Beyond Resistance

My name is Anya Sarang. I am a health and human rights activist, the president of the Andrey Rylkov Foundation. Me and my friend Tanya Ivanova have cofounded ARF in 2009 when the Russian Ministry of Health has officially rejected the international best practice on HIV prevention and we decided to take a more activist approach to reshaping community health response in the new political realities. Before that I worked with international organizations such as Médecins Sans Frontières who set up first HIV prevention interventions in Russia. I have an MSc in Drugs and Drug Policy from the University of London, an MSc in Medical Anthropology and Sociology from the University of Amsterdam, and while I’m mostly a community activist, I do qualitative research whenever possible, with focus on the vulnerable communities, health, human rights, gender, gender based violence and other urgent issues and have published around 30 scientific papers.

Russia's State Anti-Drug Strategy promotes social intolerance to drug use which  drives ill-treatment, discrimination, police abuse, over-incarceration and health crisis. Our mission is to clean up the mess caused by Russia’s iron-fisted drugs policy. Our philosophy is harm reduction. We support people in achieving their goals: rights, health, solidarity. Due to political pressure on the civil society, we are the only NGO that keeps providing essential services to people who use drugs in Moscow and loudly advocating for drug policy reform. We found our way to sustain resilient services and human rights work through the ongoing dark years of politically-driven conservative ideology, war on drugs and on the civil society. We would be happy if we could elevate the humanity by contributing our experience, ideas, political and social practice towards a more humane society driven by equality, dignity for all and compassion; free of police brutality, terror and mass incarceration. 

Russia has among the highest levels of drug abuse in the world and the worst HIV crisis outside Africa, and along with Ukraine is one of the few corners of the globe where cases are actually growing. Sharing syringes is still the main driver of the epidemic contributing to over half of the infections. Drug overdoses reach 9.000 per year. The government opposes internationally approved evidence-based interventions, such as harm reduction, opioid substitution treatment and naloxone distribution. Police behave with impunity, extorting or blackmailing Russian citizens, or planting drugs. This was highlighted last year with Ivan Golunov, a journalist accused of dealing drugs, a case that drew attention across the globe and who was eventually released due to Putin’s personal intervention. Unfortunately, 120.100 other people who went to prisons in 2019 for insignificant drug crimes mostly fabricated by police were not as lucky. A large number of the population are denied healthcare and basic human rights, falling victim to AIDS, tuberculosis and overdoses. All of these problems are the result of Russia’s draconian drug policy, which we try to mitigate and challenge through harm reduction, outreach work, legal support and more.

Our work has several components. The most important is our daily street outreach, direct communication with the most poor and vulnerable drug users in Moscow. This involves standing around pharmacies and other known hotspots, handing out condoms and clean syringes as well as naloxone, which can reverse the effects of an opioid overdose. We provide Street Lawyers consultations through our network of lawyers and community paralegals, we empower people to stand for their rights – this is particularly important in Russia, where police routinely fabricate drug cases and behave with impunity. Being on the street allows us to document human rights abuses and violations of multiple international conventions that Russia has promised to abide by, but doesn’t. We report this to the public, to the International human rights bodies and fight for justice in the European Court on Human Rights. Finally, we campaign to change public attitude to drugs as an unsolvable problem, to smash stigma, end the war on drugs, mass incarceration and extend support. We stir and inform the wide pubic debates on drug policy and do a lot of work with the (more) independent press in Russia and internationally.

In Russia problematic drug use marks the most poor, vulnerable, criminalized, stigmatized and unprotected population with the size between 2-4 million (the epi data was not available since the international organizations were pushed from the country in mid-2000s). The COVID crisis has proved again that this group will be the first to be thrown out of the ship when the government starts rationing help. According to our COVID surveys many immediately lost jobs and any economic means, did not have any safety nets, were denied access to dependency treatment, were abused by police. The opioid substitution treatment is prohibited by law and people with opioid dependency went into torturous cold turkey withdrawals.

