AFEW International and ICAP at Columbia University to improve HIV services in prisons in Kyrgyzstan and Tajikistan

In 2020, AFEW and ICAP at Columbia University will partner to implement «Technical Assistance to Central Asian National HIV Programs to Achieve and Sustain HIV Epidemic Control under the President’s Emergency Plan for AIDS Relief (PEPFAR)» in Kyrgyzstan and Tajikistan, a project funded by PEPFAR through the US Centers for Disease Control and Prevention (CDC). In Kyrgyzstan the project will be implemented by AFEW Kyrgyzstan; in Tajikistan, by NGO SPIN Plus with technical support of AFEW Kazakhstan.

With this project, the partners will strive to reach two important goals:

1) improving the 90-90-90 targets for people who inject drugs (PWID) and people living with HIV (PLHIV) in prisons in Kyrgyzstan and Tajikistan, using new technologies and services;

2) facilitating and improving collaboration between general public health care facilities and health care services within the penitentiary system, ensuring continuity of HIV-related services to people being released from prisons.

AFEW International will be the lead agency working with its in-country AFEW partners and local partners to implement this project in Kyrgyzstan and Tajikistan,” said Daria Alekseeva, Program Director of AFEW International. “We have a proven track record and evidence that working as a regional EECA network has encouraged the exchange of context-specific approaches that help to find appropriate local solutions and models of best practice. We combine local Central Asian knowledge and expertise, exchanging this within the wider EECA region, as well as the added advantage of an international, Netherlands-based Secretariat, contributing to international expertise and innovation. AFEW International – together with AFEW Kyrgyzstan and AFEW Kazakhstan, which will provide technical support to activities in Tajikistan – will aggregate lessons learned from ICAP’s previous work in Kazakhstan and combine those lessons with the methodological approach gained through the past experience of working in prisons in Central Asia to produce practical guidelines and training modules. AFEW International will look for possibilities to pilot this model in Kyrgyzstan and Tajikistan, where political and technical conditions may allow.”

“People living with HIV in prisons are less likely to be on antiretroviral therapy (ART) when compared to general population. They are also less likely to adhere to the prescribed treatment regimen and, therefore, are often viremic,” said Anna Deryabina, ICAP Regional Director for Central Asia. “Lower ART initiation and viral load suppression rates among prisoners are due to many factors, including structural factors, such as lack of trained health care personnel in prisons and limited adherence support and treatment monitoring. Also, lack of coordination between general and prison-based health care services and fragmented service delivery systems lead to many people living with HIV being lost to follow-up and discontinuing treatment after being released from prisons. ICAP has been very effective in improving the quality of HIV services provided to people living with HIV treatment facilities outside of prisons. We really hope that AFEW’s deep knowledge and understanding of subcultures and norms inside the prisons, as well as their experience working with the prison-based health care systems will allow this project to effectively improve the quality of services and HIV outcomes for people living with HIV in prisons.”

“AFEW-Kyrgyzstan is pleased to launch this joint project with ICAP. Under the Project, our organization will be responsible for the implementation of the component to achieve the 90-90-90 goal in the penitentiary system,” said Dina Masalimova, AFEW-Kyrgyzstan Programs Manager. “We plan to work in almost all large prisons in Chui Oblast. Our activities will be aimed at expanding HIV testing coverage with the provision of quality pre- and post-test peer counseling, motivation to start therapy, and adherence development. In addition, we will focus on ensuring that people do not stop their treatment even after release.”

This project is very important to maintaining an effective response to the HIV infection in the country, as 5-10% of all PLHIV in the country are in the prison system. With the high turnover of the prison population, this number can be easily multiplied by half per year.

“We are happy to work in a team with such a highly professional organization as ICAP,” said Masalimova. “It is planned that ICAP specialists will be responsible for medical aspects of providing assistance to PLHIV, and our organization will take over the community element and peer-to-peer support.”

