
This Transition Monitoring Tool was developed to assist key affected communities to stay more informed and engaged in the monitoring of the transition process and to thereby advocate for the sustainability of national HIV responses.

Based on the Global Fund’s vision, sustainability and transition are now integral parts of any grant; in the Eastern Europe and Central Asia region, transition process is advanced. Although the respective governments have declared a set of commitments with regards to the HIV response, information is scarce as to where the public sector stands in terms of the fulfillment of those obligations. This limits the capacity of communities to identify shortcomings and to advocate for the development of solutions to address such shortcomings.

To strengthen community engagement in the transition and sustainability process of national HIV responses, this Transition Monitoring Tool has been designed to collect and evaluate the achievement of countries with regards to the commitments made and to benchmark those achievements between countries using the following core components:– Identification of key public commitments with respect to HIV responses for key populations;

– Engagement of communities and national experts through consultations in the assessment process;

– Development of a matrix for data collection and analysis which will facilitate repetition of the process in the future; and,

– Calculation of transition scores for programmes for key populations by component, referred to as Health System Domains in this Tool.

This Tool is primarily designed to trace commitments by governments which have been stated in public documents; however, the opinions of communities and experts are included in identifying priority commitments for the purpose of monitoring, and for filling in information gaps where commitments are not clearly defined for the purpose of monitoring.

The publication was created in 2020 by Eurasian Harm Reduction Association (EHRA) and published within the framework of the regional project called “Sustainability of Services for Key Populations in Eastern Europe and Central Asia which is carried out by the Alliance for Public Health, in a consortium with the 100% Life (All-Ukrainian Network of PLWH), the Central Asian HIV’ Association and the Eurasian Key Populations Health Network with the aid from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

Benchmarking sustainability of the HIV response in the context of transition from donor funding. A methodological guide

The 2020 MENAHRA situation assessment has presented a comprehensive review on the situation and development of the harm reduction response of drug use and its harms in the Middle East and North African region during the timeframe 2010-2020. Key situational factors hamper the harm reduction prioritization and response in the region. The current situation of drug production, trafficking and consumption (including harmful use) is exacerbated by political and economic instability, protracted conflict in some countries, security issues, weak cross border cooperation, the relationship between weapons, human and drug trafficking, the absence of alternative livelihoods for drug producers, and migration and displacement of almost 11 million in the region. We present here an overview of the regional situation generated by the MENAHRA 2020 situation assessment followed by regional prioritisation and country specific data and advocacy briefs.


Surveillance and academic activity on drug use trends, size estimates of key populations and treatment characteristics, and BBV prevalence in community and prison settings differ per MENA country and in some countries remains scant or dated, making it difficult to assess extent and trends in the MENA region. This hampers advocacy for harm reduction and the development of effective evidence-based drug and public health policies at country and regional level.


Over 600,000 people are deprived of their liberty in the MENA region, the vast majority of who are male and detained on drug related charges (Al-Shazly and Tinasti, 2016). Repressive and punitive approaches to drugs including corporal punishment and death penalty, criminalization, coercive drug treatment mandated by the courts and aggressive policing continue to discourage health care seeking by PWUD. Some countries have reported the rise in private drug treatment and rehabilitation centers using methods which are not evidence based. This reinforces marginalization and stigmatization of PWUD/PWID and perpetuates unsafe/high risk use of drugs in the region.


Although the MENA region is primarily a drug trafficking and transit region, there are notable production and consumption trends in Captagon (commonly fenethylline), opium, heroin, cannabis, ATS and Khat. Cannabis remains the most commonly used substance. Increased use of synthetic cannabinoids, ATS, and pharmaceutical drugs in a number of countries in the region has been observed through shifting trends of drug use. A concerning rise in synthetic cannabinoid use has been noted in Jordan, Kuwait, Egypt, and Palestine. ATS use has increased in Afghanistan, Kuwait, Iran, Iraq, Lebanon and Palestine. The rise in pharmaceutical drug use however, is the most widespread and noted among 15 of the 20 MENA countries (Afghanistan, Algeria, Egypt, Iran, Iraq, Jordan, Kuwait, Pakistan, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, UAE, and Yemen). The World Drug Report 2020 has identified the trafficking and non-medical use of Tramadol and Captagon as one of the key challenges faced within the region.

Harm reduction advocacy brief for the Middle East and North Africa region

The present recommendations are intended for people and organisations responding to gender-based violence, i.e. harm reduction organisations, service and shelter providers for survivors of violence, as well as multi-disciplinary collaborations and teams responding to gender-based violence.

