Report

Report from the 6th ERNA meeting, Yerevan, Armenia,
22-25 September 2002

SUMMARY OF THE REPORT

• 27 National Societies participated in the meeting
• Yugoslav and British Red Cross were accepted as new members.
• Dr. Lise Grivois from French RC was elected the 2nd vice chairman.
• The budget was accepted, and the financial report will be amended.
• A working group was selected to clarify and modify the formalities of ERNA.
• The bureau will select themes for the next workshop based on a list of suggested topics during the meeting.
• The next meeting will be held in Latvia or Bosnia.
• ERNA will engage in TB as decided during the Berlin conference.
• A TB session was conducted with updates from country programmes and the IFRC.
• A two-day harm reduction seminar was conducted with a wide range of experience sharing.
• All National Societies are encouraged to act upon their knowledge and abilities.
• Sharing of experience through ERNA is recommended.

DETAILED REPORT

PRESENT (see attachment for details on names):

Representatives from 23 member National Societies participated + 4 observer NSs.

Four National Societies were observers (Greece, Netherlands, Turkmenistan and Yugoslavia).

ERNA secretariat and board

IFRC regional delegations in Budapest, Dushanbe and Almaty and Health and Care department in Geneva.

PARTICIPANTS’ EXPECTATIONS

A round of presentations also included a list of expectations to the meeting. Some of the expectations were:

• To learn more about HIV prevention in young people.
• Learn about HIV/AIDS in the world.
• Share experience.
• Focus on harm reduction.

The fight against all forms of discrimination requires the involvement of all of us. Our network with 179 National Societies and 97 mill. volunteers provide a basis for our action.

WELCOME SPEECHES

Welcome speech by Dr. Mkhitar Mnatsakanyan, President of Armenian Red Cross.

Speech by the President of ERNA, dr. Massimo Barra

Speech by Dr. Gizaw, IFRC Geneva, with greetings from the health department.

Speech by Mr. Choe Chang Hun, head of IFRC country delegation in Armenia.

ELECTION OF RAPPORTEUR

Merete Taksdal from Norwegian Red Cross was suggested and appointed as the general rapporteur of the meeting.

ANNUAL AND FINANCIAL REPORT

Peter Duchaj, 1^st Vice-President of ERNA presented the Annual report, the financial report and the budget proposal. The Slovak Red Cross is providing the necessary support of the secretariat. It is important for the ERNA secretariat to attract money and resources. A project-planning workshop will be held in Italy in October. There is a problem with the acquisition of financial means. Many NS’s are not contributing financially or with interest. Dr. Duchaj had gratitude towards the donors, and thanked them and Armenian Red Cross.

The presentation was followed by a discussion regarding the presentation of the financial report and some formalities. The French Red Cross would like a financial statement to be presented in a matrix covering three years. The Swedish Red Cross needs their contribution to appear on the statement, and the report to be audited and stamped.

Dr. Barra suggested to the meeting to accept the budget as proposed, and that it can be revised if additional funding is received. The financial report will be amended according to requirements from the donors. There were no objections to these suggestions. For information – after the meeting the Italian RC made a contribution for the core budget of ERNA of 12 000 CHF and the Monaco RC of 3000 EUR.

ERNA ORGANISATIONAL MATTERS

Suggestions from member NS’s for activities in 2003 and ideas from the members on the future role of ERNA and its secretariat.

·        Sub secretariat of ERNA?

The Russian RC informed that the coming ERNA president is not able to attend the meeting. Following the Berlin conference, it would be necessary to create a focus on TB within ERNA. The coming president suggested creating a sub-secretariat for TB. Both IFRC and the ERNA president gave comments. During the meeting it was not decided to establish a new secretariat within ERNA.

·        Clarification of formal procedures within ERNA

Norwegian RC suggested establishing timelines for submitting papers, and formalising aspects of the decision-making procedures in the organisation. Swedish RC supported the idea of looking into Terms of Reference and voting rights, and suggested sponsoring a small working group with participants from the ERNA regions and IFRC. Dr. Barra expressed that we can solve problems in a democratic way without bureaucracy and with a majority decision during the meeting. We do not need big rules and procedures in the network. Quite a few participants engaged in the discussion. The conclusion was that although TORs exist, it is nothing wrong in making modifications and clarifications. The decision was to establish a working group with a member from Swedish RC, Uzbek RC, Bulgarian RC, and the ERNA Board as a whole. The working group will revise the existing rules and clarify what is missing. National Societies are encouraged to give input to the group.