In Kyrgyzstan, AFEW-KG will recruit and train a team of peer navigators representing each layer of the prison sub-population (with a special focus on prison outcasts and pre-release prisoners) in order to identify those who practice risky behaviors and haven’t been tested for HIV in the past six months. AFEW-KG will work with newly identified PLHIV to motivate them to start antiretroviral therapy and take all of the necessary tests. The peer consultants will work as liaisons between patients and prison doctors to ensure that patients are prescribed ART, are adherent to treatment, and that relationships between prison doctors and patients are built on mutual trust.

In addition, AFEW-KG will provide a series of counseling sessions for at least 200 prisoners who are PWID on the benefits of starting methadone-assisted treatment (MAT) and dispelling the myths related to the therapy.

“We believe that this collaboration will yield excellent results and that by the end of 2020 we will be able to see tangible progress on each of the 90-90-90 goals in prisons,” said Masalimova.

 

A chance to be heard

Participants from Kazakhstan with AFEW International

Participants from Kazakhstan with AFEW International

Stigma and discrimination are recognized as some of the most commonly identified barriers to fight the tuberculosis (TB) epidemic. Reducing TB stigma is essential because it hinders care seeking, contact tracing, outbreak investigations, treatment initiation, adherence and quality of care. Moreover, it deprives people with TB of their rights and the respect of others.

In collaboration with partners on global, regional and national levels, KNCV Tuberculosis Foundation has developed two stigma reduction packages within TB Photovoice project and piloted them in communities and health care facilities providing TB and TB/HIV in Kazakhstan, the Philippines and Nigeria, funded by the Dutch Ministry of Foreign Affairs.

In Kazakhstan the initiative was implemented by AFEW-Kazakhstan, Sanat Alemi, and Doverie Plus.

For reference

Kazakhstan is one of the 20 high-burden countries for multidrug-resistant TB (MDR-TB). The country has made great progress towards eliminating TB in recent years, with diagnosis, successful treatment and notification rates exceeding the WHO recommenrdations and the estimated incidence.

In may 2018, 12 professional participated in a “Training of trainers” course to learn how to implement TB Photovoices, 9 of whom facilitated the intervention with patients in the end. The group included 6 psychologists, a social worker and a doctor

The TB Photovoice intervention was implemented with 9 (ex-) TB patients – with a mixture of drug-susceptible and drug-resistant TB – some of whom were still on treatment at the time.

The final products (photos, quotes and stories) were launched and shared with the broader Almaty community in advocacy exhibitions and were also reproduced into banners, desc calendars, bads, T-shirts, and postcards to use in heath facilities when counselling new TB patients.

Symbat Sapargalieva, social worker of Sanat Alemi NGO, participant of the PhotoVoices Project

When I found out that I had tuberculosis, I felt so ashamed. There were many negative thoughts in my head. I denied my disease and was pulling away from my family and friends.

I was happy to take part in the PhotoVoices Project and then realized that I have a self-stigma. This project helped me to understand that my friends did not turn their backs on me, it was me who isolated myself from them. There was an exercise called Lifeline with TB, when I had to write down all my negative and positive thoughts. I wrote down only negative ones as I could not find any positive sides of the disease. However, two weeks after I was able to find something good about TB.

I mean, when you realize your problem deep inside and bring it out, it is such a relief. After a while, I set some goals for myself and got a job with a civil society organization to help people who were the same as me. Half of my dreams have already come true!

The main thing I realized is that if you want to change people’s opinion, change yourself. The PhotoVoices Project gave me my voice and a chance to be heard.

Sholpanata Kaldarov, student of the International IT University, participant of the PhotoVoices Project and the Self-Stigma Project, volunteer of Sanat Alemi NGO

When I was invited to take part in the PhotoVoices Project, I was still receiving my TB therapy. I said yes right away as I thought that photos could somehow provide psychological support and motivation to people who just learned that they had TB and also myself, of course.

When I was found to have TB, doctors checked everyone I had contacts with. I felt worse not even because of my own diagnosis, but because all people who were in contact with me had to be checked. Back then, I lived in a student dormitory, and even though my form of TB excluded the transmission of infection, doctors still checked about 100 students from the dormitory and 20 of my group mates. Afterwards, these people had to come to the clinic for special medical check-ups every six months. I felt guilty, so I gradually pulled away from my friends. I had self-stigma.

