Sex-Workers in Russia – for Effective HIV Prevention

In 2015, the Sex-Workers’ Rights Advocacy Network in Central and Eastern Europe and Central Asia (SWAN) conducted a study ‘Failures of Justice’

Author: Anastasia Petrova, Russia

Sex-workers are one of the groups that are vulnerable to HIV. There are no government programs aimed at working with this category in Russia. According to Russian Federal Consumer Rights Protection and Human Health Control Service, over the past two years the way of sexual transmission of HIV has become more prominent: in 50.3% of instances, the positive status was received during heterosexual contacts. According to a study conducted by the Open Health Institute in 2017, the percentage of sex workers with HIV varies from 1.3% to 8.9%, depending on the region. In cases when sex work is combined with drug use, up to 15% of people become HIV-positive.

Epidemic of Violence

Sex-workers are vulnerable to HIV for a number of reasons. They have limited access to medical, legal and social services, information and prevention means. However, the most significant factor is violence from partners, clients, administrators, and police officers.

In 2015, the Sex-Workers’ Rights Advocacy Network in Central and Eastern Europe and Central Asia (SWAN) conducted a study ‘Failures of Justice’. The community on its own studied violence against sex workers. The study showed that 28% of girls in Russia were physically abused, and 4.8% – sexually abused by the police.

According to the study, the above statistics directly correlate with the HIV incidence rate among sex workers. Persecution by the police deprives sex workers of the opportunity to work in safe conditions, choose clients, or use condoms at every contact.

Unique HIV prevention project

Involving community representatives in the project work is the basis for effective prevention. In addition to highlighting services of prevention of HIV and sexually transmitted infections (STIs), a lot of emphasis is placed on strengthening the community and increasing the legal literacy of sex workers

The Silver Rose, a movement of sex workers and their supporters, has been fighting against violence since 2003. Today, the movement unites 450 sex worker leaders in more than 35 regions of the Russian Federation. Under the guidance of the leader Irina Maslova, the Silver Rose, using their own resources, are implementing a unique for Russia HIV prevention project aimed at this key group. The girls are provided with condoms, referrals to trusted doctors, and psychological and legal assistance; they are taught how to protect themselves from HIV and violence.

For instance, during March – December 2017, the Silver Rose implemented on its own the project ‘Bridging the Gaps’ in the framework of the Program on Expanding Access of Vulnerable Groups to HIV/AIDS Prevention, Treatment and Support Services in the Russian Federation. 1509 people were tested for HIV in the course of the 9 months’ work.

Involving community representatives in the project work is the basis for effective prevention. In addition to highlighting services of prevention of HIV and sexually transmitted infections (STIs), a lot of emphasis is placed on strengthening the community and increasing the legal literacy of sex workers. Girls must learn to defend themselves in the face of a constant threat of violence.

“Now this is not a project any more, but a program instead,” says Irina Maslova, referring to the continuity with which the movement helps sex workers. “These processes continue, even if funding ends. Now, at the completion of projects supported with grants of the Global Fund to Fight AIDS, we are thinking about the transition to self-financing.”

Current Legislation Does Not Solve Problems

As of today, the legislation of the Russian Federation triggers and promotes discrimination of sex workers as well as human rights violations. Sex work is punished under administrative and criminal codes. The Code on Administrative Offenses prohibits “Prostitution” (Article 6.11) and “Receiving income from prostitution if this income is associated with another person’s prostitution activity” (Article 6.12).

However, this discriminatory legislation poses more problems than it solves since it deprives sex workers of fundamental rights and freedoms, including freedom of assembly on issues of healthcare and HIV prevention. Sex workers remain vulnerable to humiliation and violence from clients, as well as to abuse from the police.

For this very reason, introducing amendments to the legislation and repeal of Article 6.11 have long been the main goal of the work of the Silver Rose movement in general and Irina Maslova in particular. After all, the repeal of the mentioned article, according to experts, will promote the observance of the rights of sex workers since they will not be afraid to turn to the police for help in cases of maltreatment or violence from clients. Decriminalization will also help sex workers self-organise to protect their rights, health and life.

Vladimir Kurpita: “Dnipro Will Become the Third City in Ukraine to Join the Fast-Track Cities Initiative”

Vladimir Kurpita thinks that the Fast-Track Cities initiative allows drawing public attention and raising additional funding for the HIV response

Author: Yana Kazmirenko, Ukraine

To learn about the benefits for the Ukrainian cities joining the Fast-Track Cities initiative and about the expectations from AIDS 2018 conference to be held in Amsterdam, read the interview with Vladimir Kurpita, Head of the Public Health Centre of the Ministry of Health of Ukraine. According to him, though Ukraine is one of the leading countries in terms of the number of people living with HIV, the government does its best to cover such people with treatment.

– What successes and challenges of Ukraine related to HIV response will be presented at the XXII International AIDS Conference in Amsterdam (AIDS 2018)?

