A Drug-Free Life: how Methadone Changed the Life of a Former Drug User from Tajikistan

Author: Nargis Khamrabaeva, Tajikistan

Methadone substitution therapy for drug dependent people has been used for many years, but so far there are both supporters and opponents of this method. 40-year-old Karim from Tajikistan shared how he personally benefited from the substitution therapy.

Heroin for breakfast, lunch and dinner

Karim started taking drugs when he was 20. At first, it was hashish and weed smoking with friends from time to time. He was 34 when one of his friends handed him a stronger cigarette with hashish and heroin mix.

“I thought, well, it is okay, in this life you have to try everything. A couple of days later I started feeling not very well. It seemed like flu, and back then I did not know that those were the withdrawal symptoms,” Karim is saying.

Karim did not manage to cope with the terrible feeling that people who use drugs get when the whole body aches and pains, there are chills, nausea and weakness. He had to buy a dose, then another one. As a result, he became seriously hooked on heroin. Heroin was for breakfast, lunch and dinner. Karim’s was thinking only about how to get another dose.

At times he would listen to his mother and wife and go to the narcology clinic to get treatment but without any success. He went to work far away, to Russia. Karim did not manage to make money but got addicted to drugs even more. Moving to another place did not help either. The wife left with the children on the condition that she would return when her husband coped with the addiction. Nevertheless, even this did not motivate Karim to knock the habit.

“Of course, I wanted to kick the drug addiction, because I realized that if the situation continued, I would lose my family. But quitting heroin is not easy, you need to harness all your willpower to do it, and not give up. I did not want to suffer. I would last a day or two, and everything began anew,” Karim says.

AFEW helped with methadone

In 2015, Karim heard that AFEW-Tajikistan helps drug users to cope with this craving with methadone substitution therapy. At first, Karim did not believe that something else could help but decided to use this opportunity.

“I went to the organization, received a referral to treatment and started taking strictly defined doses of methadone under the supervision of a doctor. By the way, I did not receive it in the form of injections but got it as a syrup instead. Over the period of three years, the dose of methadone was gradually reduced. Methadone helps to get off the needle and not spread HIV and hepatitis via a common syringe,” he says.

According to Karim, he no longer experiences withdrawal symptoms and hopes that the complete denial of drugs is around the corner.

“Now I am leading a normal life, my wife and four children are back with me,” Karim is saying.

Mikhail Golichenko: “HIV Epidemic in Russia is an Epidemic of Powerlessness”

Mikhail Golichenko is a lawyer and Senior Policy Analyst at the Canadian HIV/AIDS Legal Network

Author: Anastasia Petrova, Russia

We discussed the human rights issues in the context of HIV in Russia with Mikhail Golichenko. Mikhail Golichenko is a lawyer and Senior Policy Analyst at the Canadian HIV/AIDS Legal Network — organization, which has a special consultative status at the United Nations Economic and Social Council. Previously, Mikhail was a Legal Officer with the UNODC Country Office in Moscow. His work is focused on the promotion of human rights and addressing legal barriers to accessing health rights and effective HIV/AIDS prevention and care programs for prisoners and people who inject drugs. He holds a Candidate of Sciences degree (PhD equivalent) in Law.

– The International AIDS Candlelight Memorial Day was marked recently. What is this day about for you?

– It is a good occasion to reflect on the victims of HIV and at the same time think about our role in making sure that people who died of this disease did not die in vain.

In Tolyatti, in 2012, if I am not mistaken, on this day people traditionally went to a park, they handed out condoms, HIV awareness-raising materials, lit candles. It was all happening near the monument to the glorious heroes of the Great Patriotic War. Tolyatti is a small city and there are not many locations to hold public campaigns. It happened that during the campaign the bowl with condoms was put near the eternal fire and this fact was misinterpreted by mass media. As a result, the campaign organizers were fined for holding a mass event in close vicinity to the monument to the Great Patriotic War heroes. That is a local law in Tolyatti.

It shows that we are on different sides of the processes: the society is aware of the problem and the state doing nothing to start considering this problem from the right perspective.