We have carefully built meaningful connections within the communities during the 11 years of daily outreach work. Most of our staff and volunteers are from the community. Our simple services save lives. In 2019 only, we received reports about 396 lives saved thanks to naloxone we semi-legally distribute. We adjust services to the most urgent needs – in 2013 we initiated Street Lawyers, in 2014 – a family project, supporting parents with drug problems, in 2019 - a chemsex project, in 2020 - mental health and GBV work.

Our project builds empathy, understanding and solidarity towards the most stigmatised and marginalised group in Russia. We ask to continue a challenging debate - to hear the voices of those who traditionally were only despised and marginalised, to build solidarity. Through this comes understanding that extending attention, support and resources to the most unprivileged is key to being a human community.Together with our partners, we hope to achieve the political environment where even the more authoritarian regimes, such as Russia or Iran or the Philippines have to revise their drug policies because the public can not be fooled any longer.

The Andrey Rylkov Foundation for Health and Social Justice was born in 2009, after the Russian Minister of Health announced that Russia wouldn’t follow recommendations from the World Health Organization (WHO) to implement harm reduction programmes for people who use drugs and opioid substitution treatment. We started out with a group of friends/ activists who’d already spent years working in harm reduction and HIV but wanted to do something more pro-active that would change the country’s approach to drugs.

Our inspiration was our friend Andrey Rylkov an activist and drug user who passed away in 2006. Andrey and FrontAIDS movement that he ignited were the Russian Act up! Frontaids held radical action on Red Square and Ministry of Health and other visible spots and achieved a breakthrough in making HIV treatment available to people with drug problems. Before that treatment access was denied, since drug users were seen as useless members of society undeserving of antiretrovirals. It was an official reasoning.  His fierce struggle and joyful activism lives on through our work.

We are working for the community from which we come. We lost too many friends and peers to AIDS, tuberculosis, overdose and now COVID and we keep loosing. Despite tremendous progress in drug policy in the world, Russia's is still stuck in the murderous drug war regime.

We are all hurt by the health system failure but more so by the political repressions, by police brutality and impunity. Some of us don't use illegal drugs any more, but even distributing information and scientific data has become a crime.  

We believe that the war on drugs is a horrible historical mistake, a product of a racist, patriarchal, hierarchical and militarised society. It hurts the society, ruins communities all over the globe and serves the rich and corrupt. Drug users are the most disempowered group who are least able to fight back against abuses and injustice.

We work tirelessly, we stand long evenings in the freezing winter cold empowering our peers. These are our lives, our rights and our freedoms. If the community is attacked and oppressed we should communicate: together we should be able to find a solution and turn the game.  

We have been working on this for quite a long time now. We have super committed team of outreach workers, paralegals, case managers, medical specialists, community activists, lawyers. We managed to build societal support to our work and a network of top quality journalists who understand drug policy so we feel more protected against political adversities. We try to find the perfect balance between continuing to provide our services but also not being shut up, unable to talk about drug decriminalization, freedom of  information, rights violations publicly and sustain an important public conversations on the consequences of the war on drugs. We have the trust of the community and of the political and social activists in Russia from domains other than public health. We discussed and figured out how to continue services in case of more lethal attacks on the organisation and we are ready and inspired to continue and expand our services and activism in any political conditions.  

Our whole story is a tale of resistance and resilience. Since 2012 our site has repeatedly been blocked by the Federal Drug control service, Ministry of Internal Affairs,  Roskomnadzor, the internet censor board. In 2016 we were branded “Foreign agents”. In 2018 we were blown by a huge 12k USD fine for ‘narco-propaganda’ (we published an article on reducing health and legal risks of methedrone). A huge fine for a small organisation could have closed us for good – “suffocating”, as Amnesty International described it – but we managed to crowdfund this fine demonstrating a larger calibre of support for our cause. A little silver lining that came out of this episode was it raised our profile in both local and international media such as Meduza, Vice.

