Anke van Dam is a member of the advisory board of the European Forum for Primary Care

Anke van Dam, executive director of AFEW International has been elected as a member of the advisory board of the European Forum for Primary Care.

What is The European Forum for Primary Care?

The European Forum for Primary Care (EFPC) was initiated in early 2005 by a group of interested parties from several countries.

The basic aim of the Forum is to improve the European population’s health by promoting strong Primary Care. This is done by monitoring the state of Primary Care in the European countries, by collecting information on conditions that matter for strong Primary Care, and by exchanging experiences.

The Forum connects three groups of interested parties: the health care field, health policy makers, and the producers and evaluators of health care information. These interested parties work at three levels: the local or district level, the national level, and the supra-national level. By linking policy practice and research the Forum intends to stimulate policy making based on vision and evidence as much as it intends to support PC practice oriented towards quality and equity.

The membership of AFEW International

Anke van Dam: «The membership to the advisory board of the European Forum of Primary Care allows AFEW to learn from primary health care providers in European Countries and further the best practices to ensure equity in health and bring those to Eastern Europe and Central-Asia. What does it mean and what are the conditions when we talk about access to health services, gender and inequality per diseases? This is all discussed in the EFPC and the necessary role of primary care. AFEW International brings knowledge and vast expertise about the EECA region and a great network of contacts with organizations, institutes, agencies and professionals to the EFPC.

With the help of European Forum of Primary Car AFEW International hopes to build the bridge and to facilitate exchange, linking and learning between professionals from East and West».

 

AFEW International Releases Report on Its Activities for AIDS 2018 Conference

AFEW Network (AFEW)  has a long history of working to link the “east” with the “west” so when the decision was made to hold the 22nd International AIDS conference (AIDS 2018) in Amsterdam, the city that is home to AFEW International, the secretariat of AFEW Network, it was clear that AFEW could have an important role in leveraging the conference to bring global attention to the crisis situation in Eastern Europe and Central Asia (EECA). Starting from 2016, with the support of the Dutch Ministry of Foreign Affairs (MoFA), various strategies (fostering linking, learning and dialogue; developing creative solutions to unresolved challenges; influencing leaders, policymakers and donors; addressing stigma, discrimination and criminalization of people affected by HIV) were undertaken as to empower communities from the EECA to take part in AIDS 2018.

Leading up to and during AIDS 2018, AFEW International engaged in a range of activities to promote EECA at the conference and to promote the conference in EECA. An independent evaluator examined the impact of the implemented activities and factors that contributed to the successes and analyzed the challenges. In the report, you can read what were the key activities and lesson learned.

The short version of the report can be read here.

The full version of the report can be read here.

Videos from AIDS 2018 и IAS 2017 Now Available in Russian

Videos from AIDS 2018 and IAS 2017 Now Available in Russian. The IAS Educational Fund provides educational and inspiring sessions from IAS conferences (International AIDS Conferences and IAS Conferences on HIV Science) to clinicians and other healthcare providers and advocates. To make content accessible to more people, the IAS Educational Fund provides several sessions subtitled and transcribed in FrenchSpanishPortuguese and Russian.

You can find the sessions from AIDS 2018 Conference with the subtitles in Russian here.

Source: www.iasociety.org

AFEW Got Donation to Martine de Schutter Scholarship Fund

16,000 EUR is the amount of donation that AFEW International has got to Martine de Schutter Scholarship Fund from ViiV Healthcare UK Ltd. Initially, the Fund was launched to support participants from Eastern Europe and Central Asia (EECA) in attending the 22nd International AIDS Conference (AIDS 2018). The donation from ViiV Healthcare became the first donation after AIDS 2018.

The financing received from Viiv will be used as an effective tool for the EECA scientists, clinicians, community professionals and activists for bringing challenges of EECA region on international agenda and learning from their peers through participation in the international conferences.

Before the 22nd International AIDS Conference, Martine de Schutter Scholarship Fund raised 103,000 EUR to cover the additional scholarships of the EECA applicants to come to Amsterdam for AIDS 2018. The Fellowship Commission of the International AIDS Society (IAS) distributed part of the funds of the Martine de Schutter Fund to participants from EECA. In total, 149 scholarships were granted to delegates from the EECA region or 13% of all IAS scholarships, which means a four-fold increase in comparison to AIDS 2016, and 1.7 increase in comparison to AIDS 2010 conferences.

