IT’S TIME

24 of March is a World TB Day 2020.World TB Day is a big moment to sound the alarm, raise attention, and tell world leaders to follow through on their promise to diagnose and treat 40 million people with TB by 2022, as agreed at the UN High-Level Meeting (UNHLM) on TB in September 2018.

We all need to work together now on important activities to make sure that World TB Day 2020 is the biggest and most effective.

What we together can do?

  • REACH OUT
    Reach out to your political leaders (Mayors, Parliamentarians, Ministers of Health, Heads of State) to request their leadership in the fight to END TB, remind them of the commitments and targets that have to be reached by the end of 2022, and request their engagement for World TB Day. This could include making a public statement, supporting an event, introducing a motion in parliament, or committing to achieve the UNHLM country targets.
  • GET SOCIAL 
    The hashtags for this year’s World TB Day are #ItsTimetoEndTB and #WorldTBDay. Start raising awareness through social media. Share your plans with us on Twitter or Facebook.
  • MAKE IT STARRY
    Reach out to celebrities, influencers, TV personalities, and other figures to ask them to join your efforts and raise awareness or wear a red arrow pin ahead of World TB Day. Stop TB partnership has a list of national celebrities, journalists and personalities that we can share with you case by case, so don’t hesitate to get in touch with us to get their contacts.
  • TEAM UP
    Team up with local TB partners to join forces in planning major World TB Day events, public mobilizations, and other activities. Stop TB partnership have a database of partners at country level – so do not hesitate to get in touch with us to be able to identify the partners with whom you want to work for these events.

Text – http://www.stoptb.org/

AFEW International in Uzbekistan

AFEW International represented by Daria Alekseeva, Program Director and Yuri de Boer, Senior Program Manager, and Ainura Batyrbekova, Project Manager of AFEW Kazakhstan concluded a scoping mission to Tashkent from 15-17 January.

At the invitation of the Ministry of Health and with the support of the Ministry of Foreign Affairs of Uzbekistan, the team met with the Republican AIDS Center and the Municipal AIDS Center of the City of Tashkent, the Country Coordinating Mechanism (CCM) on HIV/AIDS, international organizations, as well as a broad range of community based organisations, including networks of people living with HIV.

At the center of the discussion are several proposed interventions to further develop and improve the quality of HIV testing and prevention services for key populations and support to people living with HIV. The overall aims of the proposed projects is to strength the role of civil society and key populations in inclusive health care in Uzbekistan, in particularly in motivating the most difficult to reach groups to get an HIV testing,  and to further strengthen the capacity of AIDS Centers and service providers. During the meetings, all parties involved acknowledged the need to keep focus particularly on key populations (people who use drugs, men who have sex with men, transgender people, and sex workers) and use the expertise of the AIDS Centers as well as the community organizations to better access these groups. Optimized ART adherence for people on treatment was also seen as a possible outcome of joint interventions.

In the coming months, project proposals will be further developed, and formal endorsement from governmental stakeholders and the CCM will be sought.

AFEW International has already supported projects for people living with HIV in Uzbekistan, and actively involved participants from the country in the AIDS2018 conference. In addition, representatives from Uzbekistan participated in AFEW International’s community based research education project.

 

The Knowledge Not Available Before

In 2018, AFEW Kyrgyzstan started training the doctors of family health centres and maternity clinics in providing assistance to the pregnant women who use psychoactive substances (PAS) within the project “Bridging the Gaps: Health and Rights for Key Populations”.

Fear of judgment

According to the assessment held in 2014 within the project supported by the Global Fund to Fight AIDS, TB and Malaria, the number of people who inject drugs in the country was 25,000 people, 12% of them being women. Besides, another study showed a rapid growth in the number of pregnant women with HIV.

Women who use drugs usually seek medical assistance less frequently than men. The reason for it is their fear of judgment and discrimination, fear to lose their children. In 2016, AFEW Kyrgyzstan and a group of experts with support of the project “Bridging the GapsHealth and Rights for Key Populations” developed an action plan for women who use psychoactive substances to provide comprehensive and timely support to such women. In the beginning, guidelines for doctors and nurses were developed called “Management of Pregnancy, Labour and Postpartum Period in Women Who Use Psychoactive Substances”. Besides, AFEW Kyrgyzstan together with experts and community members organized workshops for the doctors of family health centres and maternity clinics in Bishkek and Osh and introduced a training module in the post-graduate education of health workers. Monitoring of the knowledge using such guidelines allowed identifying a big gap in the level of knowledge between the doctors from Bishkek and Osh. There can be various reasons for such situation, but the decision taken as a result of the monitoring was to support the activities of a multidisciplinary team led by the Podruga Charitable Foundation to provide quality training to the health workers in Osh. Such team was created with support of AFEW Kyrgyzstan and the project “Bridging the GapsHealth and Rights for Key Populations”.

