Our Lives Matter: Humanitarian Action, Russia
“We understand the problems from the inside.”
As it comes to a halt along the paved shoulder, the small bus is quickly spotted by the women who line the side of the road. The bus is really a van with a few benches, cupboards, and a table. It belongs to Humanitarian Action, but the sex workers think of it as their bus. They wait for it every week, just as they wait for customers, along this stretch of highway in St. Petersburg.

Inside the bus, Irina welcomes the waiting women and invites them to sit and stay a while. Irina, whose hair is bright red, has been a sex worker for many years and a peer outreach worker for Humanitarian Action for the past year. On this night in November 2006, dressed in jeans and a sweatshirt, she is dispensing condoms, handing out clean needles in exchange for used ones, and offering advice and assistance.

Twenty sex workers visit the van. They ask for condoms and clean syringes, and they also request help getting identification papers, referrals to the hospital detoxification program, and assistance regaining custody of children. One sex worker stops to inquire about another sex worker who is due to give birth; Humanitarian Action had found emergency housing for the mother-to-be. Two sex workers come by to thank the peer educator for accompanying them to court where charges against them were dropped because a confession they signed was coerced by the police.

Like many other groups in the world, Humanitarian Action has found that peer outreach is crucial to successfully connecting with sex workers. “No one can protect our rights as well as we can ourselves,” Irina said. “We understand the problems from the inside and know how to change them. You encourage others because you are not frightened of the reality they face. You work together, and the reality begins to change.”

Irina and Alliona, a homeless sex worker, described the importance of securing their rights, and the obstacles that must be overcome. “Most sex workers don’t know they have rights as citizens,” Irina said. “They know their work is illegal, so they live in fear of the police, of clients, of everybody who passes on the street. It means they cannot defend themselves or struggle for their rights.”

“The police force us to pay money to them every day,” Alliona added. “If you have no money, they hold you in the police station for two days and force you to clean the station. Some policemen will only let you go if you have sex with them. A cop tried this on me, but I started yelling that I would sue him, and they let me go.”
“Sometimes if they have arrest quotas or think they can get someone higher up, the police will plant drugs on sex workers to arrest them. The laws against sex work are a big part of the problem,” explained Irina, referring to how sex work is penalized as an administrative offense and brothel keeping is criminalized in Russia. “The police feel the laws give them cover to get away with extorting and using us. This is why it is so important that we tell sex workers that they have human rights like anyone else, and that we will support them in defending those rights.”

Of the street-based sex workers who use Humanitarian Action’s services, 95 percent are injecting drug users. In Russia, sex workers who inject drugs have been hard hit by the HIV epidemic and by the repressive policies that have allowed the epidemic to flourish.

Russia has one of the fastest growing HIV epidemics in the world; over 80 percent of new infections come from sharing needles, with most of these occurring in young people under the age of 30. The government has hindered the provision of basic lifesaving services, however, by banning methadone and buprenorphine — medications that reduce cravings for heroin and other opioid drugs. In certain instances, government officials have also turned a blind eye to police harassment of people trying to access syringe exchanges.

Humanitarian Action began in 1995 as a Médecins du Monde outreach project for street children in St. Petersburg. It expanded to provide HIV-prevention services to injecting drug users, and in 2000 it developed an outreach program for sex workers.

In 2003, Humanitarian Action became an independent organization with its core mission remaining the provision of accessible and nonjudgmental health services. The largest of its three buses has a private room in which sex workers and injecting drug users can get tested for HIV, hepatitis B and C, and syphilis pre- and post-test counseling.

In 2006, the sex worker project made contact with 1,792 sex workers on the street. The project has expanded to do outreach in brothels. A gynecologist, a lawyer, and a peer outreach worker visit sex workers who work indoors, offering consultations and information.

In recognition of the many ways that Humanitarian Action has helped to improve the lives of sex workers, street children, drug users, and HIV-positive people, the organization received the AIDS Action Award from Human Rights Watch and the Canadian HIV/AIDS Legal Network in 2005.

Innovative Action
Institutional Partnerships
Workers at Humanitarian Action confront many obstacles as they try to give sex workers access to high quality health care. Many health care providers are prejudiced against sex workers, particularly if they are also injecting drug users or HIV-positive. For their part, many sex workers are suspicious of doctors and the health care system, which operates “narcological units” in hospitals that are notorious for poor conditions. During the night of December 8, 2006, for instance, a fire overtook a Moscow hospital and 45 women undergoing drug detoxification died. Locked in a narcological unit, they were unable to escape the blaze.35 A second fire one week later at a hospital for drug users in the Siberian town of Taiga took more lives.

