Donbass: the HIV Epidemic Growing on Both Sides of the Border

Member of the Donbass battalion Aleksey with his wife. When he was taken captive, his wife secretly brought him medications. Photo: Mikhail Fridman

Author: Yana Kazmirenko, Ukraine

HIV is rapidly spreading in the east of Ukraine, which for over three years remains the area of military actions. For two years, pregnant women have not been tested for HIV, and medications could only be delivered illegally.

The armed conflict between Russia and Ukraine divided Donbass into two parts: areas controlled by the central Ukrainian government and the so-called Donetsk and Lugansk People’s Republics (DPR and LPR). The latter are controlled by pro-Russian separatists.

This Russian-Ukrainian conflict demonstrated the differences in the approaches of the two countries to HIV/AIDS treatment and prevention. Thus, in Russia opioid substitution treatment (OST) for people who inject drugs is banned. After Ukraine no longer supplied OST drugs to Donetsk and Lugansk, relevant programmes were also terminated in the areas not controlled by the Ukrainian government. According to experts, the war brought the region back to the 90s in terms of the spread of HIV.

Only half of those in need take the therapy

Sergey Dmitriyev, member of the Coordination Council of the All-Ukrainian Network of People Living with HIV says that there are 16 thousand HIV-positive people living in the areas of Donetsk region not controlled by the Ukrainian government. Only half of them take the therapy. In the Lugansk region, the situation is similar: 2.7 thousand people living with HIV registered, 1.4 thousand – taking the therapy.

On the territory controlled by the Ukrainian government, 13.6 thousand people with HIV positive status are registered, and over seven thousand receive the therapy. It is not surprising that the level of HIV prevalence here is 676.9 per 100 thousand people, which is 2.2 times higher than the average indicator in Ukraine. The highest rates are recorded in Dobropole (1,459.6 per 100 thousand people) and Mariupol (1,154.5).

Apart from the official statistics, the number of undetected HIV cases is at least the same as the number of cases registered as the epidemic in Donbass has long gone beyond the vulnerable populations.

AIDS centres across the border

Natalia Bezeleva, Head of the NGO “Club Svitanok”

Natalia Bezeleva, Head of the NGO “Club Svitanok,” thinks that during the three years of armed conflict only services and deliveries of medications have been re-established in the region. Currently, in the Ukraine-controlled areas , here are 22 sites to prescribe antiretroviral therapy. She remembers the deficit of antiretroviral drugs as a bad dream – her organization had to smuggle the drugs for over a year. Since 2016, the Global Fund has also joined the delivery of supplies, providing the necessary drugs, while UNICEF – the United Nations Children’s Fund – has been bringing the supplies to the “LPR” and the “DPR”.

Ms. Bezeleva illustrates failure of the established HIV/AIDS diagnostics and treatment system with the following fact: in 2014, the Donetsk regional AIDS centre remained on the territory not controlled by the Ukrainian government. Polymerase chain reaction (PCR) tests have not been transported through the newly created border, so for two years, no HIV diagnostics was done for children. Another big challenge was the deficit of doctors – most health professionals left the area of the armed conflict.

According to Ms. Bezeleva, the situation improved in 2016, when the Donetsk regional AIDS centre was opened in Slavyansk. Today, thanks to the support of the Global Fund PCR tests of adult patients are taken to Kharkiv and children’s PCR tests are delivered to Kyiv. There are also first achievements in diagnostics: in 2016, over 113 thousand people or 5.8% of the total population of the region were tested for HIV, and in the nine months of this year 84 thousand people have already been tested.

The military: testing for the contracted soldiers

A social worker visits an HIV-positive TB patient in the TB treatment clinic in Donetsk. Photo: Mikhail Fridman

Even in the peacetime, the military face the risk of infections, in particular HIV, tuberculosis and hepatitis, which is 2-5 times higher than in the general population. At war, this risk grows 50-fold.

In the area of armed conflict, there are 60 thousand of Ukrainian soldiers. According to the result of the research study conducted by the Alliance for Public Health, about 4% of the military enter the conflict area with an HIV positive status, while the percentage of HIV-positive soldiers leaving the area is doubled and reaches 8-8.5%.

Activists of civil society organizations say that the military should be covered with prevention programmes and convinced that they need to be tested. Another important issue is equipping the military first aid kits with condoms.

The Digital Consultation from the Amsterdam Youth Force

Dutch Ambassador for Sexual and Reproductive Health and Rights & HIV/AIDS Lambert Grijns

We are glad to announce the digital consultation the Amsterdam Youth Force (AYF) is organising in the run up to 22nd International AIDS Conference (AIDS 2018.) AIDS 2018 will be an important event in the road to fulfilling the Sustainable Development Goals goal of ending the AIDS epidemic by 2030. Therefore, it is crucial that young people’s perspectives are heard in the lead up to the conference, which is why we a consultation to help produce position papers reflecting young people’s voices is being launched.

The consultation will build on the work the #UPROOT agenda documented by PACT, and Amsterdam Youth Force is currently investigating the best ways to do that. In the meantime, AYF is looking for volunteers to help with the project. They are specifically looking for:

  • Young people who speak both English and Russian, French, Arabic, Spanish or Chinese.
  • People who want to help manage and translate input in those languages and help write the papers.
  • People who are available for that from January until July 2018.

If you are interested in helping out, please let AYF know via advocacy.ayf@gmail.com. Then they will contact you to see how you can help.

