“If you can help someone Here and Now, you should do it without postponing it or thinking what other people can do,” says Ekatherina Rusakova, Director of Sverdlovsk Regional Charitable Organization “Malaxit” supporting people in difficult life situations. “If every one of us helps at least one person, maybe it will drive changes in the society.”
To support these words, Malaxit implements the project “Social and legal support of people who use drugs in Yekaterinburg” with financing and support of the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia (EECA).
Ekaterina how does your organization help people who use drugs in Yekaterinburg?
Mainly we provide social and legal support to clients to eliminate regulatory and discriminatory barriers, help them to get fair court decisions and access to free rehabilitation. Besides, we provide our clients with referrals to healthcare and social support institutions of the city. Our social worker makes outreach visits to families with small children. He provides consultations on HIV and treatment, helps clients to make appointments with specialists, assists them in re-issuing documents and receiving temporary registration in the city as clients are not able to receive medical or social services without registration.
Why did you decide to apply to the Emergency Support Fund for Key Populations in EECA?
We applied to the Emergency Support Fund because the situation of PUD in our city is difficult. Many people still do not recognize that substance use is a disease. However, this condition needs comprehensive treatment, including medical assistance, psychological and social support. Moreover, efforts should be aimed not only at the person using substances, but also at such person’s family as substance abuse is a systematic, family disease.
Of course, current situation contributes to the growth of HIV and other socially significant diseases (tuberculosis), while people who use drugs remain outsiders and the society prefers not to notice them. However, it is not possible to solve this problem pretending that it does not exist, after all sooner or later it will manifest itself and, most likely, in a very negative way. That is why, in our opinion, enough attention should be paid to secondary prevention and working with the “risk groups”.
What case from your practice do you remember best of all?
That’s a story of one of our clients. Andrey came to our project when he learned about it from his friends. Back then, there was an investigation against him based on part 2 of article 228 of the Russian Criminal Code. Our staff members signed a social support agreement with him, drafted procedural requests and collected all the necessary documents. Social worker of the project acted as a community advocate in court. A person from the rehab also took part in the court hearings. As a result of our joint efforts, Andrey got a suspended sentence with a course of rehabilitation.
What does the society think about your work?
It depends: some people support us, some don’t and it’s fine! All people cannot think the same and have the same “view of the world”. We are all different, with various views, values, attitudes, and that’s the beauty of human beings – in their differences…
Have you ever faced any challenges working with the key populations?
Speaking about the members of key populations, our target groups, they are all positive about our activities, they trust our staff members and our experience. We mostly see challenges related to new psychoactive substances, which our clients still use. That is why they can have unpredicted behaviours, treatment interruptions, etc.
How does engagement of the key populations in your activities help you in your work?
I think that when implementing such projects it is very important to engage members of the key populations. Without such engagement, it is not possible to reach PUD, who are a very closed target group, especially considering that in this group there is a very low level of trust to people.
Your example of a perfect society.
I don’t think I could give you an example of a perfect society. I tend to be realistic when looking at things, not losing myself to illusions. I do not like it when people say that somewhere there is a perfect country and a perfect society, where everything is fine, which we should strive to achieve. There are some pitfalls everywhere. It is important to realize that there are good things everywhere and we need to learn to notice and appreciate them. I am sure that we have to always start with ourselves and you can of course feel offended and be angry at our country and our authorities, but it does not bring any results. Speaking about a specific country with the approach to working with key populations that I like, for me it’s Portugal.
The project is supported by the Elton John AIDS Foundation.
Today, December 6, Bishkek joined Zero TB Cities international initiative aiming to reduce tuberculosis disease rate in cities, an important event happened during City Health Leadership Forum in Kyiv. Vice Mayor for social issues of the city of Bishkek Tatyana Anatolievna Kuznetsova and Executive Director of Stop TB Partnership Dr. Lucica Ditiu signed this long-waited for declaration.
“Early HIV detection is one of the important tasks in order to maintain and strengthen people’s health, achieving it to a large extent involves confronting stigma and discrimination.
Firstly, I would like to point out that Mayor’s Office of Bishkek acknowledges that stigma and discrimination create breeding ground for the epidemic spread. It is the social stigma and self-stigma that build barriers to HIV-testing as well as to its treatment and care.
