AIDS 2018: Ukraine is Looking for Expertise and Technologies

Author: Yana Kazmirenko, Ukraine

At AIDS 2018 to be held in Amsterdam, Ukraine will be the focus of attention. It is one of the leading countries in terms of HIV transmission, with half of people living with HIV not knowing their status and the war in the east of the country combined with hundreds of thousands of migrants contributing to the aggravation of the situation with HIV. Our article highlights what expectations representatives of Ukraine have from AIDS 2018 and what experiences they are ready to share.

Olena Voskresenska, Director of AFEW-Ukraine

Expectations from AIDS 2018

I hope that the conference will help to draw attention to the region of Eastern Europe and Central Asia, in particular to Ukraine. Our country is interested in the experience of countries, which have a social contracting mechanism for non-governmental organisations because NGOs currently play a key role in the delivery of services to the populations most vulnerable to HIV and the support that comes from the governmental budget to these services will be most relevant for Ukraine after withdrawal of the Global Fund.

Opportunities of the conference

AFEW-Ukraine plans to learn about the promising models of work with our target populations, primarily aimed at young people. We are going to share our experience of working with adolescents who use drugs.

This year we have been able to support our partners from the regions of Ukraine, including programme clients and community members, who will take part in the conference. Using the experience of other countries, through joint efforts we will improve our activities in Ukraine.

Vira Varyga, Chair of the Board of Positive Women NGO, leader of the self-help group for HIV-positive women, Kyianka+

Expectations from AIDS 2018

This will be my first time to participate in a conference of such level. We will share the experience of the self-help group for HIV-positive women, Kyianka+, where we provide services to women living with HIV, helping them to accept their status and overcome stigma.

The model that we apply is patented in the Netherlands. It is based on personal development and leadership. The woman not only accepts her own status, she also helps others and is involved in the life of the group, in the advocacy and representation of the community interests.

Opportunities of the conference

We would like to learn about the new methods of work with women, about prevention, treatment and diagnostics. We hope that the participants will appreciate our social theatre, where the mime performance and direction are the products of creative activities of the Kyianka+ members.

At the conference, we will also offer some hand-made items produced by our activists for sale. The money we earn will be used to support the women who are hospitalized and do not have resources to pay for their treatment.

Nataliia Isaieva, Director of All-Ukrainian Charitable Organization, Legalife-Ukraine

Expectations from AIDS 2018

Taking part in the Amsterdam conference, I plan to achieve two goals: first, study the experience of countries from which the Global Fund has withdrawn. In Ukraine, there is an alarming trend: the Global Fund withdrawal leads to the collapse of the health care system to vulnerable populations’ support. For instance, we lack friendly gynaecologists. Sex workers cannot go to public clinics as they hide vital information about their occupation and therefore they will not receive adequate treatment.

The second question, which is very important for us, are the increased restrictions of working conditions. Commercial sex services and human trafficking are more and more undesirable linked with each other and this often is leading to serious consequences for the sex-workers. USA adopted SESTA-FOSTA legislation, which intends to curb sex trafficking but has as a consequence that it prohibits offering sex services via internet. Such laws make it impossible for sex workers to look for their clients online so they are forced to go back on the streets, risking their lives and health. The “crackdown” trend is typical not only for the United States, so we need to offer a joint strategy to confront such “crackdown” policies.

Igor Medvid, HPLGBT coordinator, involved in social activism since 2004

Expectations from AIDS 2018

At the conference in Amsterdam, I will present a thesis based on the findings of “The study of behaviours of transgender persons and their needs for HIV prevention services in Ukraine.” We interviewed 438 people and currently, it is the biggest study in Eastern Europe and Central Asia. The study showed that the HIV prevalence among transgender persons is up to 21%. 91% of transgender persons provided sex services at least once. At the same time, the level of condom use is extremely low – 69% of respondents did not use condoms during the last intercourse. This study allowed us getting statistical data and receiving a Global Fund grant. Without the support of AFEW we would not be able to conduct the study.

