People who Use Drugs Deserve Love, Respect and Support

Author: Grana Ziia, AFEW-Kyrgyzstan

Sergey Bessonov from Bishkek is the head of the organization that protects the rights of people who use drugs (PWUD) – “Harm Reduction Network Association” (HRNA). Sergey himself used drugs in the past. However, he admits that everyone has the right to make his own choice whether to stop using drugs or not.

Now Sergey dedicates his life to the community of people who use drugs. In his interview with AFEW-Kyrgyzstan, Sergey is talking about the challenges of the community of people who use drugs in Kyrgyzstan, drug policy and his future plans. Below are some of Sergey’s thoughts in direct speech.

About the desire to be heard

For a long time, the problem of drug use was solved by using strict bans: prisons, fines, and information that PWUDs are no longer members of our society, that they are somehow bad, dangerous… I myself know a lot of people who died from the overdose, I saw people who spent most of their lives in prisons for using soft drugs. These people were left without work, housing and the possibility to live the life they wanted to.

Now in Kyrgyzstan, the government started to understand that a progressive drug policy cannot be built without a community. However, it is very important for us that the community participation in the development of programs was not just for show. We want our opinion to be respected, considered and trusted. We need the possibility of professional growth.

About the professional growth

The project “Bridging the Gaps: Health and Rights for Key Populations” (BtG) started to help us a few years ago. Over the past two years, this project gave people from the community the possibility to take part in trainings on negotiation skills, legal monitoring by the community, analysis of regulatory legal acts.

These trainings helped us to develop some of our skills. Using this knowledge, people from our community started to develop their own organisations, participate in working groups with governmental representatives and implement advocacy programs.

About the new drug policy

Last year, our country started talking about changes in criminal and administrative codes. Governmental representatives finally understood that sending people who use drugs to prison instead of rehabilitation and harm reduction programs is ineffective and cruel.

During the analyses of new regulatory acts that HRNA conducted with the support of the BtG project and AFEW-Kyrgyzstan, we found some negative changes. For example, new amendments, which now started to work, increased the fine for carrying and possession of drugs twice. The new fine is unaffordable, which means that people will again be imprisoned. Now we are negotiating with international and state structures, with other NGOs and explaining to them why this novelty needs to be revised.

BtG also provided us with an opportunity to conduct focus groups among PWUDs. We found out that not all people are aware of the new laws. This creates extortion and corruption. Now we are constantly monitoring new cases of detention of drug users and support people who use drugs.

About the alternative to prisons

According to the new offense code of Kyrgyzstan, alternative punishment that is called probation is provided for people who use drugs and who have committed any kind of offense. Therefore, now a person has an opportunity to avoid prison.

The initiative itself is very good and we now have a lot of work for its successful implementation. We have already come to the agreement with several probation services and they are letting us know if a person who uses drugs came to them.

HRNA also plans to work with judges to explain that we should punish people only for offenses, not for using drugs. People in our country still have many stereotypes towards people who use drugs. These stereotypes can influence judges’ decisions about sending a drug user to prison or probation.

About the needs of the community

People who use drugs almost always remain alone. Parents turn away from them, doctors reject to help, friends betray them, mass media use offensive words, police suspect them in all crimes. Sometimes we become the only home and friend for each other. With our examples, we show that people who use drugs deserve love and respect.

To help our community to be strong and united, the BtG project is supporting our dialogue platform. Thanks to this, we can meet, discuss and stay united. I feel that the community is getting stronger and more confident with years passing by.

Together we build a liberal healthy future in Kyrgyzstan, where every person can get help and fulfill their potential.

Natalya Shumskaya: “Without a Professional Team We Would Not Have Succeeded”

Author: Grana Zia, AFEW-Kyrgyzstan

The executive director of AFEW-Kyrgyzstan Natalya Shumskaya is talking about the successes and challenges of the organisation in 2018 and the new demands for 2019.

– Natalia, what are the main achievements that AFEW-Kyrgyzstan can be proud of in 2018?

– I am really proud that the World Health Organisation (WHO) recognized the clinical guideline we developed for the management of pregnancy among women who use psychoactive substances as the best practice.

In the women’s colony, where we work in partnership with the Penal Medical Service and the Republican AIDS Centre, we managed to achieve the goal of 90-90-90: 90% of HIV-positive people are aware of their status, 90% of them take antiretroviral (ARV) therapy and reach supressed viral load. This is our common contribution to the fight against the HIV epidemic, and it is very encouraging to see such results.

I am also proud that we have managed to develop guidelines for the effective functioning of the coordination commissions on HIV infection and tuberculosis. Under this guideline, we trained over 100 representatives of regional public health commissions in all regions of Kyrgyzstan. We successfully lobbied for the participation of civil society organisations in these commissions.