Humanitarian Action has created partnerships with 12 governmental medical institutions and is preparing partnerships with 10 more. The medical institutions belong to a network of “friendly clinics and trusted doctors” ready to offer free-of-charge anonymous medical and social services to sex workers.

“The seminar I attended organized by Humanitarian Action was very important. Four hundred people participated. We worked together: people from the medical world, the social services world, and sex workers. We realized that working with sex workers is the right thing to do. We must break down stigma so women know they will be treated well when they look for medical care.” —Nikolai Lobzer, MD, Dermatovenearological City Dispensary.

Ongoing Social and Psychological Support
In addition to offering support to sex workers who are seeking medical care, Humanitarian Action helps with social issues, such as finding housing and obtaining identification documents or residency registration documents.
Humanitarian Action also fills a crucial void by providing social and psychological services to sex workers after medical detoxification or during HIV treatment. Through a partnership with the Botkin Hospital, a psychologist from Humanitarian Action offers support on the maternity wing for HIV-positive mothers under age 25, many of whom have recently learned of their HIV status. HIV-positive peer educators also visit people dealing with their HIV status.

“With Humanitarian Action, we built a staircase between the street and antiretrovirals,” said Vladimir Musatov, MD, of Botkin Hospital. “The first step is the outreach bus where people get information and testing. The next step is the easily accessible center run in partnership with Humanitarian Action at the hospital, where people can go even if they don’t yet have their city registration documents. It is not intimidating, doctors don’t wear uniforms. The center can bring people to further steps if needed.”

Preventing Sexual Exploitation of Minors
Humanitarian Action runs a drop-in center, an alternative school, and an outreach program for homeless young people between the ages of 12 and 24. Such activities allow it to provide social and psychological support to homeless youth, some of whom trade sexual services for shelter, drugs, food, or money. There are, however, substantial barriers to offering care, support, and safety to these children and youth.

“In 2006, we participated in a special committee organized by the city authority to prevent sexual exploitation of children,” said Anastasiya Kapustina, coordinator of the street youth project. “But they strategize and strategize and do nothing. I reported one case of a man sexually exploiting street children to the police, but they didn’t look into it. We don’t have a witness protection program so it can be very dangerous for the children and social workers to come forward. Street children are scared to report abuse.

They run away from the police because the police are regularly physically or psychologically violent to them.”

Providing safe shelter is an essential way of preventing children or youth from being coerced into the sex trade. It is also an important means of assisting those who are or have been in the sex trade to attain greater stability.

For homeless youth who trade sex for money or goods, shelter can represent added control over their lives and a means to protect their health and well-being. And yet, according to Kapustina, “State-run shelters will not accept kids who use drugs, and almost all of the kids we see use drugs. The state shelters look down on street youth and often treat them terribly.

They have so much disdain for them that they will only give them food through a window with gloves on. There is one decent shelter, but it only accepts 12 boys in a city with 15 to 20,000 street kids.”

Humanitarian Action opened a night shelter for street children and youth only to have it closed down by the local authorities in 2006 due to complaints by local residents who feared disturbances in their neighborhood. The street youth project is hoping to reopen its night shelter.

Even though most street youth are sexually active and many inject drugs, law enforcement agencies and ministerial authorities often prohibit provision of condoms and clean needles to anyone under 18 despite the lack of clarity in the law on these matters.

The consequences of such prohibitions are dire. In 2006, 45 percent of street youth tested at Humanitarian Action were HIV-positive. In a few years, a new crisis will arise when many of these youth will need antiretroviral treatment and Humanitarian Action will be faced with the difficulty of obtaining treatment for people still living on the street.

Lasting Change
Humanitarian Action has succeeded in increasing access to medical, social, and psychological services for sex workers, injecting drug users, and street youth. It has been able to pursue its work thanks to a city ordinance recognizing harm reduction as an HIV-prevention strategy, the result of a sustained campaign by Humanitarian Action and others.

The importance of its work connecting people with medical services has increased now that antiretroviral treatment is more readily available through the assistance of the Global Fund for AIDS, Tuberculosis and Malaria.

Humanitarian Action is in the process of opening a drop-in center for sex workers. A small center has opened for women who are pregnant or have just given birth and have nowhere else to go.

The sex worker project is also seeking to expand service delivery to indoor sex workers, who represent a large portion of the sex trade and who have different needs since few of them are injecting drug users.

At the same time, the group is strategizing about how to reach out to male sex workers on the street, many of whom are injecting drug users. And, of course, the bus continues to make its rounds to sex workers, who eagerly wait for condoms, clean needles, and a friendly word.

Humanitarian Action Contact: Irina Maslova
Email: club.silver.rose@gmail.com