AIDS Conference Brought me a Job in Tajikistan

Author: Nargis Hamrabaeva, Tajikistan

Fifty-year-old Zebo from a southern region of Tajikistan – Khatlon – is a former labour migrant. At the 22nd International AIDS Conference in Amsterdam (AIDS 2018), she had the courage to speak out about what she long kept in – her HIV-positive status. Zebo once again turned the attention of the international community to the fact that labour migrants are one of the populations most vulnerable to HIV.

We interviewed her in Amsterdam, right after she delivered a speech at one of the sessions dedicated to HIV in the context of labour migration.

– Zebo, why did you decide to go to Russia to earn money? Usually that is what men do.

– In 2004, after I divorced my husband, I was left alone with three small children – my elder siblings were 9 and 6 years old, and my smallest daughter was only 3 months old. I worked as a nurse at a local maternity clinic. My children grew up, with our expenses growing along the way, and my earnings were not enough to feed them all. My ex-husband had a new family and was not helping us. Many of my countrymen went abroad to earn money and support their families. I decided to do the same. That is how my children and I found our way to Saint Petersburg.

– Isn’t it difficult for a woman to be a labour migrant?

– It is very difficult. I was desperate and went to nowhere. For the first days, we slept at the railway station or in the street. Some strangers helped us, offering food or money. Once, a woman from Tajikistan, who worked in Saint Petersburg, saw us and was so kind to give shelter to my children and me. I started baking and selling pasties, earned some money. As time passed, more people were buying our pasties: I was baking and my elder daughter was selling them at the Sadovy street market. Luckily, we had many buyers. However, I had to work my fingers to the bone.

I tried to settle my personal life again as it was very hard for me to cope with all my troubles alone. I met a young man. In the beginning, everything was fine. Then I started noticing him doing some strange things. It turned out that he was a drug user. He injected drugs. I asked him to stop but it did not help. Then I decided to break up with him. Later I heard that he felt bad and his relatives took him back to his motherland. Since then, I have never heard from this man, but my HIV status always reminds me of him.

When did you first learn that you had HIV?

– In 2015, a year after I broke up with my partner. All of a sudden, I felt bad and had a fever. My relatives called an ambulance. In the hospital, they made some tests and I was diagnosed with HIV. In a month, I felt better and went back home, but six months later it happened again. I was dwindling, with my weight going down to 34 kilos. Doctors advised me to go back to my country and get treatment. Almost all my countrymen working in Saint Petersburg had to raise money to buy airline tickets for me and my children. They knew that I was severely ill but did not know the exact diagnosis. When I came home, my family knew I had HIV. They did not really welcome me back. My relatives turned their backs on me and asked me to leave our house. My mother said that I would infect everyone, told people not to eat from the same plate with me and not to shake hands with me. I remember her yelling: “Get out of the house, aidsy!” It hurt me to hear such words, especially from my own mother. Still there are kind people in this world, so a neighbour living opposite from my parent’s house offered me to stay with her. She gave me a small room in a little building. That is where I still live.

So you had to go back to square one again?

– Yes, I did. A woman I know told me about AFEW-Tajikistan office in Bokhtar. I went there and they received me well, helping with food and treatment. They also had a business workshop for the members of vulnerable populations and I was able to get a credit from a microfinance organization. I bought everything I needed to open a small sales outlet in the neighbourhood. Sometimes, when I need to go to the city, my daughter takes over my duties. Children always help and support me in everything I do. My son also assists street market vendors, bringing home 15 somoni a day (less than two US dollars – ed. note). After my speech at the Amsterdam conference, Director of AFEW-Tajikistan Ikrom Ibragimov offered me to work as a consultant in the Bokhtar office of the organization. Now I will receive a salary. I am so grateful to him and to all the members of his great team. With their support, my life is getting better.

Great! One more question about Amsterdam. What does participation in the AIDS conference mean to you?

– It is my first trip far abroad. It is also the first time I take part in such a conference. I listened to many speakers and was inspired by their stories. They were openly saying that they lived with HIV for 20-25 years, taking care of their health and living active and complete lives. It gave me strength and confidence. I was startled to learn that in many countries people living with HIV are not prosecuted and other people do not avoid them. In those several days of the conference, I received more sincere hugs and handshakes than I did since I learned about my diagnosis. Why is there such a strong stigma against people living with HIV in my country? Why do people still hold to stereotypes and are afraid of us? At one of the sessions of the Amsterdam conference, I heard a slogan: “Chase the virus, not people.” It is such a good point! 

