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Psychologist's advice Useful materials

Learning how to positively motivate ourselves

A person is so arranged that he cannot work in the same mode all the time: from time to time there is a decline in strength, and he gives up and does not want to do anything. At this moment, it is essential to cheer yourself up and motivate yourself in order to return to the formation.

Let’s talk about how to do it correctly and effectively.

1. Remember your strong qualities and sides.

Self-doubt and one’s abilities are frequent causes of loss of strength and reluctance to do something.

2. Remind yourself of your achievements and advantages.

Compliment yourself on the skills you have developed well and take action.

3. Do what you like (in the ecological sense).

When motivation is at zero, it’s difficult to just get up and start doing labor-intensive work, so to start cognitive processes, start with something simple: do the work that brings you pleasure.

These actions will improve your mood and help restore inspiration, as a result, you will have more energy to complete work tasks.

4. Celebrate very small victories.

This will help build positive skills. It is not necessary to buy a cake every time. It is enough to simply note that something good has happened.

5. Focus on solving the problem.

It is important to focus not on the problem itself, but rather on its solution. Consider all possible options.

6. Take care of your health.

Feeling bad is a great distraction from work and lowers productivity.

7. Engage in dancing, sports, and be outdoors more often.

8. Do what you love and with what you can earn money.

Success in any endeavor is based on a combination of passion and experience. But be careful. Not everything we like can bring real income, which sooner or later will lead to burnout.

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Response stories

Discrimination by medical professionals

Zhanna turned to the REAct documentator. The woman uses street drugs and sometimes alcohol. Recently, she had an unpleasant situation during an appointment with a gynecologist.

Zhanna’s health problems began before the war. In 2021, she was successfully treated by her doctor, but with the start of hostilities near Kyiv, the doctor was forced to evacuate to another city. According to the woman, she received a referral to another gynecologist, with whom she went for an appointment.

During the examination, as soon as the doctor saw traces of the injections, she immediately began to insult the patient in the presence of the nurse, calling her a “drug addict”, assuming that the patient is HIV-positive and already has AIDS. After that, the gynecologist kicked the patient out of the office and ordered her not to come again, because she does not treat “patients with AIDS”.

After the intervention of the REActor of the NGO “VONA”, a complaint was written to the management regarding the inadmissibility of such behavior of the doctor, disclosure of medical secrets, humiliating treatment of patients, insults, and non-provision of medical assistance. The complaint was considered, and the doctor was brought to disciplinary responsibility in the form of a reprimand with an obligation to undergo training to overcome stigma and discrimination.

Currently, Zhanna is being treated by a friendly gynecologist at the same medical facility.

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Psychologist's advice Useful materials

Learning not to be a victim – a checklist from a psychologist

1. Understand: every second, minute we make one or another choice.

The position of the victim is also a choice made on the basis of certain beliefs. We cannot influence certain events, but we can choose how to react to them.

2. Replace the habit of constantly looking for the culprits in your troubles with the habit of looking for options for solving problems and getting out of the crisis.

For example, instead of asking “Why exactly did this happen to me?”, “Why is this happening to me?” accept the situation and start looking for an answer to the question “What now?”. Identify all possible solutions to the problem. This is much more productive than finding the culprits. Although it is up to you to decide whether to stand still or take a step forward. The choice is yours.

“Accept the situation” does not mean completely surrendering to the circumstances, but accepting the fact that you cannot influence some global things, but you can choose how to react to them. For example, instead of sitting under fire in a dilapidated house and wondering whether the rocket will hit the house or not, periodically switching to self-defeating questions like “Why me, for what?”, you can take care of your own safety and temporarily move to a safe place, with a clear the realization that housing can always be rebuilt.

3. If you have a difficult choice in front of you and you don’t know what to stop it at, choose what is the most profitable for you at the moment.

You can even write down the pros and cons of each option you have identified and make your choice based on this analysis.

4. Constant shifting of responsibility to others reinforces you in the position of a victim. Each of us is the forge of our own happiness. Remember this.

5. Self-love, understanding your desires and needs, and building your own behavior on the basis of this understanding will make you invulnerable and independent of other people’s judgments, opinions, suggestions.

6. Search for new meanings. Learn to perceive any experience (even very bitter) as an opportunity for your own development and growth.

Only you can choose: to take the internal position of the winner or the loser!

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News

Online meeting of representatives of the UHHRU and regional coordinators of the REAct project

Today, September 20, 2022, an online meeting of representatives of the UHHRU and regional coordinators of the REAct project was held.

The purpose of the meeting was to exchange information on the work of projects on documenting and responding to cases of violations of the rights of key communities in wartime conditions.

As part of the meeting, Nadiya Semchuk, senior specialist of the REAct project, talked about the location of REAct documentators, changes in their work, and the needs of clients requesting help. REAct’s basic statistics on recorded cases since the beginning of the war and how to respond to them were also presented.

Nadiya Semchuk, senior specialist of the REAct project

Natalya Kozarenko, coordinator of the network of public receptions of the UHHRU, shared information about the work of 12 receptions of the UHHRU in the regions and provided data on the number of appeals to the UHHRU in 2021. In particular, 2,851 appeals were registered.

Natalya Kozarenko, coordinator of the network of public receptions of the UHHRU

Within the framework of the meeting, the experience of interaction between REAct documentators and lawyers of the UHHRU was also discussed. Coordinators from Zhytomyr, Dnipro, and Mykolaiv shared the experience of their regions regarding the redirection of clients from REAct to UHHRU.

“I call on both the documentators and the REAct coordinators to be active in the framework of interaction with the UHHRU. In our region, we were able to set up a forwarding system that works well”, – Olena Kovalenko, regional coordinator of REAct in Zhytomyr.

Based on the results of the meeting, directions for the following actions were worked out to strengthen the interaction between REAct and the UHHRU, improve the client forwarding system, and increase the legal capacity of REAct documentators.

Find the full presentation at the link.

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Response stories

Humiliation and discrimination of the OST patient

In connection with the beginning of a full-scale war, Halyna, an OST patient, with two young children was forced to move to Ivano-Frankivsk and live with her mother-in-law. From the beginning, the woman was against them moving in with her, so whenever possible, she humiliated Halyna and her children in every possible way.

One day, her friend came to the mother-in-law’s house, and physical violence was added to the psychological one. Halyna and her children hurriedly left the house and turned to the police department, where she wrote a statement about violence against her and her children.

Police officers told her that they could temporarily stay at a shelter for people affected by domestic violence. The police provided the address and called there in advance to warn of the client’s arrival.

When Halyna and her children came to settle in the shelter, the workers began to ask about her health, and, after learning that she was an OST patient, they placed her and her children in a shelter for a night’s stay, where most homeless people are left. The children were so frightened that they cried all the time, so the woman was forced to leave the proposed overnight stay as soon as possible.

In desperation, Galina wrote an announcement on social networks and asked for help. The owner of the hotel responded to her request, where she was placed with people who were forced to leave their homes due to the war.

Halyna turned to the REAct documentator to get advice on the legality of the shelter workers’ actions and psychological help for her and the children. The REActor contacted the social service in the city, informing them about this case. The documentator asked to explain the reasons for settling Halyna and her children in a shelter for the homeless, and not in a shelter for victims of violence, which is very close, and the conditions that were more comfortable for the woman and her children. She received a formal answer that the head of the institution was on vacation, and social service workers could not communicate with Halyna, as she had left the shelter early.

Currently, the woman continues to stay in the hotel, she and her children are provided with the necessary psychological assistance and food kits from the “Zahid Shans” Foundation and the “D.O.M.48/24” NGO.

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Psychologist's advice Useful materials

Learning to survive a traumatic experience

Focusing on a certain traumatic event forces you to live in the past and requires a lot of energy to constantly scroll through terrible memories in your head.

The attention of such a person is similar to a lantern that shines only at one point.

Stephen Hayes in the book “The Liberated Mind” offers the following algorithm for getting rid of unpleasant memories:

1. Accept your traumatic experience.

Our memories can be distorted and incomplete. What we call memories are repeatedly edited and modified under the influence of various factors.

In order to accept your experience, you can imagine it as a metaphorical image. For example:

  • embrace your experience as you would a crying baby;
  • sit next to your own memories, as you would sit with a seriously ill person;
  • look at your experience as a picture.

2. Give up fighting your experience.

Remember and imagine your experience and try to answer the following questions:

  • Do I have a bodily sensation associated with this experience, can I say yes to it and allow myself to simply be what I feel?
  • Is there an opinion related to this event?
  • Can I just accept it and not fight it?
  • Have you watched someone struggle with something similar, and if so, are you able to look at the other person’s experience with compassion?
  • What do you need to do to stop fighting your feelings?
  • Are you ready to say “no” to feelings and give them up?
  • Is there something about your negative experience that you are holding on to?
  • Your pain about past experiences may speak to your values and vulnerabilities. What might these values, needs, and vulnerabilities be?

3. Expand your view of the situation that happened.

Experiencing something traumatic forces us to focus only on complex feelings of pain, fear, and regret.

If we add breadth to our experience, and look at the situation from a different angle, perhaps we will discover something new for ourselves or in ourselves.

Ask yourself the following questions:

  • If you looked at your life from the perspective of a wiser future, could this experience teach you something?
  • If you were to write a book in which the hero goes through a traumatic experience, would that experience make him stronger, more resilient, and wiser?
  • How would you feel if someone else you loved were going through a similar experience? How would you feel about him? What would you advise him to do?
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Response stories

Organization of the military-medical commission

Ivan received a summons from the territorial center of recruitment and social support. The man was not conscripted, as he had HIV and a number of related diseases.

During a conversation at the Center, Ivan explained that although he is not against serving in the ranks of the Armed Forces, he is afraid that he will not be able to take care of his health to the necessary extent on the front line and, because of this, perform his military duties with dignity. His medical documents confirmed all this. However, the man was told that the war was going on and he had to defend the state.

The client turned to the REAct documentator in the Chernihiv region, who provided him with advice and explained that there is a list of diseases approved by the order of the Ministry of Defense, according to which there is a procedure for determining the fitness of citizens to carry out military service in peace- and wartime.

Also, the project documenter prepared a statement requesting that the client be referred to the military medical commission to determine the degree of his suitability for military service. The written statement contained a warning about criminal liability for disclosing information about HIV status.

In addition, the lawyers of the public organization “MART” provided the client with assistance and support in collecting documents and certificates necessary for the commission.

After the examination, Ivan was declared unfit for military service in wartime. He was issued an army card, where information about exclusion from registration was entered. Therefore, under any circumstances, he should not be called up for military service; in the future, he will be able to cross the border if he wants.

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Psychologist's advice Useful materials

Myths about domestic violence

Myth 1: There is no sexual abuse in marriage.

Reality: Sexual assault is a crime that has no place in a relationship between people, whether they are married or not.

Sexual contact should take place with both partners’ consent and be acceptable and desirable for both. If sexual contact is forced, in an unwanted form, the partner intimidates, humiliates, or offends, it is violence.

Myth 2: Violence is only about beatings.

Reality: In addition to physical violence, psychological, economic, and sexual violence are no less dangerous.

In particular, economic violence often hides behind the mask of care: the partner insists that there is no need to work or study, but then there is total control, reporting of the funds used, and humiliation. Lack of economic independence is one of the main reasons for silence and acceptance of physical violence.

Myth 3: Beating means loving. Everyone lives like this.

