Metropolis 2020: on the Way to 90-90-90

Author: Anastasia Petrova

Dynamics of the HIV epidemics in big cities is a pressing issue all over the world. According to the United Nations, by 2050 most people will live in big cities. This is most relevant for the developing countries with low incomes and growing HIV epidemics. Considering that the key populations are concentrated in metropolises, experts point out that there is obviously a need to implement HIV prevention and treatment programs at the municipal level. The decision to end the AIDS epidemic in big cities by 2020 is embedded in the Paris Declaration signed on 1 December 2014 with support of the UNAIDS.

This topic is the basis of the Fast-Track TB/HIV Responses for Key Populations in EECA Cities Project implemented by AFEW International in collaboration with Alliance for Public Health and presented within the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) held in Moscow, Russia. Together with the municipalities of five big EECA cities, civil society representatives developed measures in response to the spread of HIV/TB in key populations.

On 20 April, Anke van Dam, Executive Director, AFEW International moderated a session called “Fast-Track HIV/TB Responses in Healthy Cities” at EECAAC 2018. The session was co-chaired by Svetlana Plămădeală, Country Manager, Coordinator, UNAIDS, Moldova; Alla Yatsko, President, Public Association ‘Youth for the Right to Live’, Moldova; and Erika Tserkasina, Program Officer, Eurasian Coalition on Male Health, Coordinator, MSM Programmes in Almaty, Beltsi, Odesa and Sofia, Estonia.

“We cooperate with five metropolises in the region: Odesa (Ukraine), Tbilisi (Georgia), Beltsi (Moldova), Almaty (Kazakhstan) and Sofia (Bulgaria). The key criteria in selecting the cities were HIV prevalence and readiness of the local authorities for cooperation. Through organizing a network of community representatives, we established cooperation with the municipalities,” said Anke van Dam, Executive Director, AFEW International.

The goal of the Fast-Track TB/HIV Responses for Key Populations in EECA Cities Project is to contribute to achieving 90-90-90 targets, including reduced mortality and increased funding for HIV/TB treatment. One of the main tools is strengthening partnership between the authorities and civil society. To achieve this objective, the project includes research studies, workshops, and meetings with decision-makers. It is planned that the preliminary results of the project will be presented at the International City Health Conference ‘Developing healthy responses in a time of change’ to be held in Odesa on 13-14 September 2018.

How to Become AIDS 2018 Participant

To register for the 22nd International AIDS Conference with the standard fee is possible before May 18. After this date, the registration will be possible only with the higher fee. Deadline to submit a visa application and to request a Letter of Invitation is June 1.

We are presenting this and other information on how to register for the Conference in our new video. Especially for you, we explained online registration in details and answered your questions.

Will see you in Amsterdam in July!

Ex-Prisoner in Tajikistan Advocates Healthy Lifestyle

Umed is a participant of the START Plus programme implemented with AFEW-Tajikistan

Author: Nargis Harambaeva, Tajikistan

Umed Boev, age 41, an ex-prisoner from Tajik town of Bokhtar advocates healthy lifestyle among risk groups – people who use drugs, sex workers and ex-prisoners.

In 2001, when Umed was 24, he went to Russia to earn money. He liked partying and spent quite some money on that. In 2004, during one get-together he had a quarrel and a fight, causing another person grievous bodily harm. He was sentenced for 10 years and served his time at Novosibirsk maximum security prison.

While in confinement, Umed tried heroin for the first time. One syringe was often shared by many people. One day his fellow countrymen, who served sentence in the same prison, found out and talked to him.

“They convinced me to stop taking drugs, telling me that prayers would help. I mustered all my will power, it was extremely hard during withdrawal, but I stuck it out. I prayed hard and it really helped me. I stopped using drugs,” tells Umed.

10 years later, when Umed returned home, he was diagnosed with HIV.

“Upon return, I first worked at a construction site, then the crisis hit and the construction was put on hold. I needed money. An acquaintance of mine told me I could donate blood and get some money that way. Therefore, I went to the clinic and they did an HIV test and the result was positive. I was registered with the clinic but I did not take my diagnosis seriously, did not take antiretroviral therapy,” recalls Umed.

Timely request for help

Because of his weak immune system, soon Umed developed tuberculosis.