AIDS 2018: Will Decriminalisation Resolve the Problem of HIV

Maybe one of the most important sessions at the recent 22nd International AIDS Conference AIDS 2018 held in Amsterdam was the session, which raised the question why we still fail in responding to the epidemic among people who inject drugs. Participants of the session were able to consider this problem from the different points of view: science, law enforcement and community of people who use drugs.

Methadone is good for police

For over 20 years, Professor Nick Crofts from the University of Melbourne has been working to engage police in HIV response. He considers that decriminalisation is an absolute necessity to resolve the problem.

“We fail responding to the epidemic because we have failed to enlist police as partners in the response to HIV,” he says. “Changing the situation, first of all, requires changing the role of police, which will, in turn, help bringing the marginalized communities back to the society.”

In Australia, Professor Crofts and his allies were able to convince the police that such harm reduction programmes as methadone therapy and syringe exchange may benefit police as well as the rest of the community.

“We still have not introduced harm reduction courses in police academies, have not adequately educated police and have not fostered the role of peer educators, which is important not only in the traditional environment of activists, but also in such specific group as future or current police officers. Police officers may listen only to other police officers,” says Nick Crofts with a smile.

HIV for culture change

It is essential to find police officers who support the idea of harm reduction and educate them so that they can then educate their colleagues in relevant agencies.

“Find at least one or two individuals who want to do something different! Find them and give them your support!” exclaims Professor Crofts.

HIV may be a starting point to change the culture of the police. For a start, we need to engage the police, hold joint workshops with people from civil society and police, foster gender diversity in the police (to recruit more female police officers) and, finally, include harm reduction into the programme of police academies.

However, the Professor points out that it may sound pie in the sky talking about police in some countries.

“A third of them understand harm reduction, a third can understand and another third will never understand. Our goal is to find those people who understand or can understand it and work with them until they outnumber those who will never understand harm reduction,” he says.

“Narcotic ration” for Russia

Dr. M-J Milloy, the epidemiologist from Vancouver, tells about an interesting case, which occurred in his city back in the 1990s. Back then, there was already a large needle and syringe exchange programme in Vancouver and methadone was available. The epidemic among people who use drugs had successfully been curbed, but suddenly there was an unexpected outbreak of new HIV cases. How could it happen in a city with a well-developed harm reduction programme? It was explained with the fact that people could not access the necessary services when they were incarcerated.

Epidemiologists found out that incarceration was one of the key factors increasing the risk of HIV acquisition and one in five new HIV cases in Vancouver was a result of incarceration.

At the same time, experts estimate that in Russia every hour ten people are infected with HIV, while tuberculosis is the main reason of mortality among those who live with HIV. Most of them are people who inject drugs. The country does not offer evidence-based treatment to people who use drugs, i.e. there is no methadone, which, according to a recent statement from the Russian Ministry of Foreign Affairs, is a “narcotic ration.”

Compendium of good practices in the health sector response to HIV in the WHO European Region

In response to the rapidly increasing number of new HIV infections in the WHO European Region, the action plan for the health sector response to HIV in WHO European Region was endorsed at the 66th session of the WHO Regional Committee for Europe in September 2016. From December 2017 to April 2018, the WHO Regional Office for Europe collected good practices in implementation of the action plan and compiled them in this compendium.

National health authorities, national and international experts, and civil-society organizations involved in HIV prevention, treatment and care were solicited to share their practices. The practices exemplify efforts within five target areas: HIV prevention; HIV testing and treatment; reducing AIDS-related deaths; curbing discrimination; and increasing financial sustainability of the HIV/AIDS response. This first compendium of good HIV practices in the WHO European Region includes 52 practice examples from 32 Member States. The compendium is intended as a resource for relevant stakeholders in the HIV response.

Download the compendium here.