Now we are opening a regional office, launching a site, making efforts to increase the visibility of transgender people. Before the end of this year, we would like to introduce a member of our population to the Country Coordinating Mechanism.

Another objective that I have for the conference is to learn as much as I can about the cross-cutting activities because transgender people fall into three groups: MSM, sex workers, and people who inject drugs.

Aleksandr Mogylka, Director of the Compas day care centre for adolescents who practise risky behaviours (division of the Blago Kharkiv Charitable Foundation)

AIDS 2018 is…

…a global-scale event, which can be compared to the major film festivals, air and motor shows. The only difference is that at the conference apart from successes and achievements we will also be talking about the ways to overcome challenges. It is good to watch films, drive cars and feel proud of the achievements in aircraft or spacecraft engineering when you are healthy.

The problem of HIV/AIDS may not be resolved only by fighting the virus. It may be resolved by changing the attitude to this issue and by changing people’s attitudes to themselves. Many countries have already taken such steps and reduced the risk of development of the epidemic.

Opportunities of the conference

We would like to learn about the best practices in fighting HIV and to share the experience of our organization in involving law enforcement agencies in HIV prevention among most-at-risk adolescents.

A police reform has been implemented in Ukraine and adolescents now see the police as something new and interesting. Our objective was to unite the resources of NGOs and police to prevent the use of drugs, which often lead to experiments in sexual relations. Building trust relations between adolescents and police contributed to the formation of a city mechanism to refer adolescents to the network of partner organizations formed at the initiative of the Foundation.

Unconventional formats of cooperation between the police and civil society organizations can help to change the behaviours of adolescents.

Natalia Bezeleva, Executive Director, Svitanok Donetsk Charitable Organization

AIDS 2018 is…

…an opportunity to show yourself to the world and access the best international practices. In 2010, Svitanok received the Red Ribbon Award, which is the Oscar of health care. We received it for our work with children. The award was given to us at the opening of the conference when Bill Clinton delivered his speech and the singer Annie Lennox presented her foundation. It was a great success both for our organization and for Ukraine.

Expectations from the conference

At the conference, people will be asking me questions about the situation in the east of Ukraine. We have a lot to be proud of: in two years, we restored the ruined laboratories, AIDS centre and services. For the first time ever, a regional HIV/AIDS and tuberculosis programme was adopted and funded. Now we also have a roadmap for the transition period, when donors will withdraw from the country and all services will be funded by the government.

As a social worker and an internally displaced person, I am interested in the topic of gender in terms of what impact the situation of women has on the epidemic of HIV/AIDS.

A Drug-Free Life: how Methadone Changed the Life of a Former Drug User from Tajikistan

Author: Nargis Khamrabaeva, Tajikistan

Methadone substitution therapy for drug dependent people has been used for many years, but so far there are both supporters and opponents of this method. 40-year-old Karim from Tajikistan shared how he personally benefited from the substitution therapy.

Heroin for breakfast, lunch and dinner

Karim started taking drugs when he was 20. At first, it was hashish and weed smoking with friends from time to time. He was 34 when one of his friends handed him a stronger cigarette with hashish and heroin mix.

“I thought, well, it is okay, in this life you have to try everything. A couple of days later I started feeling not very well. It seemed like flu, and back then I did not know that those were the withdrawal symptoms,” Karim is saying.

Karim did not manage to cope with the terrible feeling that people who use drugs get when the whole body aches and pains, there are chills, nausea and weakness. He had to buy a dose, then another one. As a result, he became seriously hooked on heroin. Heroin was for breakfast, lunch and dinner. Karim’s was thinking only about how to get another dose.

At times he would listen to his mother and wife and go to the narcology clinic to get treatment but without any success. He went to work far away, to Russia. Karim did not manage to make money but got addicted to drugs even more. Moving to another place did not help either. The wife left with the children on the condition that she would return when her husband coped with the addiction. Nevertheless, even this did not motivate Karim to knock the habit.

