"If there is no struggle there is no progress," said the great American abolitionist leader Frederick Douglass. "Those who profess to favor freedom and yet depreciate agitation, are men who want the ocean without the awful roar of its many waters." The history of the AIDS epidemic underscores Douglass' contention: People living with HIV/AIDS have never gotten anything without asking for it. Most of the programs that serve the needs of communities affected by HIV/AIDS and ensure their human rights were the result of community mobilization and agitation. Whether we are gay men and drug users in the United States, heterosexual men and women in South Africa, or sex workers in India, most of the advances in our lives have come from going to our leaders and demanding change.

The HIV epidemic in Central and Eastern Europe and the former Soviet Union (CEE/fSU) is the fastest growing epidemic in the world. People with HIV -- most particularly the injection drug users who make up more than 80 percent of all reported HIV cases in the region -- face rampant and severe stigma. Harm reduction services are usually not supported by local or national government. Treatment advocacy efforts are virtually unknown in many countries in the region.

Changes in the lives of drug users and people with HIV in CEE/fSU will not come without concerted local advocacy efforts. Yet the kind of activism that has worked to shift AIDS policies elsewhere in the world is largely lacking in the region.

In response to this dearth of activism, in 2002, the International Harm Reduction Development (IHRD) Program of the Open Society Institute and Gay Men's Health Crisis (GMHC) established a fellowship at GMHC in New York City for people from CEE/fSU. The program is supported by IHRD and the John M. Lloyd Foundation.

The program's goal is to ensure that fellows learn the skills they need to change the policies of governments and private institutions, such as pharmaceutical companies and employers, so that they best serve people living with HIV. The program also brings increased visibility in the United States and elsewhere to the epidemic in CEE/fSU.

The six-week program in civic engagement is based in GMHC's public policy and advocacy department and exposes fellows to GMHC departments that provide direct services to people with HIV, such as substance abuse counseling. The program involves regular interaction with the staff of IHRD and meetings with global networks of advocates for people with HIV so that fellows can continue to enhance their advocacy skills once they return home.

The fellows are introduced to the history, culture, and values of community-based AIDS organizing and treatment and prevention advocacy. They conduct site visits at other organizations serving and advocating for people with HIV/AIDS and those at risk in NYC and around the world, including the Harm Reduction Coalition, the Chemical Dependency Institute at Beth Israel Medical Center, Médecins Sans Frontières, and African Services Committee. Fellows meet U.S.-based experts on harm reduction, media advocacy, AIDS research, and clinical care, and participate in major community conferences such as the North American AIDS Treatment Action Forum (NATAF) and attend policy meetings in Washington, D.C. with other AIDS organizations and U.S. officials.

In the fall of 2002, the first fellows arrived in New York City: Olena Semenova from All-Ukrainian Network of People Living with HIV/AIDS and Bogdan Glodeanu from ALIAT, the first needle exchange program in Romania. In the spring of 2003, Vitaly Zhumagaliev from the Open Health Institute and Roman Dudnik from AIDS Foundation East West, both in Moscow, arrived at GMHC. And November 2003, the latest recruits, Anastasia Kamlyk of Positive Movement in Belarus and David Ananiashvili from the Georgian Plus Group began a six-week stay in New York.

Gregg Gonsalves is the director of treatment and prevention advocacy at Gay Men's Health Crisis in New York.

Reprinted from Harm Reduction News: www.soros.org/harm-reduction.