Kazakh Beauties Played Football for the Sake of Fighting with AIDS

Many students, young workers and musicians decided to check their HIV status

Author: Marina Maximova, Kazakhstan

Football, rock, celebrities! Youth initiative called #ЖОКСПИД2030 (#NOAIDS2030) is taking place in Kazakhstan. The founders of this initiative are the Republican AIDS Centre, the Central Asian Association of People Living with HIV (PLH), and the Kazakh Union of people living with HIV.

“With this #ЖОКСПИД2030 initiative, we want to save the memory of those who died from the epidemic. We want to draw the attention of public and youth in particular to the deaths, stigma and discrimination of people living with HIV. We want to give an opportunity to think about the problem that may affect anyone. This is why people should take responsibility for their health and the health of their close ones,” says Nurali Amanzholov, the president of the Central Asian Association of people living with HIV and Kazakh Union of people living with HIV.

Beauties on… the football field

The initiative started in May 2017 on the International AIDS Candlelight Memorial with a mini-football blitz tournament in Almaty. The members of the team were not professional sportsmen and muscular men, but delicate and the most beautiful girls in the country – the finalists of the beauty contests, popular singers and journalists. However, girls’ mentors were real football professionals, including sportsman-composer Abdulkarim Karimov and renowned players Zharko Markovich and Bauyrzhan Turysbek from Kayrat team.

Most beautiful girls in the country – the finalists of the beauty contests, popular singers and journalists – played football during the event

Beauty does not only heal, but also attacks. Girls played desperately, boldly, with an excitement, no one wanted to give in the victory. Neither spoiled makeup, nor broken fingernails, or even injured knees could get the girls to stop playing even for a minute. Women’s football is beautiful and strong. This was exactly what men, who liked the tournament, thought about it.

“Girls played dramatically and proved that they can play this manly game not worse than guys. I especially noted the fearless goalkeepers,” said Abdulkarim Karimov, who could not keep his emotions and sympathies to himself.

In this stubborn struggle, the team of journalists won the first place; show-business representatives placed the second, “Miss Almaty” and “Miss Kazakhstan” teams placed the third.

Media is everywhere

“#ЖОКСПИД2030 initiative is yet another opportunity to demonstrate the readiness and the will to counteract the future spread of HIV infection. We can stop and even reverse the epidemic with a set of measures: prophylaxis, providing access to treatment for all who need it, fighting stigma, and, of course, the active involvement of public attention to the problem of HIV infection,” Bauyrzhan Bayserkin, the CEO of the Republican Center for AIDS Prevention and Control notes.

#ЖОКСПИД2030 initiative is another opportunity to demonstrate the readiness and the will to counteract the future spread of HIV infection

It will not be possible to attract public attention without media. Therefore, some participants of the initiative were journalists. Media employees were on the training in Astana where they were taught by media trainers and experts about professional media coverage on HIV topics: the usage of correct terminology, interviewing ethics of people living with HIV, and selecting actual informational materials. Participants received a lot of important information from volunteers and outreach-employees who provide legal and social support to people living with HIV and drug users.

Practically a quarter of all HIV infection cases are infected young people aged 20-29. What should the prophylaxis for this age group be like, so that it would not leave anybody indifferent and eventually stop the epidemic spread? This important topic will be discussed on the 22nd International AIDS 2018 Conference in Amsterdam.

Rock songs on dombra

Immortal songs of Victor Tsoi – 80s rock legend – sounded in new adaptation on the musician’s birthday (the idol of millions would have been 55). It was also the anniversary of the “Needle” movie made in Almaty. The performers were not professionals, but amateurs. However, this fact did not lower the emotional heat and expression. Victor Tsoi’s greatest hits were performed with the accompaniment of guitars, the orchestra and even in the genre of opera. Rock songs played on Kazakh national instrument dombra was the most spectacular performance.

Tsoi’s hits were performed Rock songs on Kazakh national instrument dombra

In this creative and positive atmosphere, the organizers of the republican initiative #ЖОКСПИД2030 introduced a commissar to the participants. Ali Okapov, the popular singer and musician has become the commissary.

“To be a commissary on such an important social campaign is a great honour for me. As well as to promote healthy lifestyle ideology among young people. Future starts today. These are not just words. The future belongs to young people, but we should build it now, and it is definitely the future without HIV!” Ali Okapov is saying.

“Almaty – the city without HIV” is another recent event within the framework of the initiative. It was organized by Almaty HIV Centre, Public Foundation «AIDS Foundation East-West in Kazakhstan», Kazakh Union of people living with HIV, social foundation “Doverie Plus” (“Trust Plus”.) People living with HIV told their stories in the atmosphere of openness and trust. Young people took part in the quiz on the knowledge of HIV infection. The doctors informed about the preventive measures. The event ended in massive HIV express-testing. Many students, young workers and musicians decided to check their HIV status. The live queue did not even pay attention to the intense southern sunlight.

Hepatitis A Prevails in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

Hepatitis Prevention Month to commemorate the World Hepatitis Day was organised for the first time in the history of Kyrgyzstan by the Ministry of Health in July this year. Over the recent years, the list of registered and allowed for import medications to treat hepatitis C has been expanded, the new clinical treatment protocol has been approved and a six-year target program to counteract viral hepatitis was adopted. Hepatitis is one of the leading causes of death among people living with HIV and higher-risk populations. Without a doubt, the discussion of availability of hepatitis diagnosis and treatment, introduction of treatment guidelines and implementation of the national viral hepatitis interventions will be an important part of the International AIDS Conference in Amsterdam in 2018. We discussed the reasons for the increased attention to the problem of hepatitis in KyrgyzstanIn with Nurgul Ibraeva, Chief Officer of the Department of Health Services and Medications Policy of the Kyrgyz Ministry of Health.