– Today Ukraine is the second country in the European region with the biggest number of people living with HIV. Only Russia is ahead of us. In our country, there are over 230 thousand people living with HIV, while 146 thousand have been diagnosed with HIV and receive care. The HIV epidemic in Ukraine is a problem of big cities, industrial metropolises and is still concentrated in the key populations (people who inject drugs, men who have sex with men, sex workers). The issue of HIV is in the focus of attention in our country. Currently, the seventh national HIV programme is implemented, which is a result of the effective cooperation among the international partners, governmental agencies, and civil society organizations. The governmental policies may be illustrated with the fact that Ukraine is one of the few post-Soviet countries where prevention programmes, in particular, the opioid substitution treatment programme, are funded from the national and local state budgets.

The issue of detecting new HIV patients who are not aware of their diagnosis is on our agenda. In particular, we change the testing algorithms and are ready to intensively promote self-testing. A significant achievement is the fact that people already know that they can live with HIV.

 – Today, over 90 thousand people receive HIV treatment in Ukraine, and it is expected that this coverage will be increased to 196 thousand people by 2020. What will help to make it happen?

– As of 1 April 2018, over 98 thousand people received HIV treatment in Ukraine. We are actively scaling up access to treatment. Currently, the therapy is offered in more than 300 healthcare institutions and in 100 places of confinement. In 2014-2016, there were certain problems with access to antiretroviral treatment at the local level, but now the situation has been improved.

Ukrainian patients have access to innovative drugs. Besides, the cost of treatment is reduced through the use of generic drugs. Today, the average cost of treatment course is less than USD 200 a year. Now the treatment is easier both for the doctor and the patient. If the treatment is initiated on time, one pill a day will be enough.

The healthcare reform in Ukraine stipulates that testing and prescription of the first treatment scheme may be provided by the family doctor or the general practitioner. Of course, such changes require some time. There is a need to overcome fears and concerns from the side of patients and improve the level of knowledge and expertise among doctors. However, without changing the existing standards we will not be able to provide treatment to such high number of patients.

– The WHO guidelines state that to control the HIV/AIDS epidemic among people who inject drugs, 20 thousand people should receive opioid substitution therapy. Now there are 11 thousand people who receive such therapy in Ukraine…

– Opioid substitution treatment (OST) is the most effective method to prevent HIV among people who inject opioid drugs. In the recent several years, Ukraine made a big progress in scaling up the OST programmes: approaches in the government policies were changes, the number of healthcare institutions offering such treatment was increased, and we were the first in our region who started providing OST using the state budget funds. However, OST is still a high-threshold treatment method as only narcologists may prescribe it and to be prescribed with the therapy one needs to be registered with drug treatment facilities. The patients are concerned about their security and confidentiality, they are afraid that their data may be given to law enforcement bodies. Besides, it should be mentioned that OST is a therapy to treat opioid dependence. Changing drug scene, with the growing use of stimulants, salts and other synthetic drugs, requires application of other methods in addition to methadone and buprenorphine. That is why the goal of the state policy is not to increase the number of patients, but to provide access to OST to all patients who need such therapy and are eligible.

Currently, together with our colleagues from the National Police, the Ministry of Justice, the Ministry of Health, civil society and international organizations we work to change the approaches and implement innovative models to scale up OST (e.g., in places of confinement) and study the experience of pilot projects in some regions of our country, where OST programmes are managed by family doctors.

 – In Ukraine, Kyiv and Odesa joined the Fast-Track Cities initiative to accelerate the AIDS response. Have they achieved any results?

– The Fast-Track Cities initiative allows drawing public attention and raising additional funding for the programme. When the mayor of Kyiv, Vitali Klitschko, is talking about the response to the HIV epidemic, people trust him, they seek care, get tested, start treatment, and thus the municipal authorities are able to control the epidemic. It is also important that both in Kyiv and in Odesa the local authorities approved new plans and objectives for the municipal AIDS programmes and allocated additional funding from the municipal budgets. Besides, participation in this initiative allowed attracting additional funding from the international donors.

 – What other Ukrainian cities are going to join the initiative?

– Hopefully, the next city to join the initiative will be Dnipro (former Dnipropetrovsk – author’s note). Dnipropetrovsk region is already leading in terms of the number of patients who receive treatment. In the region, there are 15 thousand people who are on treatment, which is 1/6 of all the patients in Ukraine.

Expert: Polygamy Increases the Risk of the HIV Spread in Tajikistan

Author: Nargis Khamrabaeva, Tajikistan

Polygamy is one of the main factors contributing to the rapid spread of HIV in Tajikistan. This is stated in the research of the Tajik network of women living with HIV. In 2018, this network in cooperation with the public fund Your Choice conducted a review of the legal environment in relation to HIV.

Protection of rights regardless of the status

In Tajikistan, polygamy is officially prohibited and is punishable by a fine of two years of correctional labour. However, as the religious influence on the society increases, many men have several wives. The second and subsequent marriages are not registered but are consecrated by a mullah and normally wives do not live in one house.

“The committee on the elimination of discrimination against women called on Tajikistan to ensure the protection of women’s rights in existing polygamous and religious marriages regardless of their registration status,” says Larisa Aleksandrova who represents the public fund Your Choice and acts as a gender and legal consultant of the research.

According to the expert, polygamy has negative consequences in relation to HIV. First of all, in sexual relations women in Tajikistan usually do not have the right to make a decision to use condoms. Women are not able to counteract the unsafe pattern of men’s intimate behavior. According to the statistics on HIV, programmes promoting safe sexual behavior and family planning are not successful. They also do not have impact on men and youth.

