Happy with HIV in Tajikistan

Tajik wedding. Source: wikimedia.org

Author: Nargis Hamrabaeva, Tajikistan

A Tadjik girl Nozanin was diagnosed with HIV after her husband-migrant returned home a few years ago. As the man has found it out, he walked out on her… Now the 40-year-old woman is happily married again.

Everything was like a fairy tale

“It happened unexpectedly, like in a fairy tale. Once I was taking care of the household, when my friend, who liked me, called. He said that he would come with a mullah (a clergyman conducting the wedding ceremony according to the Muslim canons – editor’s note) and some of our colleagues. They really came. After the religious wedding ceremony, we went to his parents,” Nozanin is saying.

This friend turned out to be a client of the Republican Network of Women Living with HIV, where Nozanin has been working. He was also HIV positive. He wanted to marry a woman with the same status and Nozanin somehow even tried to find him a suitable candidate. It turned out that the man was already in love with her…

“I never thought that I could ever get married again, especially having HIV status,” she says.

Today Nozanin considers herself to be a happy woman. Together with her husband they have a lot of plans and ideas, and they also want to give birth to a healthy child. Many couples living with HIV have the same desire.

A marriage contract is not needed

700 people in Tajikistan receive support from the Republican Network of Women Living with HIV. For the most part, these are young people who want to start a happy family.

Tahmina Haydarova, the head of the network, says that young men between the ages of 18 and 35 come to them searching for a soulmate with the same HIV status. Often these are labor migrants, former drug users or prisoners who have never been married before. Brides are usually those who have already been married. These women contracted the virus from a migrant husband or partner who used drugs.

Such brides do not ask to sign a marriage contract; they do not ask for an apartment or dacha. The most important thing for them is the timely use of antiretroviral therapy by their future spouse and a healthy life.

HIV is not a barrier

Each year the Republican Network of Women Living with HIV helps at least 5-6 young HIV positive people to find their spouses. Takhmina Haydarova is telling about 10 couples who decided to start a family with the fact that one of the spouses is HIV positive.

“If a person loves and accepts you for who you are, then HIV is not an obstacle to start a family. Today antiretroviral drugs that block the HIV are available. A person living with HIV with a suppressed viral load can start a family, give birth to a healthy child, live a full and happy life the way our clients do,” she says.

According to the Republican AIDS Center, the total number of HIV positive citizens in Tajikistan has reached 10 thousand people, one third of them are women. Since 2004, women with HIV have given birth to 1,000 children, 600 of these children have no HIV.

Shrinking Civil Society Space Hinders NGO Activities in EECA

The results of the assessment proved to be the basis for rewarding discussions during AFEW Regional autumn school in Almaty, Kazakhstan last year where the first findings were presented

Author: Aïcha Chaghouani, The Netherlands

Different trends of more restrictive legislation hinder the development of a healthy, independent and diverse civil society in Eastern Europe and Central Asia (EECA). Shrinking civil society space in the EECA countries is making the work of many non-governmental organisations more difficult.

NGOs play a crucial role in the development of effective HIV/AIDS responses. Non-governmental organisations meaningfully involve community key population groups for a better understanding of their needs. The experts are saying that the limited space that NGOs are allowed to maneuver in, is threatening the effectiveness of national and regional policies to contain and stop the growth of the HIV epidemic in the region.

AFEW’s assessment of the situation

Many NGOs in the EECA region, especially those working with key populations and in the field of harm reduction, are currently facing significant challenges. International donors are withdrawing from the region while most local governments are unwilling and/or failing to take over. The withdrawal of funds together with the shrinking civil society space are threatening the investments made and progresses achieved in the last decades in the field of HIV/AIDS.

AFEW International’s experts Janine Wildschut and Magdalena Dabkowska conducted a mixed-methods research to explore the process of shrinking civil society space in the EECA countries, how this affects NGOs and how they are coping with it. With this research, AFEW has gained more insights and learned how NGOs are currently dealing with those challenges. The research is part of AFEW’s regional approach within Bridging the Gaps: health and rights of key populations project.

