Bridging the Gaps Returned the Faith

Tahmina’s story is one of the positive stories of women in Tajikistan, who, due to the social and legal support of the project Bridging the Gaps: Health and Rights for Key Populations 2.0, again received hope and planned positive changes in their lives.

Family issues pushed to drugs

“When I studied in the 4th grade, my parents already had five children. This is the usual situation in Tajik families in the rural areas. Due to the frequent childbirth and burdensome care for five young children at the same time, my mother often fell ill. I had to drop out of school and take care of everything by myself,” Tahmina is saying.

Tahmina was taking care of all the things in the house, raised her brothers and sisters, helped them with school. Because of the health problems, her mother was constantly in hospitals. Her father spent days at work and came home late at night.

In one of such evenings, when the father was late at work and the mother was in the hospital, Tahmina’s uncle – her father’s brother – visited their house. Asking little Tahmina to come out of the house with him, the uncle raped her. Some time later, the neighbour found unconscious Tahmina and brought her to the hospital. Long investigations started, her mother and father were almost having nervous break-downs because the relatives of the girl started to hate her and blamed her for everything.

“Policemen always came to our house and asked me strange questions. I remember that when I came to the courtroom and saw my uncle there, I just fainted,” Tahmina is saying. “My uncle eventually was sent to prison and I became the cast-away for many of the relatives from my father’s side. Trying to save me from them, my parents sent me to the relatives from my mother’s side. I was always traveling to Dushanbe or to the other cities of the country.”

The girl started to meet different people, became friends with other girls in Qurghonteppa. During one of the meetings, the girls offered Tahmina to smoke cigarettes and then marihuana. They introduced Tahmina to Azam (the name is changed) who turned to be the big drug-dealer in Qurghonteppa.

“During a year and a half, he was keeping me locked in one of his apartments. Sometimes late at night, he would take me to the restaurants,” the woman recalls. “Taking all of this into consideration, he was still sending money to my parents. He taught me how to use drugs. This is how I became addicted to heroin. After some time, Azam’s interest to me faded away and I found myself on the street. Because at that moment my life totally depended on heroin, I started to steal and do sex work so that I could get a doze. As a result, I went to prison.”

The key visit to AFEW-Tajikistan

In 2013, Tahmina went to prison because of the theft. Being imprisoned for a quarter of her term, she got free because of the amnesty. When she went back home, the woman again faced the threats from her father’s relatives side. She had to leave her home and started to live on the streets again. After many unpleasant adventures, Tahmina met people who use drugs whom she knew before, and she started to use again.

Once, Tahmina met Bahriddin whom she knew before. He was also using drugs, but, to Tahmina’s surprise, he changed, and was looking good and happy. It turned out that Bahriddin started to work in the public organisation AFEW-Tajikistan as a peer consultant. He told Tahmina about how he succeeded to change, and he also mentioned the help and services that his organisation is providing. Tahmina got interested in that and decided to visit the drop-in center for the drug users and see everything by herself.

When she just came to AFEW-Tajikistan’s drop-in center, Tahmina was surprised that even though she had a dirty dress and flip-flops were barely covering her bloody feet, she was greeted very warmly. She was offered some tea and the workers talked with her about her health.

“I was very skinny and dirty, and I could not remember the last time I took shower or bath,” Tahmina is remembering that day now.

The social workers helped Tahmina with taking care of herself. They also helped her to come back to her parents’ house, arranged the documents for her and sent her to the doctors so that she could be checked and her health could be improved.

To see the sun again

Since summer 2017, Tahmina comes to the drop-in center very regularly. She is also taking part in self-help groups of people who use drugs. She learned the basics of her personal hygiene, HIV prevention and sexually transmitted infections (STI.) She got to know how to cope with the drug use and the possibilities to live sober. During one of the meetings, Tahmina got to know about opioid-substitution treatment (OST.) The friendly and warm atmosphere, respect and the possibility to get methadone for free inspired Tahmina to change her life.

Since August of the same year, Tahmina started to take part in OST programme that is located in the drug center where she would never go by herself. Nowadays, Tahmina is taking methadone and continues to take part in self-help groups. She found many friends who understand her and are ready to support her.