Undisclosed  information is a threat to unofficial wives

Larisa Aleksandrova says that another problem is that men living with HIV prohibit their wives to go to the hospital for treatment.

Larisa Aleksandrova, representative of the public fund Your Choice, gender and legal consultant of the research

“One of the reasons why men have such behavior is the fear of public disclosure of their HIV status. Another reason is additional expenses on the treatment of the spouse, who usually is being financially taken care of by the husband. In many cases, such behavior led to the death of women,” tells the expert.

Besides that, polygamous men living with HIV infect all their spouses. During consultations in the AIDS Centre, they often choose not to tell that they have several wives because polygamy is a criminal offence. Therefore, undisclosed information becomes a threat to the lives of unofficial wives. They simply will not know about their status and will not be able to receive the treatment.

“Polygamy is a major risk for the spread of HIV. In 2017, in the town of Nurek a lawyer defended the interests of a woman who contracted HIV from her husband. She demanded compensation for moral and material damage due to the transmission of HIV. The investigation showed that the woman’s husband had a second wife who had died of tuberculosis. After that, according to the Muslim traditions, the man got remarried for the third time. He was seen together with his new spouse in the AIDS Center in Nurek where both of them were receiving antiretroviral therapy. It is possible that the third wife already was HIV-positive as well”, tells Larisa Aleksandrova.

This is not an individual incident. When interviewing women living with HIV, some respondents said that their husbands had second wives, and in most cases, they found out about it when they got to know about their positive HIV status.

 

Mother-to-Child Transmission of HIV in Kyrgyzstan is Minimal

Now about half of the money allocated by Kyrgyzstan for the HIV component goes to the procurement of test kits for pregnant women

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is getting prepared to receive a certificate to confirm elimination of mother-to-child transmission of HIV. In the last five years, over 95% of pregnant women were covered with prevention projects, while the new cases of vertical HIV transmission are now at the level of 2%.

Testing is an integral part of prevention

Since 2007, all pregnant women have been tested for HIV when registered in maternity care. In case of a positive result, the woman is registered with HIV treatment facilities and receives consultations on the need of antiretroviral treatment (ART).

“A good, easy-to-understand consultation leads to the woman giving her voluntary consent to the therapy initiation. There are rare cases when women refuse treatment due to the lack of knowledge or religious beliefs, but most often – due to their self-stigmatization. The share of such refusals is now less than 2%,” says Erkin Tostokov, physician working at the Prevention Unit of the Republican AIDS Centre. “There are some cases when a woman is first seen by the doctor only when she delivers her baby. For such women, we do rapid HIV testing in the maternity clinics and, if HIV is confirmed, we hand out ART drugs right there. We update our clinical protocols in line with the most recent WHO guidelines and train our doctors on a regular basis.”

Children born to HIV-positive mothers go through several stages of examination: early diagnostics to identify if the foetus is infected intra uterine; then within 4-6 weeks doctors have to exclude HIV transmission during the delivery; and the last test allows detecting the HIV status of the infant after the breastfeeding is completed. Children receive preventive ARV therapy depending on their risk level and receive monthly social benefits during the whole period until final confirmation/non-confirmation of the diagnosis (up to 18 months).

Social benefits for children living with HIV

Elena learned that she had HIV in 2011. In a while, the woman found out that she was pregnant. Back then, she was in a difficult situation: no job, no place to live, and no money. The woman felt lost because of her HIV status.

“The doctor prescribed ART and I started taking the pills, though before I refused to take the therapy because of my allergy,” Elena recalls. “When my daughter was born, she received preventive therapy for two months. When my girl was 18 months, the doctors did the last test and took her off the register as she was perfectly healthy. However, I was still scared and took her for HIV testing until she was four years old.”

Now about half of the money allocated by the state for the HIV component goes to the procurement of test kits for pregnant women. The government provides social benefits for children living with HIV and free breast milk substitutes.

“In the recent 7-8 years, our programmes to prevent mother-to-child transmission of HIV achieved a big progress: the share of such transmission was reduced from nine to one percent,” says Aybek Bekbolotov, Deputy Director of the Republican AIDS Centre. “To a great extent, this result was achieved through the efforts of doctors working in general and maternity clinics. Now there is almost no pregnant woman whom we miss. All maternity clinics have been provided with rapid HIV tests and ART drugs. We received a strong support from UNICEF. They provided training to doctors, supported the launch of early diagnostics in newborns and rapid testing in maternity clinics. Now they help us to get prepared to receive the certificate of having eliminated mother-to-child transmission of HIV. A country can get such a certificate provided that the rate of vertical transmission is less than 2% and if over 95% of pregnant women have been covered with prevention programmes in the recent two years. There are certain requirements to indicators and procedures to calculate such data, and now we are working on meeting them.”

Support and training in the summer camp

Currently, there are 478 children with HIV registered in care, 464 of them receive treatment. Every year, summer camps are held for children living with HIV with UNICEF support. This year, this event will be brought to the international level for the first time.