“Of course, I wanted to kick the drug addiction, because I realized that if the situation continued, I would lose my family. But quitting heroin is not easy, you need to harness all your willpower to do it, and not give up. I did not want to suffer. I would last a day or two, and everything began anew,” Karim says.

AFEW helped with methadone

In 2015, Karim heard that AFEW-Tajikistan helps drug users to cope with this craving with methadone substitution therapy. At first, Karim did not believe that something else could help but decided to use this opportunity.

“I went to the organization, received a referral to treatment and started taking strictly defined doses of methadone under the supervision of a doctor. By the way, I did not receive it in the form of injections but got it as a syrup instead. Over the period of three years, the dose of methadone was gradually reduced. Methadone helps to get off the needle and not spread HIV and hepatitis via a common syringe,” he says.

According to Karim, he no longer experiences withdrawal symptoms and hopes that the complete denial of drugs is around the corner.

“Now I am leading a normal life, my wife and four children are back with me,” Karim is saying.

Mikhail Golichenko: “HIV Epidemic in Russia is an Epidemic of Powerlessness”

Mikhail Golichenko is a lawyer and Senior Policy Analyst at the Canadian HIV/AIDS Legal Network

Author: Anastasia Petrova, Russia

We discussed the human rights issues in the context of HIV in Russia with Mikhail Golichenko. Mikhail Golichenko is a lawyer and Senior Policy Analyst at the Canadian HIV/AIDS Legal Network — organization, which has a special consultative status at the United Nations Economic and Social Council. Previously, Mikhail was a Legal Officer with the UNODC Country Office in Moscow. His work is focused on the promotion of human rights and addressing legal barriers to accessing health rights and effective HIV/AIDS prevention and care programs for prisoners and people who inject drugs. He holds a Candidate of Sciences degree (PhD equivalent) in Law.

– The International AIDS Candlelight Memorial Day was marked recently. What is this day about for you?

– It is a good occasion to reflect on the victims of HIV and at the same time think about our role in making sure that people who died of this disease did not die in vain.

In Tolyatti, in 2012, if I am not mistaken, on this day people traditionally went to a park, they handed out condoms, HIV awareness-raising materials, lit candles. It was all happening near the monument to the glorious heroes of the Great Patriotic War. Tolyatti is a small city and there are not many locations to hold public campaigns. It happened that during the campaign the bowl with condoms was put near the eternal fire and this fact was misinterpreted by mass media. As a result, the campaign organizers were fined for holding a mass event in close vicinity to the monument to the Great Patriotic War heroes. That is a local law in Tolyatti.

It shows that we are on different sides of the processes: the society is aware of the problem and the state doing nothing to start considering this problem from the right perspective.

Could you please tell us about the human rights situation in Russia and its implications for the HIV epidemic?

The key factor in the development of HIV epidemic in Russia is human rights violations, which make certain populations more vulnerable to HIV. People who use drugs, sex workers, men who have sex with men (MSM), transgender persons and migrants do not have access to adequate prevention, care and support for HIV and other socially significant diseases.

Rights are the social clothes of a modern person. They are represented by the laws imposing obligations on the state. The set of human rights keeps people warm and protects them from any aggressive impacts of the social environment. Some populations, such as people who use drugs, had part of their clothes removed. So, in fact, these people have to stay naked when it is minus forty degrees Celsius outside. Of course, they get sick. We should not cherish any illusions: even if we have sterile needles and syringes on every street corner tomorrow, it will surely improve the situation, but not much. We will still have repressions, persecution of people who use drugs, which prevent people from seeking health services.

There is a similar situation with sex workers. They know that they should use condoms. However, they know that if they get beaten up by a client who insists on having sex without a condom, nobody will protect them. Police will, first of all, blame the sex worker for being involved in sex work. Sometimes it is easier not to use condoms hoping not to get infected than being beaten up knowing that it makes no sense to seek protection in the police.

