Categories
Response stories

Violation of the rights of a convict with TB

Igor asked the REAct documentator to help in receiving treatment and transportation to a specialized medical institution at the Department of Corrections. The man explained that the administration of the colony keeps him with healthy convicts, despite the open form of tuberculosis and does not provide any treatment. Igor has not been transferred to a specialized medical institution for three months, explaining that they are waiting for an order from Kyiv because of COVID-19.

The project documentator together with the man filed several complaints to the Commissioner for Human Rights of the Verkhovna Rada of Ukraine and made a number of telephone calls to the Government Hotline and the Hotline of the Ministry of Health of Ukraine. After that, the convict was transported to a specialized medical institution for TB treatment.

Categories
Psychologist's advice Useful materials

Recovering from codependence

Recovery from codependence is not an event; it is a process demanding time and effort. Recovery will not occur automatically only because your addicted close person has sobered up, you divorced, or he died. As it takes time to become codependent, it also takes time to recover.

The main challenge is that in most cases codependent people do not want to get rid of the unpleasant feelings; instead, they want the person who, they believe, causes the unpleasant feelings, to change their behavior. In other words, they are not willing to change themselves but demand this from their chemically addicted relatives. 

Usually, the attempts to intervene encounter denial, resistance, and sabotage of the codependent person. In addition, the resistance and treatment sabotage are more aggressive with codependence.

Challenges begin with answering the “What should I do?” question. Actually, most often the clients asking this question, already know the answer and merely want to get “approval” to act according to their own decisions. If the provided recommendations do not meet their action plan, a conflict arises.

What do the codependent clients want when they seek help?

Most often they ask for help because they are desperate, incapable, and absolutely unable to cope with their addicted relative on their own. 

Since we deal with adult people, the wording “please do something about him” excludes the possibility to help. Who can do anything with a grown-up person against his or her will and what? 

Very often the root of the problem is that people suffering from other people’s conduct, do not even try to resist. Or they try but abandon further attempts after the first failure.

Usually, when radical solutions are proposed to change the catastrophic situation (relocation, reporting to the law-enforcement authorities, isolation of the sick person), codependent people feel offended and reject such proposals, opting for routine suffering. But nothing will change unless you do not try to change anything!

The request of the relatives of an addicted person should be worded like this: “Treat him to stop him bullying us, protect us from him.” This is also supported by the fact that the lion’s share of codependent people’s calls “for help” sound like this: “Could you take him away and lock him somewhere?” This is rather a prison than treatment!

Treatment is a long process, and the end result may never be achieved. The relatives of the chemically addicted person must take the responsibility for their own lives and live the lives they choose, not the lives imposed on them by the addicted person.

Sometimes chemically addicted people are quite well socialized: they may have jobs, care about their families or just live their own lives not bothering anyone. Their relatives may respond differently: some tolerate and accept the circumstances; others keep trying to change the situation. In such cases, it is not the harm caused by the addicted person to codependent people but the way they harm themselves that makes codependent people suffer. These people need other help than described above.

Such clients seek solutions how to cope with pain, desperation, fear, and depressions caused by the chemical addiction of their loved ones, or, more precisely, by their unwillingness to do anything to stop ruining themselves. If the inquiry is formulated this way, help is possible – codependent people are asking to help them, not anyone else. The best help in case of such inquiry is support and friendly sympathy, avoiding any judgment, advice, teaching, and mentor tone. The wellbeing of the relatives of the addicted person changes dramatically when they realize that they are not alone, that hundreds and thousands of people share the same problem. Mutual assistance networks and communities and empathy and understanding of at least one person are incredible resources in this situation!

Thus, there are two types of codependent people seeking help, first asking “Do something about him”, the other one asking, “Do something about me”. The status may change if the codependent person looks at the problem from a different perspective, taking an active position in his or her own life.

The codependent person may gain this insight after realizing the vanity of all the attempts to influence the other person. This will give the codependent a chance to maintain what remains.

Psychological help to a person with the second type of codependence may be successful: help targets the codependent person, upon his or her consent and with his or her active involvement.

There is the third, “most dangerous” type of codependence. It includes people who made their codependence their lifestyle, and “saving” their relative – the purpose and the sense of their lives. Such patients keep saying that they need help, but they actually do not want it and actively reject any help. Their main message is “He/she will not survive without me!” Most often these are single mothers of grown-up sons, sometimes – wives who want to keep the status quo, whether they realize it or not. Ironically, such a situation has many benefits: the sense of own significance; understanding the purpose of own being; total occupation with a seemingly useful service; maintaining the feeling of own significance; the feeling of power; help from other people. The mutual benefit of such an alliance leaves no room for changes. The only possible solution is the complete end of the relationship but usually, this option is rejected by both parties.