·        Role of the National Societies within ERNA

Dr. Barra encouraged more contact and contributions from NS’s, especially on the commitment side, and on sharing skills and experiences.  Armenia RC agreed, the NS’s should implement the programs while the secretariat would do the supportive activities.

·        New members:

Yugoslavia RC and British RC have requested memberships in ERNA, and were accepted with acclamation during the meeting.

·        Election of a 2nd vice chairman.

Croatian RC suggested Dr. Lise Grivois from French RC, and the Slovak RC supported this suggestion. Both NS’s emphasized the French RC’s strong efforts in the ERNA relevant topics. Dr.Barra supported the choice, and Dr. Lise Grivois was elected by acclamation.

·        Host for the next meeting.

Latvia RC and Bosnia RC offered to host the next meeting. The ERNA bureau will make a decision on the basis of economy and facilities available and based on the preliminary visit to the above NSs.

·        Time of the next meeting.

This issue was raised from the audience; a suggestion was to carry out the meeting in the spring due to problems with organising and high costs of travel during the summer. Most voiced opinions were supporting that the next meeting should take place in May. This point was not voted on formally, but nobody opposed the suggestion of having the meeting before the summer.

·        Follow up of the last year’s workshop on youth peer education

In this session there was a round-table update on what the different NS’s have done, and also on suggestions for the workshop during the next meeting. To reflect the variety of actions, the NS’s are encouraged to update the information of the ERNA website. The regional delegation in Budapest has facilitated for translation of the “Action for youth” manual into several languages. “Positive development” is available in Russian and English.

·        Suggestions for workshop themes 2003:

Many topics were suggested for the next workshop. The Bureau will take the decision for the next workshop themes after the planning workshop in Italy this autumn. Summaries of the themes suggested are:

• Drug-use prevention. Multinational activities. Samples.
• Outreach programs in harm reduction.
• Planning processes. Methodology and presentation of projects to donors.
• Resource mobilisation.
• Social and psychological assistance.
• Project planning. How to connect NS’s to make wider proposals.
• How to approach EU to get funding for projects in Europe.
• Experience sharing on anti-aids coalition between NGO’s and the government.
• Coordination between different actors in the same sector. Databank creation.
• AIDS is a STI. General focus on STI’s.
• Media coverage approaches. How to improve programs PR-wise.
• Social marketing in facing realities of the 21st century.
• How to improve/develop programs from crisis management to development.
• Donor communication / donors as partners.
• “Best practice” sharing on evaluation and documentation of project effects.
• TB as a part of the ERNA network. How to combine efforts in capacity building.
• Strategies for fighting stigma.

TB SESSION PROGRAMME

• Introduction by Dr. Terhi Heinasmaki from IFRC.

The IFRC financial situation regarding TB has been difficult, there have been cutbacks in funds and some country programs have stopped this year.

·        Armenia RC shared their experience in TB, presented by Dr. Ofelya Khachatryan.

Strict drug control has good effect for limiting the spreading of disease. As in all post Soviet countries there is a difficult situation with mass migration, appearance of paid medical services, poverty of population and incorrect use of antibiotics. The increase of TB incidence has been tragic and dramatic given the small population of the country. Armenia RC will be involved in buying drugs for 400 patients with the support of the Greek RC. The Armenian Ministry of Public Health (MOPH) is not able to carry out the necessary programs, and does not have reliable logistics for distributing drugs from stores to the clinics. The analysis of the situation show a lack of sputum analysis, a visiting nurses program would be good if supported, it is impossible to complete the TB control because of absence of state financing. Remote villages are vulnerable, and incorrect use of antibiotics promotes resistance. Because of misuse of Streptomycin and Tetracycline it is interesting with training of doctors. The DOTS-programme effectiveness is proven 83-86% effective. The situation in the prisons is very bad. It is a wish to see a national, coordinated TB programme in the hands of MOPH, but as this is not the case yet, the RC has to help.

