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Russia Diary Archive
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I was awed and moved by these people dedicated to caring for injecting drug users. Here we are inside the big blue bus in St. Petersburg.
Drug Users on the Road to Help
Big Blue Bus Brings Needles, Counseling and Compassion

ST. PETERSBURG, Russia - On a non-descript street several kilometers from the Winter Palace, where the czars lived in regal splendor until 1917, people are stepping onto a big blue bus for help. A scruffy couple are the first clients. They are injecting drug users. Next, a well-dressed couple - injecting drug users. Then, a fashionably dressed woman with a stylish haircut, shopping bag and, shockingly, a young daughter in tow. Although her appearances belie it, she is also a drug user. So is everyone who comes here.

They are here to exchange their dirty needles for clean ones. They are also here for condoms, counseling and testing for hepatitis, HIV and other sexually-transmitted infections. And they are here for conversation and friendship in a world that more often judges, stigmatizes and condemns them for their addictions. The bus is obviously filling a genuine need: In 2008, it acquired 4,000 new clients.

All of them come with dirty needles and some of them bring dozens of dirty needles to exchange. But the bus can only give them a limited number of needles based on the rule of thumb of four needles per day. But, as one of the bus staff said, "if he [the IDU] has a bad vein, he might demand even more than four needles per day." And the quality of the heroin, which is sometimes low, results in the IDU requiring higher doses, and more injections.

Welcome to the injecting drug user bus, a program of PSI Russia and implemented by its partner Humanitarian Action, a Russian nonprofit organization. Most days it makes a scheduled series of three-hour visits to the drug hot spots in the greater St. Petersburg area. It has a staff of four - a driver/social worker, another social worker, a psychologist and a nurse. Most are former drug users themselves and some of them have been working on the bus for years.

This is part of PreventAIDS, a PSI Russia project funded by the U.S. Agency for International Development (although the needle exchange is funded by the Global Fund since U.S. policy forbids using U.S. funds for that purpose). that aims to reach the most at-risk populations like injecting drug users (IDUs), commercial sex workers (CSWs), the military and youth. There is also a CSW bus in St. Petersburg that provides similar services to CSWs.

In Russia, the majority of HIV infections are through intravenous drug use. Of 443,286 individuals registered as being HIV positive in 2008, 64% were IDUs. It is estimated that there are around 600,000 HIV positive IDUs in Russia, and most of them are unaware of their status.

In an ideal world, this bus would not be necessary and IDUs could obtain needles and associated services from pharmacies and government clinics and social services. Oxana, the no-nonsense program manager of Humanitarian Action, says that the IDUs have a high awareness of the risk of using dirty needles. They want to use clean needles. But it's not always easy to buy needles in pharmacies because stores known to be selling needles to IDUs, even though it is legal, become vulnerable to harassment by police. And the governmental agencies that should be helping IDUs too often stigmatize them and discourage them from using their services.

Once an IDU is legally registered as an IDU, this label follows them their whole life. They are often rejected by universities and turned down for employment based on it. So they hide and avoid using health and social services that would require them to admit they inject drugs. This leads to failure to test for STIs, tuberculosis and other health problems; higher rates of HIV; lack of AIDS treatment until the latter stages of AIDS and other health problems.

Because of a highly vertical health system, the linkages between health institutions (such as AIDS centers, TB clinics and detoxification programs) are rare. Health issues are treated in isolation and not comprehensive.

Furthermore, government is not really motivated to help IDUs nor does it have the resources to do so. So it falls mostly to non-governmental organizations to help IDUs.

And Elena Arutuynova, the PSI Russia program manager who supervises the program from Moscow, says that many of the IDUs are in denial. "The majority of them do not think they are drug users and that it is only a phase they are going through," she said.

PSI Russia identifies those who are committed to behavior change and then guides their transition to case management, an individualized, interactive plan that assess the IDUs' risk of HIV, identifies obstacles and services they need, links them to health, social and legal services and follows up to ensure uptake of services like counseling and testing, STI testing, detoxification and rehabilitation. PSI Russia has research that shows a clear relationship between case management and higher evidence of positive behavior change.