Reality: one person’s violence against another is not the norm, but illegal activity for which there is no justification. Looking for an explanation for the violence, many victims do not seek help for years, which worsens the situation and can have severe psychological consequences.

Living in constant fear and stress leads to loss of confidence, formation of low self-esteem, and various ailments.

Myth 4: Domestic violence only exists in “dysfunctional” families.

Reality: Domestic violence knows no social boundaries. It occurs in all social groups, regardless of the level of education and income.

Myth 5: It is necessary to endure for the sake of children.

Reality: children who grow up in a complete family and see violence suffer much more than those who grow up with one loving parent in a harmonious relationship and family peace.

Children who witness violence between parents or close relatives, even if they physically avoid it, suffer mentally. This negatively affects their emotional state, relationships with peers, and studies.

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Response stories

Discrimination of military personnel due to HIV status

The REAct documentator was approached by a client – a military serviceman who was being treated at a local hospital. During the treatment, the young man was tested for the entire infectious panel.

Later, after receiving the results, the client and the paramedic came to the local AIDS center for ART. The doctor knew about the diagnosis and after counseling the young man, he began to ask how he should behave now, given the client’s HIV-positive status. The paramedic asked if the man needed to be separated from his unit; what to do with other guys; how to behave in a soldier’s life and whether to talk about this diagnosis at all. During such “interrogation”, the client was embarrassed and felt like a leper.

At the client’s request, the documentator conducted an informational consultation with a paramedic regarding general questions about HIV. The doctor was informed about the inadmissibility of disclosing the patient’s medical data and about the responsibility for such behavior. The man was also consulted regarding the responsibility for manifestations of stigma and discrimination against HIV+ persons, which is provided for by the Law of Ukraine.

During the conversation, the young military, having received support from the documentator, expressed an irresistible desire to remain in the ranks of the Armed Forces and asked for legal advice regarding his rights in order to feel more secure.

After assuring the client that if a person is registered, receives treatment, and expresses a desire to remain in the ranks of the Armed Forces, military doctors cannot initiate the release of a soldier from an active army unit, the man cheered up and has now received documents for transfer to another unit, which he dreamed of joining before. He realized that stigma and discrimination in medical or military institutions could not be barriers to walking together to victory!

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Response stories

Refusal to provide free treatment

Andriy is a man who lost his son due to the full-scale Russian invasion of Ukraine. After that, he ended up in the department of neurology in the city where he was forced to move. Having lost his main income and being an IDP, the client was unable to pay medical bills, so he asked the hospital administration to find reserves for partially free care. For his request, he received only insults and humiliation. It was explained to the man that by receiving IDP address assistance from the state, he must pay the bills in full on his own. After such an insult, Andriy called the REActor.

The documentator listened to the man and asked him to send her photos of the prescriptions that he had to pay. It turned out that the hospital was provided with most of the drugs that needed to be purchased. Therefore, without wasting time, the documentator went to the chief doctor of the medical institution to have a face-to-face conversation.

After meeting with the doctor, the REActor provided comparative information from an official source on the remaining medication in the hospital with this man’s bills and emphasized that it is not worth taking advantage of a mountain of people in such a difficult time and recommended he to review his moral principles.

This case was taken under the personal supervision of the chief physician. A conversation was held with the medical staff regarding the violation of medical and ethical norms of behavior. The client was provided with free treatment, with the exception of some drugs that were given to him by volunteers.

Currently, the man is recovering and undergoing a course of rehabilitation psychological assistance due to the loss of a loved one.

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Lawyer’s advice Useful materials

Social guarantees for internally displaced persons

As of August 2022, there are about 4 million internally displaced persons (IDPs) in Ukraine due to the military aggression of the Russian Federation. This new, for many forced status, provides for appropriate guarantees of state social protection. Let’s consider them.

Who is recognized as an internally displaced person?

An IDP can be a citizen of Ukraine, a foreigner, or a stateless person who is in the territory of Ukraine on legal grounds and has the right to permanent residence in Ukraine, who was forced to leave or leave his place of residence as a result of or in order to avoid the negative consequences of an armed conflict, temporary occupation, widespread manifestations of violence, human rights violations and emergency situations. The state must take all possible measures, provided for by the Constitution and laws of Ukraine, to protect and respect the rights and freedoms of internally displaced persons, and to create conditions for integration at the new place of residence in Ukraine.

What confirms the fact that a person is an IDP and where should he get registration?

Internal displacement is confirmed by a certificate of registration of an internally displaced person. Not only adults but also every child, including those who arrived unaccompanied by parents or other legal representatives, must receive such a certificate. In order to obtain a certificate of registration of an internally displaced person, such a person must apply to the structural division for social protection of the population of local councils at the place of actual displacement. The application is submitted by an internally displaced person, including minor children. In the case of little children, incapacitated persons, or persons whose legal capacity is limited, the application is submitted through a legal representative. Along with the application, the applicant must submit an identity document confirming Ukrainian citizenship, or an identity document confirming its special status, or a child’s birth certificate.

The certificate of registration of an IDP certifies his place of residence for the period of existence on the relevant grounds. The address of the actual place of residence of the IDP can be the address of the appropriate place of compact settlement of internally displaced persons (address of a town made of prefabricated modules, a dormitory, a health camp, a rest house, a sanatorium, a boarding house, a hotel, etc.).

How should IDPs’ rights to employment, pension provision, mandatory state social insurance, social services, and education be ensured?

A citizen of retirement age, a person with a disability, a child with a disability, and another person in difficult life circumstances who are registered as an IDP have the right to receive social services at the place of registration of their actual place of residence.

A registered IDP who does not have the documents necessary for granting the status of unemployed should receive the status of unemployed without the requirements applied under the normal procedure.

Children from among internally displaced persons or children who have the status of a child who suffered as a result of military actions and armed conflicts, who study in preschool, general education, vocational and technical educational institutions, regardless of subordination, types, and form of ownership, must be provided with free meals at the expense of budget.

IDPs from the temporarily occupied territory have the right to receive material support, insurance benefits, and social services under the mandatory state social insurance in connection with temporary loss of working capacity and from an accident at work and occupational disease that caused the loss of working capacity, directly from workers bodies of the Social Insurance Fund of Ukraine by the actual place of residence, stay. Material support, and insurance payments are assigned in the presence of the necessary documents confirming the right to these payments, and in the absence of them – according to the data of the State Register of mandatory state social insurance in the order established by the board of the Social Insurance Fund of Ukraine.

What else are IDPs entitled to, according to state guarantees?

An internally displaced person has the right to:

  • family unity (which implies the obligation of the state to facilitate the reunification of a family whose members were forcibly separated (lost) as a result of risks and other influencing factors during displacement/evacuation from dangerous areas, i.e. in the search and reunification of family members who lost communication);
  • information about the fate and location of missing family members and close relatives;
  • safe living conditions and health;
  • reliable information about the presence of a threat to life and health in the territory of the abandoned place of residence, as well as the location of temporary settlement, the state of the infrastructure, and the environment, ensuring rights and freedoms;
  • creation of appropriate conditions for the permanent or temporary residence;
  • payment of the cost of communal services, electricity and thermal energy, natural gas in places of compact settlement of internally displaced persons (towns made of prefabricated modules, dormitories, health camps, rest houses, sanatoriums, boarding houses, hotels, etc.) at the appropriate tariffs established for such services and goods for the population;
  • provision by state executive authorities, local self-government bodies, and private law entities of the possibility of free temporary residence (provided that the person pays the cost of utility services) within six months from the moment the internally displaced person is registered; for large families, persons with disabilities, and the elderly, this term can be extended;
  • assistance in moving the movable property;
  • assistance in returning to the previous place of residence;
  • provision of medicinal products in cases and according to the procedure defined by legislation;
  • provision of necessary medical assistance in state and communal health care institutions;
  • placement of children in preschool and general educational institutions;
  • receiving social and administrative services at the place of stay;
  • carrying out state registration of acts of civil status, making changes to act records of civil status, their renewal and annulment by place of residence;
  • free travel for voluntary return to the abandoned place of permanent residence in all types of public transport in the event of the disappearance of the circumstances that caused such displacement;
  • receiving humanitarian and charitable aid;
  • other rights defined by the Constitution and laws of Ukraine.

Discrimination against IDPs in exercising any rights and freedoms on the grounds that they are internally displaced persons is prohibited.

What accommodation allowance is provided to IDPs and on what basis?

The mechanism for providing housing assistance to IDPs is determined by the “Procedure for providing housing assistance to internally displaced persons”, which was approved by the Resolution of the Cabinet of Ministers of Ukraine “Some issues of payment of housing assistance to internally displaced persons” dated March 20, 2022 No. 332.

Starting from May 2022, assistance is provided to IDPs who have moved from the territory temporarily occupied by the Russian Federation to the territory of Ukraine, the territory of territorial communities located in the area of ​​military (combat) operations, or who are under temporary occupation, encirclement (blockade), as well as IDPs, whose housing is destroyed or uninhabitable due to damage and who submitted an application for compensation for the respective losses, in particular through the Unified State Web Portal of electronic services, or for the submission of documentary confirmation from local self-government bodies of the fact of damage/destruction of immovable property as a result of hostilities, terrorist acts acts of sabotage caused by the military aggression of the Russian Federation.

The list of territorial communities that are located in the area of the military (combat) actions or that are under temporary occupation, encirclement (blockade) is formed in electronic form in accordance with the “Regulations on the information system for forming the list of territorial communities that are located in the area of the military (combat) ) actions or which are in temporary occupation, encirclement (blocking)”.

The amount of assistance received is not taken into account when calculating the total family income for all types of social assistance provided in accordance with the law.

To receive assistance, an IDP fills out an application, which can also be submitted to the structural unit for social protection of the population of local councils, the authorized person of the executive body of the village, settlement, city council, or the center for the provision of administrative services.

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Response stories

Refusal to perform an operation due to HIV status

In the evening, Artem turned to the reception department of the city clinical hospital with a high fever and purulent wound on his leg. The surgeon on duty examined him and informed him that an urgent operation should be performed.

But after the man reported his HIV status, the surgeon refused to hospitalize the patient and recommended that he go to the polyclinic at his residence. Instead, Artem replied that he was not a resident of the city, but an immigrant from the city of Kyiv. However, this and any other arguments had no effect on the surgeon.

The man turned to the REAct documentator and asked for help. The documentator contacted the deputy chief physician of the hospital by phone and reported that the surgeon on duty refused to provide medical assistance to the patient after learning about his HIV status, recommending him to go to another medical institution. By order of the deputy chief physician, the client was admitted to inpatient treatment, and a disciplinary conversation was held with the surgeon.

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News

Results of the implementation of the REAct system in Ukraine (first quarter of 2022)

Despite the full-scale war, the REAct project continues to actively work and protect the rights of representatives of key communities.

For the period January-July 2022, a total of 1,373 appeals were received from 1,312 clients. Of these, 85% of cases were fully resolved.

Most often, men (55.4%) and women (43%) face violations of rights, manifestations of stigma, and discrimination.

The most typical violation during this period was the refusal to provide assistance or service (45%). And the main violator of the rights of representatives of key communities traditionally remains the state (82%).

See the infographic for detailed statistics for the first quarter of the year.

Remember that every person has the right to receive quality services and decent treatment. If you or your loved ones have suffered a rights violation, contact REAct specialists for free help:

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Response stories

Knowing your rights is the key to success

This winter, a man called the REAct documentator and said that his friend had been arrested by the police for committing a traffic accident. According to him, the friend did not violate traffic rules and was not to blame for the accident. The offender in this case was a woman riding a bicycle. However, police officers drew up a decision on violation of the rules specifically for his friend Ivan and refused to ensure the participation of a lawyer in the preparation of road accident documents.

