AFEW’s Intern Researches PrEP in Kazakhstan

Is Kazakhstan prepared for pre-exposure prophylaxis (PrEP)? Master student majoring in International Public Health at VU University in Amsterdam Marieke Bak was finding the answer to this question during her recent internship with AFEW International. For this reason, she spent five months in Almaty, Kazakhstan, doing her research.

“For the past five months, I have had the opportunity to do an internship at AFEW International,” says Marieke. “From the start, I felt very welcome in this inspiring organisation and it was great to experience what it is like to work for an NGO. As part of my internship, I went to Kazakhstan to explore the potential implementation of a new HIV prevention method among men who have sex with men. The interviews were incredibly interesting and I learned a lot from the people I met. Moreover, I had the opportunity to do some travelling, which made me fall in love with the region. I hope to go back there someday and I will keep following the work of AFEW with much interest.”

The global HIV/AIDS epidemic remains a major public health issue. Among the countries with the fastest accelerating incidence rates is Kazakhstan, which is characterised by a concentrated epidemic among key populations. Addressing the epidemic requires effective primary prevention, but current methods are often of limited use. PrEP is a new method of HIV prevention consisting of a daily pill combining two anti-retroviral drugs, which has been found very effective when taken consistently. Generally, men who have sex with men (MSM) are seen as the target group for PrEP. As the most developed country in Central Asia, it seems that Kazakhstan could act as a frontrunner in providing PrEP. However, in order to inform the implementation of PrEP, there is a need to understand the awareness and attitudes of MSM towards this new method.

The aim of Marieke Bak’s study was to explore the possibilities for future PrEP initiatives in Kazakhstan by investigating the potential of this prevention method among men who have sex with men. You can find the report on the study findings here.

How Kyiv Fights the HIV/AIDS Epidemic

Author: Yana Kazmirenko, Ukraine

The adoption of the Fast-Track Cities strategy resulted in launching of the HIV express-testing in all outpatient clinics in Ukraine’s capital. The strategy also allowed to increase the number of people who receive antiretroviral therapy.

The struggle against HIV/AIDS epidemic in Kyiv strengthened since the mayor Vitaliy Klitschko, signed the declaration in Paris. Apart from that, Kyiv was included into the Fast-Track Cities programme in April 2016 as a measure to fight AIDS. According to this programme, 90% of the citizens in 2020 should know about the disease, 90% of the infected ones should be getting treatment, and the treatment should be effective for 90% of the patients.

In the latest United Nations agency report on HIV/AIDS (UNAIDS) and UN-Habitat as of 2015, the Ukraine’s capital entered the list of 27 most HIV/AIDS infected cities in the world. Alexander Yurchenko, the head physician at Kyiv AIDS centre, hopes that Kyiv will not be included into the newest rating. The programme has seen first success. 800 medical workers were trained, and every outpatient clinic in Kyiv received express-tests. The result of the test is available in as little as 20 minutes. There were 2,500 more individuals (compared with the previous year) who had tested their blood in a year.

A record amount of 555 people was included into the dispensary registration with the help of express-testing only over the first quarter of 2017. To compare: only 1300 people were registered in 2016, according to Yurchenko.

In his opinion, the situation in Ukraine’s capital with a population of three million people has improved. There were only around 5,000 people getting treatment in 2012, and now there are more than 7,000. It is planned to give treatment to 12,000 people by the end of the year.

Migrants and HIV

Yurchenko attributes Kyiv’s high position in the world ratings of HIV spread due to its attractiveness for migrants. 400,000 people come to work in the capital daily.

“Men who have sex with men (MSM) also tend to come to Kyiv, as it is hard for them to even live in such regional centre as Cherkassy. They attract a lot of attention in smaller cities. In the capital, they can find work, hide themselves, and find partners,” continues the interviewee.

The prevailing factor of HIV spread in Kyiv in 2012 was an injecting way of transmission. Now the predominant way has shifted to sexual transmission.

For instance, the story of the oldest patient in the capital of Ukraine. The man admitted that his wife was refusing sexual intercourse with him and he had to use the services of sex workers.

“Doctor, now I know what I will die from,” the old patient said jokingly, after he heard his diagnosis.

“According to statistics, you will die from cardiac ischemia, but we will control and monitor your HIV,” Yurchenko remembers his dialogue with the patient.