·        ICRC TB activities in Armenia presented by Lyne Soucy

ICRC focuses on TB in detention (people deprived of freedom). The history of ICRC’s involvement in TB in Armenia was presented, along with reflection on cooperation agreements with MOPH and Ministry of Justice. The results of a TB prevalence survey in two prisons were presented. As in Georgia and Azerbaijan is TB the most problematic health problem in prisons in Armenia. 1 in 20 prisoners have infectious TB, which is prevalence 150 times higher than among the civilian population. As there is a high turnover of prisoners, the spread of TB is of importance for all people.

The main objectives for 2003 are:

• DOTS treatment in new TB department of prison.
• Raise political awareness of TB control in prison.
• Case findings
• Strengthening the diagnostic facilities
• Recording and reporting system
• Health Education Programme for detainees and their families and staff from guards to the director.
• Cooperation with other actors

·        Russian Red Cross’ work in prisons and with released former convicts by Valentina Chichkina. The presentation was also given at the Berlin conference.

Although TB control is a governmental responsibility, RC is there to support. They use RC nurses services in 10 regions in Russia. The TB situation is serious. But the infection rates are stabilised because of the stabilisation in the penitentiary centres. They have 1 mill. detainees, and more than 100 000 are infected. The infection rates are 40 times higher in penitentiary system than outside. This has huge implications for the health and social system. Homeless people are a risk group and a practical problem. TB-sick people released from prison may be lost in the system. As much as 50% of released prisoners are lost for treatment. The main target group is the first time infected who have finished the intensive phase of the treatment. Among the marginal groups, migrants are 26%, homeless 60% and alcoholic 12%.

There are three main parts of the programme:

• Provision of treatment assistance: Social support, DOTS, nurses service
• Health information dissemination: Leaflet distribution, courses, and actions like the “white daisy”, advocacy not to allow the health system to be passive.
• Assisting regional activities: Support establishment of European standard, high visibility, laboratory, technical support, equipment and organising.

·        TB prevention programmes in Central Asia 2002, presented by Lasha Goguadze, Health and Care Delegate, regional delegation in Almaty

The TB control programme comprises of

• Default tracing,
• Community health education and social mobilisation,
• Promotion of healthy lifestyle,
• Social and nutritional support for patients and families.

The five countries have scaled up their efforts from the start, and they will continue with filling gaps in the DOTS implementation. They expect challenges in the programme on governmental commitment, collaboration, long term funding and recognition of RC nurses. 4 of the National Societies are in the CCM (Country Coordination Mechanism) of the Global Fund. All coordinators in Central Asia meet 2-3 times per year, and there are visits from one NS to another.

·        Belarus program update by Dr. Romanovski:

Currently halt in program because of lack of funds. The last donation was from China. All embassies have been asked for support without success. They have created strong control programs targeting the most vulnerable, like ex-detainees, big families and homeless. They have had some support from the government regarding methodology, including new training with nurses. They have a strong nurses program. The TB prevalence peaked in 1998. This is related also to the Chernobyl disaster and increase of cancers among children and young people. In the last 3 years out of 4000 controlled patients 150 failed. Initially the IFRC said the programme would last for 10-15 years, but this promise was not kept. Now they are hoping for money from the global fund. The government has no tradition in channelling money through NGO’s, as all health care is public.

·        Ukraine experience presented by Valeryi Sergovskyi:

The TB situation is principally the same as in Russia and Belarus. Historically, in 1938, 90% of the TB dispensaries belonged to Ukraine RC. They are registered as a partner to the government. Both URC and the MOH now recognise the DOTS strategy. 1,5% of the population are sick with TB. Ukraine has a large unemployment problem, as 40% are unemployed. 38% of these have TB. They probably export TB, as labour migration exceeds 7 million people. They have 3200 nurses active, and got grants for training almost 1000 more. The TB prevention component is integrated with hiv/aids. Some time ago an amnesty for prisoners were given because of TB. Of 10000 released, 8000 were infected. RC tried to help them. The president of URC is a member of the CCM in the global fund. They hope that IFRC will manage to lobby for the European Commission regarding “silent emergencies”. The struggle against TB will continue – URC did it before, and will do it again!