Call for Application: AIDS 2018 Abstract Support

Amsterdam Youth Force, Eurasian Harm Reduction Association (EHRA) and AFEW International invite applicants from Eastern Europe and Central Asia region (EECA) to submit drafts abstracts for XXII International AIDS Conference 2018 in Amsterdam (AIDS 2018) to board panel of experts for review. 

We would like to invite Eastern European and Central Asian (EECA) researchers, clinicians, scientists, community activists and young people to submit their abstracts to our EECA AIDS 2018 Abstract Support team. Boosting the representation of academics in this region is important as this is the only region in the world where the epidemic is still growing. To increase the chances to present their work at the conference for researchers, clinicians, community activists and young people from EECA who may have less experience in writing scientific abstracts in English, we will be facilitating scientific and English language assistance. We will link you to a researcher or a professional in your field which can provide you with scientific feedback on how to improve the quality of your abstract. To specifically support young researchers and community activists, we also offer a feedback session via Skype to discuss the suggested changes to your work.

If this sounds like something you could benefit from, please read further about the eligibility criteria and review process.

Eligibility criteria

You can submit your abstract to aids2018@AFEW.nl for a professional review if you are:

  • A (young) researcher, scientists, clinician, community activist or representative of community based organization or NGO; and
  • Planning to submit an abstract to 22nd International AIDS Conference 2018 in Amsterdam, 23-27 July 2018 (AIDS 2018); and
  • Working in one of the following countries: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan;

The review process

  • We will be accepting submissions from the 1st of December 2017 until the 10th of January 2018 in both English and Russian languages. The feedback to the submitted draft abstracts will be provided in two subsequent rounds. The first round panelists will provide in-depth feedback on the initial content, and the second round will allow for the final feedback on the adjusted version.

First round feedback will be sent out to applicants within 10 days after the submission. The timing for in-person communication shall it be needed, will be coordinated individually with each applicant.

  • Limited translation and editing services will occur between the 22 January and 2 February 2018.

For those who submit in Russian language, you will first receive feedback on the academic quality of your written piece. Following this, a limited number of abstracts will also be translated into English. This is based on the need, so please indicate your capacity for translation in the letter of motivation.

For the abstract submissions written in English, you will receive feedback on the scientific quality of work, and limited number of abstracts will get assistance with English editing. Again, please indicate your English skills and need for editing in the motivation letter.

  • Due to the limited capacity of the panelists, in total up to 110 abstracts will be able to receive feedback. Therefore, the rule “first come – first served” will apply. First 110 abstracts submitted from eligible applicants will be forwarded to a relevant panelist based on his/her expertise and academical background, for feedback and in some cases for personal communication.

Please send your abstract in Word format, include a brief letter of motivation, which scientific track you will be submitting to and details about yourself including your age if you would like to apply as a young researcher or community activist.

Below you will find links to materials on how to write conference abstracts, available in English and Russian.

Requirement to abstracts

  • The abstract should be written in accordance with the official requirements of the AIDS Conference.
  • The draft abstract should be written in Russian or English.
  • The content of the abstract should be in line with one of the conference scientific tracks. The scientific track must be specified under the heading of the abstract.
  • There is a maximum of two abstracts per applicant.
  • Those applicants who want to receive language support either the translation into Russian, or editing of the English abstract, will have to submit a short motivation letter to explain why they need such support.

Confidentiality

AFEW International, EHRA and Amsterdam Youth Force form a Steering Committee and the secretariat of the EECA Abstract support project. Only people designated to serve within Steering Committee and the secretariat and the reviewers assigned to each abstract will have access to the abstract submissions as well as the contact details of the applicants. We will not release any information on who has received assistance for their submissions at any point unless we have consent to do so.

Useful resources

  1. Abstract writing module available in Russian and English

An Abstract writing module is developed in collaboration with the International AIDS Society (IAS) – the organizer of the AIDS conferences, and written by editors of the Journal of the International AIDS Society, an open-access platform for essential and innovative HIV/AIDS research. It is available for everybody in English and translated into Russian by AFEW International.

  1. Online training on abstract writing

AFEW International has conducted a training on community based participatory research and abstract writing. This training was steamed live and records as well as hand outs and presentations are available in Russian here:

Abstract writing: structure, review criteria, submission tips

Good abstract title

On the road to AIDS2018: practical guide

Presentations and handouts (downloadable, please scroll down)

If you want to receive English presentations and handouts, please refer to the email address below.

  1. Tips and trick on how to write a good abstract.

AIDS2018: Preparing for registration and submitting abstracts. An Article was written by a young researchers Anna Tokar, in Russian is available here, and in English here

You can follow us on http://www.AFEW.org/aids2018eeca/ and https://www.facebook.com/AFEWInternational/ for all the updates on the available resources and opportunities.

On the Barricades of Harm Reduction in Georgia

Author: Irma Kakhurashvili, Georgia

In Georgia, there are not many organisations working with people who use drugs to improve their health and re-integrate them into the society. New Vector is the first self-organisation of drug users not only in Georgia, but also in the South Caucasus. Since 2006, its activists openly oppose the repressive drug policy, fight for the rights of people who use drugs (PWUD), and search for the innovative approaches to resolve health problems. The main goal of the New Vector is to provide harm reduction services and advocate for the health and social programmes, which are vital for people who use drugs.