Women from all social groups are prone to gender- based violence. However, women who use drugs and women from cross-groups are exposed to far greater danger of abuse.

The present document examines the key issues and specific needs of women faced with domestic and intimate partner violence and identifies the existing legal and policy frameworks that NGOs and harm reduction workers can draw upon. It also suggests the following comprehensive approach to helping women in situations of gender-based violence that involves three key steps:

1. Prevention of gender-based violence;
2. Provision of adequate support and protection;
3. Advocacy for legislative changes (gather and document information, manage strategic cases to be submitted to courts and/or national and international human rights organisations, and amend legal regulations).

The document concludes with recommendations for harm reduction workers, social workers, peer counsellors, NGOs that provide services for survivors of violence and work to prevent professional and psychological burnout.

“Help Impossible to Ignore” - A guide to ensure shelter, psychosocial and legal services for women who use drugs and experience violence

Synthetic cannabinoids are largely unresearched substances. There is hardly any precise information available on their effects, risks, reciprocal effects with other substances or long-term consequences. The risk of overdose with strong intoxication is generally very high with synthetic cannabinoids. This risk increases significantly through incorrect declarations made at the time of sale.

Synthetic cannabinoids are not visually recognisable, nor in terms of taste; only a complex analysis, such as those undertaken by a drug checking process, provides information about the actual substances at hand. If cannabis users do not have the possibility to use drug checking services, they can use a CBD Quick Test. While the result of a CBD Quick Test is not comparable to a drug checking result from a laboratory , it can be applied inexpensively and easily at home.

A CBD Quick Test allows cannabis users to determine whether their product is CBD cannabis (less than 1% THC content) or THC cannabis (more than 1% cannabis).

Cannabis quick tests and synthetic cannabinoids - Factsheet

By Oluseyi Kehinde and Ekanem Itoro Effiong

Achieving Universal Health Coverage (UHC) is a goal we should all be striving for. Across the world, countless people are suffering unnecessary harm and death as a result of lack of access to affordable, necessary healthcare. While all of us suffer to varying degrees when healthcare is not universally available, it is the most marginalized in our societies who are impacted the most. As a young transgender woman who uses drugs my communities are among those most impacted by lack of access to healthcare. Young Inadequately Served Populations (ISPs), particularly in the Global South, are the communities who are going to continue to be left behind if we do not achieve UHC.

In the past year, the Covid-19 pandemic has made the need for UHC all the more clear. Over the course of the past year it has become clearer than ever that a lack of access to healthcare for a minority can have a major impact on the health and wellbeing of the majority, meaning to ensure the health and wellbeing of society as a whole, we must ensure that healthcare is universally available. As this report will outline, for young ISPs, even in countries with good access to healthcare overall, this is still not the case.

As we edge closer to 2030, and the deadline set for the targets of the Sustainable Development Goals (SDGs), without UHC it is clear these targets, in particular for SDG 3 of Good Health and Wellbeing, will be all but impossible to achieve. In particular, in relation to the ISPs we work with most closely at Youth RISE; Young People Who Use Drugs (YPWUD), the target of ending AIDS by 2030 is neigh-on impossible if we do not work to ensure UHC, including for HIV, drug-related, and other harm reduction services, is reached.

UHC issues for young people who use drugs and other young inadequately served populations

The dangers posed by COVID-19 to people detained and staff working in cramped, overcrowded conditions in prison were acknowledged in the earliest stages of the pandemic. High-level United Nations (UN) and government figures made statements highlighting the risk to life and health in prisons and, as Global Prison Trends 2021 describes, most countries implemented some form of emergency releases to reduce the prison population. As countries continue to navigate new waves of the pandemic, prisons remain hotbeds for virus transmission. Also, new offences for breaching COVID-19 regulations and the resumption of court processes have led to increases in prison numbers.

The challenges faced by prisons over the past year have been compounded by decades of inadequate funding and criminal justice reform. The pandemic has exposed the impact of overcrowding and underresourcing of prisons in the gravest of terms – through the loss of life. We mourn every death in prison, both people detained and staff, and encourage all actors to learn from the experience of the past year, as detailed in Global Prison Trends 2021, to ensure prison systems protect the human rights of those they hold.