The client was informed about the procedure for engaging a lawyer at the expense of the state and provided the contact details of the Regional Center for the provision of free secondary legal assistance in the relevant region in order to directly find out the possibility of appointing a lawyer at the expense of the state independently. In addition, the rights and obligations of the accused in criminal proceedings were explained to the man.

As a result, by the decision of the local court, Ivan, who was accused of committing a criminal offense, was released from criminal responsibility in connection with reconciliation with the victim. The criminal proceedings were closed.

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Response stories

Discrimination in the hospital due to HIV status

Oksana turned to a local medical facility for medical assistance. After the medical staff found out about the girl’s HIV-positive status, they began to demand money from her, arguing that due to her status, she needs more bandages and protective sterile materials than other patients. Instead, Oksana decided to independently buy the necessary materials and provide them to the doctors. However, for some reason, they did not suit them and the doctors still demanded money to purchase them in their institution.

After this situation, Oksana turned to the REAct documentator for advice and help in solving this issue. The documentator visited the hospital, during which he met with the deputy chief physician, who promised to figure out the problem that had arisen and take measures. In addition, the doctor assured that, if possible, the client will be provided with all necessary assistance in accordance with the protocols of the Ministry of Health of Ukraine.

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Psychologist's advice Useful materials

Bad dreams associated with PTSD

One of the most common symptoms of post-traumatic stress disorder (PTSD) is nightmares. Our subconscious often pushes the trauma, trying to give it a way out, but instead, our consciousness blocks it. Only when we relax does the trauma come out.

Try to understand your dreams. Even if you don’t believe they have any specific meaning, don’t dismiss the fact that some types of dreams include details that your subconscious wants you to acknowledge or process. For those who experience recurring PTSD dreams, it is clear that fear and trauma are still at work.

Pay attention to relapses. If a specific place, person, or action repeats itself in all of your dreams, pay special attention to it.

Accept that a dream is not reality. When you wake up from a nightmare, you are often overwhelmed with fear that it will come true. With the help of sleep, the psyche tries to cope with the problems left over from the trauma. Focus on the steps you have already taken. Work through the steps you need to take to get well.

Small, simple, but important tips that will help overcome bad dreams:

  • Determine what you are really afraid of. Who/what is causing this fear?
  • Face your fears. Maybe you need to return to that place and realize it can’t hurt you anymore. Perhaps the action in a dream is something against which you feel defenseless, and you need to learn to defend yourself: for someone, it is to take a self-defense course, for others – to learn to swim or to overcome one of the fears. If it is an individual, different scenarios may be involved. Sometimes you need to meet a person and share your feelings literally. In other cases, take legal action. Sometimes you need to move to a place where they are no longer a threat in your life. Sometimes it’s all together.
  • Keep a dream diary. After a nightmare, take the time to write down the details. If you often experience repetitive details in your dreams, try to analyze and resolve why they are always a part of your nightmares. This is an excellent method to learn what causes fear and how to deal with it.
  • Identify your triggers. Think about when exactly you see unpleasant dreams. If they occur only periodically, it is most likely provoked by certain things in your everyday life. Start observing, taking notes, and making changes to help eliminate triggers from your life.
  • Seek professional advice. This is a crucial step in dealing with PTSD, specifically nightmares. In addition to having an objective side to help you sort things out, you can find confidence in sharing your experience with someone you’re not close to. Professional psychologists and psychotherapists will be able to offer you other proven methods to alleviate your condition. Any appointments should only be made by professionals based on your specific situation.
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Response stories

Humiliation of PWID

Oksana had a difficult relationship with her neighbor. He often humiliated her, cursed her, and sometimes even physically abused her. The last time the man tried to blow the client’s door with foam, a fight broke out.

Oksana’s friend called the police, although before that the girl had already written a statement to the neighbor, no one responded. When the police arrived and the law enforcement officers saw that the client was a drug addict, they did not pay due attention to the situation. On the contrary, the men began to belittle Oksana’s dignity and say that she is a drug addict and that is her who has to calm down in this situation.

After that, the client turned to the REActor as a provider of paralegal assistance. The girl was consulted about the situation, and also, in order to protect her rights, she was sent to the local Public Reception Center of the Ukrainian Helsinki Human Rights Union. With the help of cooperation with the lawyer of the UHHRU, the client was able to successfully defend her rights and return home.

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News Reports Useful materials

Frontline AIDS report “Protectors or perpetrators?”

Police brutality against members of marginalized groups not only hurts the feelings of such individuals but can also cost them their lives. Moreover, such behavior of law enforcement officers completely negates the work to fight AIDS as a threat to the population’s public health.

Yesterday, during one of the sessions of the International AIDS Conference, the Frontline AIDS report “Protectors or perpetrators?” was presented. It features real-life stories that show how illegal police activity affects human rights, access to justice, and the fight against HIV.

These stories demonstrate the resilience and courage of members of marginalized communities in the face of ongoing stigma, discrimination, and violence.

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Response stories

Discrimination in the Armed Forces due to sexual orientation

Pavlo, a soldier of the Armed Forces, is serving and is in a hot spot in the Zaporizhzhia region. The man never hid his membership in the MSM community and served on an equal footing with other military personnel.

One day, one of the soldiers got drunk and began insulting Pavel, threatening him with reprisals for his sexual orientation. As it turned out later, the attacker had problems with the law and was serving time in prison for murder. As soon as he arrived at their military base, the man found out that Pavlo was gay and decided to ask directly if it was true. Subsequently, the situation developed in such a way that the man attacked Pavel with a skewer and inflicted physical injuries on the grounds of intolerance. At the shouts of the military man, other comrades rushed in with threats and stopped the attacker’s aggressive actions.

After turning to the REAct documentator, Pavlo was provided with legal advice on preventing such actions by the military, in which signs of a criminal offense can be seen under Article 126 and Article 161 of the Criminal Code of Ukraine.

Later, a report was sent to the police, but the client refused help and tried to resolve this conflict internally. A little later, the documentator still managed to finish this case and punish the culprit. A report was also sent to the head of the company. The offender was reprimanded with the deprivation of all incentives and disciplinary punishment for illegal actions.

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Response stories

Domestic violence due to HIV status

Natalya was hospitalized with pneumonia. During the conversation between the client’s husband and the doctor, the latter talked about the woman’s HIV status, which the husband did not know about.

After being discharged from the hospital, the man, under the influence of narcotics, began to use physical force and verbally abuse Natalya. The woman tried to talk, and explained that she had been taking therapy for a long time. But the man continued to abuse the client every day.

Due to the fear of stigma and discrimination from law enforcement agencies, Natalya was afraid to go to the police, so she asked for help from the REAct documentator. The woman was given legal advice and helped to make a statement to the police. Later, the man was summoned to the police station and held a conversation about the consequences of domestic violence in the form of deprivation of liberty.

The husband sometimes arranges scandals but is afraid to offend Natalya and use physical force.

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Psychologist's advice Useful materials

Recommendations for verbal de-escalation in a dangerous situation

Recommendations for verbal de-escalation in a dangerous situation

When a potentially verbal and/or physically dangerous situation arises, verbal de-escalation practices can be helpful.

Remember: an angry person has a reduced ability to think logically.

De-escalation techniques are not something natural and intuitive to our psyche, so sometimes we are forced to respond in a more familiar way: fight, or freeze when dealing with a threat. However, choosing the path of de-escalation, we must consciously appear focused and calm.

The technique described below must be practiced before it is needed so that it can become a competent habit.

Step 1. Prepare yourself.

  • Relax your facial muscles and try to look confident. Model your voice so that it sounds low and monotone, but not emotionless.
  • Don’t defend yourself! Even if the comments or insults are directed at you. Remember, they are not about you.
  • Find out about any resources available to help. Know that you have a choice to walk away or call for help.
  • Treat the person with respect, even when firmly setting limits or calling for help. An excited person is very sensitive to feelings of shame and disrespect.

Step 2: Never turn your back, for any reason. Always be at eye level.

  • Leave extra physical space between you: about three to four times more than usual. Anger and worry fill the extra space between you and the person.
  • Stand at an angle so you can move to the side if needed.
  • Do not maintain “constant” eye contact or force the other person to do so. Allow me to detach or look away.
  • Do not point or shake your finger.
  • Don’t smile. It can look like a sneer or anxiety.
  • Do not touch. Cognitive dysfunction in agitated people causes them to misinterpret physical contact as hostile or threatening.
  • Keep your hands slightly away from your pockets, up and accessible to protect yourself. It also demonstrates that you have no concealed weapons.
  • Do not argue and do not try to convince, give a choice, that is, the authority to make a decision on your own.
  • Don’t defend yourself and don’t judge.

Step 3. A de-escalation conversation.

  • Don’t be loud or try to yell back at the person who is yelling. Wait for him/her to take a breath; then speak. Speak calmly, at a medium volume.
  • Remember, there is no point in reacting quickly, other than trying to calmly reduce the level of arousal.
  • Don’t answer offensive questions or those that don’t have an answer. For example, “Why everyone …?”, “Why all this …?”, “When will it all end …?”. There should be no answer to these questions.
  • Explain boundaries and rules in an authoritative, firm tone, but always with respect.
  • Empathize with the feelings, but not the behavior.
  • Where possible, try to distract the person with “thoughts and insights”. You can clarify “… help me understand what you are telling me.”
  • Communicate the consequences of “atypical/inappropriate behavior” without threats or anger.
  • Do not try to suppress the dignity of the interlocutor.
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Response stories

Blackmail of a sex worker by the police

Women engaged in sex work are at constant risk of rights violations. In particular, Ruslana, a client of a friendly organization, was blackmailed and forced to provide sexual services for money in one of the apartments for a long time. At the same time, the girl was forced to give the earned funds to a former police officer and an employee of the anti-trafficking department, because they found out that the woman was undergoing a criminal case and threatened to tell about her status as a sex worker to her roommate.

The girl learned about the REAct project and asked for help. The documentator, after listening to the sad story, directed the victim to consult a psychologist of the organization, taking into account her difficult psycho-emotional state as a result of regular psychological manipulation by the police.

Ruslana was also provided with an initial consultation on legal issues. After all, police officers, clients, and other persons quite often commit illegal actions against sex workers and remain unpunished. Later, the girl was referred to a friendly organization lawyer for help writing a statement to the police and legal advice. After submitting the statement, the harassment by the violators stopped.

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Brochures Reports Useful materials

Human rights violations against key populations amid ongoing war in Ukraine

Key HIV-affected communities in Ukraine face widespread rights violations, prejudice, and discrimination due to their vulnerable population status.

Amid Russia’s full-scale invasion into Ukraine, starting from February 24, 2022, the situation with human rights violations against people who inject drugs (PWID), patients in OST programs, people living with HIV (PLHIV), people with TB, sex workers, men who have sex with men (MSM), and other most-at-risk groups has significantly deteriorated.

In addition to the barriers and constraints encountered by clients under the imposed martial law, the REAct system has recorded war crimes by the invading Russian military.

Read more about the key types of violators and violations, a detailed description of war crimes committed by the occupiers during the war, and barriers to receiving services and protecting the rights, which appeared for clients in connection with the full-scale war in Ukraine, in our the new booklet “Human rights violations against key populations amid ongoing war in Ukraine”.