 

Under 16 and Above: Protecting the Rights of Adolescents and Preventing HIV

Author: Yana Kazmirenko, Ukraine

Shortage of HIV prevention programmes for young people was one of the key topics discussed at the 22nd International AIDS Conference (AIDS 2018). At the conference, AFEW-Ukraine presented its best practices in HIV response among young people. Since 2012, it has been supporting the initiatives aimed at most-at-risk adolescents within the Bridging the Gaps: Health and Rights for Key Populations project funded by the Dutch Ministry of Foreign Affairs.

Gaps analysis

Over the course of project implementation, social welfare centres for adolescents who use psychoactive substances were established in Kharkiv, Poltava, Kropyvnytskyi and Chernivtsi and a rehabilitation day care centre for such young people was opened in Chernivtsi. In 2017 only, over 12 hundred adolescents received 21,290 services in those four cities.

Olena Voskresenska, Director of AFEW-Ukraine, recalls that when the project just started, a gap analysis was conducted. It turned out that there were a lot of programmes for adults who use drugs, while few donors were supporting similar activities for adolescents. It was considered that this population does not make a considerable contribution to the HIV epidemic. Thus, both most-at-risk adolescents and generally schoolchildren and students of vocational training centres remained out of focus.

“Of all the countries involved in Bridging the Gaps project, Ukraine is unique in terms of the activities implemented for under-age drug users. We work with non-injecting drug users trying to prevent them from switching to injecting drugs,” says Olena.

Children do not use drugs

One of the main achievements of AFEW-Ukraine is developing a tool to monitor the violations of human rights of most-at-risk adolescents. Questionnaires are used to collect data on adolescents’ rights violations, providing urgent response and legal support. Iryna Nerubaieva, AFEW-Ukraine Project Manager, thinks that in the Ukrainian society there is a strong belief: children cannot use drugs and they do not use them.

“This community is invisible and unheard. Most often, adolescents do not know about their rights, do not know that they have any rights or how these rights are to be protected,” says Iryna.

Adolescents – mostly high schoolers and students of vocational training centres – are brought to the community centres by their friends. Often they are referred by social welfare institutions, departments of juvenile services and even police.

Currently, AFEW-Ukraine works in four cities of Ukraine: Kharkiv, Chernivtsi, Kropyvnytskyi and Poltava. Besides, thanks to the cooperation with Alliance for Public Health, since 2017 the activities for adolescents, including monitoring of human rights violations, have been conducted in five more cities of Ukraine.

Testing as a prevention tool

At the conference, Yevheniia Kuvshynova, Executive Director of Convictus Ukraine, implementing partner of AFEW-Ukraine and Alliance for Public Health, told about the Voice of Adolescents project, which covers 717 adolescents.

The Underage, Overlooked: Improving Access to Integrated HIV Services for Adolescents Most at Risk in Ukraine project is aimed at teenagers who use drugs and live in small towns and villages in seven regions of Ukraine. Adolescents from Kyiv attend the Street Power youth club. In this club, teenagers who use psychoactive substances and practice risky injecting and sexual behaviours can watch films, play computer games and receive social support.

According to Yevheniia, most of them use non-injecting drugs and HIV testing for them is rather a prevention tool. So far, no HIV cases have been detected. Adolescents are tested for hepatitis C and B as well as sexually transmitted infections.

For many years, Convictus has been working with adults who inject drugs providing services to 11 thousand people. Working with adolescents is different: they are tested only starting from 14 years of age, with a social worker and a doctor involved.

“One of our priorities is building a network and a map of services, so that adolescents could go to any organization of the network and receive services from our partners. If a person coming to us needs more in-depth support, we provide such support and also help him or her with clothes as we maintain a clothing bank,” tells Yevheniia.

Convictus is planning to develop a School of Leadership and a sexual health programme for girls, which are to close more gaps in the system of HIV prevention among most-at-risk adolescents in Ukraine.

HIV on AIDS 2018: Global Extent, Impact and the Way Forward

The issues of stigma, discrimination and human rights violations were broadly discussed during the AIDS 2018 conference which was held in Amsterdam, Netherlands in July 2018. The conference sessions explored the political, economic and sociological manifestations of HIV related stigma, discrimination and human rights violations on the global level articulated by the civil society.

Global Network of People living with HIV presented their report on HIV stigma and discrimination in the world of work which included findings from people living with HIV (PLHIV) stigma index. The report was written based on the information provided by 13 country teams who implemented the PLHIV Stigma Index.

