REPORT
OF THE 8th ERNA MEETING IN KRAKOW, POLAND
25 - 29 SEPTEMBER 2004
SUMMARY
OF THE REPORT
-
30 National Societies participated in the meeting.
- Workshops and presentations were conducted on Harm Reduction;
Working with groups with risky behaviour; TB; Access to treatment;
and Stigma and Discrimination
- Key proposals made:
- There is a need for more to be done in harm reduction
- There is a need to work jointly with HIV and TB
- Stigma and discrimination are still a priority
- There is willingness of RC/RC to work with other partners
- There is a need for ERNA Board to have a role in advocating
for access to treatment in member countries
- There is a need to improve internal communication among ERNA
members
- There is a need for more IFRC materials in Russian
- There is a need for ERNA - through the Board to lobby and persuade
politicians and NS of the need for effective Harm Reduction
- The need for a PLWHA on ERNA Board is a question
- Organizing workshops during the next ERNA meeting that take
into account the capabilities and potential of individual NS
- Promote more cooperation between RC and PLWHA groups
- Moldavian and Romanian RC became new ERNA members
DETAILED
REPORT
Note:
Below please find basic summaries and key points of the presentations.
For more details, please refer to the actual presentations themselves,
which will be available on a CD and ERNA website.
PRESENT
Representatives
from 26 member National Societies + 4 observer NSs (Austria, Moldova,
Netherlands, Romania)
ERNA board and ERNA Secretariat Coordinator
IFRC Health &Care department Secretariat in Geneva
Regional Health delegate RD Budapest
ICRC Health Unit
Guests and guest speakers: Open Society Institute (OSI); GNP+;
Positively Women; European Monitoring Centre for Drugs and Drug
Addiction (EMCDDA); United Nations Office on Drugs and Crime (UNODC),
MONAR Poland, Polish National AIDS Centre
SATURDAY
25 SEPTEMBER 20:00 - 21:30
INTRODUCTION
MEETING
(Chair: ERNA board: Anders Milton, Peter Duchaj, Fabio Patruno)
-
Welcome speech: Mr. Lucjan Tabaka, President of Krakow branch
of Polish RC on behalf of Mr. Andrzej Trybusz, President of Polish
RC
- Introduction of participants
- Election of general rapporteur of meeting: Martina Kranerova
of the Slovak Red Cross was appointed as the general rapporteur
of the meeting
- Adoption of meeting agenda: The assembly unanimously adopted
the agenda
- Reports of the ERNA Secretariat
(Peter Duchaj, ERNA Vice President, Slovak RC)
Dr Duchaj started by thanking the Polish RC for their contribution
to the success of the meeting and all the participants for coming.
He presented five documents (available on ERNA website): Activities
of the ERNA Secretariat for the period between October 2003 and
August 2004; Financial Report for the year 2003 and the first
6 months of 2004; ERNA Plan of Action for 2004; the 2004 budget;
and Report on ERNA Plan of Action for 2003. The documents provide
a rather detailed view of the ERNA Secretariat work. Dr. Duchaj
highlighted the fact that the ERNA website has been relocated
to www.erna.sk. He also highlighted the co-operation between ERNA
and Villa Maraini, the foundation of the Italian RC, which became
Harm Reduction Training Centre for European RC/RC societies. In
conclusion of his speech Dr. Duchaj thanked the donor NSs for
their financial support and all those who supported the work of
ERNA Secretariat.
-
Market stall: All NSs present were provided a space to exhibit
the materials they brought
SUNDAY
26 SEPTEMBER 08:15 - 18:00
ROLE
OF RC/RC IN HARM REDUCTION
(Chair: Lana Kulchynska, Ukraine RC; co-chair: Fabio Patruno,
ERNA Vice-President, Italian RC; Kasia Malinowska-Sempruch, OSI;
Dagmar Hedrich, EMCCDA)
-
Introduction
(Anders Milton, ERNA President, Swedish RC)
Dr. Milton rose the question what can RC/RC do in prevention and
treatment. He highlighted the need to work with intravenous drug
users (IDU), and harm reduction (HR), we need to analyse the situation
- what governments and other organisations are doing, what are
we doing, how can we co-operate? He stressed that we do not need
more policy statements; we need to find the ways how to put into
practice what we were talking about.
-
Introduction to the Topic. Federation Guidelines around HR. Presentation
of the New programme for HR Programmes in Eastern Europe
(Fabio Patruno, ERNA Vice-President, Italian RC)
Mr. Patruno presented the Federation Guidelines on Harm Reduction:
"Spreading the Light of Science". These Guidelines positively
insert Harm Reduction into the framework of the RCRC context.