In the PhotoVoices Project, I experienced a lot of emotions. Before the photo is taken, you remember your past and drag the disease through yourself again. In the beginning, it was difficult to focus on details, but then I felt better and learned to openly talk about my disease.

In our group, there were patients, who already completed their treatment. Talking to them, I heard how they were able to overcome the disease. Gradually, I felt confident that I would also be able to finish my treatment successfully.

I want to thank this project, it really helps the patients who isolated themselves after the disease and lost their self-esteem.

Amanzhan Abubakirov, Teaching Assistant at the Phthisiopulmonology Department of the Kazakh National Medical University named after S.D. Asfendiyarov

Once, the head of our department invited me to take part in a project on stigma. I heard the term “stigma” before, but to be honest did not really know how it can be manifested and how it affects people. It was something new for me, so I agreed to participate.

In the course of the project, I realized that for a long time I was stigmatizing both myself and my patients. Sure, I was kind to them and treated them well, but I thought that I was a doctor and that I was better than them. I have to admit that I feel so ashamed for it.

During the project, we took part in such exercises as “Our Imperfection – Their Imperfection”, “Cross the Line” and so on. Thanks to such exercises, we were able to feel what patients feel, we were able to be in their shoes.

This project really changed my perspective, my view of the world. As a result, I built friendly relations with the patients who stay in our hospital for a long time. I stopped using any terms, which can stigmatize the patients.

More often, I talk to the patients’ relatives, tell them about stigma and ask them to provide more support to the patients.

Besides, I talk to the medical staff working at our department. As I also work at the Medical University, I devote special hours during my classes to talk about stigma and discrimination to my students.

I want to deliver the message that all people are equal, no one is better or worse. However, people with TB are real heroes. Every day, they take a lot of medicines with numerous side effects. Their spouses leave them, their friends turn their back on them, but they continue their fight.

Thank you everyone who fights TB!

 

 

 

 

 

The 3rd regional autumn school in Bishkek

On October 29, AFEW partners came together in Bishkek, the capital of Kyrgyzstan, for 3 days to take part in the annual Autumn School, which is organized within the project “Bridging the Gaps: health and rights of key populations“.

The great energy of the participants and amazing nature gave a chance to everyone to enjoy the event and to discuss important issues on prevention and treatment of #HIV, harm reduction, migration, and financing in the region of Eastern Europe and Central Asia. Participants in the Autumn School included representatives of AFEW partners from Kazakhstan, Kyrgyzstan, Ukraine, Russia, and the Netherlands, sub-recipients of the project “Bridging the Gaps”, as well as other partners and experts including those from Great Britain and the USA.

Active space

The Autumn School quickly became an active space for discussion: about strategy, barriers, innovations, and partnership opportunities between the participating organizations. During the first day, participants shared updates on the “Bridging the Gaps” project and activities in their countries – Georgia, Kyrgyzstan, Ukraine, and Tajikistan. The afternoon session was devoted to a World Café, in which partners exchanged ideas and developed specific actions to overcome challenges that they often encounter in their work.

The second day was devoted to the topic “Stimulant use and chemsex”. Benjamin Collins, director of International HIV Partnership (IHP), which partners with medical and community activists across Europe and the Middle East for successful responses to HIV and viral hepatitis, joined the Autumn School in Bishkek to share his experience on chemsex . The topic of (problematic) chemsex was further elaborated in the presentations of Monty Moncrieff, Chief Executive of London Friend, a London charity working to promote the health and well-being of lesbian, gay, bisexual and trans (LGBT) people, and Daria Alexeeva, program director of AFEW International. Monty spoke about the London experience in harm reduction, while Daria presented materials of Nikolay Lyuchenkov, an infectious disease doctor and expert on sexual health issues from Russia, which were focused on trends and responses to chemsex in Russia and EECA region.

