Expert: Polygamy Increases the Risk of the HIV Spread in Tajikistan

Author: Nargis Khamrabaeva, Tajikistan

Polygamy is one of the main factors contributing to the rapid spread of HIV in Tajikistan. This is stated in the research of the Tajik network of women living with HIV. In 2018, this network in cooperation with the public fund Your Choice conducted a review of the legal environment in relation to HIV.

Protection of rights regardless of the status

In Tajikistan, polygamy is officially prohibited and is punishable by a fine of two years of correctional labour. However, as the religious influence on the society increases, many men have several wives. The second and subsequent marriages are not registered but are consecrated by a mullah and normally wives do not live in one house.

“The committee on the elimination of discrimination against women called on Tajikistan to ensure the protection of women’s rights in existing polygamous and religious marriages regardless of their registration status,” says Larisa Aleksandrova who represents the public fund Your Choice and acts as a gender and legal consultant of the research.

According to the expert, polygamy has negative consequences in relation to HIV. First of all, in sexual relations women in Tajikistan usually do not have the right to make a decision to use condoms. Women are not able to counteract the unsafe pattern of men’s intimate behavior. According to the statistics on HIV, programmes promoting safe sexual behavior and family planning are not successful. They also do not have impact on men and youth.

Undisclosed  information is a threat to unofficial wives

Larisa Aleksandrova says that another problem is that men living with HIV prohibit their wives to go to the hospital for treatment.

Larisa Aleksandrova, representative of the public fund Your Choice, gender and legal consultant of the research

“One of the reasons why men have such behavior is the fear of public disclosure of their HIV status. Another reason is additional expenses on the treatment of the spouse, who usually is being financially taken care of by the husband. In many cases, such behavior led to the death of women,” tells the expert.

Besides that, polygamous men living with HIV infect all their spouses. During consultations in the AIDS Centre, they often choose not to tell that they have several wives because polygamy is a criminal offence. Therefore, undisclosed information becomes a threat to the lives of unofficial wives. They simply will not know about their status and will not be able to receive the treatment.

“Polygamy is a major risk for the spread of HIV. In 2017, in the town of Nurek a lawyer defended the interests of a woman who contracted HIV from her husband. She demanded compensation for moral and material damage due to the transmission of HIV. The investigation showed that the woman’s husband had a second wife who had died of tuberculosis. After that, according to the Muslim traditions, the man got remarried for the third time. He was seen together with his new spouse in the AIDS Center in Nurek where both of them were receiving antiretroviral therapy. It is possible that the third wife already was HIV-positive as well”, tells Larisa Aleksandrova.

This is not an individual incident. When interviewing women living with HIV, some respondents said that their husbands had second wives, and in most cases, they found out about it when they got to know about their positive HIV status.

 

Mother-to-Child Transmission of HIV in Kyrgyzstan is Minimal

Now about half of the money allocated by Kyrgyzstan for the HIV component goes to the procurement of test kits for pregnant women

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is getting prepared to receive a certificate to confirm elimination of mother-to-child transmission of HIV. In the last five years, over 95% of pregnant women were covered with prevention projects, while the new cases of vertical HIV transmission are now at the level of 2%.

Testing is an integral part of prevention

Since 2007, all pregnant women have been tested for HIV when registered in maternity care. In case of a positive result, the woman is registered with HIV treatment facilities and receives consultations on the need of antiretroviral treatment (ART).

“A good, easy-to-understand consultation leads to the woman giving her voluntary consent to the therapy initiation. There are rare cases when women refuse treatment due to the lack of knowledge or religious beliefs, but most often – due to their self-stigmatization. The share of such refusals is now less than 2%,” says Erkin Tostokov, physician working at the Prevention Unit of the Republican AIDS Centre. “There are some cases when a woman is first seen by the doctor only when she delivers her baby. For such women, we do rapid HIV testing in the maternity clinics and, if HIV is confirmed, we hand out ART drugs right there. We update our clinical protocols in line with the most recent WHO guidelines and train our doctors on a regular basis.”

Children born to HIV-positive mothers go through several stages of examination: early diagnostics to identify if the foetus is infected intra uterine; then within 4-6 weeks doctors have to exclude HIV transmission during the delivery; and the last test allows detecting the HIV status of the infant after the breastfeeding is completed. Children receive preventive ARV therapy depending on their risk level and receive monthly social benefits during the whole period until final confirmation/non-confirmation of the diagnosis (up to 18 months).