In the beginning of this year the Mayor’s Office started active collaboration with the civil community and AFEW-Kyrgyzstan. Signing Paris Declaration and joining the initiative to facilitate activities in big cities have become the first steps of this collaboration. We commenced to design the first city program for HIV prevention that will be running for 2 years. Even though these questions largely fall into the domain of the Ministry of Health, it was important to us to make our contribution to people’s health. The document is now at Bishkek City Kenesh awaiting approval. After the paper is approved we hope to contribute about 10 million som from the municipal budget to HIV program. Expanding HIV-testing coverage is one the program priorities. According to expert estimations, about 35% of Bishkek citizen living with HIV are still unaware about their status. When we were discussing how to achieve this goal, we thought to start with ourselves. This is why the Office Administratives, including myself, and Heads of the structural departments publicly went to have their HIV-tests made during a large event as part of the World AIDS Day. This event was widely covered in social and mass media. When the authorities send such precise signals like this, citizen pay attention and stigma weakens.
Our next step together with AFEW-Kyrgyzstan is to start a large-scale training course for the employees of the local territorial departments about HIV, stigma being a keynote of the whole training course.
Next year we plan to start a working group at the City’s Healthcare Department. This group will bring together vulnerable communities and the Mayor’s Office in order to mutually discuss and plan activities within HIV prevention campaign. World Aids Day 2019 slogan is Communities Make The Difference. It is the close collaboration with the civil society and communities that will help us to eliminate stigma and discrimination in Bishkek”
Dina Masalimova, AFEW-Kyrgyzstan Programs Manager: “We would like to express our gratitude to the Mayor’s Office of the city of Bishkek for cooperation and openness to the new initiatives in healthcare. Our collaboration started in the beginning of 2019 under the framework of a PITCH project “Key populations and HIV and TB prevention priorities”. A number of meetings and panel sessions were held since then where the community and city’s healthcare representatives reported to the city authorities about difficulties and problems they face. In response, the Mayor’s Office committed to facilitate UNAIDS ambitious 90-90-90 goals by joining Paris Declaration. As the first step to implement its realization the Mayor’s Office developed a municipal program for HIV prevention together with AFEW experts. We are very glad that today the City Administration expressed their desire to step in the TB problem. It is particularly important since our research shows a large spectrum of medical and social difficulties TB patients are facing in the city. We would like to believe that signing of the ZERO TB Cities Declaration and active involvement of the Mayor’s Office of Bishkek would produce positive affect in the nearest future“.
About Zero TB Cities initiative
The purpose of the initiative is to create ‘islands of elimination’ that will contribute to lowering rates of TB and further support in implementing effective strategies on the national level.
The Initiative appeals to the local authorities to support and directly and actively participate in fighting TB in cities in close collaboration with the civil sector and other interested partners in order to achieve significant reduction of TB death rate and prevalence, develop comprehensive programs at those sites in local context, mobilize complimentary financial, technical and clinical resources, exchange the resources and experts between participating cities, as well as disseminate knowledge and generate global political will.
The Kyrgyz Republic is one of the countries that demonstrates the highest rate of TB prevalence in the European region. Like any other megapolis, Bishkek has higher concentration of key population groups with high risk of HIV and TB infection. By the end of 2018, estimated rates were as follow: living with TB – 76.9, deaths – 5.1 in 100,000 people. To ensure wellbeing of the population it is very important to grant access to high quality medical and social services to these population groups as well as focus at upholding human rights.
The Forum will focus on discussing the regional context, sharing successful HIV and Tuberculosis city response models and facilitating movement towards ending these diseases in Eastern European and Central Asian (EECA) cities. It will include a Mayors’ high-level panel discussion, presentations of successful city responses and innovation to fast-track cities to 90-90-90, which will feature the inclusion of key populations in the cities’ responses. The Forum will gather over 150 delegates from 20 countries of the EECA region, including 11 city Mayors.
The Fast-Track HIV/TB Cities Project
Launched on World AIDS Day 2014, the Fast-Track Cities initiative has grown to include more than 300 cities and municipalities that are committed to attain the UNAIDS 90-90-90 targets: 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART); and 90% of all HIV-diagnosed people receiving sustained ART will achieve viral suppression.
