AFEW is Looking for the Artists: Art-Residence in the Netherlands

The Culture Initiative is an art fund set up by AFEW International for artistic interventions preceding and during the 22nd International AIDS conference 2018 (AIDS 2018) in Amsterdam. The fund is looking for visual & performing artists from Eastern European and Central Asian Countries (Russia, Belarus, Ukraine, Moldova, Georgia, Armenia, Azerbaijan, Kyrgyzstan, Uzbekistan, Tajikistan, Kazakhstan) to critically reflect on HIV/AIDS and its related topics (e.g. affected communities, stigma and discrimination, community health etc) and the relationship and dialogue between ‘The West and the East’ in tackling overarching global social and economic phenomena such as the HIV/AIDS crisis.

The Culture Initiative invites five artists for artist-residencies in Amsterdam in the months leading up to the conference (23-27 July 2018).

There will be three long term residencies (2-3 months) for artist to be placed outside traditional art spaces in institutes and organisations that work in the social and health sphere, such NGO’s, Health-, Research-, and Cultural Institutes. The invited artists will interact with social and health professionals, artists and art organisations in the Netherlands. The artists are asked to reflect on the relationship between the Netherlands and Eastern European and Central Asian Countries (EECA) countries in the sphere of social and public health matters. The final works will be presented at AIDS 2018.

In addition, there will be two short term residencies (1-2 weeks) during the conference period, where the artist will show their work and interact with the conference participants (approximately 18.000).

Criteria for artists or artist collectives applying

  • Contemporary visual and/or performing artists
  • Citizens or originals from any of the eligible EECA countries
  • Proven experience with social and community art projects
  • Good knowledge of (spoken) English
  • Not applicable to art-students

The participant artist or artist collective will be offered

  • Travel, visa and insurance cost
  • Accommodation and working space
  • Daily allowance (25 euro per day)
  • Production fee (depending on requirements max Euro 3.000)
  • Artist/collective honorarium (estimate per month Euro 1.000)

The artists are expected to deliver

Long-Term residents Short Term-Residents
2-3 months between May-August 2018 1-2 weeks 13-27 July 2018
Final Presentation/Exhibition at the Conference 23-27 July 2018
Engagement with conference participants and visitors
Min. 2 Artist presentations/open studios
Min. 2 Artist external presentations
Regular curator meeting and process documentation

The application will consist of the following (only in English)

  • Portfolio – Maximum 5 works/projects – 5 images/videos per project – total not exceeding 20 MB
  • Artist statement (max 200 words) and biography
  • Project ideas (max 300 words)
  • 3 names and contacts of people that could provide recommendations

Send the full application to jan_van_esch@AFEW.nl. Deadline – 5 December 2017. Only selected artist will be contacted.

AIDS 2018 is Looking for Abstract Mentors

Source: AIDS 2018

Abstract mentors are needed for the 22nd International AIDS Conference (AIDS 2018) in Amsterdam. The Abstract Mentor Programme (AMP) was introduced at the 15th International AIDS Conference in 2004, with the objective to help young or less experienced researchers improve their abstracts before submitting them, in order to increase the chance of their work being presented at conferences.

The programme especially targets researchers from resource-limited settings, who lack access to opportunities for rigorous mentoring in research and writing and for whom online distance education is proven to cost-effectively build research capacity. Over the years, the AMP has proven to increase the motivation of early career researchers, as well as the number of abstract submissions received from resource-limited countries.

This year’s AMP for the researchers will open on 20 November 2017 and close on 15 January 2018. The abstract submissions for AIDS 2018 will then close on 5 February 2018. This gives mentors time to submit feedback and mentees sufficient time to make their final revisions before the abstract submission deadline.

The AIDS 2016 AMP received 138 draft abstracts. From the draft abstracts that received online mentoring and were submitted for this conference, 30% were accepted into the Conference Programme.

The Abstract Mentor Programme is completely independent of the AIDS 2018 abstract review and selection process.