Remembering 2018, I should also mention the delegation from Kyrgyzstan at the International AIDS Conference in Amsterdam AIDS 2018. We have been looking for funding for a long time, negotiating with various donors. Here is our result: 16 participants from Kyrgyzstan took part in more than 15 sessions; six delegates from Kyrgyzstan became conference speakers, and five delegates took part in poster presentations. At AIDS 2018, we even organized our own workshop for the countries of the Eastern European and Central Asian (EECA) region on community participation in decision making at all levels. I consider this a success, and, taking into the account the huge amount of work for this case, I call this a great achievement.

I am also proud that in 2018 we were able to agree with AFEW International and UN-Women in Kyrgyzstan on the opening of a rehabilitation centre and a social enterprise. It was a long process of negotiating, but we were able to take this step for the sake of healthy future for our country.

– What were your main challenges in 2018?

– I think that challenges are, first of all, opportunities. For example, in 2018 we planned the opening of a centre for teenagers for the prevention of usage of psychoactive substances. It was important for us that the state also contributed to the opening of this centre. We wanted to emphasize the importance of investing in youth development by the state. Children need our help. Unfortunately, negotiations with the mayor’s office were very long. It took us a very long time to receive a huge amount of necessary permits. We organized meetings, made concessions, but we were rejected. In early 2019, the opportunity arose to open such a centre in partnership with the State Agency for Youth, Physical Culture and Sports under the Government. They gave us a large and warm room in the heart of the city of Bishkek. Starting from March, our centre for teenagers begins its work.

– What are the main goals for AFEW-Kyrgyzstan in 2019?

– First of all, we plan to start our social entrepreneurship. We have already opened a training centre and beauty studio. We plan to train women in difficult life situations and to employ them later to work in the beauty studio. Now the important task is to think about marketing strategy and put everything on a self-sufficiency track. For us, this is a new experience. Now we will master fashionable beauty services, understand all the difficulties of accounting and business.

Another goal is to ensure stable development and financial support of our rehabilitation centre. It is being built now with the support of AFEW International. We want it to be a high-quality, multi-functional, modern and convenient for people who use drugs. We do not accept “semi-results”, and will definitely achieve all the goals.

Of course, 2019 will be for us a year of searching for new directions and programs, and strengthening advocacy activities, especially in the field of budget advocacy from the state. We want to strengthen relations with the donor community, non-governmental organisations and the state.

– Natalia, what do you think distinguishes AFEW-Kyrgyzstan from other non-governmental organisations in Kyrgyzstan?

– I think our strongest point is our employees. Due to the fact that our entire team is people with completely different education and experience, we can work in a very large range of services. Among us there are specialists in the field of HIV, tuberculosis, gender experts, researchers, business consultants. In 2017, for example, we began to develop the direction of helping women in difficult life situations. It was the first experience, but now this direction is very successful: 320 women from various key groups (single mothers, victims of gender-based violence, HIV-positive women) had training on the development of economic independence. Some of them started their business after that, someone has already come to our beauty studio as a master or coach. Without a professional team that is ready for new challenges, we would not have succeeded.

Dreams of the “Invisible” Women in Kyrgyzstan

Author: Grana Ziia, AFEW-Kyrgyzstan

A photo exhibition “Dreams of the Invisible Women” was held in Bishkek, Kyrgyzstan from November 25 to December 10, 2018. The exhibition, which was held in the centre of Bishkek and in the venues popular among young people, allowed women suffering from violence, discrimination, living with HIV or using drugs as well as LBT women to send a message to the society: “We are here! We also love and are loved, we deserve to be happy and have equal rights.”

The photo exhibition was initiated by Asteria Foundation with the UNAIDS support. The photo models were participants of Bridging the Gaps: Health and Rights for Key Populations project. The exhibition was held within the 16 Days of Activism Against Gender-Based Violence Campaign, and its opening was dedicated to the World AIDS Day.

“Invisible women” face violence, they become hostage to an endless cycle of abuse, guilt and discrimination. People judge them and tell them: “That’s all your fault!” Often, drugs are the only way for them to run away from their pain, shame and despair. Due to the social stigma, women from the key populations almost never seek help, they are afraid that people will not understand them and will reject them. That is why their problems are invisible for the state and for the society,” says Irena Ermolayeva, Director of the Asteria Charitable Foundation.

Asteria’s statistics confirm this situation. According to the data available, all women from vulnerable populations who have families or intimate partners are exposed to different forms of violence. However, 80% of such women do not seek any help as they are afraid to face stigma and discrimination again.

“This campaign is very important for us. It opens new opportunities for women who use drugs, lesbians, trans women, women living with HIV and women who suffer from violence and show the issue from a different perspective. The main goal of the exhibition is not to “draw” a victim and not to label women, but to focus on the fact that first of all they are human beings and, thus, should have equal rights. I hope that this campaign will change the attitude of our society to thousands of women who are the same as the heroines of our exhibition,” says Irena Ermolayeva.

