabilitation to all
relevant service providers
• Transferring knowledge about substitution with methadone and
buprenorphine to all relevant service providers
• Ensuring that the harm reduction strategy becomes an established part of
social policy, particularly in the work of the MoH and of organisations
involved in the areas of health and social work in Uzbekistan
These project objectives have received national and international attention and
recognition in other Central Asian states.
3.4 Other project aims
• The project aims to create awareness of Swiss drug policy in Uzbekistan
and the other states of Central Asia, based on the four-pillar model.
• The harm reduction approach, which involves outreach social workers, and
work with volunteers and associates, has brought a new dimension to
efforts to combat drug abuse in Uzbekistan, which up till now have been
strongly institutionalised and based almost exclusively on primary
prevention and therapy.
• The aim of transferring knowledge is to ensure that the Uzbeks have access
to the most up-to-date knowledge in this field.
• The degree of success will depend on how far it is possible to create
awareness and establish the project among the relevant groups in
Uzbekistan. Our aim is to have as wide an impact as possible through the
model project and by working through the existing institutions.
11
Ensuring
survival /
Low-threshold
access
Taking the
wider
environment
into account
A coherent drug
policy
Creating public
awareness
The wider
Central Asian
context
Transferring
knowledge
about cessation,
substitution and
rehabilitation
Creating
awareness of
the four-part
model
Harm reduction
through
outreach work
A model project
with a broad
impact

3.5 Project costs
The project’s budget covers three years and is based on annual costs of
US$ 55,000. This does not however include the cost of syringes and condoms,
travel to Switzerland by the Uzbek delegation, or the international project
leadership. It was initially assumed that the Uzbek Ministry of Health would
contribute to the project by paying for syringes and condoms. Unfortunately this
has not been the case up to now.
3.6 Switzerland-Uzbekistan project agreement
The formal project agreement between Switzerland and Uzbekistan was signed by
the foreign ministers of both countries. It covers the objectives listed above and
depends on good, ie, close, co-operation between the ministries, the project
leaders and Swiss representatives in Uzbekistan. This agreement is the strategic
and technical basis of the Harm Reduction Drug Project.
12
Project budget
Strategic and
technical basis
of the project

4. Project organisational chart
Steering Group Switzerland
Chair: Stephanie Zobrist - SFOPH
Martin Büechi - SFOPH
Derek Müller - DFA
Jakob Huber - Contact Netz (adviser)
1 Representative - DFA PA I
Local Project Leader
Steffi Wirth (to April 2004)
Victoria Ashirova, Samarkand (from May 2004)
Contact Center Samarkand
Project Leader
Victoria Ashirova
• Volunteers/Associates
Steering Committee Tashkent
Wilhelm Meier - Swiss Ambassador (to May 2004)
Peter Burkhard - Swiss Ambassador (from Summer 2004)
Urs Herren- SCOOF, Bishkek
2 Representatives of the Ministry of Health/Interior, Tashkent
Jakob Huber - Contact Netz
Steffi Wirth - PL und Secretariat to April 2004
Victoria Ashirova – PL from May 2004
Contact Net Bern – Implementing agency
Project-Leader: Jakob Huber
(1 Doctor)
(1 Social worker)
Secretariat: Barbara Gafner
Contact Center Tashkent
Project Leader
Victoria Ashirova
• Volunteers/Associates
13

As can be seen from the organisational chart, our model project is solidly grounded
at the strategic and operational levels. It is essential to its success that this new
project should be well integrated into and supported by the relevant institutions and
this is ensured by the Steering Committee in Switzerland, through the
representatives of the SFOPH, the SDC and the DFA (PA I). The Steering
Committee is particularly important at the strategic level in Uzbekistan. The
combination of representatives of the Swiss Embassy and the SDC, and, on the
Uzbek side, representatives of the Ministries of Health, Justice and the Police has
proven its worth as a sustainable and integrative model, and the basis for a solid
exchange and learning process.
The presence of experts on the Steering Committee is essential. The successes
and failures of the project, its opportunities and its limitations become clear through
the regular discussions that take place both in the Committee and in the ministries
about the objectives and values involved in combating drug abuse and in a policy
on drugs. The organisational chart (above) reflects the project’s breadth and
integrative power.
14
Integration
Swiss/Uzbek in
Steering
Committee
Organisational
chart reflects
the project’s
power

5. The project launch: defining objectives and staffing
requirements
5.1 Project content and staffing
The representatives of the Ministry of Health in Tashkent indicated in all the
discussions that they agreed that the focus of the project should be on harm
reduction in relation to the threat of HIV. However, when the final project
description was submitted, it became clear that the Uzbeks did not plan to provide
funding for their drug clinic. This led to some very difficult discussions. These
showed that, as far as the Uzbeks were concerned, the essential question was the
financing of the planned drug clinic in Tashkent. They considered the project’s
harm reduction approach technically difficult and of secondary importance. Despite
efforts during the initial project definition process to differentiate this project from
the drug clinic, it was never easy to orient the project clearly towards harm
reduction and the transfer of knowledge in the fields of rehabilitation and
substitution.
One reason for this conflict over objectives is the fact that the Uzbek MoH did not
assign the project to its Division for Harm Reduction and HIV-AIDS, but rather to its
Division for Rehabilitation and Therapy. The Uzbek Ministry of Health’s
expectations of the project differed completely from the objectives proposed by the
Swiss. Furthermore our insistence that the project be implemented by an NGO, and
preferably a locally-based one, proved difficult for the MoH to accept. This
insistence was based on an assessment made by one of the authors of this report,
Jakob Huber, and was supported by international experts in Uzbekistan. According
to this assessment, the Ministry of Health did not meet the prerequisites that would
enable the basic approach of the project to be implemented. As a result of these
differences in perspective the project launch was sticky. Only when the Swiss
Federal Office of Public Health (SFOPH) made it absolutely clear in writing that
there could be no alternative to the objectives or to the NGO-led approach of the
project proposed by the Swiss side did the Ministry of Health finally accept the
harm reduction approach of the project.
5.2 Call for international project leadership
The project launch was marked by unforeseen events. Thus, for example, at an
international conference on health the Uzbek Minister of Health, Mr. Nasirov,
expressed the very strong wish to SFOPH Director Thomas Zeltner that an
international personality should be appointed to head the project. It had been
decided in Bern that the implementation of the project would only be headed by a
Swiss project leader in the first year, and that the objective of putting local
management into local hands should be achieved as quickly as possible. The
position of local project leader was filled as soon as the additional financing
required had been arranged with the SFOPH. However due to the personal
circumstances of the first two Project Managers selected, the position could only
finally be filled at the third attempt.
15
Difficulties in
agreeing
objectives
Differences
between Uzbek
expectations
and Swiss
objectives
The wish for
international
project
leadership