Alliance for Public Health (Ukraine) together with AFEW International (The Netherlands), licit (Switzerland) and Stop TB Partnership under technical guidance of UNAIDS EECA office with funding of The Global Fund initiated the regional Fast-Track HIV/TB Cities Project. The project was implemented between 2017-2019 and developed efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in five project cities; Almaty (Kazakhstan), Balti (Moldova), Odesa (Ukraine), Sofia (Bulgary), and Tbilisi (Georgia).
Amsterdam was one of the first to sign the Paris Declaration in 2014 and has introduced a comprehensive health policy for key populations. AFEW International with expertise on increasing access to health services for HIV, TB and viral hepatitis for key populations, is well-connected to the Municipal Public Health Service and police in the Netherlands. This expertise was shared in two training courses and a study tour.
International best practice suggests that collaborative city level models have been most effective in reducing HIV and TB burdens. The first training series, ‘Collaboration between municipalities and civil society – models and realities’, were designed as an exchange and sharing of experience and best practices in successful models of municipality and NGO partnerships. Five integrated work meetings and counselling sessions with selected project city stakeholders from municipality, health and social sector, NGOs and key populations were conducted by licit and AFEW International and improved key populations’ service access through better collaboration between relevant city stakeholders – most importantly, between municipalities and NGOs.
The second training series on innovative municipality funding approaches planned exchanged and adapted such approaches and income generating activities. The training replicated successful practices in the project cities through learning from experiences in Amsterdam. During this training the best international practices of public-private partnerships at city level and private funding for key population programmes offered inspiration for the participants of the training.
During the study tour different partners of AFEW International shared models, experiences and activities that demonstrated successes and challenges in increasing access to health for key populations. Project partners from Almaty, Kyiv and Tbilisi were provided the opportunity to connect to civil servants and different health actors within the Netherlands and discuss initiatives to reach out to key populations to increase their quality of life. Furthermore, representatives of municipality, police and NGOs working with key populations elaborated on different forms of collaboration, to prove that the only way to eliminate HIV and TB is if municipality, police and NGOs work together.
The theme of the World AIDS Day 2019 is communities. Сommunities that make an invaluable contribution to the AIDS response. Communities of people living with HIV, key populations such as gay men and other men who have sex with men, people who use drugs, sex workers, transgender people, prisoners, and communities of women and young people are all encouraging and supporting the provision of HIV-related services. Communities are a source of vital energy for an effective AIDS response and an important pillar of that response.
Representatives of these communities are very different. Some of them are already on the front line, defending their rights every day, others are just beginning their journey towards important changes – for themselves and for society. On the World AIDS day AFEW International talked to them about their experiences and goals.
About the difficulties
At some point in my work on HIV prevention among transgender people, I was faced with some frustration. There were results. But they weren’t exactly the ones I wanted. And this work did not always find support in the trans* community itself. Studies I know from NGOs in Russia show that the topic of HIV for trans*people is not a priority. The first place is occupied by issues with hormone replacement therapy for those who need it, and general difficulties with safe access to qualified medical care. And the research that I took part in at the time showed that people who took part in the survey were very indifferent to the topic of HIV prevention, given their good knowledge of other health issues. For trans*people, in my opinion, the issues of HIV prevention and treatment are most closely related to health issues in general. Trans*people very often do not seek medical help until the last moment. Because they are afraid of inadequate response from doctors, transphobia. Because they are afraid of being outed. Because they are not ready to explain again who they are. And doctors themselves often do not know what to do with such a patient. And when it comes to HIV, all these fears double, because it is an additional stigma.
For me, the main success now is that I have decided not to leave activism, despite the various circumstances that have almost already led to it. Burnout, that’s the thing…
About a reason to be proud
In Krasnodar, HIV prevention activities among LGBT people have been carried out by activists for a long time. But I am proud of the fact that my work helped to drawn attention to transgender people as a separate group with its own peculiarities and needs.
I am happy to be able to speak openly about my status because I feel the great support of my family, colleagues, activists, friends and women who have experienced HIV infection. After all, each of them has invested something so that I can now talk about HIV infection without fear, without pain or humiliation. Someone can do it right away, others need time.