“Invisible women” are first and foremost someone’s mothers, who love and are loved, someone’s friends and relatives. They need the society to stop viewing them as a problem and to recognize their right to live free, happy and safe lives. They dream to be protected by law and by the state.

AFEW-Kyrgyzstan Started the Year with Rebranding

By changing the name “AIDS Foundation East-West in the Kyrgyz Republic” at the beginning of the year 2019, AFEW-Kyrgyzstan emphasized its involvement in the international AFEW Network. Another reason for changing the name and logo of the organisation is the expanding capabilities.

“Now we are working not only in the field of HIV and AIDS. We are implementing tuberculosis treatment projects, conducting large-scale researches, carrying out advocacy campaigns to protect the rights of people and for the economic empowerment of women. Therefore, the former name no longer fully reflects our goals and values,” says the Chair of the Board of AFEW-Kyrgyzstan Natalia Shumskaya.

The new logo has retained one of the key elements of the previous one – the human figure, because everything AFEW does is aimed at helping specific people. The figure also shows that AFEW-Kyrgyzstan works, involving people from the community, and for them.

Three blue and one red objects around the white pattern represent different countries since AFEW-Kyrgyzstan is a part of an international network and is ready to use the experience of foreign partners to build a healthy future in the country.

In an updated form, AFEW-Kyrgyzstan is ready to welcome its old partners again and look for new opportunities to help people from key populations.

AFEW-Kyrgyzstan Uses the Experience of Foreign Colleagues

216 adolescents were registered for using psychoactive substances in 2017, according to the Narcology Center in Bishkek. Representatives of the police services in Bishkek stated that there is also a high possibility that 1,031 teenagers, who were registered for committing different offences in 2018, had an experience of using psychoactive substances or are at a high risk of starting to do so. However, this data does not show the real situation. In Kyrgyzstan, there are still no complete official data on the exact number of adolescents who use psychoactive substances.

This is related to several factors. One of them is that the drug policy of the country is still strict and aimed to punish. Parents and children who face the problem of using psychoactive substances are afraid of getting help from medical specialists because the doctors will add teenager’s name to the special database. In the future, being in this database will not allow this teenager to be enrolled at the university or to get a high-paid job.

Another issue is that the country is lacking ways to support such adolescents. There is also a lack of a comprehensive program for the prevention of drug use among teenagers. The combination of all these factors does not allow the country’s specialists to work effectively with adolescents and to carry out preventive work.

Bridging the Gaps: health and rights of key populations (BtG) project, implemented by AFEW-Kyrgyzstan, intends to apply international experience to help adolescents who use psychoactive substances in Kyrgyzstan. BtG has regional exchange platforms, where specialists from EECA can share with each other their experience concerning harm reduction and rehabilitation issues. It helps the project to meet contemporary challenges. AFEW-Kyrgyzstan is aiming at creating a multifunctional mechanism that will help adolescents who use psychoactive substances and a professional system for preventive teenagers from using it.

The protocol is approved by the Ministry of Health

The clinical protocol ‘Mental and behavioural disorders due to the usage of new psychoactive substances among children and adolescents’ was developed with the support of AFEW-Kyrgyzstan and approved by the Ministry of Health in 2017. Professional narcologists and members of the community of people who use psychoactive drugs and other specialists developed the protocol.

“The developed clinical protocol gives the recommendations to emergency medical doctors, toxicologists, family doctors, resuscitators, psychiatrists and narcologists,” says Elmira Kaliyeva, a participant of the working group that developed the protocol.

Having developed the protocol, AFEW-Kyrgyzstan began trainings for narcologists, doctors of family medicine centres, teachers of the Kyrgyz State Medical Institute for post graduates and juvenile inspectors in Bishkek and Osh.

Working for the future

The representatives of the UN Children’s Fund (UNICEF) got interested in the protocol too and the BtG work and approached AFEW-Kyrgyzstan with a proposal to teach doctors in remote areas of Bishkek to work with this protocol. The proposal of UNICEF gave the opportunity to expand the circle of specialists familiar with the protocol. In addition, this cooperation will allow AFEW-Kyrgyzstan to be confident that all the work done in the framework of the BtG project will continue in the country for many years.

Waiting for the city hall’s help

Establishing cooperation with government partners to ensure stable and long-term support for adolescents who use drugs was the next task of the project. In June 2018, within BtG project, AFEW-Kyrgyzstan supported a round table organized by the city administration for the presentation of the Comprehensive City Program Prevention of Juvenile Offenses for 2018-2020.

Deputies promised to consider the proposed Comprehensive City Program which also includes recommendations that were listed in the developed clinical protocol. The adoption of the program will allow to create a cross-sectorial system of cooperation in the country, where the various departments can work together and redirect children who use psychoactive substances to help them as efficiently as possible.

Opening a centre for teenagers

The round table also became a platform for discussing the urgent need of opening a specialized centre to support children and adolescents who use psychoactive substances.