 

The third and final day of the conference was devoted to workshops on migration, rehabilitation and financial sustainability. Evgeniya Alekseeva, director of Public Health and Social Development Foundation “FOCUS-MEDIA”, presented analysis of NGOs funding situation in EECA region; Elena Zhirnova, manager of the project “Our Choice: Empowering Vulnerable Women in Kyrgyzstan” (AFEW-Kyrgyzstan) told about challenges and opportunities of social entrepreneurship in the country; and Fatima Yakupbayeva, co-founder of law firm “PRECEDENT” and publisher of the book “From Grant to Business Project”, shared auditing resources for launching a business model and recommendations on how to implement business ideas.

 

The session on migration started with a presentation by Rukhshona Kurbonova, coordinator of the Migrant Health Programs at International Organization for Migration in Tajikistan. She talked about labor migration in Central Asia, while Zulaika Esentaeva (IOM Kyrgyzstan) shared their experience on service-delivery by IOM Kyrgyzstan for vulnerable migrants.

The session on rehabilitation was devoted to building information campaigns. During the session, Marina Govorukhina, specialist on strategic communications and branding, author of the books “Communications in Public Organizations”, “Strategic Communications in Public Organizations”, demonstrated specific techniques of developing informational marketing campaigns for rehabilitation centers to the participants from Georgia, Kyrgyzstan and Ukraine.

Moreover, the School included a 2-day training for AFEW communication managers, during which participants focused on learning about storytelling and SMM in the context of NGOs.

 

 

Natalya Shumskaya, director of AFEW-Kyrgyzstan

I especially noted the session on new psychoactive substances. This topic is relevant for our country, as sexual ways of HIV transmission keep growing in Kyrgyzstan, and new psychoactive substance use impacts sexual behavior. For us it is a wonderful opportunity to take on the experience of those countries that have already faced similar problems, and elaborate effective strategies for preventative measures in our country.

The third day was remarkable due to the acute topic of sustainability of civil society organizations. We all see the tendency of decreasing donor support in our countries. That means that civil society should aim to ensure financial sustainability independently, and one of the opportunities is the development of social entrepreneurship. During this meeting we shared the experience of creating our own social enterprise – a beauty salon. I would like to especially point out the session by Fatima Yakupbayeva from the “Precedent” company. She gave us specific business-ideas, which could be developed by an NGO in order to earn money independently and further direct it to realization of our statutory goals.

The importance of this event is in sharing and exchange of experience. When the financial support for our organizations is not that high, it is important to avoid duplication of activities, and, on the other hand, to consolidate our efforts in order to realize our main strategic goals. For instance, the past regional meetings allowed us to bring good practices of working with youth at risk from Ukraine to our country. We are very grateful that we didn’t have to be the pioneers in this, but rather adapt and use their experience. Also, I think that the experience of Kyrgyzstan will be useful to some of our colleagues, and they will be able to apply it in their countries.

Monty Moncrieff MBE, Chief Executive of London Friend

It’s important for people working in the region on the same issues to have the opportunity to come together and share their knowledge and experience. It helps build the data on important topics, and enables participants to share what they’re seeing locally, as well as share tips on how to address new and emerging trends. It also helps build relationships, which spark ideas for new partnerships. Even though the internet gives us great opportunities to connect and work together online it’s difficult to get that richness of connection without bringing people together in person, and doing so for a number of days provides lots of opportunities for conversations outside the formal sessions.

We can always learn from one another, and hopefully by inviting people who have been working on issues for some time in other countries we can bring the benefit of that experience. We can share leaning about what’s worked and what hasn’t for us, and hopefully that can benefit people who are only starting to see these issues emerge locally.

Evgeniya Alekseeva, PHD in medical sciences, Director of Public Health and Social Development Foundation “FOCUS-MEDIA”

Meetings such as the Autumn School are important, because they bring together people from different countries and cities, create space for discussing acute issues and situations in our field, allow to form alliances, agree about partnerships, as well as have informal conversations and take a break from the daily routine.

At the Autumn School in Bishkek, I especially noted a very interesting session on chemsex, sessions on business projects for NGOs, and on migration. I will certainly use this knowledge further while writing proposals, developing new projects and creating new ideas.