Categories
Response stories

Violation of the rights of a sex worker

Olena, a sex worker, turned to the friendly organization. When she was standing at her workplace in the evening, a car stopped near the girl. The man got out, showed his police ID and started threatening to draw up a report on prostitution. The man later insisted that he would not file a report if the girl had sexual intercourse with him. When Olena refused and tried to call the police, the man resorted to physical violence and promised that if the police did arrive, the girl would be arrested for disobeying a police officer.

The REActor provided the girl with initial legal advice and referred her to a psychological support service. The paralegal consulted Olena about receiving payments based on her status as a single mother and provided an algorithm in case of illegal actions by the police.

Categories
News

Interruptions in OST drug supply and violation of rights of OST program clients. Interview with Ivan Viktorov, REAct Project coordinator in Kyiv Oblast.

In 2021, the REActors registered multiple cases of violation of the rights of OST program clients. Such violations included interruptions in essential drug supply and illegal detentions of OST program clients by law enforcement authorities. In January – November 2021, 379 OST program clients reported violations to the REAct system. 

On the International Solidarity Day commemorated on December 20, Ivan Viktorov, REAct coordinator in Kyiv oblast, tells about the difference in receiving OST in public and private OST sites, possible causes of interruptions in drug supply, their consequences for the clients of private OST sites, and about the role of non-governmental organizations in protecting the right of key populations to receiving vital treatment. 

  1. Receiving OST in public OST sites under OST program and in private facilities, for example, through pharmacies – what is the difference, advantages and risks for the clients? 

The difference is that the client receiving OST medication with a prescription in a pharmacy does not need to adhere to the schedule of issuing OST drugs, while the state program has certain requirements for the patient. According to the routine OST administration order, the client must visit the OST site at a scheduled time on scheduled days to pick up medications. Another possible mechanism is issuing OST drugs for self-administration for a 7–10-day period. But there are certain eligibility criteria, too: the client must be registered with a state OST program with a conventional OST drug administration schedule for no less than 3 months (in context of the quarantine; earlier this term was 6 months – editor’s comment). This requires the client’s physical presence at the OST site, limiting their free time. For example, for employed clients, this requires them to be absent from work, and the employer may find this an issue. Therefore, people buy prescriptions and pay for medications to live without certain obligations.

  1. How many clients are enrolled with state OST program and how many receive medications in private OST sites? What is the statistics in Kyiv? 

The statistics on public OST sites is available from Ukraine’s Center of Public Health website (as of 01.11.2021, 16 617 persons receive OST services in health facilities – editor’s comment); as for the private sites, I can only estimate: there are about 70 OST sites in Kyiv, each serving about 400 clients. So, the total number of private OST clients is about 20 000. One patient can be registered with several private OST sites. This increases the risk that these drugs are then privately sold. The private OST sites have no shared database to trace the clients already registered with the program. A patient comes to the site, pays, and gets the prescription.

  1. Which barriers do the clients face in receiving OST drugs from private sites?

Methadone is not always available in pharmacies, so the private OST sites cannot guarantee uninterrupted OST drug supply to the client. Pharmacies can also stir artificial price increase, meaning that later they will be able to sell more at higher prices. There were cases of closure of the OST sites and seizure of all documentation, including the patient’s personal data. Sometimes police officers sweep private OST sites, which does not usually harm the site, but for the patients, it is a risk of disclosure of diagnosis, personal data because often law enforcement officers seize medical documentation (logs, patient files).

  1. You mentioned instability of receiving OST drugs in private sites. What are the possible reasons for such situations? 

First of all, this could be done to transfer more patients to the governmental OST program. But there are several issues: for enrollment with the governmental OST program, the client must be registered in the internal OST client registration system, and this can prevent getting “a normal job”. Besides, the state program sets a number of requirements for the OST clients that I have already mentioned, and they may not be suitable for everyone. Some may be depressed because this may look like the so-called “drug addict” stigma. Interruptions in drug supply occur, as a rule, at the end of the year. There can be several reasons for it: the substances for OST drug manufacturing are procured at the end of the year due to the allocations; the untimely receipt of funds from regional communal enterprises “Pharmacia”; manufacturing of large quantities of drugs for the state order, including for exporting.

  1. Is there a mechanism to prevent such situations with treatment interruption due to delays in drug supplies to private OST sites?

No. The private sites cannot guarantee uninterrupted OST supply because no one traces such clients – they issue a prescription, take the money for the prescription, and that’s all. Only public OST sites guarantee their clients’ uninterrupted OST drugs administration, therefore there is no risk of treatment interruption and clients returning to illegal street drugs.

  1. What are the consequences faced by the OST clients if their drugs are unavailable in the private sites or their supply is delayed? 