6. Project implementation
6.1 Phase One - October 2002 – July 2003
Phase One consisted mainly of familiarisation with the political situation,
networking at professional and political levels, and selecting suitable local partner
organisations.
It very soon became clear that the ideas put forward by the representative of the
Uzbek Ministry of Health were very different from the objectives that had been
formally set out in the project agreement. Above all, the MoH representative
expected all the doctors working in the project to be managed directly by and
report to the Ministry. This difference of opinion resulted in long and often difficult
discussions not only about content (“What is harm reduction?”) but also about
structure and strategy. During this phase it was important to build a relationship of
trust, but also to agree jointly on the role of the Ministry of Health. Whereas on the
Swiss side priority was given to the political dimension (gaining acceptance of the
idea of harm reduction and the four-pillar model) and to coordinating the various
players, the Uzbek MoH focused its attention very strongly on the control aspects.
Discussions constantly returned to these points and led to repeated debates and
clarifications of position.
6.1.1 Successful search for partner organisations
At the same time, the Project Leader began to look for suitable partner
organisations. The prerequisite was an organisation’s readiness to carry out
development work in collaboration with Swiss project leadership, so that the
project could be adapted to local circumstances and customs.
From the point of view of the Contact Net, it was clear from the beginning that only
a process-oriented approach could ensure successful implementation. The Swiss
experience in this area would provide guidelines and inputs. But the question --
“What should a harm reduction project for Uzbekistan look like?“ -- could only be
answered through a joint development effort and would involve a considerable
learning process for all concerned.
This manner of proceeding caused considerable uncertainty for many NGOs. They
are used to being presented with clear requirements by donors, not only at the
strategic level but also at the operational level. Moreover the whole harm reduction
approach met with resistance from some organisations. They stressed the primary
importance of prevention and had doubts about the feasibility of a harm reduction
project, partly because of the current political situation and partly due to what they
perceive as the Uzbek mentality.
The definitive choice of partner organisations therefore took place only after a twoday
seminar in which the project objectives and Switzerland’s experience were
presented and a first view of how implementation could proceed in their own
environment was prepared with the help of the participants. This created a basis
for decision-making on both sides which has certainly proven its worth.
Subsequently two NGOs, SABO in Tashkent and Ayol in Samarkand, were chosen
as partner organisations. The work began in March 2003 under the leadership of
Contact Net.
In this first phase, various international organisations already in Uzbekistan
(UNODC, WHO, UNDP, USAID, etc.) which were working mainly to prevent or
combat illegal trafficking in drugs, were contacted so as to make the best of any
possible synergies.
16
Networking
Role of the
Ministry of
Health
Process
orientation,
approach based
on participation
Need for
partnership
NGO
uncertainty
NGOs in
Tashkent und
Samarkand

6.1.2 Creating Contact Centres in Tashkent and Samarkand: objectives
The priorities for project development were agreed in collaboration with the two
partner organisations.
Creating and developing a “snowball” system
In view of the size of the budget, and also with an eye to future development, the
establishment of a “snowball” system seemed the only way to reach the maximum
number of drug users as fast as possible. The Tashkent example shows how the
“snowball” system was created by project staff and volunteers working together.
Tashkent, with 2.5 million inhabitants, covers a wide area. Four team members
divided it up between them into the areas in which they had access to the target
group. Enough volunteers were sought in the initial phase to put each team
member in charge of 10-20 people. The basic rule is that both team members and
volunteers already have direct contact with the target group - injecting heroin users
- and that none of them show any fear of contact. The volunteers are therefore
recruited from ex-drug users or people still using drugs, as well as from parents
and other relations. These volunteers in turn seek other people who are prepared
to exchange syringes and make the target group aware of the various services
offered by the Contact Centre. At present there are between 100 -140 volunteers
working in Tashkent, supplying syringes to between 800 - 1,000 users.
Regular meetings of volunteers, and additional training in handling the questions
that arise, for example about HIV prevention, how to deal with overdoses, or legal
issues, are all part of the system (see Capacity building below).
Figure 2 “Snowball” system for the exchange of syringes
Staff
I level
volunteer
II level
volunteer
ID Users ID Users
ID Users
17
Formulating
priorities
The “snowball“
system: the most
efficient
distribution
method
The “snowball“
system
in Tashkent
Organising
volunteers

Advantages and limitations of the “snowball” system
What makes the “snowball” system attractive is that, even with a small budget and
a small workforce, it is possible to reach a large number of drug users and to create
a decentralised distribution structure. The “snowball” system also allows rapid
access to information at grass roots level about the needs of drug users, the quality
or price of drugs, and police interventions. Thus, with the help of the volunteers, a
network grows up in which important information can be conveyed rapidly to a wide
audience.
The challenges include the reliability of volunteers and the need to make sure that
syringes are supplied to the target group and are not sold elsewhere. There is a
real risk of this, since many hospitals, for example, also badly need syringes.
Another risky area is the use of ex-drug users as volunteers. Experience shows
that collaborating in such a project can strengthen the resolve of many ex-users,
whose motto becomes “Look at me, I have kicked the habit!”. For some, however,
daily contact with the drug scene brings with it the danger of relapse.
Outreach work
The objectives of the project and the support services offered must be made known
to the target group and should be perceived by them as trustworthy and reliable.
This makes it possible to discover the real needs of drug users.
Creating a network
It is important to create a network that includes doctors and representatives of the
police as well as of other relevant organisations.
Protecting team members
Everyone involved in the project must be guaranteed protection from police
intervention.
Search for locations
Suitable locations must be found for the Contact Centres.
6.1.3 Capacity building
Support was provided for capacity building at various levels to ensure the transfer
of knowledge between those involved in the project, and institutions and
government representatives. This ensured the spread of information about therapy,
substitution and rehabilitation.
Team level
Both teams, in Tashkent and Samarkand, have four members (working 50%), a
local project leader, and volunteers. In the period between March and August 2003,
a number of training sessions for project workers and volunteers were held -- in
some cases lasting several days -- on the following subjects:
• The four-pillar model with particular focus on harm reduction
• Outreach work
• Safe injection
• Communication skills
• Overdoses.
18
Advantages and
disadvantages
Shortage of
syringes
Outreach work
Inter-professional
network
Protection from
police intervention
Training with
professionals
Team training