In the organisation, drug users are offered free fibroscan liver tests and dentist’s services. Besides, workshops for community members are often held. Every Friday is a woman’s day. Female drug users attend sewing and needlework classes. Since 2016, the organisation also actively provides new services – with mobile clinics, activists and social workers of the organisation test drug users and general population for hepatitis C and HIV both in the capital of Georgia and in the regions.

Staying until the issues are resolved

The New Vector takes part in reforming and humanizing the national drug policy. Several years ago, the Georgian Network of People Who Use Drugs (GeNPUD) was founded at the initiative of the organisation. Through the joint efforts of GeNPUD, different NGOs and activists, amendments were introduced in the law requiring health personnel to call police in case of an overdose. Besides, GeNPUD carried out advocacy activities to exercise the right of drug users to refuse compulsory testing in drug departments of the police granted by article 42 of the Constitution. As a result of the campaigns initiated by the activists of GeNPUD and New Vector, the state ensured access to high-cost new-generation drugs for Hepatitis C treatment in Georgia.

The New Vector holds its position of the leading organisation in the provision of social and prevention services in the area of harm reduction.

“As for HIV/AIDS prevention, for many years we have been implementing harm reduction programmes – syringe and needle exchange. Every day, our social workers go “in the field” and offer sterile syringes and other supplies to people who use drugs. As far as I know, currently there are 6,564 cases of HIV registered in Georgia, with people who inject drugs accounting for 43.2% of such cases,” the head of the New Vector Koka Labartkava is saying. “Last year, when conducting testing in the New Vector we detected 10 cases of HIV, this year we recorded seven cases. If a client has HIV, our social workers assist him in finding specialists and programmes to solve his problems. We stay with our clients until their issues are resolved. In addition to the mobile clinics, drug users can also get tested for HIV, hepatitis and syphilis in our laboratory, right here in the office.”

Problem detected first step to the solution

The Project “Supporting patients with drug-resistant tuberculosis, taking measures to improve treatment” implemented in five regions of Georgia will be operating as a pilot for 10 months. The Project was launched on 1 July 2017 and, if it proves to be successful, it will be expanded all over the country. The project management team conducted preparatory activities in five cities of Georgia: Tbilisi, Rustavi, Gori, Kutaisi, and Batumi. Multidisciplinary teams have already been formed to include a social worker, a peer consultant and a psychologist. Altogether, six groups have been created, and two of them are in Tbilisi.

The support team (a social worker, a psychologist and a peer consultant) offer individual and group psychosocial counselling, assistance in solving social problems, psychological and legal consultations, counselling and testing for hepatitis B and C, HIV and syphilis.

In September and October this year, the Georgian Network of People who Use Drugs organized information and advocacy sessions for people who use drugs, including those who have HIV and tuberculosis, as well as for different civil society organisations.

The aim of such sessions was to assist the community in defining the challenges and the barriers in terms of access to HIV/AIDS and TB treatment and prevention programmes and in terms of their quality. The sessions allowed defining the gaps at local, national and international levels. Action plans and advocacy tools will soon be defined in relation to each of the gaps.

The New Vector has close partner relations with Tanadgoma within the Task Force City project, stipulating allocation of municipal budget funds for the implementation of HIV/AIDS and tuberculosis prevention programmes. One of the conditions to ensure the effective distribution of resources and developing a municipal public health strategy is for the Mayor of Tbilisi to sign the Paris Declaration‑2014.

The First AFEW Regional Autumn School Was Conducted in Kazakhstan

Author: Marina Maximova, Kazakhstan

Representatives of 10 countries took part in the first regional autumn school organized by AFEW, which was held from 30 October to 5 November in the Oy-Karagay gorge, not far from Almaty, Kazakhstan. The school was conducted with the support of the Dutch Ministry of Foreign Affairs.

High mountains, hot sun, picturesque autumn landscapes, atmosphere of the national yurt instead of the traditional training hall – combined with the team spirit and expectations of positive changes – contributed to the creative atmosphere of the event. The school participants included representatives of the AFEW network from Kazakhstan, Kyrgyzstan, the Netherlands, Tajikistan, Ukraine, sub-grantees of the project ‘Bridging the Gaps: Health and Rights for Key Populations,’ and partner organizations. Such allies and friends are the biggest guarantee of success.

Learning to bridge the gaps

“The autumn school helps to find the answers to a range of questions and get acquainted with the new innovative practices in working with key populations,” says Dilshod Pulatov, Project Manager, ‘Bridging the Gaps’ programme, AFEW-Tajikistan.

He presented the results of the social study to assess the level of labour migration among people who use drugs. It was conducted for 18 months in Tajikistan and Kyrgyzstan. The study, which covered 600 respondents, demonstrated regional trends and showed interesting results. The main of them is that the labour migrants who use drugs do not know where they can get help and who can offer such help. In both countries, the respondents pointed out that as labour migrants they experienced problems with access to health and social services.

The results of this research study will help AFEW to scale up the access of drug users to quality HIV prevention, treatment, care, and support services and find new partners. Partnerships were created right at the discussion platform. This study proved to be interesting not only to the participants, but also to the guests invited to take part in the autumn school, including representatives of the Project HOPE in Kazakhstan.

Platform for discussion and activism

Today, ‘Bridging the Gaps’ programme is implemented by the organizations from four countries of the region. The autumn school became a platform to discuss strategies, barriers, innovations, and opportunities for cooperation.