Stigma index as a tool

Addressing stigma-affected people living with HIV is a global priority. Stigma, defined as “the co‐occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised,” has a negative impact on the health of PLHIV and contributes to the psychosocial stress, coercion and violence, job loss, and social exclusion. PLHIV, gay men and other men who have sex with other men (MSM), transgender individuals, sex workers, and people who use drugs (PWUD) – often referred to as key populations – are at the intersection of HIV‐related stigma and prejudice against their identities, occupations or behaviors that are often exacerbating their experiences of stigma and discrimination.

The PLHIV stigma index provides the evidence on stigma and discrimination that has been essential for informing HIV policy, PLHIV rights advocacy efforts, and stigma‐reduction interventions.  Stigma index is a research tool by which PLHIV capture data on their experiences of stigma and discrimination. As of November 2017, more than 100,000 PLHIV had been interviewed in over 50 languages by 2 000 trained PLHIV interviewers.

Stigma is complex

Stigma and discrimination remain a significant HIV risk factor for the key populations all over the world and mostly for people living with HIV as stigma directly and negatively affects health outcomes. At the International AIDS 2018 Conference, the participants reviewed new developments in the effort to combat stigma and discrimination, report results from researches and analyses of interventions and effective anti-stigma programs. The implications of the studies were discussed as they relate to the development of ongoing efforts to reduce HIV-related stigma and discrimination around the globe.

The construction of stigma is complex. Therefore, anti-stigma interventions must take this into account. Stefan Baral, M.D., Johns Hopkins University, presented a cross-country analysis of intersectional stigma among MSM, including perceived stigma, enacted stigma, and anticipated stigma related to family, community, and the health system.

As national AIDS programs and the international community grow efforts to implement plans for the universal access to HIV prevention, treatment, care and support, participants of the AIDS response should work together to overcome the main obstacles to achieving this goal.

MSM with depression have higher risk of stigma

Expressions of stigma in this analysis included a broad range of behaviors, such as family exclusion, rejection by friends, family gossip, verbal harassment, being afraid in public, being afraid to seek care, avoiding seeking care, poor treatment by health care workers, health care worker gossip, police not providing protection, blackmail, and even physical harm. Harassment and gossip were noted as important forms of enacted stigma that must be addressed, and intersecting identities were found to raise the risk of experiencing high stigma. MSM with depression, for example, had a higher risk of being stigmatized. These intersecting identities represent a critical target for all types of stigma reduction, particularly anticipated health care stigma.

In many countries and communities, HIV stigma and subsequent discrimination can lead to the same devastating effects as the disease itself: a break with a spouse and/or family, social ostracism, loss of work and property, exclusion from school, denial of medical services, lack of care, support, and violence. These consequences or the fear of them mean that people will not be very willing to be tested for HIV, disclose their HIV status to others, or seek treatment, care and support.

AIDS 2018 Sidenotes: How We Tested Drugs

Experts of the centre testing a tablet

Author: Yana Kazmirenko, Ukraine

Saturday morning at the Schiphol airport. A conference participant from Ukraine – camera operator Igor K. – finds out that his tablets are gone. In a second, a confident man loses his heart: he becomes pale, his hands are shaking, and his eyes are full of dread. Igor has been taking methadone therapy for a few years, and for him losing his tablets can be life-changing. In Ukraine, it is not possible to receive methadone at the weekend.

Ukrainian drug users say that losing your tablets is the same as losing your passport. In both cases, you have to report to the police, where police officers issue a certificate to confirm the loss and only then a doctor would give you methadone. Igor is standing in the huge Amsterdam airport. He has three hours before his flight. It turns out that it is easier for a Ukrainian citizen to access methadone in Schiphol than back at home. After listening to Igor’s story, the doctor at the health station just prescribes him tablets for EUR 20.

Diseases are born in the streets

That was how the 22nd International AIDS Conference in Amsterdam (AIDS 2018) ended for me. After the event, it became clear that the capital city of the Netherlands had a full right to host this global forum. First of all, this right was earned because of its innovative HIV programmes, including progressive drug policies. It is not only about coffee shops where one can taste cupcakes with marijuana…

The first syringe exchange programmes, safe injection rooms and drug testing sites – those are all Dutch inventions, which were widely practised back in 1980s. This country was the first to realize that diseases are born in the streets and that nobody can tell better about the threat of HIV and ways to prevent it than drug users.