They consider epidemiological aspects, as well as intervention
criteria and philosophy, and briefly describe the activities of
some NSs that are already following HR principles. He also introduced
the Programme "To scale up HR activities in Eastern Europe",
a dream that came true after years and that was put as an ERNA
objective in its plan of action. In order to support this initiative,
the Italian Red Cross has opened a budget line at the Federation,
permitting, first of all, to host at Villa Maraini six workshops
on Harm Reduction for RCRC delegates from Eastern Europe and Central
Asia, and then to promote actions in the involved NSs
-
Effective Approaches to Combating HIV/AIDS in the Transitional
Nations
(Kasia Malinowska-Sempruch, Open Society Institute)
Ms. Malinowska-Sempruch started her presentation by highlighting
the explosive nature of IDU driven HIV/AIDS epidemics. She then
raised the question whether the fact, that the epidemic is spreading
to the general population and the means of transmission is heterosexual,
can be used as an argument against HR. She believes that it cannot,
as most IDUs in the countries of the former Soviet Union are men
and have mainly female sexual partners, so even hetero-sexual
transmission is a drug-driven epidemic. She continued pointing
to a discrepancy in understanding drug addiction: while World
Health Organization defines addiction as a brain disease, the
authorities treat drug addicts as criminals. She stressed the
importance of HR activities and gave an overview on the countries
where HR programmes are supported by OSI. To conclude her speech
she stressed the lessons learnt from these programmes.
-
Red Cross Role in HR in Ukraine, Experience so far, Constraints
(Lana Kulchynska, Ukraine RC)
Ms. Kulchynska gave an overview on the situation in Ukraine in
the beginning of her presentation. A law supporting HR exist in
Ukraine and there are 25 NGOs active in the field, 17 of whom
form the All Ukrainian Harm Reduction Association. She then continued
to describe the HR project in Zaporizhyia branch of the Ukraine
RC that is run by volunteers supported by psychologists and RC
staff. She pointed to both internal and external constraints for
HR. Among the internal she mentioned the following: late engagement
of RC in HR activities; unclear priority status of HR; societal
indignations; low attendance of needle exchange offices (except
mobile ones); lack of financial and human resources. Among the
external ones she mentioned unfavourable legislation (the legislation
is on paper only); vague regulations regarding substitution therapy;
high level of stigma. She concluded her presentation by stressing
the need for advocacy, capacity building, co-operation, sharing
experience, and mass media involvment.
-
Harm Reduction Responses to Drugs in the EU
(Dagmar Hedrich, EMCDDA)
Ms. Dagmar Hedrich started her presentation with explaining the
role and functions of EMCDDA and continued with EU Strategy and
policy recommendations to reduce health-related harm. The target
of the EU Drug Strategy 2000 - 2004 is: "To reduce substantially
over five years the incidence of drug-related health damage (such
as HIV, hepatitis B and C, and tuberculosis) and the number of
drug-related deaths." According to the Council Recommendation
of 18 June 2003: "Member States should, in order to provide
for a high level of health protection, set as public health objective
the prevention of drug dependence and the reduction of related
risks, and develop and implement comprehensive strategies accordingly."
She presented EU recommendations to reduce health-related harm.
Then she continued with an overview of needle and syringe programmes
in EU states.
-
Group work
Group work was facilitated by representatives of OSI. ERNA meeting
participants were divided into 3 groups and worked on different
topics
-
Group 1
Access to Treatment
The group was first briefed by the facilitator on WHO guidelines
on “ARV4IDU"
1. Care must be accessible - integrated into general health infrastructure
2. "One-stop shop" - integrated care model with maximum
number of related services in one place (substitution treatment,
ARV, counselling, social services...)
3. "Step by step" from easy to more complicated interventions
4. Linking HR and outreach services to ARV utilisation
The group then continued with identifying problems: Lack of political
will, lack of funding; Lack of information and knowledge in IDUs;
Low accessibility of AIDS services; Double stigma; No ARV available;
HR is illegal (in Russia); Lack of medical knowledge among HR
programmes, outreach workers; No terminal care for people with
AIDS; Parallel TB, HIV and HR programmes.
Finally the group came up with suggestions for entry points for
RC involvment based on the problems identified earlier and highlighting
the unique status of the RC as auxiliary to the public: Join the
advocacy to access treatment; Use RC confidence and network for
spreading information about treatment; Spread the knowledge "not
only doctors"; Train on peer education; Home based care;
Linking TB, HIV and HR programmes; Fight stigma.
-
Group 2
How to Start Harm Reduction Project - Essential Basics
The second group came up with the conclusion that HR is indeed
needed. To start HR programmes, there is a need for administrative
decisions, training of outreach workers and funding.
The presentation was followed by brief remarks on the need of
involving IDUs in the development of the programme; before starting
a HR programme, a NS must be prepared to allow some time to make
the project running and a lot of communication is needed. Dr.
Milton raised the question about the position of NS leadership
and the need for ERNA involvement to influence the leaders and
encouraged participants to ask for such intervention, if needed.
-
Group 3
Sexual Health of IDUs
The third group came up with several suggestions: Effectiveness
of HR depends on whether clients sexual behaviours are taken into
account; Dialogue with our clients is needed about safer sex in
the context of their sexual lives; The goal is that they can also
judge their own behavior. In comment on this the need to consider
gender issues was stressed. Rights of female IDUs, their reproductive
health and stigmatisation at ante-natal clinics should be tackled.
