Regional Program Harm Reduction Works Fund It! Baseline assessment. Country: Georgia. Preliminary analysis. 10 October 2014

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1 Regional Program Harm Reduction Works Fund It! Baseline assessment Country: Georgia Preliminary analysis 10 October 2014

2 Main constraints The formation of representative bodies, such is CCM, is not transparent. It is not clear how the community could be involved in their activities. OST programs are funded by the Global Fund and the state budget (the state program is fee-based). International organizations try to avoid any conflicts with the government. When they need to solve controversial issues, they address NGOs and act through them. In comparison to Hepatitis C, HIV is not considered a socially significant disease. Yet, HIV infection is more stigmatized. The main impetus for change is foreign policy and the image of the country at the international arena. Harm reduction is illegal. The image of NGOs in Georgia troublemakers. The Ministry of Internal Affairs is the main opponent of harm reduction. There is a reliable evidence base: many research programs are held with support from international donors, but the evidence is not used for advocacy. The country needs a comprehensive research proving effectiveness of a full package of harm reduction interventions. Research data is available on the impact of needle exchange programs, but state agencies are reluctant to trust data on the coverage of PWUD with prevention services. The SR and most NGOs lack a strategy of working with the media, although internationally funded projects do have media components (education/contests for journalists).

3 Possible Advocacy Asks Decriminalization of drug use and legalization of harm reduction. Transparent decision making related to drug policy and the prevention and treatment of HIV and other socially significant diseases among vulnerable groups. Involving the community in debate on legislation which concerns them directly. Destigmatization of HIV. Promotion and protection of human rights of people who use drugs (a much needed service in the community). There is a mechanism of funding NGOs to provide needle exchange services, but after the transfer to the insurance-based health care it is not clear if this mechanism is going to survive.

4 Advocacy Tips Advocacy messages should be simple and clear for the general population in particular. It is important to legalize services for PWUD and demonstrate sufficient coverage of this group, so that the government and public could see that the problems of drug users are under control. It is highly unlikely that needle exchange programs will be funded by the government. However, it is possible to advocate for the allocation of local/municipal budgets to this activity (in Tbilisi and Batumi, people who use drugs have access to detoxification and hepatitis testing services; active lobbying is underway to secure state funds for Hepatitis C treatment). They country has a national program on the prevention of hepatitis. Since HIV is not a priority issue in Georgia (unlike hepatitis), advocacy for state investment in needle exchange should include components of hepatitis prevention then it will have an impact on public health. Involving high-level advocacy experts (for example, Michel Kazatchkine) could be very effective. The government is ready to hear financial arguments, politicians are interested in ensuring public order and security. Negotiation and reasoning will be more effective in advocacy than radical and aggressive measures. Criteria of harm reduction effectiveness (especially for the government) could be: 1. Reduced HIV transmission through injecting drug use; 2. Reduced levels of criminal activity among people who use drugs and around drug use in general. Work with journalists: trained journalists should get a task of signing an agreement with a media outlet to publish at least one material on a monthly basis. There is a pilot harm reduction program in the penal system that includes OST and needle exchange. Currently methadone is used for detoxification. An anti-drug strategy has been developed and is waiting to be approved. The community of people who use drugs has not been involved in its development.

5 Advocacy Tips (continued) Informal connections in Georgia work much better than formal ones. SR has links with the Ministry of health, principal recipients of Global Fund grants, the Anti-Drug Council and the Ministry of Justice; work relations have been established with international organizations working in Georgia. International donors provide funding for advocacy projects (EU Democracy & Human Rights the project on documenting violations of human rights of the community; the Soros Foundations and the Global Fund support the GenPUD activities; the Committee on Elimination of Discrimination against Women is also active in Georgia). Georgian authorities are eager to form a new image of Georgia as a progressive country, and are easily influenced by foreign stakeholders on various issues. With the new PR, it is expected that the coverage of target populations by the Global Fund projects will go down. The strategy for the development of health care in Georgia is under development. It does not mention harm reduction at all.

6 What could be funded by the government? Assumptions ARV treatment The country uses the new WHO treatment protocol (2013) that recommends to start treatment when CD4 count falls to 500 and lower. Transfer to the new protocol and covering treatment costs from the state budget requires a 3-fold increase of budget funds. HIV, TB and HCV diagnostics OST will be funded through this mechanism; it is possible that free-of-charge treatment will be provided to the low-income PWUD.

7 The PWUD community The PWUD community representatives see themselves as a resource that should be used in advocacy for the humane drug policy, access to essential medications, continuity and sustainability of services and decriminalization of drug use. They suffer from drug use-related stigma. PWUD think that there are people whose authority and influence could be used in advocacy, but find it difficult to name them. They consider decriminalization of drug use as their main objective. People who use drugs have an opinion that dialogue with the authorities is not possible, and that the only tool of influence is large-scale protest campaigns. PWUD do not have much expertise in harm reduction, human rights protection and legislative work, therefore they are currently not ready for active involvement in decision making. There is a risk of non-constructive competition from the community leaders, when the creation of new networks is perceived as rivalry. Communities may lose control over certain leaders as soon as the latter acquire financial independence.

8 Technical support needs 1. Expertise in procurement 2. Fundraising skills (developing donor proposals, analyzing data) 3. Lobbying to reduce prices on essential medications 4. Involvement in the legislative process 5. Working with the media 6. Recruiting opinion leaders for advocacy work