Coping strategies and regional exchange

The ultimate aim of the research was to assess the coping strategies in a context of shrinking space of civil society in EECA.

“I believe that these coping strategies are vital in the current circumstances and demonstrate the big resilience of the communities and NGOs working with key populations,” says AFEW’s director of programmes Janine Wildschut.

The research was conducted in Kazakhstan, Kyrgyzstan, Poland, Tajikistan, Russia and Uzbekistan.  This mixed-method research consisted of a general primary assessment of the whole region, semi-structured interviews with NGOs and donors, and a survey.

AFEW’s experts believe that by mapping different strategies AFEW is able to facilitate a regional exchange of success and failure stories in which NGOs can learn from each other’s experiences. The identification of different strategies helps organizations to develop more comprehensive coping mechanisms in the current contexts.

“We hope to raise more awareness with donors about the situation of NGOs in the shrinking space of civil society, and will offer coping tools to NGOs,” says Janine Wildschut.

Fight, hide or unite

The outcomes of the research identified three main resilience strategies NGOs adopted in order to overcome the challenges. They are: fight – opposing the authorities, hide – opposing, allying or neutral but out of sight and silent, and unite – allying with the authorities. All interviewed NGOs had different reasons to choose one of these three paths.

AFEW International’s experts Janine Wildschut and Magdalena Dabkowska conducted a mixed-methods research to explore the process of shrinking civil society space in the EECA countries, how this affects NGOs and how they are coping with it

“We want to be more diplomatic. If you are being too much of an activist, you can also just break your organization,” an NGO employee from Tajikistan said.

For some organizations, it was possible to create alliances with the local or national authorities and still continue their work while for others, creating these alliances meant stopping or changing part of their core activities.

“We believe that it is actually ethically wrong to be in alliance with this government. We also do not try to be invisible for them. We do not do anything illegal so we do not hide anything,” a Russian NGO employee said. “There is no law we are violating so there is nothing to hide. If they want to change or stop us we just go to court. We have a lot of strategic activities including cases against the government.”

Further discussion 

Which out of ‘fight, hide or unite’ positions is the most suitable for an NGO, depends on the characteristics of the organization, the context it is operating in and the beliefs of its employees.

“The different paths identified by the assessment could serve as a fruitful basis for further discussion and to build strategic plans on how to deal in such situations. AFEW can facilitate a valuable exchange of best-practices between NGOs. Besides, the discussion can serve as a way to grow awareness and understanding about why a certain NGO takes a specific position, which can prevent undesired conflicts between civil society organisations themselves,” says Janine Wildschut from AFEW International.

The results of the assessment proved to be the basis for rewarding discussions during AFEW Regional autumn school in Almaty, Kazakhstan last year where the first findings were presented. In spring of 2018, the official report will be published and will be available online.

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.

Spices – New Threat for the Tajik Youth

Photo source: http://brosaem.info

Author: Nargis Hamrabaeva, Tajikistan

While several years ago Tajikistan was concerned with young people being into opiates and stronger synthetic drugs, today there are concerns about the new-generation drugs – so-called spices.

Spicy naswar

The official reports of law enforcement agencies fail to contain any data on the seizure of spices. However, a quick survey among the young people showed that those smoking blends have long been popular in the country.

Spices are the smoking blends, which contain dry herbs and roots. The dried components themselves are not dangerous, but to make the smokers feel a more intense euphoria, the producers add cannabinoids, which are strong narcotic substances. 

“For what I know, earlier spices were distributed in the nightclubs, but now they are mostly sold in the internet and through the grapevine. I also heard that sometimes naswar – the type of smokeless tobacco typical for Central Asia, containing tobacco and alkali (hydrated lime), which is popular among many local people – is processed in the same way as the spices,” says Aziz, a student from Dushanbe.