If the drugs are unavailable in the pharmacy, people will go to the so-called “corner boys” (drug dealers – editor’s comment), but their price will be several times higher. If the addicted person has no money, he/she may commit a crime for the need of medications or go out to the street to get drugs, and this means overdose in 90% of cases. Unfortunately, a person can die in absence of timely care.

  1. If an OST client wants to shift to the state OST program, how soon can the client be enrolled? 

The government today is actively enrolling in the OST program; therefore, the client always has a choice of guaranteed provision of OST drugs. It takes a day to become an OST program client – you just need to bring your chest X-ray results. However, this may take longer, because much depends on the client’s will, how soon he/she agrees to enroll with the state program and the client’s commitment. Secondly, there is a certain procedure set forth in the regulations, according to which the patient must undergo the induction procedure (dose adjustment – editor’s comment). After that, the narcologist explains to the patient the need for the administration of such drugs and the motivation for uninterrupted intake, and then the client is administered OST. 

  1. What is the role of non-governmental organizations in supporting OST patients?

To begin with, there are no social workers in the private OST sites, and their presence is not envisaged. The role of NGOs is in counseling clients on transfer to the governmental program, referral and follow-up of such clients, working on treatment adherence. I believe this is a meaningful contribution. There is an OST Hotline operating in Ukraine where clients from all regions can call to report issues related to substitution maintenance therapy. In the beginning, such issues are quickly addressed by NGOs, then we approach public institutions in power to respond. NGOs take efforts in community mobilization and empowerment, initiate amendments to laws and regulations, but unsolved problems remain. For example, we keep writing about issues in the community, but we are unsure if our voice is heard in some public institutions. 

  1. What are the mechanisms of state control of receiving double quantities of OST drugs (from private OST sites and the governmental program)?

It is rather the responsibility of OST clients who get medications from private OST sites while being registered on the state program. However, if police find out this fact, such actions may qualify as the unlawful acquisition of drugs and their storage. This may have negative consequences for the client (there have been cases). In general, there are no mechanisms to trade duplications of OST receipt.

  1. In general, what are the cases of police violating the rights of OST clients? How are these cases resolved and in whose favor?

About half of all cases of abuses by police officers registered by REAct system in Kyiv oblast, involve OST clients. Police officers often abuse their official powers regarding OST patients, because they still consider them “drug addicts”. Most common violations include illegal detention, police searches, narcological examinations (sometimes forced), seizure of OST drugs, solicitation of money for alleged non-initiation of criminal proceedings. This is despite the fact that the patients did not breach the law, they had absolutely legal prescription for OST drugs. Partner NGOs immediately respond to such cases which more often are resolved in favor of the patient. Our friendly organizations have highly qualified professionals on staff who have been working with key populations for years and know how to act in different situations. To raise awareness of police authorities in working with key populations, training modules are conducted with the support of the International Charitable Fund “Public Health Alliance” and other partner organizations. The training participants are presented data about violations of rights of key populations collected through REAct. 

Acknowledgments to:

Ivan Viktorov, REAct Project Coordinator in Kyiv Oblast 

Svitlana Tkalia, President, Charity Fund “Hope and Trust”, a REActor

Categories
Response stories

Stigma in the maternity hospital due to HIV status

Oksana is a member of the community of people living with HIV. During her pregnancy, she signed a contract with the maternity hospital and received all the necessary services free of charge. On the last prenatal examination prior to labour, the doctor was unable to examine Oksana due to her health condition. The woman was referred to another gynecologist, who began to demand payment for his services, stating that he was more at risk when examining and supporting childbirth process for an HIV-positive person. Oksana refused to pay the doctor for the services and asked REActor for help.

After consulting with a lawyer of the partner organization, the woman wrote a complaint to the chief doctor of the maternity hospital. Oksana also got advice on further action in such cases and was informed about the Ministry of Health hotline. After the chief physician saw the complaint, he contacted the client, apologized, and assured her that it would not happen again. Further on all services were provided free of charge.

Categories
News

How to combat human rights violations against vulnerable groups and whether Ukraine has been able to overcome the HIV / AIDS epidemic. Interview with Andriy Klepikov.

In Eastern Europe and Central Asia, one in three reported violations involve police and law enforcement agencies. Representatives of these structures violate the rights to life, liberty, and security of the person.

On the eve of the International Human Rights Day, Andriy Klepikov, Executive Director of the ICF “Alliance for Public Health”, spoke about how to combat human rights violations against vulnerable groups and explained whether Ukraine has really managed to overcome the HIV / AIDS epidemic.

According to data collected by REAct, as of December 1, 2021, more than 1,700 vulnerable groups in Ukraine have faced human rights violations. Of them:

  • 379 people – SMT patients,
  • 322 – persons who inject drugs,
  • 540 – people living with HIV,
  • 167 – men having sex with men,
  • 101 – sex-workers,
  • 148 – people with tuberculosis,
  • 59 – prisoners,
  • 23 – trans*people.