Could you please tell us about the human rights situation in Russia and its implications for the HIV epidemic?

The key factor in the development of HIV epidemic in Russia is human rights violations, which make certain populations more vulnerable to HIV. People who use drugs, sex workers, men who have sex with men (MSM), transgender persons and migrants do not have access to adequate prevention, care and support for HIV and other socially significant diseases.

Rights are the social clothes of a modern person. They are represented by the laws imposing obligations on the state. The set of human rights keeps people warm and protects them from any aggressive impacts of the social environment. Some populations, such as people who use drugs, had part of their clothes removed. So, in fact, these people have to stay naked when it is minus forty degrees Celsius outside. Of course, they get sick. We should not cherish any illusions: even if we have sterile needles and syringes on every street corner tomorrow, it will surely improve the situation, but not much. We will still have repressions, persecution of people who use drugs, which prevent people from seeking health services.

There is a similar situation with sex workers. They know that they should use condoms. However, they know that if they get beaten up by a client who insists on having sex without a condom, nobody will protect them. Police will, first of all, blame the sex worker for being involved in sex work. Sometimes it is easier not to use condoms hoping not to get infected than being beaten up knowing that it makes no sense to seek protection in the police.

As for MSM, it is the same. Now the website PARNI-PLUS, which published information on HIV prevention among men who have sex with men, has been closed. There are almost no similar sources of information in Russia. Where will people who live with their sexual identities take this information? Their vulnerability and stigma will grow. There is a direct linkage. HIV epidemic in Russia is an epidemic of powerlessness.

– Could you tell about your speech in the Committee on the Rights of Persons with Disabilities? After it, a recommendation was made to revise the approach to the drug policy in Russia…

– There have already been many such recommendations. The Committee on Economic, Social and Cultural Rights, then the Human Rights Committee, the Committee on Women’s Rights, the Committee on the Rights of Persons with Disabilities, now there will be the Committee Against Torture. The committees realize that the drug policy in Russia is one of the drivers of systematic violations and issue those recommendations.

In my opinion, the main recommendation was given in October 2017, when the Committee on Economic, Social and Cultural Rights recommended Russia to decriminalize drug possession with no intent to distribute. The same goes for scaling up harm reduction services, legalizing substitution treatment, distributing truthful information on drugs, preventing overdoses, implementing substitution treatment for pregnant women, stopping tortures of drug users in police, in particular discontinuing the practice of using withdrawal syndrome to get evidence from detainees. Russia does not really follow all those recommendations, but the constant pressure will gradually give its results.

Our main tool is the attempt to involve government authorities in a dialogue so that people feel a certain need to introduce some changes. There is a set of clear recommendations, which are to be followed. It will certainly work. Where human rights are violated, there is no sustainability, there is a space for internal conflict, and there is no development.

What measures, in your opinion, does Russia need to take to stop the HIV epidemic?

We just need to remember that we are people. No laws are needed. There is a Constitution and it is enough. Safe coexistence is a value without which we cannot live. It is possible only with love, mutual understanding and help.

The Latest Global Prison Trends Publication Launched

Source: www.russellwebster.com

Last week, on 15 May 2018, Penal Reform International launched its annual flagship publication, Global Prison Trends 2018, at the UN Commission on Crime Prevention and Criminal Justice.

This is the fourth edition in their annual Global Prison Trends series and explores:

  • Trends in the use of imprisonment, including the use of pre-trial detention as an automatic response to suspects; the ongoing challenge of prison overcrowding; and the steady growth in the number of life-sentenced prisoners around the world.
  • Prison populations, such as the specific needs of women, children and LGBTI prisoners.
  • Developments and challenges in prison management, including record levels of prisoner violence in a number of prison systems; healthcare challenges and shortages of qualified healthcare staff; and the need to address violent extremism and prevent radicalisation in the prison system.
  • The role of technology in criminal justice and prison systems, such as the use of ‘telemedicine’ to provide mental healthcare and treatment, and the rise in access to online education and training.
  • The expansion of prison alternatives, including community service orders and electronic monitoring, and a growing trend in the use of restorative justice.