“We are in favour of building a modern centre that is capable of providing quality support to adolescents and is able to give parents verified and necessary information. This centre will become a model for working with adolescents from a key group as well as an educational and methodological centre for social pedagogues, juvenile inspectors and psychologists,” says Natalya Shumskaya, head of AFEW-Kyrgyzstan.

Taking into consideration that Kyrgyzstan’s culture is very traditional, there is a common misconception that people who use psychoactive substances are not good members of the society. This stigma leads to several issues. For example, teenagers are scared to talk with someone about the use of psychoactive substances. They are afraid of being expelled from the school or being suspected in crimes only due to their experience of using psychoactive substances.

“The center is also going to work on increasing the level of acceptance of psychoactive substances use among the society. This will lead to more effective support from the side of adults and to less risky behavior of adolescents as they got all proper information they need. It is the first step that can lead to final abstinence,” says Chinara Imankulova, manager of BtG project in AFEW-Kyrgyzstan.

AFEW-Kyrgyzstan specialists already developed a project of such centre. The centre will also work with those who have never used psychoactive substances and with children who are in high risk of starting using them. The prevention work will include helping teenagers to organize their leisure activity and to give them information that usage of psychoactive substances is not shameful, however it is important to ask yourself whether you are aware of the risks and if you really want to do so, to find solid information and to ask for help of professionals.

Creating the centre and the approval of the Comprehensive City Program will help thousands of teenagers to make healthy choices for a happy life.

Share Experience and Adopt New Ideas: Kyrgyzstan Heading to AIDS 2018

Author: Olga Ochneva, Kyrgyzstan

22nd AIDS Conference AIDS 2018 is an event which is particularly important for the countries of Eastern Europe and Central Asia – the region where the HIV epidemic is still growing. Representatives of governmental, non-governmental and community-based organizations from Kyrgyzstan were active in submitting applications and abstracts as well as looking for support to participate in the conference. We spoke to some of the delegates heading to AIDS 2018 and asked them how they are going to present their country at the conference. We also talked about their expectations for this major international event in the area of HIV.

Experience of preventing gender-based violence in HIV response

For three years, civil society organizations in Kyrgyzstan have been working to prevent violence against women who use drugs: 213 women attended individual sessions. They were screened for the exposure to violence, received detailed information on this issue, together with a counsellor developed safety plans, strengthened social support, and determined their goals to resolve the issues of violence and HIV.

Tatyana Musagalieva

Asteria NGO was one of the organizations implementing the Wings of Hope project to prevent gender-based violence, and Tatyana Musagalieva as a representative of this organization will present the efficiency of this rapid intervention at AIDS 2018.

“We would like to share our experience and demonstrate that this intervention is effective: it helps women to be open for medical, social services and harm reduction programs and reduces the HIV risks. I hope that the results of our work will prove the importance of preventing gender-based violence and its linkage to the risks of HIV.”

Sex-work: challenges and solutions

Ulan Tursunbayev

The needs of Kyrgyz sex-workers will be presented at AIDS 2018 by Ulukman Daryger NGO, which received support from AFEW International to carry out community-driven research.

“We are preparing a poster to present the results of our research study. We make a focus on two most pressing challenges – HIV testing and economic adaptation after sex-work,” says Ulan Tursunbayev, Director of Ulukman Daryger NGO. “After completion of the study, we have already started making first steps to resolve the issues we identified. Now we are getting prepared to submit a funding proposal within the national social contracting mechanism. There are intentions to finance a program to socialize women in difficult life circumstances from the local budget. That is why at the conference, apart from our research results, we will also present our vision of how to resolve this problem.”

Young people are going to AIDS 2018 to gain knowledge

Renata Bayazitova

The only organization in the country working with young people who use drugs will also be prominently present at the conference. Renata Bayazitova, Project Coordinator of the Ganesha NGO will deliver a poster presentation to show the results of the assessment of services for young female drug users.

“I will present the country situation in terms of the number, quality and effectiveness of the services for young female drug users offered by governmental and non-governmental organizations. This assessment was carried out by the community and showed major gender and age-related gaps. I hope that participation in the conference will help me get new information, learn practical ways to adjust services to our young people, and share the experience with other youth organizations.”

Treatment is a priority

Margarita Sabirova

Prosvet Charity Fund will represent the Kyrgyz organizations working with people living with HIV (PLWH) at AIDS 2018. The Fund provides consultations on adherence to antiretroviral therapy as well as legal and psychological counselling, navigates clients to various services, offers support in rehabilitation and reintegration in the society, and strives for better quality of the services for PLWH.

“My expectations from the conference are to get information about the new methods of HIV/AIDS treatment based on the latest achievements of modern medicine,” says Margarita Sabirova, the psychologist of the Prosvet Charity Fund. “It would be good to learn about the experience of other countries in terms of the interaction of civil society sector with governmental agencies, to see the contribution of different governments to the activities of civil society organizations and their response to HIV.”

