We believe that the end of AIDS is possible if there is more focus on key populations. Our project in Georgia addresses barriers faced by the PWUD community related to their sexual and reproductive health and rights. Driven by community champions, we work to realize PWUD activists and community initiatives are able to influence the government through an established mechanism; a supportive policy environment exists with the political will to change legislation and to meaningfully involve civil society and PWUD; and service delivery done by NGOs is financed by the government and international donors.
The epidemic continues to grow: criminalisation, stigma and poor access to prevention
Georgia is among low HIV prevalence countries being at high risk for an expanding epidemic due to widespread injecting drug use and the population movement between Georgia and neighbouring high HIV prevalence countries such as Ukraine and Russia. Since 1997 the number of newly registered cases started to increase and Georgia is one of those very few countries in the world and in the region where the HIV incidence has been increasing steadily during the last decade. The latest available evidence indicate that the HIV epidemic in Georgia is largely concentrated among key populations, including PWUD for which the estimated HIV prevalence is 2.2%.
Another major problem is the late HIV diagnosis and its association with a high mortality rate and the major multidrug-resistant (MDR) TB burden. Despite the impressive expansion of HIV prevention efforts over the last several years, coverage of key populations with preventive services and HIV testing remains low for all key populations. It should be highlighted that the state programme does not procure 4th generation HIV tests, which identify HIV positive cases earlier. There are no services addressing the specific needs of young people (between the ages of 14 and 24) who are vulnerable and most at risk of HIV in Georgia. Stigma and discrimination of people living with HIV continues to be a major barrier to HIV prevention and service utilisation. Negative social attitudes and low public awareness also remain obstacles, especially for PWUD. Besides societal attitudes, state criminal laws, regulations, and policies relevant to drug use and preventive work among IDUs and prisoners are among limiting factors. Despite the accomplishments in various areas of national HIV response, the epidemic continues to grow.
PWUD claim a right-based HIV and SRHR response
Bridging the Gaps works with a Theory of Change approach. A Theory of Change is a description of a list of events that is expected to lead to a particular desired outcome. It is a visualization how change is believed to happen. In 2016, representatives of the PWUD community developed specified Theory of Change that consists of short-,medium, and long term outcomes. The Theory of Change describes how we plan to realize PWUD activists and community initiatives are able to influence the government through an established mechanism; a supportive policy environment exists with the political will to change legislation and to meaningfully involve civil society and PWUD; and service delivery done by NGOs is financed by the government and international donors.
Through innovation and by building on previous work, we will strengthen civil society organisations’ ability to:
1. We facilitate community development
- Building the capacity of peer consultants working at the rehabilitation centre as instructors;
- Assessing the comunity empowermeent needs;
- Empowering activisits among key population groups through training;
- Training peer-educators among young people in Telavi;
- Providing opporutnities to link and learn between civil society from Ukraine and Georgia;
- Involvingof the community and offering leadership and technical expertise through the regional approach on rehabilitation.
2. We advocate for the continuously strengthening of services and upholding human rights
- Conducting regional advocacy and in the Kakheti region on service delivery;
- Promoting messages and products of the 2015 advocacy campaign “Addiction is not a Crime”;
- Providing training on advocacy and communication;
- Sensitizating and skill building trainings on HIV and human rights with healthcare providers and police staff;
- Informing policy and programme managers on the needs of young drug users and female drug users;
- Continuing the development of a guideline of methadone substitution program for semi-open prisons.
3. Deliver inclusive, rights-based and gender sensitive services
- Supporting social bureaus in Telavi and Tbilisi to increase access to HIV and hepatitis testing for PWUD;
- Supporting rehabilitation centre, case management and resocialization services in Kakheti;
- Improving psychological support for PWUD in detention;
- Supervising and monitoring of prison staff by Tanadgoma;
- Providing follow up support of PWUD after release from prison;
- Supporting self-help groups in prison to increase the awareness of prison social workers and psychologists on harm reductiondeveloping gender- and age-specific materials;
- Adressing SRHR needs of female PWUD in prison;
- Providing services for young drug users in Telavi.
4. Fostering global and in-country processes and partnerships that reinforce results
- Conducting an assessment of clients-needs, analysis of existing service provision algorithms and local policies;
- Conducting an assessment on needs of young PWUD.
Our project builds on the strong advocacy work of our partners AFEW Ukraine, Tanadgoma and Bemoni to put PWUD’s health issues on the political agenda and get them included in national plans. Their work is internationally supported by AFEW.