Source: WHO Europe

AIDS 2018: Prevention Focused on Key Populations

Source: www.aids2018.org

Author: Marina Maximova, Kazakhstan

Just before the 22nd International AIDS Conference in Amsterdam AIDS 2018, a new Global AIDS Update prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) was presented in Paris. The report shows that the HIV epidemic is still growing in the countries of Eastern Europe and Central Asia (EECA). In the recent year, the number of new HIV cases in the region has doubled.

Participants of AIDS 2018 debated a lot on the reasons of this trend. Experts explained it, in particular, with a lack of prevention programmes, especially among people who inject drugs (PWID). Today, they account for over half of the new HIV cases. That is why implementation of the innovative multilevel interventions aimed at HIV prevention in key populations is to be continued.

For several years already, the Global Health Research Center of Central Asia (GHRCCA) and the Social Intervention Group (SIG) of Columbia University have been implementing projects and evidence-based interventions aimed at HIV prevention among key populations in the region, in particular in Kazakhstan. The results and achievements of three of such projects were presented at a special session of AIDS 2018.

Good News from NOVA

Assel Terlikbayeva

Assel Terlikbayeva, GHRCCA Regional Director:

NOVA Project is the first intervention combining harm reduction services and microfinance for women in difficult life circumstances. In two years, about 500 women from vulnerable populations – sex workers and people who use drugs – developed their skills to reduce the risks of contracting HIV and other sexually transmitted infections. Women received professional training in sewing and hairdressing. The most active participants received micro loans to start their own businesses. About 82% of project participants were able to open savings accounts, and many of them did it in the NOVA Project. About 70% of project participants were qualified for non-repayable allowances to start their own businesses, while 36% of women were able to use this opportunity.

Renaissance is possible

Louisa Gilbert

Louisa Gilbert, PhD, GHRCCA Co-Director:

The Renaissance Project is an innovative HIV prevention intervention aimed at PWID couples. Project results are inspiring first of all for its participants. Here is some of the optimistic statistics: unsafe sexual behaviours among project participants and their sexual partners were reduced by 42%, hepatitis C incidence decreased by 69% and HIV incidence – by over a half in the harm reduction group as compared to the control group.

Throughout the project, there were 89 instances when Naloxone was successfully used to reverse overdoses: in 15 cases, the medication was used to deliver first aid and saved lives of the Renaissance Project participants and in 74 cases – of PWID partners and their immediate circle.

PWID choose trust

Nabila El-Bassel

Nabila El-Bassel, PhD, Executive Director of GHRCCA and SIG, Professor of Columbia University:

In the recent year, the number of PWID visiting pilot confidential counselling sites and going through HIV rapid testing has more than doubled. It is very important that the number of new HIV cases detected at such pilot sites has grown. Implementing evidence-based strategies in routine activities allowed scaling up PWID coverage with harm reduction and HIV testing services. It became possible through the Bridge Project.

Besides, the project enhanced the role of outreach workers in finding and recruiting new clients as well as the role of nurses in working with HIV-positive people. Implementing electronic data collection helps to improve tracking and monitoring of the services and referrals provided.

AIDS 2018: Engaging Young People who use Drugs in the HIV and Human Rights Response in Ukraine

Source: www.aids2018.org

Ukraine presented its experience in engaging young people who use drugs in the HIV and human rights response during International AIDS Conference AIDS 2018 in Amsterdam. Organisations ACO “Convictus Ukraine”, ICF “AIDS Foundation East-West” (AFEW-Ukraine), CF “Return to Life” and CF “KCF “Blago” shared the results of their work.

Club for teenagers

The main purpose of the activity in the framework of the PITCH project is to prevent the spread of HIV and other dangerous diseases among vulnerable adolescents and to develop healthy lifestyle habits, the director of “Convictus Ukraine” Yevheniia Kuvshynova is saying.

In their work, “Convictus” team is actively using mobile clinic where they provide services for teenagers. A multidisciplinary team is operating on the basis of a mobile clinic. The mobile clinic helps them to bring the services to those who are not covered with prevention and treatment programs. There is also a school of leaders and a Street power youth club, where teenagers can spend their leisure time and receive help from psychologist or social workers, get information, medical services, testing, etc. Around 500 teenagers received services in the club.