“In our country, the biggest gap is an access of underage people who use drugs (PUD) to services. Many services are offered to adult PUD, in particular with support of the international donors. It allows them getting qualified help. At the same time, people often forget that the first experience of drug use happens under the age of 18,” tells Anastasia Shebardina, Project Manager, AFEW-Ukraine.

The project made an important contribution for radically changing the situation: it opened the only rehab centre for drug dependent adolescents in Chernivtsi and supported four civil society organizations.

In each country, there are success stories, which became possible thanks to the project implementation. So far, these are just tiny steps forward in the big scope of the existing problems. Every such step became possible thanks to project staff and activists working hard for a long time, but such victories, even if they are small, enhance personal motivation of people and allow them to set bigger goals.

“One of our achievements is developing the standards of services for PUD serving sentences in the Georgian prisons. We educate prison staff and have drafted a special training module for this purpose. In some organizations, support groups for PUD are already functioning. Rehab centre Help has opened its doors to clients. Now 12 people can stay there and get qualified help. We plan to cover all correctional facilities in the country with our activities,” shares his plans Vazha Kasrelishvili, Project Coordinator of the NGO Tanadgoma.

From knowledge sharing to new rehabilitation models

Sharing knowledge and best practices is one of the goals of the autumn school. Together, it is easier to elaborate strategies and innovative approaches, considering that the tendencies in development of the situation in the region are similar. Today, the search to fund vital projects also requires joint efforts, taking into account the reduction of the funding received from the Global Fund to Fight AIDS, Tuberculosis and Malaria and other donors in the region. So far, national governments are not ready to take over this financial burden in full scope. Despite their broad fundraising efforts, civil society organizations do not have enough grant funds aimed at scaling up access to services for key populations.

“With the support of the Ministry of Health of the Kyrgyz Republic, within our project we developed two clinical guidelines: on managing pregnancy, delivery and postnatal period of female PUD and on mental health and behaviour disorders in children and adolescents caused by the use of new psychoactive substances. We were able to open a social office for women with HIV, which offers counselling of psychologists and peer consultants. In the country, there are two rehab centres for women with HIV and drug dependence, which cooperate with friendly clinics,” tells Natalya Shumskaya, the head of the AIDS Foundation East-West in the Kyrgyz Republic.

Today, there is a need to use new, more effective rehabilitation models. This idea has been supported by all participants of the autumn school. Such models should be aimed at developing inner strength – empowerment – of each of the members of key populations.

“Maybe now it is time to change and expand our understanding of the rehabilitation concept. It is not only detox and psychology. There should be equal opportunities, in particular based on harm reduction, to accept yourself,” points out Anna Sarang, President of Andrey Rylkov Foundation, Russia.

Preparations to AIDS 2018

Participants of the autumn school also discussed preparations to the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, the Netherlands – the main event of the next year for activists of the AIDS organizations. All countries of the Eastern Europe and Central Asia are already actively preparing for the conference. How can decision makers be involved into this crucial event? What channels are most effective in communicating information about the conference? How to make this event significant? Every day, participants of the autumn school discussed these and other questions. Besides, they learned how to write abstracts for the conference and choose catchy titles for them.

It is very important that the participants developed some new ideas, concepts and thoughts, because starting from 1 December 2017 registration for AIDS 2018 will be open. It will be a new and diverse platform for discussions making decisions significant for all countries and communities.

HIV Test: the Work of Mobile Clinic in Kyiv

Tatiana shows a card of the recipient of services from Eney

Author: Yana Kazmyrenko, Ukraine

We have spent one day with the mobile clinic in Kyiv, Ukraine, that provides HIV testing for people who inject drugs. The social worker Tatiana quit using drugs and has now been diagnosing five HIV cases monthly.

Tatiana Martynyuk (54 years old) visits up to 10 apartments every day, and at least five of her clients each month turn out to be HIV positive. She works at a mobile clinic of the Eney Club in Kyiv, where she anonymously detects HIV and hepatitis C. The project has been supported by ICF Public Health Alliance for more than ten years. There are five mobile teams from the organization in Kyiv and one team always works night shifts in order to cover the sex workers’ testing.

Eney has a large base of volunteers. These people actively use drugs. They offer their friends and acquaintances to pass HIV testing which only takes 15 minutes. If the test is positive, they persuade a person to go to the City AIDS Centre and register there. Not everybody agrees, half of them reject saying that nothing is hurting, and they will not go anywhere.

We have the meeting on Shevchenko Square, the northern outskirts of Kyiv. Our first clients live not so far away. Tatiana brings them HIV tests, alcohol wipes and condoms.

Boiling shirka

Irina shows a drop of blood during testing

Sergey and Irina are meeting us in their one bedroom apartment, where everything is filled up with their belongings. The owners have been planning to renew the closet for several years already, but they have no money and energy for that. Irina, 43 years old, takes the test first. She is already receiving services from Eney.

“I tried drugs two years ago and I liked it,” she is saying, hiding her cracked hands. Ira has been working as a dishwasher, but currently she has no income as the restaurant is being closed.

The woman is getting nervous and takes a cigarette from Tania. The social worker asks Ira to do the test on her own so that she can do the test without any help in case of emergency. A drop of blood, four drops of the special liquid, and a long ten-minute waiting during which Tatiana has the time to ask what Ira knows about HIV.

