Feature story

Positive movement: safety, trust and services for people who inject drugs

28 June 2019

Most people in the capital city of Belarus become infected with HIV from injecting drugs. As a result, a nongovernmental organization in Minsk and the government have responded with HIV mobile testing clinics, drop-in centres and peer counselling to establish trust with people who often shy away from official health services.

Last year, more than 10 000 people visited the three mobile clinics positioned around the city of Minsk offering HIV testing, care and support services. Of 4000 people tested who inject drugs, more than 500 tested positive for HIV.

Word-of-mouth lets people know the mobile clinics are parked up. Positive Movement, the Minsk-based nongovernmental organization that operates the clinics, also lists their locations on its website. In the van-sized clinics you can get an HIV test, talk to a doctor or simply drink tea and chat with peer counsellors.

Positive Movement staff members have first-hand knowledge of issues affecting their clients. Of the 200 employees working there, more than three quarters have been affected by drug use and/or HIV.

“At first, employees were clients, now they are board members,” says Irina Statkevich, the head of Positive Movement’s board. “We believe that harm reduction works and that we can defeat HIV infection,” she says. "If we decide that this service is needed by our customers, we will do everything to get it!”

Above, Positive Movement’s office

Eight years ago, when she started working at the organization, she explains that it was impossible to utter the words needle and syringe exchange programme. “We had to do things incognito.”

Now they have drop-in centres open all day that not only provide clean needles and syringes but also food, HIV testing and a place to wash as well as legal and medical counselling.  Peer-to-peer consultant Julia Stoke likens the centres to safe-havens.

Above, Julia Stoke, peer consultant in Drop-in centre

“This is an island of security,” she says. “A person who uses drugs has a need for safety first, then trust, and then a range of services."

Vyacheslav Samarin agrees. As a social worker at one of the drop-in centres, he explains that people who use drugs often face difficult situations like a loss of housing, a lack of documents, poor health and sometimes nothing to eat and nowhere to sleep. “In many cases,” Mr. Samarin says, “One problem often leads to another.”

Above, Vyacheslav Samarin, a social worker at a drop-in centre in Minsk

“Many are in denial about their health,” he continues. Many clients fear stigma and have different priorities. He says it’s key to support people and not let them feel defeated and abandoned.

“At the very beginning, people do not want to believe their diagnosis, so we are careful to talk to them about starting treatment,” says the red-haired social worker.

Over the years he has noticed changes. "Today there are more treatment methods and the staff listen much more to people living with HIV.” He says that relationships between patients and doctors are much improved.

Also, the government of Belarus has been much more supportive of the work.

Tatiana Migal from the ministry of health confirms this. “By working on HIV prevention among people who use drugs and supporting people living with HIV for nine years, Positive Movement has not only gained considerable experience in this field but has also contributed significantly to reducing HIV infection among people who inject drugs.”

Ms Migal stresses the importance of peer counselling, social support centres and syringe exchange programmes as well as methadone substitution therapy.

“According to estimates by the World Health Organization and UNAIDS harm reduction programmes will help overcome the HIV epidemic in Belarus,” she says.