“With the support of AFEW-Tajikistan, during half of the year, I changed for better. I believed the peer consultants and social workers and started to help my mother, and I have not done so since I left home. AFEW helped me to gain the trust in myself again. My eyes are shining like it was before, I again see the sun and I want to live!” Tahmina is finishing her story with the smile on her face.

Only in 2017, 688 female drug users and vulnerable women in the Republic of Tajikistan were provided with the prevention and social services within the project Bridging the Gaps: Health and Rights for Key Populations 2.0 that is financed by the Ministry of the Foreign Affairs of the Netherlands.

AIDS 2018 Early Programme Preview

In addition to a strong abstract-driven programme, the 22nd International AIDS Conference (AIDS 2018) will offer symposia, workshops and interactive sessions developed by an international committee of HIV scientists, global leaders, policy makers, researchers and advocates.

Here is a first glimpse of what you can expect in Amsterdam, which you can also browse in our preview of the conference programme. See an overview of the early programme preview below.

Improving treatment and care outcomes

  • Updates on ART options and outcomes, with a particular focus on treatment across the lifespan and in key and vulnerable populations.
  • Addressing NCDs in resource-limited settings.
  • Presenting new data on co-infections and looking at old, and new, threats in infectious diseases in the context of HIV.

The future of prevention

  • Exploring different perspectives on why combination prevention, while highly effective, is not available in many settings.
  • Understanding key population community-led health services (KP-CLHS) as an effective tool in the prevention toolbox.
  • Exploring the future of PrEP as part of combination prevention, taking into account funding concerns, uncertain treatment access for many people, lessons learned to date regarding PrEP implementation, and design issues for future trials.

Understanding HIV pathogenesis

  • State-of-the-art updates on broadly neutralizing antibodies (bNabs) and their use in the development of a potential vaccine and a cure.
  • Understanding HIV persistence and community participation as keys to developing a cure for HIV, long-term remission off ART.
  • Opportunities to tackle the virus at the moment of transmission, recruit the host and manipulate the environment in the fight to end HIV transmission.

Key and vulnerable populations

  • The evolving landscape of drugs, drug policy and harm reduction in the context of rising HIV transmission and political resistance.
  • Empowering young people to access services and make healthier choices through comprehensive sexuality education (CSE).
  • Training implementers to play an active role in changing gender norms.

Insights-driven programming

  • New approaches to using big data to strengthen national HIV responses and deliver improved and effective focused programming.
  • How new innovative approaches to big data allow us to better reach the right audience with the right intervention.
  • Exploring ethical issues in the use of state-of-the-art methodologies and interventions to tailor interventions to local populations.

Under prioritized epidemics

  • Advancing human rights and legal reforms with a focus on sexual minorities, prisoners, people who use drugs and transgender people in Eastern Europe and Central Asia.
  • New approaches on how to address the needs of children and adolescents living with HIV from Ukraine, featuring perspectives by healthcare providers and policy makers.
  • Insights on political leadership to advocating for the needs of vulnerable communities, with country examples including Kyrgyzstan and Senegal.

Source: AIDS 2018

Blind Response: Experts Offer Different HIV Estimates in Russia

National campaign: HIV testing in a train carriage, 2017

Author: Anastasia Petrova, Russia

According to the UNAIDS, Russia ranks third based on the rate of the new HIV cases in the world after South Africa and Nigeria. However, there are inconsistencies in the data on HIV incidence dynamics in the country provided by different offices.

Mixed opinions

In May 2017, it became clear that there are some discrepancies in the data on the growth rate of new HIV cases in Russia presented by different government offices. Comparing statistics for the previous years, Veronika Skvortsova, Russian Minister of Health announced that in 2016 HIV incidence dropped down twofold.

“We had the total of 86.8 thousand new cases of HIV, while a year ago, in 2015, there were over 100 thousand. Thus, the number of HIV cases fell down by 15%,” said Veronika Skvortsova.

However, Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre presented different data, which, vice versa, demonstrate a growing number of HIV cases in the country. The scientist told about the growth of HIV incidence by 5.3%. According to the recent data of the Russian Federal AIDS Centre presented shortly before the World AIDS Day, in the first 10 months of 2017 regional AIDS centres reported 79,075 new cases of HIV. This is 2.9% more than during the same period of 2016. This data shows the continuing growing trend in HIV incidence.

