06:30 a.m., Waking up
Another morning – another day. We are off to some fieldwork. Just as every other day, we start with Kisela Voda. Fortunately I didn’t stay up late last night because it’s going to be a long day. Let me take you to a one-day tour around HOPS and its main activities. It is cold outside, so you better put on some warm clothes.
I have been in HOPS from 1997 and I really like my job. I rather avoid talking about the time before HOPS. I can only say that me too, as many others at the time, was way into “horse” and it had never crossed my mind that I could catch AIDS or hepatitis from a needle. I never thought that someone else could get infected from my needles. I was constantly on the go to find “smack” and inject it without being caught by the police or my parents. Around 1996, the older junkies started talking about an organization called M.A.S.K.A. which offered sterile injecting equipment, but I was too young and didn’t want to get involved with the “elders.” On top of that, I never considered myself a “junkie.” I don’t know what exactly happened with M.A.S.K.A., but I know that later in 1997 some of the members founded HOPS. This is where my story begins. In 1997, people from HOPS visited the place where we used to get together and offered us free sterile syringes and needles. It seemed stupid at the time, but when they started talking about AIDS and hepatitis, and how I can protect myself, I was enlightened and realized I can help protect people who use drugs, but also help protect the health of people who don’t use drugs. Ever since then I have been with HOPS. Before I forget, HOPS is active only on the territory of Skopje and its vicinity, however it initiated and assisted establish similar organizations in nine other cities in Macedonia.
07:25 a.m., Fieldwork
I got caught up talking, but here we are, we have arrived at the “Methadone Center.” The harm reduction field team is here every day, from 07:30 to 10:00 a.m. Fieldworkers distribute sterile injecting equipment, give advice on safe injecting and collect the used equipment to destroy it properly. It actually functions quite well and the clients are satisfied, particularly since they can use social, health, even legal services. Sometimes they blame us for people injecting themselves, but we are here only for their protection, and the protection of the environment. Despite the advise, there are still clients who inject the therapy and this is why the field team is here every morning. During the same hours another field team goes to another “Methadone Centre” because some individuals inject therapy there as well. The two teams have the same responsibilities and so I won’t repeat myself. Now it’s time to go. We are going to the drop-in centre in Kapishtec with the vehicle of the field team.
We could use some music on the way there. EKV are the best to relax. On second thought, this song is the best.
“What a joyous day,
Birds singing Hallelujah!”
Actually, EKV rule! Geniuses!
10:16 a.m., Drop-in Centre Kapishtec
We are at the Drop-in centre for harm reduction in Kapishtec. Please be discrete, our clients’ trust is of utmost priority.
In this Drop-in Centre, as in the Centers in Mavrovka and Shuto Orizari there are people working with needle exchange, a social worker and a medical person, and legal advisors visit three times a week. Needle exchange, just as fieldwork, is HOPS’s primary activity, but contrary to fieldwork, in the Drop-in Centers clients can stick around longer and get the necessary information for safe injecting and safe disposal of used equipment. Also the Centre offers more discrete and convenient environment for social, medical and legal services. The people gathered now are members of the Creative Workshop. They are into woodcarving now, but they also produce jewelry and paint T-shirts. It is a way to earn some money, but they are mostly here for the company. We’ll stay here for a while because I need to fill in some forms, and then I’ll take you to the Executive Office. In the meantime, you can hang with the people from the Creative Workshop and look at their crafts.
11:49 a.m., Executive Office
I have to take these forms to the Executive Office. It’s the most tedious part of my obligations. At times I feel as though most of my work is paperwork. When I started it was difficult to understand, but then I realized the forms we had to fill in were records later used for the analyses necessary for the promotion of our services. Not only does it make our work more transparent, but also makes the benefits from the programs for reduction of drug related harms more visible, as well as the necessity to maintain them.