PSI Russia works to win the trust of IDUs and encourage IDUs' trust towards the services to which they refer them. "We become the link and the facilitator so must make sure that services exist and encourage that trust," said Shana Aufenkamp, a PSI technical advisor working at PSI Russia the last two years.

But building demand for services by the IDUs is not enough. PSI Russia also works on the provider side, building a cadre of providers who understand the special needs of IDUs and have been trained in communication, counseling and services in a non-judgmental way.

They stylish and well-coiffed woman leaves the bus with her clean needles, her shopping bag in one hand and her child's hand in the other. Thanks to the IDU bus, this young girl may have a mother to guide her into adulthood.



These teen-aged girls frequent a USAID-funded leisure center outside St. Petersburg that is part of a project that aims to keep teens away from risky drugs and sex. The girl on the right told me her career goal was to become minister of foreign affairs.
See my St. Petersburg photo album.

...my Moscow album

....any my photos of Red Square by night.

Helping Youth, Adults Vulnerable to HIV/AIDS

ST. PETERSBURG, Russia, April 24 - I have seen HIV prevention programs in over 20 countries but the ones I visited here today are among the most unusual I have ever seen - a substance abuse prevention programs for teenagers and a bus that cruises around the city, helping injecting drug users stay healthy.

I visited one of three locations of the Substance Abuse Prevention project, funded by the U.S. Agency for International Development and ExxonMobil, in Gatchina, a poor suburb of St. Petersburg. The project aims to prevent the use of psychoactive substances among teenagers at high risk of initiating drug use and risky sexual behavior. First, I visited a center where youth can come for medical treatment, information and counseling from the doctor, psychologist, narcologist, midwife and lawyer on staff. They work not only with teenagers but also their parents. The kids can also come just to hang out, have fun and use the computers, and have just created a website with information on the services provided by the center. Have a look: http://medcentr.ucoz.ru/. I also visited a "leisure zone" at a public school that consists of a youth center where kids can hang out during or after school and engage in games, sports, school work or access the internet. I talked to a group of teenaged girls there who told me how the center has helped improve their communication and leadership skills, and kept them out of trouble. One of them, who told me she was very withdrawn when she first started coming to the center at age 11, now hopes to become the minister of foreign affairs.

Back in St. Petersburg, I visited the injecting drug user (IDU) bus, where IDUs can exchange dirty needles for clean ones. They can also get condoms, counseling and get tested for sexually-transmitted infections including HIV and hepatitis. The bus makes scheduled stops all over St. Petersburg; IDUs in most parts of the city know where and when to find it. I was awed by the dedication of the staff of this bus, most of whom were drug users themselves, and who work in difficult situations in order to help these vulnerable people. USAID funds this project except for the needles (US policy forbids using USG funds to pay for needles), and the project desperately needs funds to pay for additional needles.


Social Media Not Adopted Despite Sign
of Growing Popularity

MOSCOW, Russia, April 23 - In our planning session yesterday, the staff of the Russian NGO I am working with to develop an external relations plan decided not to use social media in their outreach despite two surprising developments that support the use of such media, one of them in their own organization and the other one from the Russian president.

It came out that their St. Petersburg office is already using a Russian social networking site similar to Facebook to engage their youth volunteers through one group application as well as gay men, one of the groups they seek to educate on HIV prevention, through another.

And the Moscow Times reported yesterday that Russian President Dimitry Medvedev has started a blog on the popular LiveJournal blogging site, "where prominent politicians and businessman maintain online journals." Medvedev, who often plays up his Internet saavy, told reporters that the project would boost his interaction with the online community. Medvedev was to post a video on his blog Wednesday in which he will talk about the development of the Internet and what the government should do to develop it."

I plan to raise social media again today in hopes of convincing them to at least examine the Russian blogosphere to see whether there are any blogs they should be monitoring and possibly contributing to.

ST. PETERSBURG, April 24 - Last night, the head of PSI Russia and I took the overnight train to St. Petersburg, arriving here at 7:40 this morning. We spent all day visiting PSI programs serving vulnerable youth and injecting drug users through HIV and substance abuse prevention. I will report on those experiences soon.