For example, the rights of drug users are most often violated by government officials: in the health care system – 144 recorded cases, among the police – 94.

In terms of general statistics for the EECA region, the REAct system recorded more than 6,000 cases of rights violations among key communities. The focus of the study has traditionally been on rights violations in the context of access to health services.

“The biggest violators of human rights are representatives of the state system. This includes the medical sphere, the police and law enforcement agencies. In particular, we recorded refusals to provide medical services, and there were cases when the police confiscated drugs – both antiretroviral treatment for people with HIV status and substitution maintenance therapy drugs for drug addicts. We intervened, and then measures were taken – everything was returned. And violators were disciplined for their actions. However, this topic is not discussed globally in Ukraine. “

According to UNAIDS, by the end of 2030, 7,700,000 people living with HIV could die worldwide. First of all, because of the barriers associated with human rights violations. To a greater extent, this concerns the lack of access to drugs or medical services, the inability to obtain medical advice, discrimination, denial of treatment, etc. Doctors often disclose the patient’s diagnosis to outsiders and misbehave with trans*people.

With regard to tackling the HIV / AIDS epidemic in Ukraine, the situation has improved in recent years.

“If five years ago every second HIV-positive person in Ukraine knew about his status, now it is two thirds. Thus, it is better than it was, but still far from ideal. In Ukraine, the programs and coverage of testing and treatment with antiretroviral therapy have expanded, which has reduced mortality. And this is another very important result. But life brings its own unpredictable moments, such as the COVID-19 pandemic. After all, the pandemic around the world has reduced the level of HIV testing and the number of people being treated. And here Ukraine is no exception. “

According to the results of 2021, 70% of all HIV-positive people in Ukraine who learned about the status of this year did it with the help of the projects of the ICF “Alliance for Public Health”. In fact, every three out of four people. In this way, the Alliance not only tests everyone in a row, but also tries to identify the riskiest cases.

Read more information on the “Novoe Vremya” website in the full version of the interview with Andriy Klepikov by the link.

Categories
News

The results of REAct system implementation in Ukraine in January – November 2021

The international community recognized the need of broad application of the human rights-based approaches and their integration in HIV programs in order to address the HIV/AIDS epidemy. 

The REAct project operates in Ukraine with the objective to identify the existing right-based barriers for key populations to obtaining HIV and TB services.

To commemorate the International Day of Human Rights, we present you with brief information about REAct project results in January – November 2021. 

Overall, 1796 cases of human rights violations were reported by 1731 clients, 87% of cases were resolved. 

Most often violation of rights, stigma, and discrimination are directed at men (1015 cases). People living with HIV (540 cases) and OST clients (37 cases) are traditionally among the key risk groups.

Most commonly, human rights are violated in Dnipropetrovsk (478 cases); Cherkasy (179 cases); Odesa (171 cases), Kherson (106 cases), and Lviv (95 cases) oblasts.

The main abuser is traditionally the state (74%); most commonly, the key group representatives faced refusal to provide care or services (50%) and emotional violence (30%) mainly related to the refusal in providing outpatient and inpatient medical care not related to HIV and TB (17%), and verbal abuse (57%). 

More information about the results of our work is available in the analytical report posted on the project website.

Categories
News

Declaration or Decoration of Human Rights?

On December 10, the world celebrates Human Rights Day, as exactly on this day in 1948 a milestone document was signed – the Universal Declaration of Human Rights. But, after 73 years, are the rights and freedoms proclaimed in the Declaration guaranteed in practice? We analyze it in the material below.

The ICF “Alliance for Public Health” has launched a regional information campaign “Declaration or Decoration of Human Rights?” to draw public attention to the glaring number and variety of human rights violations in the region of Eastern Europe and Central Asia, especially concerning the most marginalized groups of society vulnerable to HIV and tuberculosis.

The COVID-19 pandemic has worsened the human rights situation in the region: during 2020-2021 the REAct system registered more than 6,000 cases of violation of rights, stigma, and discrimination in 7 countries.

“The evidence collected reveals the legal barriers, harassment, and criminalization of HIV-vulnerable populations. This makes it difficult or impossible for them to access health services, prevention and treatment of HIV, tuberculosis and other diseases. ” – states Andrey Klepikov, executive director of the ICF “Alliance for Public Health”.

“Declaration or Decoration of Human Rights?” information campaign, based on evidence collected through REAct and the 30 articles of the Universal Declaration of Human Rights, illustrates that the rights of vulnerable groups continue to be violated ubiquitous in practice.

Campaign offline presentation in Istanbul within Health Sustainability Forum

“According to REAct data, the main violators of rights in the EECA region are representatives of state institutions – medical professionals, police, courts. Since it was the states that proclaimed their commitment to respect, protection, and promotion of human rights and freedoms by signing the Declaration. It is the states, through their state institutions and state structures, that must protect and guarantee human rights, and not vice versa – violate them. “ – Andrey Klepikov declares.