Mentors can apply for the program starting from 23 October 2017 until 15 January 2018. Mentors must have had at least two abstracts accepted at international scientific conferences and have co-authored at least one manuscript accepted by a peer-reviewed scientific journal within the last five years. To become a mentor and to get more information about AMP, click here.

Source: AIDS 2018

AFEW Presents Important Assessments about EECA

AFEW International, together with its network members from Eastern Europe and Central Asia (EECA) is getting ready for AFEW’s Regional autumn school to be held in Almaty, Kazakhstan from October 30 till November 3, 2017. The autumn school will provide the platform for learning, exchange, strategizing and planning for community members and NGO partners from 10 different countries. The regional autumn school is an annual event that takes place as a part of ‘Bridging the Gaps: Health and Rights for Key Populations’ regional approach of AFEW.

One of the highlights of the autumn school’s program will be the presentation of three important assessments that AFEW International recently finalized as a part of the ‘Bridging the Gaps’ program. The final results of all assessments will be available to the general public around December of 2017.

Harm reduction friendly rehabilitation

The assessment on harm reduction friendly rehabilitation in EECA is the study that describes the state of rehabilitation services in Ukraine, Russia, Georgia and Kyrgyzstan. It presents seven international approaches for rehabilitation programs and its activities. The participants of AFEW’s autumn school will discuss the recommendations of what approach is better to adopt for developing stronger work capacity.

Migrant people who use drugs

The assessment on migrant people who use drugs (PUD) is coming from the questionnaire that was disseminated in the EECA region. A survey amongst 600 people who use drugs in Tajikistan and Kyrgyzstan showed that 43% of the respondents have experienced periods of migration to another country in the EECA region, mostly to Russia. From the qualitative interviews with migrant PUD in Russia and Kazakhstan, it is possible to assume that people have very little access to health facilities, legal documents and often little options to return to their native country. The participants of the autumn school will discuss the full assessment and come up with interventions for the coming two years to build good practices and to advocate for the rights and lives of the community members.

Shrinking space for the civil society

The assessment on shrinking space for civil society is the in-depth assessment on the space for the civil society organizations with a special focus on harm reduction and drug policy in NGO’s and community networks. The withdrawing of international funding and shrinking space for the civil society form a real threat for the fight against the further spread of HIV in the region and the rights and lives of communities. During the autumn school, the coping mechanisms will be discussed and further steps will be designed to address the conclusions.

TB and HIV – a Plague of Tajikistan Prisons

Prisoners in the yard at a colony in Dushanbe. Photo from the archives. Author – Nozim Kalandarov

Author: Nargis Hamrabaeva, Tajikistan

Around 12,000 people are held in correctional institutions and pre-trial detention centers in Tajikistan. Approximately 100 of them have tuberculosis, and 220 live with HIV.

“HIV prevalence in prisons in Eastern Europe and Central Asia (EECA) is estimated to be between 2 and 50 times higher than that in the general population. In EECA, Tajikistan has the highest rate of HIV infection among prisoners – 7%, which is about one-fifth of all people infected with HIV in the country. Additionally, according to the estimates, the risk of contracting TB in prison is 60-100 times higher than outside prison walls. Within the prison population, there is an increased rate of tuberculosis-related mortality compared to that in the general population,” states an overview of HIV and TB in Tajikistan prisons as described by AFEW International in 2015. Now, two years later, let us see how this situation has changed.

100 TB patients

“Over the last eight months, 59 new cases of TB in penal institutions were diagnosed. All these patients are registered and receive treatment. In total, there are 100 prisoners infected with TB in Tajikistan, which is less than 1% of the prison population. Compared to the previous years, the situation has improved significantly: TB detection increased, the laboratories are being modernized, there is new equipment and adequate provision of medications,” the Head of the Medical Department of the Main Directorate of the Penal System of the Tajikistan Ministry of Justice Saidkul Sharipov is saying.

According to Mr Sharipov, a real lifesaver for them was the mobile fluorography unit that could be taken from region to region, allowing for step-by-step screening of inmates.