As for MSM, it is the same. Now the website PARNI-PLUS, which published information on HIV prevention among men who have sex with men, has been closed. There are almost no similar sources of information in Russia. Where will people who live with their sexual identities take this information? Their vulnerability and stigma will grow. There is a direct linkage. HIV epidemic in Russia is an epidemic of powerlessness.

– Could you tell about your speech in the Committee on the Rights of Persons with Disabilities? After it, a recommendation was made to revise the approach to the drug policy in Russia…

– There have already been many such recommendations. The Committee on Economic, Social and Cultural Rights, then the Human Rights Committee, the Committee on Women’s Rights, the Committee on the Rights of Persons with Disabilities, now there will be the Committee Against Torture. The committees realize that the drug policy in Russia is one of the drivers of systematic violations and issue those recommendations.

In my opinion, the main recommendation was given in October 2017, when the Committee on Economic, Social and Cultural Rights recommended Russia to decriminalize drug possession with no intent to distribute. The same goes for scaling up harm reduction services, legalizing substitution treatment, distributing truthful information on drugs, preventing overdoses, implementing substitution treatment for pregnant women, stopping tortures of drug users in police, in particular discontinuing the practice of using withdrawal syndrome to get evidence from detainees. Russia does not really follow all those recommendations, but the constant pressure will gradually give its results.

Our main tool is the attempt to involve government authorities in a dialogue so that people feel a certain need to introduce some changes. There is a set of clear recommendations, which are to be followed. It will certainly work. Where human rights are violated, there is no sustainability, there is a space for internal conflict, and there is no development.

What measures, in your opinion, does Russia need to take to stop the HIV epidemic?

We just need to remember that we are people. No laws are needed. There is a Constitution and it is enough. Safe coexistence is a value without which we cannot live. It is possible only with love, mutual understanding and help.

The needs of women living with HIV/AIDS in the Kyrgyz Republic

Community-based participatory research report “The needs of women living with HIV/AIDS in the Kyrgyz Republic”

Women and girls with HIV infection are culturally, socially, biologically and economically more vulnerable than men. The lack of reliable statistics, misconceptions about HIV transmission routes, stigma and discrimination on the part of society lead to the fact that HIV-positive women face many problems.

For several years in the Kyrgyz Republic, there has been a trend towards increased sexual transmission of HIV. The most vulnerable groups, along with injecting drug users (IDU), are women. HIV infection affects a whole range of problems – psychological, social and spiritual. Women, living in the conditions of “traditional culture”, are in a more difficult situation; gender inequality, which exists in the initial ethno-cultural environment, strengthens their social and economic problems. Women in particular, whose HIV status creates obstacles for the realization of basic needs, are particularly vulnerable in this regard, and therefore it has a negative impact on their quality of life. At present, services for HIV positive people (HPP) in the Kyrgyz Republic are universal, not taking into account the gender, which often limits access to legal, social, psychological and medical support for women living with HIV (WLH).

Despite the urgency of the problem, in the Kyrgyz Republic there was no systematic study conducted to reveal the needs of WLH, identifying factors that affect the quality of their lives and the barriers to obtaining services.

Read the research here.

EECA Success on the Road to AIDS 2018

Author: Olesya Kravchuk, AFEW International

The total of 603 abstracts from Eastern Europe and Central Asia (EECA) were submitted to 22nd International AIDS Conference AIDS 2018 to be held in July in Amsterdam, the Netherlands. 182 abstracts out of them were selected for the abstract book, posters and oral presentations.

These results were achieved with the support of AFEW International, Dutch Ministry of Foreign Affairs and in partnership with EECA regional networks EHRA, ECOM, ECUO and GNP+.