These sessions were given in collaboration with local specialists. A key aspect of
project leadership in this context– apart from communicating specific knowledge –
is the need to move towards a pr-active working style 3 . Access to the target group
is made more complicated by the fact that drug addiction is very much a taboo, so
that drug use takes place almost exclusively in the private sphere. This means that
outreach workers must be able to gain access to these private circles.
Law enforcement
Training sessions for the people in charge of law enforcement in the districts (15-20
people in Tashkent and Samarkand) were conducted in parallel. These were
included in the harm reduction strategies as part of the project. The objective was
to make participants aware of opportunities for collaboration. The reaction of the
law enforcement representatives was very positive, partly because they are
confronted with drug abuse situations every day and the resulting demands on their
time are great. The fact that the international co-trainer was also once a police
officer proved very helpful. Subsequent co-operation with the police force was
good. In most cases it was possible to solve problems arising from the exchange of
syringes with the help of the police contact person for the project.
Steering Committee study tour
A study tour to Switzerland took place in June 2003. This involved the Uzbek
members of the Steering Committee in Tashkent (representatives of the Ministry of
Health, the Government Commission on Drug Control and the Interior Ministry) and
the Directors of the two NGOs. The tour provided an opportunity to familiarise the
participants with Swiss drug policies (visit to the SFOPH) and with the full range of
support services offered by Contact Net and the Berner Gruppe für Jugend-, Eltern-
und Suchtarbeit (Drug addiction assistance for young people and parents, Bern
Region), which they visited. The participants’ assessment of the study tour was
extremely positive. This was in part because, during the tour, government and
NGO representatives were able to hold informal discussions and to discuss
controversial views and opinions freely.
First Switzerland-Uzbekistan drug conference, 2003
The project management organised a two-day drug conference in Tashkent on 10-
11 July 2003, attended by some 120 representatives of government organisations,
as well as by government officials and NGO representatives. The conference had a
considerable impact. It focused on the four-pillar model and on its implementation
and development at the political and professional levels over the past 20 years.
Swiss experts involved with various aspects of help for drug addicts, as well as a
police representative, talked about their experiences.
During workshops the participants were able to go deeper into the following topics:
• Switzerland’s innovative and pragmatic drug policy
• The Contact Net Harm Reduction Project
• Co-operation between people involved in law enforcement and in social
work
• Harm reduction
• Substitution treatment for opiate dependent individuals
• Therapy and rehabilitation.
3 A legacy of the Soviet period is that the attitude to work is often bureaucratic and limited to
carrying out orders rather than taking initiatives.
19
Effect of taboo
Collaboration
with police and
others
Trip to
Switzerland
Learning about
the Swiss drug
policy
Switzerland-
Uzbekistan drug
conference
Dialogue and
workshops

The Uzbek partner outlined developments related to the drug problem and the new
challenges arising from these. For the Uzbek participants the participation in the
conference of all the relevant groups from institutions and NGOs was a new
experience. Doctors, as well as representatives of the NGOs, the police, and the
government, commented on various aspects of the problem from their own points
of view. While the discussions did not always lead to consensus about harm
reduction and substitution therapy, most participants agreed that the debate must
continue and that new ways to overcome the problems must be found. From the
doctors’ point of view, the fact that anonymity is not guaranteed in their dealings
with drug addicts is a very serious problem. Here the reality seems to fall well short
of the project’s objective. 4
One objective of the conference was to work with the Uzbek participants to develop
ways of carrying out the work in a way that fits in with their own work environment.
This proved difficult. In a number of cases the discussions were unable to move
beyond questions about Swiss-style implementation. It proved extremely difficult to
develop ideas of how the Swiss approach could be adapted. In the unanimous
opinion of the participants there is an urgent need for discussion in this area at the
political and expert levels.
6.2 Phase Two - August 2003 – October 2004
6.2.1 Opening the Contact Centres in Tashkent and Samarkand
At this point Contact Centres were opened in Tashkent and Samarkand. These are
meeting places for addicts, and it is here that syringes are exchanged and
information provided. The Contact Centres also serve as meeting places for other
interested parties including parents and self-help groups.
The search for suitable locations ran into difficulties, particularly in the Tashkent
region. Although there are many empty apartments and houses in Tashkent, it
proved impossible to find one for the project. As soon as the landlord discovered
how we intended to use the property, it was withdrawn from the market. In the end
a house had to be bought so that the centre could be opened.
6.2.2 The project teams in Tashkent and Samarkand
Each of the four paid employees supervises between 100 and 140 volunteers who
distribute syringes. The volunteers are not paid for their services. As incentives,
however, they are offered additional training as well as items such as T-shirts and
food. The counselling provided by staff and volunteers is more or less limited to
concrete questions about heroin use – the transmission of diseases such as
HIV/Hepatitis, overdoses, etc. Psychosocial counselling is rare, partly because staff
lack the necessary basic training, and partly because there are no therapeutic
support services accessible to all. 5
A pilot project for the supply of methadone was due to start in August 2003, in
collaboration with the Soros Foundation. It has still not been launched however,
and is unlikely to start up in the near future, since the Soros Foundation was forced
to curtail its activities in Uzbekistan for political reasons.
4
See the report “Drug Policy and Practices Uzbekistan - Switzerland, Harm Reduction Drug
Conference July 2003”.
5
The few therapeutic services available are in general too expensive for those involved in
the project.
20
Challenge of
new drug
problems and
drug policy
Developing
scenarios
Need to buy a
house for the
Tashkent
Centre
Help from
volunteers
Methadone pilot
project
postponed
indefinitely

6.2.3 Facts and figures from the Contact Centres
A total of 324,878 syringes were distributed in the cities of Tashkent and
Samarkand between the months of January and July 2004.
Figure 3 Syringes distributed by and returned to the Samarkand Contact
Centre
number of syringes
25000
20000
15000
10000
5000
7101
7507
7662
5778
11099
6505
12443
0
January March May July
6955
18553
10840
24180
11332
17171
10116
Distributed
Returned
Figure 4 Syringes distributed by and returned to the Tashkent Contact Centre
the number of syringers
60000
50000
40000
30000
20000
10000
8075
8701
13689
10756
29286
27615
42610
0
January March May July
41600
32984
29426
43650
40055
56375
53287
Distributed
Returned
In total, some 1,200-1,500 heroin addicts and their circle were supplied with
syringes and/or additional information, the numbers in Tashkent being twice as
high as in Samarkand. On the assumption that each individual requires a minimum
of two syringes a day to ensure reliable protection against infection, the total
monthly requirement is between 72,000 and 84,000 syringes (see Table below).
21
Over 300,000
syringes
distributed in 6
months
Syringe
exchange in
Samarkand
Syringe
exchange in
Tashkent
Comparatively
high rate of
access to
addicts