Surviving thanks to the Foundations

Kyiv’s mayor Vitaliy Klitschko stressed that one of the main responsibilities that Kyiv took within the framework of the Fast-Track Cities programme is the provision of sufficient amount of antiretroviral medicines for treatment of people diagnosed with HIV/AIDS.

There would be significant progress in the implementation of the Fast-Track strategy if the government did not delay the supplies of medicines for antiretroviral therapy. This leads to patients receiving one month course of treatment instead of six or three months’ courses.

The variety of options in treatment schemes (around 38 of them) does not yet allow to pass the dispensing of medicines to the family doctors’ level. Yurchenko promised that there will be two or three variants of treatment made, and they will be passed on to the outpatient clinics as soon as the government supplies of medicines are in full scope.

Now patients literally survive at the expense of international and private foundations. On July 11, Kyiv has become the first Eastern European city where HIV-positive patients received dolutegravir (sixth generation medicine for antiretroviral therapy) at the expense of the Elena Pinchuk ANTI AIDS Foundation. The yearly course of medications will cost $170. This allows to increase the number of people who will receive the life-saving treatment in as early as 2018 at no additional cost.

The adoption of the law on mandatory HIV testing* can also bring the capital closer to the standards implemented by Fast-Track Cities. Alexander Yurchenko says that this law might be enacted by the end of the year.

As estimated by the experts, the number of HIV/AIDS infected people in the capital is 23,000 inhabitants. This is the tenth of the estimated figures in Ukraine – 250,000. There were 304,914 officially registered new cases of HIV infection in Ukraine since 1987. Since that time, there were 42,987 deaths from AIDS. The regions most affected with HIV infection, apart from Kyiv, are Dnipropetrovsk, Kyiv, Donetsk, Mykolayiv and Odesa regions.

*AFEW International is not aware of the law on mandatory HIV testing and will advocate against such law.

Central Asian NGOs Built a Network for Cross-Border Control of Tuberculosis

Author: Marina Maximova, Kazakhstan

During the regional seminar-meeting held on 6-7 June in Almaty, Central Asian nongovernmental organizations established a network of partner organizations to address issues of labour migration and tuberculosis. The participants accepted draft Memorandum of cooperation between non-profit organizations to reduce the prevalence and incidence of tuberculosis among migrant workers in the countries of the region.

“This document was created in response to the need of NGOs consolidation to educate migrant workers about TB symptoms and the opportunities of free treatment and diagnostics in the framework of the project, to promote treatment compliance, to exchange information and to disseminate best practices in the countries of Central Asian region,” says a project manager of the Global Fund, a representative of Project HOPE in the Republic of Kazakhstan Bakhtiyar Babamuratov.

The event was organized by the Project HOPE in the framework of the grant from Global Fund to fight AIDS, tuberculosis and malaria. Representatives of non-governmental organizations from Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan attended the seminar .

Migrants do not want to be treated

From all the countries in the Central Asian region, Kazakhstan is accommodating the main stream of migrant workers from neighbouring countries. Migration flow continues to grow. Those who come to find a job often agree to any work, they often live in poor housing conditions and do not eat well. This results in tuberculosis development. In 2016, 753 external migrants addressed the organizations of primary health care and TB facilities of Kazakhstan and were tested for tuberculosis. In 2015, there were only 157 visits. Most migrant workers prefer not to attend medical institutions and refuse to be treated in the TB clinics or to be examined by a doctor. They consider it to be a wasting of working time, i.e. money. They have to support families left at home, therefore money is the main reason to come to a foreign country. For the same reason people do not want to spend money on health, even though a Comprehensive plan to combat tuberculosis in Kazakhstan for 2014-2020 involves activities to improve TB services for migrant workers.

Particularly alarming are the cases when a migrant worker is diagnosed with HIV/TB co-infection, and when such patient needs a serious treatment and social support. This important topic will be discussed in 2018 in the framework of the 22nd international AIDS conference – AIDS 2018 – in Amsterdam. This conference will be very special as for AFEW International and the whole region where the organization works — Eastern Europe and Central Asia.