A Special Focus section looks at the rehabilitation and reintegration of offenders in the era of sustainable development.

Here you can find ten key facts that are of particular interest about the report.

Source: www.russellwebster.com

Martine de Schutter Scholarship Fund Launched

AFEW International sets up Martine de Schutter Scholarship Fund that allows participants from Eastern Europe and Central Asia (EECA) to attend the 22nd International AIDS Conference (AIDS 2018). Martine’s commitment to the international fight against AIDS and her unwavering support to the Eastern European region has set an example for us to follow. That is why AFEW International established the Scholarship Fund named after Martine de Schutter – our friend and fellow activist.

As of today, Martine de Schutter Fund raised 103.000 EUR to cover the additional scholarships of the EECA applicants to come to Amsterdam for AIDS 2018. A part of the Martine de Schutter Fund has been distributed to the applicants from EECA through the established Scholarship Committee of the International AIDS Society (IAS) of which 45 are regular scholarships and 20 – for speakers who will be invited from the EECA region. AFEW thanks Gilead, Janssen Cilag, Deutsche AIDS-Stiftung and Aidsfonds for their contribution to this Fund.

Martine de Schutter was a strong advocate for human rights. For about 10 years she managed the European network AIDS Action Europe, which connects more than 400 AIDS organizations throughout Europe and Central Asia. Martine worked with dedication and passion to keep the AIDS problem on the agenda at the European Union and to connect all organisations working on the same issues in Eastern Europe. In 2014, Martine became the Program Leader for Bridging the Gaps: Health and Rights for Key Populations program. She travelled a lot and her last trip was to AIDS 2014 Conference in Melbourne on the MH17 plane that was shot down and crashed.

 

EECA Success on the Road to AIDS 2018

Author: Olesya Kravchuk, AFEW International

The total of 603 abstracts from Eastern Europe and Central Asia (EECA) were submitted to 22nd International AIDS Conference AIDS 2018 to be held in July in Amsterdam, the Netherlands. 182 abstracts out of them were selected for the abstract book, posters and oral presentations.

These results were achieved with the support of AFEW International, Dutch Ministry of Foreign Affairs and in partnership with EECA regional networks EHRA, ECOM, ECUO and GNP+.

“It is a great success, and we can see that especially by comparing it with the previous AIDS conferences. In comparison to the AIDS 2016 Conference that took place in Durban, South Africa, the amount of submitted abstract has more than tripled, and the number of accepted abstracts has increased by almost six times,” says AFEW International Project Manager of AIDS 2018 EECA Daria Alexeeva. “124 abstracts were submitted to AIDS 2016, and 31 were accepted. The acceptance rate has increased this year as well – 31% against 25%.”

The special group of 25 EECA organizations whom AFEW International supported with on- and offline training program on community-based participatory research and funded their local community-based researches, has shown even greater results. Eight of the abstracts that were developed based on their researches were accepted. 13 scholarships were awarded.

Besides, a special EECA communities networking zone was secured at the Global Village of the Conference. Challenges and successes of the region will be featured there. EECA regional networks and community organisations will use the zone to jointly advocate for financial sustainability for the AIDS response in the EECA region, vanishing legal barriers for effective prevention programs and increasing meaningful participation of the communities in decision and policy making.

Joint Statement of Civil Society Organizations in Advance of the Thirty-Ninth Meeting of the Global Fund Board

On May 9–10 2018, the Global Fund’s Board will consider revisions to the Fund’s Eligibility Policy based upon recommendations from its Strategy Committee. While some of these recommendations are positive, others raise serious concerns.

In this regard organizations representing civil society and including communities of people living with and affected by the three diseases and other key populations from different countries and regions – developed a Joint Statement to share with Global Fund Board members their position on several critical issues that should be considered by the Board during its deliberations on the Eligibility Policy.