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Response stories

Disclosure of the patient’s HIV status in a medical institution

Maria was hospitalized in a serious condition with a diagnosis of COVID-19. In order to prescribe the correct treatment, the girl informed the doctor about her HIV status. However, after hearing about this, the doctor refused to prescribe treatment. During the morning round, the patient asked why she was being treated so indifferently, to which the doctor replied that there was no place for HIV-positive people in this hospital. Which, in turn, revealed her status to other patients in the ward and department.

After this conversation, the roommates began to insult and psychologically humiliate the woman and even threatened to kill her.

Considering her serious condition, Maria decided to seek help from her social worker, who notified the REAct documentator about this case. The documentator contacted the woman by phone, offered her support, and provided an initial psychological consultation.

An official letter was sent to the head doctor of the medical institution where the woman was staying, describing the situation in which the client found herself due to public disclosure of her status, which led to stigma and discrimination from other patients. The documentator explained to the doctor that his actions were discriminatory and it was recommended to adhere to the code of medical ethics in order not to have trouble in the future due to failure to fulfill his official duties.

The situation was resolved by transferring the client to another ward, where she received the necessary treatment in full.

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Lawyer’s advice Useful materials

Peculiarities of providing medical services during martial law

In connection with full-scale hostilities, the issue of citizens’ access to medical services in the conditions of martial law has become urgent. Many Ukrainians were forced to escape from the invaders and leave their homes, evacuating to other regions of Ukraine as internally displaced persons. This led to the need to make corrections to the mechanisms of providing medical care, taking into account the actual circumstances.

It should be noted that all state guarantees for the provision of medical care continue to apply, and some features of their application will be analyzed below using examples of emerging questions and the practice of solving them, taking into account the position of the Ministry of Health of Ukraine.

Where and under what conditions can internally displaced persons receive medical assistance?

Ukrainians currently have simplified access to primary medical care: internally displaced persons can be admitted to a medical institution in any region of Ukraine in which they are located if such an institution is able to provide the necessary treatment. A declaration is not required for this.

How can you get “affordable medicine” during martial law in another city?

For those citizens who need medical treatment, the “Affordable Medicines” program works in Ukraine, thanks to which patients can receive the medicines free or with a small surcharge. If, for example, a patient needs medication for cardiovascular disease, bronchial asthma, or type II diabetes, and if he has been forced to change his place of residence due to military action, one needs to see any other family doctor, therapist, or pediatrician, even with whom there is no declaration. Immediate assistance for IDPs is provided in full. At the same time, the doctor must conduct an examination, diagnosis, and prescribe the necessary treatment, including medication. If medication is needed due to mental and behavioral disorders, one should consult a psychiatrist, epilepsy – psychiatrist, or neurologist. If the patient needs to be prescribed the first insulin treatment regimen, this is done by an endocrinologist. He also makes changes to the scheme. And after approval of the scheme, the family doctor can write prescriptions for insulin.

Medical documents were lost during an emergency evacuation, how can they be restored?

As a result of Russian military aggression, many Ukrainians lost their documents, including medical ones, during evacuation. There are several ways of restoring lost medical documents recommended by the Ministry of Health of Ukraine, depending on their type:

  1. To restore such medical documentation as examination results, treatment, performed inpatient and operative interventions, and rehabilitation recommendations, one needs to contact the family doctor or any other primary care doctor at one’s place of stay. The doctor must make a decision on the restoration of medical documents through the Electronic Health Care System and/or conduct additional examinations to restore further treatment.
  2. If it is necessary to restore documents related to disability, it is necessary to contact the social security authority in the city of actual stay, which has access to the Centralized Bank of data of persons with disabilities and can make an extract for a person with a disability.
  3. Suppose it is necessary to restore or renew the MSEC certificate or there is a need to pass a medical and social examination. In that case, such a person can apply to the medical and social expert commission at the place of the actual stay. It should be noted that all forcibly resettled persons are examined by commissions regardless of the city of residence, according to the person’s place of stay.

Do persons with disabilities need to undergo a repeat medical examination?

In case of impossibility of examination and registration of referral to MSEC, the period of re-examination for persons with disabilities, which fell during the period of martial law, is postponed for a period of up to 6 months after its termination/cancellation. At the same time, all payments and relevant benefits are kept for the person until the end of the re-examination period. It is important that during the period of martial law and 6 months after its termination/cancellation, Ukrainians have the right to apply to the MSEC to establish disability not only regardless of the place of residence or stay, but also in absentia. That is, if a person does not have the opportunity to come to the MSEC, the commission can make a decision on the establishment of disability in absentia on the basis of a referral from a health care institution.

The attending physician, including the family physician, to whom the patient sought medical help, should, if necessary, issue a referral to the MSEC. At the same time, it is not required to make a declaration between the internally displaced patient and the doctor who makes the referral to the MSEC, and there are no legal grounds to need it. Conducting a medical and social examination at the direction of the medical and advisory commission is carried out regardless of the place of registration, residence, or stay of the person applying for the establishment of disability.

How to make a planned operation during the war?

Planned operations, which were suspended in the first days of the war, can now be carried out by the decision of the chief doctors of health care institutions. In order to perform the operation free of charge, it is necessary to receive an electronic referral from the family or attending physician. It should be noted that during martial law, planned operations can only be carried out by those institutions that have the resources for this because in some regions hospitals are overloaded with helping the wounded. One can get up-to-date information about hospitals where elective surgeries are performed at the contact center of the National Health Service at number 16-77. Also, after receiving the information, one should call the hospital and clarify the possibility of performing the surgery you need.

How can one get HIV treatment abroad and in Ukraine during the war?

Ukrainians living with HIV who have remained in Ukraine can still receive antiretroviral therapy. According to the new requirements, according to the place of the actual stay. That is, a person can receive ART at his place of residence or at the AIDS Center, or at the “Trust” office where he is registered. If a person had to leave the place of permanent residence, it is necessary to contact the AIDS Center or the “Trust” office in the new city.

If, as a result of military aggression, a person was forced to move abroad, then he needs to go to one of the hospitals that provide similar assistance to Ukrainians abroad. Such assistance became possible thanks to the intergovernmental initiative “ART for Ukrainians Abroad”. The complete list of these hospitals in different countries of the world is given at the link https://www.eceenetwork.com/patients?lang=en

For an application to a person applying for ART abroad, it is advisable to have information about the history of treatment for HIV infection with you. But even if the person does not have any medical documents (lost during evacuation and relocation), with his consent, the doctor can ask colleagues from Ukraine for the necessary information, and the person will be able to receive appropriate help.

How can you get medical services and help for Ukrainians who fled the war abroad?

Information on the medical care of temporarily displaced Ukrainians abroad is now available on the website of the Ministry of Health. Most European countries provide a wide range of free medical services for Ukrainians who were forced to seek refuge abroad due to the beginning of Russian aggression on the territory of Ukraine.

You can find out on the official resource of the Ministry of Health:

  • verified contacts of medical institutions;
  • a list of services that are available to displaced persons free of charge;
  • information on where to get doctor’s consultations in Ukrainian;
  • how to issue a prescription for medicine and much more.

Information on medical care for forced migrants abroad is available at the link https://moz.gov.ua/medichna-dopomoga-vimushenim-pereselencjam-zakordonom

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Response stories

Blackmail in disclosing the secret of the diagnosis

Vika, an HIV-positive woman, got a job as a nanny for a family through an agency. After working for a month, the woman was offered an HIV test. At the same time, Vika was warned that, in case of refusal, she would be fired, as the family in which she worked insisted on passing all the tests. In the end, Vika agreed.

The testing was conducted in the office of the agency’s HR manager, which was already a violation of confidentiality, as well as a violation of the testing procedure since it should be conducted exclusively by a medical professional. When the manager saw the positive result of the HIV test, Victoria was fired without payment of wages for the month worked.

After that, the client turned to the friendly organization “Positive Women” for help. She was offered two options for reaching an agreement with the agency on the payment of the earned money. However, Vika refused due to blackmail by the HR manager. After all, the latter threatened that they would notify all agencies about the woman’s HIV-positive status, as well as write a police report against her.

When the REAct documentator heard about this, she immediately scheduled a one-on-one consultation with Victoria to discuss an action plan to resolve the situation. The woman, accompanied by a documentator, sent a complaint to the management of the agency regarding the selection of nannies and wrote a statement to the police about forcing disclosure of the secret of the diagnosis and blackmail. After that, the head of the agency apologized to the client for the actions of her subordinate, who was fired after some time. Currently, the client receives psychological, humanitarian, and financial assistance from the specialists of the “Positive Women” organization.

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Psychologist's advice Useful materials

Emotional fatigue from waiting for victory in the war

When we wait for something for a long time, emotional fatigue accumulates, irritation, anger, and resentment at the lack of a positive result appear.

How to stabilize yourself, what to rely on in moments of crisis and change?

There is a term in psychology called resilience. This is a feature of our psyche that allows us to cope with unstable times, prevent emotional burnout, and get out of a pre-depressive state. This is the response of our psyche to various difficulties.

How to develop this relevant quality in yourself, cultivate mental resilience and be as stable as possible in this difficult time?

  • First of all, start with personal actions and remember the simple formula: nutrition + sleep + physical activity.

Our body is created for activity, it needs to be fed, given the opportunity to recover through sleep, and activate the work of lymph and other body systems through training and hiking. In this case, a tone appears, and the body will begin to look for ways to get pleasure and rest after spending efforts.

  • Plan! Start with small daily plans. Write down all plans so you don’t forget.

Add new activities to your diary every day. And most importantly: write down your sensations in the body when the plans are implemented! Catch the feeling of satisfaction from the realization of what has been achieved, even in small things!

  • Strengthen social activity! Go to the community, and act where there is an opportunity for physical meetings, and dialogue.

Through meeting with people, a different experience is transferred, difficulties are better experienced and digested, and your resilience is strengthened.

  • Memories should have a place, but they can be dangerous!

Remember your past experiences, and record the skills you have acquired in a journal of thoughts. But do not forget to find new effective strategies to achieve the desired result.

  • Look at the world more broadly, from different angles.

Almost all of us have an idol. It can be a famous person or an authoritative figure from your life experience. When life’s situation is difficult enough, stop, take a few deep breaths, close your eyes and imagine that your idol is in your situation. What life advice would he give you? How would you behave?

After that, imagine that you are giving a recommendation to your idol in a difficult life situation. If possible, write down your idol’s advice and your own recommendation. Look at the results obtained. Decide what suits you, and what you like. Complete this exercise by writing 3 specific actions you are willing to take.

Each crisis provides an opportunity to find hidden resources and opportunities within yourself that you did not even know about before. Take action and strengthen your inner resistance!

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Response stories

Breach of privacy and anonymity

A client turned to the friendly organization the CF “Health Source”. Her daughter Svetlana, a 10th-grade student, shared with the school psychologist that she has HIV and worries that she won’t be able to date boys.

A little later, her friend stopped communicating with Svetlana. When the girl tried to find out what the reason was, it turned out that her friend’s mother forbade her to be friends with Svetlana because the latter has HIV. It turned out that the psychologist told “in secret” to her friend, who was the mother of a classmate and friend of Svetlana.

The client turned to the school psychologist with a request to refute the information about HIV in front of her friend. However, the school psychologist rudely replied that she had nothing to do with it. The client turned to the director of the educational institution and complained about the psychologist’s actions. However, this did not yield any results.