“In December 2015, I suddenly felt very ill, had a torturing cough for three months. In April 2016, I was taken to a hospital and diagnosed with tuberculosis. I was in a very poor state of health. I could not even walk, had no appetite. During that time, I rapidly lost 20 kilos. Only later doctors told me I turned for help just in time. Another couple of weeks and I would have died. I was treated, and recently when I had fluorography examination tuberculosis was gone. I am so happy about that,” he says.

Today Umed is a participant of the START Plus programme implemented with AFEW-Tajikistan. The purpose of the programme is to reduce the prevalence level of public health concerns like HIV, TB and viral hepatitis at penitentiary facilities and improve the quality of life of persons released from prison.

“I discovered help for people like me when I was diagnosed with tuberculosis. I came to AFEW-Tajikistan local office in Bokhtar. I received food packages as well as assistance in the form of information. Currently, they are helping with the purchase of necessary medicines,” tells Umed.

Becoming part of the Board

Umed is a member of the Board of representatives of key population groups that was organised within AFEW-Tajikistan office in Bokhtar to help persons in risk groups who are neglecting their health.

“There are four of us in the Board. I am responsible for creating awareness among key groups about infectious diseases. These groups include ex-prisoners, people who use drugs and sex workers. We help AFEW-Tajikistan, inform them about the needs of the groups, adjust assistance that is being provided so that it gains better quality and effectiveness,” says Umed.

By the way, one of the topics of the 22nd International AIDS Conference in Amsterdam is prison health. Other public health issues like HIV, hepatitis and TB in Eastern Europe and Central Asia will be also in focus during AIDS 2018.

PLWH Network Launches New Concept Clinics in Ukraine

Author: Yana Kazmirenko, Ukraine

All-Ukrainian Network of People Living with HIV (PLWH) plans to open five 100 Percent Life all-patients-friendly clinics this year. The ultimate plan is to cover the entire Eastern Europe and Central Asia (EECA) region.

The Project to create the 100 Percent Life network of clinics is a challenge for the Charitable Organisation All-Ukrainian Network of People Living with HIV/AIDS. It is considered to be the largest patient organization throughout the former Soviet Union. During the past several years, modern medical centres accessible for all patients have been opened in each region of Ukraine. Medical centres will provide treatment and social support to those frequently dealing with discrimination at regular hospitals: people living with HIV, representatives of key risk groups. HIV-positive patients will receive services free of charge, clients, in general, will receive them at below-market prices.

In autumn of 2016, a pilot clinic was opened in Poltava, and this year medical centres in Kyiv, Zaporizhia, Lviv, Chernihiv and Zhytomyr will receive their first patients. The capacity of the clinic in the capital will be 900 patients per month.

The Network is preparing to present the Clinic Network Project at the 22nd International AIDS Conference AIDS 2018 in Amsterdam. They are convinced that such format will be highly sought in all countries of the EECA region.

“The first centre of this kind abroad will be opened in Moldvova – they have liberal legislation. Georgia and Kazakhstan are also expressing interest,” says Dmitriy Sherembey, the Chairman of the Coordination Board of Charitable Organisation All-Ukrainian Network of PLWH.

The philosophy and services of these clinics will be a drastic difference from the reality of Ukrainian AIDS centres. Below is the outline of the main differences.

Donors become investors

The Clinics Project changes the roles of donors and non-profit organisations. Under the PLWH Network, model donor organisations become investors, and non-governmental organisations (NGOs) become entrepreneurs.

“At the present time, donors award grants, and in the end, they receive a report on “why it did not work and how flawed the world is.” We are knocking this system down: each hryvnya spent on the clinic by donors continues to work after grant completion. All profit from clinics will be invested into the development of new services. The donor acts as an investor and receives profit not in monetary equivalent but in humanitarian terms,” says Mr. Sherembey.

According to calculations of the Network Head, 50 thousand dollars invested in a clinic will turn into a million within 20 years. At the same time, money spent by a patient at the clinic will turn into a service to a person who wants to live, as opposed to being just owner’s profit.

Medical staff of Poltava clinic praised for thoughtful treatment. Photo by PLWH Network

The clinic in Poltava has become profitable just six months after opening. This gives a chance to NGOs to say good-bye to the role of petitioners and enter the market of medical services, which is rated at 100 billion US dollars a year in Ukraine.