Fighting stigma and discrimination

Since March 2018, the multidisciplinary team trained 72 doctors in all family health centres and maternity clinics in Osh. According to Irina who is a social worker at Podruga Charitable Foundation and the project coordinator, when most health workers come to the workshops, they lack trust. They say: “We do not have any female patients who use drugs, and even if there are some, why do we need to treat them – they can be just sent somewhere, and that’s it”. “Usually, women do not tell doctors that they use drugs, they are afraid to say that they have HIV”, says Irina. “As for the doctors, they do not pay attention to it. However, pregnant women living with HIV require a special approach to avoid possible complications and to make sure that mothers-to-be are not afraid to seek medical assistance and get tested. The truth is, though, that after the training most of them change their point of view”.

Before start, all the training participants fill in questionnaires. The results are not so brilliant – the average score is 5-7 correct answers out of 20. After they complete the training, the results are much better: most health workers have not more than one incorrect answer or make no mistakes at all. “I am very happy that after the workshops doctors at least start noticing that there are women who use PAS among their patients. Now, if an HIV-positive woman or a woman who uses PAS comes to them, they often call me or the trainers, we look at her case and try to help every woman. That’s how lives are saved”, smiles Irina.

To a great extent, the training is effective due to the fact that doctors with extensive experience are part of the multidisciplinary team. Each of the trainers is a role model and a real expert. Thanks to the trainers’ reputation, the participants are more willing to listen to them and agree with them. That is how the ice of misunderstanding and ill treatment is broken.

Gradual improvement

It should be noted that the project helps the health workers to work not only with pregnant women. Nadezhda Sharonova, Director of Podruga Charitable Foundation, says that now it is easier for their organization to find friendly specialists and women who use PAS do not have to fight hard to receive health care as more doctors are now willing to help the patients and treat them better.

“Once a woman came to me, she started crying and said that a cleaner told all other patients of the maternity clinic about her HIV positive status, so nobody wanted to talk to her, people turned their backs on her and the doctors were rude and neglectful”, tells Irina. She says that such cases are less frequent now. Irina recognizes that through one-time training it is not possible to ruin all the fears and stereotypes, which have been building up for many years, but it can at least considerably improve the situation. In our work, the phrase “improve the situation” means better lives of women and children that can be saved with this new knowledge.

I Love Every Minute of My Life

HIV is not a verdict. It is a reason to look at your life from a different angle and get to love every moment of it.

That is exactly what Amina, the protagonist of this story who lives with HIV, did. She went through the dark side of self-tortures, reflections, and suicidal attempts to realize that every minute is precious and HIV is what helped her to become strong, independent and happy.

Amina works in the Tajikistan Network of Women Living with HIV. She found herself in this field and nowadays she is actively involved in the Antistigma project implemented within the Bridging the Gaps programme.

How I learned about my status

“In 2012, I got pregnant for the fourth time. Seven months into my pregnancy, I got tested for HIV within the routine health monitoring. Four weeks after, I was asked to come to the clinic and was told that they detected haemolysis in my blood. I got tested again. My doctor told me the result of this second test after my baby was already born.

HIV. The diagnosis sounded like a verdict. What should I do? How should I live? Where can I get accurate information? My conversations with health workers were not very informative. Nobody told me that one can live an absolutely normal life with the virus. I felt that I was alone, left somewhere in the middle of an ocean. I had my baby in my arms, my husband who injected drugs was in prison. Back then, I hoped that I could tell at least my mother about the diagnosis to make it easier for me. However, the virus drove us apart. My mother, who took care of me for all my life, turned her back on me. At the same time, my three-month-old daughter, who also had HIV, died of pneumocystis pneumonia. I hated myself so much that I even had suicidal thoughts. I took some gas oil, matches… If not for my brother, who saw me, I would have burned myself. Then I remember a handful of pills, an ambulance and another failed attempt to kill myself. I felt that I was completely alone on this dark road of life. I started losing weight and falling into depression”.