“The most important thing: HIV can be in shirka (the popular name for one of the most commonly injected opiate derivates,) where a syringe was put for just a second. If in doubt – boil shirka,” Tatiana is instructing, asking other people to leave the kitchen. The HIV test result is strictly confidential.

Ira is satisfied with the test results, and she is going to wash the dishes. The 33-year-old Sergey is sitting at the table. It was he who “tricked” his female partner into trying drugs. He has been using drugs for 10 years.

Our client is not interested in getting the information about HIV: he is arguing, and saying that you can get HIV while visiting a dentist. Tatiana changes the subject and asks him to invite his friends for the check. Initially, three more people were willing to take the test, but at the end, only 28-year-old Artem came in. He has a rich biography, which includes a 10-year record of drug usage and imprisonment.

“If I want – I will take the drug. If I decide to quit it – I will quit it. I am not in the system. I earn 18,000 hryvnia (about 600 euros) on repairs and construction sites. I can do everything,” he boasts while lighting up a cigarette.

Receiving assistance from their peers

Vladimir’s wife, Inna, waiting for test results

While we are driving, Tatyana keeps telling her story: she has been injecting drugs for 25 years, and then she quit. She was tired and wanted to change her life. Her husband died, her son was drinking alcohol, and her mother is sick. At first, she found work as a street sweeper, but then she settled in Eney Club.

“I get more tired at this job than when I was sweeping the streets. Everyone needs to talk and to be heard, I need to organize things. I am not judging anyone. These people will only accept a help from a person like they are,” she shares.

It seems that with each visit to the next apartment, Tatiana challenges her willpower. She could possibly get her dose of drugs in any such place. Nevertheless, she is holding on. In her situation, one needs to have a special talent in order not to lose the spirit and to do the work with all your heart.

Needle veteran

Vladimir is having a holiday in his apartment in Obolonsky Lipky, the elite district in Kyiv. His prison sentence for the distribution and transportation of drugs has been changed into the conditional one. This was the fourth prison sentence for the 54-year old Kyiv citizen.

Tatiana helps Vladimir with a test

“I have been injecting drugs for 35 years now. I wonder how I survived. Everybody with who I started, is already dead. I prepare everything myself as I know all the recipes. I have studied the 1938 medical military handbook,” Vladimir is saying.

“Vova, you are such a fine fellow,” admires Tanya. The toothless Vova smiles and invites us to see his bathroom, where he has recently changed the tiles.

Vladimir takes the test and tells that he is going to get tooth implants and will start taking care of his health.

“I would not survive without drugs. I got all possible strains of hepatitis and in this way, I keep myself in shape,” he explains.

Vladimir’s elder brother is 59. He has been trying to quit drugs after a stroke. He smells of alcohol – he has been drinking vodka.

“That is how life used to be. In the 90s you would make a whole basin of shirka and you treat the whole district, but times changed and shirka is not the same anymore. We had loads of heroin,” he recalls with nostalgia.

The wives of the two brothers, Inna and Irina, also use drugs. During the test, Inna tells Tatiana to hurry up. She did not have time for injecting the dose, and now she cannot wait to get it.

Improving personal life

“Can you imagine this? I woke up in the morning and noticed that I lost my tooth and ate it in my sleep,” Marta is saying. She works as a hairdresser and has colorful hair.

Marta has been using drugs since she was 12. She says that drugs in Kyiv in the 80s were an element of prestige like a cherry VAZ 2109 (car model.) There was a seven-year break in her history. She started using drugs all over again when she had found out that her first love was HIV positive.

“He died, and I went crazy. In general, I cannot live without injecting. It is an addiction,” she explains.

Marta tries to take the test once a year, and she is going to improve her personal life.

“Tania, please, give me more condoms. My friends have been searching for a fiancée for me. I imagine him taking drugs, but not being a goner; I want him to have an apartment, as I would like to give birth to a child,” she continues.

Tania asks Marta to take her friend for the testing next time. A woman with a dark hair bandage is nervously waiting for her friend. She has recently become a widow, her husband died because of an overdose.

The social base of drug users is expanding

After the test, Tatyana immediately agrees to meet with the next client

After three visits, the social worker is tired, but there are still some addresses from the other side of the city.

“Our program helps them to be safe and control their health. I would also like to add some food arrangements – some of them do not have any food for weeks,” Tania is saying.

The harm reduction program among people who inject drugs in Eney Club started in 2001. The annual coverage was more than 6000 people in 2016. Out of these number, 80% of people have been tested for HIV. Now, the average level of HIV detection among clients is 3.5%, where 80% of people have been placed on dispensary records. The level of drug usage has been growing in Kyiv. There appeared separate subgroups among the people who use drugs. Veterans of the Donbas conflict and immigrants from the Eastern Ukraine form such subgroups.

AIDS 2018: Preparing for Registration and Submitting Abstracts

Author: Anna Tokar, Ukraine

The registration for the 22nd International AIDS Conference (AIDS 2018) will symbolically start on December 1 – the World AIDS Day. The conference will gather scientists, political leaders, and people living with HIV from all around the world. One of the key objectives of AIDS 2018 is to spotlight the state of the epidemic and the HIV response in Eastern Europe and Central Asia with a focus on investments, structural determinants and services.