“The network of clinics will allow maintaining programmes and staff in case the Global Fund leaves Ukraine. We have been observing the negative experience of closing up programmes and discharging specialists in the Eastern European countries that have joined the European Union,” adds Yaroslav Blyakharskiy, Manager of Social Entrepreneurship Section of PLWH Network.

Medical centre is put together like Lego

Each clinic will have a different set of services, depending on the diseases in the region, what is offered by competitors and the paying capacity of the population. Three specialists will form the basis: a family doctor, an infectious disease specialist and a drug treatment specialist.

Poltava was not a random choice for the pilot project – it is a typical medium-size Ukrainian city. If the project proved to be sought after in this city, it is bound for success in other regions.

“The pilot clinic provides help in the following fields: neurology, allergology, nosology, narcology, pain and withdrawal syndrome relief. Narcology has proven to be in the highest demand,” says Mr. Blyakharskiy.

In Kyiv centre this list will be supplemented with gynecology, urology and dermatology.

Progressive standards of care

Progressive European treatment protocols will be used at 100 Percent Life medical centres. The Clinics Project is integrated into the medical reform, which is currently dismantling the Soviet-times model. Under the reform, each citizen of Ukraine will have to select a family doctor; and the Government will transfer money to the doctor for treatment of this patient. The family doctor will be able to prescribe antiretroviral therapy, which is currently received by 90 thousand patients in Ukraine.

A mobile application as your health manager

100 Percent Life medical centre will make all communications between patients and medical staff automated as much as possible. Clients will be able to install an application on their mobile phones enabling on-line arrangement of appointments, medical tests, receipt of prescriptions and seeing the entire treatment regimen. Patient’s medical record will also be available electronically. The application will allow covering 60% of all communications between the patient and the clinic.

Medical centre accommodates the patient

Poltava clinic is open until 10 p.m. seven days a week. For the PLWH Network it is vital that all categories of patients get equal access to proper quality services and treatment and do not face rejection and discrimination.

According to the research conducted by the PLWH Network, around 19% of surveyed HIV-positive patients in Ukraine have faced refusal of medical examinations that did not involve contact with blood (the research is titled Evaluation of multiple stigma faced by high risk group representatives with regards to HIV infection – editor’s note). Around 80% of patients were refused by the consulting physician.

HIV in Georgia: is there any stigma

Author: Irma Kakhurashvili, Georgia

Our meeting with David Ananiashvili was appointed in a green courtyard of the Infectious Diseases, AIDS and Clinical Immunology Research Centre. The Centre is located in an old building in one of the central districts of Tbilisi, Georgia. The authorities have been promising a new working space for the centre since long ago, but so far there has been no progress in this process. However, David feels at home – he knows every corner here. He was one of the first people in Georgia who publicly spoke about their HIV status. David is the head of the Georgian Plus Group NGO. Since 2000, the NGO has been implementing various projects to protect the rights of people living with HIV and standing up to stigma and discrimination.

In the meeting room, David says that the civil society sector in the area of HIV/AIDS is quite small. Besides, there are not many resources available to fight stigma. In Georgia, all people have access to free HIV treatment (antiretroviral therapy is available and accessible for patients since 2004 through the grant of the Global Fund to Fight AIDS, Tuberculosis and Malaria), while stigma is one of the main factors hindering access to testing of HIV. David says that most stigma-related issues may be observed in health facilities, in the relations between doctors and patients. The HIV-related stigma in the healthcare system – both in state-run and in private clinics – is so strong that sometimes doctors and other medical personnel do not provide the required high-quality services. There have been cases when doctors refused to perform life-saving surgeries if their patients had HIV.

Stigma is reinforced by myths

The situation is worse in regions of the country, especially in smaller towns and villages where patients are afraid of social isolation and are reluctant to disclose their status even to their family members. Here, the HIV diagnosis still leads to the feelings of panic and helplessness as it used to be in the 80s.

“HIV is a stigmatized disease causing a number of emotional and social problems. Stigma is reinforced by a variety of myths, for instance, that HIV is a result of the person being irresponsible, practising immoral behaviours or using drugs,” explains David.

The community of people living with HIV in Georgia is not as open as it should be but David believes that everything has its time and that this issue may be resolved. Current scale of the response to hepatitis C may serve as a good example. Until 2015, people in Georgia had never talked out loud about this disease, but after the government started the national program of hepatitis C elimination the ice was broken: many people were able to recognize they had hepatitis and start effective treatment.