Through suicidal attempts to the new life

“Two years passed, and my suicidal thoughts started to gradually go away. I had to go on living. Throughout all this time, I kept ignoring my status, but I was searching for the information on HIV in the internet. I was not even thinking about ARVs, I was not ready for the therapy. Sometimes I did not believe that I had HIV as doctors kept telling me that HIV was a disease of sex workers.

After a while, I came to the AIDS centre with a clear intention to start ART. I passed all the required examinations and told the infectious disease doctor that I wanted to start the treatment. Six months after, I already had an undetectable viral load! I believed in myself, in my results, so I wanted to share this knowledge with all the people who found themselves in similar situations. That’s how I started working at the AIDS centre as a volunteer and later as a peer consultant”.

I am happy!

“HIV helped me to start a new life. I am happy – I help people, I am doing something good for the society working at the Tajikistan Network of Women Living with HIV. Recently, I was the coordinator of the Photo Voice project.

I want to keep people who find themselves in similar situations from repeating my mistakes. I want to protect them from unfair attitude, stigma and discrimination against PLWH as well as different conflicts, in particular based on gender.

In 2019, I gave birth to a baby. My boy is healthy. Just recently, with the help of the Photovoices project I disclosed my HIV status to my older sons.  Before that, I wanted to keep that as a secret, but after training and meetings with women within the framework of this project, I decided that I need to open my status. For me it was the scariest thing to do as I thought that they might not accept me as my mother did. However, I did not have to worry. My children hugged me and said that I am the best mother in the world. Now I’m a happy wife of my husband, whom I convinced to start opioid substitution treatment.

HIV helped me to be happy and independent! I am not afraid to say that I have HIV and I love every minute of my life!”

 

 

Prospects for cooperation in the health sector in Uzbekistan

On January 10, 2020, AFEW International, represented by Anke van Dam, Executive Director, and Daria Alexeeva, Program Director, met with Ambassador of Uzbekistan in Benelux countries Dilier Hakimov.

AFEW International is considering possibilities to implement two projects in Uzbekistan. The first one is to develop and improve the quality of HIV testing and prevention services for key populations and support people living with HIV.

The second project, entitled “Strengthening civil society in inclusive health care in Uzbekistan”, is currently under consideration by the European Commission and is on the reserve list of projects.

At the end of the meeting, the parties agreed on a schedule for the AFEW International delegation to visit Tashkent on 15-16 January 2020. AFEW International’s team will have negotiations with the Republican AIDS Center, as well as with representatives of some international organizations, which may act as donors for the implementation of projects of the non-governmental organization in Uzbekistan.

AFEW International already has experience in working in Uzbekistan: the organization supported several projects in the country through ESF, as well as was involved in preparations for the AIDS2018 conference. In addition, representatives from Uzbekistan participated in AFEW International’s community based research education project.

Help Here and Now

“If you can help someone Here and Now, you should do it without postponing it or thinking what other people can do,” says Ekatherina Rusakova, Director of Sverdlovsk Regional Charitable Organization “Malaxit” supporting people in difficult life situations. “If every one of us helps at least one person, maybe it will drive changes in the society.”

To support these words, Malaxit implements the project “Social and legal support of people who use drugs in Yekaterinburg” with financing and support of the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia (EECA).

Ekaterina how does your organization help people who use drugs in Yekaterinburg?

Ekatherina Rusakova, Director of Sverdlovsk Regional Charitable Organization “Malachite”

Mainly we provide social and legal support to clients to eliminate regulatory and discriminatory barriers, help them to get fair court decisions and access to free rehabilitation. Besides, we provide our clients with referrals to healthcare and social support institutions of the city. Our social worker makes outreach visits to families with small children. He provides consultations on HIV and treatment, helps clients to make appointments with specialists, assists them in re-issuing documents and receiving temporary registration in the city as clients are not able to receive medical or social services without registration.

Why did you decide to apply to the Emergency Support Fund for Key Populations in EECA?

We applied to the Emergency Support Fund because the situation of PUD in our city is difficult. Many people still do not recognize that substance use is a disease. However, this condition needs comprehensive treatment, including medical assistance, psychological and social support. Moreover, efforts should be aimed not only at the person using substances, but also at such person’s family as substance abuse is a systematic, family disease.

Of course, current situation contributes to the growth of HIV and other socially significant diseases (tuberculosis), while people who use drugs remain outsiders and the society prefers not to notice them. However, it is not possible to solve this problem pretending that it does not exist, after all sooner or later it will manifest itself and, most likely, in a very negative way. That is why, in our opinion, enough attention should be paid to secondary prevention and working with the “risk groups”.