·        Bulgarian RC presentation by Dr. Ventseslav Ivanov.

TB is on the increase in Bulgaria, from 1990 to 1998 TB doubled. As TB is a social disease, this is connected to the decline in living standard, problems in the health care, unemployment and poverty. People use 50-55% of their income for food. The state expenditure for health care is going down; currently it is at 4.8% of GDP. There is a lack of medicine in the health care system, and patients cannot afford to buy. The TB problem is huge, both in morbidity and resistance. There are regional and local differences, in total the prevalence is 180/100 000. They have a national TB program in 28 regions, and DOTS strategy in 4 pilot regions. TB among hiv+ are at almost 24%, this is 30 times higher than in the general population. Bulgarian RC is working in 3 regions with patients with active TB. Mainly with basic medicines, supplementary medicines and foodstuffs. They also administer leaflets to the public. Within prevention, the focus is on dissemination of health knowledge, and training of volunteers. The challenges for the volunteers are to motivate the patients, distribute the food, and provide psychological and social support.

IFRC-presentation by Dr. Terhi Heinasmaki

• TB operational guidelines are made in all IFRC languages + Russian. If anyone has suggestions or amendments, please contact IFRC.
• The idea “don’t start if you can not continue” is important for TB, but it is complicated when it is a huge health crisis. Funding has not been available for the long-term engagement IFRC ideally wanted.
• Prisoner support after release is a critical issue.
• HIV/AIDS is to be connected to TB, but in Eastern Europe to a large extent they come from different risk-groups. They could be united in education, and later in home-care programmes.
• Partnerships have proven useful. Experience with Merlin, MSF and other NGO’s.
• The Berlin conference decided that the involvement in TB needs to be broadened in Europe, using RC operational guidelines. Integration of the TB and hiv/aids programmes in the NS’s through ERNA.
• The Global Fund against AIDS, tuberculosis and malaria (GFATM). This is a result of the UN special session on HIV/AIDS in New York last year. The first application round had a short deadline. The secretariat is in Geneva, but has nothing to do with IFRC. There is a web page at the IFRC website under DMIS. The deadline for the second application was September 27th. IFRC selected 8 countries for special assistance for the application, in Europe that was Bosnia and Armenia. (Data on the global fund are available from the web: www.imrs.sante.fr).
• A new book is published: “Infections and Infectious diseases for nurses and midwives in the WHO European region. Is available in English, and to be published in Russian.

HARM REDUCTION SEMINAR, chaired by Annamari Raikkola, Health and Care delegate from RD Budapest.

·        Why Red Cross / Red Crescent and Harm reduction, Dr. Massimo Barra.

Harm reduction is representing a means between public health and human rights. It touches survival and quality of life for drug users. Based on the principle of neutrality (non-interference in political decisions) and scientific results, RC as auxiliaries to governments should recommend scientifically proven facts. When a fight against drugs becomes a fight against the drug users (as “sinners”), it breaks the principle of humanity. RC should care, and prevent human suffering. RC should raise their voices against threats to human dignity. Care for drug users means less violence in the streets and less HIV. A harm reduction policy means seeking for vulnerable people on the road. RC should be in the forefront of these battles.

·        General presentation on the HIV/AIDS situation in Europe and Central Asia, Summary of Berlin Conference recommendations concerning HIV/AIDS. Dr. Terhi Heinasmaki

By 31/12-01 there are 40 million cases in the world, 1 million in Eastern and central Europe – rapidly rising. In some of the eastern European countries they have low figures of AIDS, indicating that the infection is young. Western Europe is characterised by sexual transmission (both homo- and hetero), 31% less than 30 years. In Eastern Europe 83% are less than 30 years, and the main mode of transmission is through drug injection. The reduction of AIDS in the west is mainly due to ART (Anti retro viral therapy). Blood supply is still not safe in East Europe as there is a lack of voluntary and not remunerated blood donors.

During the Berlin Conference a declaration on HIV/AIDS was made. Strengthening NS’s capacity is important, as well as advocacy and services. Details can be found on the IFRC Europe web site.

·        Working with hard to reach persons. Dr. Fabio Patruno, Italian RC.