WORKING
WITH OTHER GROUPS THAT HAVE RISKY BEHAVIOUR
(Men having sex with men, commercial sex workers, heterosexual
risks)
(Chair: Indrek Simisker, Estonian RC; co-chair: Julian Hows, GNP+;
Bjorn Malmquist, Swedish RC)
-
Macro Economics and Health
(Bruce Eshaya-Chauvin, IFRC)
Mr. Eshaya-Chauvin started his speech by saying, that "the
world is much simpler today than it was 15 years ago," referring
to the change of World Bank's attitude to health. In the past
good health was seen as a side effect of good economy, today it
is the opposite. Evidence shows that investments in health can
be a concrete input into economic development. Improving people's
health may be one of the most important determinants of development
in low-income countries. Poverty and ill-health are closely linked.
Ill health undermines economic development and efforts to reduce
poverty. Investments in health are essential for economic growth
and should be a key component of national development strategies.
The greatest achievements can be made by focusing on the health
of the poor and the least developed countries.
He continued by saying that RC/RC is doing a lot in health promotion,
however, he stressed the need for increased promotion of our work
and the need for co-operation with government authorities, such
as Ministries of Health, Social Welfare, Justice and Defence.
He concluded his speech saying that a drop of HIV/AIDS prevalence
in some countries is a question of commitment of government and
RC has a role to play in lobbying.
-
A Youth Perspective on HIV/AIDS
(Mikolaj Bekasiak, Polish RC)
To begin his speech, Mr. Bekasiak raised the question: "Why
youth?" There are several points to answer this question:
Youth Are Affected; Youth Are Playing a Role; Youth Are Diverse;
Advantages of Youth Approaches. Mr. Bekasiak continued with raising
another question: "What can youth do?" And he found
several answers to that question: Provide relevant information;
Represent youth interests; Make AIDS an everyday topic. He concluded
by stressing that youth is not just a target group - they are
a resource.
-
The Situation in Estonia, Who is at Special Risk? Current RC Activities
in the field of HIV/AIDS in Estonia
(Indrek Simisker, Estonian RC)
Mr. Simisker began his presentation with an overview of HIV/AIDS
statistics in Estonia 1988 - 2002: in Estonia the first HIV infection
case was registered in 1988 and the first AIDS case diagnosed
in 1992. From 1988 to 1999 the number of new HIV infections varied
between 1 (in 1988) and 12 (in 1994). Big increase in infection
rate took place in the second half of 2000 and continued in 2001.
(From 1988 till 1999 91 cases were diagnosed, in the years 2001-2003
it was 2763 cases). Mr. Simisker then continued with more detailed
statistics: data by age and sex; data on prisoners; data on injecting
drug users; and data on pregnant women and newborns. Mr. Simisker
concluded his speech by suggesting "Maybe it's finally time
to stop marginalization by trying to put people in to a different
"risk" groups, instead let's speak about people with
risky behaviour."
The presentation was followed by several questions: whether the
prisoners were infected in prison and how the decline in newly
diagnosed cases in 2003 can be explained. Unfortunately, no data
are available and no research was carried out. Possible reasons
for decline can be new drugs of choice with less injecting or
the lack of testing, usual in former Soviet countries.
-
Noah's Ark: Working with Groups with Risky Behaviour in Sweden
(Bjorn Malmquist, Swedish RC)
Mr. Malmquist gave a presentation on the work of the support program
at the Noah's Ark-Red Cross Foundation. The support is practical,
emotional and informative and is provided to PLWHA, relatives
and friends.
Services provided are: At Noah's Ark: individual and group counselling,
"body and soul weekends", massage, yoga, lunches, major
holiday celebrations, and "job studio. Outside Noah’s Ark:
home visits, outreach to prisons and hospitals, boarding school
weekends, excursions, children’s holiday camps and school break
activities, theatre and cinema visits, patient associations, regional
security offices. Mr. Malmquist then continued by explaining some
basic psychological concept about people's needs and the linkage
between reflection, emotions, actions and sensations stressing
that in a work with the target group these need to be kept in
mind.
-
Risk Groups, Ideas Around How RC/RC Can Work with Different Groups
(Julian Hows, GNP+)
To begin his presentation on working with "risk" groups,
Mr. Hows stressed the importance to raise the question how safe,
welcoming, inclusive are: the political and social environment
in which you work; policies, procedures, and operational methods
of National Societies; and people themselves. He continued his
presentation with issues to consider when working with different
groups. In all cases a profound knowledge of epidemiology is necessary.
Special issues need to be considered when working with men having
sex with men, sex workers and heterosexuals. Mr. Hows continued
his presentation with his findings on RC/RC work since he started
attending ERNA meetings: RC/RC is working more on the issues;
building strategic partnerships; is more welcoming; however, more
involvment of PLWHA is still needed;
He concluded his presentation with questions for the working groups:
-
What is our definition of risk behaviour or a risk group?