“In July, there will be a one-week summer camp for children, parents, doctors and social workers from Kyrgyzstan, Kazakhstan, Tajikistan, Uzbekistan, and Turkmenistan. There will be trainers from the UK, Ukraine, Russia, Germany, Spain, the Netherlands, and Italy,” tells Aybek Bekbolotov. “The camp will include several parallel events: a forum for adolescents living with HIV and their parents, workshop for pediatric medical staff and training for psychologists and social workers.”

Medical and social workers will be trained to work with children living with HIV, while children and their parents will develop support and leadership skills and are expected to form a new community.

19 June: Second Edition of EECA Food and Art Night in Amsterdam

The second edition of PLOV ARTxFOODxCINEMA is coming to Amsterdam on 19 of June. Culinary experiences and cinematographic impressions of Eastern Europe, the Caucasus and Central Asia will come together during the event organised by the AFEW Culture Initiative in collaboration with the partners IDFA and Studio/K.

PROGRAMME

▹ 16.00 – 22.00: Four visual artists-in-residence (AiRs), Hanna Zubkova (Minsk/Paris), Hassan Kurbanbaev (Tashkent), Ilya Fedotov-Fedorov (Moscow) and Lado Darakhvelidze (Kutaisi/Arnhem) showcasing their ongoing artistic projects.

▹ 18.00 – 19.45: Two-course dinner (Armenian ajab sandal/ajapsandali (summer stew) and Georgian khachapuri (cheese pastry).

▹ 19.45 – 22.00: Documentary screening ‘When the Earth Seems to Be Light’ by Salome Machaidze, Tamuna Karumidze and David Meskhi (Georgia, 2015) & Q&A.

“Revolutionary skaters wreaking havoc in the streets of Tbilisi, stories of a vacated Red Light District brothel, photographic footage of Tashkent’s revolutionary youth, vegetarian-friendly Armenian Summer stews, popular mythologies of HIV/AIDS in a post-Soviet world, medicines vs poison, ChemSex and ‘slamming’ subcultures of Amsterdam, queer visibility in contemporary Uzbekistan and an explosion of dairy and cheese à la Georgian. These are just some of the ingredients of PLOV #2.

Young Georgian skaters, artists and musicians feel trapped between the powers of the Church and the political world. They create their own open spaces beneath viaducts and at other “non-places” that lend themselves to romantic notions of a free existence. Questions are posed to them about God, love and freedom, but these boys would much rather just be skating – for many of them it has grown into an obsession. They may be unfazed by painful falls, but narrow-mindedness really gets to them. One of them was bullied because of his hairstyle, and he explains that Georgians simply won’t accept people who look different. Many of their friends share their bleak vision of their country. The way they see it, Georgia is all about the old rather than the new. They get no acknowledgement here, so they spend their evenings throwing Molotov cocktails at a concrete slope. Their tattoos are “a diary you can’t escape from. You tattoo what you feel; what’s important for you at that moment.” The portraits of the skaters are based on a series of photos by David Meskhi, one of the three directors. This impression of their daily lives is intercut with news footage of demonstrations in Georgia.”

[Georgian language, English subtitles]

TICKETS

– Open atelier/showcase space is free of charge.
– Ticket €20,00 for dinner + documentary.
– Ticket €15,00 for dinner only.
– Ticket €9,50 for documentary only.

* Ask about student discounts when reserving.
** Cineville Pass discounts accepted [only pay for dinner option].

For reservations, please call 020 692 0422 (Studio /K) or email the AFEW Culture Initiative at judith_kreukels@AFEW.nl.

Subscribe to AFEW Culture Initiative‘s newsletter here, follow their Facebook and Instagram.

Georgian Youth for Music and Harm Reduction

For the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day during 4GB festival

Author: Irma Kakhurashvili, Georgia

4GB is an annual electronic music festival which has been held in Georgia since 2011. The festival is dedicated to the memory of DJ Giorgi Bakanidze – one of the Georgian club music pioneers. This year, 4GB was held in an abandoned Cosmic Constructions Centre near the Saguramo village. Apart from the high-quality lineup, sound systems and headliners performing on stage, 4GB festival had another prominent feature – for the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day. Mandala – Harm Reduction youth project team members did their best to make sure that more than one hundred participants of the festival stay healthy. Thanks to this project, drug and alcohol intoxication, overdoses and other risky situations were brought to naught.

Information as weapons

Information about the new project first appeared in social networks. Several days before opening of the festival, organizers announced that due to the growing number of drug-related deaths (last month, seven young people died in Georgia – author’s note) they decided to protect their guests and music lovers with the help of Mandala – Harm Reduction.

With the financial support of Doctors of the World (France), 20 young volunteers, who received harm reduction training, were engaged in the project.

“Last month, several young people died of drugs, and we thought that in such circumstances our initiative will be very timely. We still remember the last-year GEM FEST, where 22-year-old Natia Tavartkiladze died of drug intoxication in Anaklia. Therefore, our goal was to give all people, especially young ones, objective information about health, drug use and personal safety,” says Temur Khatiashvili, Project Coordinator.

20 young volunteers, who received harm reduction training, were engaged in the project

According to Temur, the awareness-raising materials distributed at the festival were specially developed for young people – pocket-size brochures with the original design, which used simple language to describe a number of popular club drugs, their potential harms, and universal overdose prevention and safety rules. The brochure included a matrix showing the compatibility of different low- and high-risk drugs and a map of the festival territory marking the tent offering harm reduction services. In the friendly atmosphere of the tent, all interested people could receive consultations, get free condoms, drinking water and hematogen (nutrition bar that is often considered to be a medicinal product and is used to treat or prevent low blood levels of iron and vitamin B12 – editor’s note).

