Harm Reduction Drug Project Uzbekistan - Contact Netz

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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
Page 1 and 2: Harm Reduction Drug Project Uzbekis
Page 3 and 4: 8.2 NEED TO DEVELOP TREATMENT OPPOR
Page 5: 1. Abstract BACKGROUND The number o
Page 9 and 10: find employment and accommodation,
Page 11 and 12: 3.2 Key project data Harm Reduction
Page 13 and 14: 3.5 Project costs The project’s b
Page 15 and 16: As can be seen from the organisatio
Page 17 and 18: 6. Project implementation 6.1 Phase
Page 19 and 20: Advantages and limitations of the
Page 21 and 22: The Uzbek partner outlined developm
Page 23 and 24: Table: Minimum number of syringes n
Page 25 and 26: 6.3.4 NGOs and their contribution t
Page 27 and 28: 7. Project development 7.1 The stre
Page 29 and 30: 8. Challenges to be faced for effic
Page 31 and 32: The features that the three options
Page 33 and 34: 8.2 Need to develop treatment oppor
Page 35 and 36: 10. Conclusions and new challenges
Page 37 and 38: 11. A learning experience In conclu
Page 39 and 40: In 2003, 15 million children were o
Page 41 and 42: C Bibliography Analyses of Internat

Harm Reduction Drug Project Uzbekistan - Contact Netz

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