The most common offenses are discrimination, misconduct, law enforcement violence, denial of access to health services, disclosure of health information and stigma from health care workers, physical violence against women by sexual partners and relatives, as well as by police officers.

“Analyzing the cases in REAct, we saw that there is no area of ​​life in which representatives of communities would not face stigma, discrimination, or infringement of their rights. Not only are human rights violated all the time, but it is also widespread. The info campaign just illustrates this. It was not difficult for us to find examples of violations from real-life under each of the thirty articles of the Declaration. And under the “hottest” articles like the right to freedom from cruel and inhuman treatment and torture, the right to freedom from arbitrary detention, we had to tearfully choose the loudest cases among hundreds of others … “- Coordinator of the REACT system in Eastern Europe and Central Asia and author of the campaign idea, Victoria Kalynyuk shares her impressions.

Categories
Response stories

Violation of the Rights of PWID / PLHIV to Accessing Social Services

The REActor was approached by a drug injecting man living with HIV who was involved in the OST program. The client asked for help in getting him re-registered with the local employment center.

During the interview, it turned out that due to the fact that once he was late for an appointment with a specialist of the Center because of delays on the OST delivery site on the day of receiving the drug, he got denial in continuation of services.

The following day, the client brought over to the center’s specialist an official note from the healthcare facility stating that he indeed was involved in the OST program and asking to confirm the reason for his being late. Although the man was trying hard to find a job as soon as possible while not losing his unemployment benefits, the staff member he approached still said no, saying that the man must regularly visit the OST site and will not be able to show up at the center on time.

The REActor and the client applied to the local free legal advice center and the man was given a consultation along with relevant explanations regarding his right to access social services. The legal professional agreed to visit the employment center with the man to explain to the specialist concerned the client’s rights and possible consequences of non-performance of official duties.

After the necessary steps were taken, the man was re-registered with the employment center without losing benefits and referred to a new job place.

Categories
Response stories

Dismissal From Work Due to HIV-Positive Status

Eduard is an HIV-positive man. He used to inject drugs and this addiction ruined his family. Recently he worked as a long-haul truck driver. He liked his job and earned a good living.

A short while ago, his employer learned about this man’s HIV status and his past history. Eduard was fired on the grounds that “there’s no such thing as a former drug addict,” even though he has not injected drugs for more than 10 years. Eduard was depressed and frustrated because he lost his only source of income. As a result, he had to get a new job and do hard manual work despite his health problems.

The Project’s REActor met Eduard on the doorstep of the Charitable Foundation and suggested they get this incident recorded and reported through the REAct system and take necessary steps in response to the rights violation against key populations vulnerable to HIV and TB. The man was provided with psychological and emotional support as well as legal advice regarding the disclosure of his HIV status. Currently, Eduard’s life is gradually returning to normal.

Categories
Lawyer’s advice Response stories Useful materials

What do you need to know if the police stop you to check your documents and belongings?

The REAct project often registers violations of the rights of key populations by the police. Quite often this relates to unreasonable detention of OST program clients, especially if they have drugs for self-administration on them. 

Most often police officers check personal ID documents or frisk the suspect

Such acts of the police often cause resentment in the OST program participants, but, according to the Law of Ukraine “On the National Police”, the officers have the right to do it, especially when there are sufficient grounds to believe that the person carries drugs or other banned or restricted things or things requiring special authorization for storing, use or transportation. 

Frisking is a visual examination of a person by the police officer; patting or sweeping over the person’s clothes with hands, special equipment, or a device; visual examination of the belongings. During frisking, you must personally show the police officer the content of your belongings. This means that the police officer cannot try to examine or search you under your outerwear and cannot reach into your pockets.

Before frisking or examination, the police officer must inform you about the reasons for the stop. According to the Law, frisking can be performed by a police officer of the same sex. In urgent cases, frisking can be performed by any officer with the use of special equipment or device.

Remember: any interaction with the police must begin with your request to show their badges. You should read them carefully, and, if possible, record the names and positions of the law enforcement officers, and the badge numbers (if any). You may need this information to identify the officers to appeal against their actions. The police officers must tell you this information. 

To avoid conflicts with the police, OST program clients must always carry: 

  • A personal ID; 
  • Properly filled medication chart;
  • A copy of the request to receive OST drugs for self-administration signed and sealed by the chief physician of the health facility.

The police officer does not have the right to seize any documents or belongings unless they are an instrument or an object in the offense. If any belongings are seized by the police officer (including the OST drugs), it must be reported in the protocol in presence of two official witnesses. Police officers cannot demand you to follow them to the police department without specifying the reasons and referring to legal justification. 