Such discrepancies became visible to the public, so the Ministry of Health offered relevant explanations on its official website. In the article dated 17 May 2017, it is written that “in his report, Dr. Pokrovskiy presents the results of scientific epidemiological monitoring of the Institute of Epidemiology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) based on the positive laboratory tests for HIV and not the statistical data on HIV incidence for the previous year. The incidence, however, shows the number of people with the confirmed diagnosis (not the number of laboratory tests).”

Thus, according to the Ministry of Health, the calculation method used by Rospotrebnadzor is less accurate considering that one person tested for HIV several times is calculated as several new cases. Some experts, however, say that both statistical approaches may be used as there is a growth of the HIV incidence in the country, but the rate of such growth is decreasing.

“Positive” statistics

Veronika Skvortsova, the Russian Minister of Health

The data on the total number of people living with HIV in Russia is also not quite clear. The Rospotrebnadzor report mentioned above states that as of 1 November 2017 there were 924,608 Russian citizens living with HIV. As for the Ministry of Health data, we have not received any reply to our official request on the number of people living with HIV as of the date of this article. The Ministry fails to submit such data to the UNAIDS to prepare annual reports on the HIV epidemic in the region.

However, some data suggest that the number of people living with HIV in Russia is much higher. Thus, 25,000 Russian citizens were tested in the course of the famous free anonymous testing campaign run by the Ministry of Health in a train carriage, which was held from 7 July to 28 October 2017. Out of them, 375 results were positive. If such statistics is extended to the general population, up to 1.5% of people in Russia may be diagnosed with HIV.

Creating a register

Experts say that the country needs an accurate estimate of the number of people living with HIV.

“The first and the most important goal is to understand the situation and have full information on the number of people living with HIV, the treatment regimens they use and the need in medicines,” says Sergey Krayevoy, Deputy Minister of Health.

It is planned to introduce a Federal Register of People Living with HIV in Russia to analyse the scope of medicines needed and to systematize the statistics. Such database will be administered by the Ministry of Health. Apart from the diagnosis, records will also be made on the health state of the patients, medicines prescribed to them and other data allowing to see the full picture of their health. Thanks to such register, a person relocating within the country will be able to get help in any region.

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

Author: Olga Ochneva, Kyrgyzstan

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

Services and coverage are retained

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

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

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

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

Gender component reduced

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

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

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

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

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

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

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

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

Civil Society Letter to Support the Position of Prof M. Kazatchkine as UN special Envoy on HIV/AIDS for Eastern Europe and Central Asia

To: United Nations Secretary-General Mr Antonio Guterres

Amsterdam, 22 January 2018

Re: Civil Society letter to support the position of Prof M. Kazatchkine as UN special envoy on HIV/AIDS for Eastern Europe and Central Asia dd 23 June 2017

Your Excellency Mr Guterres,

With this letter, we – undersigned civil society organizations – call on you to reconsider the position of Prof. Michel Kazatchkine as your Special Envoy on HIV/AIDS in Eastern Europe and Central Asia (EECA).

Michel Kazatchkine was recently announced to serve as special advisor to UNAIDS for HIV, tuberculosis and hepatitis C by the UNAIDS executive director Michel Sidibe.

We are happy to greet Prof. Michel Kazatchkine with his new position. We believe however that the urgency of three epidemics in the EECA region justifies a position as UN special envoy for the region. A region in which the HIV/AIDS, TB and viral hepatitis epidemics are out of control. This development concerns us deeply:

  • The annual number of new HIV infections in Eastern Europe and Central Asia increased with 60% between 2010 and 2016.
  • From all regions in the world, the EECA region is furthest away from reaching the UNAIDS 90-90-90 targets by 2020. Treatment coverage remains alarmingly low (28%), and less than a quarter of people living with HIV had suppressed viral loads (end-2016).
  • Specific populations, such as men who have sex with men, people who use drug users, sex workers, prisoners and migrants face specific human rights violations, impeding their access to prevention and health services.

Despite these alarming developments, donors and multilateral institutions are pulling out of the region. Achieving the SDG’s on health and the promise to leave no one behind is therefore still far away in the EECA region.

Prof. Michel Kazatchkine has played a key role in highlighting the region to institutions as UN Special Envoy on HIV/AIDS in Eastern Europe and Central Asia. He 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.

In our letter of 23 June 2017, we asked to continue the position of Prof. Michel Kazatchkine as your Special Envoy on HIV/AIDS in Eastern Europe and Central Asia. We express our disappointment about not having received a response yet.