I could see it with my own eyes when I went with a study visit to the Jellinek drug testing centre with a group of journalists accredited at the conference. The building of the centre looks just the same as the neighbouring buildings. The centre has branches in Amsterdam, Utrecht, Almere, Amersfoort, Hilversum and other cities. In all of them, you can anonymously test your drugs for dangerous components.

Nightclub goers test their drugs

In 2017, over 12 thousand people tested their drugs (in 60% of cases ecstasy was tested). The centre has two tasks: monitoring of the market of club drugs and reducing the harms associated with their use.

A staff member of Jellinek says that visitors can access two types of tests: rapid test with a marker and laboratory testing, which takes a week. All kinds of things can be tested: tablets, powders, liquids, capsules or crystals. Every visitor may bring up to three samples to be tested. The price of one test in EUR 2.50.

E.g., an ecstasy tablet is first inspected, recording its colour, size, logo, acid test and comparing it to the national database with aggregated data of 30 drug testing centres from all over the country. If such tablet has already been tested (which happens in 75% of cases), the visitor is informed about its content straight away. If the tablet does not match any entry in the database, with the consent of its owner it is sent to a laboratory for further testing. The result is ready in a week. The only exception is LSD. Testing this drug is expensive, so Jellinek does partial testing not to go bankrupt.

Rapid test is the preferred option of the main drug users in the Netherlands – nightclub goers. After getting the testing results, they usually follow up with claims to the dealer who has sold them a dangerous product.

By the way, every year the Netherlands host more than a thousand musical festivals, with a mobile drug testing site operating at each of them. Such strict measures were introduced after 2014 when three visitors of a festival died after using low-quality drugs. However, using any drugs is a risk.

“People who started using drugs 5-10 years ago have to realize that now drugs may be more potent with a higher risk of overdose,” warn the experts working at the centre.

Ukraine needs changes

AIDS 2018 participant from Ukraine Anton Basenko, who is the head of the Ukrainian Union of People Who Use Drugs (PUD.Ukraine) says that establishing drug testing centres and safe injection rooms is the reason why there are no more streets covered with used syringes in Amsterdam.

In Ukraine, there are also talks about opening such drug testing centres and safe injection rooms. However, they will not appear unless the legislation changes. So far, such facilities are outlawed and people who open them may be incarcerated for running drug dens.

AFEW on AIDS 2018: Cases and Efforts to Spotlight Eastern Europe and Central Asia

Author: Olesya Kravchuk, AFEW International

AFEW International and AFEW Network have organised and supported numerous activities within 22nd International AIDS Conference AIDS 2018. AFEW joined many initiatives by other organisations and networks and presented successful cases of work in Eastern Europe and Central Asia (EECA). Find some highlights below.

Together with EECA regional networks and committed advocates, AFEW has put great effort into making sure that the AIDS crisis and related public health concerns in EECA were featured in the conference program. Each plenary session of the AIDS 2018 had a speaker from the region and lots of sessions addressed the challenges in stopping new HIV and TB cases in the EECA countries. AFEW also supported Russian-speaking delegates to the Conference and helped with translation to and from Russian during AIDS 2018. More than 35 sessions were translated into Russian. A team of 25 dedicated Russian and English-speaking volunteers was recruited, trained and coordinated by AFEW International. These volunteers have provided language support during the conference and at the events organised by AFEW.

AFEW has also contributed with financial and technical support to the EECA networking zone ActivEast which was one of the busiest zones in the Global Village with more than 50 sessions during the conference led by community leaders.

Besides, AFEW International helped Amsterdam Youth Force by providing it with fiscal and administrative support, technical assistance and financial means to bring young volunteers to the conference. 35 young people from different countries of EECA have travelled to Amsterdam by bus from Kyiv and have worked at youth-focused events of the Global Village.

A migrant from Tajikistan came to talk

AFEW’s Leadership workshop ‘Migration in Eastern Europe and Central Asia: Access to healthcare for all?’ presented information about migrants in EECA, and labor migrants from Tajikistan in particular. Findings from a needs assessment survey of labour migrants among people who use drugs in Kyrgyzstan and Tajikistan were presented.

A labor migrant from Tajikistan Zebo Alimahmadova came to Amsterdam to tell about her migration experience to Russia. Working in Saint-Petersburg, Zebo got to know that she was HIV-positive. Even though it was difficult for her, she found strength to go back to her home country with her children and get the proper treatment. Now she has a job and feels support from her three kids and AFEW-Tajikistan.