The Statement signed by 41 international, regional and national level organizations was sent to the focal points of all Delegations to the GF Board as well as to GF Board Leadership and GF ED. 7 more organizations signed the statement after it was sent.

We hope that our position will be taken into account by the Global Fund Board members when making decisions on the eligibility issues during the Board meeting.

The final version of the document – Joint Statement of Civil Society Organizations in advance of the Thirty-Ninth Meeting of the Global Fund Board.

AIDS 2018: Call for Journalists

The International AIDS Conference is the largest conference on any global health issue in the world. First convened during the peak of the AIDS epidemic in 1985, it continues to provide a unique forum for the intersection of science, advocacy, and human rights. Each conference is an opportunity to strengthen policies and programmes that ensure an evidence-based response to the epidemic. The 22nd International AIDS Conference (AIDS 2018) will be hosted in Amsterdam, Netherlands 23-27 July 2018.

The theme of AIDS 2018 is “Breaking Barriers, Building Bridges”, drawing attention to the need of rights-based approaches to more effectively reach key populations, including in Eastern Europe and Central Asia and the North-African/Middle Eastern regions where epidemics are growing. AIDS 2018 aims to promote human rights-based and evidence-informed HIV responses that are tailored to the needs of particularly vulnerable communities – including people living with HIV, displaced populations, men who have sex with men, people in closed settings, people who use drugs, sex workers, transgender people, women and girls and young people–and collaborate in fighting the disease beyond country borders.

If you are a journalist and interested to learn more, please register at http://www.aids2018.org/Media-Centre. There are still opportunities for scholarships. You can also subscribe to newsletters to support your work in-country. For further questions, please contact media@aids2018.org

EECAAC 2018: in Search of Optimism

Peter Reiss, Local Co-Chair of the 22nd International AIDS Conference (AIDS 2018), Professor of Medicine at the Academic Medical Centre (AMC) in Amsterdam, the Netherlands

Author: Marina Maximova, Kazakhstan

While the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) was going on in Moscow, Svetlana (the name was changed), a 28-year-old woman living in Karaganda, Kazakhstan became a mother for the first time. It seems that these events are not related at all. However, these two facts were brought together not accidentally. At the international forum, scientists, medical professionals, policy-makers, public officials, international experts and civil society activists argued and discussed how to curb the HIV epidemic and achieve the ambitious 90-90-90 UNAIDS targets. Meanwhile, they were not particularly optimistic. At the same time, a woman living with HIV for eight years gave birth to healthy twins. Maybe it is a sign that we should not give up hope?

Optimists and pessimists together

The question of HIV vaccine has become proverbial. For many years, the best scientific minds of the world have been struggling to invent it. There is no consensus among scientists about the feasibility of a panacea for HIV – the discovery of a vaccine.

Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre honestly says that he is pessimistic about it.

“Personally, I think that it is not possible. There are infectious diseases, to which people naturally become immune after they recover from them. HIV is more like malaria, which does not belong to this category. However, I would be very happy to see such vaccine discovered,” says Dr. Pokrovskiy.

Salim Abdool Karim, Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), vice versa, says that he has never been as optimistic about the HIV vaccine as today.

“A study on the production of HIV antibodies is already in progress. In South Africa, there is a woman, whose antibodies kill about 87% of all known modifications of the virus. We take her antibodies and test their efficiency in HIV prevention,” tells the scientist.

This positive attitude is also shared by Peter Reiss, Local Co-Chair of the 22nd International AIDS Conference (AIDS 2018), Professor of Medicine at the Academic Medical Centre (AMC) in Amsterdam, the Netherlands. He points out that HIV vaccine trials successfully started in Thailand several years ago. Currently, research is going on and the preliminary data are promising. However, this work takes a long time.

Prolonged ART gives a hope for tomorrow

At EECAAC 2018, the leading world scientists shared information about the development of two ARV drugs with prolonged effect

At EECAAC 2018, the leading world scientists shared information about the development of two ARV drugs with prolonged effect. It means that people living with HIV will be able to substitute daily pills with periodic injections. It is much more convenient. Currently, two major research studies of prolonged-action drugs are going on in South Africa.