What case from your practice do you remember best of all?

Andrey, a representative of the Rehabilitation Center, Dmitriy Kadeikin, consultant, and a social worker of the project, after a lawsuit in Revda, Sverdlovsk Region

That’s a story of one of our clients. Andrey came to our project when he learned about it from his friends. Back then, there was an investigation against him based on part 2 of article 228 of the Russian Criminal Code. Our staff members signed a social support agreement with him, drafted procedural requests and collected all the necessary documents. Social worker of the project acted as a community advocate in court. A person from the rehab also took part in the court hearings. As a result of our joint efforts, Andrey got a suspended sentence with a course of rehabilitation.

What does the society think about your work?

It depends: some people support us, some don’t and it’s fine! All people cannot think the same and have the same “view of the world”. We are all different, with various views, values, attitudes, and that’s the beauty of human beings – in their differences…

Have you ever faced any challenges working with the key populations?

Speaking about the members of key populations, our target groups, they are all positive about our activities, they trust our staff members and our experience. We mostly see challenges related to new psychoactive substances, which our clients still use. That is why they can have unpredicted behaviours, treatment interruptions, etc.

How does engagement of the key populations in your activities help you in your work?

I think that when implementing such projects it is very important to engage members of the key populations. Without such engagement, it is not possible to reach PUD, who are a very closed target group, especially considering that in this group there is a very low level of trust to people.

Your example of a perfect society.

I don’t think I could give you an example of a perfect society. I tend to be realistic when looking at things, not losing myself to illusions. I do not like it when people say that somewhere there is a perfect country and a perfect society, where everything is fine, which we should strive to achieve. There are some pitfalls everywhere. It is important to realize that there are good things everywhere and we need to learn to notice and appreciate them. I am sure that we have to always start with ourselves and you can of course feel offended and be angry at our country and our authorities, but it does not bring any results. Speaking about a specific country with the approach to working with key populations that I like, for me it’s Portugal.

The project is supported by the Elton John AIDS Foundation and Aidsfonds.

 

What does good collaboration between municipalities and NGOs mean?

AFEW International (The Netherlands) was a technical partner in the Fast-Track HIV/TB Cities Project, which was implemented between 2017-2019. The main goal of the project was to develop efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in five project cities; Almaty (Kazakhstan), Balti (Moldova), Odesa (Ukraine), Sofia (Bulgaria), and Tbilisi (Georgia).

AFEW International with expertise on increasing access to health services for HIV, TB and viral hepatitis for key populations, is well-connected to Dutch health care providers. Within the Fast-Track HIV/TB Cities Project, videos were made to feature professionals working for municipalities, consultancies and NGOs, law enforcement agencies in the Netherlands and on an international level. What good collaboration between municipalities and NGOs means, why service-delivery for sex workers, People Who Use Drugs and LGBTQI is funded by the dutch municipality, and how this is organized? Answers on these questions are in this video.

 

 

 

Study tours help the public and non-public sectors to hear and see each other

For many years, NGOs have been engaged in study tours with visits to various organizations and institutions in other countries. While experience shows that not all study tours are equally useful – sometimes practices that work well abroad are incompatible with local realities – study tours have overall proven to provide participants with new knowledge and valuable practices that can be applied.

AFEW-Ukraine, partner in the “Bridging the Gaps: Health and Rights for Key Populations” programme, has noticed that at the local level partners benefit from sharing knowledge and experiences. Whereas each organization has its own reality and experience, NGOs all work in similar conditions. Since 2016, AFEW-Ukraine is regularly involved in the organisation of study tours for representatives of public organizations and government agencies, and colleagues working in other regions of Ukraine.

For Oleksandr Mohylka, Project Coordinator at the Compass Social House (KCF “Blago”, Kharkiv) and Nataliia Zlatopolska, Project Coordinator at the Altair Youth Friendly Center (PRCF “Public Health”, Poltava) study tours in Ukraine have proven to be an inspiration for bringing about change in their organisations and for their work with adolescents using drugs.

Where?

Oleksandr: As part of the project “Bridging the Gaps” this year, two social workers and me went to the CF “New Family” in Chernivtsi and their Psychosocial support center “Dialogue”. We wanted to know about their rehab program for teens. This was important for us because we wanted to provide rehabilitation services for adolescents who use drugs.