- How can the RC/RC work with and for risk groups and how to achieve
partnerships with risk groups
- How can we transfer emotional/social experience about HIV from
one generation to another - and from 'mature' to 'emerging' epidemics
And for each of the above questions
- What do we know works already - examples of good practice
- How do you ensure that the expertise of PLWHA is acknowledged
in this work and they are supported in maintaining safer sexual
behaviours
- Based on your discussions produce two or three recommendations
on action points on what national Societies in collaboration with
partners and/or Federation/secretariat should/could/will do concerning
the topics
-
Group work
Group work was focused on the question raised in the presentation
by Mr. Hows above. All three groups worked on the same questions.
-
Group 1
The first group came with the following suggestions: Avoid the
term "risk" group as everyone may be at risk, use "target
group" for specific programmes instead; Target groups can
be defined by their behaviour or settings that make them more
vulnerable to HIV infection - this classification shall be based
on scientific data; Learn from experience, use approaches that
work - peer approach; involvment of target group; changing the
perception (until people do not see themselves at risk, they do
not change their behavior); co-operation with organisations/individuals
who have access to the target group.
-
Group 2
The second group came with the following suggestions: Needs and
capacity assessments are necessary before starting a project;
We need to ask the target group: whether they need support; whether
they wan support from RC; whether they can be partners; Build
partnerships with other organisations is vital.
-
Group 3
The third group identified that the transfer of emotional and
social experience about HIV as such is impossible, however, to
overcome a generation gap: Permanent and obligatory education
is needed; Methodology is a question; Involvment is necessary.
In his remarks to the findings by Group 3 Mr. Hows stressed, that
a shift of paradigm is vital to overcome the generation gap -
not only the "young" learning from the "old",
but vice versa too. He also raised the question how can we use
the experience of PLWHA and facilitate learning through emotions
rather than lectures.
MONDAY
27 SEPTEMBER 08:15 - 15:30
RC/RC
ROLE IN TUBERCULOSIS CONTROL (Looking Specifically at Links to
HIV/AIDS Programmes)
(Chair: Sholpan Ramazanova, Kazakh RC; co-chair: Eric Burnier,
ICRC; Monica Beg, UNODC; Russian RC)
Dr. Milton opened the session with wrap up from Sunday: We agree
that we need to work with Harm Reduction, the question is: what
to do and how to start; we recognise, that there is a lack of
political will leading to lack of resources; IDUs and sex workers
are not seen as a target group; There is a lack of knowledge on
both sides; There is a question, whether there is a lack of will
in the NSs themselves - if so, we shall raise awareness within
the Movement itself; We are all at risk of being infected by HIV;
Usage of peers to reach the groups with risky behaviours is necessary.
-
Presentation of Programme, Special Emphasis on Possible Links
Between HIV/AIDS and TB programmes
(Sholpan Ramazanova, Kazakh RC)
Ms. Ramazanova presented the findings of a research that was carried
out in frame of a TB prevention project in Kazakhstan. Objectives
of the study were: to study the attitude of society to TB patients,
to find effective measures to prevent stigma and discrimination.
The target group were: patients, medical personnel, families,
journalists, local authorities and randomly selected healthy people.
One of the findings of the research was reasons why people tend
to discontinue treatment: economic reasons (no means to travel
to TB centres), medical reasons (side effects), and personal reasons
(including lack of knowledge and alcohol dependency). High influence
of RC nurses on the decision to renew/continue treatment was found.
RC provides psychological support, food, accommodation and financial
support to TB patients.
Another finding was the attitude of society to infectious diseases:
TB is the most feared one followed by HIV/AIDS and atypical pneumonia.
Society would describe a sick person as male, middle aged, unemployed,
with bad habits/dependencies, with low level of education. Most
TB patients in fact do not fit this description.
Patients were asked whether they felt the attitude of society
towards them changing: as time passes, they get more used to their
disease and do not perceive the attitude of society as changing.
Reasons for stigmatising TB patients are: fear of infection, fear
of the poor and unemployed.
A part of the research was focused on the importance of self-help
groups and the reasons, why people were afraid to join them (fear
of other TB patients, fear of being re-infected).
Ms. Ramazanova concluded her presentation by recommendations to
provide information for the general public using mass media and
provide psychological support to affected persons.
-
TB Control Programmes in Prisons
(Veronika Agapova, Russian RC)
Ms. Agapova introduced a project of the Russian RC for TB infected
convicts. The target group of the project are prisoners, that
are just to be released and those who were released the previous
year. From 700.000 convicts in Russia, 92.000 are TB patients.
TB rate as well as mortality is several times higher in prisons
than in the general population. The prisons are facing several
problems: overcrowding, poor hygiene, poor co operation between
Ministry of Health and Ministry of Justice affects TB patients
in prisons and RC access to them.
Prisoners often discontinue TB treatment either convinced by fellow
prisoners, that the treatment won't help them anyway, or, when
leaving the prison, they find themselves left alone in a society
that has changed.
The project of the Russian RC aims at improving the knowledge
of the patients as well as improve co-operation between prisons
and medical services and thus achieve better access to TB patients
in prisons.