Zarina Siyakova, program coordinator of the Tajik Network of Women Living with HIV

This meeting provided me with a great opportunity to learn more about what is happening in other countries in regards to promoting prevention and treatment of HIV. I especially noted the session on chemsex, as I hadn’t had a chance to encounter this issue before. I was particularly interested in the presentation by Monty Moncrieff, as well as the presentation of Nikolay Luchenkov from Russia on chemsex in EECA.

Also, I received answers to many questions on migration that I’m interested in, and most importantly, exchanged contacts with almost all the participants. It is well known that nowadays there is a very large stream of migrants from Tajikistan to Russia, and many of them lack information about services for migrants and d existing organizations in Russia. Now our organization will be able to refer our clients to these organizations, and we won’t lose them out of sight.

If you are interested in specific presentations of the Autumn School, please send your request to autumnschool@AFEW.nl.

Support. Do not punish!

In June 2019, dozens of cities in the EECA region hosted the campaign «Support. Do not punish». Activists took to the streets to publicly protest against repressive drug policies.

This action, which is held annually all over the world, is a great chance to once again draw attention to this unresolved problem. How it was in the EECA region in 2019 you can read here.

Plans for 2020

Are you part of a collective, network or organisation advocating for drug policies that prioritise health and human rights? Are you planning to join the 2020 Support. Don’t Punish Global Day of Action and have an outstanding plan to build momentum? If your answer is “yes” then this call for applications might be for you!

Through this call, the Support. Don’t Punish campaign aims to identify and support local partners (up to 7) with funding of between USD 2,000 – 4,000 for strategic, creative and collaborative projects building up to the 2020 Global Day of Action that advance drug policy reform, bolster harm reduction and build bridges with/within/between communities disproportionately affected by the “war on drugs” (e.g. people who use drugs, farmers of crops deemed illicit, youth, ethnic minorities, LGBTQ+, among many others).

You can apply for the grant here.

What is “Support. Do not punish”?

Support. Don’t Punish is a global grassroots-centred initiative in support of harm reduction and drug policies that prioritise public health and human rights. The campaign seeks to put harm reduction on the political agenda by strengthening the mobilisation capacity of affected communities and their allies, opening dialogue with policy makers, and raising awareness among the media and the public.

The campaign’s yearly high point is the Global Day of Action, which takes place on, or around, 26th June (the International Day Against Drug Abuse and Illicit Trafficking). Historically, this date has been used by governments to showcase their drug control “achievements” in coercive terms. The campaign’s Global Day of Action seeks to reclaim and shift that day’s narrative. And so, every year, an increasing number of  activists in dozens of cities all over the world join this unique and multifaceted show of force for reform and harm reduction.

The Support. Don’t Punish campaign aligns with the following key messages

  • The drug control system is broken and in need of reform
  • People who use drugs should no longer be criminalised
  • People involved in the drug trade at low levels, especially those involved for reasons of subsistence or coercion, should not face harsh or disproportionate punishments
  • The death penalty should never be imposed for drug offences
  • Drug policy should focus on health, well-being and harm reduction
  • Drug policy budgets need rebalancing to ensure health and harm reduction-based responses are adequately financed.

 

Children’s health is a top priority

In Atyrau, Kazakhstan, the incidence rates of tuberculosis among children (0-14 years old) and adolescents (15-17 years old) are significantly higher than the national average: the incidence of tuberculosis in 2017 here is 1.5 times higher than the average around the country.

For this very reason, the project on Implementation of Highly Effective Measures of Prevention and Treatment of Tuberculosis among Children and Adolescents, the purpose of which is to improve the organization of activities on TB prevention among adolescents and children, is ongoing here, in Atyrau. The project is implemented by the international organization Project HOPE – Kazakhstan within the framework of the Social Investment Program of Tengizchevroil LLP, in cooperation with the National Scientific Center of Phthisiopulmonology of the Ministry of Health of the Republic of Kazakhstan.