We understand that Prof Eric Goosby continues as UN special envoy on TB, due to the important UN High Level meeting on TB in September 2018.

At the same time, the AIDS 2018 conference in July 2018 will be a key moment for the region and for the world as well. The Dutch government acknowledges the issues and has prioritized Eastern Europe and Central Asia for the conference. We applaud their leadership as this is the moment to bring political leaders, policy makers, scientists, clinicians and community leaders together and draw attention to the urgent need to next steps. Prof. Michel Kazatchkine is helping in the process. We, the civil society organizations, look forward to your presence and support in Amsterdam next July.

We ask you to re-consider the position of Prof. Michel Kazatchkine as your Special Envoy for Eastern Europe and Central Asia, 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.

Please, support this letter by signing it before Monday, 29 January 5pm CeT. You can sign this letter here

Yours sincerely,

Anke van Dam,

Executive Director, AFEW International

Roman Dudnik: “The HIV/TB CITIES Project led to a more open dialogue between NGOs and the municipality of Almaty”

Roman Dudnik, Executive Director of the Public Foundation AIDS Foundation East-West in Kazakhstan

Author: Marina Maximova, Kazakhstan

It has been a year since the project Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia (HIV/TB CITIES) has been operating in Almaty, Balti, Odesa, Sofia, and Tbilisi. Different countries, contexts, mentalities and different… results. Roman Dudnik, Executive Director of the Public Foundation AIDS Foundation East-West in Kazakhstan is telling about the project implementation in Almaty, Kazakhstan.

– Roman, one of the results of project implementation is a major and important outcome not only for the city, but also for Kazakhstan in general – the Almaty akimat (regional executive body in Kazakhstan editor’s note) has signed the Paris Declaration. That is a high standard. Do you manage to keep up with it?

– In summer 2017, Almaty became the first city in Central Asia joining the Paris Declaration to end the AIDS epidemic. It is a crucial step for the city as along with Pavlodar, Karagandy and East Kazakhstan regions it has the highest rate of HIV prevalence in the republic. That is why we really need to take popular actions and measures, which will help us to draw attention to this problem and stop the growth of the HIV epidemic. The declaration was signed not only “for the record” as they say. There is an interest to this topic from the side of the municipality and it does not fade. Using this momentum, we hope to implement our project in the most effective way and make further, not less ambitions steps – develop an effective city model of HIV and tuberculosis (TB) response and increase the share of municipal funding allocated for the prevention programs among key populations.

– Do you feel any support from the side of government authorities? How tricky is the East?

– I worked in Russia for years and I saw the attitude of government officials to civil society organizations there… Fortunately, in Kazakhstan the situation is entirely different. I was even surprised that mazhilis (lower house of the Kazakhstan Parliament – editor’s note) deputies can meet with non-governmental organizations (NGOs) or people from akimat can refer to NGOs as their partners. If at first it seemed that akims (heads of the local executive bodies in Kazakhstan and Kyrgyzstan – editor’s note) are out of reach, and the topics of HIV and harm reduction are not their top priorities, the HIV/TB CITIES Project has changed the perception of priorities and significance of this issue, and it is not only my perspective. Here if people commit to something, they do it. Maybe they are not very loud and showy about it, but they surely reach good results. Several years ago, 18 confidential counseling points were opened in Almaty, where people can get tested for HIV and other diseases, receive relevant specialists’ consultations and awareness-raising materials or exchange syringes. Today they are already funded from the municipal budget and supported by the local authorities.

Public officials in Almaty are very busy people with a lot of things to take care of. Not all of them know about the scope of HIV problem, they do not have time for it. They need information and are grateful when they receive it, in particular from NGOs. In this chain, we became allies. The first achievement of the HIV/TB CITIES Project was the development of an order to create an HIV/TB City Task Force at the Health Department of Almaty. Here an order is equal to a law: it is strictly implemented and controlled. All meetings of the Task Force, which are held every quarter, are recorded, and its decisions are implemented with no time-consuming bureaucracy. One of the outcomes is that medical professionals now more actively attend training workshops on HIV prevention, stigma and discrimination, which are held by community leaders.

With the participants for the community platform “The city with no fences between people”

Roman, what are the other activities, which marked the first year of the Project implementation and what are you plans for the nearest future?