Sixteen delegates supported by AFEWKyrgyzstan

Natalya Shumskaya

Thanks to the support of donors (Dutch Ministry of Foreign Affairs, USAID, GIZ, UN Women, WHO), AFEW-Kyrgyzstan was able to support 16 delegates providing them with an opportunity to attend the conference. Those are representatives of AIDS centres, municipal bodies, healthcare coordinators, researchers, community leaders of key populations and AFEW-Kyrgyzstan staff members.

“The delegates will present the experience of AFEW Network in strengthening community monitoring and community involvement in service delivery will tell about the HIV prevention, treatment, care and support in Kyrgyz prisons. There will be poster presentations dedicated to the country’s experience in economic empowerment of women vulnerable to HIV as well as HIV prevention through opioid substitution therapy. I will speak about the assessment of opportunities of female leaders of the community of people who use drugs and their impact on the access to and quality of HIV programs,” tells Natalya Shumskaya, director of AFEW‑Kyrgyzstan. “Participation in AIDS 2018 is a unique opportunity for all of us to get acquainted with the best practices in HIV diagnostics, prevention, treatment and care as well as present our own experience. Kyrgyzstan has an extensive experience as our country has implemented innovative HIV prevention approaches both in public health care and in penal institutions.”

Bridging the Gaps in Clinical Guideline to Care in Pregnancy for Women Using Psychoactive Substances

All the regions of Kyrgyzstan already received the developed clinical guideline

The estimate number of people who use injected drugs (PWID) in Kyrgyzstan is about 25,000 people. Many of these people are women. Such is the data from the research that was conducted within the framework of the Global Fund’s grant in 2013.

Applying recommendations in practice

In 2016, Public Fund (PF) Asteria, a community based organisation that protects rights of women who use drugs in Kyrgyzstan, applied to AFEW-Kyrgyzstan seeking for a help in developing a clinical guideline to care in pregnancy for women who use drugs. Within the framework of the project Bridging the Gaps: health and rights for key populations, AFEW-Kyrgyzstan decided to support this initiative as there were no modern standards for working with women who use drugs in the country before. A working group that included an expert in narcology, an obstetrician-gynecologist, an expert in evidence-based medicine, and a representative of the community of women who use drugs was created. In January 2017, the clinical guideline “Care in pregnancy, childbirth and the puerperium for women who use psychoactive substances” was approved by the order of the Ministry of Health and became mandatory for doctors’ use.

“When the guideline was approved, we realized that it is not enough to simply distribute it among the doctors. It was necessary to organize a comprehensive training for the family doctors, obstetrician-gynecologists and other specialists so that they could not only apply the developed recommendations in practice, but also share their experience with their colleagues,” said Chinara Imankulova, project manager of the Bridging the Gaps: health and rights of key populations at AFEW-Kyrgyzstan.

In April 2017, trainings were organized for the teachers of Kyrgyz State Medical Institute for postgraduate students. The manuals for teachers with presentations have been developed so that in the future trained teachers could deliver reliable information to the course participants. This approach gives an opportunity to train all healthcare professionals in the country and provides them with an access to the protocol.

In August 2017, trainings were offered to obstetrician-gynecologists of the centers of family medicine and obstetrical institutions. During the trainings, specialists got acquainted with the latest research in this field, studied the peculiarities of pregnancy, prenatal and postnatal period of women, who use drugs, as well as ways to avoid or minimize the risks of drug exposure to women and children.

“Two or three years ago, when our pregnant women who use drugs visited doctors, they were afraid that doctors would force them to have an abortion. In September 2017, our client Victoria, who at that time was on methadone therapy, visited the obstetrician-gynecologist. Victoria gave birth to a healthy girl, and doctors treated Victoria and her child very well. Moreover, the doctor even helped Victoria to get methadone so she could spend enough time in the hospital for rehabilitation after the childbirth,” said Tatiana Musagalieva, a representative of PF Asteria.

Women should not be discriminated

During the trainings, 100 specialists who are working in the republic of Kyrgyzstan were trained. Doctors from the regional centers were also invited for the training. It is very important to provide access to quality medical services for women who use drugs in the rural areas. Doctors also learned to get rid of their stigma towards women who use drugs and always treat them with respect. A class on stigma and discrimination was taught by women from the community of drug users. They told the participants of the training their stories, talked about how difficult it was when doctors refused to treat them or insulted them. This part was useful in reducing stigma and discrimination among doctors, in showing them that women who use drugs are just like the others.

“Before the training I met several pregnant women who use drugs. To be honest, I was not sure that they could give birth to healthy children. Having received the clinical protocol, and with the knowledge I have got in the training, I realized that these women should not be discriminated. I learned about scientific recommendations for conducting pregnancy in the situations that cannot do harm to either mother or child. This helped me a lot,” said the participant of the training, obstetrician-gynecologist Kaliyeva Burul.