Health crises and other emergencies are not unprecedented in prisons. This year’s Special Focus examines prisons in crises, and how authorities respond to health crises, natural hazards and extreme weather, or in fragile and conflict-affected settings. We look at how prisons and the people within them are affected, as well as the involvement of prison populations in times of such crises and consider what measures authorities can put in place for better preparedness and response.

Global Prison Trends 2021

New psychoactive substances (NPS) started to appear on the Lithuanian drug market in 2005. However, they have gained momentum only in the last few years. For comparison, in 2012 there were 62 cases of confiscation of NPS, while in 2016 there were 433, and in 2017, 441.14 The most commonly used NPS by people who have drug use experience in Lithuania are synthetic opioids and cannabinoids, whereas young people who use drugs occasionally tend to use synthetic cathinones, as well as dissociative hallucinogen NPS and classic hallucinogen NPS.

Drug policy laws in Lithuania were changed in 2017 with the aim to decrease drug supply and demand. However, different data (see Chapter 4) show that drug use is stable or, in some populations, increasing. Meanwhile, more people are being punished for minor drug offenses, and the State is investing in the persecution of people who use drugs, while treatment and harm reduction programs are suffering and struggling to survive. There is no sustainability of funding, and existing funding is not covering the entire need.

The project “New Psychoactive Substance Use in Kazakhstan, Kyrgyzstan, Georgia and Serbia” was undertaken to generate a more accurate picture of the use of new psychoactive substances (NPS) in Kazakhstan, Kyrgyzstan, Georgia, Serbia, and additionally in Estonia and Lithuania, to assess harm reduction and law enforcement responses to the emerging issues related to the use of NPS. In 2019, similar research was conducted in Belarus and Moldova. Results from this project will supplement scarce international data on the use of NPS in these countries, present a more accurate picture of their use, and provide information to national civil society organizations for political advocacy.

The present report provides research results from Lithuania. The study was conducted in partnership between the Eurasian Harm Reduction Association (EHRA) and the School of Law, Swansea University, and supported by the Global Challenges Research Fund. The Principal Investigator for the overall project was Dr. Rick Lines of the Swansea University School of Law, and the research methodology was reviewed and approved by the Ethical Review Committee at Swansea University. This report was prepared by the coordinator and researcher for this project, Eliza Kurcevič, Senior Program Officer at EHRA.

New psychoactive substance use in the Republic of Lithuania

The Biden-Harris Administration has an unprecedented mandate to advance equity, which it has identified as a key priority. The advancement of equity cannot be meaningfully achieved without bold action in the domain of drug policy, as recognized by the Office of National Drug Control Policy (ONDCP) by including racial equity among its priorities for the first year of the Biden-Harris Administration. For decades, current policy approaches to drug use and addiction have been amplifying inequities across racialized and economically marginalized Americans.

This is the direct result of an overreliance on the criminal justice system and supply-side enforcement (collectively described as drug prohibition) to control drug-related harms. This continues to be the status quo despite clear scientific evidence that this approach is ineffective. To address emerging and long-standing drug-related crises, the United States needs drug policies grounded in the best available scientific evidence. This is critical to addressing three interrelated issues: the opioid overdose epidemic, the disproportionate harms of the criminal justice among racialized Americans, and the potential opportunities presented by drug decriminalization and regulation.

Below, we outline five key drug policy issues that require immediate, bold, and evidence-grounded action. These are: 

 Removing obstacles to harm reduction for overdose and infectious disease prevention; 

 Increasing access to medication for opioid use disorder; 

 Elevating the use of discretion in drug law enforcement.

Redressing inequities in America’s drug policies: An evidence-grounded call for bold action

By Penelope Hill, Orsi Fehér & Jamie Bridge

Civil society, including addiction practitioners, have been actors in policy spaces since United Nations (UN) drug control debates began under the Leagues of Nations (Bruun, 1975). Since the early 1990s, prime responsibility for UN drug-related matters has been held by Viennabased institutions. Although initially experiencing limited space for engagement with UN institutions and Member States, opportunities for civil society to influence international drug policy have grown, with the recognition of the importance of collaboration with non-government organisations (NGOs) increasing across all major UN agencies and institutions managing drug-related matters.

International debates and decisions directly influence and shape on-the-ground practice in the field of addiction. Though national policies are generally made on the state-level, signatories of the drug control conventions are bound to follow their commitments to the treaties and have limited sovereignty in unilaterally regulating internationally scheduled substances. The narratives, power-dynamics and decisions on the highest levels trickle down to regional policy making, so it is very important to shift the debate from substances to people at the highest level, so drug policies can operate effectively on the national level.