Nataliia: We had two trips to Kropyvnytskyi and Kharkiv. In Kropyvnytskyi we visited colleagues from the Social bureau “Lily” (CF “Return to Life”) and their partners in the city. In addition to Altair employees, we included representatives of the center for vocational training education, the department of juvenile prevention and the city center for family, children and youth.

The choice of partners for the trip was not accidental. For example, the practice has shown that our clients are mainly students of vocational schools, and through direct interaction with management, it is easier to connect with this group, to make our work process systematic to reach more people and achieve positive dynamics. Juvenile prevention redirects clients to us, and we engage them in training project leaders.

In Kharkiv, we had the opportunity to get acquainted with the experience of their Compass Center. First of all, we were interested in what tools the organization uses to work with our target audience, and how their partners’ network works.

Goal

Oleksandr: We had a very tight trip. It was interesting how the rehabilitation was organized – statutes on rehabilitation, the program, orders of local authorities etc. This is what we can apply now in our everyday work. It was interesting to learn how it all began to work, why there was a need for certain documents, what mechanisms these documents regulate, what is the role of the City Coordination Mechanism. We were also interested in the interaction of the “New Family” with the Coordination Council since this is a positive experience of interaction.

Nataliia: We had a meeting with the deputy mayor of Kropyvnytskyi for humanitarian issues, a dialogue showed that the public sector in Kropyvnytskyi understands what benefits it has from working with NGOs. Project specialists proved the importance of interacting with them with the help of numbers, statistics, cases, and stories. And we took this experience forward.

We also saw how the ideas of the project clients are implemented. We saw that they are really possible to fulfil. And these are not just dreams – it is actually possible to realize the ideas of adolescents. For example, we liked the idea of ​​sketching the addresses of Telegram drug distribution channels, not on their own, but using the resources of the city.

What was learned?

Oleksandr: It was after the trip to Chernivtsi that we made a firm decision that we would do a rehabilitation program. And we realized that we should do our own program, not the same as in Chernivtsi. The drug scene and, accordingly, the behaviour of adolescents and the consequences of using drugs change. Thanks to the trip to Chernivtsi, we now better understand how to take into account the unique experience of our colleagues and to make our rehabilitation program maximally meet modern challenges. We have already presented our idea to the Coordinating Council of Kharkiv. In the new City drug program, the development and support of a rehabilitation center for youth are now registered on the basis of our Social home! We were inspired by their experience and success; we saw that this is all real in our country. Moreover, now, apart from the “Dialogue”, no one is doing rehabilitation separately for teenagers in Ukraine. We always say that in Ukraine we have the experience of a successful rehabilitation center for adolescents and that we learn from them and are ready to contribute.

Nataliia: We “brought” new work tools home – for example, a step-by-step mechanism for referral clients from our city partners (educational and law enforcement agencies, social services, etc.) to us. In Kropyvnytskyi, if one of the key partners discovers a teenager who is probably using drugs, he or she will immediately be redirected to the social bureau “Lily”. And we studied communication mechanisms, registration log and so on. We also liked the practice of the leaders’ school. In addition, we spied on the work in the organizations themselves, how employees interact and were inspired by their atmosphere.

Results

Oleksandr: Study tours with partners to colleagues from Ukraine are a very high-quality mechanism for obtaining of well-deserved trust from government bodies and our main partners – the police, social services, educational and medical institutions. Such joint actions help them understand that we are doing real things, we are doing things that government agencies are not doing because of limited resources, instructions or something else. But the main thing is that we complement their work very well. We let them know that we are ready to help and train. We noticed that upon returning, even the level of relations changed, as well as the number of redirects to the Center. At the same time, during such study tours, we ourselves see how government bodies work and what kind of help they need.

Nataliia: Study tours help the public and non-public sectors to hear and see each other. Employees of various services in different cities may have different views, but this does not prevent them from communicating and sharing experiences and thoughts. They can understand what powerful resources we have, and that we really bridge the gaps in their work, too. Previously, for example, various myths were circulating about NGOs in our city that interfere with the organization’s work. After this visit, all questions of officials were removed, and the level of mutual trust continues to grow.

With the organisation of study tours, AFEW-Ukraine thus fosters in-country processes and partnerships to reinforce results in line with Bridging the Gaps Theory of Change. The organisation contributes to deliver and advocate continuously for strengthening services and upholding human rights for adolescents who use drugs in Ukraine.