Table: Minimum number of syringes needed for intravenous drug users
(IDUs)
Minimum number of syringes
In Tashkent 800-1,000 IDUs In Samarkand 400-500 IDUs
Each requires a minimum of two syringes per
day
The minimum number of syringes required for
distribution is 48,000 – 54,000 per month
Each requires a minimum of two syringes
per day
The minimum number of syringes
required for distribution is
24,000 – 30,000 per month
Of the 1,200 -1,500 heroin addicts, three-quarters are men ands one quarter are
women.
Figure 5 Gender ratio of intravenous drug users
22%
78%
man
woman
The above statistics show that the project has successfully overcome its first major
hurdle, reaching the target group in the field. The “snowball” system clearly works.
Involving NGOs rather than Ministry of Health institutions has proved to be the right
approach. In just three months, the Contact Centres in Tashkent and Samarkand
managed to reach 10 times as many drug addicts as the Trust Points set up
several years ago by the Ministry of Health.
22
At least 72,000
syringes per
month required
Supplying
1,200 – 1,500
heroin addicts
Gender ratios
Successful
overcome of
Contact Centers
Tashkent and
Samarkand

6.3 Co-operation with Uzbek partners
6.3.1 Co-operation with government officials
Co-operation with the Ministry of the Interior and with the Government Commission
on Drug Control has been very good. When concrete problems arose it was
possible to gain rapid direct access to the official concerned without red tape.
During this phase the police made no serious efforts to interfere with staff or
volunteers. Following the bomb attack at the end of March 2004, and the tense
situation it created, the police recommended that the Centre be closed for a few
days for security reasons.
Co-operation with the Ministry of Health proved more difficult. After about a year of
practical development work and confidence-building measures we were left
speechless on learning at a meeting that there had been a change of staff at the
Ministry. The new person responsible was not happy with the harm reduction
approach and our discussions moved right back to basic questions about the
meaning and purpose of harm reduction. This break in the continuity of contact
persons, and the MoH’s insistence that our clients should be registered, made cooperation
more difficult. It became important at this stage to constantly renegotiate
with our partners who should have what role and responsibilities.
6.3.2 Co-operation , trust and key network partners
While co-operation remains the guiding principle for all Swiss members of the
Steering Committee, it has become increasingly clear that the interests and views
of Uzbeks and Swiss differ considerably in relation to the measures required for
dealing with injecting drug addicts. In this context, however, the study tour which
brought the Uzbek members of the Steering Committee to Switzerland, and the
drug conference held in the summer of 2003, marked a turning point. The central
service providers in the Uzbek government began to understand the importance of
the harm reduction strategy. Every staff change on the Uzbek side make it much
more difficult to stay on course. The project and its orientation is so
incomprehensibly new and different for some of the Uzbek authorities that every
change in personnel means that training in drug policy and knowledge goes to
waste, and the trust that has slowly built up through co-operation is lost. It is
precisely when working in such a sensitive area and at a distance that we see how
vulnerable networks can be.
6.3.3 Switzerland has something to offer and should continue
Clear specialist leadership from the Swiss side is essential in this context.
Specialist leadership does not mean forcing the Uzbek authorities to do things, but
deciding, based on the problems and on Switzerland’s own experience of
implementing its drug policy, how and where to employ Swiss knowledge and
funds. The project is a major challenge for Uzbekistan. It means focusing all efforts
on the problem of HIV prevention. In addition it requires a paradigm shift in
people’s understanding from “drug addicts are criminals“ to “accepting the reality
that this problem can never finally be solved but is one that society can deal with
either more or less effectively. The aim of the project is to adapt health and social
policies in such a way as to limit as far as possible the damage to those directly
affected, their environment and society as a whole. This means accepting drug
abuse as a social phenomenon and drug addiction as an illness.
23
Good
co-operation
with the Ministry
of the Interior
and the police
Lack of
continuity at the
Ministry of
Health
Vulnerability of
the network
Swiss specialist
leadership
Changing the
paradigm:
Addiction =
Illness

6.3.4 NGOs and their contribution to a process of democratisation
This project, with its organisation and basic orientation, operates in an area which
presents no small problem to the Uzbeks. From the beginning, the ideas of working
through NGOs and of outreach work were new and were radical and difficult for the
Uzbek ministries to accept. The objectives of working closely with the drug addicts
and keeping organisational costs as low as possible, require a disciplined approach
to tasks and the handling of finances which is not customary in Central Asia in any
area of work. Placing responsibility for the project in the hands of NGOs makes an
active contribution to a process of de-bureaucratisation and democratisation in
Uzbekistan today. Close and careful co-operation with ministry officials, and
between the NGOs and the ministries, is therefore even more important. Without
these so-called strategic levels - based in the Steering Committee - the project and
all those involved would soon find themselves sinking in the harsh realities of the
outside world. It is precisely this combination of field work with the target group and
management by the NGOs that has led to the success of Swiss drug policy and
efforts to combat drug abuse. It would be unthinkable today to expect government
officials to have the necessary direct contacts with drug addicts on the street and
where they live, not least because the addicts themselves do not trust government
agencies.
6.3.5 Drug policy and efforts to combat drug abuse: a difficult learning
process
We in Switzerland are also familiar with heated debates about how to deal with the
drug problem. Whatever the assessment of the situation, the drug policy and the
preferred approach, in this area it is natural to keep discussing the same basic
questions – “What should we do?“, “What direction should we take?“, “Would it not
be better to encourage abstinence?“. The Swiss four-pillar model, which has today
gained supporters among Uzbek professionals, administrators and policymakers, is
based on the conviction that only through an interdisciplinary and integrated
approach is it possible to tackle the drug problem thoroughly and effectively, and
to make it part of normal institutional practice. The greatest challenge for Central
Asia and Uzbekistan is for existing institutions (administration, healthcare system
etc.) to change direction, rethink their policies and learn new ways. This project
must and will, particularly because it is independent of institutions, set an example
in the areas of healthcare and law enforcement, showing what procedural changes
are necessary if we are to deal effectively with the burning problems of drug
addiction and HIV.
6.3.6 Risks and opportunities in relation to staff and the social context
Our experience shows that flexibility and perseverance, combined with specialist
work to increase awareness about drug policy, and to improve relationships, can
keep the project on course. As mentioned above however, every personnel change
in one of these areas of work, where so much depends on individuals, brings with it
the danger that what has been accomplished will be lost, or, at the very least, will
be seriously set back. Continuity of personnel, and long-term stability in the
carefully developed Uzbek-Swiss network are key elements in the success or
failure of this project.
As well as the drug policy, the social context in which the project has to operate in
Uzbekistan and Central Asia is another important factor in its effectiveness and in
achieving its objectives. It is clear that the overall situation has deteriorated in
recent years. Moreover, the terrorist attacks of the past few months have refocused
the attention of the Uzbeks and changed their priorities from what they were when
the project was launched.
24
Importance of
NGOs and
outreach work
Challenge to
change existing
institutions
Stability of
personnel key
elements in the
success or
failure
Worsening
socio-political
context