The pilot phase of the project is being carried out in Ivanovskij
region, which has successfully piloted several projects and the
staff is experienced in DOTS too. They started the project with
arranging legal agreements with prison, medical services and local
authorities. They start working with the prisoners shortly before
release, so that they know what to do, when they leave prison,
psychological and legal counselling is provided. They also produced
a leaflet for them in form of a personal letter to help them find
their way once released. After being released, the RC supports
the ex-convicts with food and clothing, thus meeting some of their
needs - and ensuring they will come to the Red Cross and more
of them will continue their TB treatment. The Russian RC also
helps ex-convicts to adapt to the society and find a job.
-
Experience of Working with TB in Prisons in the Caucasus
(Eric Burnier, ICRC)
ICRC delegates have a 9-year experience in working with TB patients
in the prisons of Azerbaijan, Georgia, and Armenia. In his speech,
Mr. Burnier presented the lessons learned from this experience:
- Prison is not a closed world; there is a lot of communication
going on with the outside world (visitors, prisoners being moved
to other prisons...). There is a high concentration of people
with risky behaviours: alcohol and drug dependencies, TB and HIV
infected individuals; overcrowding and lack of hygiene are common.
Such prison environment increases the risk of TB infection - the
rate can be 50-100 times higher than the national average, with
a high mortality rate and discontinuing treatment is common. "Being
in prison is a sentence, but catching TB in prison is not a sentence"
- this is one of the lessons learned.
- The co-operation between the Ministry of Justice and Ministry
of Health is poor - that leads to a gap where TB patients in prison
fall. The medical units under Ministry of Justice are "second
category" - with low salaries of personnel and poor training.
This is another of the reasons leading to discontinuing treatment
in released prisoners.
- The problem of multi-drug resistance (MDR) is severe in prisons.
The reasons for this are: late detection of cases, inadequate
treatment, interrupted treatment. DOTS+ is a solution here, however,
it is difficult, takes long time and is expensive. Experience
shows, that DOTS and DOTS+ should be joined in one unique programme,
not two separate ones.
- A TB programme can never be efficient in the short term.
-
Scaling Up RC/RC Response to Tuberculosis - Strengthening the
HIV/AIDS Component
(Lasha Goguadze, IFRC)
Mr. Goguadze started his presentation by giving an overview on
TB: 8 - 9 million new TB cases every year; TB kills 5,000 people
a day - 2 million each year; one third of the world’s population
is infected with TB. He presented the 5 components of the internationally
recommended TB control strategy. He continued by introducing the
global targets of STOP TB Partnership (American and Russian RC
and IFRC Secretariat are members of this partnership) - these
aim at 85% cure rate and 70% case detection rate by 2005. He then
gave an overview on the geographical areas where Red Cross is
active in TB programmes worldwide and lessons learned from pilot
projects in Russia and Central Asia. Mr Goguadze concluded his
speech by raising the question of future steps. He also suggested
some points to consider.
-
HIV/AIDS in Prison Settings
(Monica Beg, UNODC)
Dr. Beg started her presentation with an overview of global statistics:
at the end of 2003 there are 34 - 46 millions of PLWHA worldwide,
5 million new infections and 3 million deaths occurred in 2003.
Eastern Europe is facing the fastest growing epidemics in the
world with injecting drug use being the main mode of transmission.
There are over 13 million IDUs in the world, 1,2 million of them
live in Western Europe and 3,2 million in Eastern Europe and Central
Asia. She then continued with pointing to the fact, that HIV rate
is higher in prisons than in general population in some countries
- Russia, Ukraine, Estonia, Latvia, and Lithuania. Prison conditions
are characterised by: overcrowding, violence, self harm, and higher
prevalence of drug use, HIV, hepatitis B and C, TB, mental illnesses
than in society outside. Dr. Beg then introduced WHO, UN Economic
and Social Council, and UNAIDS regulations regarding HIV/AIDS
in prisons. Dr. Beg concluded her presentation by expressing her
belief, that RC/RC is well positioned to "do something"
in this issue and as well expressed her hope that action will
indeed be taken.
-
Group work
Group
work was focused on the question raised in the presentation by
Mr. Goguadze:
1. What are the ways to increase voluntary and community involvement
in TB programmes?
2. What are the ways to ensure HIV/AIDS and TB interrelation?
3. What are the ways to increase partnership coordination?
All three groups worked on the same questions.
-
Group 1
Question 1: Involve family members; Involve TB patients, who were
cured, apply peer education principles; Involve the target group;
Organise awareness raising campaigns.
Question 2: Cooperate from planning level; Training for TB (nurses,
peer educators) should include HIV/AIDS components and vice versa;
Use existing networks of nurses for both TB and HIV/AIDS programmes;
Existing resources should be used for both programmes; ERNA should
work out recommendations to overcome the problem.