In the nearest future, hepatitis C elimination programme will also include screening for HIV, which means that the patients who are tested for hepatitis C will also be screened for HIV. The initiator of this idea – AIDS Centre – is sure that integrated services will significantly improve the HIV detection rates. David says that countering stigma requires a comprehensive approach instead of one-sided efforts.

Strategic plans

The estimated number of people living with HIV in Georgia is 12,000 people. Apart from countering stigma and discrimination, the main goal in the AIDS response is detection of the new HIV cases.

David says that there is a need to bring up the issue of preventive treatment of discordant couples in Georgia. Pre-exposure prophylaxis of HIV (PrEP) is a new method of HIV prevention. PrEP provides additional protection in cases when people do not use condoms for whatever reason.

David Ananiashvili and his colleagues plan to make their contribution to the development of a new National Strategic Plan to Fight HIV/AIDS. Its main objectives will be delivery of services to vulnerable groups and further scale up of prevention programmes.

“We would like to implement a new project by creating a consortium to make sure that in future our services – counselling centre, mobile clinics, outreach services, group activities, etc – and interventions are explicitly described in the HIV/AIDS strategic plan and to add new services to the existing ones. We will conduct focus groups, identify common challenges and needs to analyse and understand which services are needed for vulnerable populations and which of them are more effective,” says David.

Artificial Respiration: will Russia End Tuberculosis by 2030

In 2016, 1.3 million people worldwide died of tuberculosis. Over the same year, 10.4 million people fell ill with tuberculosis

Author: Anastasia Petrova, Russia

March 24 is World Tuberculosis Day. Tuberculosis (TB) is the ninth leading cause of death worldwide. Russia is one of the top three countries with the highest burden of drug-resistant TB. At the first World Health Organisation Global Ministerial Conference on Ending TB held at the end of the last year in Moscow, the Russian Minister of Health Veronika Skvortsova proclaimed that Russia, supporting the global community goal, aims to end TB by 2030. Experts comment on how feasible this goal is.

Treatment is not cost efficient

Tuberculosis is called a biosocial disease as people from the most socially disadvantaged populations face the highest risk of being infected. People from low- and middle-income countries – India, Indonesia, China, Nigeria, Pakistan, Philippines and South Africa – are affected the most. Such countries cannot procure the required drugs at high prices and, as the treatment access experts point out, it is not cost effective for the pharmaceutical companies to invest in the production of drugs, which will not bring them enough income. It complicates the development and launch of new drugs, while the lack of innovative drugs leads to the development of drug-resistant forms of tuberculosis, aggravating the situation.

In 2016, 1.3 million people worldwide died of tuberculosis. Over the same year, 10.4 million people fell ill with tuberculosis.

Sustainable threat

TB morbidity rate in Russia is 58.44 cases per 100,000 people. On one hand, there has been a steady declining trend in TB mortality in the country since 2005 (except for the vulnerable populations). According to the WHO, in 2016 the mortality rate was 8.2 cases per 100,000 people a year (as compared to 16 cases in 2011). On the other hand, WHO experts observe two crucial problems in the Russian Federation: growth in TB morbidity among people living with HIV and widespread of the drug-resistant forms of TB – extensively drug-resistant tuberculosis (XDR-TB), multidrug-resistant tuberculosis (MDR-TB), and rifampicin-resistant tuberculosis (RR-TB).

According to the WHO, Russia is one of the top three countries with the highest burden of extensively and totally drug-resistant tuberculosis, with higher rates in India and China only. In 2016, the share of XDR-TB in the new TB cases in Russia was 27%, and in recurrent TB cases – 65%. It means that now there is no effective treatment for many people. Only 31% of people recover from XDR-TB. The cause of drug-resistant TB is first of all associated with treatment interruptions. The main reason of patients “dropping out” is the lack of social support.

“Patients should not only be treated but should also be provided with comprehensive social support. The treatment is long and hard, it takes over a year. It leads to many people losing their jobs. If people have no means of subsistence, they have to stop their treatment and go to work. The situation is even more complicated for people who have small children,” says Svetlana Prosvirina, member of TBpeople, the Eastern European and Central Asian network of people with experience of TB. “Such drop-outs are extremely dangerous as the bacteria which survive after the treatment interruption adjusts to the medications, which contributes to TB evolution to MDR-TB and XDR-TB.”