Statistics and the real picture

“The problem of viral hepatitis in Kyrgyzstan is growing every year. Blood-borne hepatitis B and C remain a challenging concern, as patients consult the doctors whey they already have advanced illness and complications, such as liver cirrhosis and cancer. During the Hepatitis Prevention Month, we raised awareness in the population about the need to get tested and offered discounted tests that were supported by private laboratories. Many people in Kyrgyzstan find the price for hepatitis testing (around $50) challenging, so patients often discover their disease at an advanced stage,” Nurgul Ibraeva says. “Following the official statistics, in the last five years 11,000–22,000 people with viral hepatitis were registered on an annual basis. Health services provide treatment to more than 2,000 patients with parenteral hepatitis (hepatitis B, C and D – author’s note), but we believe that the actual number of those infected is much higher: more than 250,000 people.”

Prevalence of hepatitis A is the highest. It accounts for 96% of the registered cases, with blood-borne hepatitis B coming second. According to the National Immunization Schedule, since 2000, hepatitis B vaccine is administered to all newborns free-of-charge. As a result, hepatitis B incidence had a fourfold decrease over the last 16 years. Currently, our health services register around 300–400 new cases of hepatitis B among adults annually, while incidence among children dropped to several isolated cases.

“Immunization brings its fruit. According to the Ministry of Health regulation, health workers exposed to blood should be vaccinated, yet no funds are allocated for it, and not every health worker can afford a vaccine,” Nurgul Ibraeva is saying. “Unfortunately, there is no vaccine against hepatitis C. Even if you use means of protection and take the necessary precautions, there is always a risk. Some health care staff remain untested, and it is our estimate that around 1000 health workers have hepatitis C.”

According to the Republican AIDS Center and the Research and Production Association “Preventive medicine” of the Kyrgyz Ministry of Health, in 2014–2015, the share of health personnel with hepatitis C in the general HCV prevalence amounted to 2.5%. The same percentage is attributed to the general public.

Hepatitis C prevalence is the highest among people who inject drugs (PWID). In 2010, 50% of all hepatitis C cases was registered among PWID. By 2015, this share dropped to 35%. Inmates are also among those especially vulnerable to hepatitis C. Over the last six years, 24–53% of all cases were identified in correctional institutions.

“Needle exchange services and opioid substitution therapy are available in Kyrgyzstan, including prisons,” Nurgul Ibraeva is telling. “Prevention programs strive to break the chain of transmission, but the share of infections remains high, even though we managed to stabilize the situation.”

As is the case with other population groups, key populations are still inadequately covered by diagnostic services. According to the official data, from 100 to 200 new cases of hepatitis C are annually registered in Kyrgyzstan. However, the estimated number of people with hepatitis C is much higher: 101,960 cases among the general population and more than 11,000 cases among people who use injecting drugs.

Availability of treatment

In April 2014, the coalition of non-governmental organizations under the initiative of the “Partner Network” Association of Harm Reduction Programs successfully lobbied changes in the Kyrgyz patent legislation. This allowed Kyrgyzstan to import and license generic medications to treat hepatitis C. Currently, a 12-week treatment course on the basis of an officially registered drug costs $615 for a generic and $1500 for the original.

“We have access to several licensed medications produced in China, Egypt and India,” Nurgul Ibraeva says. “If earlier treatment for one patient amounted to $15 000–20 000, today patients can choose medications they can afford. With the expansion of the list of available drugs, producers have been lowering their prices. Yet, patients still have to pay for treatment, which is a challenge for key populations.”

All imported medications have been included in the Essential Medicines List, which is a pre-requisite for the potential state procurement in the future. A Target Program to Address Viral Hepatitis for the period till 2022 has been approved, yet it does not guarantee treatment and does not have financial backing for the planned activities. At the same time, only among people living with HIV, the prevalence of parenteral viral hepatitis exceeds 14%. Over the past six years, the registered number of people with HIV and hepatitis C co-infection increased twofold and reached 701 cases in 2015. Advocates succeeded to include annual hepatitis C treatment for 100 people with HIV into the State Program for HIV Control. Treatment will be financed by the government for the period of five years. Besides, this year a Clinical Protocol for Diagnosis, Treatment and Prevention of Viral Hepatitis B, C and D has been approved. The document is aligned with the latest WHO recommendations and treatment regimens based on direct acting antiviral drugs that are widely available on the market.

“Kyianka+”: Understanding the Lives of Ukrainian Women Living with HIV

Author: Yana Kazmirenko, Ukraine

Vera Varyga (in the center) is often sharing the success of Kyianka+

Members of “Kyianka+” self-help group conduct regular meetings to exchange positive emotions, share success stories and learn how to resist psychological abuse.

Vera Varyga, leader and founder of the “Kyianka+” self-help group for women living with HIV, receives at least three anonymous phone calls a day to their hotline phone number +38 (067) 239 69 36 from women who have just learned about their HIV status. This hotline number is promoted at the HIV testing locations. Vera’s words may have a significant influence on the future lives of these women and their ability to accept their status and move on.