“Rich kids” having fun

Our anonymous respondent who has 20 years of experience working at law enforcement agencies said that it would not be right to say that young people in Tajikistan are addicted to spices, but this threat should not be disregarded.

“Yes, spices can be easily accessed, but their price is higher than the price of marijuana which young people have traditionally been smoking and continue smoking now. After the heroin “rush” at the turn of the century, many people who use drugs have been massively switching to marijuana and opiates. They strongly believe that marijuana is not more harmful than cigarettes,” he says.

According to him, spices are mostly used in nightclubs by those, who have enough money for it – the so-called “rich kids.”

“They think that spices do not cause addiction and that they can quit using them whenever they want as opposed to opiates and heroin,” says the law enforcer.

Spices do not have the euphoric effects they used to

However, Dr. Mahmadrahim Malakhov who studied the sociocultural aspects of the substance use in Tajikistan, says that the dependence develops much quicker when using spices than when using natural marijuana.

Meanwhile, the exact number of people who use drugs in Tajikistan is not known. Doctors say that few people who use drugs seek medical assistance when they want to quit. They are the ones who are included in the official statistics, which shows that there are a little more than 7 thousand people who use drugs in the country.

Last year, Tajik law enforcers seized about 4.5 tons of narcotic drugs, which is 29.8% more than the year before.

“In particular, 110 kg of heroin, 1.2 tons of raw opium, 2.4 tons of hashish and 742 kg of cannabis drugs were seized. The offences of 52 criminal groups consisting of 115 individuals were investigated and terminated, including five organized transnational groups,” said Murtazo Khaidarzoda, Deputy Head of the Drug Control Agency of the Republic of Tajikistan at the press conference.

About Us with Us Only: Russian Specialists to Attend AIDS 2018

Author: Anastasiya Petrova, Russia

February 5th 2018 was the deadline for submission of abstracts for the 22nd International AIDS Conference (AIDS 2018). One of the key issues during AIDS 2018 will be the discussion of the response to the HIV epidemic in Eastern Europe and Central Asia (EECA) countries. Below you can see the expectations from experts and representatives from Russian NGOs who have submitted their applications for the Conference.

Yevgeniy Pisemsky

Yevgeniy Pisemsky, HIV and LGBT activist, Head of Organisation PHOENIX PLUS, Person of the Year according to Winq magazine

About the organisation

Our organisation has been active for 11 years now. The main area of activity of Phoenix Plus is support, care and prevention for MSM in relation to HIV. We also support expanding of service centres and fulfillment of human rights.

What the AIDS Conference means for me

In general, I have a positive history with AIDS Conferences. I have visited four. When I came to my first conference in Thailand, I saw a tremendous community of professionals, however, I did not feel myself part of their camp. At that time, the AIDS Conference stimulated my ambitions and I made a resolution to move forward and get something done. So we did – the conference in Mexico City was opened by the fellows from my organisation. This was such an honour! I sat there, in the middle of the conference hall, and cried remembering how it all started.

At the conference in Vienna, I met Elton John AIDS Foundation representative for the first time. Seven years passed and we are still working together. They are our main partners. This is also a result of such conferences. A conference for me is most importantly a possibility to start new acquaintances, form joint plans, and only then acquire knowledge about new technologies and innovations.

My expectations from AIDS 2018

It is very important that at the conference in Amsterdam an attempt to focus attention on EECA region, where HIV situation is worse than in Africa will be made. I would like to share success stories about what we did in Russia on self-testing and learn something new from others. I have prepared an abstract and hope to deliver an oral presentation. We will try to communicate that there are achievements in Russia as well.