“Such testing is conducted every six months. For example, recently we have examined about three thousand inmates for mycobacterium tuberculosis in all cities and regions, except Dushanbe. We identified 40 suspected cases of TB that will be followed through during the secondary examination,” Mr Sharipov adds.

In total, some 500 prisoners are kept under regular medical supervision, including those who had already received treatment and have fully recovered.

The Deputy Director for Infectious Control of the Republican Center on Social Protection from TB Saydullo Saidaliev also confirms that the situation with tuberculosis is under control and TB prevalence in Tajikistan has decreased.

“In 2005, more than 300 inmates had TB, this year – only 100. The rate of new infections has also been declining: 77 cases in 2016, 59 over the last eight months. Last year, seven prisoners died from mycobacterium tuberculosis, this year we had zero deaths from TB,” Mr Saidaliev says.

Almost all correctional institutions have special TB hospitals for 5–10 beds, as in prison settings one TB carrier could infect tens of people within a year.

HIV “enters’” prisons from outside

Mycobacterium tuberculosis and HIV are often spread in closed institutions.

Prisoners at a colony in Dushanbe. Photo from the archives. Author – Nozim Kalandarov

“Although we have not analyzed this thoroughly, one could assume that most cases of HIV infection among inmates take place within correctional institutions. Quite some detainees are imprisoned because of drug related crimes, like drug possession. People who inject drugs have a higher risk of living with HIV. Most of them serve a short term, but have the risk to be detained shortly after their release again for another short term. With the window period of detecting HIV, it is difficult to say if and when prisoners have got HIV while detained,”  the Deputy Director of the Republican AIDS Center Dilshod Saiburhanov is saying.

Inmates often learn about their HIV status in prisons, where HIV testing is offered twice a year. Currently we have 220 registered people with HIV, two of them are female, one under age, and 150 receive antiretroviral treatment.

Since 2010, the number of HIV cases among inmates has decreased: 292 were identified in 2010, while over the last nine months only 31 cases were registered – a nine-fold decrease. Screening procedures are improving every year, and 65–70% of prisoners get tested for HIV,” Mr Saiburhanov adds.

Currently, three correctional colonies in Tajikistan have the so-called “friendly offices” that distribute prevention materials – syringes, condoms and information leaflets.

HIV+TB: a particular risk

Experts note that they are especially concerned about HIV and TB co-infection, as people with HIV have a higher risk of getting TB as well.

“That is why there are cases of co-infection in Tajikistan prisons: about 25% of the total number of TB patients,” the Head of the Medical Department of the Main Directorate of the Penal System Saidkul Sharipov says.

Mr Sharipov adds that AFEW-Tajikistan is one of the few international organizations that work in Tajikistan prisons to reduce the burden of infectious diseases, such as HIV and tuberculosis.

“We have been collaborating with AFEW since 2003 to conduct HIV and TB response projects in prisons, as well as information campaigns among inmates to prevent these diseases,” Mr Sharipov says.

One of the main problems is not even the lack of costly treatment and nutrition, because international organizations help with these. It is the lack of healthcare personnel in the penal system.

Drug Treatment Systems in Prisons in Eastern Europe Discussed by AFEW Board Member

Council of Europe Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs published a new publication “Drug Treatment Systems in Prisons in Eastern and Southeastern Europe”. The publication sheds light into the situation of drug users among criminal justice populations and corresponding health care responses in ten countries in Eastern and Southeastern Europe: Albania, Bosnia-Herzegovina, Georgia, Kosovo, Macedonia, Moldova, Montenegro, Russia, Serbia, and Ukraine. AFEW‘s board member Vladimir Mendelevich is one of the contributors of the publication. 

The research project on drug-treatment systems in prisons in Eastern and South-East Europe looks in detail into the situation of drug users among criminal justice populations and the corresponding health-care responses in nine countries in Eastern and South-East Europe – Albania, Bosnia-Herzegovina, Georgia, Moldova, Montenegro, Russia, Serbia, “the former Yugoslav Republic of Macedonia” and Ukraine – and Kosovo. It was conducted between 2013 and 2016, and is a first attempt to collect relevant data on drug use among prison populations and the related responses in the nine countries and Kosovo.