“Kyianka+” group, operating with support from ICF “AIDS Foundation East-West” (AFEW-Ukraine), was created three years ago, and has already helped more than 150 women. Women living with HIV attend monthly meetings, participate in master classes and get psychological counselling.

“It was very difficult for me to accept my HIV status. I received my first psychological assistance from another woman living with HIV only two years after I was diagnosed. During my first self-help group session, I cried a lot, but women supported me, believed in me and showed me that I am not an outcast. Now, in my groups, I see other girls crying like I was,” says Vera.

In the district hospital of Kharkiv region, Vera had to deal with cruel and unfriendly attitude from staff, which was typical of the Ukrainian provincial medical facilities back in the early 2000s. People diagnosed with HIV were perceived as socially dangerous elements, almost criminals.

Today Vera is a role model – a self-assured woman, a mother of two healthy boys, a beloved wife. She is very friendly, laughs a lot and loves her coral lipstick.

Difficulty of disclosure

At “Kyianka+” sessions, women share their concerns and success stories, trying to find their own way to get on with their lives.

“For example, we conduct role plays during which we model HIV-status disclosure to different people: mothers, partners, children, bosses or health workers. Mothers usually face the most difficult task of telling their sons or daughters about their status. Preparation for such disclosure takes more than a year, and we recommend having a psychologist present: it is hard for a mother not to burst out crying in such a situation,” Vera explains.

Vera is proud of the atmosphere in her group: all the girls get along well, not least because of the set of rules that they developed together:

  1. Confidentiality: nothing discussed in the group can be shared outside of the group.
  2. Attendance is not allowed for women who currently use drugs – they have other values. If they succeed in quitting – they are always welcome.
  3. No criticizing: all women are free to express their opinions.
  4. No medical advice or recommendations: treatment can only be prescribed by a doctor.
  5. The group is for mutual support: you get help and you give help.

All responsibility is on her

Men and women react differently when they hear about HIV-positive status. Men usually need a clear plan, while women often feel panic and become depressed. In our culture, the challenges of solving health problems and thinking about the future of the family often fall upon women.

“Our task is to teach a woman to love and respect herself, to find time for treatment and to make her health a priority. It is like an emergency situation in a plane: first put on your mask, and then put a mask on your child,” Vera says.

Traditions are another area of concern for Ukrainian women: what will the parents say? How will children, neighbours, colleagues react? Is my husband going to leave me? Women have to deal with stigma: everything they had thought about HIV before becomes part of their personal story.

Teaching to share and to help

Anna Lilina, a 30-year-old woman from Kyiv, was diagnosed with HIV when she was three months’ pregnant. Doctors’ prescriptions saved her daughter from getting HIV. Back in the municipal AIDS Center, Anna learned about the self-help group, but she only went there later, when in trouble. She and her daughter were thrown on the street by her boyfriend, whom she had met at the hospital.

Anna Lilina took part in a photo shoot that raised awareness about violence

“My relatives gave me money to pay for the first and last months of the apartment rent. He suggested I moved in with him and spent the money to renovate his house and fix his car. When the money was gone, he forced me out into the street in winter,” Anna says.

Anna needed support and sympathy. Therefore, two years ago, she came to the self-help group.

“After every self-help group session, I get so much energy that it feels I have wings and I can fly, but with every stressful situation, I return to the ground, and feel depressed,” Anna confesses.

It is not only positive impressions that women share at the group. They also started exchanging clothes, baby formulas, information about babysitters and apartments for rent, vacancies and tickets to theatres.

Professional training courses in manicure, floristry, office-management and the English language help these women to change their lives and start making an income. Master classes are also an important part of the therapy, through which women do not only develop new skills and get a profession, but also make steps towards opening up.

Anna remembers how she tried to convince a guy who infected her to start taking antiretroviral therapy. He, however, was saying that AIDS is an invention of American doctors who want to make money. He did start taking the therapy, but only after he had fainted and had to be hospitalized.

“I do not mind anymore that I have HIV. I have met real friends and learned how to be happy about simple things. Volunteer work and organizing help for people in need – this is my new talent, and in the future I would like to become a social worker,” Anna shares.

The number of women in need of Anya and Vera’s help will only increase, as in April 2016 Kyiv joined the Fast-Track Cities initiative to accelerate and scale-up AIDS response, one of the goals of which to ensure that by 2020 ninety per cent of people living with HIV know their status and receive therapy.

Who needs you?

Group master class on felting toys

“Kyianka+” members have a secret Facebook chat to share their thoughts and concerns. The online group allows participants to interfere and help each other in critical situations. Among the most discussed are postings about psychological abuse, especially in discordant couples with an HIV-positive woman and HIV-negative man.

Vera says that her clients often have difficulties with setting the boundaries and counteracting manipulation. If a woman does not make it clear that her status is not a humiliation, her partner’s manipulative actions may reach new levels. For example, he may decide to take charge of the family budget.

“I was stunned by the stories of our clients. To avoid a break-up, one woman’s husband was threatening his wife to tell everyone about her status. Another man said he would disclose this information at their son’s school. In another family, a husband and wife had not invested time to discuss the situation, and once, during a picnic with close friends, they had a fight. The man got drunk and yelled: who needs you now, you AIDS-ridden cow? This story echoed deeply in me – back in the day when I was pregnant, a doctor yelled at me in a similar way: you are ridden with AIDS, and you still want to have a baby?” Vera shares her emotions.