All the regions of the republic already received the developed clinical guideline. Doctors who have been trained, share their experiences with their colleagues and help women who use drugs to safely plan their pregnancies and give births to healthy children. AFEW-Kyrgyzstan continues to monitor the work of specialists who have been trained, and monitors if all health specialists have access to the guideline. In the future, AFEW-Kyrgyzstan will continue to work on improving the quality of life of people who use drugs, and will monitor the usage of this protocol by doctors.

In Kyrgyzstan, the New Year Started with Reduced Funding for the HIV Response

Author: Olga Ochneva, Kyrgyzstan

Since January 2018, HIV and tuberculosis programmes in Kyrgyzstan are funded from the new, significantly reduced grant of the Global Fund. There were six months of discussions concerning cost optimization and reduction, taking into account the growing deficit of funds that the country is facing in the nearest three years. The cost-saving mode has already been introduced, first of all affecting the prevention programmes.

Services and coverage are retained

In 2018-2020, Kyrgyzstan will receive 23.4 million US dollars for HIV and tuberculosis response from the Global Fund. For the reference, the previous Global Fund grant stipulated allocation of 20.8 million US dollars for the period twice shorter. The country decided to cut the expenditures gradually. The first six-month cost-saving period started in January 2018. According to Oksana Katkalova, the representative of the UNDP country office, which administers the Global Fund grants in Kyrgyzstan, treatment and diagnostics have been defined as the priorities and prevention interventions have been significantly cut down due to the reduced number of partner organisations.

“The money will be mainly used to purchase anti-tuberculosis and antiretroviral medicines (antiretroviral therapy or ART is a method of HIV treatment) as the number of people who need treatment is growing,” says Oksana Katkalova, HIV Grant Coordinator, UNDP. “We try to retain the services and the coverage, while optimising and reducing the administrative costs.”

Since the beginning of the year, two methadone maintenance treatment (MMT) sites have been closed, with patients referred to the nearest sites. The MMT clients will no longer receive the community support of some non-governmental organisations (NGOs), which used to be financed by the Global Fund. The number of implementing NGOs which receive funding has been diminished. Two NGOs working with people living with HIV (PLWH) in Bishkek and Osh will not be funded, with their services being consolidated and handed over to the organisations, which still get the funding. In smaller towns, services for different key populations have also been consolidated.

“One organisation working with different key populations is quite a good option for smaller regions. It allows saving costs for administrative personnel,” explains Oksana Katkalova. “When in a small town there are two organisations, one working with sex workers and the other one – with people who inject drugs (PWID), each with a coverage of 100-200 people, it makes sense to consolidate those services in one organisation if there is a shortage of resources. Our implementing partners – NGOs – have been selected through tender procedures and now have set coverage indicators, which mostly have been raised. However, they can and should engage outreach workers and peer counsellors for different key populations to reach the required coverage.”

Gender component reduced

The number of needle and syringe exchange points (NSPs) has been reduced from 21 to 15. Two of them used to operate in NGOs as service delivery sites. One of such sites was located in the Asteria residential community centre for women who inject drugs, with the Global Fund grant partly covering rental, personal services (accommodation, laundry, shower, meals, and hygiene packages) as well as the package of basic prevention services and consultations of an STI doctor.

“Unfortunately, the gender component for women who inject drugs has been excluded from the Global Fund project: diagnostics and treatment of sexually transmitted infections, hygiene packages and personal services are no longer available,” tells Irena Yermolayeva, director of the Asteria Charitable Foundation. “The Soros Foundation-Kyrgyzstan and the AIDS Foundation East-West in Kyrgyzstan agreed to cover the rental costs and partly the services for six months. We are doing our best to retain our residential project.”

Two sites in each of the medical and penal systems were closed in 2018

Financial support of the four national networks has also been reduced. Now there will be one network promoting the rights and interests of all the key populations. Medical professionals working with PLWH also feel the shortage of funding. They receive benefits in addition to their salaries from the donor funds. Currently, the strategy of bonus reduction is continued, with shrinking resources, and the amount of the remaining benefits will depend on achieving the performance indicators. It is also planned to reduce payments to the medical personnel engaged in the MMT programme, but it is more complicated as in this case donor funds are the only source of financing. Just to remind that so far, the government has not allocated any money for the methadone maintenance treatment programme.

The programme aimed at the ART adherence improvement has also been cut. Before, all adherent patients used to get monthly motivation payments of 8 US dollars, while since January this year only children receive the allowances of about 14 US dollars, which are to be reduced by 2020.

By 2020, up to 30% of ART costs are to be covered by the state

The country will face even more funding cuts in the following two and a half years of project implementation. It is expected that four more MMT sites will be closed during this period. While in 2017, support within the Global Fund grant was provided to 26 NGOs, it is anticipated that by the end of 2020 only 10 of them will remain.