Although the places chosen are quite heterogeneous in size, structure, legislation, economy, culture and language, they are all in a process of economic, social and cultural transition. This has triggered reforms of some of their prison systems and policies but it has also led to financial and political instability and lack of leadership due to frequent changes in the prison systems’ top management.

The full publication can be downloaded here.

HIV Prevention in Key Populations: an Overview of Service-Delivery Projects in Russia

The Blue Bus mobile prevention unit, the bus of hope

Author: Anastasia Petrova, Russia

According to the World Health Organization, about half of new HIV cases occur in key populations: injecting drug users, men having sex with men and sex workers. Social stigma, violation of human rights, lack of access to the necessary services create barriers to protection of health for millions of Russian citizens. That being said, providing care to people with an HIV-positive status and those who are at risk of infection is an essential measure to safeguard health of the whole nation. By implementing service-delivery projects for key groups, non-governmental organizations play an important role in preventing the spread of the HIV epidemic both in the communities and among the general population.

The bus of hope

The Blue Bus mobile prevention unit, engaging clients in service provision

The Blue Bus of the Humanitarian Action Foundation is the first mobile prevention unit for drug users. In 2017, the project celebrates its anniversary: 20 years ago, the Blue Bus started its first journey in St. Petersburg.

Throughout these 20 years, Humanitarian Action has been true to its principles of helping those most vulnerable to the HIV epidemic. Many clients have double or even triple diagnosis: HIV, tuberculosis, hepatitis B and C, and addiction to psychoactive substances.

People are referred to service-provision programs through street outreach, mobile units and stationary needle exchange centers. Peer counsellors provide motivational counselling, assist with hospitalization to specialized medical institutions and follow-up their clients to increase retention in treatment programs.

The Blue Bus mobile prevention unit, distribution of materials, motivational counselling

Bus workers distribute sterile syringes, needles, water for injections, alcohol swabs, cotton balls, bandages, vitamins, vein ointment, naloxone, etc. People who use services are not always ready to change their behavior just like that. Talking to the project staff, they get important information on how to reduce infection risks and protect their health.

For most clients, the Blue Bus is the only safe place where they are treated with respect and understanding, and the only possibility to take a rapid test, receive primary medical counselling, get access to HIV and TB testing and treatment, be referred to public institutions and learn how to protect human rights. The team of the Blue Bus proudly values these trustful relationships between project staff and clients that have been built over the years of program implementation.

Dialogue between equals

Outreach work in the Cabaret bar

NGO Positive Dialogue is one of the oldest HIV-service organizations in St. Petersburg. Since its establishment in 1996, Positive Dialogue has gained substantial experience in working with key populations. In July 2015, the organization launched HIV prevention projects for closed population groups: men having sex with men (the Positive Dialogue project) and sex workers (the Silver Rose project). Both projects are community-driven, with the main goals to promote safer sex practices among MSM and SWs, increase access to services, including HIV/STI testing, uphold human rights, strengthen communities and counteract stigma.

The outreach team of the Positive Dialogue project conducts weekly field work in the night clubs visited by MSM and the LGBT community. The clients talk to peer counsellors and ask questions about HIV and other STIs, learn about pre- and post-exposure prophylaxis, receive condoms and lubricants.

Outreach work in the Priscilla club

The Silver Rose staff members provide counselling for sex workers in their office and conduct outreach work in the local saloons and street sex work areas. The project helps the girls preserve their health and human rights, protect themselves against violence, receive contraceptives, get tested for HIV and get referrals to trusted doctors. Peer counsellors also provide psychological support and involve sex workers in client management programs.

Training on how to use a female condom

Legal components make up an important aspect of the project’s work – the so-called “street lawyers” trained by the project provide legal aid and support in cases of violations of MSM/LGBT and SWs rights. Project clients take part in educational trainings and seminars.