She is certain that with this one phrase that man said everything he thought about his partner and their relations. It is possible to forgive him afterwards, but it is not possible to trust him again. This breaks up the family, and all his reassurances and pleads for forgiveness are in vain – the couple had to discuss the situation earlier. After the picnic the couple broke up, and now they are undergoing therapy.

The Facebook post about blackmailing had a lot of responses: the participants shared links to study psychological tricks of manipulators, and the women who had similar experiences helped others with advice and recommendations on how to stand firm and raise their self-esteem.

Vera is very happy to see this meaningful participation of women. She hopes that her clients will eventually leave their worries behind and start living full lives, and that the most active of them will help organize such groups in every Ukrainian city.

AFEW is Looking for Digital Producers

AFEW International is looking for an organisation or individuals to produce a series of materials on knowledge and skills required for successful preparation for AIDS 2018, including but not limited to creating conference profile system, abstract development, scholarship applications submission, applying for workshops, taking part in the Global Village and Youth Program etc.

AFEW International with the support of the Dutch Ministry of Foreign Affairs is implementing a range of activities to empower CBOs, NGOs, activists, policy makers, stakeholders, researchers and clinicians from Eastern Europe and Central Asia (EECA) region to take part in the 22nd International AIDS Conference 2018 in Amsterdam AIDS 2018.

There are several barriers for the delegates from EECA region in their participation in the AIDS conferences: lack of skills on scientific writing and abstract development, costs of participation, and language barrier.

Because of these barriers, the delegates from EECA region have traditionally been disproportionally underrepresented at the AIDS conferences since its inception.

AFEW International is implementing several strategies to support delegates from EEAC region to meaningfully participate in AIDS2018.  Among them webinars and trainings on community-based participatory research for NGOs from EECA, free online resources on writing and submitting abstracts developed by AFEW International and Health[e]Foundation, and newsletters with information from the EECA region and the Netherlands on the preparation for AIDS 2018.

The application deadline is 31st August. More details about the procedure and requirements can be found here.

Almaty is the first city in Central Asia to sign the Paris Declaration

Paris Declaration in Almaty was signed by Deputy Akim of Almaty city Murat Daribaev and UNAIDS Director in the Republic of Kazakhstan Alexander Goleusov

Author: Marina Maximova, Kazakhstan

The world movement, which already includes more than 70 major cities around the world, has reached Central Asia. The first city, whose authorities signed Paris Declaration with an appeal to stop AIDS epidemic on July 20, 2017, was Almaty. Signing of the declaration became possible and was organized within the framework of the project “Fast-Track TB/HIV Responses for Key Populations in EECA cities”, implemented by AIDS Foundation East-West in Kazakhstan.

Almaty is the largest city in Kazakhstan. It is cultural, financial and economic centre of the republic with a population of more than 1.7 million people. For many years it was the capital of the country. The megapolis, along with Pavlodar and Karaganda regions, has the highest rate of HIV infection in the country. Therefore, signing Paris Declaration gives Almaty opportunity and hope to improve the sad situation.

“This fact will undoubtedly attract city residents’ attention to HIV issues. People will get tested more actively, and will start their treatment in time if necessary. Almaty will participate in international health events and will have access to the most advanced achievements and developments in the field of HIV and AIDS. The best world practices will be included into the City Improvement Plan on HIV and tuberculosis until 2023. This will stop the growth of HIV epidemic and improve population’s health,” Valikhan Akhmetov, the head of the Almaty Public Health Department said during the ceremony of signing the declaration.

Sexual transmission of HIV increases

Today, there are more than five thousand registered HIV cases in the city. A quarter of the cases is observed among internal and cross-border migrants. For many years, the main route of transmission was parenteral. To stabilize the situation, the Akimat (regional executive body in Kazakhstan – editor’s comment) has introduced harm reduction programs targeted to key populations: people who inject drugs, sex workers, men who have sex with men. There are 18 syringe exchange points in the city and six friendly cabinets at polyclinics. This year, despite strong public confrontation, site for substitution therapy has been launched.

The trend of the HIV infection spread has changed dramatically in recent years. Today, the sexual transmission is already 65%. Infection, as doctors say, is now targeting general population, but people are still not aware of it and live as if it has nothing to do with them.

“It is very difficult for people from secured families and those who have good jobs to accept the positive HIV status. Women who live in a civil marriage, refuse to name their sexual partners. There can be another situation: imagine a girl coming to us with her mother, who claims that her daughter is a pure child, and she simply cannot have HIV infection,” Alfiya Denebaeva, deputy head physician of the Center for Prevention and Control of AIDS in Almaty is saying.

Some pregnant HIV-positive women do not take antiretroviral therapy (ART) because of the disbelief. Several years ago, there were cases in the city where mothers who did not believe in HIV-infection refused to take medicine, and their infants then died. Now there is an occasion to discuss this topic at the 22nd International AIDS Conference AIDS 2018 in Amsterdam, in which participants from Kazakhstan will also take part.

Regardless of what was mentioned before, Kazakhstani doctors manage to achieve high results. 99 percent of HIV-positive women give births to healthy children. There are several cases when HIV-positive women become mothers for the second and even third time. It is mostly possible thanks to mandatory two-time testing of every pregnant woman when timely diagnosis and starting of ART is possible to establish.