Work at construction sites and markets

In the situation mentioned above, the participation of the NGOs in addressing of this issue has become very important. Outreach workers and volunteers – people, whom the target group trusts, – are searching for migrant workers on construction sites, at the farms, markets, in the restaurants or cafes. They tell migrants about the disease and the free treatment, convince to pass the examination and to provide social support. The results of such work are impressive.

“Within the project, implemented by Project HOPE in 2016, staff and volunteers of our public Fund helped 898 migrant workers to be tested for tuberculosis. For 25 of them the diagnosis was confirmed, and with our assistance people were able to receive free treatment. Besides, we provided migrant workers with motivational food packages. 8,312 labour migrants received information about the symptoms of tuberculosis, and now they know where to go if they are sick,” says the Director of the Public Fund Taldykorgan regional Foundation of employment promotion Svetlana Saduakasova.

These are the results of the activity of only one non-governmental organization in Kazakhstan. Nowadays, social activists are effectively working in eight regions of the country. Such results are possible to achieve only thanks to active collaboration with the non-governmental organizations from those countries where work migrants come from. The community members actively communicate with each other and exchange useful information to be aware of whether the diagnosed person came back to his home city, got registered in the TB clinic, continued to receive treatment, and so on. Only under these conditions we can achieve a complete recovery from TB for each individual and finally stop the growth of morbidity in the region.

Rapid HIV Testing was Discussed in Kyiv

Psychologists, social workers, medical personnel and other employees of four social bureaus in Ukraine gathered for the three-day training Conducting Voluntary Counselling and Testing on HIV with Rapid Tests that AFEW-Ukraine conducted on June 7-9.

“This training was useful because we had a closer look at the regulatory framework in the field of HIV testing, in particular in the work with minors because this procedure always caused many questions,” says Alina, the social worker from Kharkiv. “Besides, it was useful to get the information about personal and professional risks of HIV infection, what to do if such situation happens, and now everything is clear. The session of practical training in the development of pre- and post-test counselling skills has been a pleasure for me. The trainers showed what mistakes a counselor can make during counselling and how to avoid them.”

The aim of the training was to provide the participants with the knowledge and skills on the methodology of counselling related to HIV testing with rapid tests. During three days, the trainers focused on the overview of the HIV epidemic in the world and in Ukraine, aetiology, epidemiology, diagnostics, ways of HIV transmission. Stigma and discrimination, the impact of stigma on the epidemic, legal framework of HIV/AIDS, key elements of ethical and effective HIV counselling practices, pre- and post-test counselling were also discussed during the training.

The training was held within the framework of the project ‘Bridging the Gaps: Health and Rights for Key Populations’ with the financial support of Dutch Ministry of Foreign Affairs. In August, AFEW-Ukraine plans to hold a coordination meeting for regional partners to plan the next ‘Bridging the Gaps’ project year.

Harm Reduction: Redirection of Resources Needed

Why do we need action?

Harm reduction is an evidence-based and cost-effective approach to drug policy and practice that is about keeping people who use drugs, their families and communities safe and healthy.

Harm reduction is about saving lives and it works!

Yet many countries still do not provide harm reduction services. According to UNAIDS, between 2010 and 2014 only 3.3% of HIV prevention funds went to programmes for people who inject drugs.

Why now?

Harm Reduction International’s data shows that since 2014, no new countries have established needle and syringe programmes (NSP) and just three have introduced opioid substitution therapy (OST). Of 158 countries where injecting drug use is reported, over half (78) do not offer OST and more than a third (68) still do not provide NSP. In 2015, a UN target to halve HIV transmission among people who inject drugs by 2015 was missed by more than 80%.

These figures are a call to action.

By contrast, each year governments spend over $100 billion on drug control strategies that have little effect on demand for drugs or on those who profit from the drug trade. At the UN General Assembly Special Session on Drugs in 2016, governments showed a new willingness to rethink these approaches. But now they must rebalance their spending.

What are we calling for?

We are calling on governments to redirect 10% of the resources currently spent on ineffective punitive responses to drugs and invest it in harm reduction by 2020.

What we will this achieve?

Even this small redirection of funding could achieve big results.

A 10% redirection of funding from drug control to harm reduction by 2020 would:

  • End AIDS among people who inject drugs by 2030.
  • Cover annual hepatitis C prevention need for people who inject drugs. Globally. Twice over.
  • Pay for enough naloxone to save thousands upon thousands of lives every year from opiate overdose.
  • Ensure effective advice, healthcare and emergency responses in the face of newly emerging challenges.
  • Strengthen networks of people who use drugs to provide peer services and campaign for their rights.
What will happen if we don’t act now?