Project to be continued

The 4GB festival had a happy end. Participants of the Mandala – Harm Reduction project coordinated their efforts with the ambulance team, which they contacted over the radio in case of need.

The 4GB organizers welcomed Mandala – Harm Reduction as it clearly demonstrated that such project is important for thousands of people who are brought together by such large-scale music event. Participants of the festival were also positive about the project.

21-year-old Tamar Ninua thinks that today electronic music is the fastest growing youth culture in the world, and such projects are especially important for people who may use drugs, not being fully conscious of the consequences of their unsafe behaviours. In such cases, access to timely assistance is very important.

“Despite of the high health risk, people still use various substances. The festival is not an exception. The efforts of Mandala volunteers helped to mitigate the risks. Many young people lose self-control in the euphoria of the festival. The Mandala volunteers, who were easy to recognize as they were wearing kind of a uniform, were moving around in an organized way and were promptly responding to any cases who might need help,” says Tamar.

The project initiators are optimistic and say that in the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia. They hope that they will receive support not only from different harm reduction charities but also from the mayors’ offices.

It is not that easy

In the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia

“We will try to improve this project and will learn to overcome the barriers that we face. E.g., festival organizers said that we could by no means hand out syringes. They said that young people might see it as an incentive for using drugs. However, we insisted until the end that this service is necessary. Besides, they were against the distribution of naloxone but we were able to prove that having a highly effective medication to deal with overdoses is vital,” told Mariam Ubilava, project volunteer and coordinator.

According to Mariam, the project is aimed at preserving the health of each festival participant, at mitigating the negative consequences of substance use and achieving behaviour changes.

“We noticed one more problem. When some young people saw us, they were more eager to practice risky behaviours, hoping for our help. Thus, they reduced their own responsibility, shifting it on us. That is why we will have to think how to prevent it from happening in future and find a balance,” says Mariam.

Such projects as Mandala – Harm Reduction are widely implemented at various music events all over the world, such as Amsterdam Open Air, Lollapalooza Paris, Tomorrowland, etc.

Integrated Care Centre in Almaty – a Home for Everybody

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices

Author: Marina Maximova, Kazakhstan

A month ago, the first Integrated Care Centre for people in difficult life circumstances, called Revenge, was opened in Almaty, Kazakhstan. The centre was established at the initiative of the community of people living with HIV.

Invisible People

People living with HIV (PLWH), people who use drugs (PUD), those who are released from places of confinement… Those people are often left behind and ignored. They are invisible, pinned to the wall of despair, with a trail of problems that remain unresolved for years, not believing that there is a light at the end of the tunnel. Now they know where they can find help. Where they will be understood and will not be neglected. Now the address 14A Omarov Street, Almaty is well known to many people. They pass it on to each other, realizing that for someone it might be the last hope.

“The centre was opened by the community, which is one of the factors attracting the potential clients. Here people can stay overnight or even live for a while until they are able to resolve their most pressing problems. The main thing is that here they are able to get a temporary registration, which is the main barrier in re-issuing the documents, getting “registered” with a healthcare facility, etc. The centre is a unique initiative and its launch was very well timed,” tells Roman Dudnik, Executive Director of AFEW Kazakhstan.

AFEW Kazakhstan supported the idea of opening the Revenge Centre within the Project “Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia.” Among other initiators – activists of the Kazakhstan Network of Women Living with HIV and the Revenge Social Support Fund.

I reached the lowest point of my life

Director of the newly established centre Yelena Bilokon knows about the lives of people who practice risky behaviours not by hearsay. She was using drugs, lived in the street and has been living with HIV for 22 years. Rehabilitation centres inspired her to start a new free life. She got acquainted with the rehab clients within her community activities. When she saw the premises, the joint work, the support people provided to each other and their enlightened faces, she felt that she wanted to open her own centre.

Timurtau centre was her first success. It is a crisis centre for families called My Home, which provides assistance to many women and their children who are in trouble. The Almaty project is more large-scale.

“We have clients who have not been able to access antiretroviral treatment (ART) and, thus, to reduce their viral load and even go through medical examinations for three years or more. What can we say about migrants if even our citizens cannot receive these services? The same story is with tuberculosis patients who are left without social benefits, which they are entitled to. People are not even able to find jobs. As for children, when they get into crisis situations with their parents, they also need help, sometimes even more than adults,” says Yelena Bilokon, Director of the Kazakhstan Network of Women Living with HIV.

Up to 40 calls a day

In the centre, telephones are ringing all day long. Many people need help. The centre, in fact, is also in need of help. Kitchenware, clothes, bed linen, furniture, food… All these things are brought by good people. There was a call for help in social networks – and a lot of people responded.

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices. 25 people were tested for HIV with rapid tests, 17 found jobs, 11 were examined for hepatitis and tuberculosis. It is not just statistics. Every number symbolises the struggle for someone’s health and life. Every day.