Particular attention is devoted to community development and mobilization, to encourage community-driven HIV responses. Project activists organize campaigns and round table discussions aimed at overcoming societal stigma.

Women plus

Social support center for women, pre-test counselling

HIV-positive women are the focus of one of the projects run by EVA Association. In October 2017, a social support center for women affected by HIV will be launched by EVA – a low-threshold service offering comprehensive individual assistance to HIV-positive women in crisis situations.

The project team unites specialists with various experiences: peer counsellors, client management officers, lawyers, psychologists. Clients will be offered counselling, rapid HIV testing with pre- and post-test counselling, and individual management of each case. Women will be able to obtain contraceptives (condoms) here and take part in self-help group sessions for women living with HIV and their family members.

Social support center for women, rapid testing for HIV

Experienced specialists working in EVA will do their best to make the center as client-friendly and as responsive to clients’ needs as possible – for example, by allowing clients to bring their children, organizing distribution of clothes for women and kids, giving out hygiene kits. EVA collaborates with the municipal public services and socially oriented NGOs, which will improve activities aimed at informing women about the existing support services, providing access to various specialists and representing women in these institutions.

The center will give special attention to the prevention of violence and dependent and co-dependent behaviours. It is pilot project, unique for the region, with a focus of preventing negative social consequences of HIV among women.

Social support center for women

Prevention projects for vulnerable groups in Russia were launched 20 years ago by our western colleagues. However, international funding for these and other social projects has been significantly reduced. Unique low-threshold HIV prevention programs are becoming as vulnerable as their clients. Some organizations manage to secure financial support from the government. Others try to change their structure. We would like to believe that projects that help thousands of people representing very closed populations to protect their health will not become extinct in Russia.

NGO-Based HIV Testing Available in Kazakhstan

President of Central Asian Association of People Living with HIV and the ‘Kazakhstan Union of People Living with HIV’ Nurali Amanzholov

Author: Marina Maksimova, Kazakhstan

From early 2018, HIV rapid testing in Kazakhstan will be available based in the non-governmental organizations (NGOs). With the President of Central Asian Association of People Living with HIV and the ‘Kazakhstan Union of People Living with HIV’ Nurali Amanzholov we are talking about advantages, mechanisms and preparatory work associated with this innovative step in fighting HIV.

– Nurali, it is well known that in Kazakhstan HIV screening test can be conducted at any regional AIDS Center. What is the reason for organizing rapid testing on NGOs’ premises?
– Nowadays, only AIDS Centers are authorized to conduct HIV testing in Kazakhstan. Every regional center has such a department. The problem is that representatives of the key populations (people, who use drugs, sex workers, men who have sex with men) prefer to avoid them. NGOs, using peer-to-peer approach, have better access to these groups, and in such a way there is more confidence. Non-governmental organizations can significantly increase the coverage of those tested for HIV, which means that the control over the epidemic will also increase. Another advantage of the proposed innovation is that it allows to identify HIV infection at an early stage, ensure timely treatment, preserve health and employability, and prevent new cases.

– What are exactly NGOs doing to introduce such service?

– Last year, with the support of the Corporate Foundation Eurasia Foundation of Central Asia, which is supported by the United States Agency for International Development (USAID), Kazakhstan Union of People Living with HIV implemented the project ‘Access to the NGO-based rapid HIV testing in Kazakhstan.’ Its goal is to create an enabling legal environment for providing HIV rapid testing services by NGOs to improve access to this service for key populations. Within the framework of the project, we analyzed the barriers during the introduction of the NGO-based rapid testing. Now we are working on the methodological recommendations and draft of the decree, which should make this initiative legal. It will contain clear operational rules of this system as well as all requirements and methods of control.

– Nurali, what kind of preparatory work is carried out to introduce this NGO-based services next year?