If the adoption of harm reduction in new countries continues at the current pace, it will be 2026 before every country in need has even one or two harm reduction programmes. In the meantime, thousands, if not millions, of lives will be lost.

Source: Harm Reduction International

‘Building a Healthy Future Together’ – AFEW Releases its 2016 Annual Report

AFEW International releases its 2016 Annual Report ‘Building a Healthy Future Together.’ The report highlights AFEW Network’s key activities in the region of Eastern Europe and Central Asia (EECA).

“Now more than ever, key at-risk populations need increased access to health services to combat the three epidemics of HIV, TB and viral hepatitis, something that was highlighted last year in the new World Health Organisation global health sector strategies on HIV and on viral hepatitis,” said Anke van Dam, executive director of AFEW. “Eastern Europe and Central Asia is the only region in the world where new infections of HIV are still on the rise, and where multi-drug resistant TB and viral hepatitis cases, also as co-infection with HIV are so highly prevalent.”

On the road to the 2018 International AIDS Conference that will be held in Amsterdam, last year AFEW International started to engage representatives at all levels to ensure that the relevant issues, successes and challenges from EECA are addressed at AIDS2018.

“With AIDS2018 and through all of our projects detailed in this report, AFEW International continues to contribute to a healthy future for the people of EECA,” says Anke van Dam.

The English version of our Annual Report is available here (download PDF.) The Russian version of the Report can be read here (download PDF.)

The Photo Exhibition ‘Life in the Shadow’ was Shown in the Netherlands

Author: Olesya Kravchuk, AFEW International

Last week the photo exhibition ‘Life in the Shadow’ was brought to the Netherlands by public Foundation ‘AIDS Foundation East-West in Kazakhstan.’ It was possible to see the images of people affected by HIV and tuberculosis during Wolfheze workshops in the Hague on 31 May – 2 June.

The main goal of the exhibition is to reduce stigma and discrimination against people with HIV and tuberculosis.

“We were very lucky with the opportunity to bring the exhibition to the Netherlands and show it to the bigger number of people,” the project manager of AFEW Kazakhstan Kristina Zhorayeva is saying. “Our models were very brave to show their faces and share their personal stories. They wanted to tell people that they are not different and they also have dreams and hopes.”

At the end of March the photo exhibition ‘Life in the Shadow’ was shown in Almaty, Kazakhstan. Some people from Kazakhstan saw the images for the first time in the Netherlands though.

“I have heard about this exhibition from AFEW, and today I saw it in the Netherlands even though it was displayed in my native Almaty,” the head doctor of one of the private clinics of Almaty Galiya Tulebayeva is smiling. “I look at these pictures of the patients with pleasure. It is great to see that there are smiles on their faces and they are in positive mood.”

As of February 2017, in Kazakhstan there were registered 29,568 HIV cases. According to the official data, in 2016 there were 14,345 tuberculosis patients registered in the country.

Visitors reviews of the photo exhibition ‘Life in the Shadow’

Jamshid Gadoev, WHO Country Office for Combating Tuberculosis, Hepatitis and HIV-AIDS in Uzbekistan:

– Only brave people can show themselves in such a way. They got sick and went through the processes that other people are going through now and do not hesitate to show all of this. On each photo I see a smile. Probably, they are happy with their treatment and are glad that they were rescued. They seem to be happy with their lives.

We also published a book and made a video about what tuberculosis patients feel before, during and after their treatment. We asked our patients to associate tuberculosis with some color, and children were asked to associate it with color and with the animal. Many people said that the disease for them is associated with red, yellow or black. Children usually said that their illness is a red teddy bear. Adults told that for them tuberculosis is black and is associated with the sound of a trumpet. After treatment, these associations often change and colors become brighter.

Alexei Bobrik, WHO technical specialist on HIV, tuberculosis and hepatitis, WHO Country Office, Ukraine:

– To overcome the burden of these diseases, it is necessary to talk about this problem so that the population knows about it, and the negative attitude towards the diseases decreases with time. It is necessary to communicate information, so that there is no stigma and discrimination. We must know that normal people are vulnerable to these serious diseases as well.