Recently we survived another unexpected attack - a Kremlin-supported news agency published two large smear articles and a Duma deputy accused us of 'drug propaganda'. The attack followed our press statements on the miserable situation of people who use drugs and the absence of any help during COVID.

While many other NGOs have been closed due to Foreign agents and increasing fines, we keep expanding  services and seeking ways  around the government pressure.

One of our pioneering strategies is strategic litigation, where we fight abuses of human rights through the courts. On many occasions we’ve successfully taken our clients’ cases to the European Court of Human Rights (ECHR) to change the law or unfair legal practices in Russia. To give you a recent example: in 2013 one of our clients, Yelena I., was arrested after selling less than half-a-gram of heroin to an undercover informer. For this she was not only sentenced to prison, but deprived of custody of her 3 children on the grounds that she was a “drug addict” and therefore, a bad mother (she was not). The children were taken away even though there was no evidence she abused or neglected them, other than leaving them alone for those few hours she spent in police custody. We fought the case for several years until finally earlier this year the ECHR awarded Yelena 20,000 euros on the grounds this was wildly disproportionate, which we hope will not only restore her parental rights but also set a precedent for those thousands of other families which have been torn apart by the legal system. 

Details of the case here: https://hudoc.echr.coe.int/rus#{%22itemid%22:[%22001-201326%22]}

Harm reduction approach is not new. Its been implemented in many countries for many years and quite successfully -- its public health mainstream. Whats new is how this work is carried out in one of the more conservative, repressive and inhumane political regimes and in the conditions of fragile and interrupted resources. We proved to ourselves so far, that even in the toughest political environment even the most marginalized and repressed communities are able to creatively mobilize support. And we keep evolving, keep extending. We are flexible and well prepared to rapid change. Our dream is to live in a world where communities do not have to fight for fragile health systems in the context of political right, but until political pessimism is fullyoutweighted by optimism we need to be prepared to stand for our communities.      

Aside from our direct outreach work offering services to Moscow’s most vulnerable residents, we also take part in activism, campaigning and are the “go-to” group for drug policy for international and Russian independent media. While the Russian government is led by oligarchs and securocrats, like all governments it’s decisions are guided by popular opinion. Our theory of change is by disseminating more positive and truthful information through our campaigning and work with the media, including the journalistic collective Narcophobia, we aim to create a shift in values and public discourse about drug use. In the short-term (five or more years) we hope there’ll be a move towards decriminalisation, where possession of small amounts for personal use is no longer treated as a crime, and allowing methadone-assisted therapy as recommended by the WHO. Our end goal is a humane drug policy in which vulnerable people can get the help without abuse or coercion. In turn this will help society as a whole by reducing drug-related crime, easing the burden on healthcare, and removing opportunities for police corruption.

This won’t be easy, but it took a long time for ideas about treating users as human beings to take hold even in the West. We draw inspiration from the VANDU (Vancouver Area Network of Drug Users) movement in Vancouver and the Rotterdam Junkie Union, both of whom successfully pushed for reforming drug policy in the face of deeply-entrenched prejudice and opposition.

We hope we can in turn inspire reforms across other illiberal societies in the former Soviet bloc, Eastern Europe and perhaps even parts of Africa and Asia. With the rise of authoritarianism around the globe, people working with vulnerable populations may be afraid of what to in that situation. We can help. Over the years, we’ve developed a certain know-how and expertise in health services and human rights activism under a politically repressive atmosphere where the standard practise doesn’t apply, so our experience can be very useful – in fact, we may be seen as an example of best practise.

In 2019- March 2020 we reached out to 4454 people, of them 1530 women, provided 332.000 syringes and needles, almost 40.000 condoms, 1083 HIV self-tests, received 806 reports of lives saved with our naloxone. We have provided 1024 legal consultations, 2427 consulations on HIV and 75 referrals to HIV treatment, 138 consulations/ referrals on tuberculosis and 1234 on hepatitis as well as other important health issues. In one year we hope that we will reach out to at least 4500 people annually. While it is rather hard to make a prediction to the five years ahead due to increasingly repressive political situation in Russia. The money from this prize could raise our profile and make it easier to survive government attacks, and allow to reach more people. If funded to the full current capacity we could reach out to at least twice as many people from the poor communities.