Coverage of people living with HIV with treatment is low

Experts agree that to curb the epidemic of tuberculosis by 2030, the government should make efforts to fight drug-resistant forms of TB and create conditions for the patients not to interrupt treatment

Tuberculosis is the main AIDS-defining disease and the leading cause of death among people living with human immunodeficiency virus. The risk of co-infection is related to the low immune function of people living with HIV, who need to receive antiretroviral therapy (ART) constantly to stabilize their immune responses. However, in Russia treatment coverage of people living with HIV remains extremely low. According to the Federal AIDS Research Centre of the Rospotrebnadzor Central Research Institute of Epidemiology, in 2017 the coverage rate was only 35.5%.

People who use drugs are also in a difficult situation. TB activists point out that TB treatment clinics often do not have a drug counsellor and sometimes do not even have a license to provide help to people who suffer from the abstinence syndrome (group of symptoms with varying combinations and severity, which develop when a person terminates using psychoactive substances or reduces the dose taken after their recurrent use, usually during a long-term and/or in high doses – editor’s note). Those symptoms make the patients refuse from further treatment, which not only leads to drug resistance but also creates pre-conditions for further transmission of the disease.

Ending TB by 2030

Experts agree that to curb the epidemic of tuberculosis by 2030, the government should make efforts to fight drug-resistant forms of TB and create conditions for the patients not to interrupt treatment.

“Comprehensive support of vulnerable populations, including the patients, is required to prevent the spread of tubercle bacillus,” says Kseniya Shenina, activist, member of the TBpeople Coordination Council.

Based on the conclusions of the Russian Public Mechanism for Monitoring of Drug Policy Reform, an important pre-condition to overcome the problem is the revision of the Russian drug policy in compliance with the “Support Don’t Punish” approach. Experts believe that the country urgently needs to approve recommendations of the numerous UN bodies on drugs and HIV, including recommendations of the Committee on Economic and Social Rights. Only compliance with these conditions will make the goal of ending tuberculosis by 2030 more feasible.

Persecution and Activism of Sex Workers in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

For almost a year and a half, law enforcement agencies have been persecuting sex workers in Kyrgyzstan. During this period, the number of sex workers receiving HIV prevention services in some regions of the country reduced twice. Civil society organisations registered more than 450 cases of sex workers’ rights violations by the police every year.

Extortion, detentions, and threats

In 2017, 81% of all reports of abuse and human rights violations submitted to the Shah-Aiym Sex Workers Network were complaints against police officers on extortion. Shah-Aiym documents such cases with the support of Soros Foundation-Kyrgyzstan and street lawyers of public associations all over Kyrgyzstan within the framework of the Global Fund via Soros Foundation-Kyrgyzstan. Both sources recorded 475 cases of sex workers’ rights violations by law enforcement agencies in 2016 and 459 cases in 2017. Most often, those are cases of extortion, arbitrary detention, threats, blackmailing, pressure and degrading treatment.

“The wave of mass raids started in mid-2016 when City Directorate of Internal Affairs in Bishkek announced that it was going to “clean the city by getting rid of prostitution.” They even asked local people to conduct night raids, make photos of sex workers and pass such photos on to the policemen,” tells Shahnas Islamova, head of NGO Tais Plus. “At first, press service of the Chief Directorate of Internal Affairs was reporting detentions, not even hesitating or not understanding that they were, in fact, announcing unlawful acts of the law enforcement agencies.”

In Kyrgyzstan, sex work is decriminalized, which means that it is neither an administrative nor a criminal offense. To punish sex workers, law enforcers use other provisions of the Administrative Offences Code. Most often, sex workers are detained for alleged disorderly conduct or petty crimes.

“Sex workers try to avoid court proceedings: they buy off. There are some cases when law enforcers know what a girl does to earn her living and start blackmailing her. They threaten to take photos of the girls, tell their relatives about their occupation or take them to a police station, so the girls agree to pay: the standard charge is up to 1,000 soms ($15),” tells Alina (the name is changed), a street lawyer of a civil society organization. “If girls try to defend their rights, law enforcers find other ways to detain them: they draft reports of disorderly conduct or failure to obtain registration. Those who have bad luck or are not able to buy off may be arrested for three to five days.”

According to Alina, many sex workers have gone underground: they often change their rented apartments and phone numbers. Such situation in some regions of the country hinders the access of NGOs to sex workers to conduct HIV prevention interventions: distribute condoms, offer testing, conduct awareness-raising activities, and consultations.