About open conversation
Sometimes I talk about HIV because I have thousands of people behind me who are living with HIV and they are not ready to speak for themselves because of the stigma and discrimination in society. And for the voice of the community to be heard, you have to talk and sometimes even scream. Sometimes I talk about HIV for the public to break existing stereotypes about people living with HIV and motivate them to take responsibility for their own health and HIV testing. Sometimes I talk about HIV for PLHIV who have learned about their status, I share with them my positive experiences of living with HIV. Given my personal experience of having a child without HIV, I understand that this is a question that concerns every woman living with HIV personally and affects so many areas of a woman’s life, from self-esteem to an external social environment.
I care about women and HIV first because I am a woman, mother and wife who have gone through all the hardships of living with HIV. Secondly, it is important for me to involve women living with HIV in addressing women and HIV. We know our needs and requirements better, and what actions lead to the improvement of their quality of life. Thirdly, by helping to build women’s capacity to advance their rights and improve the national response to the needs of HIV-positive and vulnerable women, we could significantly reduce the spread of HIV among the entire population and increase support for children living with or affected by HIV.
My colleagues and I initiated the submission of documents to the Ministry of Justice in order to obtain the legal status of the women’s organization “Positive Women” in Uzbekistan. I very much hope that in 2020 we will have more opportunities to lobby for the interests of our members at AIDS Centers in the field of expanding access to HIV treatment for women and children, improving the quality of medical services provided to reproductive health and combating violence against women.
As an ex-prisoner, I faced different barriers on my way.However, the biggest challenge for me was my release from places of confinement. When I tried to return to the society, the society demonstrated its resistance and did not accept me as a person. It was very important for me to regain self-confidence, overcome self-stigma and learn how to respond to discrimination.
After the release from prison, working in an NGO is the best option. Here people are more open and treat you like a normal person, which is a rare case in government institutions, for example. An important part of my way was my work, thanks to which I was able to help people from key populations and heal myself.
About a reason to be proud
Most of all I am proud of the fact that now I really start seeing myself as part of the society as I have completely quit injecting drugs and methadone. I am proud that I am married and can work in an NGO. A big achievement personally for me is having the freedom to openly say that I have seven records of criminal conviction, went to penal colonies four times and spent 12 years in places of confinement.
Besides, I am very happy that now government bodies start working on creating better conditions for people who are released from places of confinement. To a great extent, it is due to the fact that our community not only continues its fruitful work with civil society organizations, but also starts interacting with government agencies and probation departments.
About the challenge
The biggest challenge in my life was to accept my status. Till the last moment, I did not believe that it could happen to me. Only when I found myself in a hospital and almost lost one of my eyes, I finally believed that HIV exists. At that moment, I was aware that there is life-long therapy, I read a lot about it, even though I rejected my status.
This year, I had some difficulties overcoming stigma in places of confinement, when I was arrested and convicted with no reason. First, I couldn’t explain to the policemen that I am sick and that I need treatment and ART. Then, when I managed to explain it to them, I was labelled as “AIDSy”, “black death”, “syph”, etc. I faced all kinds of psychological pressure, including people telling me that I was going to die. It lasted for about three months.
About how to cope
Information helped me to cope with my disease. I was able to show that I was not dying, vice versa I was feeling well and had good health, better than some others! Later I was even called in for questioning, where I was asked about HIV, routes of transmission, if it can be transmitted through air or hand-shaking, how it is treated, etc. Thus I could show that people living with HIV have strong spirit and are almost undefeatable. People shouldn’t play blame games with us as it can happen to anybody. In four months, all my charges were dropped and I was released from prison.
About a reason to be proud
Most of all, I am proud that our community has knowledge and many of us can protect our legal interests at the government level. I am happy that more and more PLWH adhere to treatment and that the government tries to help us. We have a law on HIV/AIDS, a law on probation. People in places of confinement have uninterrupted access to ART, though just last year detention centres could ignore the needs of PLWH.
My peers and I organize self-help groups again. Before, we used to get together at my place, up to five people at a time, and today we have 35 or more people attending our groups. My activities really changed the world, the world inside me. Now I understand people, not only from the community, but also others, much better. Once I changed the world inside me, the outside world also changed its attitude to me and now it treats me better!