Later, the woman turned to the REAct documentator for help in punishing the guilty person and organizing psychological help for her daughter. The documentator arranged a meeting with the school director and the psychologist, during which they discussed that the psychologist had disclosed Svetlana’s secret, thus violating the confidentiality and anonymity of the client. The documentarian emphasized that the psychologist must correct the situation, even if she has to “lie” to her friend, to whom he opened up “secretly”. Also, the documentator talked about the possible consequences of disclosing the secret of communication and diagnosis. The client, in turn, warned that she would complain to the city education department, if necessary.

The director and the psychologist apologized and promised to help rectify the situation. After some time, Svetlana’s classmate apologized for her behavior and said that her mother had allowed them to continue communicating. Unfortunately, it was not possible to restore real friendly relations, but after the help, Svetlana began to feel more confident in her future.

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Response stories

Stigma and discrimination at work due to HIV status

Sometimes, in order to feel successful in life, you don’t need to achieve something significant for others, the main thing is to overcome a milestone in your head.

This is what happened to Hanna, who became a victim of stigma and discrimination in the workplace because of her HIV status. And all because once a woman was spotted taking ART pills. After that, the employee accused Hanna of endangering all the other employees and shamed her for having the disease, and for not telling others about it.

Anna then hid her status from everyone and was ashamed of it. But this situation helped to reassess her attitude towards it.

After the incident, Hanna turned to the REAct documentator. He, in turn, referred the woman to a friendly psychologist, who helped her to realize the “normality” of this disease, and to stop hiding it among her close circle. And it helped! Hanna stopped feeling the burden of the secret. Relationships at work and with loved ones have improved due to the increased level of trust. Moreover, the woman’s well-being, both physical and psychological, has also changed for the better.

Hanna now jokes that if it weren’t for the incident and REAct’s help, she would have hid her status anyway, fearing her own shadow.

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Psychologist's advice Useful materials

How to reduce anxiety?

It is impossible to completely eliminate anxiety from your life now and in general. Anxiety highlights the danger. The higher the degree of danger, the greater the anxiety.

Here are some tips to help you reduce your anxiety:

  • Be more attentive to your impulses and environmentally, without harming yourself and others, give them a way out.
  • Do not constantly live in the past and future. Remember what warms your soul, dream. Don’t make long-term plans. Keep your focus for the next 1-3 days.
  • Live now without global plans.
  • Add so-called rituals. This is important for our psyche. It can be a morning cup of tea, sitting alone, or minimal yoga practice. Do what you can afford in the conditions in which you are. The main thing is not to pick up the phone with the news at this time.
  • If you have the opportunity to be in nature, listen to the sound of the wind, and water, enjoy the greenery and flowers, and listen to soothing music – do it as often as possible.
  • Hugs and communication with loved ones – an effective way to deal with anxiety.
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News

Receiving monetary compensation to citizens of Ukraine

The European Court of Human Rights has announced the possibility of obtaining monetary compensation for Ukrainian citizens who have suffered from Russian aggression.

List of situations giving the right to apply to the ECtHR:

  • death of a relative
  • destroyed housing
  • injury
  • unlawful imprisonment (captivity)
  • torture
  • rape or enforced disappearance of a person

For free assistance/advice or assistance in filing an application and receiving compensation, please contact the REAct project documentators.

Each statement is important because it helps both the personally injured person to receive compensation for the damage caused, and every Ukrainian – to achieve condemnation of the actions of the aggressor and prevent new crimes.

A site where you can provide more information about the possibility of obtaining compensation – https://espl.com.ua/

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Response stories

Refusal to treat an internally displaced person

Dmytro asked the REAct documentator to help him get medical help and an examination from a phthisiologist. The man said that he had tuberculosis and was being treated in his region before the war, but after moving he wanted to continue the therapy and receive the necessary drugs.

When Dmytro applied directly to a phthisiologist at his new place of residence, he refused referring to the client’s internally displaced status due to the hostilities in the country.

The Project documentator visited the doctor and explained to him that despite the fact that the client is an IDP and does not have a referral from a family doctor for tuberculosis examination and treatment, he still has the full right to receive treatment at his current place of residence.

The documentator provided Dmytro with initial legal advice and provided assistance in obtaining a certificate for an internally displaced person. Later, on the basis of the received certificate, a referral was taken from the family doctor on duty, after which the phthisiologist diagnosed and provided the necessary drugs for further treatment to the client.

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News

The work of the REAct system was presented at the DHIS2 Annual Conference

Today, June 21, was the second day of the DHIS2 Annual Conference. The REAct system operates on this software platform.

Since 2019, the REAct system has been implemented by the ICF “Alliance for Public Health” (APH) with the full support of Frontline AIDS. During the first year of implementation of the System, the Alliance registered about 2,000 cases of violations of the rights of representatives of key communities in Ukraine and other countries in Eastern Europe and Central Asia.

Layla Ismail, Senior Advisor: Monitoring Systems, Frontline AIDS

At the end of 2020, APH decided to get independent management of the system, because it gives more opportunities for data collection and analysis, and instant reflection in the system of the necessary changes. In the first quarter of 2021, the Alliance was granted legal rights to the REAct database from Frontline AIDS.

However, this process of system transition and migration of data and settings had its subtleties and stages, required effective planning, and underwent several testing and revision stages.

Thanks to the coordinated work of Frontline AIDS, BAO Systems, and the Alliance, the system was successfully transferred to the new APH server.

During one of the sessions of today’s Conference, our partners from the UK Frontline AIDS, together with Nadiia Semchuk, Senior Program Officer: Research Project Coordination, ICF “Public Health Alliance”, presented their experience of technical and software side of the system, mentioned possible challenges and shared their tips.

Together with its leading partners, REAct works to break down the social, political, and legal barriers faced by marginalized people and innovates to create a future free of AIDS.

Nadiia Semchuk, Senior Program Officer: Research Project Coordination, Alliance for Public Health, Ukraine

In total, as of early 2022, REAct has registered 10,337 cases in 13 countries under the auspices of the ICF “Alliance for Public Health”. Currently, 174 NGOs, including more than 300 users, are implementing the REAct system on the ground.

To achieve these results, REAct project specialists regularly monitor and evaluate the performance of the system, promptly responding to program changes and requests.

Thanks to the work of the REAct system, the obtained data serve as a reliable source for advocacy in the implementing countries. In addition, the regular training, and interactive guides for users to ensure data quality are conducted.

Nadiia Semchuk, Senior Program Officer: Research Project Coordination, Alliance for Public Health, Ukraine
Categories
Response stories

Assistance to PWID in prescribing treatment

Ruslana is a person who injects drugs. The girl has long been a client of a partner NGO, as she has a positive HIV status, has been receiving ARV therapy for many years, and uses outreach services.

One day, the mother of a client who lives and works abroad, called the REAct documentator and asked for help for her daughter. When the documentator and the case manager came to the client’s house, they saw a horrible picture: the apartment was dirty and cluttered, and the girl was unconscious and lying in her excrement. The ambulance they were trying to call refused to come due to lack of fuel.

The next day, the documentator talked to the doctor of the treatment-and-prophylactic institution about the hospitalization of the client and prescribing her treatment to relieve the state of drug intoxication. However, after learning about the client’s serious condition and her HIV status, the doctor refused to hospitalize Ruslana, citing a lack of places in the ward.

The documentator later agreed to treat Ruslana in a private medical center with money sent by the client’s mother. The girl was constantly taken care of by a case manager, who brought her food and maintained her emotional state, communicating as an equal.

Now the client is on the road to recovery and plans to apply for an OST program.

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Psychologist's advice Useful materials

How to quarrel less with relatives during the war?

Unfortunately, it is impossible not to quarrel at all, because now aggression is coming from all sides and finds a way out either through excessive food or alcohol or through quarrels.

Therefore, it is extremely important now to control the expression of one’s opinions, which sometimes turn into accusations.

Instead of accusations, you can say, “I am very angry now because of the feeling of helplessness. I’m scared and I don’t understand what will happen tomorrow. I don’t feel safe. Let us think with you as partners about what we can do. “

In a couple, it is always easier for someone to process information, while someone, on the contrary, keeps everything to himself and thus preserves his fears.

Be careful with criticism.

Try to use the principle of a sandwich: good accent ➡️constructive criticism ➡️good accent.

So criticism will be perceived by the partner more adequately.

For example, if your husband said something unpleasant to you, you can answer him: “Listen, I appreciate and love you very much as my husband/partner, but your words hurt me a lot now. Don’t do that, please. It is better to be a defender for us. We can handle everything. “

If you have the strength and desire, you can organize a ritual of negotiations. For example, every night at 18:00 sit down together to talk.

Ask the following questions:

  • How do you feel today?
  • How can I help you?
  • What’s wrong with you? For example, I am angry at this and that. How are you?
  • Let’s find a compromise, if possible.

If you have young children, you can experience aggression by playing with them. Or try this game in your pair.

Game to work with aggression: you stand on 4 “paws” and imagine yourself as an animal that can defend itself with paws, teeth, and growling. For example, you play a family of tigers. You bite, you push with a paw. It will be much easier to experience aggression in such a game form.

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News

Changes in the work of the REAct system during the full-scale war in Ukraine

A full-scale war has exacerbated the human rights situation in Ukraine. During the 100 days of the war, the REAct system registered about 700 violations of the rights of key groups, of which 85% were resolved in whole or in part. For the most part, clients continue to face barriers to receiving ARV therapy, OST, and access to other health services. The occupiers recorded cases of seizure of OST and ART drugs at checkpoints, cases of illegal searches and seizure of personal belongings, and infliction of physical harm.

Since the beginning of the war, the system has recorded cases among a new category of clients – refugees (52 cases) who are internally displaced persons (IDPs) or those who have been forced to go abroad. Interaction with clients and resolution of cases takes place mainly online and by phone, but in case of urgent need and due to the limitations of martial law, clients are also directly escorted to various institutions to help solve their problems. Referral routes and links with governmental and non-governmental organizations are rapidly changing (providing shelter, humanitarian assistance, and information on available assistance opportunities in other areas and abroad). The main strategy of the Project now is to use the available response capabilities to the maximum.

Among refugees, the group of OST program participants is particularly notable. Unfortunately, the aggressor does not recognize OST treatment and considers the participants of the therapy as criminals involved in drug trafficking. Also in the occupied territories, the occupiers do not provide the population with medicines and hinder humanitarian convoys. Therefore, a large number of people are moving to other regions. As the result, they all need help to resume treatment.

In addition to increased stigma and discrimination against OST clients, there are many reports of violations of MSM rights, primarily due to forced migration, which often leads to conflicts based on homophobia.

Since the beginning of the war, the needs of representatives of key groups in the context of interaction with various social structures have increased. As a result, the number of transgender people who have been discriminated against during the war has increased. Odeska oblast receives the most complaints about violations in state and medical structures (military registration and enlistment offices and dispensaries). Solving these problems at the primary level has become more difficult, as government agencies have some immunity from appealing their decisions.

On the other hand, the coordinators of Kyivska and Dnipropetrovska oblasts note positive changes in working with government agencies. Currently, public sector representatives promptly respond to customer and documentator complaints and provide assistance in resolving them. It can be stated that this crisis situation has contributed to positive changes in the work of medical institutions in these areas. There is less bureaucracy in dealing with issues. Doctors, with some exceptions, are more likely to take responsibility for resolving difficult situations, more to consult with clients about certain problems.

Over the last two months, the range of social issues addressed by Kryvyi Rih documentators has significantly expanded. Special attention is paid to IDPs. Such work is carried out in close cooperation with local and district aid headquarters, labor and social protection departments.