A person who takes drugs may be of harm to other people because drug is a primary need; he has a lack of respect (also for his own person), and is self-destructive. There are periods of passivity and periods of frenetic action. The drug user may have a loss of time perception, and is waiting for “something”. When accepted as he is, it is a basis for getting the person interested in his own health. The carer must have an open approach, not ask for anything in return. Assistance may be food, shower, syringes, condoms or information. The operator must respect the user needs. There are more than 30 000 drug users in Rome, and many are not ready for therapy.

The operator of harm reduction programs should keep an open door with low threshold. No uniforms. Good team building is necessary. They should build approaches with the opinion leaders. Their role is very important, and can change group subcultures. Can lead to possibility for first aid courses or safe ways of using drugs. Bridges can be built between harm reduction and detoxification / rehabilitation. It is important to face human reality.

·        Introduction to Harm Reduction (HR) Presentation of IFRC Concept paper on HR. Dr. Getachew Gizaw, IFRC health department, Geneva.

A concept paper and handout was presented, and is accessible as attachment.

Substance abuse is seen in all countries, and implies social, economic and health risks. The legal approach to IDU and HR are different from the public health view. The role of RC in harm reduction is linked to improving the lives of vulnerable people, and IDU’s as vulnerable groups. NS’s can engage in implementation of programmes or engage in advocacy.

Hiv/aids documents and policy is to be revised by IFRC next year.

·        What is harm reduction in reality? Dr. Sinisa Zovko, Croatia RC

If a drug user is not capable or willing to give up use, he should be assisted to reduce harm to himself or others. Drug addiction means a life style. A presentation on differences in approach between harm reduction and demand reduction were given, where harm reduction (as the desired approach) had some of these characteristics:

• Accepts continued drug use.
• Short-term pragmatic goals.
• Public health orientation.
• Law enforcement mainly for high-level traffickers.
• Drug education is factual and credible for all users.
• Minimal interventions for many.
• Law enforcement respects benefits of harm reduction programmes.

Prevention of HIV between IDU’s through:

• Information, education, communication.
• Easy access to health and social services.
• Reaching out programmes.
• Providing sterile injection equipment and disinfectant material.
• Providing substitute material.

Problems to harm reduction programs may come from law regulation, attitudes of decision makers or society, conflicting interests, lack of financial resources or stigmatisation. Dr. Zovko presented data showing that illicit drug use in Croatia represents an illegal economy of 98 mill USD; this is a problem in the national economy. To understand a drug users problem you have to be involved. The drug user is a human being. He cannot live without the drug, and addiction is classified as a chronic disease. The only interest in his life is the drug.

During the discussion following this presentation, Dr. Barra said that taking drugs is a disease. It is not normal. Use, abuse, dependence and mania of substances are four different things. Both legal and illegal drugs affect health. Stigmatisation is affecting the disease, this also affects doctors and inside of RC, as any parts of society. The majority of RC members in Italy would disagree with these speeches. But it takes courage to influence society for common interest. Even Henry Dunant was not normal for his time! We must educate the rest of the society. It is possible to change attitudes, and an example is the way the police in Rome now interacts with Villa Maraini for abstinent people in arrest.

·        Prevention. Dr. Sinisa Zovko, Croatian RC

It is a myth in society that young people are pushed into drug use. Many young people want drugs, are attracted into using it and go through efforts to get it. Prevention by messages is useless. The traditional “just say no”-approach is not working. It should be “Just say I know”-approach, this is recommended from UNAIDS and UNDP. Methods are information, education, demystification and drug awareness. Should include professionals like police, social workers and doctors as well as parents and children. The goal is that individuals adopt responsibility. Unless children receive correct information in the schools, they learn in the streets. One example is that “heroine can only be used by injection”. This leads to quick addiction. Information must be attractive, direct and confident, and should not avoid facts.

·        Group work session is reported on separately.

The discussions were related to questions handed out in advance. Conclusion was that HIV/AIDS exist in all countries. There are differences between countries. The quality of treatment differs from inadequate to satisfactory. Most countries have national bodies responsible for HIV/AIDS; many countries have state strategies for harm reduction. Few countries have NGO’s or RC national societies in these state strategies. Many RC societies would like to be involved, but finds it difficult. Scale of participation differs. Some harm reduction programs by RC societies exist.