“Opening of such centre offering integrated services for vulnerable populations is an important event for our city. All the crisis centres, which existed before, had their own profiles and worked only with certain populations. People who need help cannot always find a centre offering the necessary services quickly. The Revenge Centre helps everybody,” says Alfia Denebayeva, Deputy Chief Physician of the Almaty AIDS Centre.

Workshops on case management, outreach work, stigma and discrimination delivered by medical professionals and civil society leaders help the centre clients to become volunteers. Recently a youth and adolescent club was opened in the centre, with many guests coming for the opening ceremony. In fact, they are not called guests here – those are our friends and allies, and their number is growing day by day.

AIDS 2018: Ukraine is Looking for Expertise and Technologies

Author: Yana Kazmirenko, Ukraine

At AIDS 2018 to be held in Amsterdam, Ukraine will be the focus of attention. It is one of the leading countries in terms of HIV transmission, with half of people living with HIV not knowing their status and the war in the east of the country combined with hundreds of thousands of migrants contributing to the aggravation of the situation with HIV. Our article highlights what expectations representatives of Ukraine have from AIDS 2018 and what experiences they are ready to share.

Olena Voskresenska, Director of AFEW-Ukraine

Expectations from AIDS 2018

I hope that the conference will help to draw attention to the region of Eastern Europe and Central Asia, in particular to Ukraine. Our country is interested in the experience of countries, which have a social contracting mechanism for non-governmental organisations because NGOs currently play a key role in the delivery of services to the populations most vulnerable to HIV and the support that comes from the governmental budget to these services will be most relevant for Ukraine after withdrawal of the Global Fund.

Opportunities of the conference

AFEW-Ukraine plans to learn about the promising models of work with our target populations, primarily aimed at young people. We are going to share our experience of working with adolescents who use drugs.

This year we have been able to support our partners from the regions of Ukraine, including programme clients and community members, who will take part in the conference. Using the experience of other countries, through joint efforts we will improve our activities in Ukraine.

Vira Varyga, Chair of the Board of Positive Women NGO, leader of the self-help group for HIV-positive women, Kyianka+

Expectations from AIDS 2018

This will be my first time to participate in a conference of such level. We will share the experience of the self-help group for HIV-positive women, Kyianka+, where we provide services to women living with HIV, helping them to accept their status and overcome stigma.

The model that we apply is patented in the Netherlands. It is based on personal development and leadership. The woman not only accepts her own status, she also helps others and is involved in the life of the group, in the advocacy and representation of the community interests.

Opportunities of the conference

We would like to learn about the new methods of work with women, about prevention, treatment and diagnostics. We hope that the participants will appreciate our social theatre, where the mime performance and direction are the products of creative activities of the Kyianka+ members.

At the conference, we will also offer some hand-made items produced by our activists for sale. The money we earn will be used to support the women who are hospitalized and do not have resources to pay for their treatment.

Nataliia Isaieva, Director of All-Ukrainian Charitable Organization, Legalife-Ukraine

Expectations from AIDS 2018

Taking part in the Amsterdam conference, I plan to achieve two goals: first, study the experience of countries from which the Global Fund has withdrawn. In Ukraine, there is an alarming trend: the Global Fund withdrawal leads to the collapse of the health care system to vulnerable populations’ support. For instance, we lack friendly gynaecologists. Sex workers cannot go to public clinics as they hide vital information about their occupation and therefore they will not receive adequate treatment.

The second question, which is very important for us, are the increased restrictions of working conditions. Commercial sex services and human trafficking are more and more undesirable linked with each other and this often is leading to serious consequences for the sex-workers. USA adopted SESTA-FOSTA legislation, which intends to curb sex trafficking but has as a consequence that it prohibits offering sex services via internet. Such laws make it impossible for sex workers to look for their clients online so they are forced to go back on the streets, risking their lives and health. The “crackdown” trend is typical not only for the United States, so we need to offer a joint strategy to confront such “crackdown” policies.

Igor Medvid, HPLGBT coordinator, involved in social activism since 2004

Expectations from AIDS 2018

At the conference in Amsterdam, I will present a thesis based on the findings of “The study of behaviours of transgender persons and their needs for HIV prevention services in Ukraine.” We interviewed 438 people and currently, it is the biggest study in Eastern Europe and Central Asia. The study showed that the HIV prevalence among transgender persons is up to 21%. 91% of transgender persons provided sex services at least once. At the same time, the level of condom use is extremely low – 69% of respondents did not use condoms during the last intercourse. This study allowed us getting statistical data and receiving a Global Fund grant. Without the support of AFEW we would not be able to conduct the study.

Now we are opening a regional office, launching a site, making efforts to increase the visibility of transgender people. Before the end of this year, we would like to introduce a member of our population to the Country Coordinating Mechanism.

Another objective that I have for the conference is to learn as much as I can about the cross-cutting activities because transgender people fall into three groups: MSM, sex workers, and people who inject drugs.

Aleksandr Mogylka, Director of the Compas day care centre for adolescents who practise risky behaviours (division of the Blago Kharkiv Charitable Foundation)

AIDS 2018 is…

…a global-scale event, which can be compared to the major film festivals, air and motor shows. The only difference is that at the conference apart from successes and achievements we will also be talking about the ways to overcome challenges. It is good to watch films, drive cars and feel proud of the achievements in aircraft or spacecraft engineering when you are healthy.