“The high incidence of tuberculosis in this region may have several reasons, explained Bakhtiyar Babamuradov, the Project HOPE Representative in Kazakhstan. One of them is a low coverage of new-borns by the BCG vaccination, as parents refuse vaccination for personal reasons and religious beliefs. In addition, low levels of alertness and awareness of kindergarten and school personnel, as well as of the parents, about the symptoms of tuberculosis lead to delayed treatment at the medical facilities. Therefore, the important components of the project include increasing the health and non-health personnel alertness to the symptoms of tuberculosis, as well as raising the public awareness about the necessity of tuberculosis prevention. Media is also actively involved in the work”.

According to the test results, 85 teachers, lecturers and educators of preschool and educational institutions, who had participated in the seminar on Prevention of Tuberculosis among Children and Adolescents have demonstrated a 40% improvement of knowledge level (from 51% up to 92%).

“Alliance for supporting youth affected by the problem of tuberculosis” by Sanat Alemi

Fight against tuberculosis among the youth of Kazakhstan plays an important role in the work of AFEW Kazakhstan, and in particular, the Sanat Alemi public foundation. In the framework of the “TB/HIV Prevention & Care – Building Models for the Future” project in March 2019, the “Alliance for supporting youth affected by the problem of tuberculosis” was presented in the country. The main goal of the alliance is to comprehensively support young people with TB, as well as increase their adherence to treatment, and improve the quality of life.

Consultations and trainings are regularly held for members of the Alliance; sports events and joint trips aimed to unite children who until recently didn’t even know with each other are organized to promote a healthy lifestyle. Such active events contribute to rapprochement and building communication among children and adolescents.

EECA INTERACT is a step towards the development of unified community

Why is the Workshop EECA INTERACT so important for the EECA region?

Alexei Alexandrov, a member of the international committee of EECA INTERACT 2019, head of Minsk regional clinical centre “Psychiatry-narcology”.

EECA INTERACT can become a model for building regional and country interaction between young and experienced researchers, medical practitioners, employees of non-governmental organizations and members of community initiatives, as well as representatives of the government.

All these specialists are involved in solving the problems of HIV infection, tuberculosis and viral hepatitis, and also related problems of drug use, criminalization, prison health, stigma and human rights. The exchange of experience by specialists from EECA countries with similar situations on HIV, TB, Hep, drug use, the results of new studies and expert assessments will allow choosing the best solutions to change the situation and begin to really implement them.

For me, EECA INTERACT is not only a meeting with new colleagues and getting acquainted with the results of their work, discussing pressing issues, forming direct contacts to continue cooperation or a network of interaction. The seminar is a continuation of the efforts that we, experts of the EECA countries, are directing to respond to the HIV epidemic in the region, implementation of those innovations that have already been tested in the world and are evidence-based.

The workshop is a step towards the development of a unified scientific, expert and practical community of our countries, united by common tasks. Everyone can have their own vision of the situation, challenges and solutions, but only joint discussion and analysis will allow finding potential points of influence for success.

 

How would you rate the development of clinical and research networks in the EECA region today?

Sergii Dvoriak, a member of the international committee of EECA INTERACT 2019, M.D., D.Med.Sci, founder and senior scientist, UIPHP, professor at the department of social work, ALSRT.

In our region, a lot of problems are associated with the traditions and imperfections of medical education. For several years I conducted training seminars “Effective Treatment of Drug Dependence” in Salzburg (organized by the Open Society Foundation), where all participants, mainly doctors, were divided into 2 groups, the Russian-speaking from EECA and the English-speaking from Southeast Asia and Africa. People from EECA were educated in the “Soviet” system, the others – in the “Western”.

I noticed a very clear difference in the methods for solving clinical problems. People from EECA went into “philosophy” and the so-called pathogenetic way of thinking, and “Western” immediately appealed to existing protocols and standards, objective data, etc. I then realized that many of our specialists need to be retrained and they should focus on evidence-based methods, and not on general considerations and “clinical points of view.” For this, we need such meetings like EECA INTERACT, where these points can be emphasized. It is important also that decision-makers participate in such events.