Our immediate goal is to keep providing services so our participants could stay safe, healthy and alive by maintaining the organization’s work at least at the current capacities. We hope to continue street services and increase digital outreach to younger people with information on health and safety.

Our aspiration in the next year is to establish a more comprehensive mental health service, continuous volunteer education, gender-based violence response protocol and improve our monitoring technologies. We plan to develop a more advanced monitoring and data collection system allowing for both routine monitoring and rapid assessments of the needs and health emergencies. Such system could compensate for lack of official health data, especially on the vulnerable communities and guide our focus.  

We will continue our work on human rights, advocacy and strategic litigation to push for the decriminalisation and depenalization of drug use and possession for personal use. Incarceration rates are exceptionally high in Russia  -- more than 120,000 of about 420,000 adults imprisoned in penitentiary institutions in 2019 were convicted of drug-related offences.

Within Narcophobia project we raise public awareness and end the stigma surrounding drug use. 

Our biggest obstacle, by far, is the repressive political climate in Russia. Since we’ve been branded ‘foreign agents’ we can’t get local financing from municipal or presidential grants, and international donors streams for Russia are very unstable and unpredictable, not many donors believe that communities and NGOs will be able to resist much longer. We also have to be careful to declare our status on all documentation, even the New Years’ cards we send to our clients so they won’t feel lonely. All this takes up time and resources we could have provided to  people in need.

We carry on at a personal risk to ourselves, but we also work on safety and risk mitigation. As the arrest of journalist Ivan Golunov on trumped-up drugs charges shows, the authorities are routinely fabricating cases and drug cases are the easiest to fabricate and used against dissenting views. 

As mentioned earlier,any form of discussion about drugs and drug problems is increasingly viewed as "narcotic propaganda" - a punishable offence. After a recent smear campaign in a pro-Kremlin press on ARF for our public statements regarding health and rights abuses during COVID for people who use drugs we had to restrict access to our website to avoid charges of ‘narco-propaganda’. In extensive consultations with lawyers and other human rights defenders, who have been labled as "foreign agents" we have developed several scenarios that will allow us to continue service provision even if our organisation itself formally ceases to exist.

Because our foreign agent status limits our funding, we’ve had to think of ways to use what we have more efficiently. For instance, we have a volunteer training program in order to save expenses – the problem of drugs touches everyone in society so there’s no shortage of volunteers. At the moment, we have around forty super-committed volunteers who do amazing outreach work on a daily basis.

We receive a little cash flow from our supporters and crowdfunding, which slightly increased after the Golunov case brought drug policy into the public eye. But this is a very small stream that allows us to patch over small holes than a considerable source of income.

We co-operate with like-minded groups and individuals both in Russia and abroad, and are very actively developing partnerships with representatives from other countries. For example, our staff have recently been on an internship to Paris to two reputable organizations involved in harm reduction and social work with drug users. In Russia, we partner closely and take part in a coalition of organizations involved in harm reduction and protecting the rights of people who use drugs.

In Russia we have close partnerships with advocacy groups such as Association Agora, providing legal aid, MediaZona and Zona Prava, founded by Pussy Riot members Masha Alyokhina and Nadya Tolokonnikova, which are committed to fighting the injustices in Russia’s courts, police and prison system. Our friend and lawyer Arseny Levinson runs Hand-Help.ru, a legal aid service for those who’ve fallen afoul of the strict drug laws.

The Canadian HIV/AIDS Legal Network helps us in international advocacy and strategic litigation, while Amnesty International is helping us prepare a plan to protect our physical and legal security in the case of attacks from the government or their supporters.