Stefano Vella, Head of the Department of Therapeutic Research and Medicines Evaluation at the Italian National Institute of Health says that the studies of prolonged-action drugs are currently underway.

“It is not just about injections, but also about implants. For instance, like female contraceptives. It is important that there should be an option to remove them in case of side effects. Every patient should have a choice which medicines to use and the patient’s preferences should be taken into account,” he says.

There is no doubt that the right to choose has an impact on adherence to treatment. For those who have problems with adherence, the ability to take drugs not in the form of pills and without the need of daily administration may be the key to undetectable viral load and better quality of life.

Just a story

Svetlana from Karaganda learned about her positive HIV status when she was 20. The woman did not have a vaccine. For a long time, she could not accept her diagnosis. She even had suicidal thoughts. Svetlana had no idea how to go on living her life. However, she met a man, fell in love with him and they got married. ARV medicine helped her to give birth to healthy children. The happy mother with her babies has already been released from the maternity clinic. The twins have a good appetite; they are quickly gaining weight. This is the main cause of optimism for the woman.

According to the statistics since the 1990s, only in Karaganda region mothers living with HIV gave birth to more than 400 babies. Last year, 36 babies were born. They all remain under follow-up care until they turn 18 months old.

Civil Society of Kyrgyzstan in the Fight for Availability and Affordability of Medicines

Director of the Partner Network Association Aibar Sultangaziev

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is gradually switching to state drug provision system. Some of the tuberculosis medicine will be purchased out of the budgetary funds this year, and some of the antiretroviral (ARV) medicines – starting from the next year. Respective financial resources are planned to be allocated in the budget. At the same time, the question regarding the national legislation remains. A number of important documents is currently under the review. We discussed how these documents consider patients’ needs as well as the results of the analysis regarding the availability of medicines for HIV, hepatitis C and tuberculosis treatment with Aibar Sultangaziev, the representative of public council at the Ministry of Health and the Director of the Partner Network Association.

– Your organization and you personally are actively researching medicine availability and affordability. What are your successes so far?

– We started our work in 2009 with the issue of intellectual property. A respective study was conducted and, on the basis of the facts of high cost on brand medicines used for hepatitis C treatment, we advocated for the amendments to the Patent Law. In 2015, the Law was adopted; it also included the flexible provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Due to this, it became possible to bring more generic medicine into the country. To date, seven medicines have been registered. We keep the cost of hepatitis C treatment at the lowest level in the region: from 615 US dollars for a 12-week course.

Back then, the legislation lagged far behind the needs. We developed an intra-organizational strategy for ensuring the availability of medicines and started to work in several directions. In 2014, we approved the clinical guidelines for the treatment of hepatitis C that became a clinical protocol in 2016 that included a full range of medicine available within the country. Hepatitis C treatment was added to the State Program on HIV/AIDS, and from 2018 onwards, 150 people living with HIV (PLHIV) will receive it free of charge annually. We participated in the revision of protocols on HIV treatment, and now they include modern and inexpensive medicine, such as dolutegravir, darunavir, rilpivirine.

– The Essential Drugs List (EDL) is currently undergoing a revision. It is an important document related to the availability and affordability of medicines and holding public procurement. Did you participate in its elaboration?

“For the availability and affordability of hepatitis C treatment!” Campaign on amendments to the Patent Law

– In 2015, we conducted a study on five diseases: HIV, tuberculosis, hepatitis C, oncological diseases, conditions after transplantation, and found out what medicines for their treatment were registered in the country or included to the EDL and clinical protocols. We identified the differences between the WHO recommendations and the situation in the country, and then submitted a List of necessary medicines to the Ministry of Health (MoH). All of them were added to the EDL and will be approved soon after several amendments to the Law on Circulation of Medicines are introduced. By the way, the Law provides a List of medicines that can be imported and used in the country without registration. This List is used for socially significant diseases, and, as part of the working group of the MoH, we are currently working to determine the procedure for its formation.

– Will it allow the pharmacological companies not to register medicine in Kyrgyzstan?

