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«The person I am counseling is, first and foremost, someone in a bad situation”

On HIV prevention among people who use drugs in Tyumen oblast

Since October 2018, EVA has been carrying out a project called PWID In Focus for HIV Prevention, supported by the Elton John AIDS Foundation in Orenburg, Tyumen, and Leningrad oblasts. We have already shared about the experience from this project in Orenburg and Leningrad oblasts. This time we managed to meet with those who are conducting HIV prevention among people who use drugs in Tyumen oblast. Herewith we publish a brief interview.

UPD: The interview with project participants took place prior to the measures taken in Russia to prevent the spread of coronavirus. Now project staff are providing support to clients remotely.

Participants: Natalia – Regional Project Coordinator, Mikhail – outreach specialist, Sergei – outreach specialist.

Natalia Ustyouzhanina, Project Coordinator in Tyumen oblast

— Who is this project for?

Natalia: This project is focused on people who use drugs and also people who are in close contact with them. We test, counsel. And link people whose tests show a positive result to the AIDS Center.

— Who is currently working in the project?

Natalia: I have 6 people on my team: me (Coordinator), a social worker, and 4 outreach specialists. There’s also a trustworthy doctor at the AIDS Center who is always in contact with us, answering our questions. We have an agreement that our clients are seen by the doctor without waiting in line.

— Where is your target group located?

Natalia: We test in different places: in office, at narcotics anonymous groups, and in rehabilitation centers. We also work at penal inspection centers where people on probation and those who have recently been released check in. Of course, word of mouth still is relevant – there are acquaintances, neighbors, and those around so-called disadvantaged areas.

Mikhail: It seems to me that a significant benefit of the project is the possibility to work with narcotics anonymous and alcoholics anonymous. People from these groups often get into active use. By establishing contact with them we receive access to places drugs are used, which is not so simple now, and draw more people who use drugs to the project.

— Who seeks out support from the project – men or women?

Natalia: Without a doubt, men. Mikhail now tests women who use drugs. They consider themselves sex workers. We have faced great challenges linking women who test positive to AIDS Centers.

Mikhail: We stressed the work with rehabilitation centers and AA and AN groups. Now we are just starting to test and counsel sex workers. I think we now need some time to gain their trust.

Mikhail. Project outreach specialist

— Please share more about the work in penal inspection centers. I know that in Vyborg there is also interaction with penal inspection centers, but the experience has not been particularly effective. 

Natalia: We have a similar situation. There aren’t that many people, the detection rates are low. Also people at first are hesitant to be tested. Then, it seems, they began to tell one another that they can get condoms from us and the process went more smoothly. There are also challenges with linkage: if it’s not possible to gain one’s contact the first time, the next time they are seen is only when they come to check in again.

Sergei: What’s more, sometimes people come to the penal inspection centers under the influence of substances. They aim to leave as quickly as possible so they aren’t “caught”.

Natalia: I think the issue still lies with trust. People fear that if they are detected with HIV at the penal inspection, all the systems will be informed immediately.

— Do you have motivational packets as part of the project?

Natalia: Yes, the standard handout in such projects – sterile equipment and condoms. And it’s in great demand for people actively using. However, the issue arose about work with rehabilitation centers regarding what we can offer to them to draw them into the project? We know that in the centers the first things in need are socks, toothbrushes, toothpaste, and razors. Not all relatives support them, and the period of rehabilitation is long. Therefore for those who are at rehabilitation centers, we put together packets based on need.

—What does linkage to AIDS Centers entail for people detected in rehabilitation centers? Colleagues from Orenburg oblast shared that they faced serious problems regarding this issue due to the fact that people from different regions go to the centers.

Natalia: Currently there is a decree in Tyumen oblast that any citizen of the RF can be monitored by an infectious disease doctor, have immune system and viral load tests done and receive treatment regardless of registration. The situation for treating migrants is solved on an individual basis.

— How many rehabilitation centers are participating in the project?

Natalia: In general there are tons of rehabilitation centers in Tyumen oblast – over 30. No more than 10 follow the “12 step” system, while the others personally I consider to be social hotels, not rehabilitation centers. There is one protestant center with whom we are currently building a relationship. Additionally we test at state rehabilitation centers where there are high numbers of people and high detection.

— What do you think is the most important part of the project?

Sergei: The main thing in our work is the principle of equality. For me, the person I am counseling is, first and foremost, someone in a bad situation, regardless of their beliefs, behavior, or sexual orientation.

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