Coping with shrinking space

Shrinking space of civil society in the EECA region was also an important topic during many events of the Conference. AFEW’s director of programme Janine Wildschut led an active discussion on the strategies for coping with shrinking space for the civil society and shared AFEW’s techniques in the EECA networking zone in the Global Village.

“In EECA, we have observed a diminishing space for civil society organisations, perhaps best exampled by the ‘Foreign Agent Law’ in the Russian Federation. The shrinking civil society space threatens the effectiveness of the response to HIV and other public health issues, particularly as it pertains to the health and rights of key populations,” says Janine Wildschut.

The report on the coping strategies amongst resilient harm reduction organisations and community networks in the context of shrinking space for civil society in Eastern Europe and Central Asia can be read and downloaded here.

Martine de Schutter Fund donors meeting

Martine de Schutter Scholarship Fund event was organised during the AIDS 2018 to bring together the donors of the Fund and the scholars and give them an opportunity to meet the family of Martine. The Fund established by AFEW raised 130.000 EUR to cover the additional scholarships of the EECA applicants to come to Amsterdam for the AIDS Conference. It was an emotional gathering, with gratitude expresses by the scholars for an opportunity to come to the conference – for many for the first time in their lives. AFEW’s executive director Anke van Dam said that AFEW has an intention to continue fundraising for the Fund to further support EECA delegates for international scientific meetings and conferences.

Martine de Schutter was a strong Dutch advocate for human rights and had a passion to Eastern Europe and Central Asia. Her last trip was to AIDS 2014 Conference in Melbourne on the MH17 plane that was shot down and crashed.

EECA ministers showed their political will

Within AIDS 2018, AFEW took part in Ministers and civil society dialogue meeting, organized by the World Health Organization Regional Office for Europe and UNAIDS, in cooperation with the Government of the Netherlands. Ministers of health and senior policy-makers from 10 countries in EECA were introduced to the civil society organisations’ representatives during the meeting. The participants exchanged their experiences and the results of their national AIDS responses with a view to adapting them and scaling them up across the region. They discussed the Fast-Track priorities for achieving the 90–90–90 targets. EECA government representatives reaffirmed their political commitment to scale up national HIV responses during a ministerial policy dialogue on HIV, which was held on the eve of the International AIDS Conference in Amsterdam, Netherlands.

Hermitage dinner as the climax of Culture Initiative events

AFEW established International Cultural Initiative – a platform to complement AFEW’s consolidated track record in advocacy, education and outreach campaigns on matters of public health in the EECA region. The artistic work put forward by our six artists-in-residence, who came from EECA countries, was showcased at a variety of cultural institutions of the city of Amsterdam between May and July 2018. During the AIDS Conference, art-pieces were accessible to the general public in the Global Village.

The special Dialogue Dinner was the climax of AFEW’s cultural activities, taking place in the Hermitage Amsterdam Museum. We hosted an evening with dialogues about the EECA region, while savouring food and art from the region. 60 invitees representing policy makers, researchers, NGOs, foundations and international development specialists focusing on public health in the EECA region attended the dinner.

Chasing the virus together

AFEW Network members were actively participating in the EECA Campaign “Chase the virus not people!” that was launched at AIDS 2018 by the region’s community networks. EECA regional networks joined forces in response to the current situation to urge the world to overcome discrimination and the stigmatisation of key populations. AFEW International joined the campaign and was also one of its organisers.

“It was very important for us to join this campaign because this is the first campaign in which all regional networks united their efforts to draw attention to the problems of key population groups. AFEW is also against the backdrop of the catastrophic situation with the HIV/AIDS epidemic in EECA,” says Daria Alexeeva, EECA at AIDS2018 project manager at AFEW International. “Being actively present in six countries of the region, we realize how important it is to unite our efforts with other networks to achieve the common goal.”

AIDS 2018: Prison Corner and Harm Reduction Networking Zone Activities

More than 5 000 people, including famous actress Charlize Theron, visited the prison corner in Harm Reduction Networking Zone (HRNZ) located in the Global Village at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam. During five days, visitors could stop by, have a delicious cup of coffee made by former prisoners and participate in a programme with interactive debates, interviews, and presentations. Prisoners are usually a forgotten group since very few organisations pay attention to this vulnerable group of people. Taking into consideration that in many countries the issue of HIV/AIDS in prison is very sensitive and that the implementation of programs in prisons can hibernate or even fail, a pragmatic step-by-step guide for prison authorities and civil sector actors is now being developed by European Monitoring Centre for Drugs and Drug Addiction and European Centre for Disease Prevention and Control.