About the challenge
Probably the biggest challenge for me is that now it is not safe to have sex in Kyiv if you do not have a regular sexual partner. After PrEP became available, we see more sexual freedom, more ways to experiment in our community. That is why many of my friends and acquaintances started using drugs and engaging in chemsex. Back in the middle of 2017, it was difficult for us to find respondents for our first pilot chemsex study in Kyiv, but now finding respondents is not a problem anymore. If I say that every second person could take part is such study, it would not be an exaggeration. Now it is super easy to get an STI in our city, though there are still some problems with the treatment. For instance, to treat syphilis, apart from the standard antibiotic, one needs a couple of other medicines, which are hard to find at the Ukrainian pharmaceutical market as such medicines are mostly produced in Russia. Earlier, we used to have outbreaks of syphilis in spring, but now they happen all the time. Many guys do not notice any symptoms and engage in self-therapy – either as they are afraid of stigma from the side of doctors or as they do not realize how serious the consequences may be.
In the recent year, I delivered many lectures on sexual education and health in Kyiv-based universities for the students studying PR, marketing, journalism, medicine, psychology and social work.
Currently, I continue holding workshops, presentations, training for MSM, trans people, sex activists and all those interested in HIV/STIs. My training events are popular and demonstrate positive changes in public opinion on LGBT, in particular through raising people’s awareness on HIV/STIs.
Before July 2019, I was coordinating the project of the national information platform for MSM called GET TEST (ALLIANCE.GLOBAL NGO).
Thanks to a number of successful information campaigns, GET TEST became one of the main information portals on health for MSM in Ukraine with a possibility of fast online registration for testing and access to prevention services in 17 regions of Ukraine.
I think I can be proud of our successful information campaign “HIV Test is Easy”, for which we engaged some celebrities, opinion leaders and bloggers. We made a number of social videos, which have tens of thousands of views and receive positive feedback.
They were presented during a morning show at UA:PBC channel on the eve of the World AIDS Day. It was the first time for ALLIANCE.GLOBAL when a project aimed at MSM was publicly presented on TV.
At the same time, I think that my biggest personal achievement this year is that I started working in one of the most famous HIV/AIDS organizations in Ukraine – Elena Pinchuk Foundation, where I manage and coordinate the activities of our education centre – dialogue hub – organizing the work of its residents, developing sex education programs for youth and implementing a number of projects to increase the visibility of LGBT community (exhibitions of LGBT painters, social bullying theatres, Gender Studies talk show, etc.). Besides, in the hub I continue delivering lectures on how to reduce the risks related to chemsex and how to prevent STIs. In particular, I inform and consult MSM community members on PrEP. These lectures are attended by the representatives of our target groups, for whom such topics are most relevant.
About a reason to be proud
For the first time, LGBT agenda was brought up publicly in the Elena Pinchuk Foundation. Before, this organization did not work with this target group. For instance, in October I organized the Gender Studies talk show, with a famous TV host publicly interviewing a transgender woman, Anastasia Eva Domani. The audience of the dialogue hub was positively interested in the talk show.
However, the most significant achievement for the community of PLWH in Ukraine was cancellation of p. 3 of the Order of the Ministry of Health dated 2008, based on which people affected with HIV (B20-B24) did not have the right to adopt or take custody of children. It became possible thanks to the lawyer Vitaliy Matveyev, whom I provided with my expert support. Together we registered the PROJECTOR NGO, which will engage in human rights, advocacy and research activities. Besides, I have been consulting Vitaliy on dealing with the criminal cases against the members of key populations in terms of HIV/AIDS as well as LGBT. Currently, the lawyer makes preparations to defend clients who faced discrimination on the grounds of their sexual orientation or against whom hate crimes were committed.
The activities of PROJECTOR NGO will also be focused on organizing research studies aimed at analysing the behaviour patterns of the groups vulnerable to HIV/AIDS.
About the challenge
The hardest challenge for me was losing a close friend of mine. I was in a lot of pain, I felt loneliness and I had nothing. But I coped with it. I don’t think that I could do that without the help of a psychologist at school. The specialist helped me to put everything in its place. I am very grateful to him.
About a reason to be proud
Activism has become a part of my life. I am proud of my activity in Teenergizer and everything I have done in such a short time. My role in the organization is to conduct and organize training. I think it’s important to involve new people in health care because many people still live with the notion that HIV is a sentence, that HIV positive person is necessarily a drug user. But if we look at HIV-positive teenagers, mostly we will not see this. But parents of HIV positive young people indeed had such problems.