Accepted the monitoring tool

Iryna Nerubaieva

The project manager of the ICF “AIDS Foundation East-West” (AFEW-Ukraine) Iryna Nerubaieva shared the results of the piloting of the tool for monitoring the violations of human rights of most-at-risk adolescents which was developed and implemented in the framework of the project Bridging the Gaps: Health and Rights for Key Populations. From January till December 2017 in four pilot cities, 792 interviews with adolescents and youth aged 14-21 were conducted. 430 adolescents were 14-18 years old. The number of cases of human rights violations registered in an online form was 92 of all surveyed. A young activist of the CF “Return to Life” Daria Kopyevska, a social worker of the CF “KCF “Blago”Alina Khokhlova and a lawyer and AFEW-Ukraine’s consultant Vita Musatenko also shared their experience.

“It is good to see that teenagers realized why they need this tool, and how social workers accepted it. Now they know how that it will help in their work,” Vita Musatenko is saying.

According to the latest estimates, the number of most-at-risk adolescents is 129 000, including 21 700 injection drug users. However, there is no official data on the exact number of most-at-risk adolescents, including underage drug users. In Ukraine, most-at-risk adolescents represent a very closed group, thus the lack of statistical data, stigma, discrimination and legal barriers make their access to HIV/STI services more complicated.

 

AFEW International Receives Grant from the Elton John AIDS Foundation

Sir Elton John during International AIDS Conference in Amsterdam

Author: Olesya Kravchuk, AFEW International

AFEW International received the Emergency Support Fund Manager grant from the Elton John AIDS Foundation. This news was announced during the 22nd International AIDS Conference in Amsterdam. AFEW has got this grant together with AIDSfonds.

Within this ‘Emergency Support Fund Manager” grant, AFEW will use its long-lasting expertise and history in grant-making and support to strengthen the capacity of Community Based Organisations (CBOs) and Non-Governmental Organizations (NGOs) in Eastern Europe and Central Asia (EECA) to overcome emergencies and to become stronger organisations.

Louise van Deth, Director of AIDSfgonds

“We are very honoured to receive this grant that will last three years,” says the executive director of AFEW International Anke van Dam. “Access to the treatment in Eastern Europe and Central Asia is a crucial need, particularly for key populations most at risk and people living with HIV. Unfortunately, not more than 30% of people living with HIV have access to the treatment. Stock outs of anti-retroviral treatment (ART) do happen, and the Emergency Support Fund is a great means to avoid this.”

AFEW will disburse emergency grants to enable key populations CBOs and NGOs in Eastern Europe and Central Asia to survive emergency situations and to be prepared or avoid emergencies in the future. NGOs and CBOs often deal with emergency situations due to a restrictive legal environment for key populations at risk for HIV, stigma and discrimination of those groups and a limited space to operate as a CBO and NGO.

AFEW Network at AIDS 2018

AFEW Network at the 22nd International AIDS Conference AIDS 2018 in Amsterdam, the Netherlands, July 23-27, 2018

Date Status Event title and type Place
21/07 – 22/07 Pre-Conference Youth

Empowermentand Validation

Roeterseiland Campus: Roetersstraat 1012 WX, Amsterdam
21/07

15:00-18:00

Affiliated event Theatre play in the framework of the

Teenergizerproject “Voices of Youth from Eastern Europe and Central Asia at AIDS 2018”

CREA Cultureel Studentencentrum – Nieuwe Achtergracht 170, Amsterdam
22/07

10:45-11:45

Affiliated event Roundtable: A person-centred response to the epidemic, Journalist Fellowship training RAI, Elicium Centre D203
22/07

14:30

Affiliated event Opening of ATLAS 2018 exhibition: I will speak, I will speak! Beurs van Berlage

Damrak 243, 1012 ZJ Amsterdam

22/07 Pre-Conference Meeting 90-90-90 targets is not the end of AIDS; Joep Lange Institute;

Mayors of Kyiv and Almaty

RAI
23/07

08:30 – 10:00

Open for public Walking the walk: youth movements to fight

HIV epidemic in Eastern Europe and Central Asia

RAI, Global Village
23/07

11:30-12:30

Open for

public

Art and Social Change: a dialogue with artists and social and health professionals on how culture and social initiatives can strengthen each other. Guided tour along the artworks with AFEW Culture Initiative lead Jan van Esch and and Ambassador International Cultural Collaboration Arjen Uijterlinde RAI, Global Village

