Case Studies

Examples of successful advocacy efforts in different settings around the world

Inside information – Overdose trainings in prisons and jails

Tomsk Anti-AIDS Foundation is a harm reduction organization in a Siberian city of about 500,000 people. They provide integrated social, psychological, medical, legal, and harm reduction services for people vulnerable to HIV/AIDS and tuberculosis, including drug users, people living with HIV, and sex workers, with a special focus on women who use drugs and their children. They also work with street children, migrants, and prisoners.

Tomsk is the site of prison “colonies” that house about 7,000 inmates from all over Russia. Through funding from the AIDS Foundation East-West (AFEW), Tomsk Anti-AIDS operates a six-month program for prisoners, many of who are incarcerated for drug-related charges. The organization employs four social workers who work with prisoners from the Tomsk area, providing them with three months of pre-release and three months of post-release support in a program called “The Bridge.” Since the prisoners are from Tomsk and the surrounding towns, many of them are able to transition to the organization’s regular programs upon release.

Increased risk for overdose after prison

“From our experience we know that some people who use drugs tend to abstain from drugs or significantly lower their dose while in prison,” says the organization’s director, Elena Borzunova. “Moreover, many experience severe health problems, particularly with their lungs and liver, while in detention. In the first days and hours after their release people often mix substances, beginning with alcohol and following up with heroin. All these factors increase their risk and vulnerability to an overdose. That's why we pay particular attention to overdose prevention among people recently released from prison. Our goal is to train and provide naloxone to as many people as possible.”

Overdose training: part of a comprehensive health program

“The Bridge” is a comprehensive program comprised of four group meetings and six individual meetings. Individual meetings may include such things as psychological and behavioral counseling, and anger management training. Group meetings include information about HIV and tuberculosis, as well as overdose risk factors and prevention measures. Upon release, a social worker follows up with the client to see what ongoing issues need to be addressed. If interested, participants are referred to the organization for more comprehensive overdose training, and to get naloxone – a particularly important intervention, as prisoners who use drugs may be more vulnerable to overdose upon release as a result of lowered drug tolerance. Prisoners are also provided with other supplies they will need after release, such as clothes and a cellphone SIM card.

A year-and-a-half into the program, Elena reports that authorities view it in a positive light. Though many of the prisoners are incarcerated on drug-related charges, authorities do not seem to be opposed to overdose training – which implicitly acknowledges that prisoners may use drugs upon release – as it is presented as part of a more comprehensive health program. 

"My mom found me; she knew I had naloxone at home. She called my friends, they told her how to administer naloxone. From what my mom tells me, I woke up two minutes after she injected me with naloxone. Thank you so much for giving me another chance at life!”

- Overdose program participant, Tomsk, Russia

Program benefits both participants and prisons

The prison project is able to operate thanks to positive relationships that Elena had built with local authorities over the years. In fact she had served as a member of the public board that oversees the prison. When her organization wanted to start working with prisoners, Elena sought permission from the top prison administration, who gave orders to the lower ranks to allow the social workers to come to run the counseling sessions. Other prison employees also seem to appreciate the initiative, as they bring much-needed supplies into the prison: As part of their project, Tomsk Anti-AIDS budgeted for flip charts, markers, and other small supplies that the prison lacks.

To date, the program has helped about 240 people. As one program participant said, “I was home alone, I injected heroin and fainted. My mom found me; she knew I had naloxone at home. She called my friends, they told her how to administer naloxone. From what my mom tells me, I woke up two minutes after she injected me with naloxone. Thank you so much for giving me another chance at life!” 

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