About the challenge
The main and most difficult challenge for me is drugs. These drugs drag and eat you up, you live in them, breathe them…and there is nothing else around you. I had the strength to run away from them to the other side of the country. I am proud that I had the strength to do so, and I was able to give up my addiction to terrible substances. Now I am happy – I have a sunshine over me, I have home. I found an abandoned house where nobody lived for 5 years, made repairs, and now I have a house in Russia.
I talk about myself openly so everyone can see how difficult life can be sometimes. I want people who use drugs to be not afraid to talk about themselves. I guess I’m one of the first people in Russia who speaks with an open face about addiction when I’m in it. But I’m not afraid of that. If you don’t say anything, if you keep quiet, nothing will ever change. I live without a passport, without a homeland, without a flag, and I dream of living like a normal person.
Next year I’m planning to start farming, get chickens, ducks, goats and rams. I want me to have a home, a family, a wife I love. I really want “salts” to disappear from Russia, they kill people.
Since the 21 of November RADIAN grants for both the ‘Model Cities’ (Almaty only) and ‘Unmet Need’ funds are open for grant seekers to submit concept notes.
The RADIAN ‘Unmet Need’ fund will support local initiatives across the EECA region and beyond the select ‘Model Cities’. Initiatives selected will focus on prevention and care, education, community empowerment, and novel partnerships. The programme will be implemented locally, working with key stakeholders and partners.
The Fund is welcoming concept notes for evidence-informed solutions implementing in Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Estonia, Georgia, Kosovo, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Montenegro, Republic of Moldova, Russian Federation, North Macedonia, Romania, Serbia, Slovenia, Tajikistan, Turkmenistan, Ukraine, or Uzbekistan. The Fund welcomes concept notes for multi-country projects.
You can join for a webinar on applying for a RADIAN Unmet Need Fund grant. This webinar will guide applicants through the RADIAN Unmet Need Fund Opportunity Announcement and application process, and offer an opportunity for participants to ask questions on the Opportunity Announcement and application process.
The webinar will be held on December 3rd 2019 11:00-12:30 (GMT). Please register for the webinar here.
Applications to implement Model Cities in Almaty are now open as well. The programme will support innovative approaches, including new models of care and expanded prevention and healthcare programmes, led by groups who are on-the-ground and part of the community.
The first RADIAN ‘Model City’ will be Almaty, Kazakhstan’s largest city. The RADIAN Model Cities Fund is looking to support programmes centred around existing health system infrastructure that deliver measurable impact in the response to HIV in Almaty. Organisations who share Radian’s vision of significantly improving the quality of care for PLHIV, addressing new HIV infections and AIDS deaths in Almaty can apply for grant funding. A detailed Opportunity Announcement, including eligibility and selection criteria can be downloaded below. Additional ‘Model Cities’ will be announced in 2020.
HOW TO APPLY
RADIAN grants for both the ‘Model Cities’ (Almaty only) and ‘Unmet Need’ funds are now open for grant seekers to submit concept notes. All concept notes must be in English.
Applicants whose Concept Notes are selected to move forward to the Application stage will be notified by the Foundation and will be requested to submit an Application with further details on their solution. A detailed Opportunity Announcement for each fund, including eligibility and selection criteria, can be downloaded below.
On November 18-19, with the support of the Ministry of Health of the Republic of Kazakhstan, the first scientific workshop EECA INTERACT 2019 on HIV, tuberculosis, and hepatitis in Eastern Europe and Central Asia (EECA) was held in Almaty.
The international event was organized by the Amsterdam Institute for Global Health and Development (AIGHD), the Kazakh Scientific Center for Dermatology and Infectious Diseases of the Ministry of Health of the Republic of Kazakhstan, non-profit organizations AFEW Kazakhstan and AFEW International.
For two days, more than 100 researchers, representatives of communities and clinicians from Kazakhstan, Russia, Ukraine, Belarus, Uzbekistan, Kyrgyzstan, Tajikistan, Georgia and other countries shared their experiences, the latest scientific developments in the field of treatment of HIV, tuberculosis (TB), hepatitis in order to strengthen the scientific base and improve the situation in the region.