“It is a great success, and we can see that especially by comparing it with the previous AIDS conferences. In comparison to the AIDS 2016 Conference that took place in Durban, South Africa, the amount of submitted abstract has more than tripled, and the number of accepted abstracts has increased by almost six times,” says AFEW International Project Manager of AIDS 2018 EECA Daria Alexeeva. “124 abstracts were submitted to AIDS 2016, and 31 were accepted. The acceptance rate has increased this year as well – 31% against 25%.”

The special group of 25 EECA organizations whom AFEW International supported with on- and offline training program on community-based participatory research and funded their local community-based researches, has shown even greater results. Eight of the abstracts that were developed based on their researches were accepted. 13 scholarships were awarded.

Besides, a special EECA communities networking zone was secured at the Global Village of the Conference. Challenges and successes of the region will be featured there. EECA regional networks and community organisations will use the zone to jointly advocate for financial sustainability for the AIDS response in the EECA region, vanishing legal barriers for effective prevention programs and increasing meaningful participation of the communities in decision and policy making.

EECAAC 2018: Treatment or Epidemic

The problems of EECA were discussed at the VI Eastern Europe and Central Asia AIDS Conference in Moscow on 8 – 20 April 2018

Author: Anastasia Petrova

Russia accounts for two-thirds of the new HIV cases in Europe and Central Asia. This is what the UNAIDS data show. One of the key factors contributing to the further spread of the epidemic is low treatment coverage: only one-third of people who need treatment get it. This fact, as well as other problems of the region, were discussed at the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) held in Moscow on 8 – 20 April 2018.

“What should be done to make sure that every HIV positive person has access to high-quality modern treatment from the day he is diagnosed with HIV in any place of our huge country? Maybe we should all – activists, business, government – honestly recognize that the AIDS war is lost, should join our efforts and reconsider where we are and where we go,” said Aleksandr Chebin, the activist of the Patient Control Movement, Yekaterinburg.

Patients demand treatment

“A special program was adopted in Russia to prevent the spread of the virus in the country, which allowed significantly increasing HIV/AIDS patients’ coverage with treatment services,” told Olga Golodets, Deputy Prime Minister of the Russian Federation at the EECAAC 2018 opening ceremony. However, experts say that the measures taken are not enough.

According to Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre, only 35.5% of people living with HIV in Russia receive treatment. Even those who are registered in HIV care are not guaranteed treatment. In early 2018, fifteen regions of the country have reported stock-outs of antiretrovirals (ARVs).

On activists’ of the Patient Control Movement made attempts to voice this message at the opening ceremony T-shirts there was a message STOP, STOCK-OUTS!

Activists of the Patient Control Movement made attempts to voice this message at the opening ceremony. During the speech of Olga Golodets, people present at the ceremony stood up and took their coats off. Red letters on their snow-white T-shirts read STOP, STOCK-OUTS! This silent protest was a way for the patients to express their indignation with access to treatment in the country.

“Fight with HIV is a joint fight, which includes civil society and the volunteers who are now standing in front of us,” said the public official about the protest.

Disease of the system

According to experts from the International Treatment Preparedness Coalition in EECA (ITPCru), stock-outs are a systematic problem in Russia.

“The Ministry of Health announces tenders too late, and then the suppliers fail to supply drugs to the regions in time,” said Natalia Yegorova, Monitoring and Advocacy Officer, ITPCru.

Svetlana Prosvirina representing SIMONA+ project mentioned that according to the survey held by the patients’ community, 50% of patients of the AIDS centres faced problems when receiving their antiretroviral therapy (ART), such as stock-outs and frequent changes of treatment regimens.

“Apart from the stock-outs, we also identified other barriers in access to the health services: location of the AIDS centres, queues, long list of medical examinations to be completed before ART initiation (which is a significant barrier for injecting drug users), long-term before treatment start – 1 to 3 months, and health care system-related problems, such as stock-outs of ARV drugs and diagnostic tools,” told Svetlana.