“Since the start of the “purge”, our organization has been monitoring the dynamics in the coverage of sex workers with prevention programmes in Bishkek,” says the head of Tais Plus NGO. “In a year and a half, the coverage has reduced twice, and in the second quarter of 2017 the actual indicator went down to 39% of the planned coverage.”

Activism in the challenging environment

Mass raids of 2016-2017 echoed almost in every region of the country. Groups of people who explained their actions with the “religious motives and interests of the society” helped law enforcers in their “fight” against sex workers. As the end of 2017 approached, things calmed down: sex workers got used to the new conditions, while the pressure from the side of police weakened a bit and the mass raids ended. However, “police marks” stipulating sex workers paying money to the law enforcers for the so-called “protection” and “permit to work” are still there.

“Currently, in most cases pimps are the ones to keep contact with police, while there are almost no girls who work on their own,” says Nadezhda Sharonova, director of the Podruga Charitable Foundation about the situation in Osh. “Recently, our street lawyer has been more and more often reporting complaints of sex workers against their pimps who beat and blackmail the girls.”

Despite the fact that civil society organizations in Kyrgyzstan offer legal support, sex workers rarely report their offenders. Representative of the Tais Plus NGO thinks that this fact is easy to explain: to go through all the legal prosecution process, one needs boldness and strength as well as certain savings – not to cover the legal expenses, but to be able not to work for a while and keep out of the law enforcers’ sight.

At the same time, the sex workers movement is growing and becoming stronger. The Shah-Aiym Network unites sex workers in Kyrgyzstan, Tajikistan, Russia. The network documents human rights violations and provides support to the victims of human rights violations, actively protects the interests of sex workers’ community and publicly campaigns against violence towards sex workers. The network ensures conditions for strengthening activists’ capacity to claim and defend their rights.

“We have seen cases when sex workers defend themselves,” says Shahnas Islamova. “For instance, at the court hearings on administrative offenses some sex workers now openly say that they are engaged into sex work and do not violate any laws, while the police has violated the law when detaining them. As a result, such sex workers have left the courtroom free from any accusations.”

Programme to Eliminate Hepatitis C in Georgia Needs to Include an HIV Test

Author: Irma Kakhurashvili, Georgia

In 2004, Georgia became the first and only country in the Eastern European region that succeeded in ensuring universal coverage by antiretroviral therapy (ART). The government funds treatment with first-generation medication, the rest is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Treatment and testing are free of charge, and if a person seeks assistance at the appropriate time, the assistance is sure to be provided. When observing the dynamics of HIV/AIDS epidemic in Georgia in the past years, positive changes are noticeable right away. Life expectancy and quality have significantly improved in many patients. However, notwithstanding evident achievements in overcoming HIV/AIDS epidemic, the low HIV detection level remains to be the main problem. This and other issues are part of our conversation with Nika Chkhartishvili, Deputy Director of Infectious Diseases, AIDS and Clinical Immunology Research Centre, Infectious disease specialist and Epidemiologist.

How long have you been working in the field of HIV/AIDS epidemic counteraction in Georgia?

– Since 1984, the time, when a group of young doctors led by Tengiz Tservadze who now leads the Centre, took interest in the new disease. That same year the AIDS Diagnostic Laboratory was established, the first one in the Eastern European region. In 1985, mass study of the entire Georgian population began.

We escaped a pandemic, but are far from the best situation when it comes to detection. Why is that?

– In 2004, with support from the Global Fund, the country granted access to treatment. We use an extensive arsenal of prevention measures, such as, for example, substitution therapy and syringe exchange programme for people who use drugs. For the record, among the recently registered cases during 2011-2017 we have been observing a dramatic decrease in transmission index among people who use injecting drugs: in 2011 it was 45% whereas in 2017 – 24%.

In 2015 Georgia was one of the world’s first to introduce the treatment-for-all principle. Nowadays, all HIV-positive persons in Georgia are being treated, regardless of immunity status and disease stage. However, unfortunately, the epidemic is still growing.

Since the beginning of 2011, we have managed to stabilise new cases. According to UNAIDS data, 1,100 persons are infected every year in Georgia, however, we detect only 700 persons, over half of whom quite late, at the advanced stage of the disease. There is a large gap between diagnostics and detection. Therefore, we can identify two main issues: insufficient coverage of key populations (people who use drugs and men having sex with men) and absence of testing in the primary sector of public health services. For instance, a person shows certain symptoms, has multiple complaints, however is not offered an HIV test.