We are a horizontally managed grass-root organization and our services and activities develop organically through the constant feedback from the community. Throughout the years of working in different districts of Moscow we have established stable channels of feedback in the local community networks and can swiftly react to emerging problems and re-adjust. The COVID crisis in Moscow witnessed to our ability to promptly adjust both the technologies and the content of our services. We quickly reshaped our work  during COVID. As daily outreach with face-to-face contact became impossible we came to rely on the networks of community carerers and informational technologies (eg ran several needs assessments and feedback loops through Telegram). The COVID crisis and feedback we received pointed us to the need to strengthen the economic safety nets for ourselves (as an NGO) and for our participants. We are now working to develop new models of sustainability through alternative funding, social enterprises and networks mobilization.

The main planning problem for ARF is our very dependent funding. Due to ARF adamant position on human rights, explicit advocacy and strategic litigation, and international advocacy based on extensive documenting and consistent reporting on the crimes against people who use drugs to UN Human rights bodies, in 2016 ARF has been labelled a 'Foreign agent'. This brings to zero our chances to receive any local funding be it from the presidential initiatives, or municipal sources. So except for tiny crowdfunding streams, we are pretty much dependent on the international or private funding. Our sustainability strategy evolved in a funding landscape where we never knew when the next source of funding for harm reduction or human rights work will be available. The international donor landscape for Russia is very unpredictable, international and bilateral organizations have significantly reduced support, most just dropped Russia off the list, since its a 'rich country'. Currently our harm reduction services are supported by the Elton John AIDS Foundation,  this will last for a couple more months. We have some prospects for the next year and together with the coalition of Russian NGOs we are applying for funding of the Global Fund to Fight AIDS which surprisingly still havent given up on Russia. We approach to sustainability by allowing the unknown and exercising flexibility. COVID proved our strategy – things can change in one day as no one have predicted. We are developing more alternative funding models through building solidarity, crowdfunding, volunteer networks, social enterprising.

In the past few years most of our funding comes from private and international donors such as the Elton John AIDS Foundation (EJAF), AIDS Foundation East-West, Solidarite Sida (France), Global Network of People living with HIV. Our Narcophobia project is supported by the Federal Foreign Office of Germany. 

We are always on the lookout for new donors and partners

Our estimated expenses in 2020 are around 400 thousand in USD. This includes 5 staff salaries, an outreach service (though not to its full capacity!), small drop-in place, min-van services, materials procurement, Street Lawyers, mental health support, naloxone. This also includes our advocacy and human rights work – documentation of human rights violations, regular reporting to UN human rights bodies, capacity building to the Russian Forum of People who use drugs (ARF is the Secretariat), and Narcophobia campaign aimed at debunking the myths of the war on drugs and shaping informed and humane public discourse on drug policy.

We are applying in order to make our cause more visible and to mobilize resouces. Awarding us the prize would allow us the financial stability to continue running our services and withstand government attacks without losing ourselves in anxiety wondering where the next month’s supplies are coming from.

Currently, we are the only group providing harm reduction in a capital of 13 million people, in a country which still refuses to follow globally-recognised practises of medicine.  The consequences of Russian drug policy can be as disastrous : after the territory of Crimea fell under Russian control in the 2014 Ukrainian conflict, draconian drug policies were instated including cutting-off the region’s methadone supply, and within a year hundreds of opioid users were dead. This illustrates the kind of grave situation Russian drug users may be in when they lose their only lifeline.

Finally, the funds will be used for rapid mobilization in serious high-profile events and crises (such as the Golunov case), and for supporting the influx of fresh, motivated volunteers from outside our regular group.

We need technical assistance and mentorship in the following areas:

1) Developing our monitoring and data collection tools with the modern approaches to digital community health 

2) Alternative funding models for NGOs, social enterprises, strengthening communities and NGOs economic resilience

3) while we are doing very successful work with media, we also need training on international media and promoting our cause 

We would like to partner with the Harm Reduction Coalition and Drug Policy Alliance in the USA who have unique experience in networking and advocating for drug policy reform. 

We would also like to partner with the Dutch NGO Mainline, who have extensive experience in developing and linking mental health services for people who experience problems with drugs.