You can already start preparing for the registration for the Conference. Below you can find some important tips:

  • You will be asked to create your personal account – a webpage at the conference website – where you will need to put your key personal information (name, date of birth, education, etc.) Through this account you will submit your thesis or register for the Conference.
  • Registration can be individual or group (only applicable to the registration of five people or more.) The company or organization requesting a group registration must nominate one group representative who will administer the group communication with the Conference committee.
  • Usually, when applying for a scholarship, one should submit a cover letter with clear reasoning of why this scholarship is needed. Your personal details and passport data will be requested.

Scientific tracks

AIDS 2018 Conference will welcome submission of abstracts for original contribution to the field in the following scientific tracks:

Track A: Basic and Translational Research.

Track B: Clinical Research.

Track C: Epidemiology and Prevention Research.

Track D: Social and Political Research, Law, Policy and Human Rights.

Track E: Implementation Research, Economics, Systems and Synergies with other Health and Development Sectors.

Tips for writing a strong abstract

Even though there are no abstract guidelines yet available, you may consider developing a draft anyhow.

Language and grammar

The official language of the conference is English. Thus, all abstracts should be developed and presented only in the English language. The abstracts that are written well have higher chances to be selected by the Conference committee, regardless of their content. Grammar mistakes and typos will distract the reviewers from the actual study content. The reviewers might also wonder if the author is able to communicate study findings in the English language at all. For a non-native speaker, it might be quite difficult to spot all the mistakes or weird phrases. That is why we highly recommend asking for some assistance, for example from your English-speaking colleagues or friends. We also suggest to use the examples of previous conference abstracts and peer reviewed scientific papers. Studying them will help you to understand how to be succinct and informative at the same time. Besides, you might be able to see some useful linguistic construction and techniques.

Brevity is the soul of wit

The abstract should be short, yet informative. That is why you would need to have sufficient time to “pack” all the information into 300 words. If you plan to write an abstract in the last moment, you would not have time to think it through, and thus, most probably you would start “cutting.” As a result, you can end up with the text full of abbreviations, with one line of introduction and super reduced methods section, which will look like a broken puzzle.  Good abstract should be well-balanced, and all its sections should be connected and should smoothly tell the story to your reader. The reviewers would not appreciate any quizzes in your abstract, they would not guess what you mean or what you intend to say. Therefore, the text should be easy to follow, it should be reader-friendly and logically built. In other case, the reviewers might decide that the information provided in the abstract is not enough and simply reject your abstract.

Results will come later

The common problem of many people is to write the abstract without having data or analysis done. It is better not to write an abstract at all, if there are no results available. You also might consider using some previous data. Just try to have some new research questions in your abstract, or try to use a new analytical approach.

Prioritizing the key message

The abstract should be written in such a way, that a key message can be easily grasped. This key idea should be stated in the introduction as the study goal. It should also be presented in the methods, proved by the results, and finally, it should “crystalize” in the conclusion. Think it over for this type of task requires slow thinking and digesting.

Abbreviations and professional terms

Even though the reviewers should be familiar with commonly used abbreviations and professional terms, it is seen as a bad manner to use these concepts without full spelling or clear description. Therefore, when using abbreviation and professional terms, try to follow the norms of scientific writing. Firstly, all abbreviation should be spelled out, when used for the first time in the text. Secondly, the professional language should be avoided or used upon clear definition. Besides, no discriminating or stigmatizing language is acceptable.

Conclusion

If in the Post-Soviet countries, the phrases like “we recommend conducting an additional study” or “more research is needed” are well-accepted, in the Western world such phrases can be perceived as a bad tone, since there is no such field of science where no additional research is needed. Yet, using the precious words for providing these kind of statements is a waste, especially when talking about the conference abstracts. In the conclusion of the abstract, the reviewer is waiting for your final word, the answer to your research question, not for an empty phrase. Another typical mistake is to make ambitious loud claims which are not supported by the results, for instance, that the sample size was not representative, but the conclusions are made based on the whole country population. The best advice is to support the conclusions by data, not by the ambitions of the author. One should also remember that conclusion is like saying goodbye to your readers. Therefore, you should think about leaving them with the feeling of the firm handshake and with a polite smile on your face. This is what you reader will remember.

Fifteen Years of HIV Prevention in Kyrgyz Prisons

A convict takes methadone therapy in a correctional colony

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is a leading country in the Central Asia in terms of implementation of harm reduction and HIV prevention programs in the correctional settings. Syringe exchange programs have been available in prisons since 2002, and today over one thousand five hundred people receive clean injecting equipment in all twelve correctional facilities. Atlantis rehab centers have been gradually introduced since 2004 for those convicts who made a decision to quit drugs. Currently, eight such centers are functioning, with the ones who have almost succeeded in stopping with drugs continuing treatment in a separate, so-called “clean compound.” In ten institutions, including two pre-trial detention centers and one penal settlement, people have access to the methadone substitution therapy. Besides, governmental agencies, together with donors and civil society organizations, conduct awareness-raising activities, diagnostics and treatment of HIV infection, tuberculosis, and provide social support for ex-prisoners. Such programs have been implemented for 15 years, and local experts share their best practices.

Correctional settings form adherence

Roman had been enrolled into the opioid substitution treatment (OST) program before he got into prison, but he was still using heroin. Due to drugs related crime, he had to go to jail, where at first his HIV test showed a negative result. However, in a while, the virus has shown itself. Now Roman is free. He works in the Ranar Charitable Foundation offering people released from prisons the same kind of support that he got back when he walked out of the jail: accompanies them to the sites providing OST services, antiretroviral therapy (ART), makes contact with the law enforcement agencies, and provides support with employment seeking and accommodation as well as with the restoration of personal documents, if needed.