Recently, specialists started elaborating the idea of a state programme to eliminate hepatitis C aimed at treatment of the entire population. The cost of HIV test could be added to the total cost of such programme to facilitate detection of HIV cases.

Does the Centre have plans to open new branches in regions? Every month many patients are forced to travel long distances to receive medication – to Tbilisi or other regional centres, which are not so numerous…

– When the Centre started working, there were fewer HIV-positive people. With the increase of patients, we started opening centres in Samegrelo, Adzharia, Imereti, where hot spots of the epidemic appeared. We cannot open a branch to take care of five clients. Needless to say, those people are important to us, however we do not have sufficient resources to cover Georgia entirely.

The Centre does not have its own building. Does it mean that the Government underrates the epidemic problem?

– It is not just an AIDS Centre; it is the Centre for all infectious diseases. We must be able to adequately face any epidemic that may come our way.

The space we occupy now was purchased by Aversi Company in 2009. There was a promise of constructing a separate building for us in two years. Several designs were developed; however, they remain on paper only. Currently, 7,700 square meters were allocated for us in Digomi region, then the area was reduced to 5,500 square meters. This is not enough, as infection control requires multiple units – an AIDS building, hepatitis building, intensive care unit, central nervous system infections unit, AIDS inpatient department, etc. Ideally 10 thousand square meters are needed for a facility like ours. HIV patients alone, who we provide services for, amount to 3,000 people. We have been in this situation for the past nine years and it really is a problem.

In 2009, the Infectious Diseases, AIDS and Clinical Immunology Research Centre was honoured with the highest award of the World Health Organisation – Dr. LEE Jong-wook Memorial Prize and 85,000 US Dollars. No other medical facility in Eastern Europe has such an award. The Centre, which is doing so much in the best interests of the state, deserves greater attention. We hope the state shares the same opinion.

AIDS 2018 March in Amsterdam

AFEW International received the invitation to join AIDS 2018 march in Amsterdam, and we are sharing this message with you. Please fill in the form below in case you are planning to join the march:

Hello everybody,

In a couple of months the International AIDS Conference 2018 will be held in Amsterdam. We are excited and are looking forward to work together with activists all over the world and make this event one to be remembered.

As you might know from previous conferences, traditionally there will be a march or demonstration of HIV and AIDS activists. This year the march will take place just before the official opening of the conference at the RAI Amsterdam Convention Centre in the afternoon of Monday, 23rd of July 2018. With this email we would like to introduce us to you and ask you to join us in the march/demonstration to raise our voices for and with people living with HIV.

We are aware that we might be a little ahead of time. But it gives us together with you more time to activate more people and to organise a good march in cooperation with the local authorities. Please forward this email to more organisations, people, living with HIV or relatives and friends you know and who might like to become part or support the march. 

For some organisational matters we kindly ask you to let us know if you and your organization are interested in updates or possibly want to get  involved. You can do so by filling out an online form: https://goo.gl/forms/ahKbXV9xO2gRSmnd2

You will soon hear from us again (if you want).

Kind regards,
Alexander P. &
Hans V.  &
Alexander S.

Source: www.aidsactioneurope.org

Do we Treat or Harm: how Ukraine is Fighting against Tuberculosis

Olga Klimenko in the children’s ward of the tuberculosis dispensary. Photos from the personal archive

Author: Yana Kazmyrenko, Ukraine

At the entrance to any public polyclinic in Ukraine, an announcement is greeting a patient: visit a doctor is possible after a fluorography only. The obligatory lungs X-ray maintains a semblance of the fight against tuberculosis. In Ukraine, most of the patients get to know their status very late. The country has not been able to take the tuberculosis epidemic under control for more than twenty years. Ukraine has the world record of multidrug-resistant forms of tuberculosis and is still treating patients, sending them to prolonged isolation in overcrowded dispensaries.

Olga Klimenko – an activist of TBpeople – Eurasian Network of People who have had tuberculosis – was diagnosed with this desease in 2015. By the time of hospitalization, she was sick for at least six months. In 2016, Olga published a book The world inside me. Confession of the tubercular woman in which she described her life experience with the disease.