Question 3: IFRC should support NSs in developing activities;
Periodical exchange of information is needed; Link existing programs;
Use ERNA as a platform to provide information; RC has a unique
position being close to both governments and vulnerable people
- needs to "sell" this position to potential partners
-
Group 2
Question 1: Provide information to the communities; Establish
partnerships with all stakeholders
Question 2: Advocate to governments for integration; Appropriate
legal base is needed for RC activities
Question 3: ERNA should act as a more effective co-ordinating
body; ERNA Secretariat should send questionnaires to member NSs;
NSs should report annually to ERNA; Everything should be published
on ERNA website; Working groups should be set up on different
issues
Issues raised by Group 2 were commented by the audience: It was
agreed on the Berlin conference that a working group will be created
and guidelines developed. Mr. Goguadze informed that the working
group was created, terms of reference were designed and sent out
for comments, however, there is a poor communication with some
NSs and now the question is how to continue. Dr. Milton expressed
his opinion that "we shall move ahead with those who can
and will move". As regards ERNA responsibilities, Dr. Milton
agreed, that ERNA Board and Secretariat can collect information
and put it together, however, needs to rely on expertise and co-operation
of members.
-
Group 3
Question 1: Design programs in a way to increase volunteer motivation
(this depends on age, sex, profession...); Award volunteers with
certificates; Give volunteers the opportunity to be a part of
a group.
Question 3: Meetings with government representatives and other
partners should be initiated by RC; Share experience; Work together
ANTIRETROVIRALS,
INTRODUCTION TO ACCESS TO TREATMENT
(Chair: Anders Milton, Lasha Goguadze, Julian Hows)
-
The New Federation ARV Guidelines
(Lasha Goguadze, IFRC)
In his presentation Mr. Goguadze introduced the new IFRC guidelines
to ARV that were published under the title: "Service delivery
model on access to care and antiretroviral therapy for people
living with HIV/AIDS." While in the developed world ARVs
have significantly improved the lives of PLWHA, in the developing
world often even treatment for opportunistic infections is not
available. Mr. Goguadze introduced the mission that preceded the
development of guidelines. Mr. Goguadze continued with explaining
the model, which is based on holistic approach, continuum of care,
phased approach, use of existing structure, NS niche, focus on
vulnerable groups, advocacy, resource mobilisation, capacity building
and sustainability. Mr. Goguadze concluded his presentation with
ensuring, that the use of the model is not limited to Africa,
after adapting to local conditions it can be used in other regions
too.
-
Discussion Between the RC/RC and the Pharmaceutical Industry
(Anders Milton, ERNA President, Swedish RC)
Dr. Milton began his speech by explaining the reasons for contacting
the research-based pharmaceutical companies:
- Co-operation in the field of access to drugs
- Use the strength of partnership to influence governments
He explained what the situation in Africa is and introduced IFRC
efforts in convincing pharmaceutical companies to provide consultations
on production of generic drugs. The reason why they should do
it is that they will not lose business as they do not have any
in Africa anyway - and they could improve their image. The pharmaceutical
companies are ready to co-operate to some extent, however highlighting
some problems related to poor quality drugs.
Dr. Milton continued with expressing the need for working with
IDUs, sex workers, trafficking, trade unions and gender imbalance.
He gave examples from Africa again, where polygamy is common,
as well as trans-generation sexual intercourse, female students
are raped by teachers, women are left helpless after being diagnosed
with HIV infection and AIDS orphans are used as slave labour by
their own extended families. Dr. Milton stressed the need to seek
support from governments, local leaders, traditional healers,
sports/music stars. We need to focus on prevention, access to
treatment and stigma and discrimination issues.
Mr. Hows commented that we not only need a dialogue with pharmaceutical
companies, we need local production and local availability of
drugs.
-
Introduction to the Masambo Fund
(Lasha Goguadze, IFRC)
Mr. Goguadze introduced the Masambo Fund. The purpose of the Fund
is to ensure the survival of RC/RC humanitarian workers so as
to maintain organizational capacity to deliver humanitarian assistance.
The Fund was named after Masambo, who was a long time staff member
of Zimbabwe Red Cross. Masambo produced a video with a testimony
she wanted to leave just before dying of AIDS. If Masambo had
been able to access treatment, she would have been probably still
with us. Masambo's work and situation symbolises all this fund
seeks to address. The aim is to provide treatment for 500 people
- this requires CHF 2.5 million for 5 years. National Societies
are encouraged to raise a voluntary annual contribution using
the equivalent of 1% of that Society's statutory contribution
as a minimum annual fundraising target. Mr. Goguadze then explained
the functioning of the Fund. To conclude his presentation, Mr.
Goguadze urged ERNA meeting participants to persuade the leadership
of their NSs to contribute to the fund.
FEEDBACK
FROM THE CONFERENCES
-
Dublin Conference; February 2004
(Mikolaj Bekasiak, Polish RC)
The conference was held under the title: 'Breaking the Barriers'
in Dublin, February 23-24.2004. It was Irish EU Presidency ministerial
level conference for all countries of the European and Central
Asian region in regards to HIV/AIDS. The outcome of the conference
is the Dublin Declaration. Mr. Bekasiak outlined some important
quotes from the Declaration. To conclude his speech Mr. Bekasiak
highlighted that the Dublin Declaration was signed by government
representatives and urged ERNA meeting participants to "push"
the governments of their countries to take action.