– With the support of Almaty AIDS Centre , an assessment was made of the HIV and TB situation and the needs of key groups. Through focus groups, the main factors were identified, which influence reducing the HIV morbidity in every key population. It will allow developing an effective model of response to the epidemic. A memorable event was the city community festival Art Energy Almaty. Work in Progress. Our community platform was called “The city with no fences between people.” It was the time when a lot of fences between buildings and near the roads were dismantled in Almaty to make the city more free and open. Our message – that the main fences usually exist between people, and we are the ones who can ruin them – got together people living with HIV, LGBT, people with drug use history and sex workers at our platform. It was the most popular platform. Our visitors liked listening to frank stories with open faces. We have already launched an operational research of the model stipulating low-threshold access to HIV testing and treatment for people who inject drugs. We plan introducing rapid oral HIV tests. Besides, preparations are in progress for the Almaty akimat to sign one more important document to demonstrate the political commitment to ending TB – the Zero TB Declaration.

Do you plan to take part in the XXII International AIDS Conference (AIDS 2018) in Amsterdam?

– Yes, of course. I am sure that this forum will become a platform for intensive knowledge sharing and discussing the efforts of governmental, non-governmental and international organisations in response to the HIV epidemic. We have got our messages and suggestions to come up with.

Decriminalising Cannabis – a Step Forward to the Liberal Drug Policy: Opinions and Reflections of Discussions in Georgia

Author: Irma Kakhurashvili, Georgia

The former clergyman David (name changed – editor’s note) from Georgia, who was charged with cultivating cannabis, will have to pay 2,000 laris to the government based on the law and the plea agreement plus 500 laris for using marijuana.

David did not keep it secret from the police that he was growing and using cannabis for self-treatment and herbal therapy. According to the man, for two years it helped him to overcome pain and lose appetite, as Giorgi has diabetes, pancreatitis, cholecystitis, hepatitis C and hepatic cancer.

The former clergyman was “lucky” not to find himself behind the bars as on 30 November 2017 the Constitutional Court of Georgia resolved that the provision on criminal responsibility and imprisonment was a human rights violation, even in case of the repeated use of cannabis.

No legalization

The decision of the Constitutional Court only applies to people who use cannabis. Now cannabis possession for personal use within the set limits will not be prosecuted in line with the Criminal Code, but will rather be treated as an administrative offence.

The government will also expunge the convictions of those who were prosecuted for the use of cannabis in the past. The studies initiated by the Human Rights Education and Monitoring Centre in Georgia show that currently every third inmate is convicted for drug-related crimes. People using cannabis are also on this list.

In the joint survey conducted in 2015 by the National Centre for Disease Control and Public Health, 32% of men and 2.9% of women in Georgia reported having used marijuana. The issue of cannabis decriminalisation and legalisation was first raised five years ago, but then the initiator of this idea – civil movement “The 2nd of June” – failed to get support even from the community of people who use drugs because they demanded to decriminalise not all the drugs, but only cannabis.

Kote Rukhadze, activist of the Georgian Network of People Who Use Drugs, explains that advocating for cannabis separately from other drugs is not fair.

“Marijuana is also a psychoactive substance. Any person with physical or mental dependence needs help. Therefore, we will not support only those who smoke weed”, says Kote.

Despite the decision of the Constitutional Court, people advocating for reforming the Georgian drug policy are convinced that decriminalising cannabis is only a small part of positive changes in the repressive approaches of the state, though it gives hope for better results – decriminalisation of all drugs.

David Otiashvili, director of the Alternative Georgia NGO is sure that the decision of the Constitutional Court will help to change the attitude of the government to other drugs as well and will make the general approach more humane.

“The injecting drug use more often leads to dire consequences, which is clearly demonstrated by the number of overdoses and the spread of infectious diseases. Therefore, the reform should first of all focus not on the people who smoke but on improving the situation of people who inject drugs”, says David Otiashvili.

Pros and cons

The discussion of the draft law stipulating decriminalisation of all the types of drug use causes heated debates in the Georgian Parliament.

“I represent the generation of people whose friends started from smoking weed and then died of hard drugs. I am against decriminalisation, which will lead to the danger of uncontrolled distribution of drugs in the country and will paralyse the police”, says Giga Bukia, a member of the Georgian Dream parliamentary group.