Trust in NGOs, Social Media Emerge as Key PR Challenges

MOSCOW, Russia, April 21 - As expected, the lack of trust by the Russian government in non-governmental organizations -- both Russian and international -- emerged as a big issue in the external relations planning process I am facilitating with PSI Russia. However, there have also been some positive developments: Russian President Dmitry Medvedev and a few members of the Duma (parliament) have made conciliatory remarks towards NGOs recently. But more good will is needed to compensate for years of hostility. This problem is hard to address both because it is huge and because it is a problem of all NGOs (although particularly foreign ones), not just the one with which I am working.

We had a lively debate today on another issue of great interest to me, the extent to which social media can be used to promote the organizations, its HIV and substance abuse prevention work and good public health policy. And the arguments I heard (in Russian, translated into English) mirror my own thought processes over the last year: On the one hand, social media are inexpensive financially, potentially effective at reaching very specific target groups, increasingly popular and could attract attention here because few other non-profits are using them. On the other hand, social media require substantial human resources (that are already committed in other directions) and it is not clear that the effort required would justify the human resources cost. The discussion ended in apparent agreement that social media may be appropriate in reaching certain key audiences but not all. I suggested trying social media on a trial basis before committing to it on a large scale. We will take up this issue again on Wednesday.

NOTE: Since the term social media is often misunderstood, let me clarify that I am referring to the interactive media (also called "new media") that allows viewers and readers to comment, respond, contact, rate or otherwise interact in some way with the content provider. They include social networking sites such as Facebook, blogs, microblogs, podcasting and sites that allow video and photo sharing.


Talking About HIV Prevention & Substance Abuse

MOSCOW, Russia, April 19 - I arrived here today to work with an emerging Russian non-profit organization to improve their external relations and help them develop a focused and strategic external relations plan. I've done this work in many African and Asian countries but never in Eastern Europe, a very different environment to be sure. I do not claim to know Russian culture well; the last time I was here was in the 1970s when I was a high school student. A lot has changed in Russia and communication since that time (not to mention me!).

Moreover, I face a challenge I didn't face in any African or Asian country - the low regard with which Russian influencers hold non-governmental organizations. Unlike most European countries, where opinion elites aged 35-64 have high faith in NGOs, these elites in Russia have far less trust in NGOs than either business and government, and only slightly more than religion and media (Edelman Trust Barometer 2008). That is a huge obstacle that we will have to address.

Why do I think I have anything to contribute here in Russia, a culture I hardly know? Well, I do know non-profit public relations and I know HIV prevention (the main area of my Russian non-profit, along with substance abuse).

And to make up for my Russian cultural deficit, I have Janna McManus, a native Russian who has worked for a big American PR agency and is now a PR consultant in California. The fact that I even have an online relationship with her is a testament to the power of LinkedIn, the business-oriented social networking site. I found her when I put out a request for help with my Russian assignment. Janna is a friend of a friend of a friend, a relationship that can only happen in a place like LinkedIn. So now I have Janna as my Russian reality check and advisor, who has strongly confirmed the lack of Russian faith in NGOs, and I confidently begin my work in Moscow tomorrow.

Here's a link to a description of the work of PSI Russia.


My Russian colleagues and I on the second day of our two-day external relations planning workshop.

As soon as I arrived in Moscow on April 18, I headed straight for St. Basil's Cathedral on Red Square, the most iconic image in all of Russia.
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In April 2009, I traveled to Russia to give public relations training to PSI Russia staff, facilitate strategic PR planning and write stories on its projects in Moscow and St. Petersburg. This page contains one of those stories (left) and the blogs posts I wrote on that experience (below).

National Poker Face: This story in Psychology Today explains why Russians rarely smile in public.

Legendary Moscow Metro: This wonderful Washington Post story story really captures the feeling of the Moscow underground.

Animal instincts highlight the importance of making consistent condom use a habit in this classic TV ad from PSI Russia.


These are the used needles that the drug users have brought to the bus in order to get clean ones.