Aleksey Mikhailov

Aleksey Mikhailov, Monitoring Division Manager at the International Treatment Preparedness Coalition in Eastern Europe and Central Asia, Patient Control Movement activist

About the organisation

Since 2010, we have been conducting monitoring of state procurement of ARV medications. At that time interruptions in the supply of HIV treatment medications began, and we tried to understand why that was happening. Following analysis of state procurement, we realized where interruptions come from and undertook attempts to change the situation.

What the AIDS Conference means for me

I have never been to AIDS Conferences before, this one will be my first. Since the situation with AIDS in the EECA region is currently one of the most challenging epidemiological situations in the world, the AIDS Conference is a great opportunity to put problems of the region into focus. At the same time, it is also an opportunity to discover world trends and implement them in the Russian Federation. This is probably more related to prevention, as our country has its own way of optimizing treatment.

My expectations from AIDS 2018

It is my hope that the organisers will place greater emphasis on what is going on in Russia, Ukraine and other EECA countries. Today we stand at the threshold of a revolution in treatment. Soon we will have prolonged-release medication forms. Development of enhanced dolutegravir, which can be taken once a month, is in progress. It would be vital to learn about similar research, which is for sure to be presented at the AIDS Conference.

Irina Maslova

Irina Maslova, Leader of Silver Rose – Sex Workers’ Rights Movement, CEO of Astra Charitable Women’s Foundation

About the organisation

My official position is Chief Executive Officer of Astra Foundation, where we deal with HIV prevention among women and access to HIV related services. From this position, I am able to communicate with the government from the public healthcare perspective. At the same time, I lead Silver Rose – the movement of sex workers and their supporters, which is not registered but is fighting violence and HIV spread within this vulnerable group. In the past three years, we have done a lot to reverse article 6.11 that criminalizes sex work and to improve the situation for sex workers in our country.

What the AIDS Conference means for me

AIDS Conference for me is a possibility to meet new people. It is vital for experienced specialists to be able to pass their best practices on to those who follow. We have submitted two abstracts to this Conference. The first one is based on the research conducted jointly with Trans-regional NGO Positive Dialogue and AFEW International and related to violence as an obstacle to access to prevention programmes. The second one is on analysis of a project within the framework of co-funding to the main programme of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The uniqueness of this project is that we have managed to reach the 90/90/90 goal. It would be great to share that experience.

My expectations from AIDS 2018

Today we need to talk about bringing the main donors back to Russia. The Global Fund is shutting down its operation in the country, and the government does not finance work with key groups and will not do so while sex work remains to be criminalized. Until the government starts working with this target group, sexual transmission rate will keep growing. In order for the projects for key groups to be effective, we need continuity and that is impossible without funding.

Maria Yakovleva

Maria Yakovleva, HIV activist, Director of Candle Charitable Foundation

About the organisation

We are a self-organization of people living with HIV established in 2004. We provide direct services to vulnerable groups, however currently this activity is being carried out outside projects. We provide equal counselling, social support, as well as first-aid kit and a hotline. The Foundation also provides technical assistance for the Global Fund Coordination Board Secretariat.

What the AIDS Conference means for me

I attended the previous AIDS Conference in South Africa and that was my first International Conference. I was lost at first and only towards the end gained an understanding of how all the resources could be utilized. During the first several days I just walked around open-mouthed at the amount of communication, new information and acquaintances with representatives from organisations around the world. During the previous conference I got acquainted with professionals in AIDS services – representatives of influential organisations in our domain. I really want to go to AIDS2018. The possibility of sharing the information about what is going on in Russia is also very vital. I believe that speaking about your position is also a way of impacting the situation in the country.

My expectations from AIDS 2018

The focus of the upcoming AIDS Conference is EECA region, so the problems to be addressed there will be much closer to us. I hope there will be donors interested in projects in our region. We are also eager to find ground for dialogue with decision-makers.

HIV Risks Grow in Kazakhstan

The number of new HIV cases in Kazakhstan is still growing

Author: Marina Maximova, Kazakhstan

In Kazakhstan, the key alarming trend of the recent years is the growing sexual transmission of HIV. Before, most people in Kazakhstan contracted HIV when sharing injecting equipment, but now most infections are transmitted through sexual contacts.