ActivEast community zone 515

23/07

14:30-15:00

Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone

24/07 Open for public Strength in Resilience: Learning from key population communities in EECA confronted with shrinking civil society space RAI, Global Village

ActivEast community zone 515

24/07

10:30-11:30

Open for public Meet, Greet and Brainstorm on

Harmreductionand the EU Parliamentary elections 2019

RAI stand COALITION PLUS (exhibition zone)
24/07

11:00-12:00

Open for public Meet & greet RAI, Global Village, booth 509 (Prison Corner)
24/07

11:30-12:00

& 14:30-15:00

Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone

24/07

16:30-18:00

Open for

public

Panel discussion: Protecting people who migrate in countries of origin, transit and destination RAI Forum
24/07

18:00-19:30

Open for public Prison Health a Logic Choice: Key Implementation Factors RAI AFEW Office,

Amtrium2nd floor, above the entrance to the Global village

25/07

10:00-12:00

Open for

public

Panel discussion: Providing health services in prisons: addressing inequities, preventing and treating HIV and TB RAI UNAIDS Office Space, meeting room 2
25/07

11:30-12:00

& 14:30-15:00

Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone

25/07

16:00-17:30

open AFEW Network‘s Experience in strengthening community monitoring and involvement in service delivery: From

grassrootto policy level

Global Village, Eastern Europe and Central Asian Networking zone
26/07 10.30-11.30 open for public Strength in resilience: learning from key population communities confronted with shrinking civil society space AIDS Fonds Networking zone
26/07

11:15-12:15

open for public Bridging the Gaps: Health and Rights of Key Populations and PITCH. Engaging young people who use drugs in Ukraine in the HIV and human rights response RAI, Global Village, booth 509 (Prison Corner)
26/07

11:30-12:00

& 14:30-15:00

Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone

26/07

12:45-13:15

open for public HIV prevention, treatment and care in prisons activities in Eastern Europe/former Soviet Union countries RAI, Global Village, booth 509 (Prison Corner)
26/07

14:45-15:15

open for public Press moment: “Don’t let the prisoners behind” RAI, Global Village, booth 509 (Prison Corner)
26/07

16:30 – 18:00

For AIDS2018 delegates Workshop Migration in Eastern Europe and Central Asia: access to health care for all? RAI, E105-108
26/07

21:00 – 24:00

Open event AFEW Disco “From EECA with Love” Tolhuistuin – IJpromenade 2, 1031 KT Amsterdam
27/07

11:30-12:00

Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone

                                                                               Activities throughout AIDS2018
Date Status Title Place
22/07 – 27/07 Open for public Dutch Approach Booth RAI, Global Village
22/07 – 27/07 Open for public EECA Region Networking zone RAI, Global Village, EECA networking zone

ActivEast community zone, 515

22/07 – 27/07 Open for public Harm Reduction, People Who Use Drugs and Prison Health Networking Zone RAI, Global Village
23/07 – 27/07 Open for public The Walking History Corridor: Visualising the Mythologies of HIV/AIDS, the Caucasus and Beyond RAI, 812

corridor that is linking the Global Village with the main Conference Space

23/07 – 27/07 Open for public Transparent Dining: An Evolving Museum of Life Experiences, Social Commentary and Culinary Gatherings by and for Women Affected by HIV/AIDS in the EECA Region RAI, outside of the Global Village
23/07 – 27/07 Open for public Putting on a different lens: sex work, harm reduction and medical research in the Netherlands viewed through an artistic Eastern European and Central Asian lens RAI, Global Village – 823, time TBD

 

AFEW Network Issues Guide for AIDS 2018 Visitors

With 22nd International AIDS Conference approaching in about two weeks, AFEW Network issued a guide for AIDS 2018 visitors with the useful information. The guide provides general information about Amsterdam – the home city for AIDS 2018. It also has information on public transport, drug policy, medical services, police, culture in the Netherlands, and practical questions.

The guide is in English and Russian languages and it can be downloaded here.