In case of violation of the rights of OST program clients by police officers, you can: 

  • Call 102 to report about police wrongdoing; 
  • Call police hotline at 0-800-50-02-02; 
  • Call OST hotline;
  • Report the offence by the police officer to the Main Police Department of the oblast. 

Criminal acts by police officers must be reported to the State Investigation Bureau.  

Categories
Psychologist's advice Useful materials

Codependency: manifestations and stages

Despite a large number of articles and materials, the subject of codependency still remains a societally “inconvenient” one. 

It is not yet officially recognized by the International Classification of Diseases, but it is difficult to imagine addicts’ relatives and close ones as healthy physically and psychologically. Codependency is the cause of many disorders that can wreck a person’s life and mental health. Its manifestations include:

  • A codependent person is constantly fixated on their sick relative;
  • Aggressive behavior, which is shown in maintaining a strict control over the addicted person’s movements, actions, and contacts;
  • Loss of control over their emotions;
  • Self-deception, which manifests itself in the inability to accept and face the problem at hand;
  • Feelings of guilt, shame, self-accusation for someone else’s addiction issues;
  • Increased resistance to internal psychological pain;
  • Lowered self-esteem;
  • Perceiving the patient as a “little child,” taking on responsibility for the addicted person’s actions and pinning the blame on yourself;
  • Self-destructive behavior and loss of ability to think in realistic terms;
  • Use of psychoactive substances together with the addicted person (motives to the effect that “you do anything to keep the child happy and safe”);
  • Persistent hatred of the patient, which leads to nervous exhaustion and prolonged depression.

The above symptoms can easily develop into severe psychiatric disorders.

As a medical condition, codependency has several stages of development:

  1. Anxiety. Manifested by the codependent person’s hyper vigilance. They may deny the problem or make excuses for the behavior concerned. Also possible are minor memory lapses or increased resilience to emotional stress.
  2. Self-protection. The codependent person has a sense of increased responsibility for the patient’s state and actions. The codependent person usually acts as a pursuer, who persuades, threatens, or uses pressure to convince the addict of the need for treatment. Memory lapses can become more frequent.
  3. Adaptation. Prevalent feelings of shame and guilt are gradually being replaced by anger and irritation. Attempts at exercising control are intensifying. Under the patient’s manipulative powers, “the role of a victim” is taken on, with the result that the codependent person constantly blames themselves for the addict’s problems. There emerges a feeling of resentment and anger toward the patient.
  4. Depletion. Resentment, frustration, and anger are transformed into a bitter hatred for the addicted person. Most commonly, in this phase chronic psychological and physical illnesses resurface with a vengeance under the impact of constant stress.
  5. Recovery. This outcome is achieved only if the codependent person separates themselves from the addict’s life and problems, focusing on their own goals and needs.

Doctors, substance abuse specialists, psychologists, and psychiatrists unanimously assert that a successful outcome can be achieved only if both the addicted person and the co-dependent family members undergo psychological therapy.

Practice shows that people surrounding the addict may not understand the underlying problem and often are reluctant to admit the truth about their condition.

Read the next section to learn about how to overcome codependency.

Categories
News

Analysis of cases of violation of the rights of people who inject drugs, presented at the Third Conference on Drug Policy

The Third Conference on Drug Policy and Implementation of Public Drug Policy Strategy until 2030 was held on November 24-25. 

The main conference objectives were a further development and implementation of the Action Plan through the use of the best international practices and most effective approach for its implementation.

The conference facilitated dialogue and experience sharing between the research and professional community, law-enforcement, and political circles of Belarus, Moldova, Ukraine, and other countries of Eastern Europe and Central Asia. Representatives of national and non-governmental organizations discussed modern evidence-based approaches to behavioral health, prevention of drug consumption and HIV/viral hepatitis C, treatment, care, and rehabilitation of drug users.

In one of the sessions Oksana Pashchuk, senior manager of REAct project, presented the analysis of cases of violation of rights of people who inject drugs (PWID) in Ukraine. The speaker noted that as of today, 314 reports from IDU were registered in the REAct monitoring and response system, 72% were fully resolved. 

Презентація аналізу випадків порушень прав людей, які вживають наркотики ін’єкційно, на Третій конференції щодо наркополітики

Based on the obtained data, in 87% of cases PWID did not seek the protection of their rights in proper institutions, mainly due to lack of awareness and knowledge on how to seek protection (25%), and due to lack of confidence in the positive outcome (19%). However, if the clients did seek protection from the relevant authorities, in most cases their requests were ignored. 

Violation of rights most often was on the part of the state (77%), in particular, healthcare workers (144 cases). The most common offenses were verbal insults (79 cases), refusal to provide healthcare (50 cases), and extortion (22 cases). 