The executive director of AFEW International Anke van Dam stressed on the necessity of working in prisons in Eastern Europe and Central Asia (EECA). Health protection in prisons is a serious public health issue. Even though international law recognises the right of everyone, including people deprived of their liberty, in practice, many prisoners receive healthcare of a lower standard to the one available outside of the prison, if they receive treatment at all. In Eastern Europe and Central Asia, the unbearable circumstances and lack of coherency within the penal systems of the regions exists. AFEW recognizes the importance of people living within prisons receiving the same healthcare and life opportunities during and after their stay in prison. Together with prison authorities, AFEW is in constantly implementing prison health projects that seek collaboration with organisations working in prison. To introduce the region where AFEW is actively represented, Anke van Dam gave a book Invisible Lives: HIV on the Fringes of Society to Monica Beg, Chief of HIV/AIDS Section and Global Coordinator for HIV/AIDS at United Nations. Stories from the representatives of key populations from Tajikistan and Ukraine are depicted in the book.

AFEW expresses a big gratitude to our prison corner partners: The Council of Europe Pompidou Group, Asian Harm Reduction Network, International Corrections & Prison Association, Health Through Walls and UNODC.

Ukrainian success with the monitoring instrument

During the session about engaging young people who use drugs in Ukraine in the HIV and human rights response, AFEW-Ukraine presented the developments achieved during ‘Bridging the Gaps: Health and Rights for Key Populations’ and PITCH projects, supported by the Ministry of Foreign Affairs of the Netherlands.

AFEW-Ukraine’s manager Irina Nerubayeva presented the instrument for monitoring violations of human rights of adolescents using drugs in Ukraine, that has been used for a year among the partners in four regions of Ukraine. ‘Bridging the Gaps’ project partner – social worker from Kharkiv NGO Blago Alina Khokhlova – told about challenges and results of using the instrument and emphasized the importance of her organisation in developing effective advocacy programs in the city. Youth activist Daria Kopyevskayskaya from Kropyvnitsky (NGO Return to Life) emphasized the role that young people play in delivering information to their peers about rights.

Legal expert Vita Musatenko presented the most typical cases that were identified in the process of monitoring and advised what social workers can do to provide adequate response and help to a young person. Evgenia Kuvshinova from NGO Convictus told about her work with young people who use drugs in Kyiv at the Street Power Club where young clients receive a range of services, including testing for HIV, sexually transmitted diseases, hepatitis. There they also engage in educational activities and are trained as leaders.

From harm reduction programmes to methadone therapy

The session on HIV prevention, treatment, and care in the countries of the former Soviet Union allowed to learn about challenges and achievements of prison programmes from various countries of the former Soviet Union and receive information from government officials and NGOs. The head of the Medical Department of Kyrgyz Penitentiary Service Nazgul Soltobekova told about the system of HIV prevention and treatment in Kyrgyz prisons. She also shared the country’s successful experience in providing comprehensive services for people who use drugs in penitentiary facilities – from harm reduction programmes to methadone substitution therapy.

Konstantine Turashvili from the medical department of the Ministry of Corrections of Georgia told about HIV programmes in Georgian prisons and the country’s successes in hepatitis elimination programmes. Both speakers emphasized the importance of cooperation with community-based organisations that provide effective counseling services for inmates and help to ensure continuity of care of those released from detention facilities. This topic was further followed by Natalia Rudokvas from Kazakh NGO “Answer” who shared the experience of her NGO’s work with HIV positive inmates. Ikrom Ibragimov from AFEW-Tajikistan shared his experience of cooperation with the penitentiary system and told how NGO can build the capacity of prison staff in HIV, TB, and other related issues.

Being an expert in prison health, AFEW will continue advocating for HIV, TB and hepatitis C prevention and treatment programs for prisoners in EECA. We are promoting essential elements like harm reduction, including needle and syringe programmes, and opioid substitution therapy. Transitional client management that prepares prisoners for release and ensures linkage to follow-up after release is a valuable variant of client management that meets many of (ex)prisoners’ needs.