Stigma Affects the Motivation for HIV Testing

Author: Marina Maximova, Kazakhstan

As estimated by UNAIDS, 35 million people globally died of AIDS-associated diseases since the onset of the epidemic. People living with HIV die of tuberculosis, cancers, hepatitis… Meanwhile, there is no data on how many lives are lost to stigma. Today stigma is the strongest barrier for testing among those who are not aware of their status and for receiving services among people living with HIV (PLWH).

Migrant with HIV double stigma

Salavat Kabjalelov is an outreach worker and a peer consultant in the Zabota (‘Care’) Charitable Foundation. He helps labour migrants: offers consultations on HIV, tells about the need to get tested, navigates clients for diagnostics to the AIDS Centre and to the tuberculosis clinic. Salavat can find the right words for every client. He had no citizenship or registration, no access to antiretroviral treatment (ART) and he wanted to hide not only from his problems but also from hostile stares and rough remarks of people around him.

Salavat Kabjalelov

He and his wife lived a quiet life, not seeking medical care. For migrants, the main thing is their job, not their health. Then, three years ago something tragic happened. Salavat lost his wife. The young woman died of cancer.

“I tried to arrange hospice care for my wife. I was even ready to pay for it, but it was not possible. They refused me. She was living with HIV. It appeared that it was more important to be a citizen. If you had a severe disease, it was not an argument. The good news is that now the situation in Kazakhstan is improving and migrants with HIV will be provided with ART. However, it will not bring my wife back,” complains Salavat.

Everyone goes through self-stigma

Lyubov Chubukova

Lyubov Chubukova works in the Kazakhstan Union of People Living with HIV. She is a delicate woman of strong character, who can convince people both from the tribunes of international forums and in one-on-one arguments. Twelve years of living with HIV made her a leader. She experienced stigma in a private health centre where she came when she got pregnant – young and confused. An older woman gave her an advice – to seek health services only in the AIDS Centre. However, Lyubov says that her self-stigma was even stronger. Every person who learns about having HIV faces this problem.

“I no longer consider myself a victim as it makes it impossible for me to live and grow. Good support in fighting self-stigma is trusting people and knowing your rights. You have to live on, not restricting yourself, and overcome your fears. Otherwise, you may reach the worst point,” says Lyubov.

Lyubov does not hide her status. Vice versa, she often takes part in TV shows and open discussions as an expert. She is convinced that stigma affects the motivation for HIV testing. People are afraid to get tested for HIV as they are worried that their test may come back positive. At the same time, if a person living with HIV starts the therapy too late, the probability of treatment success is much lower and it can even lead to death of the patient.

Every tenth person living with HIV has suicidal thoughts

Three years ago, the Central Asian Association of People Living with HIV within the Leader of People Living with HIV Project funded by USAID for the first time in the region carried out a survey to assess the index of stigma in three Central Asian countries – Kazakhstan, Kyrgyzstan and Tajikistan.

Results of the study in Kazakhstan showed that every tenth person living with HIV had suicidal thoughts. PLWH aged 30 and above suffer most from self-stigma as well as people with small (one to nine years) history of living with HIV. Self-discrimination mainly leads to the decision not to have any more children. Every third person living with HIV in the country makes such a decision.

The study demonstrated that the experience of injecting drug use as well as the experience of imprisonment were the drivers of stigma towards people living with HIV. Most often, PLWH faced discrimination from the side of health workers (first of all, refusal to provide health care) and public officials, while discrimination from the side of their immediate social environment was far less common. Moreover, the cases of discrimination were accumulated in the first ten years of a person living with HIV.

No silence about stigma

Baurzhan Bayserkin

The first step in overcoming stigma is to break the wall of silence. Approval of regulations at the country level is a real victory. In the beginning of the year, the National Plan to Fight Stigma and Discrimination against People Living with HIV was approved in Kazakhstan.

“Stigma and discrimination related to HIV status are the major barriers for PLWH to access prevention, care and support services. To end the spread of HIV, a focus should be made on the complete eradication of discrimination, first of all in health institutions. It will allow achieving a significant reduction in the growth of HIV epidemic,” says Baurzhan Bayserkin, General Director of the Republican AIDS Centre.

Kazakhstani are going to continue this discussion at the 22nd International AIDS Conference in Amsterdam AIDS 2018.