In Ukraine over the past 10 years, significant progress has been made in the development of clinical and research links. To some extent, a solid research infrastructure has been created, several organizations were found which can not only participate in international collaborative projects but also independently carry out research and receive funding from donors such as National Institutes of Health, CDC, WHO etc. Unfortunately, national donors are still very sparingly involved in this process.

Ministry of Health also does not understand enough how important the systematic and continuous process of conducting scientific research is, and the importance of implementation projects is underestimated.

Officials believe that only mainly state institutions have the right to make scientific research. They expect global discoveries or creation of new vaccines, effective drugs, but they do not really understand that in the modern world only a limited number of countries and companies are able to take such steps. There are no such resources in EECA countries, but this does not mean that research is not needed. Doctors should be involved in scientific projects as much as possible, because this disciplines clinical thinking, makes it possible to get acquainted with the modern scientific context.

 

 

 

 

RADIAN for the EECA region

On the 10 of September the Elton John Aids Foundation with Gilead Sciences announced the launch of a new project RADIAN. This major project aims to bring support to Eastern Europe & Central Asia, where the AIDS epidemic is on the rise.

A ground-breaking initiative

The global community now has the tools to meaningfully address new HIV infections; however, HIV is on the rise in Eastern Europe and Central Asia (EECA). To address the challenges in EECA and ensure no one is left behind in the global effort to end the HIV/AIDS epidemic, the Elton John AIDS Foundation and Gilead Sciences have partnered together in a ground-breaking initiative called RADIAN.

RADIAN is a natural evolution of the existing collaboration between the Foundation and Gilead in the EECA Key Populations (EECAKP) fund, which gave the organisations a greater understanding of the urgent needs in EECA and the necessary experience to respond. The RADIAN partnership will provide investment, support and on-the-ground resources over the next five years to support interventions and drive measurable impact in EECA.

Model Cities

RADIAN consists of two programs: ‘Model Cities’ and the RADIAN ‘Unmet Need’ Fund. 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. Additional ‘Model Cities’ will be announced in 2020

The Radian Unmet Need Fund

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 project encourages local and regional organisations in EECA who share its vision of significantly improving the quality of care for PLHIV, addressing new HIV infections and AIDS deaths to apply for grant funding when the Request for Proposals opens in mid-October 2019. Best practices and learnings from the local implementation of RADIAN over the next five years will be used as a blueprint towards creating change across the region.

Peer navigators – indispensable medical assistants

Author: Marina Maximova, Kazakhstan 

Over the past three years, express HIV testing in key populations in the East Kazakhstan region of Kazakhstan increased by a third. Peer navigators play a very important role in this success.

Today among key populations, including people who use drugs, sex workers, men who have sex with me, etc. there is a major increase in infection in the country. Representatives of these groups usually don’t come to AIDS centers and medical facilities for testing, but, as experience has shown, they easily visit non-governmental public organizations (NGOs) or ask peer navigators for such services.

Peer navigators – who are they?

The term “peer navigators” is very popular among social activists. People living with HIV (PLHIV) become voluntary medical assistants and help professionals to care about patients. They do express testing for HIV infection in peri-gingival fluid, provide counseling, and, if necessary, accompany PLHIV to AIDS centers for complete testing.

“Another important work of peer navigators is to increase the motivation of PLHIV for the constant and systematic use of special antiretroviral therapy (ARVs), which is extremely necessary for our patients to improve their health, – says Marina Zhigolko, head of the East Kazakhstan Center for the Prevention and Control of AIDS. With the participation of volunteers, in recent years, PLHIV adherence to treatment has quadrupled. Today, more than 80 % of these people take rescue therapy and can work fruitfully, have families, give birth to healthy children”.

Today in the East Kazakhstan region there are 20 peer navigators. In the framework of the USAID Flagman project, they are provided with rapid tests, tablets for record-keeping, disposable syringes, lubricants, and promo materials.