Almost 90% of PLHIV, who need treatment, receive ART

Regional Director of UNAIDS in Eastern Europe and Central Asia Vinay Saldana

In Almaty, testing and treatment of HIV infection is possible at the expense of the city and republican budgets. Back in 2009, the country was the first in Central Asia to start purchasing ARV drugs for adults and children. Today Almaty is the leader: more than 88% of people living with HIV (PLHIV) in need of ART, receive this treatment. This figure is higher than the same figure in the republic by eight percent. The megapolis is much closer to achieving AIDS targets 90-90-90 than any other city in the country: 90% of people living with HIV should be aware of their HIV status; 90% of people who are aware of their positive HIV status should receive antiretroviral treatment; and 90% of people receiving treatment should have a suppressed viral load that will allow them to stay healthy and reduce the risk of HIV transmission.

Another statistic data is showing the advantages of life-saving therapy. The effectiveness of treatment for PLHIV is more than 76%. Thanks to the early beginning of ART, there has been a 20% decrease in new tuberculosis cases among HIV-positive people. This is a very important achievement because the combination of HIV and tuberculosis infections is the main cause of death among PLHIV. Over the past year, this number has increased by 20%. The main reasons for this are late detection of HIV and amnestied patients, who arrive home from places of detention in critical condition. In every third case, the death was inevitable due to the specifics of the damage of the immune system and other organs. Mostly it was cancer or general body atrophy.

“Thanks to United Nations assistance, Kazakhstan has developed a new mechanism for purchasing ARV drugs. Only three years ago, we were spending several thousand dollars per year for a single patient. Now this cost is reduced to the minimum. Therefore, previously we could not advise people living with HIV to start treatment immediately, but now this treatment is available to everyone,” Vinay Saldana, Regional Director of UNAIDS in Eastern Europe and Central Asia is saying.

The Need for a European Union Communication and Action Plan for HIV, TB and Viral Hepatitis

Author: Anke van Dam, AFEW International

For a couple of years, European civil society organisations advocate for a new European Communication and Action Plan for HIV. In the World Health Organisation, new HIV diagnosed infections in European region increased by 76%. These infections more than doubled in Eastern Europe and Central Asia (EECA) from 2005 to 2014. The whole European region accounted for 153 000 reported new infections in 2015 (ECDC 2017). The cumulative number of diagnosed infections in the European region increased to 2,003,674, which includes 992,297 cases reported to the joint ECDC/WHO surveillance database and 1,011,377 infections diagnosed in Russia, as reported by the Russian Federal AIDS Center.

Co-infection in the EECA region

According to ECDC monitoring and the WHO Europe HIV action plan  adopted in September 2016, these underline the high rate of tuberculosis (TB) and hepatitis B and C coinfection among people who live with HIV (PLHIV). In 2014, TB was the most common AIDS-defining illness in the eastern part of the region.

Of the estimated 2.3 million PLHIV who are co-infected with hepatitis C virus globally, 27% are living in the EECA region. An estimated 83% of HIV-positive people who inject drugs live with hepatitis C in the eastern part of the region.

Plan was prolonged

The European Union had a Communication ‘Combating HIV/AIDS in the European Union and neighbouring countries, 2009–2013’ and its associated Action Plan.

The overarching objectives of the Communication were to reduce the number of new HIV infections in all European countries by 2013, to improve access to prevention, treatment, care and support, and to improve the quality of life of people living with, affected by, or most vulnerable to HIV/AIDS in the EU and neighbouring countries. This Plan has been prolonged for another three years. It was followed up with a Commission Staff Working Document: ‘Action Plan on HIV/AIDS in the EU and neighbouring countries: 2014-2016.’’

Already during the period of the prolongation and for three years, the European civil society organisations, including AFEW International, that work in the field of HIV, are advocating for the new communication and action plan. So far without success, despite the fact that according to the evaluation, the Communication and its Action Plan were seen by stakeholders to have provided the necessary stimulus, continuous pressure and leverage for various stakeholders to advocate for and take actions against HIV/AIDS in Europe.

Response is developed

The epidemiology of the three diseases – HIV, TB and viral hepatitis – urged the European Commission to develop a ‘Response to the Communicable Diseases of HIV, Tuberculosis and Hepatitis C’ in 2016. Next to this, the European Commission changed the civil society forum on HIV and AIDS, an advisory body to the European Commission into a civil society forum on HIV, TB and viral hepatitis in 2017, in which AFEW International takes part. This combined focus from the European Commission and civil society organisations could give an impulse to meet the needs for prevention, treatment and care for the three diseases.

Actions within the plan

The European civil society organisations developed a list of actions that should be included in the new communication and action plan.

Prevention needs to be scaled up: HIV can be prevented by a combination of proven public health measures. Yet two third of the European countries do not have a prevention package at scale. Pre-exposure prophylaxis (PrEP) is only provided in a couple of countries.

Treatment access needs to be scaled up: treatment and early treatment improves the health outcomes of the patient and prevents onward transmission. Therefore, countries should scale up testing and offer treatment upon diagnosis and remove barriers to testing and linkage to care. Governments should remove political, legal and regulatory barriers preventing communities most affected by HIV (people living with HIV, gay men and other men having sex with men, migrants, people using drugs, sex workers, transgender person, people in detention) to access health services.

Medicines should be affordable: the price of medicines is still a major barrier to the implementation of treatment guidelines and combination preventions strategies including pre-exposure prophylaxis (PrEP).

Community-based services as one of the components of the health system: include and recognise community base services who can deliver services closer to affected populations as important part of the health system. Invest in them.

