Harm Reduction Drug Project Uzbekistan - Contact Netz

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
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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