-
15th International AIDS Conference; Bangkok, July 2004
(Ulugbek Aminov, Tajik RC)
Mr. Aminov thanked all those who enabled him to participate at
the Conference. Obviously, harm reduction was the most interesting
topic for him. This is very sensitive problem for Central Asia
and East Asia. He continued with identifying problems in implementing
HR programs. To succeed, the following are vital: partnerships
with other organizations, work with PLWHA and IDUs and special
attention shall be given to youth.
- Europe and HIV/AIDS: New Challenges, New Opportunities; Vilnius,
September 2004
(Iveta Balode, Latvian RC)
Ms. Balode started with quoting one of the most frequently used
sentences in the conference: "The only way to cope with the
problem is to take the matter seriously and to fight against the
disease with cooperation of all possible instances and in all
the areas of life." Issues discussed at the conference were:
HIV pandemic has inflicted its worst damage on marginalized populations;
In Central and Eastern Europe and the former Soviet Union, the
vast majority of HIV-positive people are injecting drug users;
Fight against HIV/AIDS starts with human beings - he fate of many
will depend on the ability of large numbers of human beings to
change their behavior and attitudes in the face of PLWHA; Summing
the conclusions of the conference, National Red Cross and Red
Crescent Societies have become valued members of the big HIV/AIDS
network. We give a vast number of human beings the knowledge and
tools to personalize the issue.
TUESDAY
28 SEPTEMBER 08:00 - 13:30
STIGMA
AND DISCRIMINATION
(Chair: Martina Kranerova, Slovak RC; co-chair: Julian Hows, GNP+;
Angelina Namiba, Positively Women)
Dr. Milton opened the session with wrap up from Monday: Social
mobilisation is necessary; Co-operation, more inclusion in HIV/TB
programmes is needed; Prevention programmes are needed; If questionnaires
are sent out to National Societies, they should be answered; If
National Societies need support from ERNA in talking to the government,
they should ask for it.
-
Stigma and Discrimination
(Julian Hows, GNP+)
Mr. Hows defined stigma and discrimination in the beginning of
his presentation. He continued with asking whether stigma enhances
risky behavior. He gave overview on statistical data from the
European Study (Sherr & Sherr 2001). Mr. Hows then presented
some ideas RC/RC is doing or should do from his point of view.
He continued with introducing a project on research - and an opportunity
to partner at the strategic level. The project concerns the criminalisation
of HIV transmission in Europe and Central Asia. The research is
not finished yet and Mr. Hows asked ERNA meeting participants
for help.
-
International Workshop on HIV/AIDS Prevention, Stigma and Discrimination
of PLWHA, Best Practices CD ROM
(Martina Kranerova, Slovak RC)
Ms. Kranerova presented a toolkit in form of a CD that was produced
at an international workshop organised by the Slovak Red Cross
Youth with representatives of: 8 Central European National Societies,
PLWHA, and IFRC. Aim of the workshop was to produce a regional
information pack in a form of a CD focused on Red Cross/Red Crescent
Youth role in the HIV/AIDS field (prevention, anti-stigma and
discrimination) including: Candle march campaign description;
Common visual identity; Statistical data; List of actions in Central
Europe region; and IFRC materials. Then she introduced the toolkit
itself, and encouraged meeting participants to take the CDs and
use them.
It was also agreed that Slovak Red Cross will co-ordinate World
AIDS Day 2004 activities in Central Europe in co-operation with
the Regional Delegation in Budapest.
A suggestion was made by Mr. Hows for the Slovak Red Cross to
collect information on World AIDS Day related activities from
other ERNA members too. This suggestion was supported by some
of the other participants too and was accepted by Ms. Kranerova.
-
Living with HIV... Changing Lives
(Angelina Namiba, Positively Women, UK)
Ms. Namiba presented the work of Positively Women - the only national
charity in the UK providing support for women living with HIV
by women living with HIV. The history of the organisation started
in 1987 by HIV+ women. Ms. Namiba then spoke about issues for
women living with HIV. These issues often differ from those male
PLWHA face. Relationships - one of the problems is that women
are often tested positive earlier than their partners and then
they are blamed for "bringing HIV to the family". Positively
Women are trying to get couples to get tested together; Reproductive
issues - while if a woman with cancer decides to have a baby,
she is considered a heroin, if a woman living with HIV does the
same is considered a criminal by the society. Ms. Namiba presented
the possibility of "sperm washing" - a procedure that
allows artificial insemination without risk of HIV transmission
from father to mother or child; Treatments - one of the problems
with treatment for women is that research is done mainly on males,
as researchers are afraid to test drugs on women or children.
Women then may face unexpected side effects; Other Social issues
- poverty, unemployment, inability to influence sexual relationships,
role of carer in the family
The work of Positively Women is based on peer support process
from isolation to involvement. Long term goal is creating a society
where an HIV diagnosis is not aggravated by huge stigma and discrimination.