The results of the research study published on the website of the Chief Prosecutor’s Office of Georgia demonstrated that for 79.2% of probationers the first substance they tried was marijuana and the second one was opium.

However, one of the leading substance abuse treatment specialists, Nika Kapanadze notes that in his practice he has never seen any patients physically dependent on marijuana.

“Marijuana does not cause an acute abstinence syndrome. When people use it systematically, they may develop psychological dependence, bronchitis, sometimes short-term troubles controlling movements or concentrating, but nothing more,” says the doctor.

When meeting the MPs, Kaki Zoidze, chairman of the parliamentary healthcare committee and one of the supporters of the draft law, always reminds them that the document does not stipulate legalising drugs, cannabis in particular.

“This draft law is about liberalisation, and liberalisation does not cover article 260 on drug dealing and distribution. It will remain a criminal offence,” he explains.

Parliamentary majority member Dmitri Khundadze thinks that this draft law is a danger to the society as in Georgia there is no rehabilitation for people who use drugs, and without this component even dreaming about decriminalisation is dangerous.

The President of Georgia Giorgi Margvelashvili does not support the drug policy which has “ruined the lives of many people.”

“I am for developing a more adequate drug policy,” said the President to the experts working on the draft law.

**

The assessment document prepared by the parliamentary healthcare committee describes various scenarios of the expected outcomes which may come out of drug policy reform. According to the document, if the reform is not implemented, by 2027 the number of people who use drugs will grow by 12.06% as compared to 2017 and will amount to 55,614 persons, and the number of people who use drugs infected with HIV will increase by 154%.

Massive HIV Testing Campaign for Residents of Kyiv and Odesa

Kyiv residents can do an express test not only at the mobile laboratory, but also at all district polyclinics. Foto: Informator

Author: Yana Kazmirenko, Ukraine

Over 250 thousand HIV tests will be done in Kyiv allowing to cover 10% of the employable population of the Ukrainian capital. Nikolay Povoroznik, the Deputy Head of Kyiv City State Administration, informed UNIAN Information Agency that in order to reach these numbers, city authorities will additionally procure 140 thousand express tests. HIV testing is the first step towards overcoming the epidemic because information about one’s positive status allows the timely start of treatment for the patient.

Kyiv is home to over three million people. According to experts’ estimates, there are 23 thousand HIV-positive residents. This is one-tenth of the estimates for Ukraine – 250 thousand people. As the Medical Superintendent of Kyiv AIDS Prevention and Control Centre Aleksandr Yurchenko clarifies, procured tests are not intended for residents of Kyiv from risk groups and categories not subject to mandatory testing (pregnant women, donors, patients prior to surgeries, etc – editor’s note.)

“Tests have already been procured and distributed. Screening is available at all polyclinics in the capital. The procedure takes 15-20 minutes. With mass testing, we will increase the HIV detection level to 5%,” forecasts Mr. Yurchenko.

Besides, the routes of patients with HIV are being optimized in the capital of Ukraine to ensure immediate referral for treatment, receipt of antiretroviral therapy and professional medical advice.

Medical professionals after testing have the task to promptly put patients under observation. At the end of 2017, 42% of HIV-positive patients were receiving therapy. A year ago, this number reached 30%. By the end of 2018, doctors intend to have 70% of patients who are aware of their status registered.

High expectations from reform and strategy

Nikolay Povoroznik forecasts that the number of people receiving antiretroviral therapy will amount to 8 thousand in 2018. The official has high expectations from the medical reform, which commenced in Ukraine in autumn of last year. HIV-positive residents of Kyiv will be able to receive prescription of antiretroviral medications at the level of district polyclinics and their health condition will be further monitored by the family doctors.

In 2016, Kyiv Mayor signed the Paris Declaration allowing Ukraine to join the Fast-Track Cities programme to expedite AIDS control measures. Over 70 major cities in the world joined the global movement. This year implementation of Fast-Track Cities strategy also envisions start of educational programmes, expansion of the number of substitution therapy courses, and start of operation of five offices for integrated assistance during substitution therapy, monitored treatment of tuberculosis, etc.

It is envisioned that in 2020 90% of people shall know their status, 90% of those infected shall receive therapy, and for 90% of patients the therapy shall be effective with a zero viral load.