A commonplace story

Zhaniya (the name is changed) learned about her positive HIV status when she got pregnant and went to the maternity clinic for the medical check-up. She got tested and could not believe her eyes when she saw the test result as she never used drugs and her husband was her first and only man. Repeated testing confirmed the positive result. The woman was afraid to tell her husband and family about her status, feeling scared, ashamed, hurt and confused. She could not remain silent either as any news are spread quickly in her village, let alone bad news. The conversation with her husband made it all clear.

“He confessed that he used to inject drugs. It was long ago, when he was still very young. Now he is sorry about that and wants to have a family and children. My husband also got tested for HIV and his result was positive too. He did not know about his disease and did not want to infect me. Now the main thing is for our baby to be born healthy. Doctors say that it is possible,” says Zhaniya.

In Kazakhstan, 99% of pregnant women living with HIV give birth to healthy children. These women often give birth to two or even three children. In the recent decade, the rate of mother-to-child transmission of HIV dropped four times.

Taking into the account the achievements of the national AIDS service, the stories of Zhaniya and other women living with HIV sound commonplace. The face of the epidemic is becoming more and more female. If earlier mostly men got infected with HIV, now the gender proportion looks more equal. The statistics is illustrated by the following trend: most men rarely go to clinics or make appointments with doctors. Women take more care of their health in general, while pregnant women twice get tested for HIV free of charge.

No sexual education in schools

Natalia Rudokvas, Director of the Answer Charitable Foundation

Another problem contributing to the increased risks of HIV is lack of relevant educational programs in schools and colleges. High school and college students have no access to the information about the routes of HIV transmission and ways to protect themselves at special classes or lectures. There are no guidelines or instructions for educators on this topic. In families, where the topic of sex is a taboo due to the peculiarities of local mentality, children fail to get any information or advice from their parents.

“When our activists make attempts to offer school lectures on the safer sex – we are told we cannot do it. For some reason, promotion of condoms and other contraceptives is considered equal to… debauchery. People blame us, saying that this is what our presentations cause,” tells Natalia Rudokvas, Director of the Answer Charitable Foundation from Ust-Kamenogorsk. She is puzzled with such attitude and hopes that this crucial topic will be discussed at the upcoming 22nd International AIDS Conference AIDS 2018.

Lack of any systematic sexuality education in past years loudly echoes today. Natalia says that people over 30 years of age more and more often seek counselling at their charitable foundation. While young people injecting drugs regularly get tested for HIV and fall under control of the health professionals, older people with “forgotten” histories of drug use stay in the shadow.

The epidemic is growing older

Baurzhan Bayserkin, General Director of the Republican AIDS Centre at the Ministry of Health of Kazakhstan

Several years ago, mostly young people aged 20-29 got infected with HIV in Kazakhstan. Now the age threshold went up to 30-39 years old. Most people got infected twelve or more months ago, and only 10% of the patients were infected within the recent nine months.

“The data received became the ground to carry out an additional epidemiological survey to determine the network of contacts and expand the list of potential risks of infection. High proportion of people who got infected long time ago demonstrates that people have low concerns about contracting HIV. The new approach shows the real picture of the morbidity and allows evaluating the efficiency of prevention measures,” sums up Baurzhan Bayserkin, General Director of the Republican AIDS Centre at the Ministry of Health of Kazakhstan.

The number of new HIV cases in Kazakhstan is still growing. As of today, there are about 29,000 of Kazakhstani and about 2,000 of foreign citizens living with HIV in Kazakhstan.