At times I see the colleagues from the Executive Office as pure bureaucrats. Most of the time they are at meetings or yawning in front of the computers, or they are simple jabbering. It seems as though they don’t do any work. And then a new report on a research is published, or a new issue of “Drugs – Policies and Practices,” HOPS’s website is updated, there is a new brochure or they come up with the Summer school on addictions. Then when an acquaintance mentions the product I contributed to, I realize they put all their efforts to sustain the programs and make them more transparent.
Today they are busy with meetings, arguing. They can discuss all they want, we are going to Gjorche. A client of ours needs help.
EKV can keeps us company on the way there.
“Blue light across blue faces
A blue world out of blue boxes
ооо, city people
ооо, city people.”
1:32 p.m., Visiting a client
Ž. has been our client for a long time. He lives alone in Gjorche and his health prevents him from visiting the Centers. He has no relatives and friends to help him and lives off a minimal social care. He has no money to pay his bills, with executors constantly breathing down his neck. Fortunately the apartment is not in his name, or he would have lost it and been out on the street by now. Live can be cruel at times. It really is a “Live and Let Die” situation. Sometimes it seems as though we are the only ones who care.
“Hi, Ž. How are you?”
“Difficult, man, very difficult! I am freezing. They turned off the electricity as well.”
“We have a mattress and some warm covers for you. Will that do?”
“Great! Thanks a lot. If it wasn’t for you guys, life would be difficult, very difficult. Who are these people?”
“They are interested in what we do. They want to see how users live.”
“Difficult, man. Very difficult! I got out of prison and now no one wants to hire me. I was released without any documents. If it wasn’t for HOPS, I wouldn’t have had ID, or social care. No one likes junkies. If it wasn’t for the doctor to change the bandages on my legs, they would have let me drop dead here. No one likes junkies.”
“Ž., how much equipment do you need?”
“I need 10 cc ‘guns’, give me 20, and 50 thin needles. You can collect the old ones. Drop by next week.”
“We will. See you!”
Needle exchange is our primary activity, apart from that whenever we try to help our clients in other ways. Some people donate used things, and then we give them to our clients. Mostly we get second-hand clothes, sometimes sheets, or used household objects – cupboards, stoves, fridges or similar. Some people donate baby food, clothes and pampers for clients with babies. Thank God there are some good people left. We make ends meet to help our clients. Clients keep repeating they would be helpless without us. There are clients who can’t visit the Centers from different reasons throughout Skopje and the surrounding villages.
From here we are going to Gazi Baba and show you the Support Centre for sex workers. On the way there we are going to stop and drop injecting equipment to some clients.
4:17 p.m., Support Center for sex workers
The Program was initiated as a support for sex workers who use drugs, however it quickly extended to offer services for all open street sex workers in Skopje. They started with fieldwork and later opened the Centre. Of course, we do fieldwork there as well, but we won’t be able to go there because we have to think of the discretion sex workers and their clients need.
Here in the Centre, sex workers get social, health and legal services as well as psychological support. They can have a bath, do their laundry, do their hair and cook a meal. Apart from discussions about safe sex and safe sex work, they also discuss gender issues, women’s rights, legislative regulation of sex work, or they simply chit chat. In fact, it can be quite fun here.
Talking about party, let’s leave them do their job…. We are going to an after-work party in R. Our colleague D. is playing with his band.
5:45 p.m., After Work Party
It’s great when we get the chance to get together. We like hanging out after work. Many of the colleagues have a fondness for art, although most of them are interested in music. A bit of fun and then we’re off home.
It’s rocking?! Come on, people! Play some EKV!
“What a joyous day,
Birds are singing Hallelujah!”
This is how HOPS works!
Find out more!
Services for reduction of drug related harms
The primary activity of the harm reduction services is exchange of injecting equipment and collecting the used equipment to be properly destroyed. It is a proven practice throughout the world for protection of people who inject drugs, as well as the broader community from HIV/AIDS, hepatitis and other blood borne and sexually transmitted infections.
There are three drop-in centers for harm reduction (or simply drop-in centers), a field team and a Center for rehabilitation and re-socialization of people who use drugs active within the services. The centers are located in Kapistec, Bit-Pazar and Suto Orizari, while the field teams cover the territory of Skopje, its suburbs and surrounding villages depending on the clients’ needs.