Now Olga is trying to help patients with this diagnose. On the webpage of her community in Facebook The world inside me, requests appear every day: to transfer money for the purchase of inaccessible drugs, which for the most part are not licensed in Ukraine, to purchase washing machines for tuberculosis dispensaries or diapers for recumbent patients. Last month, Olga was “coaching” 34 patients.

“I do not know when and where I contracted tuberculosis. No one knows. Everyone remembers the last long-lasting flu after which he or she felt weakened and broken down. Ukrainians usually do not go to the doctor, we go to the drug store and buy a full set of antiviral drugs. We remove symptoms, but do not cure diseases,” says Olga.

During the treatment, Olga had good and bad times. The most difficult was the separation from her daughter: the girl was sent to a special boarding school for children who were in contact with infected people, where her homegrown girl spent six months with children from dysfunctional families. Olga still did not forgive doctors who did not tell her that after two weeks from the start of the treatment she was not contagious anymore.

Ukraine is breaking records

Olga’s story is typical for Ukraine where the epidemic of tuberculosis is spreading for several years. More than 30 thousand of Ukrainians are diagnosed with a not active tuberculosis and more than 10 thousand – with an active form. Every day 90 people get their status. These figures are underestimated: according to the World Health Organization (WHO), every fourth patient in the country stays undiagnosed.

Back in 1995, WHO announced that Ukraine has exceeded the epidemic threshold – 50 cases per 100,000 people. Since then, the situation has only worsened – the conflict in the East of the country forced 1.5 million residents of Lugansk and Donetsk regions to resettle. In these regions, there were 15% of Ukrainians who were diagnosed with tuberculosis. Every fifth TB patient is HIV-positive.

Tuberculosis for export

The resettlers are at risk of tuberculosis in Ukraine. Photo by UNIAN

Compared to the other post-Soviet countries, indicators of Ukraine look particularly depressing. If in Ukraine the incidence rate according to the data for 2016 was 67.6 per 100 thousand people, in Belarus it was at the level of 39.9, in Kazakhstan – 52.2, in Poland – 17. The European average is 12 people per 100,000 population.

In the top 20 countries of the world, tuberculosis has already become an exotic disease. The epidemic in Ukraine frightens the neighbors – about 5 million Ukrainians work in the EU countries and Polish media write that a visa-free regime with the EU will allow tuberculosis to migrate to Europe. Warsaw is even discussing the possibility of medical control on the border with Ukraine.

Resistant mycobacteria

Director of the Public Health Center of the Ministry of Health of Ukraine Vladimir Kurpita says that the prevalence of multidrug-resistant tuberculosis (MDR-TB) is the main feature of the Ukrainian epidemic.

Many patients refuse to continue treatment the moment they start feeling better. They do not want to spend at least six months in the dispensary and to be unemployed, staying on the verge of poverty. Due to discontinued treatment the health situation worsens – mycobacteria becomes resistant to drugs. To treat this form, more toxic drugs should be used, the duration of treatment gets longer and it becomes several times more expensive. Now in Ukraine, 85% of the funds allocated for tuberculosis are spent for treatment of multidrug-resistant tuberculosis.

According to Kurpita, treatment of regular tuberculosis lasts six months and costs the state about 30 euros, compared to the treatment of a complicated form of infection, which takes up to 20 months, and the price for that reaches 400 thousand euros. Currently, there are 1.2 thousand cases of such highly resistant bacteria diagnosed in Ukraine. In this sad rating, only India overtakes Ukraine.

Family doctors will start to treat tuberculosis

Experts agree that it is possible to defeat tuberculosis if compulsory hospitalization will be replaced by outpatient treatment. This step may reduce the chance for reinfection in the hospital. Now patients at different stages of recovery are getting treatment in hospital rooms for 5-7 people for years, and they have the risk of catching a nosocomial infection at any time.

A health reform that is currently ongoing in Ukraine, involves the transfer of patients with non-active tuberculosis under the responsibility of family doctors. The last ones are supposed to get extra paid for each of the cured patients.

“The main idea is that doctors will be in closer contact with patients, will know their health history. Responsible people will receive their pills and will lead a familiar lifestyle,” explains Olga Klimenko.

She dreams for three Ukraine-wide days off not because of some celebration but because of a mass medical examination for the all Ukrainians so that people could find out that they have some dangerous disease before it gets to the last stage.