“So far, the smallest budget has been allocated for 2020 as it is planned that by this time the government will cover up to 30% of expenditures for the ART medicines; besides, we hope to have additional savings,” says Oksana Katkalova. “If during this period the government allocates significantly more funds, they can be used to purchase more ARTs, tests or, for example, to pay bonuses to the medical personnel engaged in HIV prevention, treatment, care and support programmes. Then we will be able to re-distribute part of the donor funds to cover prevention interventions. Every six months, we will adjust the expenditures for interventions and negotiate them in the format of a country dialogue. We hope that there will be a gradual increase in the scope of domestic funding.”

Five People Disclosed their HIV Status to Mark the World AIDS Day in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

The Shukurov family tells about their HIV status during the campaign in the Kara-Balta school

Kyrgyzstan marked the World AIDS Day on December 1 under the Slogan “My Health, My Right.” Competitions, quizzes, a flash mob, debates, a race, a fashion show, and meetings with journalists were dedicated to the World AIDS Day. The most surprising thing during these events was the number of people who publicly disclosed their HIV status.

“Live” stories

Every year on the first winter day mass media publish a year’s supply of reports on the situation with HIV and its prevention. This time, the main message in this load of media reports was the topic of fighting stigma against people living with HIV (PLWH). This message was delivered by people who decided to publicly disclose their HIV status and tell their stories. The start to this spontaneous campaign for the freedom from fears, myths and prejudices was given by Baktygul Shukurova in September this year at the National HIV Conference. Baktygul says that she decided to make this step for all PLWH, to refute myths and give people an opportunity to reflect on the fact that everyone has a right to life and health. Back then, Yevgeniy Yuldashev also made a decision to have an open conversation with journalists.

Charitable race to help children living with HIV was supported by people of different ages and occupations

Following the example of his wife Baktygul, Umid Shukurov also disclosed his HIV status during the December 1 campaign in his home town of Kara-Balta. The spouses opened the truth, which they had been hiding for seven years, and that, as they say, helped them to feel free. On November 29, two more women disclosed their status.

Race to support people living with HIV

A charitable race “My Health, My Right” was organized in one of the Bishkek parks with the USAID support. Despite the cold Saturday morning, over two hundred people took part in the three- and six-kilometre races. Participants had a chance to donate some money to buy New Year presents for children living with HIV. The task of this race was to raise the awareness on the need to be responsible about one’s health and to prevent the spread of HIV.

HIV Quiz Night

Participants of the Quiz Night had only one minute to think over the questions, but many of them replied ahead of time

UNAIDS organized a Quiz Night dedicated to the topic “Right to Health” in the context of HIV. The battle for the title of the smartest brought together 18 teams, each of them making a money contribution. Among the participants, there were teams of journalists, health professionals, students, staff members of AIDS organizations and fans of the Quiz Night game. The participants had to answer 20 questions. Questions about HIV related to the areas of medicine, cinema, history, and music. The best performing team got the game bank and the viewers learned many unexpected facts about HIV and health.

Prevention month

The Republican AIDS Centre dedicated its activities within the month to mark the World AIDS Day to prevention and fighting stigma against PLWH. There was a contest for the best materials on HIV among college and high school students and journalists in three nominations: video, poster, and article. Twenty teams took part in the debate tournament.

Female penal colony against HIV and violence

Women from the penal colony No. 2 demonstrate creativity while talking about important issues

This day was also marked in the penal institutions. AIDS Foundation East-West in the Kyrgyz Republic organized a creative contest in the female penal colony No. 2. Each team presented a leaflet, a dance, a song and two theatre performances on two cross-cutting topics – how to prevent HIV and how to protect yourself from violence. Women spent a month on working on the scenarios and creating the costumes and, as a result, the event was very informative and impressive.

 

 

Fifteen Years of HIV Prevention in Kyrgyz Prisons

A convict takes methadone therapy in a correctional colony

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is a leading country in the Central Asia in terms of implementation of harm reduction and HIV prevention programs in the correctional settings. Syringe exchange programs have been available in prisons since 2002, and today over one thousand five hundred people receive clean injecting equipment in all twelve correctional facilities. Atlantis rehab centers have been gradually introduced since 2004 for those convicts who made a decision to quit drugs. Currently, eight such centers are functioning, with the ones who have almost succeeded in stopping with drugs continuing treatment in a separate, so-called “clean compound.” In ten institutions, including two pre-trial detention centers and one penal settlement, people have access to the methadone substitution therapy. Besides, governmental agencies, together with donors and civil society organizations, conduct awareness-raising activities, diagnostics and treatment of HIV infection, tuberculosis, and provide social support for ex-prisoners. Such programs have been implemented for 15 years, and local experts share their best practices.

Correctional settings form adherence

Roman had been enrolled into the opioid substitution treatment (OST) program before he got into prison, but he was still using heroin. Due to drugs related crime, he had to go to jail, where at first his HIV test showed a negative result. However, in a while, the virus has shown itself. Now Roman is free. He works in the Ranar Charitable Foundation offering people released from prisons the same kind of support that he got back when he walked out of the jail: accompanies them to the sites providing OST services, antiretroviral therapy (ART), makes contact with the law enforcement agencies, and provides support with employment seeking and accommodation as well as with the restoration of personal documents, if needed.