“AFEW has been working in the Eastern Europe and Central Asia region for about 20 years and constantly experiences a lack of data on the HIV, TB and viral hepatitis epidemics in the region, – says Anke van Dam, member of the international organizing committee of EECA INTERACT 2019; executive director of AFEW International. These data are needed to develop evidence-based policies and interventions. Through EECA INTERACT, AFEW strives to stimulate and facilitate research in the region. Also our goal is to foster new research interactions among leading investigators and those who represent the potential future scientific leadership for health care and research in the region and to build research and clinical capacity across EECA”.
EECA is the only region in the world where the HIV epidemic is still growing rapidly. UNAIDS estimates that as of 2018, about 1.7 million people in the Eastern Europe and Central Asia region are living with HIV. About 38,000 people died from AIDS in 2018.
Significant barriers to prevention and treatment services remain for people living with and affected by HIV, TB, and hepatitis across the region. For example, although the HIV epidemic in EECA is concentrated predominantly among key populations, particularly among people who inject drugs, coverage of harm-reduction and other prevention programs is insufficient to reduce new infections. The region urgently needs more effective strategies of prevention, treatment, and care and support that are tailored to the particular circumstances of individual countries.
“I hope EECA INTERACT will become an effective forum for discussion, the issues raised at scientific discussions, the exchange of experience, will allow us to put the necessary emphasis on the near and long-term prospects, and familiarize a wide circle of participants with new methods, developments and approaches on these issues. The abstracts will be appreciated, feedback will be established, the scientific community and the geography of further cooperation and investment will expand. This activity is necessary to achieve UNAIDS goals 90-90-90”, says Bauyrzhan Bayserkin, head of the local committee of the EECA INTERACT 2019 workshop; Doctor of Medical Sciences; Director of the Kazakh Scientific Center of Dermatology and Infectious Diseases of the Ministry of Health of the Republic of Kazakhstan.
EECA INTERACT 2019 took an innovative approach by bringing together experts in HIV, TB, and hepatitis to participate in the International Conference Committee developing the scientific program.
It included experts in the field of HIV, TB and hepatitis from around the world, including Michel Kazatchkine, UNAIDS Special Advisor on HIV, TB and Hepatitis in the EECA region; Catherine Hankins, professor, Deputy Director, Science at AIGHD, co-chair of the annual INTEREST conference; Alexey Alexandrov, head physician of the Minsk Regional Clinical Center “Psychiatry-Narcology”; Sergey Dvoryak, founder and senior scientist, UIPHP, professor at the department of social work, and many others.
EECA INTERACT will be an annual event and will be held in different countries of the EECA region to enable scientists from all countries to demonstrate their discoveries.
See more pictures here.
The WHO Regional Office for Europe is collecting examples of good practices of intersectoral collaboration for HIV, tuberculosis and viral hepatitis for publication in a dedicated compendium.
This compendium will include examples of actions undertaken by sectors outside the health sector, possibly (but not necessarily) in collaboration with the health sector. The practices should be aimed at improving the outcomes or the determinants of the HIV, tuberculosis and viral hepatitis epidemics, as encouraged by the UN Common Position on ending HIV, TB and viral hepatitis through intersectoral collaboration. They should also be accompanied by impact evaluations and credible monitoring mechanisms or research.
The above-mentioned UN Common Position was developed with an inclusive and consultative process to identify shared principles and key actionable areas within and beyond the health sector to address HIV, tuberculosis and viral hepatitis in Europe and central Asia. It was successfully launched at a side event to the UNGA in New York in November 2018 and subsequently distributed within UN system to all UN Resident Coordinators of the region.
The good practices must be submitted in either English or Russian using the form provided below. All submissions will be reviewed by the WHO Regional Office for Europe against the following criteria: relevance, sustainability, efficiency and ethical appropriateness. The authorship of each good practice will be highlighted in the compendium, which is expected to be published in 2020.
The deadline for submission is 18 November 2019. If you have any questions, please do not hesitate to contact firstname.lastname@example.org.
Since July 19, 2019, a new version of article 157 “Transmission of Human Immunodeficiency Virus” of the Criminal Code of Belarus has been enforced. Despite the approved amendments to this article, it still contributes to vulnerability of the key populations, in particular serodiscordant couples (where one of the partners has HIV). However, a solution has been found, thanks to which the amendment will be able to serve for the benefit of people living with HIV.