Tim Martino, Deputy Director of UNAIDS called Russia to adopt the international ‘test and treat’ strategy. This approach stipulates treatment initiation not waiting for the immune status going down. Such strategy proved effective in the African states. However, it is still ignored in Russia.

Vinay P. Saldanha, UNAIDS Regional Director for Eastern Europe & Central Asia explained that to cover all patients with treatment the price of a yearly course per patient should not exceed USD 100

Timofey Nizhegorodtsev, expert of the Russian Federal Antimonopoly Service delivered a speech at the session “Strategies to Enhance Access to ARVT and Drugs to Treat Comorbidities in the EECA in the Light of Current State of Affairs.”

“Currently, a draft law on public health is prepared, which will allow local producers to manufacture the required drugs at affordable prices,” he said

Price reduction is the key

Only a sharp price reduction will make it possible to provide all people in need with treatment in the country, experts say. Vinay P. Saldanha, UNAIDS Regional Director for Eastern Europe & Central Asia explained that to cover all patients with treatment the price of a yearly course per patient should not exceed USD 100.

“Only in this case, the Russian Federation has a chance to achieve the 90-90-90 targets and meet the commitment to end the HIV epidemic by 2030,” pointed out Mr. Saldanha.

The key results of EECAAC 2018, as well as the actions to be taken, are included to the Final Statement of the VI Conference. The document is currently to be adopted by the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor) and will be published before the end of April.

EECAAC 2018: in Search of Optimism

Peter Reiss, Local Co-Chair of the 22nd International AIDS Conference (AIDS 2018), Professor of Medicine at the Academic Medical Centre (AMC) in Amsterdam, the Netherlands

Author: Marina Maximova, Kazakhstan

While the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) was going on in Moscow, Svetlana (the name was changed), a 28-year-old woman living in Karaganda, Kazakhstan became a mother for the first time. It seems that these events are not related at all. However, these two facts were brought together not accidentally. At the international forum, scientists, medical professionals, policy-makers, public officials, international experts and civil society activists argued and discussed how to curb the HIV epidemic and achieve the ambitious 90-90-90 UNAIDS targets. Meanwhile, they were not particularly optimistic. At the same time, a woman living with HIV for eight years gave birth to healthy twins. Maybe it is a sign that we should not give up hope?

Optimists and pessimists together

The question of HIV vaccine has become proverbial. For many years, the best scientific minds of the world have been struggling to invent it. There is no consensus among scientists about the feasibility of a panacea for HIV – the discovery of a vaccine.

Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre honestly says that he is pessimistic about it.

“Personally, I think that it is not possible. There are infectious diseases, to which people naturally become immune after they recover from them. HIV is more like malaria, which does not belong to this category. However, I would be very happy to see such vaccine discovered,” says Dr. Pokrovskiy.

Salim Abdool Karim, Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), vice versa, says that he has never been as optimistic about the HIV vaccine as today.

“A study on the production of HIV antibodies is already in progress. In South Africa, there is a woman, whose antibodies kill about 87% of all known modifications of the virus. We take her antibodies and test their efficiency in HIV prevention,” tells the scientist.

This positive attitude is also shared by Peter Reiss, Local Co-Chair of the 22nd International AIDS Conference (AIDS 2018), Professor of Medicine at the Academic Medical Centre (AMC) in Amsterdam, the Netherlands. He points out that HIV vaccine trials successfully started in Thailand several years ago. Currently, research is going on and the preliminary data are promising. However, this work takes a long time.

Prolonged ART gives a hope for tomorrow

At EECAAC 2018, the leading world scientists shared information about the development of two ARV drugs with prolonged effect

At EECAAC 2018, the leading world scientists shared information about the development of two ARV drugs with prolonged effect. It means that people living with HIV will be able to substitute daily pills with periodic injections. It is much more convenient. Currently, two major research studies of prolonged-action drugs are going on in South Africa.

Stefano Vella, Head of the Department of Therapeutic Research and Medicines Evaluation at the Italian National Institute of Health says that the studies of prolonged-action drugs are currently underway.