– Today specialists from the Republican Center for AIDS Prevention and Control together with their colleagues from Kazakhstan Union of People Living with HIV provide trainings for NGOs on how to conduct rapid testing in two pilot regions – East Kazakhstan and Pavlodar. We have already conducted trainings for the representatives of four non-governmental organizations. Specialists have taught our staff how to do an HIV rapid testing, and how to conduct pre-test and post-test counseling. They provided information about the quality control of the procedure, safety measures, recycling of consumables, talked about the observance of professional ethics. Each participant knows that if the test results are positive, the patient should be redirected to the AIDS Center for further laboratory diagnosis and confirmation of the HIV status.

Was your initiative supported by the governmental structures?

– Representatives of the Ministry of Health of the Republic of Kazakhstan, the Republican Center for AIDS Prevention and Control, leading international organizations dealing with HIV in the country are actively involved in this process. There is a good chance to include NGO-based rapid HIV testing into the national testing algorithm, which is being currently reviewed by the Ministry of Health. This will make fundraising efforts of NGOs more efficient, including attracting public funding for these services. This approach insures stability of the services, and of NGOs in general. I am sure that the topic of HIV rapid testing on NGOs’ premises deserves a separate discussion at the 22nd International AIDS Conference AIDS2018 in Amsterdam, and we are ready to share our experience there.

 

 

 

 

 

 

 

 

 

Newlyweds in Tajikistan should Know HIV Status of Partners

Author: Nargis Khamrabaeva, Tajikistan

According to the UNAIDS estimates, there is around 1.5 million people living with HIV in Eastern Europe and Central Asia. The Ministry of Health and Social Protection of the Republic of Tajikistan registered 348 new cases of HIV infection in Tajikistan in the first half of 2017. There is a compulsory rule for newly married couples in Tajikistan now: the couple has to submit not only the application for marriage to the registry office, but also the results of a comprehensive medical examination, including the test on HIV. Authorities believe that these measures will facilitate the creation of strong families and the birth of healthy children*.

We are talking about this with the medical doctor and expert in HIV field, the member of European AIDS Treatment Group (EATG), the member of online conference committee EECA 2017 (Moscow, Russia) Zoir Razzakov.

– Zoir, please tell us about the obligatory medical and HIV couple examinations for the registry offices in Tajikistan.

– The number of HIV infected women in the country has been growing lately. Many of these women acquired HIV positive status from their migrant husbands. There were many cases when women found out about their status after the marriage and before giving birth to children. For example, women have to take the HIV test prior to receiving the prenatal record. I will tell you about one example: there was a child in one family who often got sick, had temperature and doctors were unable to come up with a diagnosis. Somebody advised to take the HIV test, and it turned out the child had been infected. It also turned out that the mother of the boy was infected from her migrant spouse. Unfortunately, doctors could not save the child.

– Do you have any statistical data of the number of identified HIV-infected people through the introduction of this particular testing?

– According to the available data, the local AIDS centre detected two cases of HIV infection of those who did before-marriage testing this year. I do not know if the marriage was prohibited due to these reasons. Another question: if future spouses know about each other’s statuses and are not against creating a family, what happens then?

– Many experts note that such compulsory HIV testing contradicts with international standards on voluntary testing of the population and the basic law on HIV. What do you think?

– From some point, I consider the compulsory before-marriage testing discriminating. Suppose we find out one spouse is HIV-positive, what happens next? HIV-infected people are equal to all other citizens of Tajikistan and have equal rights.

There are some advantages of this testing, of course. Many people in the Republic of Tajikistan do not know about their status, and are not informed about the HIV infection and its ways of transmission and prevention. Migrant workers are in the risk group. They live in poor conditions in foreign countries and have to satisfy their physical and sexual needs with someone else while living away from their families.

After they return home, they usually do not get tested and infect their partners. This leads to conflicts in families and further divorces. Everybody should know their status. This should become a common unspoken rule for the society. It should also be a voluntary action in which people should take interest. Media should also come to the rescue. We need more informational materials, social ads on TV and radio. I would say that people have to be informed, and in this way, they will be forearmed. Forearmed means protected, and protected means safe.

– Do you think the following testing can prevent HIV spread in the country?