There is a number of important provisions in the new version of article 157 of the Criminal Code of Belarus.
Besides, the amendment to this article says that the individual committing the actions stipulated in the first and second parts of the article may be relieved from the criminal liability in case if the other person, who was exposed to HIV or was infected with HIV, had been in advance warned about the fact that such individual had HIV and voluntarily agreed to perform any acts, which led to HIV exposure.
Before this amendment was enforced, the People PLUS Republican Public Association in cooperation with the Republican Center for Hygiene and Epidemiology held a round table to develop a set of measures, which would allow people to fully use the amendments in laws and protect themselves from the criminal prosecution. It resulted in the development of a road map and other documents regulating the fact of warning, which would lead to the enforcement of this amendment. Such documents include.
– New form “How to warn another person that I have HIV”
– Form to warn a contact person of a patient with HIV
– Memo on HIV prevention
“When preparing the documents, we tried to take into account any possible circumstances and potential barriers,” says Anatoliy Leshenok, Deputy Director of the People PLUS Republican Public Association. “For example, the Investigative Committee, commenting on the amendment, pointed out that it is important to understand what is the procedure to check in which state an individual gave his or her consent to have a contact with a person living with HIV, to check if he or she had enough information, etc. The Notary Chamber suggested to register informed consent as a confirmation of consent for the contact with a person living with HIV. The Republican Center for Hygiene and Epidemiology developed a new notification form to be used when registering people with HIV diagnoses for follow-up, provided explanations on the amendment to article 157 of the Criminal Code of Belarus and told that it is possible to come to them with a partner to register the fact of warning of HIV exposure. A memo on HIV notification has also been developed and will be published within our project. It will be given to the partners of HIV-positive people. The memo contains contact details of the organizations providing services to PLWH as well as legal consultations.”
Who is at risk?
In the recent 6 months, there were 55 criminal cases initiated in Belarus based on article 157 of the Criminal Code. This number is similar to the one that was registered in 2018. However, it should be noted that 28 cases out of this total number were opened based on the first part of this article, where there is no fact of HIV transmission, but only a perceived risk.
“Recently, we were defense witnesses at a court hearing, when the defendant was charged with putting five sexual partners at risk of HIV,” tells Anatoliy. “The defendant did not transmit HIV to any of those partners – he took ARVs and had an undetectable viral load. The court took into the consideration the scientific consensus statement on HIV transmission, the answer of a WHO representative and the reply from the Professor of the Infectious Disease Department of the Belarus State University on the risk of HIV transmission by a person with suppressed viral load. However, the verdict of the court was that there was still a risk of HIV transmission, so the sentence remained unchanged – 18 months at standard regime penal colony. Just imagine – 18 months of imprisonment for not transmitting HIV to anyone!”
In fact, article 157 put a question mark over the existence of serodiscordant couples, who often live together for many years and even have children. Usually, within such criminal cases charges are brought against a husband or a wife, while the “victim” clearly states in court that he or she has no complaints to the spouse and that he or she was consciously taking risk to conceive a child with a loved one.
Drawbacks of this article also relate to the fact that criminal cases are initiated with no complaints from the victim.
“When making amendments in article 157, we were suggesting more radical changes – to fully exclude responsibility for exposure to HIV from this article – but the society is so far not ready for such changes,” continued Anatoliy. “Currently, the cases initiated based on this article are reviewed, where the sentences directly state that the partner was informed about HIV and consciously agreed to the actions, which led to HIV transmission or exposure to HIV. According to the Code of Criminal Procedure, the review of such cases is initiated by penal colonies and prisons, and if a person is not imprisoned, such person should file a relevant request for review with a court.”
Approval of the amendment to article 157 of the Criminal Code “Transmission of HIV” allowed talking about the first successes of the activists in HIV response in Belarus. Now hundreds of people can have the record of their conviction expunged.
“People PLUS” thanks for the help provided in 2017-2019 by HIV justice, GNP +, EWNA. Amendment to art. 157 was brought in Criminal Code Belarus thanks financial and technical assistance from these organizations.
Thanks the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia (EECA) People PLUS have implemented additional set of measures people living with HIV in Belarus will be able to avoid criminal prosecution.