“It is not just about injections, but also about implants. For instance, like female contraceptives. It is important that there should be an option to remove them in case of side effects. Every patient should have a choice which medicines to use and the patient’s preferences should be taken into account,” he says.

There is no doubt that the right to choose has an impact on adherence to treatment. For those who have problems with adherence, the ability to take drugs not in the form of pills and without the need of daily administration may be the key to undetectable viral load and better quality of life.

Just a story

Svetlana from Karaganda learned about her positive HIV status when she was 20. The woman did not have a vaccine. For a long time, she could not accept her diagnosis. She even had suicidal thoughts. Svetlana had no idea how to go on living her life. However, she met a man, fell in love with him and they got married. ARV medicine helped her to give birth to healthy children. The happy mother with her babies has already been released from the maternity clinic. The twins have a good appetite; they are quickly gaining weight. This is the main cause of optimism for the woman.

According to the statistics since the 1990s, only in Karaganda region mothers living with HIV gave birth to more than 400 babies. Last year, 36 babies were born. They all remain under follow-up care until they turn 18 months old.

Take part in the Fast Forward Award 2018

Proud winner of the first edition of the Fast Forward Award: Ugandan Network of Young People living with HIV/AIDS (UNYPA)

The Fast Forward Award searches for ‘golden eggs’ – innovative interventions organised by and for the community. The awards aims to link these innovative local solutions with donors in order to increase funding for communities and scale up successful approaches.

Four community-led organisations will be selected to pitch their local innovation on stage at AIDS 2018. A high-level jury of innovation experts and investors will select a winner. The winner receives the Golden Egg, Fast Forward Award, for best community HIV/AIDS solution!

Are you a community-led organisation? Do you implement an activity, approach, or project, which fits this description? Apply or nominate others to take part in the Fast Forward Award 2018!

The deadline is the 7th of May 2018. Download the full call for proposals and/or the application form.

Source: aidsfonds.org

Metropolis 2020: on the Way to 90-90-90

Author: Anastasia Petrova

Dynamics of the HIV epidemics in big cities is a pressing issue all over the world. According to the United Nations, by 2050 most people will live in big cities. This is most relevant for the developing countries with low incomes and growing HIV epidemics. Considering that the key populations are concentrated in metropolises, experts point out that there is obviously a need to implement HIV prevention and treatment programs at the municipal level. The decision to end the AIDS epidemic in big cities by 2020 is embedded in the Paris Declaration signed on 1 December 2014 with support of the UNAIDS.

This topic is the basis of the Fast-Track TB/HIV Responses for Key Populations in EECA Cities Project implemented by AFEW International in collaboration with Alliance for Public Health and presented within the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) held in Moscow, Russia. Together with the municipalities of five big EECA cities, civil society representatives developed measures in response to the spread of HIV/TB in key populations.

On 20 April, Anke van Dam, Executive Director, AFEW International moderated a session called “Fast-Track HIV/TB Responses in Healthy Cities” at EECAAC 2018. The session was co-chaired by Svetlana Plămădeală, Country Manager, Coordinator, UNAIDS, Moldova; Alla Yatsko, President, Public Association ‘Youth for the Right to Live’, Moldova; and Erika Tserkasina, Program Officer, Eurasian Coalition on Male Health, Coordinator, MSM Programmes in Almaty, Beltsi, Odesa and Sofia, Estonia.

“We cooperate with five metropolises in the region: Odesa (Ukraine), Tbilisi (Georgia), Beltsi (Moldova), Almaty (Kazakhstan) and Sofia (Bulgaria). The key criteria in selecting the cities were HIV prevalence and readiness of the local authorities for cooperation. Through organizing a network of community representatives, we established cooperation with the municipalities,” said Anke van Dam, Executive Director, AFEW International.