AFEW advocates for the plan

In July 2017 the European Parliament adopted the resolution on the EU’s response to HIV, tuberculosis and viral hepatitis. This is an important step towards a communication and action plan. The EU commissioner for Health and Food Safety Mr. Andriukaitis expressed that he is in favour, and a couple of governments also feel a need for such plan. The European Commission and the Commission on Public Health Directorate are still silent though.

AFEW International, together with many governmental and non-governmental organisations, think that the International AIDS Conference in Amsterdam in July 2018 would be a wonderful opportunity and the right moment for the European Commission to present its intentions and good will to fight HIV, TB and viral hepatitis by a communication and action plan. Civil society will not stop to advocate for this. Otherwise we feel that European citizens will be left behind.

New Technologies and Youth Sexuality Education in Georgia

Author: Gvantsa Khizanishvili, Georgia

Improving access to and awareness of health issues among youth using new technologies has become a new way for non-profit sectors around the world to advance issues on their agenda. IntiMate by Bemoni is the first application of such type in Georgia, and it is an excellent example of sexuality education using innovative technologies. It is available for download both by App store and Google play. The app has been developed by Public Union Bemoni as a part of the project “Investing in Sexual and Reproductive Health Promotion and HIV Prevention among Young People in Georgia”.

Non-profit for sex education

Georgia has inadequate policies in the area of sexual and reproductive health and rights. There are strong religious and conservative powers and gender inequality in addition to a fragile civil society that especially influences the lives of adolescents and young people. Much progress has been made in recent years in advocacy to advance youth sexual and reproductive health and rights, for example. In May of 2017, the Georgian Ministry of Education and Science signed a Memorandum of Understanding with the United Nations (UN) Joint Programme for Gender Equality to assist the ongoing revision of the national curriculum and help integrate the issues of human rights, gender equality and healthy living into the educational programme. Additionally, this February, United Nations Population Fund (UNFPA) Georgia initiated an interactive learning module for evidence-based family planning called Virtual Contraception Consultation (ViC), which was introduced at Tbilisi State Medical University.

Despite these advances, there are still many gaps in advancing youth sexual and reproductive health and rights for young people. For example, there are no state supported sex education programs that exist in many countries of Eastern Europe and Central Asia including Georgia. Since there is no state supported sex education programs including information about HIV/AIDS, no information targeted specifically at young people is available, and health service providers are not equipped with the skills to meet young people’s needs for information, counselling and confidentiality of services. Therefore, the non-formal education mostly led by non-profit sector play a significant role in youth sex education.

New ways to raise awareness

The IntiMate app aims to improve knowledge of young people around issues of sexual and reproductive health and rights including HIV/AIDS. With the goal to spark the conversation around the issues, by containing easily comprehensible, fun, attractive content and to encourage participation of young people in prevention of HIV/AIDS. Containing quiz games, video information, definitions, calendar, list of youth friendly services among others, now young people in Georgia will have access reliable information on sexual health and wellbeing at their fingertips. Launched in July 2017, it already has already attracted international media attention.

Russia is Dancing for Life

Author: Anastasia Petrova, Russia

“Congratulations to “FOCUS-MEDIA” and dance4life for the victory in presidential grants competition!” This was the message Ekaterina Artemenko, the coordinator of projects in Moscow “FOCUS Media” foundation, got from her colleague around midnight on July 31. The happy news spread quickly and all danc4life project members knew about it the next day. The initiative was supported this year by the Presidential Grant Foundation.

Starting from 2006, non-commercial organizations in Russia are supported by the president. This was the first year of the presidential grant competition. For 10-year existence, the system of finance distribution was quite complicated: at first the head of the state approved the list of non-commercial organizations (NCO) – the receivers of grants with his decree, and then the NCOs were included into the finance distribution system. In 2017, the procedure was simplified: grant participants may apply online. There has appeared the unified operator – presidential grant foundation.

Coordination committee summed up the results of the first competition on 31 July, 2017. There were 970 NCOs-winners from 79 regions in the winner list, which is around 15% of all applications. There were 6,623 projects that participated in the competition. Three Russian NCOs, included in the register as “foreign agents,” are among presidential grants recipients. Operator has distributed grants with the total sum of 2.25 billion Russian Rubles within the first competition. The most financed project among the 12 grant departments was “Citizen Health Protection, Promotion of Healthy Lifestyle.”

Recognition of merit

Public Health and Social Development Foundation “FOCUS -MEDIA” celebrated its 20th anniversary last year. “We are happy to have received this grant, but frankly, we are also a bit surprised,” the employees of the foundation are saying.

There is a lot of work ahead even after receiving the grant. Financing will allow to run the project dance4life in 14 Russian cities. It will also include a module on tobacco addiction prophylaxis and anti-tobacco campaigns. Besides, the project will include additional component in the form of helping teenagers and young people with HIV. They will be able to volunteer in the project and take part in all of the activities.

Dancing is a universal language

Dance4life project, which won the grant, is a unique international initiative. The initiative aims at promotion of healthy lifestyle among young people, preservation and promotion of reproductive health, HIV infection prevention and many more socially important diseases. More than two million people from 20 different countries have been a part of the programme over the years of its existence.

The project started in 2005 in Russia. It began after “FOCUS Media” Foundation director Evgenia Alekseeva met the Dutch creator of the project Ilco van der Linde. After this meeting, she decided to take this international initiative to Russia. “FOCUS Media” Foundation existed for seven years by that time, dealt with health protection and, in particular, with AIDS prophylaxis among youth. That is why the aim of the project (which includes the prophylaxis of socially important diseases, addiction formation and strengthening young people) coincided with the foundation’s activity.