·        Street drugs. Dr. Sinisa Zovko, Croatian RC

This presentation was comprehensive with pictures on drugs defined as “any substance abused due to its effect on the CNS”.

• Opioids: Produced from poppy with Central Asia as the main producer. History of opium since 3500 BC. Morphine and Heroine. Effect is relaxation and pleasure.
• Cocaine: From two types of coca plants. Traditional “upper society” drug, today more in entertainment and yuppies. Can sniff, inject or chase (inhale smoke) this white powder.
• Crack. Designer drug from USA. Cheap, quick addiction creates aggressivity.
• Cannabis. A plant can produce marihuana and hashish. A sweet, typical smell. Creates de-motivation, apathy and problems with school, society and the law. Cannabis has medical use for some diseases.
• Ecstasy. Synthetic drug brands / “marketing” brands. May cause damage to liver and brain, even sudden death. Serious dehydration is a risk. To avoid negative effects like depression and sleeplessness, other drugs may be used in combination.
• LSD (“acid”). Looks like small stickers. Can be taken in the mouth, through drinks or through the skin. May cause fear or paranoia.
• Amphetamines (“speed”). Was used by soldiers during the 2^nd World war. May be used as treatment for narcolepsy.
• Liquid Gamma hydroxide. Also called “drug of the rapist”. Used in relation to club scenes and rave parties. Most substance components can be found in ordinary shops, and may even be manufactured at home.
• Also lots of products from the chemical industry, “jabba” (crazy medicine) and mushrooms.

There was an engaged discussion following this presentation.

Dr. Barra: Information is not the same as prevention, and it is a big difference between prevention of HIV and prevention of drug use. Knowledge does not necessarily lead to change of behaviour. It is important to speak about pleasure, as drugs stimulate dopamine release in the brain and a feeling of intense pleasure.

Bulgaria RC focuses on important messages in peer organised training. Environment, behaviours, values and identity.

Bosnia RC: You have to formulate what you say so that you effect what you want to effect. Drugs programs have many approaches, and may be like a sward with two sharp sides.

Belarus RC: When talking to children all topics must be open, and all topics must be honest.

Slovakia RC: Peer education puts young people first. The RC youth must be well trained not to place them in danger. It may have a contradictory effect, especially in outreach programmes. There are many misbelieves and confusion.

Uzbekistan: In Uzbekistan there are very strict laws on drug use. Although a free choice is important, people should be aware that it might be a worry of going to jail.

French RC: Participates as medical back up and gives first aid at rave parties. They train people on specifics on first aid in this connection, and to stay away from dogs (they may have eaten vomit with drugs). Based on the principle of neutrality they participate. They have not checked the quality of the drugs, as MDM is doing for ecstasy. This is often mixed with other substances.

·        Approaches to harm reduction. Dr. Sinisa Zovko, Croatian RC

• Needle exchange. Could be done from a fixed location or mobile. Should be free and anonymous. Users can get new equipment and remove used. It is possible to provide simple medical assistance like care of abscesses. Many drug users do not have health insurance, and basic health assistance could be very important.
• Hand out material and condoms.
• Guidance centre.
• Injection room (depending on local legislation).
• Drop in centre. With or without beds. Basic medical help. Access to food or coffee. Wash clothes. Have a shower.
• Substitution treatment. Methadone?
• First aid (depending on status of emergency services and number of drug addicts).

Harm reduction is helping people in need. Focus is on the client.

·        Presentations by the National Societies that run Harm Reduction programmes.

LATVIA. Presented by Ieva Brinkmane

Latvia has a population of 2,5 million, with 0,5 million in Riga. Hiv-cases are accumulating in increasingly younger age groups. They started syringe exchange in Riga in 1997, programs with outreach workers in 1999, and in 2002 they have programs in 8 municipalities with a network of needle exchange and distribution of education material. They have 100-300 new clients every month. New clients need new info. The exchange rate of used and new syringes is close to 1:1. They use data collection and behaviour studies for the evaluation. They have improvement of HIV testing rates since the start. In the youth program their ambition is to reduce both the number of HIV infections and the number of drug users. They also want to expand the programme.