-
Group work
Group
work was focused on questions raised by Mr. Hows:
1. If we are planning activities for World AIDS Day 2004, how
are they going to be better than last year?
2. Over the next year which NS will be looking at new work to
counter stigma and discrimination? And will it be internal (in
the NS); lobbying to open doors; creating the enabling environment
or working with others (partnership).
All three groups worked on the same questions.
-
Group 1
The first group came with the following suggestions: Involve more
groups; improve fundraising; improve co-ordination at headquarters;
involve more regions; organise activities at different places
at the same time and with the same slogan; improve media coverage;
improve existing partnerships and establish new ones (with PLWHA,
government, NGOs, UN agencies...); disseminate information within
Red Cross.
-
Group 2
The second group added the following suggestions: put GIPA (Greater
Involvment of PLWHA) into practice; increase international engagement;
broaden the target group.
-
Group 3
The third group came with similar suggestions: big events; Candle
marches; more efficient and intense prevention work; better co-operation;
media involvment.
Group work was then summarised by Mr. Hows, who identified common
patterns in the suggestions: Scaling up; new partners; new target
groups. To conclude he raised the question, whether if we are
doing more, we need to spend more funds too. He asked meeting
participants to think of possibilities of doing more things cheaper.
WHAT
HAPPENS NEXT
(Chair: Anders Milton, ERNA President; Fabio Patruno, ERNA Vice-President;
Peter Duchaj, ERNA Vice-President)
The session was introduced by Dr. Milton, who also facilitated
the discussion.
Main outcomes of the meeting were identified as:
- There is a need for more to be done in harm reduction
- There is a need to work jointly with HIV and TB
- Stigma and discrimination are still a priority
- We are willing to work with other partners
After having an agreement on these main points, Dr. Milton went
forward with discussion points:
- Is there political will in the country and the NS for working
with the vulnerable groups?
Responses: sometimes our governments are conservative, sometimes
our NS is conservative. Sometimes there is a need to convince
the National Society, eliminate stigma and discrimination. Sometimes
management shows willingness to work in HR, but local branches
claim to have no capacity and are conservative or will of volunteers
is insufficient. Difficulties in harm reduction and working with
HIV may arise from moral issues about commodity supply creating
demand.
- Do we need to develop specific resources for ERNA work in Harm
Reduction? (toolkits, check lists)
Responses: In Italy training for trainers has started at Villa
Maraini. In Central Europe the leadership of NSs does not seem
to be very educated in Harm Reduction issues; there is a need
for the toolkit to educate the family of the RC/RC to accept the
work needs to be done. Especially in Estonia there is a great
need for such a toolkit to convince the leadership. In some countries
general public, including IDUs, are not ready to start HR programmes,
IDUs do not trust any officials. A toolkit for advocacy both within
and outside RC is needed. Information on how to influence government
officials should be a part of the toolkit too. Experience from
Croatia shows that if are starting with harm reduction, there
is a need to educate the society and professionals. Ownership
by the governance of NS is necessary. A statement from ERNA would
be useful; ERNA should push for this agenda. However, harm reduction
should not be driven by political will but by personal and local
needs. Effective fundraising and efficient use of resources are
vital.
- There is a need for ERNA Board to have a role in advocating
for access to treatment in member countries, where treatment is
not available. Request for such help should be made to ERNA Board.
- There is a need for more IFRC materials in Russian
- There is a need for ERNA - through the Board to lobby and persuade
politicians and NS of the need for effective Harm Reduction. Request
for such help should be made to ERNA Board.
- The need for a PLWHA on ERNA Board is a question for the next
elections. As Dr. Milton commented, it is a budgetary question
too - more ERNA members should contribute. However, fundraising
from other sources in this case would be possible.
Future
ERNA activities were the next point to discuss.
- Next Meeting - Where? What priorities? When?
Ukraine Red Cross proposed to host the next meeting on September
5-8, 2005 in Kiev.
Priorities are the following: There is a need to improve communications
and find a way of developing our priorities over the coming year.
The meeting needs to be better tailored to the needs of the NS
and we need to develop a process for this to happen. It is questionable,
whether fundraising should or should not be one of the topics
for the next ERNA meeting. While some National Societies are eager
to share experience on this issue, others are afraid of turning
ERNA meeting to a "donor" meeting. Suggestions were
made to have a specific track for youth and share best experience
in harm reduction and peer-education. There is a need to discuss
the methodology of the meeting too. Mr. Hows raised the question
whether we want to try and run the next ERNA meeting in partnership
with another organisation? (Suggestion of PWA network of Ukrainian
being a full partner in the network)
Before closing the meeting, new members were welcomed: Moldova
and Romania. Representatives of Moldova and Romania gave short
speeches expressing their gratitude. With the two National Societies
ERNA has now 36 members.
In their closing remarks ERNA Board and others expressed their
thanks to Polish Red Cross, the Secretariat, interpreters and
participants.
Reported
by: Martina Kranerova, Slovak Red Cross with assistance from Silvia
Kostelna, ERNA Secretariat |