AFEW Kazakhstan Helps People Getting out of the Shadows

Author: Olesya Kravchuk, AFEW International

29,568 HIV cases were registered in Kazakhstan as of February 2017. According to the official data, in 2016 there were14,345 tuberculosis patients registered in the country. Usually, these people hide themselves, and are often afraid even to tell their relatives about their diagnosis. But there are also those who openly talk about their status, and who show that it is possible to get out of the shadow.

At the end of March, the photo exhibition ‘Life in the Shadow’ dedicated to the World Tuberculosis Day took place in Almaty. AIDS Foundation East-West in Kazakhstan organized this event. The exhibition featured photos of people affected by HIV and tuberculosis. Today we will tell the stories of some of them.

LEARN TO LOVE YOURSELF

After the death of her mother in 2008, Venera started to lose weight. The woman thought it was because of the grief she was experiencing, but still went to the hospital for the X-rays and medical tests. There it was discovered that Venera had an open form of tuberculosis.

Venera realized that it does not matter what your position in the society is, the tuberculosis makes everyone equal

“By that time, I was very weak and all the time felt sick in my stomach. I weighed 48 kilograms,” says Venera. “During three months I was out there with an open form of tuberculosis until they accepted me in the hospital. All I wanted at that time was to lie down and die! I was in darkness, alone, rejected by everyone. I did not believe that I would get out of that hospital alive. All the time I was sick because of the pills. My son and my sister, who, after my mother’s death, was taken to an orphanage, as I did not have time to register custody, were the only people who kept me alive. They called me, told me they needed me, asked not to die. It was the strongest motivation to live! After some time, I started to feel better and began recovering.”

A year later, Venera was diagnosed with tuberculosis and lung disintegration. At that time, the woman was pregnant. Since no one told her that during the pregnancy tuberculosis can be treated, Venera was advised to have an abortion.

“In the hospital they gave me the bed that was standing in the hallway, and soon the whole department knew I had tuberculosis,” Venera recalls. “People were scared of me. The gynaecologist was commenting something like, why people like me are even allowed to give births at all. That was such a humiliation!”

After she got out of the hospital, Venera realized that it does not matter what your position in the society is, the tuberculosis makes everyone equal. The woman became stronger and kinder, started to pay more attention to her relatives, helped those who needed help. Three years later, Venera gave birth to the healthy twins.

“I defeated tuberculosis. If you have such diagnosis, do not be not afraid and believe that you will recover!” says Venera. “Do not be scared of anyone, this is not a disgrace. Most importantly – do not refuse the treatment, otherwise you can infect your relatives and friends. Learn to love yourself!”

A DECISION TO LIVE

To those who only got to know about their diagnosis, Salavat advises to be strong and take care about their health

Salavat has been living with HIV since 2011. The man has heard something about this disease, but did not have a clear understanding of it. He thought it was somewhere far away, not here, and he could not even imagine that he could get infected.

“The doctor was calming me down, saying that people live with it, that it is not fatal, that in the future there probably will be a medicine… At first, of course, I felt bad, but I quickly overcame my fears,” Salavat says. “I made a decision to live. Now I know a lot about HIV. I am confident that I can work, and I am able to live. I know that we are the same people as everybody else, we are not infectious.”

To those who only got to know about their diagnosis, Salavat advises to be strong and take care about their health. It is very important to enjoy life, to share joy, and not to lapse into a cocoon of self-isolation.

ACCEPTING THE DIAGNOSIS

Oksana learned that she was HIV positive in the rehabilitation centre for drug addiction.

The acceptance of her diagnosis benefited Oksana’s professional and personal development

“It was scary, somehow I made myself believe that I had only five years left to live and I have to fill my last years with fun and unforgettable experience!” Oksana is saying. “Before my diagnosis, I thought that HIV is something that is far away and it is impossible to get it in Kazakhstan.”

At that time, the woman needed support, and she got it from her family. The first one who learned about her diagnosis was Oksana’s sister.

“Later I asked her what she felt when she found out that I was HIV positive,” Oksana remembers. “Surprisingly enough, most of all she was worried about me, because the first thing I could convince her in was that I had only five years to live. About three years later, I accepted my diagnosis. I realized that I am not dying, and started to learn how to live with HIV.”