6.3.7 The project leader – strategic integration
During this phase of the project, which was marked by unforeseeable events which
seemed to compromise its success, leadership of the project passed to Mrs.
Victoria Ashirova. When we appointed we already knew that her position as a
member of an NGO might jeopardise her acceptance by the Ministry of Health. We
nonetheless decided to appoint Mrs. Ashirova as project leader for three reasons:
first, she had already demonstrated her commitment and responsibility during the
year she served as director of the Samarkand Contact Centre. Second, none of the
other candidates could match her competence. And finally, Mrs. Ashirova speaks
and writes English well enough for us to work together without using an interpreter.
The authors of this report, Jakob Huber and Steffi Wirth, have managed to
establish good personal and professional relations with all the project partners in
Uzbekistan. The resulting atmosphere of trust has been crucial for the successful
launch of the project. The Uzbek delegation’s trip to Switzerland, and the
opportunity they had to see the Contact Net at work, gave further impetus to the cooperation
efforts. Although it was scarcely given sufficient time, the joint Swiss
project leadership of Huber and Wirth functioned extremely well both at the
professional and the emotional level. Finally it was a piece of good luck that the
Swiss Project Leader lived and worked alongside her partner in the wider context of
Swiss development co-operation in Tashkent. An additional bonus was the high
level of commitment from, among others, Switzerland’s Ambassador Willi Meier.
The representatives of the strategic control group in Switzerland, particularly those
from the SFOPH, ensured that the project had the necessary strategic support in
Bern.
25
Transfer to
local project
leadership:
Victoria
Ashirova
Recognition
of and
confidence in
local
leadership
Good cooperation
between the
Swiss team,
the embassy,
local project
leadership,
Contact Net
Bern and the
SFOPH

7. Project development
7.1 The strengths of the project
The implementation of the project by Contact Net (CN) Bern has to a great extent
proven its worth. CN’s long years of experience in helping drug addicts made cooperation
with its Uzbek partners much easier. The good relations which Jakob
Huber established right from the start ensured that the Uzbekistan project had the
necessary expertise, credibility and reliability. The competent and indeed expert
support which the project leadership was able to count on for the duration of the
project was of great importance. The fact that efforts to combat drug abuse in
Switzerland rely mainly on NGOs, and that responsibility for this project was
handed over to an NGO, Contact Net, was an important signal to the Uzbeks that
co-operation with local NGOs is actually possible.
All this was enough to convince influential circles that Switzerland’s harm
reduction strategy promises success. There is great interest in the project and in
the idea of harm reduction at all levels. Many practising doctors have been
extraordinarily positive towards the idea. Although the representatives of the
neighbourhoods, who are daily confronted with serious drug-related problems,
showed limited interest, they did not offer any opposition.
The project’s process-oriented approach proved a major challenge to all the
partners. Normally, the various players have either a “controller” function (Ministry)
or an “executive” function (NGOs). The requirement for independent strategies
adapted to the Uzbek situation at all levels presented an unusual challenge. The
joint development of harm reduction in an Uzbek context, and the many related
discussions on its feasibility and limitations, were an important learning
experience.
The fact that two Uzbek NGOs have been able to generate know-how and
experience in harm reduction must be considered a bonus. In this context, more
intensive co-operation between the NGOs working in this field would be a good
thing. The rivalry that often arises between NGOs in Uzbekistan is understandable
in view of the shortage of resources.
At the level of institutional networking, the co-operation of the Swiss Embassy has
been a major advantage for this project.
7.2 Weaknesses of the project
The project was able to reach many addicts in a relatively short time, especially
when compared to the Trusts Points organised by the government. However, the
project’s “snowball” system in its present form has shown its limitations. The
number of heroin addicts is believed to be very large (in Samarkand, for example,
between 10,000 and 15,000) and HIV prevention will remain inadequate until
much more extensive exchanges of syringes can be achieved. But truly
comprehensive syringe exchange requires enormous financial resources, and
perhaps also new distribution strategies.
The turnover among both staff and volunteers is considerable, particularly in the
Tashkent area. The presence of ex-drug users and people still using drugs among
the volunteers brings with it the danger of instability, and, too frequently, of
relapse. The pay structure for staff working 50 per cent is another cause of high
turnover. Other institutions have offered considerably higher wages. There is a
26
Competent and
reliable
leadership from
Bern
Positive
reception of the
harm reduction
approach
Process
orientation of
the NGOs
Strong
competition
between NGOs
The limitations
of the
“snowball“
system
Seeking new
distribution
strategies
High turnover of
people

danger that the people hired by Contact Net at a time of capacity building will later
“migrate“. This is a threat to the stability and subsequent development of the
project.
There are virtually no women in our teams (none in Samarkand, one in Tashkent).
This is because many parents will not allow their daughters to work with the
project, and find outreach work especially much too dangerous. It will be important
for the future to integrate more women into the teams. This will make it much
easier to reach female addicts.
The position of the NGOs carrying out the project will become much more difficult
if international support is discontinued. When the project leadership was
transferred to a local person, the government side already showed a tendency to
limit the project’s autonomy.
The autonomous implementation of the project without the involvement of the
Swiss Agency for Development and co-operation (SDC) or other local structures
has proved expensive, and has led to a considerable waste of energy
The idea of having international management for only one year was soon shown to
be unrealistic.
We shall have to wait until the end of the project to see if it will be possible to
achieve sustainability through a commitment from the Uzbek government or other
players in this area. A commitment from the Uzbek government seems unlikely in
view of the poor state of Uzbek government finances. The Uzbek government also
shows a tendency to engage in “donor shopping“. 6 Another problem is the fact that
there is insufficient coordination of donors working in this area and that it is only
voluntary. There is also a major need to lobby other potential donors for additional
financing for the project.
6 There is no actual strategy, but whatever donors propose is simply accepted.
27
Few women
Project will be
weakened
without
international
support
Sustainability
compromised
without
additional
financing