The problem of HIV/AIDS may not be resolved only by fighting the virus. It may be resolved by changing the attitude to this issue and by changing people’s attitudes to themselves. Many countries have already taken such steps and reduced the risk of development of the epidemic.

Opportunities of the conference

We would like to learn about the best practices in fighting HIV and to share the experience of our organization in involving law enforcement agencies in HIV prevention among most-at-risk adolescents.

A police reform has been implemented in Ukraine and adolescents now see the police as something new and interesting. Our objective was to unite the resources of NGOs and police to prevent the use of drugs, which often lead to experiments in sexual relations. Building trust relations between adolescents and police contributed to the formation of a city mechanism to refer adolescents to the network of partner organizations formed at the initiative of the Foundation.

Unconventional formats of cooperation between the police and civil society organizations can help to change the behaviours of adolescents.

Natalia Bezeleva, Executive Director, Svitanok Donetsk Charitable Organization

AIDS 2018 is…

…an opportunity to show yourself to the world and access the best international practices. In 2010, Svitanok received the Red Ribbon Award, which is the Oscar of health care. We received it for our work with children. The award was given to us at the opening of the conference when Bill Clinton delivered his speech and the singer Annie Lennox presented her foundation. It was a great success both for our organization and for Ukraine.

Expectations from the conference

At the conference, people will be asking me questions about the situation in the east of Ukraine. We have a lot to be proud of: in two years, we restored the ruined laboratories, AIDS centre and services. For the first time ever, a regional HIV/AIDS and tuberculosis programme was adopted and funded. Now we also have a roadmap for the transition period, when donors will withdraw from the country and all services will be funded by the government.

As a social worker and an internally displaced person, I am interested in the topic of gender in terms of what impact the situation of women has on the epidemic of HIV/AIDS.

A Chance to Find a Way Out

Methadone administration at the OST site in Oskemen

Author: Marina Maximova, Kazakhstan

Since 20 December last year, no new patients have been enrolled in the opioid substitution treatment (OST) programme in Kazakhstan. This decision based on the governmental inspection results led to concerns among civil society activists and medical professionals and to panic among people who use drugs (PUD).

I just want to live!

Her story is a cry for help. Aygul (the name was changed) from Almaty spent half of her 34 years on drugs. There was a time when she was dreaming to become a fashion designer, conquer Paris, meet her love, have children… Then, when she was 17, she tried heroin in a group of other adolescents and could not quit it. Back then she was sure that she could change everything and start her life with a clean slate. It seemed that she had all her life ahead. However, ahead of her there was only a fight for life. Drug abuse, HIV, hepatitis C…

“Due to drugs, I failed to receive an education. I spent my days in jail instead of school. As for my long-awaited love, it was the love for drugs. My dreams were buried together with my unborn babies. My window to Europe was the grilled window in the compulsory therapy department of the drug treatment centre together with other women who were as miserable and weak-willed as I was,” tells Aygul with tears in her eyes.

The only support comes from the woman’s parents who are elderly and exhausted with the daughter’s disease. Aygul hopes to enroll in the opioid substitution treatment programme and receive methadone. Now this dream is falling apart. Aygul was getting prepared, gathering documents. She found a job and believed that she would be able to start a new life. After all, she wants to live so badly!

Insight but not for all

In Almaty – the biggest city in the country – methadone-based OST has been implemented since 2017. It started later than in other cities of Kazakhstan. There was a strong public lobby against it. In less than a year, 15 people were enrolled in the programme with strict eligibility criteria, through the plan was to enroll 50 patients. Considering the estimated number of PUD – over nine thousand – the coverage was extremely low. However, even in this situation PUD and their co-dependent people had a goal and a hope – try to get in the programme and, thus, survive.

As of the end of the last year, 359 people were enrolled in the OST programme in Kazakhstan, including 31 women and 62 people living with HIV. There are success stories: 44 people found jobs, five started families and two female patients became mothers.

“The next steps were anticipated and planned to strengthen OST – approve a programme at the legislative level, launch OST in places of confinement, conduct ongoing monitoring of the patients’ health state. It is proven that methadone therapy has a positive social and psychological effect as people who receive treatment reintegrate into the society. Then, all of a sudden – the programme will not be scaled up, new patients will not be enrolled,” complains Sergey Shetnikov, Substance Abuse Consultant from the Answer NGO based in Oskemen (Ust-Kamenogorsk).

The last chance

In Kazakhstan, the OST programme was started in 2008 with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Within the period of its implementation, the programme was expanded into 13 cities. OST was included into the 2006–2010 National AIDS Programme. Its further implementation was stipulated in the National Programme “Healthy Kazakhstan 2011–2015.” Methadone is registered in the country. Staff is trained. The therapy is provided by multidisciplinary teams consisting of drug treatment doctors, psychologists, social workers, and nurses. The programme was positively assessed by the international organizations – UNODC and ICAP. It seems that there are all the prerequisites for scaling up OST…

“Apart from the recruitment of new clients being suspended, there is one more alarming trend – exclusion of clients. Thus, in Timurtau in Karaganda region the number of clients halved in three months. There are also disturbing signals from other regions of the country. How should people who have been excluded live on? Go back to heroin and jail?” asks Oksana Ibragimova, Advocacy Officer of the Kazakhstan Union of People Living with HIV.