– This is a difficult question. Usually, when people find out about their positive status, they start denying it. During the period of denial they do not understand the importance of protection. Others take avenger’s position: they think that once they are infected, they should infect others in vain. There are also HIV-dissidents, who begin to assert that there is no such virus in nature. In any case, all of them are informed on the criminal liability for deliberate infection of others. I would suggest that a person takes HIV test twice a year, without taking into consideration whether he had unprotected sex or did some irrational thing.

*AFEW International does not support mandatory testing while getting married.

Cry for Access to Treatment for People Living with HIV in Russia

The event dedicated to the Day of Remembrance of People who Died from AIDS, Moscow, May 2015

Author: Anastasia Petrova, Russia

“Medicines for the treatment of HIV, hepatitis C, and tuberculosis are provided free of charge to all needy patients in Russia.” This phrase is the first thing we see on Pereboi.ru main page – the resource where people living with HIV in Russia can tell their stories about how they were refused treatment.

Professional patients

Pereboi.ru is one of the projects of the Patient Control – a public movement whose members are people living with HIV and other socially significant diseases, as well as their supporters. The movement has existed for seven years in Russia. The initiative group, not being an organization or legal entity, has grown into a professional community of patients who have risen to defend their rights.

In addition to direct actions, activists of the Patient Control monitor government procurement of antiretroviral therapy (ART), write complaints and make appeals to public authorities. Representatives of the community also work with pharmaceutical companies: one of the main obstacles to treatment is inflated prices for medicines.

Founded in autumn 2010, the movement’s goal is to ensure effective control of the provision of high-grade medical care and the improvement of quality of life for HIV positive people. Activists say that any person sharing their views can join them. The main concern on which activists are working is the disruptions in medical supplies for people living with HIV, hepatitis and tuberculosis in Russia.

Fighting with supply disruptions

“For more than six years there have been interruptions in medical supplies for the treatment of HIV/AIDS in Russia. Life-saving medicines, that have to be taken strictly by the clock and in a certain order are partially or completely lacking in AIDS centres,” activists are saying.

This situation is interconnected with repeated changes in the system of procurement of medicines for people living with HIV. The latest change is the transition to a centralized system in 2017. Before that, the medicines in regions were bought according to special schedules, and now the Ministry of Health of the Russian Federation is the responsible party. These changes have led to the slippages in the procurement schedule and serious supply disruptions this year.

The event by the Ministry of Health of the Russian Federation, Moscow, July 2013

At the moment, supply disruptions of medicines happen almost everywhere throughout the country. People living in different regions of Russia such as Nizhny Novgorod, Norilsk, Tomsk, Kostroma write messages to pereboi.ru almost every day. Only in 2016, the activists counted appeals from more than 30 cities. These cities are also situated in such prosperous areas as Moscow, the Leningrad and Moscow regions.

Last summer the activists of Patient Control facilitated the situation with interruptions in treatment of children and pregnant women in the AIDS centre near Moscow. 30 patients signed the petition after which the Federal Service for Surveillance in Healthcare conducted an unscheduled inspection at the AIDS centre near Moscow and in the regional Ministry of Health office.

In order to avoid the following situations, activists get updated on the formation of purchases for 2018 by raising the issue at a high authority level. On August 14, 2016 there was a meeting of patients with representatives of the Federal Service for Surveillance in Health Care and the Ministry of Health of the Russian Federation. The government informed activists about the expected additional financing in the amount of 4 billion rubles this year and the planned annual increase by 1.5 billion rubles in the budget for the purchase of medicines. However, according to the representatives of the movement this is not enough to solve the problem completely.

Improving quality

Side effects from the low-quality medicines is another issue patients are talking about. Due to the strong health issues that arise in response to therapy, people often abandon the existing treatment. A short list of the issues they face includes rash, kidney problems, lipodystrophy. It is difficult to get treatment replacement afterwards if the therapy scheme was changed according to medical or pseudo medical indications, because formally the therapy is still being provided.