IVF for Women with HIV in Ukraine: Bringing the Right to Have a Child Back

Svetlana Moroz (second on the right) discusses the elimination of the discriminatory norms at a round table. Photo by Positive Women NGO.

Authors: Yana Kazmirenko, Tamara Balayeva, Ukraine

In Ukraine, amendments are prepared to the regulations of the Ministry of Health (MoH) prohibiting in vitro fertilisation (IVF) for women living with HIV. Currently, HIV is in the list of diseases, which are contraindications for IVF, approved by the MoH. In Western countries, IVF has been successfully delivered to women living with HIV for a long time. Ukrainian activists strive for the prohibition on in vitro fertilisation for women living with HIV to be abolished.

In early July, a round table discussion was held in the Public Health Centre at the MoH. At AIDS 2018 in Amsterdam, activists are planning to meet with Ulana Suprun, Acting Minister of Health of Ukraine, to present their insights and explain why it is so important to abolish the outdated regulations.

Discrimination and self-stigmatization

There is no statistics on how many women living with HIV apply for IVF in Ukraine every year and are refused. Svetlana Moroz, representing the Positive Women NGO, sent relevant requests to 10 regions. So far, there have been no replies. Svetlana says that information about the attempts of women living with HIV to make IVF is shared only among civil society activists.

A woman with HIV status sought help in their organization. After long searches, she found a clinic in Kharkiv, which was ready to work with women living with HIV

“She made two attempts, which have not been successful so far. Another woman from Sloviansk used her advice and also sought assistance in this clinic, but she had a miscarriage,” tells Svetlana.

She says that some private clinics agree to make IVF to women living with HIV but do not advertise it due to the orders of the MoH. Such clinics charge their clients a double price because of the possible risks. Other health facilities use standard excuses: lack of equipment or reference to HIV being on the list of contraindications for IVF.

Apart from the MoH orders and reluctance of clinics, there is another barrier – self-stigmatization. According to Svetlana Moroz, many women living with HIV do not even try to seek assistance in IVF clinics: they know that they will face a refusal or do not know that they even have such a right.

All IVF risks are myths

Valentina Kvashenko, chief physician of the A.A. Partners Health Company also thinks that refusal to make IVF to HIV-positive women is a discriminatory practice and that concerns about the risks of HIV transmission are ungrounded. Doctors carry out all the manipulations with semen and eggs with disposable catheters and needles. In the course of deliveries, they wear gloves, glasses, and aprons. The same safety precautions are used during all standard deliveries. Usually, only one embryo is transferred to women with HIV status to reduce the potential need of invasive interventions.

“There is no need in “prohibiting” regulations, due to which people are not able to perform their reproductive functions and become parents,” says Valentina, adding that HIV may be transmitted from mother to child, but only if the woman is not taking antiretroviral therapy (ART).

She gives statistics to prove her words: in 1996-1997, when there was no access to antiretroviral drugs in Ukraine, HIV was transmitted from mother to child in 60% of cases. Now this rate is less than 10%. Even this percentage only relates to children born to women who do not receive ART. Besides, the IVF procedure reduces the risk of virus transmission to a minimum.

Litigation for the right to IVF

If the letter to the Ministry of Health will not give a result and will not allow to promptly introduce amendments to the regulations, the activists have a second option – legal action.

“We will work on creating a legal case. The fact is that the MoH regulations contradict the laws of Ukraine, which do not prohibit in vitro fertilization for HIV-positive women. If nothing else works, we will find a woman living with HIV who is ready to go all the way and defend her rights in court,” explains Svetlana Moroz.

It is expected that draft amendments to the regulations will be ready and presented to the Ministry of Health in late November. While the old regulations are still in force, Svetlana gives recommendations to women who are refused the IVF services.

“Always demand official refusals. With the doctor’s words only, you will not be able to file a lawsuit in court and all the more to win it. Secondly, seek assistance in human rights organizations. For example, our organization is ready to provide free lawyers’ services to women, help them to prepare the required documents and in general offer all the necessary legal support,” sums up Svetlana.

After the discriminatory regulations are abolished, Ukrainian women living with HIV will have a right to participate in the state-funded IVF program for childless couples.