“For three years in prison, I was sharing needles with everyone and had no idea that I had HIV till I developed tuberculosis and pleuritis,” Roman says. “When I was in prison, I did not even think about what I was going to do after the release. I thought I was just living out my days. When I got out, my state was really bad: I was taking high doses of methadone and was not taking any ARV drugs. Then my friends showed me some sober guys, whom I knew back in prison. Before that, I could not even imagine that one can quit methadone.”

Today, convicts with HIV amount to 5% of all the people living with HIV (PLWH) in the country, whereas in 2010 this share was 13.7. There has been access to ART in the correctional settings since 2005; and currently, 305 out of 357 officially registered PLWH serving their sentences receive the treatment.

In prison, Roman received ARV drugs but did not take them. He admitted that he took the pills only because they were given together with motivational food packages distributed in Kyrgyzstan to develop an adherence to treatment. Next year, those who receive the treatment for over one year will no longer be getting such packages because their adherence has already been formed.

“In correctional settings, there is a favorable environment where an outstanding program to form adherence may be implemented as the patients are always in plain sight,” Natalia Shumskaya, AFEW Chairperson in the Kyrgyz Republic says. “The quality of treatment and care of people living with HIV, unfortunately, leaves much to be desired. There is a deficit of qualified health professionals and a lack of proper attention to the patient. It is important to make sure that the officers of the department for the execution of sentences see additional benefits for this work. Currently, donor organizations provide funding for additional support, but starting from next year there will be no funds to cover those needs. In this context, it is rather difficult to ensure quality performance of all the guidelines on implementation of the programs aimed at harm reduction, HIV prevention, diagnostics, and treatment, which have been developed over the years.”

How it works “from the inside”

Atlantis: rehabilitation of drug users in correctional institutions

On the average, in penal colonies 85 prisoners attempt to overcome their drug dependence in the Atlantis rehab centers every year. About half of them successfully complete the program and are transferred to the Rehabilitation and Social Adaptation Center (RSAC) or the “clean compound” in the colony No. 31. In this compound, the convicts who decided to quit drugs get additional professional training and are prepared for the release.

OST in closed settings was introduced in 2008, and today such treatment is provided to 479 patients. According to ex-convicts, the methadone substitution treatment program in the places of confinement has been to a great extent discredited by the patients who take additional illegal substances. Access to services varies depending on the type of institution.

“When I found myself in a pre-trial detention center, I got no access to methadone,” tells Roman. “It was not available there, and local staff members only organize transportation to the OST sites if there are at least 4-5 people who take part in the OST program. To get ART, it was also necessary to go outside of the center territory. Sometimes, people have to wait for a court decision for several years there and for all this period of time they may have no access to medications. In a prison, once a day they take you to a sanitary unit, where you get your methadone. There are also ARVs and clean syringes available. You must always give back the used equipment, but if there is a search in the ward, the guards take away all the syringes and needles. In colonies, it is much easier to get all those services.”

The “Kyrgyz miracle”

Madina Tokombayeva, whose Association “Harm Reduction Network” (AHRN) has been providing support to convicts for fifteen years, says that the existence of such programs in the country may already be called a miracle.

HIV prevention training for staff of the State Department for the Execution of Sentences

“We started our activities in correctional settings with self-help groups for PLWH back in 2002 through the first community organization of people who use drugs uniting PLWH and ex-convicts,” tells Madina. “We saw that after the release people need support, so at our own initiative we started helping them after they got out. We were speaking about all the problems existing in prisons, and thus we found people and donors who were ready to support our ideas. At that time, AFEW Kyrgyzstan supported the establishment of the first social bureau in colony No. 47, activities of the Ranar Charitable Foundation aimed at ex-convicts and helped to purchase a house for them, which is still functioning with the support of AFEW Kyrgyzstan. Later, the CARHAP project disseminated social bureaus and support services in all the correctional facilities.”

Currently, harm reduction programs in prisons are financed by the Global Fund and the US Centers for Disease Control and Prevention (CDC). AFEW Kyrgyzstan strives to build the capacity of staff members of the State Department for the Execution of Sentences and, together with the AHRN, provides HIV prevention and social support services to ex-convicts with the support of the USAID.

“We conduct regular monitoring of the harm reduction programs, in particular in correctional settings. I have a feeling that they are still in the bud, but they have got a chance,” says Madina Tokombayeva. “We have to make the adopted laws and the approved guidelines work in these three years, while we still have the donor funding. We need to consult with our clients and, together with the governmental agencies, organizations working in the area of HIV and communities develop a totally new approach to the implementation of such programs so that their quality is really high by the moment when we face the transition to the state funding. They must not be closed under any circumstances or otherwise, we will go back to the parlous times when prisons were the driver in the spread of HIV.”