Презентація аналізу випадків порушень прав людей, які вживають наркотики ін’єкційно, на Третій конференції щодо наркополітики

The speaker also presented recommendations about amending the current legislature in order to improve the situation in the country. For a long while, offenses by police and rehabilitation centers’ staff against PWID are reported and registered in the REAct system. Based on this, Oksana proposed to review and modify the threshold quantities of drugs defined in the tables endorsed in Order of the Ministry of Health # 188 as of 01.08.2000 “On endorsing the tables of small, large and especially large quantities of drugs, psychotropic substances, and precursors in illicit drug trafficking”, as unreasonable small quantities of drugs are used as the cause of prosecution of PWID by police.

As for the operation of rehabilitation centers, Ukraine lacks legislature regulating the provision of their services to people addicted to drugs. This results in violations of the rights of PWID and the absence of control over the operation of such centers. The work of the rehabilitation centers involves healthcare interventions, therefore must be subject to regulation by the Ministry of Health of Ukraine as the authorized public institution. 

Oksana highlighted that engagement of the Ministry of Health into this issue is necessary, with further development of the sectoral regulatory framework, based on best international practices and consultations with the civil society.

Categories
Response stories

Bullying in kindergarten

A former sex worker with HIV-positive status sent her child to kindergarten. It soon turned out that the child of a client’s classmate, who knew about her former occupation and HIV-status, was studying in the same group. He wrote about this to a parent group in Viber and insisted on asking the headmistress not to allow the client’s child to attend this preschool.

Although the child had a negative status, no medical references or explanations from the mother were valid. The parents boycotted her and the child. Even the police, who were called to the scene because of a fight between a mother and a client, did not take any action and just left as soon as they found out what was going on.

The client was provided with primary legal and psycho-emotional assistance. After that, accompanied by a human rights activist-volunteer, she visited the institution and finally informed the parents and the management of the kindergarten that their children are not in danger. The REActor also clarified the situation regarding the client’s further actions in case of continuing the stigma and told what awaits the parents and management of the institution in the event of inaction against bullying.

An application was submitted to the management of the institution about cases of bullying in relation to a child demanding a full and impartial investigation in accordance with the Law of Ukraine “On Citizens’ Appeals”. The head of the children’s institution considered the appeal and promised to improve the microclimate in the children’s environment and resolve the conflict within the institution.

Subsequently, the management of the institution conducted a training for parents with the involvement of a health worker, who spoke in detail about the ways of HIV transmission and assured that the child has the full right to attend kindergarten.

Categories
News

Presentation of REAct system performance and cases of successful responses at the webinar on reducing stigma and discrimination of people affected by TB

A webinar on the implementation of measures to reduce the stigma and discrimination of people affected by TB was held on November 23 by “Stop TB. Ukraine” Partnership

During the event, the representatives of non-governmental and national organizations discussed matters related to effective methods and successful experiences of overcoming the stigma and discrimination of people affected by TB. 

Презентація роботи системи REAct та історій успішного реагування на вебінарі щодо зниження рівня стигми та дискримінації по відношенню до осіб з ТБ

In one of the sessions Nadiia Semchuk, senior specialist of REAct project, presented the work of the REAct system. The speaker noted that as of today, 1694 reports of violations of rights of people vulnerable to HIV and TB, were registered in the REAct monitoring and response system, 77% were fully resolved. Thanks to the work of 69 organizations, the system operates in 18 regions of Ukraine. 

As for the violations of the rights of people affected by TB, 130 reports were received in 2021, 54% of which related to stigma and discrimination. According to the collected data, the majority of cases faced by people affected by TB included refusal to treat TB (38), verbal insults (20), and refusal to provide social services (16). The most common violations were on the part of the public institutions (89%). 

Oksana Tropina, a REActor, a SCO “Ukraine without tortures” member, presented two cases of successful response to address the violations of rights of key populations in Kherson oblast. The speaker noted that the system is actively used considering the large TB incidence in the region. Oksana said that there are quite many TB   patients in Penitentiary Facility # 7 in Kherson Oblast. After their release, they often face the realia they are not ready for. Often, they do not classify problems they encounter in obtaining services, as stigma and discrimination, therefore such cases demand special attention. 

The first case told by the REActor was about a man with TB who wanted to re-establish communication with his children upon release from the colony. The mother of the children reacted negatively, so he contacted the Service on child matters. The officials did not want to talk to him and closed the door in front of him after they heard about his disease. After that, the man contacted the REActor, who offered psychological support and conducted initial legal counseling. According to the man, reestablishing contact with children was the most important thing for him, so, together with Oksana, they approached the Service again for proper assistance. This time they negotiated a meeting with the former wife of the client. They talked, and she agreed to allow communication of the children with their father, upon condition that personal protection means are worn, and the man continues his treatment.