8. Challenges to be faced for efficient prevention of HIV/AIDS and
drug addiction in Central Asia in the years ahead
8.1 Reaching a large number of addicts in Uzbekistan
There are two basic questions that must be answered before a sustainable HIV
prevention strategy with the comprehensive exchange of syringes and the
distribution of condoms can be achieved:
1. What kind of distribution system would guarantee us the widest possible
and least bureaucratic access to the target group?
2. Can such a system actually be financed?
According to WHO estimates there are around 400,000 injecting heroin addicts in
Central Asia. The number and anonymity of drug addicts and their circle is so great
that we can only guarantee comprehensive access by co-operating closely with the
drug addicts themselves. Furthermore it is our assumption that only professional
government or NGO structures can build and develop the structures required for
networking with the target group, and for distributing and monitoring syringes and
condoms.
8.1.1 Efficient distribution structures, and the affordability of HIV/AIDS
and drug prevention
A comprehensive solution to the HIV problem will only be possible once everyone
in Uzbekistan has access to cheap syringes and condoms. This would eliminate
the danger of misuse, since syringes and condoms for normal users in Central
Asia, including Uzbekistan, are still much too expensive. A syringe in Uzbekistan
currently costs between 50 and 100 som in the market (US$1 = 1000 som). On an
average income of about $30 (or 30,000 som) a month, the price is clearly too high.
The syringes which the project buys from the factory cost 26 som each. At this fair
market price it should be possible to meet the objective of providing a
comprehensive and inexpensive supply of syringes available to all Uzbeks.
A cost-effective distribution system can only be developed when it is not necessary
for everything to be done through professional or semi-professional structures. An
incentive system is needed that places the exchange of syringes for the most part
in the hands of volunteers and other involved people.
The options outlined below were discussed at the first Central Asia Harm
Reduction Conference, organised by the Contact Net in October 2004:
Option 1: Drug addicts and their circle to be widely involved in the
distribution of syringes
The syringes will be provided at cost price (eg, 25 som) either directly to the drug
addicts or to other volunteers. They will also be given the chance to buy syringes
for 10 som if they turn in a used syringe. The project thus gets 15 som back and so
can buy more syringes.
This option would require a change in the law, which currently does not allow
NGOs to engage in “business activities” that are subject to tax.
The strength of this option is the incentive system for people who distribute
syringes, since they will be paid for selling them. At the same time, funds for buying
new syringes etc will be generated. Furthermore, selling syringes also counteracts
28
Advantages
and
limitations of
HIV
prevention in
Uzbekistan
and Central
Asia
Efficient
distribution
structures,
and
affordability
Encouraging
injecting
heroin users
to exchange
syringes
Strengths
Offer
incentives

the old Soviet “everything is free” approach even among drug addicts, and this
could have a positive impact on the good will of the general public.
This option contains the possibility of sustainable development and greater
autonomy from external donors. It would legalise the current, to some extent
“illegal“, sale of syringes by volunteers. The latter would have a real income, and
the project’s professionals could concentrate on the appropriate monitoring. The
infrastructure and staff costs required for the implementation of a comprehensive
strategy would fall greatly, and the costs of materials could be halved. There is a
genuine chance of implementing this option. It could be turned into reality very fast.
The difficulty of this option is that it is very likely that a change in the law would be
needed. At present there are no plans in the Uzbek legislature to give NGOs the
necessary tax exemption.
Option 2: Enable syringes to be financed from the Global Fund and adapt the
government Trust Points to the Contact Net model
When Jakob Huber visited Uzbekistan in October 2004, it was agreed verbally with
the Uzbek Ministry of Health as well as the relevant Uzbek officials responsible for
the Global Fund, that the Trust Points should adopt our model. This strategy was
confirmed at the Steering Committee. This creates an opportunity to implement this
option. It has been planned that the Ministry of Health will organise a two-day
workshop to be conducted by Jakob Huber and Victoria Ashirova in the spring of
2005. Some 70 Trust Point representatives are expected to attend. The objective is
to adapt the 206 Trust Points so as to make them more attractive to injecting heroin
users. Moreover, a “snowball” system using affected volunteers would be
developed in line with our model.
Contact Net will present a draft of this option to the MoH. It is intended that the
Ministry should meet the costs out of the Global Fund. The lasting institutional
changes would be achieved in a period of one year by Victoria Ashirova, and by
Jakob Huber as and when necessary, through visits to the Trust Points and two
follow-up seminars after six months. If the project in Uzbekistan succeeds, we will
have achieved the second objective of our drug project: The experience from our
model project would have been adopted by the Ministry of Health and integrated
into its supply structures.
It will then become clear whether our objectives were realistic and whether the
institutional structures of the Trust Points are really adaptable. If they are not, it will
be necessary to rely exclusively on NGOs in future. However, a positive outcome
would also provide a useful example for the other countries of Central Asia.
Option 3: Making Contact Centres more attractive so as to reach a greater
number of drug addicts
This option involves making the Contact Centres so attractive, either through
offering methadone, an injection room, or a smoking room, that they would appeal
to a much wider circle of drug addicts. This would lead to a massive increase in the
number of syringes exchanged at the Centres.
There is little likelihood of being able to implement this option in Uzbekistan. One
possibility would be to launch a pilot project together with the person responsible
for the AIDS Division and the Global Fund at the Ministry of Health. After attending
a meeting, Jakob Huber felt that this might indeed be a possibility. Politically,
however, such a project would need support at the highest level.
29
Weaknesses
Need for a
change in the
law
Financing
through
Global Fund
Applying the
model to
Trust Points
Importance of
cultur and
structur
changes of
Trust Points
Improve
attractiveness
through more
low-threshold
approaches
such as
methadone
programme of
Contact
Centres, or
fixer rooms

The features that the three options have in common
All three options have the objective of reaching 60-80% of injecting heroin users as
quickly and cost-effectively as possible, either through new structures within the
government healthcare system or through NGO distribution structures. The graphs
below show the current relationships between the institutions, the supply of
materials and access to drug addicts. The broken red lines in the first two graphs
indicate the disproportionate relationship between overheads and actual
effectiveness in the field in relation to HIV/AIDS and drug abuse. The third graph
shows the ideal distribution system, in which the costs born by government and
NGO structures are kept low while an optimum number of drug addicts are
reached. This change is essential in the context of the options described above;
without it the current system remains inefficient.
100% funding of projects
HIV/AIDS/drug abuse harm reduction & prevention
Costs of syringes and condoms
State activities
Wages,
management,
administration,
evaluation,
etc.
10% - 20%
Syringes and
condoms
Funding for syringes and condoms Funding for institutions
NGO activities
Wages,
management,
administration,
evaluation,
etc.
20% - 40%
Syringes
and
condoms
NGO monitoring only
Those concerned
(incentives)
parents,
mahallas
70% - 80%
Syringes
and
condoms
Funding for organisation and materials
30
Objectives of
three options
Improve access
to injecting
heroin addicts
Disproportionat
e relationship
between
institutional
costs and cost
of syringes and
condoms

100% drug users
Dependents
HIV/AIDS/drugs HR activities
Prevention by exchange of syringes, use of condoms
State activities
1% - 5% accessibility
100%
Drug users come to
Trust Point
health centres
Accessible dependents Inaccessible dependents
Accessibility of the drug users
NGO activities
Semi-professional
outreach activities
5% - 15% accessibility
GOAL: a distribution system that can
invert the pyramid
20%-30%
Costs distribution
structure
Syringes/condoms
70% - 80%
Accessibility of IDUs
60 – 80%
NGO monitoring only
Those concerned
(addicts, parents,
mahallas)
40% - 80% accessibility
Distribution system
Distribution costs
These three options show that HIV prevention and harm reduction activities can
only be developed further in Uzbekistan and Central Asia if they are process
oriented. New experiences and knowledge, or changes in drug policy, make it
necessary continually to rework and reconsider implementation strategies. These
options are based on experience and are the result of intensive discussions. They
should not be seen “just” as assessments of trends, but as practical possibilities for
solutions to the question of harm reduction strategies in Central Asia.
31
Access to
injecting heroin
users
Objectives
- Considerably
reduced costs
to institutions
- High level of
access
- Use of funds
for condoms
and syringes

