A programme to help high-risk groups protect themselves from HIV infection has proven increasingly successful thanks to the commitment of nine volunteers from the Krasnodar branch of the Russian Red Cross who have overcome secrecy and suspicion to reach out to people in real need.
In February 2006, the Krasnodar branch of the Russian Red Cross launched its ‘harm reduction’ programme. Developed with support from the International Federation and with funding from Swedish Red Cross and the Public Health Foundation, the programme aims to support people whose lifestyles leave them at high risk of HIV infection.
Within the programme, the Russian Red Cross offers health advice, education on HIV transmission, the distribution of condoms and a needle exchange. Two psychologists also help run a telephone hotline. Similar programmes have also been set up in Komi, Irkutsk, Novokuznezk and Hakassia.
Reaching the target groups and building their trust was a difficult task in Krasnodar but a recent evaluation has shown that the determination of the nine Russian Red Cross volunteers involved has made this all worthwhile. One year on from its launch, the programme is having a significant impact, reaching 1,258 drug users, 428 commercial sex workers and 671 clients of a state dispensary.
The volunteers include former drug users and students, all of whom are committed to reaching as many people as possible. “I felt this was a unique opportunity for me to make a difference to people in need who live around me,” said 17-year-old student Sasha Ivanova. “I was very encouraged by the training offered by the International Federation and listening to volunteers involved in similar programmes elsewhere.”
Despite the training and the experience of other branches, the programme was slow to start. “Yes, volunteers were trained,” explained Yulia Bogacheva, volunteer department manager for the branch. “We also had information and handouts but we didn’t realize how difficult it would be to get the programme underway.”
In fact, it took months to investigate where drug users gather and to build their trust.
“They were very suspicious and didn’t want any interference from outside,” said 20-year-old volunteer, Anna Medyanik. “They were scared that we would bring the police with us and that they would be thrown in prison.”
Every Friday, the Red Cross van travels to a disused factory on the outskirts of Krasnodar to provide the outreach needle exchange. The factory is a popular meeting point for drug users - most of whom are students - and homeless people. It is not unusual for some to bring their families so there are sometimes even small children playing nearby. “
“It was so difficult in the beginning. We were scared of possible violence. Now, they tell us a lot about their life stories,” said Anna Medyanik, a 20-year-old medical student and Russian Red Cross volunteer. “Now I understand how easily people can go down and how difficult it is to regain a normal life when everyone turns away.”
Anna’s fellow volunteers are 30-year-old Alik and his wife Olga. Both are HIV-positive drug users. “Others don’t understand what it means to be HIV-positive,” explained Alik. “Our main goal is to ensure these young people use clean needles. People start to use drugs when they lose hope. When they see that somebody else cares about their lives, it is easier for them to find the inner strength to quit. We don’t push them to do so but we support them.”
Alik promotes the programme among his friends at the ‘factory’ and the number of new volunteers is expected to grow – volunteers like 29-year-old Sergey, an unemployed drug user. “I want to help others like me,” he said. “I hope, too, that it will help me get rid of my bad habit. We all hope the Red Cross will help us regain normal lives.”
Sasha Ivanova volunteers at a state dispensary providing medical services to drug users. “The chief medical officer was sceptical to start with and believed his patients would not talk to us,” she said. “When we first visited, there were so many of them and so few of us. They asked a lot of questions. Now they think our work is useful, but they have no faith of getting out of this hell. They were very emotional. They cried when telling their sad stories and we cried with them. After half an hour, we felt like squeezed lemons. Every visit since then has attracted a lot of people desperate to escape their addiction.”
Detailed investigation was also needed to reach commercial sex workers. Prostitution is illegal in Russia and sex workers are therefore reluctant to seek treatment. “When a girl gets infected, she has nowhere to go to get help,” explained Petya Kayurov. “She is scared to contact the state clinic because she knows she will end up in prison. This is why HIV prevention is so important.”
At weekends, outreach volunteers go to where the sex workers stand waiting for clients. The volunteers raise awareness of HIV prevention and distribute condoms. “Our vans visit up to fifteen meeting points in one night,” said Petya. “The girls listen because they know how important it is. There are always new girls on the streets so we have to keep reinforcing the message.”
Injecting drug users and commercial sex workers are also referred to trusted doctors where necessary.
“The main achievement of the harm reduction programme is the trust in the Red Cross that has been built up,” explained Evgeny Steshenko, branch chairman. “We have to be consistent in how we provide the services, making sure we are there at the same time every week and encouraging everyone to share the information, condoms and needles on the other days.”
In the coming year, the branch aims to increase the number of volunteers, particularly people who have been sex workers or drug users themselves.