In the Zaporizka oblast there are regions that are under the occupation of russian troops. The situation there is quite complicated and interaction with representatives of government agencies is impossible. It is almost impossible to register new cases, as they are quite difficult to isolate due to the constant problems that arise in connection with the occupation. Currently, most complaints come from clients who have tuberculosis and need the necessary treatment.

The humanitarian situation in Kherson is difficult. Due to the occupation, there is no medicine in the region and no state control and law enforcement agencies, which has led to a rapid increase in crime. Many people are forced to live in unsuitable living spaces. Constant communication outages, the inability to recover lost documents and the presence of a large number of russian military personnel in the city led to people being afraid to move on the streets during the first months of the occupation, rather than seeking help from any organization.

Despite this, there were constant reports of violations of the rights of individuals to receive medical care, particularly among patients with tuberculosis. In order to respond to violations and support clients, meetings are held with volunteers, who, in turn, disseminate information in their chats about where to go for help. To date, the first and foremost is maximum safety. It is becoming more and more difficult to work every day. If earlier people used to talk about human rights violations, today they ask for help with hygiene products and food.

In the Kharkivska oblast, most of the documentators went to other regions of Ukraine due to the impossibility of permanent stay in the combat zone. Unfortunately, in the first months of the war, all contact with customers and partners was lost. For the most part, all documentators are currently volunteering and seeking various resources to support local communities.

Since the beginning of the war, the Lvivska oblast has faced the need to organize the reception of IDPs from all over Ukraine. This, in turn, significantly increased the number of people from key groups who needed help and support. The people who came were very different. In a state of stress, they reacted sharply to any unforeseen situations, and therefore needed proper attention and prompt response to their requests. Nevertheless, there are noticeable changes in the attitude of government officials of various orientations to people, especially at the beginning of the war. Despite the fact that there is enough work and enough regrettable cases, there is more understanding in solving issues.

As before the war, at the heart of the work of REAct are human rights. Most attention is currently being paid to ensuring that the work of the Project yields a quick and concrete result, because, as the war has shown, time is the most valuable resource. Therefore, we believe in our strength and go together to Victory!

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Response stories

Stigma in a medical institution due to HIV status

Oksana faced stigma and discrimination from health care staff and denial of medical care. The woman suffered a leg injury and sought medical help at a regular polyclinic for an appointment with a surgeon, where she was denied help when a health worker learned that she was a drug addict and had HIV-positive status.

The doctor said to go to “her hospital”, where everyone is as clumsy and contagious as she is because they don’t have time to take care of everyone here, especially since she has HIV and has to be treated in an infectious disease hospital.

Oksana turned for help to the paralegal of the All-Ukrainian Association of Drug-Addicted Women “VONA”, a documentator of the REAct project, who took the situation under support.

The next day, the paralegal helped the woman and referred her to a friendly local hospital, to the surgical ward, where the woman was examined by a surgeon and prescribed treatment.

In the case of stigmatization and discrimination, non-provision of medical care to the patient, a complaint was filed with the management of the HCF against the surgeon’s actions regarding the violation of the right to medical care. Based on the results of the complaint, a decision was made to discipline the doctor and a reprimand was issued for failing to provide proper medical care. The doctor was also instructed to undergo a training course to overcome stigma and discrimination.

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Lawyer’s advice Useful materials

Features of the organization of social services during martial law

On December 24, 2022, Russia carried out a military attack on our state. In response to the beginning of the war, the Decree of the President of Ukraine of 24.12.2022 № 64/2022 imposed martial law in Ukraine. In connection with the hostilities, there was a question of citizens receiving social services from the local governments in emergencies.

According to the Law of Ukraine “On Social Services”, one of the factors that can cause difficult life circumstances is the damage caused by hostilities, armed conflict, or temporary occupation.

According to the law, in martial law, if it is impossible to apply the general order of organization and provision of social services, social services must be provided urgently (in crisis). This organization of work ensures prompt decision-making on the provision of social services during an emergency.

Various social services can be provided in crisis – case management, home care, inpatient care, asylum, counseling, social support for families in difficult life circumstances, and others.

To assist in the provision of services to citizens by social services of local governments, the Ministry of Social Policy of Ukraine has developed guidelines for the organization of social services under martial law.

Let’s look at how this affected the receipt of social assistance and services.

According to Article 18 of the Law of Ukraine “On Social Services”, in the case of providing social services emergency (in crisis), case management is not applied.

That is, it does not require mandatory social services:

  • analysis of the application/request of a person for the provision of social services, notification of persons/families who are in difficult life circumstances or situations,
  • assessment of the needs of the individual/family in social services,
  • decision-making on the provision of social services taking into account the individual needs of the person/family,
  • development of an individual plan for the provision of social services;
  • concluding an agreement on the provision of social services;
  • execution of the agreement on the provision of social services and the individual plan for the provision of social services;
  • monitoring the provision of social services and assessing their quality.

The decision to provide or refuse to provide social services urgently (in crisis) must be made by social services immediately, not later than one day from the date of receipt of the relevant application, appeal, or notification.

In order to speed up the provision of social services to local governments, it is recommended to give the right to decide on the provision of services directly to providers of such services (social service centers, etc.) with further informing local governments about their provision.

Social services for the period of martial law should be provided by social assistance departments of local authorities:

  • home care (assistance in self-service, housekeeping (purchase and delivery of food, medicine, and other goods, cooking, cleaning, payment of utility bills), in the organization of interaction with other professionals and services (call a doctor, utility workers, transport services, etc.); psychological support; information and representation of interests);
  • counseling (assistance in analyzing the life situation, identifying the main problems, ways to solve them, drawing up a plan for overcoming a difficult life situation; psychological counseling);
  • in-kind assistance (provision of food, personal hygiene items, sanitary facilities and care, clothing, footwear, and other essentials);
  • social support for families/people in difficult life circumstances (counseling, regular meetings, or visits to the social service recipient to monitor the implementation of tasks aimed at solving the difficult life situation of the social service recipient; assistance in understanding the importance of actions and/or skills development manage them, training and development of social skills, skills of upbringing and care for children, household management, counseling, psychological support;)
  • representation of interests (negotiation on behalf of the recipient of social services on his behalf; assistance in registration or renewal of documents; assistance in providing access to resources and services at the place of residence/stay, establishing links with other professionals, services, organizations, enterprises, bodies, institutions, establishments, etc.)
  • informing (providing information on social protection).

Potential recipients of social services include the following vulnerable groups:

  • persons/children with disabilities;
  • lonely elderly people, low mobility persons;
  • internally displaced persons (IDPs);
  • families/individuals with low-income and single status;
  • foster families.

Payment of housing assistance to internally displaced persons According to the law, the status of an internally displaced person is established for every person, including a child.

According to the resolution of the Cabinet of Ministers of Ukraine dated 20.03.2022 № 332 internally displaced persons are provided with housing assistance in the amount of:

  • for people with disabilities and children – 3000 UAH per month;
  • for others – 2000 UAH per month.

From May 2022, residence assistance is provided to internally displaced persons:

  • who moved from the territory of territorial communities located in the area of military (combat) operations;
  • who moved from the territory of territorial communities under temporary occupation, encirclement (blockade);
  • whose housing was destroyed or unfit for habitation due to damage and who submitted an application for compensation for relevant losses by May 20, 2022, in particular through the Unified State Web Portal of Electronic Services or subject to documentary evidence from local governments of damage/destruction of real estate combat operations.

Internally displaced persons who have returned to their place of residence but have their homes destroyed will continue to receive housing benefits.

The list of territorial communities located in the area of the military (combat) operations or under temporary occupation, encirclement (blockade) approved by the order of the Ministry of Reintegration of the temporarily occupied territories of Ukraine № 75 of 25.04.2022 (as amended).

The list is not a fixed document – it is regularly updated. You can also view current information on the status of communities on the digital map at https://map.edopomoga.gov.ua/

Categories
Response stories

Refusal to provide temporary housing to an HIV-positive person

After the start of a full-scale war in Ukraine, the city of Ivan was occupied. The man was forced to move to the Kirovograd region to his relatives. There he received the status of an internally displaced person (IDP).

He was later offered a job in Kryvyi Rih, but Ivan did not have the funds to rent housing. Therefore, the man decided to turn to a local organization that deals with the selection of free housing for IDPs. During the conversation, he asked that the dormitory where he would be accommodated was near the hospital. After all, Ivan needs to receive ART regularly. After that, the employee of the organization replied that he would not be able to provide the necessary services because the man was allegedly registered as an IDP in another area.

Ivan then turned to the REAct documentator, who provided legal advice on the incident, explained the intricacies of obtaining services for IDPs, and helped draft a complaint against the employee of the organization. On the same day, together with the documentator, Ivan visited an institution where the man was provided with temporary housing despite his place of registration as an IDP.

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Psychologist's advice Useful materials

Separation from a child due to war

Since the beginning of the war, many people have been forced to leave their homes and separate from their families. Some parents had no choice but to send their children to a safer place abroad and stay in Ukraine to continue working.

How to be in such cases?

  • Be an example to your child, especially at a distance. The emotional state of the parents is easily transmitted to the child.
  • Tell the children what is happening in Ukraine, but do not make false promises to return home soon. The road to victory can be long.
  • Talk about the emotions together. This will help to cope with stress and reduce anxiety.
  • Spend time together. If you can communicate via video, try doing something together, such as making breakfast. There are also programs for sharing movies at a distance. It is the support of parents that can help a child develop psychological resilience.

Try not to lose touch with the child, communicate, talk about the day’s events, and provide support, even if it is virtual.

The important thing to remember is that every day brings us closer to victory, so we will soon be able to hug our loved ones and be safe.

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Response stories

Assistance during the war

Oleg was forced to leave his home due to Russian aggression in Ukraine and move to Prykarpattia. There he was temporarily placed in a communal facility, along with many other people, as an internally displaced person.

In addition, Oleg is a person with a disability and an HIV-positive drug user. When the man was forced to change his place of residence, he firmly decided that he wanted to change his life for the better, get rid of this terrible addiction, start receiving ART and, if possible, go abroad. To do this, the man tried to join the program of OST but was refused.

Despite this, Oleg did not give up and decided that he would go to receive treatment for HIV. However, new challenges have arisen here as well – incomprehensible “extracts” from the military registration and enlistment office are needed. The man then appealed to the military registration and enlistment office with a request to deregister him as an HIV-infected consumer of psychoactive substances in order to go abroad for treatment. Oleg was again denied, saying that the military registration and enlistment office could not remove him from the military register, but they were ready to provide a “deferment” for treatment for two months.

To get help, Oleg turned, on the recommendation of a friend, to the representative of the Charitable Foundation “Volna” in the region, the documentator of the REAct project. After all, he did not understand what to do next.

The documentator listened carefully to Oleg’s case, reviewed the documents, and provided initial advice. On the same day, the client was escorted to the regional drug dispensary. And in a few days – to the AIDS center – to conduct relevant examinations and tests. Thanks to the assistance and support of the documentator in medical institutions, Oleg was put on the appropriate records, after which he received OST and ART as soon as possible.

However, this did not solve the difficult financial situation of the client, who agreed to start searching for work. Therefore, for a start, Oleg was provided with food and financial support. The documentator, in turn, continued his job search for Oleg and, who was soon hired as a social worker at the CF “Zahid Shans”.

To support Oleg and improve his living conditions, with the assistance of a documentator, the ICF “Alliance for Public Health” paid for the man’s stay in the apartment for the first three months.