The goal of the Fast-Track TB/HIV Responses for Key Populations in EECA Cities Project is to contribute to achieving 90-90-90 targets, including reduced mortality and increased funding for HIV/TB treatment. One of the main tools is strengthening partnership between the authorities and civil society. To achieve this objective, the project includes research studies, workshops, and meetings with decision-makers. It is planned that the preliminary results of the project will be presented at the International City Health Conference ‘Developing healthy responses in a time of change’ to be held in Odesa on 13-14 September 2018.

HIV in Georgia: is there any stigma

Author: Irma Kakhurashvili, Georgia

Our meeting with David Ananiashvili was appointed in a green courtyard of the Infectious Diseases, AIDS and Clinical Immunology Research Centre. The Centre is located in an old building in one of the central districts of Tbilisi, Georgia. The authorities have been promising a new working space for the centre since long ago, but so far there has been no progress in this process. However, David feels at home – he knows every corner here. He was one of the first people in Georgia who publicly spoke about their HIV status. David is the head of the Georgian Plus Group NGO. Since 2000, the NGO has been implementing various projects to protect the rights of people living with HIV and standing up to stigma and discrimination.

In the meeting room, David says that the civil society sector in the area of HIV/AIDS is quite small. Besides, there are not many resources available to fight stigma. In Georgia, all people have access to free HIV treatment (antiretroviral therapy is available and accessible for patients since 2004 through the grant of the Global Fund to Fight AIDS, Tuberculosis and Malaria), while stigma is one of the main factors hindering access to testing of HIV. David says that most stigma-related issues may be observed in health facilities, in the relations between doctors and patients. The HIV-related stigma in the healthcare system – both in state-run and in private clinics – is so strong that sometimes doctors and other medical personnel do not provide the required high-quality services. There have been cases when doctors refused to perform life-saving surgeries if their patients had HIV.

Stigma is reinforced by myths

The situation is worse in regions of the country, especially in smaller towns and villages where patients are afraid of social isolation and are reluctant to disclose their status even to their family members. Here, the HIV diagnosis still leads to the feelings of panic and helplessness as it used to be in the 80s.

“HIV is a stigmatized disease causing a number of emotional and social problems. Stigma is reinforced by a variety of myths, for instance, that HIV is a result of the person being irresponsible, practising immoral behaviours or using drugs,” explains David.

The community of people living with HIV in Georgia is not as open as it should be but David believes that everything has its time and that this issue may be resolved. Current scale of the response to hepatitis C may serve as a good example. Until 2015, people in Georgia had never talked out loud about this disease, but after the government started the national program of hepatitis C elimination the ice was broken: many people were able to recognize they had hepatitis and start effective treatment.

In the nearest future, hepatitis C elimination programme will also include screening for HIV, which means that the patients who are tested for hepatitis C will also be screened for HIV. The initiator of this idea – AIDS Centre – is sure that integrated services will significantly improve the HIV detection rates. David says that countering stigma requires a comprehensive approach instead of one-sided efforts.

Strategic plans

The estimated number of people living with HIV in Georgia is 12,000 people. Apart from countering stigma and discrimination, the main goal in the AIDS response is detection of the new HIV cases.

David says that there is a need to bring up the issue of preventive treatment of discordant couples in Georgia. Pre-exposure prophylaxis of HIV (PrEP) is a new method of HIV prevention. PrEP provides additional protection in cases when people do not use condoms for whatever reason.

David Ananiashvili and his colleagues plan to make their contribution to the development of a new National Strategic Plan to Fight HIV/AIDS. Its main objectives will be delivery of services to vulnerable groups and further scale up of prevention programmes.

“We would like to implement a new project by creating a consortium to make sure that in future our services – counselling centre, mobile clinics, outreach services, group activities, etc – and interventions are explicitly described in the HIV/AIDS strategic plan and to add new services to the existing ones. We will conduct focus groups, identify common challenges and needs to analyse and understand which services are needed for vulnerable populations and which of them are more effective,” says David.