8.2 Need to develop treatment opportunities for drug addicts
It is very important that drug addicts who want to kick their habit have access to
treatment, even in Central Asia. Our activities in Samarkand and Tashkent bring
drug addicts into contact with the healthcare system through syringe exchange.
Many drug addicts want treatment. At present however, the available treatment is
very high-threshold, as well as expensive. In addition to cessation of drug use and
rehabilitation, there is the possibility of substitution, ie, transferring dependency
from heroin to methadone. If Contact Centres or Trust Points could supply
methadone they would become far more attractive. There are currently two pilot
projects in Kyrgyzstan, at Bishkek and Osh, each with 100 people involved in
methadone programmes. The methadone prescription project In Uzbekistan has
been on hold for two years.
9. First Harm Reduction conference in Central Asia
9.1 Harm Reduction Network for NGOs in Central Asia
Contact Net organised the first harm reduction conference in Tashkent on 28/29
October 2004 7 . It was attended by 70 representatives from Kyrgyzstan, Uzbekistan
and Tajikistan, including people from ministries and international organisations, as
well as local NGO leaders and field workers. The results of this conference were
encouraging, particularly with regard to future prospects and the need for changes
in the area of harm reduction outlined above. Everyone at the conference agreed
with Jakob Huber’s analysis -- that the efficiency of HIV prevention must be
massively increased through the distribution of syringes and condoms. The
different presentations -- Switzerland’s four-pillar model, our project with its the
“snowball” system, places for injecting and smoking, methadone substitution, the
heroin programme, mobile centres for syringes , etc. – were very well received by
the NGO representatives.
Another great success was the nomination at the end of the conference of six fully
committed NGO leaders. This group, two each from Uzbekistan, Kyrgyzstan and
Tajikistan, have a year in which to build up the Harm Reduction Network for NGOs
in Central Asia. They will define the mission of this Network, its objectives and
activities in line with what was discussed at the conference. If all goes well, it will be
possible to hold the Second Central Asian Harm Reduction Conference in Bishkek
in the autumn of 2005.
All this has given our activities in Uzbekistan a Central Asian dimension. The Swiss
drug policy and our model project in Uzbekistan were introduced at the conference
and were very well received. With Central Asia’s First Harm Reduction Conference
we have made history. If this results in the creation of a workable network, it will
have a positive impact throughout the region.
The network idea has been designed for NGOs. Co-operation with government
structures and providing them with information is therefore a high priority. Indeed it
was clear to everyone present that the Central Asian governments want to know
exactly what the NGOs are up to.
The conference also provided the first opportunity to exchange project experiences
and Best Practices. The informal setting enabled many fruitful discussions. Another
unique aspect of the conference was the intermingling and interaction of all
7
The report and other documentation on this first Harm Reduction conference can be accessed at
the following internet address www.contactnetz.ch.
32
Importance of
access to
treatment
First Harm
Reduction
conference in
Central Asia
Selection of 6
NGO
representatives
to build up a
harm reduction
network in
Central Asia
The Central
Asian
dimension
Exchanging
experiences on
an informal
basis

participants, from volunteers right up to high-level official government
representatives. This made the discussions much more lively.
The organised feedback from participants at the end of the conference was very
positive. Everyone left with their “batteries recharged“ and with many stimulating
new ideas and experiences to ponder on their return home. It is hoped that the
volunteer structure of the current network will provide sufficient strength and
resources to continue to develop the process that began at this meeting.
33
Unleashing
positive energy

10. Conclusions and new challenges
The Uzbekistan-Switzerland Harm Reduction Model Project has started something
big. It has proved the advantages and limitations of an efficient syringe and
condom distribution programme to prevent HIV among injecting heroin users.
However, although it offers an improvement over the government distribution
programme and the efforts of other NGOs, the project still needs to achieve much
more in terms of both quantity and quality. Its basic orientation is, as illustrated by
the options above, harm reduction through the distribution and exchange of
syringes and the supply of condoms, monitoring these activities, and corresponding
efforts to create awareness of the possibility of coming off drugs.
Above all, the pilot model demonstrates the limitations of efforts to achieve
comprehensive HIV prevention among drug addicts. Rather than multiplying the
model 100-fold, it would be better to adopt the following strategies:
• The government must ensure that good quality syringes and condoms are
available at prices that make them easily affordable to all Uzbeks who need
them.
• The pilot model must show still more clearly how awareness and
acceptance of the need for HIV prevention can be achieved with high risk
groups.
• Once this has been done, the project workers can move on, like a mobile
task force, to the next high-risk group. Drug addicts and their circle,
supported, or at least not hindered, by the government, must take over
responsibility for HIV prevention, or at least should not prevent drug addicts
with from taking
• Sweeping changes must be made in the government healthcare structures
(in Uzbekistan this means the Trust Points) so that injecting heroin users
can use them without hesitation. Outreach work by volunteers and in cooperation
with those affected is essential.
• The model should be viewed as a trailblazer for harm reduction projects in
Central Asia today. If the project is terminated due to lack of funding, the
acceptance that has been achieved and the general impact of the project
throughout Central Asia would be largely wasted.
• The first Harm Reduction Network for NGOs in Central Asia, with
representatives from Uzbekistan, Kyrgyzstan and Tajikistan, was founded at
the first Harm Reduction Conference which was organised by Contact Net
in October 2004. This Network is intended to achieve lasting networking
and the development work in relation to harm reduction strategies and
implementation in the next few years.
• There is an urgent need for treatment programmes for addicts who want, to
come off drugs. Government agencies and NGOs must make sure that
such programmes are available and affordable. They should include
substitution with methadone, as well as places for cessation of drug use
and rehabilitation.
The Contact Net model project can only hope to achieve a lasting effect in this field
if it is funded beyond the pilot project stage. The SFOPH has already indicated that
there is little likelihood of providing further funding in the present circumstances.
Possible new sources of financing must therefore be discussed. These include a
takeover of the project and its development in Central Asia that has been outlined
above by the SDC, by an international organisation, or by the local NGOs that are
already involved. Financing must be assured for the next 4-5 years.
It is high time for a definite answer to these questions. If it is not possible to finance
syringes and condoms for the project through the Global Fund, the current project
34
Advantages and
limits of HIVprevention
Future HIV
prevention
strategies
Government
responsibilities
Supplying highrisk
groups and
creating
awareness
Making
healthcare
institutions
accessible to
drug addicts
Impact
throughout
Central Asia
Harm Reduction
network for the
region
Question of
additional
financing
Need for longterm
financing

funds are likely to be used up by the end of 2005. Taking into account the delays at
the beginning of the project, it might be possible to continue financing the project
until the autumn of 2006 under a restrictive budget policy.
In our view, an evaluation of the success of the model project and its effectiveness
in achieving its objectives only makes sense if it is based on a comparison with
other projects in Central Asia. This could be carried out by the new Central Asian
Harm Reduction Network in Kyrgyzstan, Uzbekistan and Tajikistan. The necessary
funds were not included in the project budget and would have to be found
elsewhere.
35
Evaluating the
model project in
the context of
other Central
Asian projects