Day prior to the meeting of the Commission on Vital and Essential Drugs (VED) on September 4, 2017 in Moscow Patient Control representatives addressed the Minister of Health of the Russian Federation. The request was to include VED in the list of contemporary drugs in 2018 for the treatment of HIV-infection and chronic hepatitis C. Following the meeting, the Commission made a decision to add six medications, four of them were also in the activists’ list. The Commission included two medicines for HIV infection treatment: dolutegravir, raltegravir for children and two for hepatitis C: dasabuvir/ombitasvir/paritaprevir/ritonavir and daclatasvir.

Activists are also working on the ways to achieve patient feedback in cases when ART was proven ineffective or had side effects. Patients along with the physicians will now be able to fill out an online form on the Federal Service for Surveillance in Health Care. This will help to improve the quality of medication control.

Treatment as prevention

The internationally recognized principle of treatment as prevention is one of the most effective and yet most underestimated ways to prevent the spread of HIV infection in Russia. The number of HIV infections in our country keeps growing and thus patients’ collaboration is extremely important.

At the Red Ribbon Award 2012 during AIDS 2012 in Washington, USA

The Patient Control movement is one of the communities in the Eastern European and Central Asian (EECA) countries dealing at a highly professional level with access to therapy of people living with HIV. SIMONA+ project is one of Patient Control initiatives aimed at systemic problem solving. This project studies access to medical and non-medical services for people living with HIV, as well as reacts to violations of patients’ rights by direct actions, press conferences and round-table discussions. Nowadays, SIMONA+ covers more than 13 entities of the Russian Federation. Its main goal is to improve the quality of HIV treatment and diagnostics, as well as to increase adherence among the representatives of key groups. Apart from serving patients’ interests, the project tries to minimize HIV spread among the general population.

The Patient Control projects are a community response to the epidemic. These projects consider the needs of people living with HIV and facilitate cooperation between specialists working in the AIDS control field. These merits have already been recognized once: at the 19th International AIDS Conference in Washington in 2012, the Patient Control initiative group was awarded the Red Ribbon Award for outstanding work concerning the AIDS epidemic. Promotion of such initiatives is declared as one of the leading goals for the 22nd International AIDS Conference, which will take place in Amsterdam next July. Representatives of the Patient Control movement plan to submit the report on their work in 2016-2018 to AIDS 2018.

90-90-90 Strategy was Discussed in Tajikistan

Civil sector representatives together with the heads of the AIDS prevention and control centers in Tajikistan worked out practical steps for the implementation of the voluntary counselling and testing (VCT) service in the activities of public organizations. They talked about this during the meeting National strategies of expanding access to HIV testing. Response measures for the implementation of UNAIDS strategy 90-90-90. Republican public organization AFEW Tajikistan shared its successes on September 6, talking about the work of its HIV voluntary counselling and rapid testing point in Qurghonteppa.

“Thanks to this meeting, now I have a vision of how to organize a VCT office in a public organization, where to start, what documents should be prepared and what services should be consulted beforehand. This meeting with its practical exercises, in my opinion, united us with the partners. This can influence the personal growth of each participant,” the director of Tajikistan Network of Women Living with HIV in Dushanbe Tahmina Haydarova is saying.

During the meeting, 50 representatives of state, public and international organizations from Gorno-Badakhshan Autonomous Region, Khatlon and Sughd Region, and the city of Dushanbe talked about the interaction of state and public organizations in providing integrated and coordinated services to key populations in the field of HIV, TB/HIV. They also got acquainted with the main provisions of new UNAIDS strategy 90-90-90, key activities of the National Program to Counteract the HIV/AIDS Epidemic in the Republic of Tajikistan for 2017-2020, and AFEW Tajikistan experience in integrating services and introducing VCT.

The meeting National strategies of expanding access to HIV testing. Response measures for the implementation of UNAIDS strategy 90x90x90 was held within Bridging the Gaps: Health and Rights for Key Populations project that is funded by the Dutch Ministry of Foreign Affairs.