In connection with the recent events, Oleg decided not to leave Ukraine but instead began to help people who found themselves in difficult life circumstances.

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Psychologist's advice Useful materials

How does war affect sex life?

A reproductive function may be impaired during life-threatening events. For example, women often lose their periods.

But another reaction is also possible – hypersexuality. It may be based on an evolutionary mechanism – the desire to leave offspring at risk of death. Sex is also used as a way to regain control, get pleasant emotions, and relax.

Due to constant stress and uncertainty, prolonged lack of sleep, depression, and taking certain medications libido might be reduced. Women have difficulty arousing and reaching orgasm, and men – have premature ejaculation and lack of erection.

Thoughts about “how I can have sex when others die” can also cause a decrease in sexual desire.

If lovers have not seen each other for a long time, then after the first meeting, the sexual life that was once usual may not return immediately. After long-term abstinence, there are difficulties in achieving an erection for men, and orgasm – for women.

This is normal, don’t worry. Sexual function will be restored after a while, and before that think about how to express your feelings differently.

Information about rape can cause increased anxiety, disgust toward the partner, and unwillingness to be close. You can identify yourself with the victims, and then the excitement will be frightening.

It is very important to talk to your partner about your feelings. This will give him the understanding that your reluctance to have sex is not because of him. If this condition persists for a long time, you should work out these feelings of disgust, fear, or shame with a specialist.

During the war, interpersonal conflicts intensify. Excessive expectations from a partner, inability to delineate one’s boundaries, different views on the need to evacuate/stay in the shelter – all this leads to mutual resentment and frustration, which, in turn, negatively affects libido.

It is important to remember that intimacy in a relationship can be maintained through hugs, kisses, and kind words.

Whether or not to have sex during the war, the regularity of sex is your couple’s decision. You have the right to have sex as well as to pause. Always talk to each other about your feelings, find words of support, remind yourself how important your loved one is to you, and find the formula of intimacy that suits both of you. And, of course, never forget to use a condom – your reliable helper and protector.

Categories
Response stories

Refusal to perform surgery due to drug addiction

Eugene belongs to the category of injecting drug users. In addition, the man has comorbidities that in the complex led to the appearance of trophic ulcers on the legs. He does not have a large income, that’s why he is not able to apply to private medical institutions, so first of all the man turned to the state medical institution for surgery.

Before the surgery, Eugene underwent a full medical examination, but at this stage, he began to have problems: the man was ignored in the hospital, refused to be placed in the ward, and was allocated a bed in the hallway. As the client himself is convinced, such actions of medical workers were the result of doctors learning about his addiction, and from that moment they stopped paying attention to the patient. As a result, he was discharged from the hospital without surgery.

For help, the man turned to the REAct documentator because he lost the ability to move and did not understand how to proceed. As a result, the man was escorted to a military hospital for surgery. During the operation, doctors were forced to amputate one foot. Eugene was provided with free transportation to visit the medical facility after the surgery. The man quickly went through the rehabilitation process, received crutches for free, and will soon be on the OST program. Today his life is not in danger.

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Psychologist's advice Useful materials

12 habits that increase anxiety

First of all, it is worth noting that there are two similar emotions that are often confused – anxiety and fear. However, if you dig deeper, they differ significantly. Fear is what we feel right now as a reaction to ongoing events, while anxiety is about events in the past or future that we are transferring to the present moment.

We are used to saying that fear, anger, or anxiety are negative emotions, something bad. However, in fact, these are normal feelings, they are important and useful for a person, like any others. Until the moment when a person is completely immersed in this anxiety, it becomes difficult for him to switch from thoughts about the past or future to the present moment when he stops noticing that he is really in a safe place and there is no threat. This is how anxiety arises.

The following 12 habits are common among anxiety sufferers. It is not an easy task to change habits that are with you throughout life, but it is worth the effort.

  1. Skipping meals

Skipping meals causes hypoglycemia (when blood sugar falls below normal levels), which can lead to common anxiety symptoms such as irritability, nervousness, dizziness, and weakness.

  1. Cravings for sweets

Sugar can temporarily depress an area of the brain normally active during times of anxiety, stopping the release of the stress hormone (cortisol). Therefore, we can feel relief from anxiety when we eat something sweet. But scientific research suggests that sugar consumption increases anxiety and reactivity to stress, leading to more anxiety.

  1. Bad eating habits

Unhealthy eating habits can have a big impact on the intake of essential nutrients: carbohydrates, proteins, essential fatty acids, vitamins, and minerals that are essential for mental health and nervous system function. Certain nutrient deficiencies (B vitamins, vitamin C and E, magnesium, selenium, and omega-3 fatty acids) can affect mood and anxiety levels.

  1. Unsportsmanlike lifestyle

Your body is designed to move, and some body functions depend on physiological movement. If you sit all day and don’t exercise, your physical and mental health is bound to suffer.

  1. Constantly watching the news

Anxiety is characterized by excessive worry and fear, and watching the news can exacerbate this problem, leaving a depressed mood and anxiety. While it’s especially important to be aware of what’s happening in the country right now, watching or reading the news in the morning can set an alarming tone for the day, while negative images and words before bed can affect the quality of sleep. If possible, avoid reading the news first thing in the morning and last thing before bed.

  1. Ignoring the state of anxiety

Your anxiety is a signal that tries to indicate that you need to work on something or change something. If you ignore this signal, the condition will only get worse.

  1. Caffeine intake

Caffeine is the main anxiety trigger. This link between caffeine and anxiety is not obvious because we temporarily feel good after consumption and only feel the disturbing effects after a few hours.

Start drinking a variety of herbal teas. The best teas for anxiety are chamomile, valerian root, and oat straw.

  1. Binge eating and fast food

Very often, when preparing fast food, chemical ingredients and additives are used. These ingredients may contribute to anxiety while lowering mood and social behavior. The worst culprits are artificial sweeteners, colors, and flavor enhancers.

  1. Insufficient water intake

Dehydration puts stress on your body, and when your body is under stress, you may experience general symptoms of anxiety.

Drink more water throughout the day to stay hydrated.

  1. Drinking alcohol

Alcohol increases anxiety levels for several hours after drinking. As the alcohol begins to fade, the person feels more anxious, tired, and depressed than before the alcohol was consumed.

  1. Lack of sleep

Lack of sleep increases the appearance of negative thoughts, significantly increases the level of anxiety, and reduces control.

  1. Comparing yourself to others

When you do this every day, you will have a bad mood and negative thoughts that lead to anxiety. In addition, we tend to focus on someone’s best features, comparing them to our weaknesses.

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News

OST Patient Certificate – What is it and how to get it?

In 2021, the REAct system recorded 22% of cases of violations of OST patients’ rights. Violations usually concerned illegal searches and police detention of clients who had OST medications for self-reception.
Although OST patients usually have documents proving the legality of obtaining the necessary drugs with them, this information is often insufficient for police officers. In such cases, they can call the medical facility to find out if the person is really a patient of the Program, or forcibly take him to the police station to further determine the reasons for the person’s drug findings.
To reduce the reasons for such situations between OST patients and police officers, the REAct project team initiated the widespread introduction of an appropriate advocacy mechanism.
Currently, our colleagues from ICF “Alliance for Public Health” are actively lobbying for amendments to the legal act governing the implementation of the OST program – Order of the Ministry of Health of Ukraine from 27.03.2012 № 200 “On approval of the Procedure for substitution maintenance therapy for people with mental and behavioral disorders due to opioid use”, to provide OST patients with appropriate certificates of program participants. As a result of such work, a pilot phase was agreed upon by the relevant group at the Ministry of Health in February this year.
As of May 2022, partners of the ICF “Alliance for Public Health” have already begun to receive forms of “OST Patient Certificate” for further issuance to interested patients who receive drugs for self-reception for up to 30 days.
The forms also include the OST Patient’s Note, which contains an algorithm for the patient’s actions in various situations.
Those wishing to obtain a certain number of copies of the OST Patient Certificate should fill out the form at: https://forms.gle/an1ybF1PZeYe6bUe8.
We remind you that we are currently collecting real needs to decide on the next edition.
The deadline for applications is May 15, 2022.

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News

Implementation of the REAct system during the war in Ukraine

The full-scale war on the part of the Russian Federation (RF) in Ukraine on February 24, 2022, significantly affected the implementation of the REAct system. In particular, it affected the work of documentaries in the regions, mechanisms of interaction with clients, customer needs, and the implementation of the appropriate response. An additional category of people has emerged in the REAct system as a risk group assisted by the Project – refugees, which include both internally displaced persons (IDPs) and those who have been forced to move abroad.


Prior to the armed aggression, the REAct project operated in 18 regions of the country. However, so far some of the documentaries from the most dangerous regions have had to travel to other cities in Ukraine or abroad. Among them are most documentaries and coordinators of Mykolaiv, Kharkiv, Kyiv, Chernihiv, and Zaporizhia regions. Some continue to stay in Ukraine and serve in the Armed Forces of Ukraine or the Territorial Defense, some volunteer, help internally displaced persons, and accompany humanitarian aid.

Kharkiv. Photo: Alex Lourie

Currently, most clients’ inquiries concern the inability to receive vital treatment in time, or obstacles to obtaining it at a new location (SMT, ART, anti-TB drugs), issues of recovery/conclusion of declarations with a family doctor, difficulties in obtaining temporary housing, the need for an evacuation from the hottest spots, barriers to receiving other services against the background of temporary job loss.


Interaction with clients is mostly online and by phone, but the working hours of documentaries have increased during the day. In urgent cases of clients and due to the limitations of martial law, in some cases, there is also direct support for the client in resolving his case. Documentaries point out some circumstances that sometimes complicate or prolong the process of resolving clients’ cases. Among them: reduced time for receiving specialists in social services and hospitals, temporary cessation of services to individual specialists and institutions, and re-profiling the activities of partner organizations.


Starting from March 3, 2022, Kherson is under blockade by Russian troops with all the logical consequences: lack of supply of food and medicine, the danger of movement in the city, inability to move around the region, power outages, and Internet communications. Currently, all work of REAct documentaries in this area is carried out exclusively remotely. Among the services provided: are psychological support, initial legal advice, and social support. Due to the remote format of the work, it is currently not possible to provide assistance to applicants in cases of humanitarian need, namely food or essential medicines.

“Due to frequent shelling and poor quality or sometimes no communication at all, it is not always possible to provide assistance and therefore the applicant’s situation may worsen”, – said Kutsenko Volodymyr, coordinator in the Kherson region.

At the level of Kherson oblast, the work of representatives of state institutions with key groups is completely absent due to the occupation and blockade of settlements in the region. However, in the city, the work continues in an active and effective format.


The number of appeals from citizens has increased significantly since the beginning of the war in the Kherson region. This applies to all categories of the population without exception. Appeals are usually made on issues such as the need for food; the need to purchase drugs, undergo treatment; psychological support; social benefits; the possibility of evacuation; compensation for damage caused in connection with the start of full-scale hostilities, and armed aggression directly in the Kherson region.


Currently, due to a lack of communication, it is not possible to obtain information on the status of the Project in Chernihiv. However, it is known that a number of documentaries left the city and went abroad.


In the Kyiv region, the work was adapted to the real conditions of the war. Clients turn to documentaries by phone or messenger. Cases of violation of rights are resolved through consultations, referral of clients to friendly specialists, and sending appropriate letters to government agencies.