Civil society engagement and attendance at CND sessions throughout the year is crucial, in order to bring “real world” issues and the voices of affected populations to the forefront of the UN debates. Addiction practitioners are critical in relaying information on evidencebased practice to these forums, to ensure that international drug policies follow scientific evidence and not preconceived ideologies, and to guarantee health-centred and rights-based approaches prevail in the global drug control framework.

International drug policy: The impact of civil society and opportunities for addiction professionals to engage

At its 47th meeting, the UNAIDS Programme Coordinating Board (PCB) adopted a new strategy to end the AIDS epidemic as a public health threat by 2030. The PCB is made of 22 Member States, elected from among the Member States of the Cosponsoring Organizations. Five non-governmental organizations, three from developing countries and two from developed or transitioning countries, are also invited to participate in meetings of the PCB but without the right to take part in the formal decision-making process and without the right to vote.

The UNAIDS 2016–2021 Strategy is one of the first in the United Nations system to be aligned with the Sustainable Development Goals, which sets the framework for global development policy over the next 15 years. The new global AIDS strategy will serve as a road map for the whole world, guiding key stakeholders to ensure effective country-led AIDS responses.

The strategy was developed through a datadriven and consultative process involving the UNAIDS staff, the Cosponsors, civil society, people living with HIV and key populations, young people, faith institutions, ministers of health, finance, and gender and parliamentarians, scientists, donors, and the private sector.

Briefing Note: Global AIDS Strategy 2021 - 2026

For too long public attitudes, political debate and government policy in Scotland failed to take full account of the real drivers of problem drug use. A drug problem is neither a lifestyle choice nor a personal failing; drug problems originate in a lack of support to parents, families and vulnerable young people; the failure of health and other services to engage people in need of support and in Scotland’s social, income and health inequalities that result from poverty.

Recently, a consensus has emerged that begins to recognise all this and address problem drug use and the harms caused by drug use as a public health issue.

Scotland needs a new drugs strategy that reflects this reality. Scotland’s new drugs strategy should provide a full response to our drug overdose deaths public health crisis, improve the overall quality of life of people with a drug problem and prevent problem drug use by supporting vulnerable young people and their families. This strategy needs to articulate with government poverty, equalities and other strategies.

Drugs: Policy and Aims - A Manifesto for Scotland

The global drug market is expanding and becoming more complex. Globally, opium production and cocaine manufacture remain at record levels (despite declines observed in some regions), with synthetic opioids and their analogues (for example fentanyl, Tramadol) continuing to pose a serious threat to health (UNODC Global Drug Report, 2019; 2020). Heroin continues to reach the market despite declining opium production in 2018 in Afghanistan and record levels of seizures (UNODC Global Drug Report, 2019; 2020). Methamphetamine use and related harms are of rising concern across several regions (South East Asia, North America). There has been observed diversification of cannabis products (with increased potency) consumed in some jurisdictions that permit the non-medical use of cannabis.

IDU continues to represent a key global public health issue of importance due to the associated elevated risks of drug overdose, dependence, and BBV transmission (Degenhardt et al., 2016; Larney et al., 2020; Hines et al, 2020). An estimated 15.6 million people aged 15–64 years inject drugs (Degenhardt et al., 2017). Untreated chronic HCV and opioid use disorders are responsible for most of the deaths and disability attributed to the use of drugs (UNODC Global Drug Report, 2019). Of those injecting drugs, some 1.4 million live with HIV and 5.6 million live with HCV. Patterns of HIV infection among PWID also have wide regional variations (UNODC Global Drugs Report, 2019). In 2017, 40.5 million people were dependent on opioids and 109 500 people died from opioid overdose (Degenhardt et al., 2019).

Harm reduction approaches are underpinned by the principles of pragmatism and public health, alongside dignity and human rights and focus on reducing the health, social, and economic harms associated with drug use (Harm Reduction International, 2019; Sander et al., 2019). The provision of harm reduction both in community and in prison is widely recognized as a legally binding human rights obligation (Puras, 2015).

We report here on the 2020 assessment of situation and response of drug use and its harms in the MENA region for MENAHRA. These countries are diverse in terms of geography, population size and demographics, characteristics of key populations, nature and extent of the BBV problem, and scale of harm reduction implementation. They included Afghanistan, Algeria, Bahrain, Egypt, Iraq, Iran, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, UAE and Yemen.

Publications from IDPC Members