OST for all people who need it may be the last chance for them to go back to normal life, to the society and the family, find jobs and feel that they are normal people.

The Z hour is in a month

Assessments of the OST efficiency and performance in Kazakhstan have been conducted more than once. Now an interagency committee is working, which is to issue its opinion in a month, on the eve of the 22nd International AIDS Conference in Amsterdam (AIDS 2018). Maybe, this decision will influence the attitudes of the Kazakh delegation. So far, some optimism may be derived from the opinion of Nikolay Negay, General Director of the Republican Scientific and Practical Centre of Mental Health at the Ministry of Health of the Republic of Kazakhstan.

“The Ministry of Health of Kazakhstan supports OST. It is one of the key elements of the cluster of drug treatment provision to patients with the opioid dependence. The programme is continued. In future, we hope that it will be implemented in line with the evidence-based international best practices,” he says.

Coalition of Communities of Kyrgyzstan: “We United to Strengthen the Voices”

The Coalition of Four Communities is developing a media campaign to eradicate hate and stigma speech

Author: Olga Ochneva, Kyrgyzstan

Community organizations are often not cooperative: each one deals with specific problems and has its own approaches to work. Nevertheless, the Coalition of Four Communities: people who use drugs (PUD), sex-workers (SW), people living with HIV (PLHIV), lesbians, gays, bisexuals and transgender people (LGBT) is developing and gaining strength in Kyrgyzstan. Consolidation began three years ago without any financial support. The goal is to make the participation of communities in solving the problems of their groups meaningful, to fight against HIV, to reduce stigma and discrimination. Below we discussed the experience of interaction, successes and plans with the representatives of the Coalition.

Four years ago, our interlocutors could not even dream of uniting all groups vulnerable to HIV.

“I said three years ago, that organisations for people who use drugs can only unite with a group of PLHIV, and probably with sex-workers organisation. The representatives of our group often have experience of imprisonment and would never join the LGBT community,” says Sergey Bessonov, leader of the IDU community organization Harm Reduction Network Association. “At the meeting earlier this year, 99% of my employees agreed to work with convicted men who have sex with men. This is the result of the gradual and systematic work on the consolidation of our groups, which we have been carrying out in recent years. People start looking at each other differently.”

The true spirit of unity

The groups began to unite in 2015, when women who use drugs (Asteria), sex-workers (Tais Plus) and the LGBT community (Labrys) took part in presenting an alternative report on the situation with all three groups at the 60th session of the CEDAW Committee on the Elimination of Discrimination against Women in Geneva. According to the members of the Coalition, they sensed the real spirit of unity during the election of a representative from the community to the governmental Coordinating Council for Public Health.

“As community organizations, we have mobilized to promote our candidate as an alternative to a candidate from AIDS-service organizations, since we have different approaches to work. Spontaneously, within two hours we managed to organize 47% of the votes,” recalls the director of the organization for women who use drugs Irena Ermolaeva. “Then the community of PLHIV and men who used drugs joined us. Although our candidate did not win, we understood that we are stronger standing together than alone, understood the real power of consolidation and were inspired by it.”

Similar problems in groups

The first activity of the Coalition was the development and submission of two project applications. At this time, a large regional network announced grants for the development of consortiums of communities. According to the representatives of the Coalition, the focus of their applications was on maintaining tolerance among groups as the basis for the future work. The Coalition has not received support but did not stop a joint activity. In 2017, the Coalition together with the Office of the Ombudsman conducted monitoring: they monitored the rights of all four communities. Later the organizations united to conduct a media campaign to eradicate hate speech and a language of hatred.

“Initially, the campaign had to be focused on the LGBT community. At the joint meeting last summer we decided to include all our communities in the campaign,” says Nazik Abylgazieva, the LGBT representative of the Labrys organization. “We made a video with famous people of the country who spoke about our problems. Our message has been heard: during three days, the video was viewed by more than 150 thousand people.”

50 representatives of different communities took part in a joint training, recalls the psychologist of the PLHIV-organization Prosvet Margarita Sabirova, and the team-building process was seen. People overcame external and internal discrimination. It became clear that groups had similar problems.

Involvement on a short notice

Now the Coalition includes seven community organizations representing women, men and young people who use drugs, PLHIV, sex-workers and the LGBT community. The Coalition is considering two more candidates. The association is not officially registered and is currently developing its strategic plan.

“Memorandums, agreements and the formal creation of consortiums do not solve the problem. If we understand each other and trust our partners, there is no need to register it legally since we are ready to help each other on a short notice, ready to get involved, to support,” claims Sergey Bessonov. “Together we already submitted several applications for our Coalition. The first joint project is aimed at bringing our communities closer together. We develop the three-year strategy of our Coalition and determine how we will interact to promote common interests.”

The Coalition received Global Fund project this year. Due to cuts of funding, it was decided to leave only one network that would work for all the groups instead of four separate national networks of communities. In the framework of this activity, communities monitor and advocate to improve the quality and access to HIV programs as well as receive technical assistance to increase community capacity and solidarity.