“For three years in prison, I was sharing needles with everyone and had no idea that I had HIV till I developed tuberculosis and pleuritis,” Roman says. “When I was in prison, I did not even think about what I was going to do after the release. I thought I was just living out my days. When I got out, my state was really bad: I was taking high doses of methadone and was not taking any ARV drugs. Then my friends showed me some sober guys, whom I knew back in prison. Before that, I could not even imagine that one can quit methadone.”

Today, convicts with HIV amount to 5% of all the people living with HIV (PLWH) in the country, whereas in 2010 this share was 13.7. There has been access to ART in the correctional settings since 2005; and currently, 305 out of 357 officially registered PLWH serving their sentences receive the treatment.

In prison, Roman received ARV drugs but did not take them. He admitted that he took the pills only because they were given together with motivational food packages distributed in Kyrgyzstan to develop an adherence to treatment. Next year, those who receive the treatment for over one year will no longer be getting such packages because their adherence has already been formed.

“In correctional settings, there is a favorable environment where an outstanding program to form adherence may be implemented as the patients are always in plain sight,” Natalia Shumskaya, AFEW Chairperson in the Kyrgyz Republic says. “The quality of treatment and care of people living with HIV, unfortunately, leaves much to be desired. There is a deficit of qualified health professionals and a lack of proper attention to the patient. It is important to make sure that the officers of the department for the execution of sentences see additional benefits for this work. Currently, donor organizations provide funding for additional support, but starting from next year there will be no funds to cover those needs. In this context, it is rather difficult to ensure quality performance of all the guidelines on implementation of the programs aimed at harm reduction, HIV prevention, diagnostics, and treatment, which have been developed over the years.”

How it works “from the inside”

Atlantis: rehabilitation of drug users in correctional institutions

On the average, in penal colonies 85 prisoners attempt to overcome their drug dependence in the Atlantis rehab centers every year. About half of them successfully complete the program and are transferred to the Rehabilitation and Social Adaptation Center (RSAC) or the “clean compound” in the colony No. 31. In this compound, the convicts who decided to quit drugs get additional professional training and are prepared for the release.

OST in closed settings was introduced in 2008, and today such treatment is provided to 479 patients. According to ex-convicts, the methadone substitution treatment program in the places of confinement has been to a great extent discredited by the patients who take additional illegal substances. Access to services varies depending on the type of institution.

“When I found myself in a pre-trial detention center, I got no access to methadone,” tells Roman. “It was not available there, and local staff members only organize transportation to the OST sites if there are at least 4-5 people who take part in the OST program. To get ART, it was also necessary to go outside of the center territory. Sometimes, people have to wait for a court decision for several years there and for all this period of time they may have no access to medications. In a prison, once a day they take you to a sanitary unit, where you get your methadone. There are also ARVs and clean syringes available. You must always give back the used equipment, but if there is a search in the ward, the guards take away all the syringes and needles. In colonies, it is much easier to get all those services.”

The “Kyrgyz miracle”

Madina Tokombayeva, whose Association “Harm Reduction Network” (AHRN) has been providing support to convicts for fifteen years, says that the existence of such programs in the country may already be called a miracle.

HIV prevention training for staff of the State Department for the Execution of Sentences

“We started our activities in correctional settings with self-help groups for PLWH back in 2002 through the first community organization of people who use drugs uniting PLWH and ex-convicts,” tells Madina. “We saw that after the release people need support, so at our own initiative we started helping them after they got out. We were speaking about all the problems existing in prisons, and thus we found people and donors who were ready to support our ideas. At that time, AFEW Kyrgyzstan supported the establishment of the first social bureau in colony No. 47, activities of the Ranar Charitable Foundation aimed at ex-convicts and helped to purchase a house for them, which is still functioning with the support of AFEW Kyrgyzstan. Later, the CARHAP project disseminated social bureaus and support services in all the correctional facilities.”

Currently, harm reduction programs in prisons are financed by the Global Fund and the US Centers for Disease Control and Prevention (CDC). AFEW Kyrgyzstan strives to build the capacity of staff members of the State Department for the Execution of Sentences and, together with the AHRN, provides HIV prevention and social support services to ex-convicts with the support of the USAID.

“We conduct regular monitoring of the harm reduction programs, in particular in correctional settings. I have a feeling that they are still in the bud, but they have got a chance,” says Madina Tokombayeva. “We have to make the adopted laws and the approved guidelines work in these three years, while we still have the donor funding. We need to consult with our clients and, together with the governmental agencies, organizations working in the area of HIV and communities develop a totally new approach to the implementation of such programs so that their quality is really high by the moment when we face the transition to the state funding. They must not be closed under any circumstances or otherwise, we will go back to the parlous times when prisons were the driver in the spread of HIV.”