AIDS Conference Brought me a Job in Tajikistan

Author: Nargis Hamrabaeva, Tajikistan

Fifty-year-old Zebo from a southern region of Tajikistan – Khatlon – is a former labour migrant. At the 22nd International AIDS Conference in Amsterdam (AIDS 2018), she had the courage to speak out about what she long kept in – her HIV-positive status. Zebo once again turned the attention of the international community to the fact that labour migrants are one of the populations most vulnerable to HIV.

We interviewed her in Amsterdam, right after she delivered a speech at one of the sessions dedicated to HIV in the context of labour migration.

– Zebo, why did you decide to go to Russia to earn money? Usually that is what men do.

– In 2004, after I divorced my husband, I was left alone with three small children – my elder siblings were 9 and 6 years old, and my smallest daughter was only 3 months old. I worked as a nurse at a local maternity clinic. My children grew up, with our expenses growing along the way, and my earnings were not enough to feed them all. My ex-husband had a new family and was not helping us. Many of my countrymen went abroad to earn money and support their families. I decided to do the same. That is how my children and I found our way to Saint Petersburg.

– Isn’t it difficult for a woman to be a labour migrant?

– It is very difficult. I was desperate and went to nowhere. For the first days, we slept at the railway station or in the street. Some strangers helped us, offering food or money. Once, a woman from Tajikistan, who worked in Saint Petersburg, saw us and was so kind to give shelter to my children and me. I started baking and selling pasties, earned some money. As time passed, more people were buying our pasties: I was baking and my elder daughter was selling them at the Sadovy street market. Luckily, we had many buyers. However, I had to work my fingers to the bone.

I tried to settle my personal life again as it was very hard for me to cope with all my troubles alone. I met a young man. In the beginning, everything was fine. Then I started noticing him doing some strange things. It turned out that he was a drug user. He injected drugs. I asked him to stop but it did not help. Then I decided to break up with him. Later I heard that he felt bad and his relatives took him back to his motherland. Since then, I have never heard from this man, but my HIV status always reminds me of him.

When did you first learn that you had HIV?

– In 2015, a year after I broke up with my partner. All of a sudden, I felt bad and had a fever. My relatives called an ambulance. In the hospital, they made some tests and I was diagnosed with HIV. In a month, I felt better and went back home, but six months later it happened again. I was dwindling, with my weight going down to 34 kilos. Doctors advised me to go back to my country and get treatment. Almost all my countrymen working in Saint Petersburg had to raise money to buy airline tickets for me and my children. They knew that I was severely ill but did not know the exact diagnosis. When I came home, my family knew I had HIV. They did not really welcome me back. My relatives turned their backs on me and asked me to leave our house. My mother said that I would infect everyone, told people not to eat from the same plate with me and not to shake hands with me. I remember her yelling: “Get out of the house, aidsy!” It hurt me to hear such words, especially from my own mother. Still there are kind people in this world, so a neighbour living opposite from my parent’s house offered me to stay with her. She gave me a small room in a little building. That is where I still live.

So you had to go back to square one again?

– Yes, I did. A woman I know told me about AFEW-Tajikistan office in Bokhtar. I went there and they received me well, helping with food and treatment. They also had a business workshop for the members of vulnerable populations and I was able to get a credit from a microfinance organization. I bought everything I needed to open a small sales outlet in the neighbourhood. Sometimes, when I need to go to the city, my daughter takes over my duties. Children always help and support me in everything I do. My son also assists street market vendors, bringing home 15 somoni a day (less than two US dollars – ed. note). After my speech at the Amsterdam conference, Director of AFEW-Tajikistan Ikrom Ibragimov offered me to work as a consultant in the Bokhtar office of the organization. Now I will receive a salary. I am so grateful to him and to all the members of his great team. With their support, my life is getting better.

Great! One more question about Amsterdam. What does participation in the AIDS conference mean to you?

– It is my first trip far abroad. It is also the first time I take part in such a conference. I listened to many speakers and was inspired by their stories. They were openly saying that they lived with HIV for 20-25 years, taking care of their health and living active and complete lives. It gave me strength and confidence. I was startled to learn that in many countries people living with HIV are not prosecuted and other people do not avoid them. In those several days of the conference, I received more sincere hugs and handshakes than I did since I learned about my diagnosis. Why is there such a strong stigma against people living with HIV in my country? Why do people still hold to stereotypes and are afraid of us? At one of the sessions of the Amsterdam conference, I heard a slogan: “Chase the virus, not people.” It is such a good point!