 

Antonio Guterres Replied to AFEW Support Letter

Prof. Michel Kazatchkine, Special Adviser to the Joint United Nations Programme on HIV/AIDS on HIV, Tuberculosis and Hepatitis for Eastern Europe and Central Asia

AFEW International received a response to the letters we have sent to the United Nations Secretary-General Mr Antonio Guterres. We have sent two letters that can be read here and here, and asked Mr Guterres to support the position of Prof Michel Kazatchkine as UN special envoy on HIV/AIDS for Eastern Europe and Central Asia (EECA.)

83 organisations from the whole world signed the letter. We asked to reconsider the position of Prof M. Kazatchkine as UN Special Envoy for EECA, as he is in an excellent position to create a momentum to raise awareness on the disruptive situation the epidemics has caused in the region. Prof. Michel Kazatchkine played a crucial role in mobilizing local authorities, (inter)national civil society, donors, researchers and other relevant groups to come to better outcomes to the UNAIDS indicators as we see now. As a result, he enjoys great support from communities in the region.

“Mr Kazatchkine has been an unwavering champion for HIV/AIDS in Eastern Europe and Central Asia. With rising HIV infections across the region, he has served as a tireless advocate and helped to unite stakeholders across sectors to address pervasive challenges that continue to leave our most marginalized communities behind. Mr Kazatchkine is well positioned to build on this work in his new role as Special Adviser to the Joint United Nations Programme on HIV/AIDS (UNAIDS) on HIV, Tuberculosis and Hepatitis for Eastern Europe and Central Asia,” the letter is saying.

Mr Guterres also expressed the hope for the future collaboration with AFEW International.

The full version of the letter can be read here.

Georgia: Problems under the Tip of the Iceberg

Lasha Tvaliashvili, the Executive Director of Organization of PLHIV Real People, Real Vision

Author: Irma Kakhurashvili, Georgia

A middle-aged man comes into a dental clinic and explains to the dentist that he is HIV-positive. The dentist refuses to treat the patient. Under the rules, the doctor must sterilize all instruments and the patient is not obligated to inform about the diagnosis, but the patient is being honest and is ‘punished’ by the dentist for it. The man asks the doctor what he is to do, where to turn. The doctor’s response is that it is none of his concern. The dentist is not aware he is being recorded with a hidden camera…

As reported by the Infectious Diseases, AIDS and Clinical Immunology Research Centre, around 600 to 700 new HIV cases are registered in Georgia annually. Although every citizen is able to receive publicly-funded free treatment, this is insufficient to end HIV. NGO Real People, Real Vision is a member of East Europe and Central Asia Union of People Living with HIV (PLHIV), which has implemented interesting projects on prevention, support and mobilization of people involved in HIV treatment. Discrimination and stigmatisation of HIV-positive people is just one of the problems obstructing prevention of HIV epidemic in Georgia. This and other topics are part of our conversation with Lasha Tvaliashvili, the initiator of multiple video-experiments and the Executive Director of Organization of PLHIV Real People, Real Vision.

Lasha, in your opinion, what is the greatest achievement in the field of HIV/AIDS treatment?

– For instance, the fact that during the past two years there has not been a single case of mother-to-child transmission. This is a result of daily efforts of the AIDS Centre, which does not even have its own building. The Centre operates under critical conditions, resulting in serious violations of rights of patients and medical staff, violation of sanitary, epidemiological and other norms. There is not enough space where an HIV-positive person could receive all services. There can be no talk of anonymity when there is one office where two physicians are seeing two patients at the same time. Government entities promised to allocate premises to the Centre but never did. Such attitude puts the existence of this strategic medical facility into question.

Is late testing the main reason for the increase in the number of new cases? Is that the only reason?

– Many patients come to the Centre already with clearly marked symptoms. Of course, timely testing followed by therapy would have protected them from various illnesses. However, lack of awareness among the population is not the only reason; it also concerns approaches of medical staff. I still hear stories about doctors, who keep treating patients for various illnesses for years, and it does not occur to them to refer patients for HIV testing.