Apart from its primary activity, the Harm reduction program provides social, medical and legal services. People who use drugs are counseled on HIV/AIDS, hepatitis, tuberculosis, possibilities for treatment of drug dependence and other health issues. The socially endangered clients are supplied with food. The Suto Orizari drop-in centre has a washing machine, and a bath is to be build for the homeless clients.
The Daily center for rehabilitation and re-socialization offers psycho-social, psychiatric and pedagogical support for people who use drugs and their families. Special activities for children consist of a pedagogue who helps them in their studying, there are organized visits to the theater, the cinema, the ZOO, celebrations and other entertaining and beneficial activities.
In addition, there is a Creative workshop for all clients with artistic and creative affinities twice a week in the Drop-in center in Kapistec and the Daily center for rehabilitation and re-socialization.
In 2014, a field team for working with children who use drugs was formed. Due to the lack of structural institutional solutions, the team can only map the places where children who use drugs gather, distribute donated clothes, acquire new information on their drug use habits and help them deal with the daily problems.
Of course, this is just a small part of the daily activities within the services for reduction of drug related harms.
Services for support of sex workers
In 2000, the non-governmental organization HOPS – Healthy Options Project Skopje initiated a project which extended into a comprehensive Program for support of open street sex workers in Skopje, and later among sex workers in the Roma settlements in Skopje, as well as sex workers working in the close settings (private apartments, massage parlors).
In line with the needs of the sex workers which could not be meet by the existing institutions we offer services for: social, health, legal, psychological, pedagogical-andragogical support. Apart from the basic services in the drop-in centers, sex workers can use a washing machine, bath, kitchen, hairstyle and make up. There are often discussions on: safe sex, protection while working, gender issues, women’s rights, legislative regulation of sex work etc.
In addition, we extend our services to: the intimate partners and families of sex workers, clients of sex workers, mediators and professionals working in the field of health, social protection and human rights.
2014 brought an initiative for researching the requirements and possibilities to start the process for legislative regulation of sex work in Macedonia, another big step for the promotion of the social status of sex workers.
Centre for education, documentation and research (CEDR)
HOPS has worked on research and trainings related to drugs and drug use in Macedonia from its very beginning, however this activity was developed more structurally in 2012.
With its activities, CEDR supports all HOPS’s programs in the efforts for implementation of humane policies for drugs and sex work, striving for a society based on humanity and fair inclusion.
CEDR is particularly proud with the Summer school on addictions which offers training for young professionals working with issues related to drugs and drug dependences. The School is particularly focused on drug policies and practices, psycho-social support and the human rights concept of people who use drugs.
Social marketing department
The Social marketing department provides significant support in the efforts the organization makes for informing, education and motivation of people who use drugs and sex workers in order to introduce changes in the individual risk behavior and help them realize their rights to use the services within the social and health system in Macedonia. Within its activities, the Social marketing department addresses journalists and media, the key actors in the creation of the public opinion, hoping to win their support and cooperation to decrease the stigmatization and discrimination these communities face. Furthermore, with their activities they support the efforts for advocacy to the decision-makers and relevant institutions for the introduction of humane policies in order to provide a supporting environment for people who use drugs and sex workers.
The activities within the services for reduction of drug related harms and support of sex workers would be impossible without advocacy. It is advocacy that helped the police understand HOPS’s humane mission and treat our clients with more dignity. With its advocacy, HOPS participates in various local, national and international working groups looking for solutions of drug and sex work related issues. However, despite the many achievements, advocates are confronted with numerous challenges in the introduction of humane drug and sex work policies.
Doctor Hedgehog has never studied medicine or any other conventional science for that matter. His profession is related to the exchange of sterile injecting equipment. Hedgehog has been a member of HOPS – Healthy Options Project Skopje from its foundation, and was given the title “Doctor” by the colleagues and clients owing to his dedication in the development of the harm reduction programs.