Projects  

The «ACCESS» Project HIV/AIDS and TB/HIV Collaborative Efforts in Central Asia

Project Duration:
3 years

Donor:
Ministry of Foreign Affairs, The Netherlands(Medefinancieringsstelsel – MFS)

Partners of the Project:
Civilian and penal governmental institutions and NGOs involved in HIV/AIDS and Tuberculosis in Central Asian Republics, international organisations and the KNCV Tuberculosis Foundation – The Netherlands

Countries of the Project:
Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan

Background:

AIDS Foundation East-West (AFEW) is launching the innovative large-scale «ACCESS» Project HIV/AIDS and HIV/TB Collaborative Efforts in Central Asia

The «ACCESS» Project HIV/AIDS and HIV/TB Collaborative Efforts in Central Asia will build upon a previous programme managed by AFEW and complement current national programmes and international initiatives; it is designed to mitigate the impact of HIV/AIDS and tuberculosis (TB) among vulnerable populations in the Central Asian Republics. To this end, the programme aims to improve access to HIV and TB prevention, treatment, care and support services for sex workers (SWs), injecting drug users (IDUs), prison inmates, people living with HIV/AIDS (PLHIV) and TB patients through increasing the continuity in prevention services and ensuring that patients with HIV and/or TB have access to adequate medical care related to the treatment of HIV/TB co-infection.

Project activities will be developed around a mixed balance of three inter-related components, including:

• policy development awareness raising and advocacy,

• capacity and skills building, and

• direct service support for vulnerable groups.

The Central Asian Republics (CARs) lie along major drug trafficking routes from Afghanistan to Western Europe. The abundance of cheap illicit drugs has contributed to the increase in injecting drug use in recent years as well as the number of HIV cases due to the use of non-sterile injecting equipment.

Compared with other regions in the world, Central Asia is currently experiencing one of the fastest growing HIV/AIDS epidemics, mainly among injecting drug users (IDUs). The number of officially registered HIV-positive individuals continues to rise, while the epidemics in Central Asia continue to expand, with Uzbekistan and Kazakhstan leading the pack. In 1996, there were 96 registered cases across the region. By December 2006, there were 19,099 cases officially registered by the governments of Central Asia; it is generally accepted that the actual number of HIV cases is likely several times higher than official figures suggest. According to official statistics, 70–85% of all HIV cases in Central Asia are transmitted via injecting drug use and more than 80% of those who are currently HIV positive are under the age of 30. Thus, the epidemic is threatening the very future of the region.

Along with widespread injecting drug use, CARs are confronting four overlapping epidemics, namely hepatitis, HIV/AIDS, sexually transmitted infections (STIs), and TB. Incidentally, all of these epidemics affect similar vulnerable groups such as prison inmates, SWs, IDUs, and migrant populations.

TB/HIV morbidity and mortality in the region are expected to accelerate significantly if adequate measures are not adopted to halt their spread and treat those already infected. ‘TB and HIV fuel each other and the implementation of sound client centred TB/HIV collaborative activities tailored to injecting drug users in civil as well as in prison settings must be addressed as a priority in order to take advantage of the existing window of opportunity before the TB and HIV epidemics fully merge,’ states AFEW’s Executive Director Dr. Joost van der Meer.

One of the principal challenges facing effective prevention, treatment, care and support efforts for HIV/AIDS, STIs and TB in the Central Asian Republics is the way in which the healthcare systems are vertically structured. Assessments conducted by AFEW and national partners across the region serve to convince experts of the acute need to establish relays between target groups and service providers in order to increase information about, access to and the utilisation of services.

It has been demonstrated that, through increasing the number and quality of services available to vulnerable populations and ensuring that these groups gain access to these services, the impact of HIV/AIDS in Central Asia can be dramatically reduced. More specifically, it is believed that through increasing the availability and quality of these services, vulnerable populations will have access to the services they need to help them avoid contracting HIV or to assist them in coping with living with HIV, including support towards engaging in safer behaviours and in improving adherence to essential HIV and TB treatments (and, thus, reducing drug resistance). The outcome of this is anticipated to be a lower rate of HIV infection as well as a general improvement in the quality of life for PLHIV.

AFEW’s «ACCESS» Project will guide its activities in two main directions. The first centres around improving the quality, range and distribution of HIV/AIDS services available within the target regions, including the wide dissemination of the client management service model. The second direction focuses more on HIV/TB co-infection issues and facilitating the co-ordination of HIV/TB activities between quite vertically separated and isolated healthcare structures. HIV/TB co-infection issues have been specifically targeted since HIV/TB co-infection and the associated issues have thus far received little attention in Central Asia despite the high prevalence of TB in the community and the importance of TB amongst HIV/AIDS patients.