Nevertheless, there has been a positive trend. When friends and family find out about the status of a close person, they treat that person with more sympathy than it used to be in the past. However, I am puzzled at the situation with medical staff, when sizeable finances are invested in their education… The level of discrimination and stigmatisation is high in Georgia. Several days ago, one of the micro-lending organizations requested HIV test results from its employees. Should the test be positive, the employee must leave, which is a direct stigma. Regular work at the office with zero risk of HIV transmission shall not be equivalent to cruel treatment of people.

– What stands in the way of defending rights of patients who have lost their jobs?

– The patients themselves. At first, the discriminated person feels insulted, but then emotions quiet down and he or she refuses to continue the argument in a courtroom. People are afraid of publicity of their positive status. They are not sure they will continue on living peacefully. They are afraid of complicating their public position. For reasons above, such precedents are not made public, thus increasing discrimination.

What is your view on treatment availability in Georgia from geographic standpoint?

– HIV/AIDS more frequently occur in socially lower-standing population segments. These people often live in regions without AIDS Centres. For instance, patients from Samtskhe–Javakheti region go to Tbilisi for medications once a month. The same is also true for a huge region of Kakheti, Guria, Racha, and Svaneti. Treatment must be continuous, and every month patients travel long distances. It is harder in winter when roads in mountainous areas are closed. AIDS Centres are located in big cities only – Tbilisi, Kutaisi, Zugdidi and Batumi.

Please share your experience about the lowest-budget but effective project.

– In 2012-2013, we had a project that saved 300 patients. Throughout the year our activists were on duty at the AIDS Centre. During registration of new cases, when patients were most shocked at the test results, our activists tried to explain in a non-medical language about HIV/AIDS, and further assisted in the course of treatment. Throughout the year 10% of patients diagnosed with AIDS did not return to the Centre. The project objective was not to lose those 10%. The project budget was 10 thousand US Dollars, but above that, we have found a lot of like-minded fellows and friends, some of whom even got married. This project was implemented jointly with the HIV/AIDS Patients’ Support Foundation. Currently, we are thinking about a new project – psychological and moral support for those convicted persons, who found out about their status in prison. I am confident this will be a humane and successful project.

Methadone Breakthrough: Ukraine to Independently Purchase Opioid Substitution Therapy

Patient receiving OST at Kremenchug drug treatment centre, Poltava region Source: kremenchug.ua

Author: Yana Kazmirenko, Ukraine

From 2018, opioid substitution therapy (OST) programme in Ukraine is financed by the Government. Activists are asking international organizations for a backup to prevent disruptions in the supply of life-saving medications.

The Government of Ukraine plans to independently procure substitution therapy programme medications in 2018. According to the World Health Organization (WHO), over 10 thousand people received therapy last year at 178 institutions throughout the country. It is planned to double the number of patients in 2018.

Ukraine wants to beat HIV

Ukraine can be proud of its implementation of OST because this is the largest-scale coverage programme in Eastern Europe and Central Asia. Since 2005, the programme to substitute opioids with methadone or buprenorphine was financed by the Global Fund. Patients under the care of a physician received syrup or pills.

“This is a major milestone for public health care in Ukraine,” says WHO representative Martin Donoghue. “For many years WHO and partners have worked with the Government and opioid substitution therapy received the endorsement and comprehensive financial support. This attests to the fact that Ukraine wants to beat HIV.”

People who inject drugs belong to key groups who are most at risk of HIV and its transmission. The numbers are a confirmation: HIV was diagnosed for 42% among OST programme participants in Ukraine, and 21.3% of new HIV cases account for the transmission through injecting drug use. Sexual transmission still remains to be the main way of transmission – 63.9%.

Financing doubts remain

WHO recommendations indicate that to control HIV/AIDS spread among people who inject drugs 20 thousand people shall receive therapy. Ukraine intends to reach these numbers by the end of 2018.