11. A learning experience
In conclusion we would like to sum up the most important lessons that have been
learnt from the Harm Reduction Drug Project Uzbekistan.
There is now greater acceptance in Uzbekistan and Central Asia of the need for
a coherent and sensible drug policy. The four-pillar model (prevention,
counselling and therapy, harm reduction, law enforcement) on which the Swiss
drug policy is based can serve as a model for the future formulation of a drug
policy in Uzbekistan and Central Asia.
All the parties involved with drug addiction in Uzbekistan must learn to pull
together. Co-operation has already begun between the healthcare and social
welfare authorities, as well as in the areas of policing and the law, and must be
developed further. The same can be said for the harm reduction projects in
Kyrgyzstan and Tajikistan.
All government agencies must guarantee anonymity to drug addicts who accept
help. This is a basic requirement if drug addicts’ strong mistrust of
programmes which aim to help them is to be overcome.
Swiss knowledge and experience can provide the impulse for solutions which
can then be adapted to the cultural context of Uzbekistan and Central Asia.
The knowledge and experience of those involved in the outreach programme,
including those who have worked with drug addicts and their circle in this project,
should be exploited in developing appropriate provision. However intelligent and
sophisticated the strategies developed at the strategic policy level, they are
irrelevant unless they can be implemented in the field.
Drug addicts and their circle know their own needs. They should be actively
involved in all the possible programmes and activities in this area.
Although our project compares very favourably with similar government or NGO
programmes in cost/benefit terms, an entirely new approach is needed to the
budget terms and to achieving comprehensive access to drug addicts in the
context of HIV prevention. Possible solutions have been discussed in this report.
Long-term prospects are absolutely essential for this model project. There is an
urgent need for financing to cover the next 4-5 years. If this is not possible, the
positive and innovative dynamic which the project and the Swiss presence
have brought into being in the field of harm reduction will rapidly fade away.
There is a real danger that once again, a project will become bogged down.
The ministries of the Central Asian governments are unwilling or unable to offer
funds for syringes and condoms. Our project also lacks the necessary
funding. Money from the Global Fund needs to be channelled to the more
efficient NGOs for HIV/AIDS/drug prevention, and this includes to our own
project.
36
Harm reduction:
9 key points
Increasing
acceptance of
Swiss style drug
policy
Importance of
co-operation
Guaranteeing
anonymity
A model project
Using the
knowledge and
experience of
outreach staff
Active
involvement in
interventions
New conclusion
and decisions in
HIV prevention
Clarifying the
financial
situation
International
support needed

12. Appendix
Excerpts from the World AIDS Conference in Bangkok
HIV/AIDS, which according to Nelson Mandela is one of the greatest challenges
facing the 21 st century, was the theme of the 15 th World AIDS Conference in
Bangkok. This conference focused mainly on funding the fight against AIDS.
According to the estimates of the United Nations AIDS Programme (UNAIDS), the
annual requirement will be US$12,000 million as of 2005, rising to US$20bn as of
2007. The total sum of donations falls far short of that amount.
37

In 2003, 15 million children were orphaned by AIDS, 38 million people were
infected with AIDS , and 2.9 million died of the disease (see graphs above). There
is still no prospect of an effective vaccine. The warning from UNAIDS is clear:
unless the international community acts quickly, this fatal immune deficiency
syndrome will ravage Asia – home to 60 per cent of the world’s population – as it
has already ravaged Africa.
At present, a large number of HIV carriers in Central Asia are injecting heroin
users. Injecting heroin users are clearly a high risk group. It is for this reason that
the Bangkok conference demanded the decriminalisation of drug addicts and ready
access to clean syringes. Pharmaceutical companies should waive their patent
rights on the relevant medicines, exclusion and stigma must be combated.
According to Roger Staub, head of the AIDS Section of the SFOPH, Switzerland
too needs to increase its financial contribution to international efforts to combat
AIDS. This will also benefit private industry, because the spread of AIDS in Asia
and Eastern Europe will eventually destroy export markets that are important to
Swiss industry.
38

B Information via the internet
• Harm Reduction Drug Project Uzbekistan – project description
• Switzerland - Uzbekistan Agreement
• SFOPH /Contact Net project contract
• Uzbekistan - Switzerland Drug Policy and Practices Document (Drug
conference Uzbekistan - Switzerland, 10.-11. July 2003)
• Media reports, including article in Der Bund, July 2003
• Report and documentation on first Harm Reduction conference in October
2004
• Interim Report Autumn 2004
Accessible at http://www.contactnetz.ch/de/content---1--1069.html
Contact Netz
Jakob Huber and Steffi Wirth
Monbijoustrasse 70
P.O. Box
CH - 3000 Bern 23
Tel. ++41 31 378 22 44
Fax ++41 31 378 22 25
jakobhuber@contact-bern.ch
www.contactnetz.ch
39

C Bibliography
Analyses of International Crisis Group ICG – Central Asia: Drugs and Conflict or
Report of the Swiss Delegation to the “Breaking the barriers“ Meeting in Dublin of
23/24 February 2004 – “Partnership to fight HIV/AIDS in Europe and Central Asia”.
Swiss Federal Office of Public Health (SFOPH) (2000). Swiss Drug policy.
SFHOPH, Bern.
40

13. Glossary
Ayol
Local NGO in Samarkand – in charge of Samarkand Contact
Centre
DFA- PA1
Federal Department of Foreign Affairs - Political Affairs
Division 1
HR Harm reduction
IDU Injecting drug users
MoH Ministry of Health
NGO Non-Governmental Organisation
SABO
Local NGO in Tashkent – in charge of Tashkent Contact
Centre
SC Steering Committee
SCOOF Swiss Co-operation Office Bishkek
SDC Swiss Agency for Development and Co-operation (DFA)
SFOPH Swiss Federal Office of Public Health
Trust Points
Government health centres for exchange of syringes in
Uzbekistan
UNAIDS United Nations AIDS Programme
UNDCCP United Nations Drug Control and Crime Prevention
UNODC United Nations Office on Drugs and Crime
UNDP United Nations Development Programme
USAID US Agency for International Development
WHO World Health Organisation
41