Personal example and motivation

Sergey Baranyuk, a peer navigator from the Answer public foundation, packs a backpack in the morning and sets off on his route to work “in the field”. He is an ex-prisoner, has been living with HIV for many years, he used drugs. Today Sergey has a family, a job, and he helps other people to overcome the life situation he had before. His life experience helps him to convince those who, for various reasons, fall out of medical control and are not tested for HIV.

“The express test for peri-gingival fluid is convenient to use,” says Sergey. It can be done on a bench in a park, in a car, at home. After 15-20 minutes, a person already knows his HIV status. While he is waiting for the result, a peer navigator can talk to him about the risks of behaviour, ways of transmitting HIV infection and precautions. ”

Trust on the Health Route

Over three years, with the joint work of peer navigators and health visitors in the East Kazakhstan region, the number of PLHIV on follow-up has doubled. People come for medical monitoring of health, testing and medication. Peer navigator work not only in the regional center, but also in villages. For example, some villages of Glubokovsky, Shemonaikhinsky, Ulan districts, as well as Ridder-city are also under the control of public activists.

Many people prefer to come for testing at an NGO. For this, for example, the public funds “Answer” and “Kuat” have specially equipped rooms. Here people can talk frankly and do a test.

The first six months are the most important in the work of peer navigators. After some time, patients start to understand the importance of treatment themselves. But before peer navigator should find a person from the risky behaviour group and convinces him to find out his HIV status and, if necessary, start treatment.

“Navigators are our ears, eyes and foot,” says Neil Mamyrbekova, head of the treatment department at the Semey AIDS Center. «One doctor is not able to single-handedly cover patients, set them up for treatment, and convince them in the possibility to start a new life. A person must come to us prepared, therefore navigators are our main assistants. They are trusted!»

Facts abour EECA region

HIV epidemic status in Eastern Europe and Central Asia (UNAIDS, 2017)

Since the start of the epidemic:
• Over 76 million HIV-infected patients registered
• 35.0 million people died of AIDS-related illnesses
• The number of people living with HIV was 36.7 million, of which 2.1 million were children under the age of 15.
• 20.9 million people (28%) living with HIV received treatment
• 76% of pregnant women living with HIV had access to treatment to prevent transmission of the virus to the fetus
• In 2017, 1.8 million new HIV infections were reported worldwide.

Have you already registered your abstracts for the EECA INTERACT 2019 workshop?

Attention! Selected abstracts will get free registration. Please find here more information. 

School of MSM and TG Leaders

On August 12–16, the “School of MSM and TG Leaders” was held in Almaty, Kazakhstan.

The objectives of this training were: to mobilize and increase the visibility of the community in the country; to create cohesion of the community itself; to create a tolerant attitude of the general population towards LGBT people.

More than 20 novice activists from different parts of Kazakhstan got new knowledge and skills to create a safe environment, maintain health and to improve the quality of life of LGBT people in the country.

“This is one of the best training I attended because it is not just a lecture but real master classes and personal experience of successful people’’ says one of the participants of the School. Indeed, the presenters – Amir Shaykezhanov – editor of www.kok.team and Elena German – program director of the Eurasian Coalition on Male Health www.ecom.ngo shared their professional experience.

The world is changing rapidly and today the most creative and innovative thinking leaders are pushing forward. The training itself and the presentation of the material were very unusual. From the beginning, the group was immersed in a creative trance – the participants were declared heroes of the Game of Thrones universe. “Five houses” – five groups of participants were engaged in the development of their unique projects for implementation in their regions. “Video blog to increase visibility”, “Community centers to support the LGBT community”, “Live libraries for anti-discrimination of HIV-positive MSM within the community”, “Improving HIV literacy among the LGBT community”, “Legal protection of the LGBT community” – during “The School” all these projects have gone all the way from the origin of the idea to a completed project application for receiving funding from the event organizers – AFEW Kazakhstan.

“We could not choose the best or most relevant topic, since all topics are important for the community,” admitted Roman Dudnik, chairman of the jury, director of AFEW Kazakhstan. As a result, the jury members – representatives of AFEW Kazakhstan and the Kazakhstan Union of PLHIV – decided to finance all projects. Teams are ready and are going to start in September.