– Registration is needed. However, in cases when the government urgently needs medicines that are not available on the market, it will be possible to legalize them by the decision of the commission without registration. Of course, there are criteria: medicine must be of high quality, prequalified by the WHO, etc. This list already exists. Last year in November, together with UNDP, (the organization manages grants of the Global Fund in the country – author’s remark), we submitted a list of 12 essential tuberculosis and antiretroviral medicines for the Ministry of Health to consider the possibility of importing them. This is a matter of political will and one commission’s meeting, but there has been no progress with the documents yet. That is why we are preparing a new regulation so that another commission could formalize it via a new procedure.

– Does it mean that practically all conditions for public procurement are in place?

Activists’ campaign to support the amendments to the Patent Law allowing the import of generic medicines to the country

– A lot has been done but the risks still remain. We have to make every effort to regulate the process by autumn. The point is that this year the state’s responsibility is to purchase 10% of second-line tuberculosis medicines, none of which has yet been registered in the country. In 2019, the state should purchase 20% of the required amount of ARV medicines, and in 2020 the share will increase up to 30%. Not all pharmacological companies enter the national small market, and those that do, inflate prices. We are determined to promote the possibility of medicine purchase through international mechanisms. For example, if Kyrgyzstan purchases medicines through UNICEF, one can expect a 5-7-fold decrease of the cost since UNICEF places a single long-term order that covers several countries with the medicine producers.

– What other plans do you have and what is the ultimate goal of your work?

– We carry out constant monitoring of procurement. Price regulation remains one of the priority tasks. We want people to have unhindered access to inexpensive and effective treatment, and the state to provide medicines for socially significant diseases.

Metropolis 2020: on the Way to 90-90-90

Author: Anastasia Petrova

Dynamics of the HIV epidemics in big cities is a pressing issue all over the world. According to the United Nations, by 2050 most people will live in big cities. This is most relevant for the developing countries with low incomes and growing HIV epidemics. Considering that the key populations are concentrated in metropolises, experts point out that there is obviously a need to implement HIV prevention and treatment programs at the municipal level. The decision to end the AIDS epidemic in big cities by 2020 is embedded in the Paris Declaration signed on 1 December 2014 with support of the UNAIDS.

This topic is the basis of the Fast-Track TB/HIV Responses for Key Populations in EECA Cities Project implemented by AFEW International in collaboration with Alliance for Public Health and presented within the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) held in Moscow, Russia. Together with the municipalities of five big EECA cities, civil society representatives developed measures in response to the spread of HIV/TB in key populations.

On 20 April, Anke van Dam, Executive Director, AFEW International moderated a session called “Fast-Track HIV/TB Responses in Healthy Cities” at EECAAC 2018. The session was co-chaired by Svetlana Plămădeală, Country Manager, Coordinator, UNAIDS, Moldova; Alla Yatsko, President, Public Association ‘Youth for the Right to Live’, Moldova; and Erika Tserkasina, Program Officer, Eurasian Coalition on Male Health, Coordinator, MSM Programmes in Almaty, Beltsi, Odesa and Sofia, Estonia.

“We cooperate with five metropolises in the region: Odesa (Ukraine), Tbilisi (Georgia), Beltsi (Moldova), Almaty (Kazakhstan) and Sofia (Bulgaria). The key criteria in selecting the cities were HIV prevalence and readiness of the local authorities for cooperation. Through organizing a network of community representatives, we established cooperation with the municipalities,” said Anke van Dam, Executive Director, AFEW International.

The goal of the Fast-Track TB/HIV Responses for Key Populations in EECA Cities Project is to contribute to achieving 90-90-90 targets, including reduced mortality and increased funding for HIV/TB treatment. One of the main tools is strengthening partnership between the authorities and civil society. To achieve this objective, the project includes research studies, workshops, and meetings with decision-makers. It is planned that the preliminary results of the project will be presented at the International City Health Conference ‘Developing healthy responses in a time of change’ to be held in Odesa on 13-14 September 2018.