Odesa to host City Health Conference

Odesa is a seaport in the South of Ukraine that is home to over one million people. Odesa followed suit after Kyiv undertaking obligations under the Paris Declaration in February 2017. Residents are provided with medications for prevention and treatment of opportunistic infections under the municipal Health programme using budget funds.

“After the Mayor of Odesa signed the Paris Declaration, it was decided to develop the special-purpose program for the city for 2018-2020 to counter the epidemic of HIV infection and tuberculosis. This document has been developed and is prepared for approval at the City Council session,” says the Medical Superintendent of Odesa AIDS Prevention Centre Vitaliy Novosvitskiy.

Last year the Department of health of Odesa City Council issued a number of orders for procurement (for the total amount of 1.5 mln. UAH), implementation and use of express tests at all health care institutions in the city.

According to the Ministry of Health statistics, the largest number of HIV infected in relation to population lives in Odesa region, where there are 865.8 HIV-positive patients per 100 thousand people. For 77% of those residing in Odesa, HIV was sexually transmitted. The latest surveillance data clearly shows that increase in the number of HIV-positive persons is closely linked to the dangerous sexual behaviour of injecting drug users and their partners. 11.5 thousand people are registered at the HIV/AIDS Prevention and Control Centre. The intention is to increase this number to 19 thousand by 2020. 4.5 thousand people are receiving antiretroviral therapy.

In 2017, Odesa infectious diseases hospital was modernized – a cubicle-ward building was added. This year the sea capital of Ukraine will host the City Health International Conference, in the course of which the best practices in fighting HIV will be addressed.

Voluntary HIV Testing Points in Tajikistan: Fast, Convenient, Free

In the VCT point in Vita NGO

Author: Nargis Hamrabaeva, Tajikistan

Several more cities in Tajikistan – Dushanbe, Kulob and Khujand – opened their first voluntary counselling and testing (VCT) points in three civil society organisations – Vita, SVON Plus and Amali Nek.

Opening the VCT points, training the medical staff, renovating the premises and procuring the necessary furniture and equipment became possible thanks to the Bridging the Gaps: Health and Rights for Key Populations project and consultations with the AFEW-Tajikistan specialists.

VCT points are in demand

The first VCT point was opened in December 2016 in the southern part of the country, in Qurghonteppa in the representative office of AFEW-Tajikistan in Khatlon region.

“This initiative was a success and several NGOs contacted us asking to support the opening of similar facilities. People who live in small towns and villages all know each other and may be vulnerable, so such points are in high demand,” says Zarina Davlyatova, AFEW-Tajikistan project manager.

Ismoil (27 years old), a former drug user with a five-year history of drug use was recently able to “quit” his past and is now trying to start a new life. He was one of the first people tested for HIV in one of the NGOs.

“It is easy, fast, free of charge and confidential. The staff is very friendly. I could not make myself go to the AIDS centre but I am ready to come back to this place,” the young man is saying.

Trust is the key

According to Nasim Fayzov, project coordinator at SVON Plus NGO, such facilities are one of the best options to cover as many members of the key populations – people who use drugs, sex workers, ex-prisoners – as possible with HIV testing.

“In rapid testing points people do not feel any discomfort or stigma. Besides, members of the key populations can get a number of services at one place. For instance, people who use drugs may get tested for HIV, receive a consultation and get disposable syringes,” tells Nasim.

Two trained staff members with medical background work in the VCT point.

Since the facility at the SVON Plus NGO was opened, about 50 people got tested for HIV there. Six people were tested in the VCT point at the Vita NGO in Dushanbe. Director of the NGO Eraj Nazarov says that they share information about the newly opened facility with program participants and volunteers so that more members of the high-risk populations can hear about it.

The third VCT counselling point was opened in the premises of Khujand-based Amali Nek NGO.

“The key is trust. No money can buy it. Members of the key populations trust us, probably because we use a client-oriented approach in our work,” says the director of Amali Nek NGO.

According to the Republican AIDS Centre, the total number of people living with HIV in Tajikistan is almost 10 thousand persons, among them 1,207 cases were diagnosed in 2017.

We would like to recall that the issue of countering HIV-related stigma and discrimination will be one of the main topics of the XXII International AIDS Conference (AIDS 2018) to be held in Amsterdam in July 2018.