CROATIA. Presented by Dr. Sinisa Zovko.

Croatia RC has 105 official branches with professional staff. They have good infrastructure. Three projects of needle exchange are carried out in areas chosen because of a high number of drug users. They started in 1998 requested by MOPH, as part of a national strategy. They distribute needles / syringes for active IDU, condoms and information material. Even if the number of clients is not so high, they have a “secondary distribution” when users bring syringes to their circle and friends. IDU in Croatia are between 15-18000, 80% male, mainly heroine users. Most transmission among IDU is through sex. They conduct lectures with the goal of demystifying drugs, and lobby for changes of laws regarding drugs. Dr. Zovko showed pictures from their center outside Zagreb.

ITALY. Presented by Fabio Patruno.

Villa Maraini has a wide range of activities. It was founded in 1976. They have an emergency unit with a help line, street unit, prison project and different types of shelter. Both drop-in and night. The mobile teams have objectives of reducing overdose deaths, reducing HIV transmission and other infectious diseases, and assistance to drug addicts without contact to rehabilitation centre. The tasks are mainly:

• To exchange syringes (in order to limit syringe sharing).
• Distribute condoms (educate to safer sex).
• Give information of drugs, HIV and infectious diseases.
• Look for housing solutions.
• Psychological support.

Syringe distribution takes place at two locations in Rome. The results were presented; among other things they have had 247612 interventions with drug users at Termini railway station during the last 10 years. Of the 140 people working with Villa Maraini Foundation, 50% are previous users.

·        Open Society / Soros Foundation. What could be included in a project proposal.

Overall goal to diminish individual and social harms associated with drug use.

Harm reduction as a pragmatic approach with needle / syringe exchange. Substitution therapy. Expansion in the area of vulnerable people: Prisons, street children, sex workers, and roma community. Soros Foundation funds more than 200 programs by more than 130 organisations in 25 countries.

Further info can be found at www.soros.org/harm-reduction

Anyone can apply for funding.

·        Harm reduction legislation. Marina Koulikova, Russian Red Cross.

Harm reduction is important, but legal restrictions make it difficult. Harm Reduction is a new phenomenon. Ethically: drug abuse is seen as evil, and this is giving way to evil. Legally: drugs are illegal. Syringe exchange and safe drugs procedures are seen as criminal acts. Harm Reduction breaks Russian laws both in Federal law and other legal texts.

Methadone is included in drugs listed in Federal Law (“About drugs and psychotropic substances of January 8, 1998”). This requires a professional prescription. Criminal prosecution can be implemented against people involved, including syringe exchange.

Syringes are not under special control. The question is whether syringe exchange can be propaganda for drug consumption. Is consulting individuals using drugs advertising / propaganda for drug consumption?

Exchange of syringes can only take place on an individual basis, and only on exchange of the used syringe. Police must monitor destruction. The personnel must not give any information on how to prepare drugs or where to get them.

There is a Federal law about preventive measures against the spread of disease caused by HIV. Syringe exchange with mandatory testing cannot be passed to the police because of laws on medical confidentiality. This could be a possibility for action. The conclusion is: In Russia obstacles exist for HR programs, but under certain conditions it is possible. We can start with limited syringe exchange, but methadone is absolutely forbidden.

CONCLUSION of the Harm reduction workshop:

All national societies may play an active role in their country. It is important to reduce stigma and discrimination. Everybody is encouraged to use the website of ERNA actively. Please contact Sinisa Zovko for any relevant question: sinisa.zovko@hck.hr

CLOSING REMARK.

The meeting was closed with a dinner hosted by Armenian RC. They have filled their task as the host society excellently. 20 NS’s will meet again at the PPP workshop in Italy. Dr. Duchaj said the bureau would use the suggestions that have come up during the meeting. This is a revitalisation of ERNA! Thanks were forwarded to Dr. Barra, who will be replaced as a leader of ERNA in connection with the next ERNA meeting.

Reported by: Merete Taksdal, Norwegian Red Cross

Attachments

Attendance list of participants of the 6th ERNA meeting

Annual report of ERNA

Financial report

Budget proposal

Injecting drug use and Harm Reduction, Concept paper by Getachew Gizaw