Now dance4life is a project with 12-year-old history in Russia, and it runs in more than 14 regions. During the years of its activity, it managed to involve around 220,000 young people, who say that dance4life has changed their lives. The keys to the uniqueness of the project are youth culture, energy and creativity that help spread the information on preserving health and taking responsibility for one’s life. Dancing as a part of the project is a universal language, connecting dance4life participants from all over the world.

The results will be presented on AIDS 2018

There were some guests in the ““FOCUS -MEDIA” Foundation office a week before receiving the news about winning the grant. Yulia Koval-Molodtsova, a former project coordinator in Russia and now an associate in the main dance4life office in the Netherlands, came to Russia to talk about the new working models.

After running the same programme since 2005, the international dance4life team has been working on the analysis and improvement of the project methodology. While the old working model made an accent on youth education, the new programme aims at self-realization of society. Now the programme invites young people on a journey: from relationship with oneself, to the relationships with partners and society in general. The components of HIV and sexually-transmitted infections (STI) prophylaxis, issues of contraception and gender equality are now skillfully connected with such important for young people topics: self-knowledge, establishment of personal boundaries, and control of social stereotypes. The principles of work have not changed: to inspire, teach, involve and celebrate. Due to the “peer to peer” approach, young people become the driving force of the project.

New model of work will be approved during this year. The pilot project is running in two regions. In Nizhny Novgorod, where the project is successfully running from the start, they work in cooperation with local schools. The new contacts will be established from scratch in Kolomna, a city in Moscow region, where dance4life is just starting. The model of the project is universal and can be used for both learning and leisure purposes of young people.

Even though the project will be financed by the Presidential Foundation till the end of 2018, the managers of the project would like to sum up the first results of work by next summer. The results of work and experience in the area of HIV/AIDS among youth will be introduced on the International AIDS Conference in 2018. The focus of this conference will be on Eastern European and Central Asian countries.

Tuberculosis and HIV are the “Imported” Diseases of Migrants

Author: Nargis Hamrabayeva, Tajikistan

A big amount of working age population in Tajikistan (where the entire population is eight million people) take part in labour migration to Russia. After their return to homeland, migrants get diagnosed with tuberculosis and HIV.

A 32-year-old labour migrant from Tajikistan named Shody has just returned from Russia. The doctors have diagnosed him with tuberculosis. The man states that he spent six years working in Russia. He went back home only a couple of times during that period.

The fear of deportation – reason for tuberculosis

“I worked at the construction site. Along with several other fellow countrymen we lived in damp and cold premises. A year ago, I started feeling weak, suffered from continuous coughing, but did not seek any medical advice. First of all, I did not have spare money, and secondly, I was afraid to lose my job. If I was diagnosed with tuberculosis, I would have been deported. Who would take care of my family then? Every day I felt weaker and weaker and I had to buy the ticket home,” told the migrant. Now Shody gets the necessary treatment according to the anti-tuberculosis programme, and his health is getting better.

A few years ago, the results of the research on tuberculosis spread prevention were revealed in Dushanbe. These results have shown that hundreds of Tajik migrants return from Russia with tuberculosis.

Experts say that around 20%, or every fifth patient, from the newly diagnosed patients turn out to be labour migrants.

“For instance, in 2015, 1007 people (which is 19.7% cases from the entire number of patients diagnosed with tuberculosis) were labour migrants. In 2016 there were 927 or more than 17%,” Zoirdzhon Abduloyev, the deputy director of the Republican Centre of Population Protection from Tuberculosis in Tajikistan says.

According to him, the research has shown that most of the migrants became infected during their labour migration period.

“The main factors that lead to the spread of this disease among migrants are the poor living conditions. Big amounts of people in small areas, unsanitary conditions and poor nutrition, late visits to the doctors, and most importantly the fear of deportation from Russia,” says Abduloyev.

HIV is “brought” due to the migration

Many experts say the same thing about the spread of HIV in Tajikistan. That “it is being brought from there, due to the migration.”

Dilshod Sayburkhanov, deputy director of the Republican HIV/AIDS centre in Tajikistan, says that big number of Tajik migrants go to work in countries with significantly higher HIV prevalence rate compared to Tajikistan. Usually these are seasonal migrations, and after the end of the season migrants come home.

“Official statistical data shows the dynamical growth of the number of people who have been in labour migration among the new cases of HIV in Tajikistan. In 2015, there were 165 people diagnosed with HIV, whose tests were marked under the labour migrant category. Among them there were 151 men and 14 women, which is 14.3% from the whole number of new HIV cases. In 2016 – 155 (14.8%), in the first half of 2017 – 82 people (13.1%). In 2012, 65 migrants (7.7%) were diagnosed as HIV-positive,” says Sayburkhanov.

Statistics demonstrates the connection between international Tajik labour migration and the growth of new identified HIV cases, according to him.

Ulugbek Aminov, state UNAIDS manager in Tajikistan, also agrees with this. He thinks that migration and HIV are closely connected and result in a social phenomenon.

“There is an assumption that migrants, being in tough emotional and physical conditions, can behave insecurely in terms of HIV and thus have risks of the virus transmission in destination countries. Tajikistan HIV import issue is still in need of an in-depth study,” believes Ulugbek.

It is important to consider that migrants often represent vulnerable to HIV groups of population (for example people who inject drugs), and not knowing their pre-migration HIV status complicates the future process of HIV monitoring. Apart from that, the chances for migrant to receive the necessary specialized treatment go down. The treatment would prevent the spread of HIV to migrant wives and partners in their home country.