Deadline Extended: AIDS 2018 Abstract Support

Amsterdam Youth Force, Eurasian Harm Reduction Association (EHRA) and AFEW International invite applicants from Eastern Europe and Central Asia region (EECA) to submit drafts abstracts for XXII International AIDS Conference 2018 in Amsterdam (AIDS2018) to board panel of experts for review. The deadline is extended until 25th January 2018.

We would like to invite Eastern European and Central Asian (EECA) researchers, clinicians, scientists, community activists and young people to submit their abstracts to our EECA AIDS2018 Abstract Support team. Boosting the representation of academics in this region is important as this is the only region in the world where the epidemic is still growing. To increase the chances to present their work at the conference for researchers, clinicians, community activists and young people from EECA who may have less experience in writing scientific abstracts in English, we will be facilitating scientific and English language assistance. We will link you to a researcher or a professional in your field which can provide you with scientific feedback on how to improve the quality of your abstract. To specifically support young researchers and community activists, we also offer a feedback session via Skype to discuss the suggested changes to your work.

If this sounds like something you could benefit from, please read further about the eligibility criteria and review process.

Eligibility criteria

You can submit your abstract to aids2018@AFEW.nl for a professional review if you are:

  • A (young) researcher, scientists, clinician, community activist or representative of community-based organization or NGO; and
  • Planning to submit an abstract to 22nd International AIDS Conference 2018 in Amsterdam, 23-27 July 2018 (AIDS2018); and
  • Working in one of the following countries: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan;

The review process

  • We will be accepting submissions from the 1st of December 2017 until the 25th of January 2018 in both English and Russian languages. The feedback to the submitted draft abstracts will be provided in one round. The panelists will provide in-depth feedback on the initial content, as well as suggestions for improvement.
  • If you want to receive language support – translation into English or English editing, you have to submit our abstract before 21st Limited translation and editing services will occur between the 22 January and 2 February 2018.

For the abstract submissions written in English, you will receive feedback on the scientific quality of work, and the limited number of abstracts will get assistance with English editing.

After you have finalized your abstract based on the received feedback, you can send it to us again with the email title «Need language assistance».

  • Due to the limited capacity of the panelists, in total up to 110 abstracts will be able to receive feedback. Therefore, the rule “first come – first served” will apply. First 110 abstracts submitted from eligible applicants will be forwarded to a relevant panelist based on his/her expertise and academical background, for feedback and in some cases for personal communication.

Please send your abstract in Word format, include a brief letter of motivation, which scientific track you will be submitting to and details about yourself including your age if you would like to apply as a young researcher or community activist.

Below you will find links to materials on how to write conference abstracts, available in English and Russian.

Requirement for abstracts

  • The abstract should be written in accordance with the official requirements of the AIDS Conference.
  • The draft abstract should be written in Russian or English.
  • The content of the abstract should be in line with one of the conference scientific tracks. The scientific track must be specified under the heading of the abstract.
  • There is a maximum of two abstracts per applicant.
  • Those applicants who want to receive language support either the translation into Russian, or editing of the English abstract, will have to submit a short motivation letter to explain why they need such support.

Confidentiality

AFEW International, EHRA and Amsterdam Youth Force form a Steering Committee and the secretariat of the EECA Abstract support project. Only people designated to serve within Steering Committee and the secretariat and the reviewers assigned to each abstract will have access to the abstract submissions as well as the contact details of the applicants. We will not release any information on who has received assistance for their submissions at any point unless we have consent to do so.

Useful resources

  1. Abstract writing module available in Russian and English

An Abstract writing module is developed in collaboration with the International AIDS Society (IAS) – the organizer of the AIDS conferences and written by editors of the Journal of the International AIDS Society, an open-access platform for essential and innovative HIV/AIDS research. It is available for everybody in English and translated into Russian by AFEW International.

  1. Online training in abstract writing

AFEW International has conducted a training on community-based participatory research and abstract writing. This training was streamed live and records, as well as handouts and presentations, are available in Russian here:

Abstract writing: structure, review criteria, submission tips

Good abstract title

On the road to AIDS2018: practical guide

Presentations and handouts (downloadable, please scroll down)

If you want to receive English presentations and handouts, please refer to the email address below.

  1. Tips and trick on how to write a good abstract.

AIDS2018: Preparing for registration and submitting abstracts. The article was written by a young researcher Anna Tokar. In Russian, the article is available here, and in English here.

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