Презентація роботи системи REAct та історій успішного реагування на вебінарі щодо зниження рівня стигми та дискримінації по відношенню до осіб з ТБ

The other story was about a woman who was seeking care from the policlinic for she was not feeling well. Based on the results of the examination, she was diagnosed with TB. When her employer learned about her diagnosis, he started to pressure her and then told her to resign. At one moment the woman remained unemployed, without any means for living and treatment. She contacted the REActor for psychological and legal support. Together they decided to file a request to the Main Office of the State Labor Service, where the woman was provided clear explanations and instructions. The situation was positively resolved, and the woman continues working. 

Презентація роботи системи REAct та історій успішного реагування на вебінарі щодо зниження рівня стигми та дискримінації по відношенню до осіб з ТБ
Categories
Response stories

Combating domestic violence associated with HIV-positive status

Iryna found out she was HIV positive during her first pregnancy. She immediately informed her husband, who also passed necessary tests and turned out to be healthy. After that, constant quarrels, humiliation, and beatings began at their home.

After some time, Irina divorced her husband and stopped living with him. However, he later asked to restore the family. Two years later, the former couple started living together again. Irina got pregnant for the second time and gave birth to another boy. However, happy family life did not happen. The man started drinking alcohol and continued to humiliate the woman due to her HIV+ status.

Later, Iryna decided to change her life and turned to the crisis center for women who suffer from domestic and gender-based violence. REActors provided psychological support to the woman, Iryna with her two sons settled in the crisis center and changed her job. Social workers helped to quickly collect all the necessary documents and transferred the boys to other educational institutions. After a while, the woman moved to another region and settled up there.

Categories
News

Access to justice in the EECA region for key communities presented at the 3rd EECA Judges’ Forum

During the Third session of the Eastern European and Central Asian Forum of Judges on HIV, Human Rights and Legislation, organized by the UNDP regional team, on November 11, representatives of government agencies and international non-governmental organizations discussed the problems of access to justice in the EECA region for people who use drugs, sex workers, LGBTQ and people living with HIV, including during the COVID-19 pandemic.

Analysis of the situation shows that the key types of violation of rights are the following:

  • Discrimination in health care facilities and barriers to accessing services;
  • Lack of social support and problems with housing, work;
  • Arbitrary detention, police violence;
  • Abuse of power by child protection services, deprivation of parental rights;
  • Failure of the state to protect against gender-based violence (access to shelters, prosecution of perpetrators).

Ganna Dovbakh, Executive Director of the Eurasian Harm Reduction Association (EHRA), presented data on violations of the rights of PLHIV and representatives of vulnerable groups, collected in 7 countries of the region using the REAct monitoring system. The data was accumulated in Moldova, Ukraine, Georgia, Russia, Uzbekistan, Tajikistan and Kyrgyzstan.

In less than 2 years, para-lawyers collected 7056 appeals from key vulnerable groups. Most of the violations were related to the refusal to provide medical services. This type of incident was recorded in 1708 hits. Among other common violations, the speaker also noted intimidation, threats, violence, blackmail and coercion by the police to confess guilt. Such cases should be viewed as common practice and not as rare exceptions.

Moreover, Ganna noted that people are often not ready to talk about violation of their rights, because they are afraid that this will further worsen their situation. The speaker drew attention to frightening statistics compiled by the REAct, about a rather low percentage (less than 10% on average) of acquittals by judges in EECA countries, especially if the case is filed by the police. Therefore, illegal actions, torture, blackmail on the part of law enforcement agencies in relation to representatives of key communities have such a negative impact on people’s readiness to defend their rights.

As part of her presentation, Ganna also presented results on the most common legal barriers and human rights violations that beneficiaries experience when accessing public health services, which were collected under the regional project “Tiberius: Overcoming Legal Barriers for Key Populations – Towards 90 -90-90”, implemented by the EHRA. Namely:

  • Lack of registration and documents, which leads to a lack of insurance and the need to pay for COVID-19 PCR before receiving inpatient treatment;
  • Stigma and discrimination by healthcare professionals and government authorities;
  • Refusal to provide social assistance by social welfare authorities;
  • Disclosure of personal data and HIV status by healthcare professionals and service providers;
  • Violence in family;
  • Workplace discrimination.
Categories
Response stories

One step closer to adoption

Maria is an HIV-positive woman. She has been collecting the documents needed to adopt her niece for several months.

During her recent visit to the custody and guardianship department, she was told that she could not adopt a child because of her HIV-positive status. Those were shocking news for the woman, because adoption is the only opportunity for a child to get a loving family again.

The woman reached the REActor with this issue and was informed that the refusal due to HIV status was illegal. According to the Order of the Ministry of Health “On approval of the List of diseases suffering from which a person cannot be an adoptive parent”, HIV was excluded from this list, so it is no longer an obstacle.

With this information, the woman re-applied to the custody and guardianship department, where the staff took this into account and later continued the adoption process.