“It is difficult to work in these conditions because the laws of war are in force. In some cases, human rights are restricted, as is the order in which cases of violations of rights are resolved, as priority is given to violations of the customs of war. Therefore, some cases that need to be resolved at the state level have been postponed until better times”, – said Ivan Viktorov, coordinator in Kyiv region.

Kyiv. Photo: Sergey Korovayny

Due to the occupation and blockade of Melitopol by Russian troops and the difficult situation in Zaporizhia, interaction with customers in these cities is also remote. Many appeals are received regarding access to ART, anti-tuberculosis treatment, SMT. However, representatives of public organizations try to meet the needs of clients in treatment by delivering drugs to patients and transporting patients to appropriate medical facilities. We also managed to establish cooperation with volunteers, through whom humanitarian aid is received and provided to Project clients.


In Odesa Oblast, documentaries noted that the war did not critically affect the Project work. NGOs continue to operate, with most social workers on site. Work in the Odessa region, as in other regions, is carried out mainly by telephone, calls are now received throughout the day and night. Personal meetings with clients and doctors are carried out as needed according to the situation in the city, due to restrictions on movement and changes in the schedule of sites. Clients are interested in whether the SMT will work, where to get ART, how to go abroad, and where to get treatment in another country. Currently, there is a problem with the drug in Odesa oblast (patients have had their dosages reduced), private websites have closed, and the state has been unable to accept new patients.


In Kryvyi Rih, some program activities of partner NGOs have been suspended to assist key groups in coordinating evacuations and meeting their urgent needs, including humanitarian aid. Most documentaries noted that the war made significant adjustments to the rhythm of life. However, some issues began to be addressed more quickly, and clients applying for the Project’s services became more responsible. The format of work and provision of services to the clients of the Project remained almost unchanged. In addition, the documentaries noted that war disciplines and awakens humanity. For example, the number of cases related to stigma and discrimination against PWUD, SP, MSM, and PLHIV by health workers has decreased.


In Ternopil there is anxiety and depression among both the team and customers. Most often, there are appeals from SMT clients (mostly from Kyiv) who received drugs at their own expense, and now doctors in Ternopil do not want to accept them for government programs and send them to other regions, explaining that their clients do not have enough drugs.

“In such a difficult time, we want to pay full and as much attention as possible to everyone who asks for help and to be useful. The priority is just a kind word and a friendly attitude to those who need it”, – Kozaretska Tetyana, coordinator in Ternopil region.

In the Ivano-Frankivsk region, work has increased much since the beginning of the war due to the provision of services to people who have been forced to leave their homes and currently live in the region. All work went into 24/7 mode. There are various requests from community representatives: from requests for food and medicine to consultations on going abroad and receiving ART or SMT both abroad and in the region. If the cases occur in other oblasts or districts, they try to refer the person to social workers nearby and provide telephone consultations. In addition to the main work of support and assistance to clients, the work today is very similar to the work of hotlines or counseling centers. The documentaries note that communication with government agencies in Ivano-Frankivsk Oblast has deteriorated as many structures have now become focal points for IDPs. But doctors are understanding, trying to help more than before.


“The last case was addressed by a drug addict, who, according to him, was in Kyiv on the paid SMT website, and he does not know whether he was registered at all, in our region he was immediately accepted for the program,” said Svitlana Demyanchuk, coordinator in Ivano-Frankivsk. Frankivsk region.


Quite often in Ivano-Frankivsk oblast, there are complaints about violations of citizens’ rights regarding forced mobilization of HIV-infected and drug addicts to the Armed Forces of Ukraine; committing domestic violence against women living with HIV; failure to provide SMT in penitentiary institutions. Complaints are received from IDPs alleging that CNAP staff do not apply for monthly payments to adults and children when registering and obtaining an IDP certificate.


Despite the difficult working conditions today, the regional coordinators note that attention is paid to all people who seek help. It is important to organize work in detail in all directions in order to keep people alive, although sometimes it is very difficult to create safe conditions. It helps to support a large number of friends, colleagues, acquaintances, experts and volunteers in various fields. The work of the Project is currently very relevant and is in great demand among both clients in the region and among IDPs. Due to the high percentage of population migration, documentarians have to perform many additional functions.

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News

Assistance to Ukrainian refugees in terms of war

On February 24, 2022, Russia carried out a full-scale invasion of the territory of Ukraine along the entire borderline, both from the Russian Federation and from the Republic of Belarus.

The Russian invasion is accompanied by such brutal war crimes as the shelling of evacuation corridors and humanitarian convoys, the bombing of peaceful neighborhoods, residential buildings, hospitals, and other infrastructure buildings, etc. In this regard, about 3 million Ukrainians were forced to leave their homes and go abroad to seek salvation.

It is in such difficult times that the work of the REAct project becomes even more necessary and in demand. Based on today’s conditions, we managed to quickly reformat the system of work of the REActors and partially change the scope of assistance to Ukrainians for their further protection.

Every Ukrainian who was forced to leave the country, and not just representatives of the HIV and TB communities, can report a violation of their rights and receive free assistance.

We have created a group of specialists who will be able to remotely assist or advise Ukrainians on the protection of human rights abroad as soon as possible. These issues include violence, human trafficking, stigma and discrimination, denial of services, etc.

One can report a violation and get free help by leaving a message in one of the REAct chatbots, updated in accordance with the conditions which each of us suffers today.

In addition to Ukraine, other countries that implement the REAct tool have also rebuilt their system of work. Among such countries are Moldova, Georgia, Kyrgyzstan, Uzbekistan, and Tajikistan. Moldova has already begun to document cases not only of its own citizens but cases of violation of the rights of Ukrainians on its territory. To this end, we have adapted the REAct database, adding new fields and questions that provide further qualitative documentation and analysis of the specifics of human rights violations among refugees who ended up in countries of influence of the REAct system.

Such international cooperation allows one to get not only remote assistance but also rapid response and provision of services on the ground. In addition, such a system allows the REActors to work together and find the most optimal ways to solve the problems of Ukrainian refugees as soon as possible.

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Response stories

Discrimination in hospital due to HIV status

In early November, Oksana got a fever and had trouble breathing. After a week of this condition, she decided to take a test for COVID-19, but the result was negative. The girl lay in this state at home for a week. Despite taking a bunch of drugs, her condition became worse and worse.

An ambulance was called and the client was taken to a local hospital. After a CT scan, the doctor diagnosed her with pleurisy and left her to continue treatment. A few days passed and the doctor found out that Oksana had HIV-positive status.

The man came to the girl’s ward and told her to pack up and go to “her” hospital for treatment, where everyone with HIV status is examined. The client explained that there is no such hospital, so she has nowhere to go.

No arguments and pleas convinced the doctor. With a high temperature, he put Oksana outside the door. The girl called the REAct documentary and she arrived at the hospital. The head of the department was categorical and told the staff of the department to discharge the client from the hospital because she was HIV-positive. Thus revealing her status to all patients of the ward and others.

After that, the documentary of the Project wrote a complaint to the chief physician of this medical institution and called the hotline of the Ministry of Health, leaving an oral complaint about this case. Then Oksana was referred to friendly doctors in another hospital, where the girl arrives to this day.

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Response stories

Disclosure of the child’s HIV status

A PLHIV turned to the REActor for advice and a request to help resolve the current situation in relation to her minor daughter, who also has an HIV-positive status.

The woman and her daughter came to their family doctor in order to draw up medical documents for the child to visit a holiday camp. The doctor completed the necessary documents and gave them to the woman, on the title page of which the client saw the inscription “B-20”, which means that the owner of this document is PLHIV.

The woman asked the medical worker to take away the inscription since it is a disclosure of HIV – the status of a child and is considered an offense. However, the doctor refused to do so.

The client turned to the employees of a friendly NGO to help her resolve the situation. The social worker of the organization, together with the client, went to the family doctor, where the documenter held an explanatory conversation with the medical worker, spoke about the criminal liability for her actions and about the regulations that the doctor violates. After that, the inscription on the child’s document disappeared and the social worker secured the doctor’s promise that such situations would not happen again.

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Lawyer’s advice Useful materials

Forms of Medical Care Delivery in Detention and Prison Settings

To further explore the subject of medical care for prisoners, let us review the specific forms of medical care that should be made available to incarcerated individuals as well as the particular requirements that the administrations of correctional facilities of the State Penitentiary Service of Ukraine (SPS) are obligated to comply with to make sure that relevant arrangements are in place.

Mandatory preventive health assessment of prisoners.

With a view to detecting and preventing the spread of infectious diseases, as well as identifying general medical conditions and mental disorders among incarcerated individuals held in SPS correctional facilities, inmates must undergo an annual preventive health assessment, whereas juvenile (minor) detainees and prisoners held in cell-type settings have to undergo such an assessment on a biannual basis. 

The following physicians have to be involved and take part in a preventive health assessment: 

– general internist (or general practitioner/family doctor); 

– psychiatrist; 

– dentist. 

If there are no such specialists available in the medical unit of the correctional facility concerned, they have to be procured by the correctional facility’s administration from SPS-controlled or other health care facilities. 

Outpatient medical care for prisoners. 

Outpatient medical care for incarcerated individuals should be provided by the designated medical worker of the correctional facility daily during the hours scheduled by the head of the medical unit (paramedic station) and approved by the facility’s administration. Escorted by a correctional officer, inmates who have been prescribed outpatient treatment have to report to the medical unit for their medications and other procedures during scheduled times during the day. Normally, prisoners have to take their medicines in the medical unit as prescribed by the doctor and under the supervision of a paramedic (physician assistant). However, if, based on medical needs, these medications are supposed to be taken around the clock, the dispensed medications must be handed over to the prisoner. 

Inpatient medical care for prisoners

Incarcerated individuals might need hospital care from the medical unit for the following purposes: 

– health assessment and treatment of prisoners in need of inpatient care for up to 30 days; 

– medically necessary inpatient treatment of prisoners discharged from SPS-controlled or other health care facilities; 

– temporary isolation in the infirmary (isolation ward) of the medical unit for infected or suspected patients before referral to a specialist hospital; 

– inpatient treatment of non-transportable cases until their condition becomes stable before referral to a SPS-controlled or other health care facility. 

During the stay in the hospital section of the medical unit, incarcerated individuals must be examined and evaluated based on their existing medical condition across all instrumental and laboratory research options available in the medical unit concerned. 

Referrals to healthcare facilities for hospitalization shall be provided to any prisoners who have become ill or experienced an acute exacerbation of the chronic disease, which requires inpatient treatment in SPS-controlled health care facilities (or, if services are unavailable and under a certain set of circumstances, said patients can be referred to general-public health care facilities), including situations when some additional examinations needed cannot be performed by SPS health care facilities (if they are outside of the scope pre-determined and require equipment, laboratories, or medical care other than that available on site).

Emergency medical care for individuals detained or sentenced to imprisonment is provided by the medical staff of the relevant SPS-controlled health care facility, or, if it is impossible to ensure the full scope of services needed, by the emergency (ambulance) team of the center for emergency medical services located in the administrative division (geographic area) where the correctional facility or pre-trial detention center is situated. 

The administration of the correctional facility or pre-trial detention center where the inmate concerned is held shall be obligated to immediately summon an emergency ambulance if required and requested by the medical worker of the SPS-controlled health care facility. 

If the emergency ambulance crew should decide that a prisoner needs to be hospitalized, they will be transported to the relevant health care facility by the ambulance crew concerned. In this case, the administration of the correctional facility or pre-trial detention center in question must put in place and ensure appropriate guarding and security arrangements.