The acceptance of the diagnosis did not only benefit Oksana’s professional development, but also her personal development.

“I am happy to be busy with my favourite things, I am with a person I love and my family is very friendly. I learned how to live with HIV. You just need take more care about your health and love life!” Oksana resumes.

TO BELIEVE IN RECOVERY

After being diagnosed, Sultanamurat started to appreciate life more

The only thing Sultanmurat knew about tuberculosis was that it is a dangerous disease. When he heard his diagnosis, he became horrified.

“I experienced haemoptysis. It was scary, but I did not even suspect that it could be tuberculosis. I thought that I had some problems with my internal organs,” recalls Sultanmurat. “I really wanted to be cured, but the treatment was going very difficult. In the beginning, I did not tolerate the medicine and developed allergies. I was fighting with myself, tried not to miss a single day of taking medications and injections. Now I feel much better.”

After being diagnosed, Sultanamurat started to appreciate life more, treated people who are ill with better understanding, began to appreciate and love his relatives even more.

“I would like to tell those who are diagnosed with tuberculosis that this disease is curable, like many other diseases. The main thing is to follow the regime in everything, do not miss taking pills and eat well, move and do sports, be friendly,” Sultanmurat says. “The most important thing is to believe in the best, that is, in your recovery.”

Join AFEW at Harm Reduction International Conference in Montréal

AFEW International is taking part in 25th Harm Reduction International Conference that will take place in Montréal, Canada next week. AFEW’s executive director Anke van Dam and program director Janine Wildschut will take part in the side event on harm reduction.

The side event ‘Future Proofing Harm Reduction’ is supported by the Dutch Funded Harm Reduction Programs – Bridging the Gaps, PITCH and the Alliance Integrated Harm Reduction Programme (AIHRP). These three alliances are represented by Aidsfonds, International HIV/AIDS Alliance, International Network of People Who Use Drugs, AFEW International, and the Mainline Foundation. The side event will take place on Monday, 15th May, 2-3.30 pm at Mansfield II, Entry hall, Centre Mont-Royal.

AFEW will be represented by the talk by AFEW International’s program director Janine Wildschut with the talk ‘Shrinking space for civil society in the EECA region’ and AFEW Kyrgyzstan’s director Natalya Shumskaya who will talk about women who use drugs in Kyrgyzstan. More detailed program of the side event can be found here.

Harm reduction goes much further than HIV prevention, and contributes significantly to the quality of life of people who use drugs and to the realization of the Sustainable Development Goals (SDG). This side event, moderated by the Dutch Ambassador for Sexual and Reproductive Health and Rights and HIV/AIDS Lambert Grijns, will share examples from the variety of grassroots harm reduction projects currently funded by the Netherlands. Current challenges in harm reduction funding beyond HIV and framing programmes within the context of the SDGs will be discussed.

The theme of this year’s Harm Reduction International Conference is ‘At the Heart of the Response’, and the programme includes presentations, panels, workshops and dialogue space sessions on innovative harm reduction services, new or ground-breaking research, effective or successful advocacy campaigns and key policy discussions or debates.

Communities will be Educated how to Analyse Data and how to Act

Two new modules for the program community-based participant research CBPR [e] Education that is supporting and strengthening the research capacity of organizations acting on behalf of and representing the interests of communities in Eastern Europe and Central Asia (EECA) are released online today.

The program consists of the number of activities, including training for community-based participatory research, small grants program, workshop on dissemination and abstract writing and workshop on presenting research findings on AIDS2018 Conference.

AFEW International gives program participants the opportunity to take part in online e-learning modules for further development of their research skills. The modules are also available for others who are interested in community-based participatory research. Course that costs 75 euros, includes 7 modules on the preparation and conduct of community-based participatory research.

The first module announced today is Data Analysis. Analyzing data is necessary to make sense of the outcomes of the study and to answer the research questions. Analyzing data will help working towards a way of representing the data to a larger public.

The second module is called Bringing about social change: translating knowledge into action. After the data is collected and analyzed, the participant is ready to write the reports and to disseminate the results to others. It is the time now to determine how the participant can bring social change that will benefit the community. The evaluation of the research will be also discussed in this module.

Later on, everyone will be able to participate in the webinar on data analysis, which will be held in late spring or summer of 2017.