“Therefore, experts’ first priority task is the timely identification and quality monitoring of the disease in the countries where migrant live and transfer to, until the return of the migrant back home,” notes Ulugbek Aminov.

Experts believe that there should be a complex of prevention activities for HIV, sexually transmitted diseases and tuberculosis among such vulnerable groups as migrants and their sexual partners.

The Path to the Self-Financing of the HIV Programmes in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

A significant reduction of funding for the programs against HIV infection was registered during the recent years in Kyrgyzstan. Last year the news that the Global Fund – the main donor of the HIV and tuberculosis programmes in the country – cuts their funding, got into the headlines.

Needs and opportunities

Funding for HIV programmes from the Global Fund over the past two years in the country has actually decreased by 30%, from $7.5 million in 2014 to $5 million in 2016 and 2017. The trend continues to grow: in the application for 2018-2020 only $3.7 million per year were pre-approved, and that is one more million less than before.

“$7.8 million per year are divided in the new Global Fund application between HIV and tuberculosis, but previously such amount of money was allocated only for HIV. Notice that reduction of funding comes amid the growth of demands. The situation with HIV in the country is now getting close to the concentrated phase, and the number of people on treatment over the past two years has grown almost twice,” said the head of Harm reduction programmes association “Partner Network” Aybar Sultangaziyev. “We have enough funds for this year, but in the next three years we expect the budget gap to grow. Only for persons who need treatment – about 6,000 people – we need $3.5 million by 2020, but for HIV we only have $3.7 million allocated in the budget.”

From donor to national funding

The general global trend of reducing grant support and the rise of Kyrgyzstan in the qualification of the World Bank from the level of countries with low income to the level of countries with lower middle income encourages the transition of the country to national funding. It is a difficult process for the state, because from the very beginning the prevention programmes in the country (about 15 years) were funded by international donors.

Ulan Kadyrbekov

“Previously money from the state budget was allocated only to support infrastructure and salaries of the AIDS-service employees,” Director of the Republican AIDS-center Ulan Kadyrbekov says. “Starting from the year before last, the state started to allocate 20 million soms ($289 thousand) annually for HIV programmes. The condition of awarding $11 million grant for HIV from the Global Fund for the next three years was the state contribution of 15% of the whole grant amount. Nowadays we set the national program on overcoming HIV in the Kyrgyz Republic until 2021 and in the budget we have allocated these 15% of the national contribution.”

Until the last November it was not clear if Kyrgyzstan receives the Global Fund money or not. This fact became the main argument for the civil sector in their work on promotion of national funding.

“In fact, the result of our work was the development of the roadmap, i.e. the transition plan to national funding, which comes as an addition to the National program on overcoming HIV,” says Aybar Sultangaziev. “In addition to already allocated budget we have received further 23 mln. soms ($333 thousand) in 2018 and 50 million soms ($725 thousand) per year starting from 2019. It is still not enough. In fact, we requested up to 4.5 times more in 2018 and 2.5 times more starting from 2019 from the state budget.”

Now the National program for overcoming HIV in the Kyrgyz Republic until 2021 and Roadmap for the transition to national funding are submitted to the Government of Kyrgyzstan. The program must be approved this August. It will become known if this money is included in the Republican budget by the end of 2017.

Costs saving and optimization

Upon the condition that the government will fulfill the financial obligations under the National program until 2021 and the country will receive donor funds, there still will be a deficit in the amount of $1.5 million per year. Global Fund’s money has not been finally divided between programme activities. It will be decided which expenditure headings will be underfunded in the nearest future.

Aybar Sultangaziev

“We expect that deficits will be covered by funding from the other donors and by reduction of preventive measures,” Aybar Sultangaziev is saying. “For example, it is likely that we will close social centers. Nowadays six social centers are already closed, we excluded the treatment of STIs (sexually transmitted infections – ed.), we also partly excluded diagnosis and treatment of opportunistic infections, we decreased the number of condoms and syringes for distribution. There are other donors for HIV in our country, the largest of which is the USAID project Flagship. It allocates about $700 thousand a year on drug users. With this money we are able to cut funds from the budget of the Global Fund for this group. Now we have a narrower task of responding to the epidemic. Therefore, the only must have budget items are methadone and antiretroviral (ARV) drugs. We are trying to increase or at least keep these budget lines at the same level.”

Another step in cost optimization and in the transition to national funding is the transfer of control of Global Fund grants from the current recipient – UNDP – to the Ministry of health. Experts predict that it will happen no earlier than during the second half of 2018, as the Ministry of health needs to get prepared.

“Nowadays the treatment is provided by the Global Fund. Even after funds were allocated in the national budget, we still cannot use them for the purchase of ARVs for key vulnerable groups, because there is no mechanism for procurement of drugs and for social procurement. Our priority is to provide all the necessary documents for these procedures,” Ulan Kadyrbekov said. “Thanks to funds reallocation and optimum employment of resources, the National programme for the next three years will be able to slow down the spread of HIV. Even now we have good chances to reach the 2020 UNAIDS goals of 90-90-90. The process of transition to national funding and running programs in the face of cutbacks of donor funding is a great challenge. The Ministry of Health has already submitted the preliminary topics of presentations at the conference AIDS 2018 in Amsterdam, I think, by July of the next year we will have a great practical experience to share.”