Communities in Kyrgyzstan Explore their Needs for the First Time

Community research provides an opportunity to objectively assess the existing services. Focus group in the office of Ulukman Dariger NGO in Issyk-Kul area

Author: Olga Ochneva, Kyrgyzstan

Sex workers over the age of 30 desperately need employment; women living with HIV have a need for women’s dormitories – these are the preliminary conclusions of two different studies conducted in Kyrgyzstan. The complete results of the needs’ assessment and HIV prevention programs in the country will be presented at the 22nd International AIDS Conference (AIDS 2018). The research is conducted by these communities for the first time. AFEW International provided this opportunity for key populations in Kyrgyzstan and other countries of East Europe and Central Asia (EECA) within the Small Grants Program.

New and unexpected discoveries

International AIDS Conference is a platform for the community to express their voices. Currently, community organizations from the EECA countries supported by AFEW International are carrying out the research, the results of which will be presented at the International AIDS Conference in July 2018 in Amsterdam. There are two research teams in Kyrgyzstan.

“Our organization has wanted to conduct a similar assessment for a long time. This is the first full-scale study among sex workers in the country,” Ulan Tursunbayev, the director of Ulukman Dariger NGO says. His organization assesses the effectiveness of HIV/AIDS prevention program with the help of the sex-workers themselves. “The preparation of the research and data collection took us four months. We traveled the country – four people, two of which being consultants. First, we tested our questions in mini sessions, so that they were clear to the community members and could open them up for the dialog.”

Another organization from Kyrgyzstan – PF Prosvet – conducts research work among women living with HIV. They study the impact of HIV-positive status on women’s lives.

“Community representatives are the main executors of the project,” Margarita Sabirova, a psychologist at Prosvet is saying. AFEW International has provided all training opportunities: trainings, online modules, technical expert support. Community education has become one of the most important and long-lasting pre-research phases. Nowadays, they possess new knowledge and skills, and we have honest and frank research data.”

Data mining has been conducted since April, and the final reports are being currently prepared. It has already become clear that the research contains new and unexpected discoveries.

“It was really interesting to see how the needs of sex workers differ before and after they turn 30,” Ulan Tusunbaev says. “They even sat apart from each other during the focus group meetings. Young women said they had enough condom supplies from prevention projects, outreach work and legal assistance. Older sex workers wanted to change the area of work and asked for the assistance with this.”

Many said that they rather would not provide sex services for the rest of their lives, and wanted to start building their future then.

“In course of my work, I was able to buy some land where I am starting to build a house, and where I will then open a store. I have already prepared the materials for construction,” says one of the interviewees of the research. “I hope this store will help me and my child when I will no longer do sex-work. Therefore, it is good to have some skills training programs available. After all, we have all been working here for 5-8 years and have no education. In order to engage in something different, we would need additional skills.”

The South and North have different needs

Women with HIV: “We need special support.” The head of Public Foundation Prosvet conducts a focus group in Bishkek

Employment is also one of the most important problems for women living with HIV. According to the representative of PF Prosvet, women say that many of them have no spouses and thus they need to take care about their own financial well-being. Some of them are the only ones who financially support their children. Employers often unreasonably demand HIV and medical examination and refuse employment.

“Thanks to the research, we are sure now that the services need to be divided according to the needs of a certain group,” Margarita Sabirova shares. “We have not only identified the priority needs, but also clearly noticed the difference in the set services needed in the North and South of the country. For instance, people in the South need social support, while people in the North of the country are more socialized clients who have different needs.”

The next phase in the Small Grant Program by AFEW International is the training on how to write abstracts (thesis) for organizations in preparation for AIDS 2018 and teaching them how to present their research results.

“The lack of gender approaches in the provision of services and the specifics of different areas of the country often limit access to the health care, legal, social, and psychological support. We hope that the presentation on the results of our study during AIDS2018 will encourage participants from other countries to pay attention to this problem in their own part of the country,” Margarita Sabirova is saying. “The research has identified a number of specific service needs for women, which are not met now either fully or partially. We hope that funds will be available to finance this unmet need. We have many recommendations in our report, and these will help to improve existing services. In any case, as an organization, in whom the community trusts, we should express community needs to the government, donor and non-governmental organizations.”

AIDS 2018 is Looking for Abstract Mentors

Source: AIDS 2018

Abstract mentors are needed for the 22nd International AIDS Conference (AIDS 2018) in Amsterdam. The Abstract Mentor Programme (AMP) was introduced at the 15th International AIDS Conference in 2004, with the objective to help young or less experienced researchers improve their abstracts before submitting them, in order to increase the chance of their work being presented at conferences.

The programme especially targets researchers from resource-limited settings, who lack access to opportunities for rigorous mentoring in research and writing and for whom online distance education is proven to cost-effectively build research capacity. Over the years, the AMP has proven to increase the motivation of early career researchers, as well as the number of abstract submissions received from resource-limited countries.

This year’s AMP for the researchers will open on 20 November 2017 and close on 15 January 2018. The abstract submissions for AIDS 2018 will then close on 5 February 2018. This gives mentors time to submit feedback and mentees sufficient time to make their final revisions before the abstract submission deadline.

The AIDS 2016 AMP received 138 draft abstracts. From the draft abstracts that received online mentoring and were submitted for this conference, 30% were accepted into the Conference Programme.

The Abstract Mentor Programme is completely independent of the AIDS 2018 abstract review and selection process.

Mentors can apply for the program starting from 23 October 2017 until 15 January 2018. Mentors must have had at least two abstracts accepted at international scientific conferences and have co-authored at least one manuscript accepted by a peer-reviewed scientific journal within the last five years. To become a mentor and to get more information about AMP, click here.

Source: AIDS 2018