According to Director of charitable organization Meridian and Executive Director of All-Ukrainian union of people with drug addiction VOLNA Oleg Dymaretskiy, there are 368 thousand injecting drug users in the country. The majority uses several types of drugs, including medications from pharmacies. The activist has doubts regarding the timely supply of OST medications by the Government.

“I do not believe that transition to Government financing will be fully implemented in 2018. 13 mln. Ukrainian Hryvnyas a year ago were allocated for medications for 9.6 thousand patients, but they reached them only in December 2017,” says Dymaretskiy.

NGOs requested the Global Fund to back up the supply of medications, and, according to Dymaretskiy, received a positive response. To double the number of patients, the activist suggests increasing the number of OST offices along with prescribing therapy at the level of district poly-clinics.

OST will reach prisons

Our colleague told us about another initiative of VOLNA union – start-up of a programme on continuous treatment at institutions of detention, which will include detoxification and prescription of substitution therapy. Two thousand people withdraw from OST programme every year, one in ten – due to serving a sentence in prison.

“Substitution therapy changes lives of people who use drugs. It is the first step and acknowledgment: it is beyond my power to cope with addiction, but I will change the quality of living,” summarizes Dymaretskiy.

AIDS 2018 Abstract Support for EECA: 100 Abstracts Submitted

Almost 100 researchers from Eastern Europe and Central Asia (EECA) have received mentorship and expert support through the mentorship program that was established by AFEW International together with Amsterdam Youth Force and Eurasian Harm Reduction Association (EHRA). Applicants for XXII International AIDS Conference have received support with editing, translating, and structuring their work according to the abstract requirements. Out of 100 abstracts got by the expert team, 70 received support with formatting and editing and 30 have received an additional language support (full translation into English.)

The mentorship program was developed to enhance the quality and increase submission chances for the applicants from EECA. Within the program, applicants had an opportunity to consult with experts before submitting their abstracts to the Conference Committee. AFEW International is expressing a big gratitude to the experts who were reviewing the abstracts of the EECA applicants.

“The importance of this mentorship can hardly be overestimated. We were able to significantly increase submissions from the region of Eastern Europe and Central Asia,” AFEW’s project manager Daria Alexeeva is saying. “We are excited to see the fruits of this collaboration both in form of submitted abstracts but also in form of something that is hardly quantifiable: expertise that our applicants have gained in the area of scientific writing for international events. The very communication with and guidance of the mentors was an enormous capacity building exercise for our applicants. They have trained putting their entire research projects into a concise form of an abstract of 350 words. We are confident that this training will lead to more high-quality research from EECA in the future.”

The board panel of experts consisted of:

Anna Szczegielniak, Youth Coalition

Catriona Ester, independent consultant

Chris Obermeyer, Fulbright Public Policy Fellow, Ministry of Health of Ukraine, Public Health Center

Daniel Kashnitsky, Eurasian Harm Reduction Association (EHRA)

Eliza Kurcevic, Eurasian Harm Reduction Association (EHRA)

Gayane Arustamyan, Eurasian Harm Reduction Association (EHRA)

Gennady Roshchupkin, Eurasian Coalition on Men’s Health (ECOM)

Jill Owczarzak, John Hopkins Bloomberg School of Public Health in Baltimore

Julian Hows, Development Research Advocacy Governance (DRAG)

Katherine Kooij, National Institute for Public Health and the Environment (RIVM), the Netherlands

Lela Serebryakova, Eurasian Harm Reduction Association (EHRA)

Mariam Uberi, BEARR Trust

Roman Ivasiy, All-Ukrainian Charitable Organization FULCRUM

Ulla Pape, University of Bremen

Heather Stacey, Stand International

Janet Gunn, BEARR Trust

Michael Rasell, BEARR Trust

Karen Kraan, Flowz

Anna Sarang, Andrey Rylkov Foundation for Health and Social Justice

Alexandra Volgina, GNP+