Social benefits for children living with HIV

Elena learned that she had HIV in 2011. In a while, the woman found out that she was pregnant. Back then, she was in a difficult situation: no job, no place to live, and no money. The woman felt lost because of her HIV status.

“The doctor prescribed ART and I started taking the pills, though before I refused to take the therapy because of my allergy,” Elena recalls. “When my daughter was born, she received preventive therapy for two months. When my girl was 18 months, the doctors did the last test and took her off the register as she was perfectly healthy. However, I was still scared and took her for HIV testing until she was four years old.”

Now about half of the money allocated by the state for the HIV component goes to the procurement of test kits for pregnant women. The government provides social benefits for children living with HIV and free breast milk substitutes.

“In the recent 7-8 years, our programmes to prevent mother-to-child transmission of HIV achieved a big progress: the share of such transmission was reduced from nine to one percent,” says Aybek Bekbolotov, Deputy Director of the Republican AIDS Centre. “To a great extent, this result was achieved through the efforts of doctors working in general and maternity clinics. Now there is almost no pregnant woman whom we miss. All maternity clinics have been provided with rapid HIV tests and ART drugs. We received a strong support from UNICEF. They provided training to doctors, supported the launch of early diagnostics in newborns and rapid testing in maternity clinics. Now they help us to get prepared to receive the certificate of having eliminated mother-to-child transmission of HIV. A country can get such a certificate provided that the rate of vertical transmission is less than 2% and if over 95% of pregnant women have been covered with prevention programmes in the recent two years. There are certain requirements to indicators and procedures to calculate such data, and now we are working on meeting them.”

Support and training in the summer camp

Currently, there are 478 children with HIV registered in care, 464 of them receive treatment. Every year, summer camps are held for children living with HIV with UNICEF support. This year, this event will be brought to the international level for the first time.

“In July, there will be a one-week summer camp for children, parents, doctors and social workers from Kyrgyzstan, Kazakhstan, Tajikistan, Uzbekistan, and Turkmenistan. There will be trainers from the UK, Ukraine, Russia, Germany, Spain, the Netherlands, and Italy,” tells Aybek Bekbolotov. “The camp will include several parallel events: a forum for adolescents living with HIV and their parents, workshop for pediatric medical staff and training for psychologists and social workers.”

Medical and social workers will be trained to work with children living with HIV, while children and their parents will develop support and leadership skills and are expected to form a new community.

19 June: Second Edition of EECA Food and Art Night in Amsterdam

The second edition of PLOV ARTxFOODxCINEMA is coming to Amsterdam on 19 of June. Culinary experiences and cinematographic impressions of Eastern Europe, the Caucasus and Central Asia will come together during the event organised by the AFEW Culture Initiative in collaboration with the partners IDFA and Studio/K.

PROGRAMME

▹ 16.00 – 22.00: Four visual artists-in-residence (AiRs), Hanna Zubkova (Minsk/Paris), Hassan Kurbanbaev (Tashkent), Ilya Fedotov-Fedorov (Moscow) and Lado Darakhvelidze (Kutaisi/Arnhem) showcasing their ongoing artistic projects.

▹ 18.00 – 19.45: Two-course dinner (Armenian ajab sandal/ajapsandali (summer stew) and Georgian khachapuri (cheese pastry).

▹ 19.45 – 22.00: Documentary screening ‘When the Earth Seems to Be Light’ by Salome Machaidze, Tamuna Karumidze and David Meskhi (Georgia, 2015) & Q&A.

“Revolutionary skaters wreaking havoc in the streets of Tbilisi, stories of a vacated Red Light District brothel, photographic footage of Tashkent’s revolutionary youth, vegetarian-friendly Armenian Summer stews, popular mythologies of HIV/AIDS in a post-Soviet world, medicines vs poison, ChemSex and ‘slamming’ subcultures of Amsterdam, queer visibility in contemporary Uzbekistan and an explosion of dairy and cheese à la Georgian. These are just some of the ingredients of PLOV #2.

Young Georgian skaters, artists and musicians feel trapped between the powers of the Church and the political world. They create their own open spaces beneath viaducts and at other “non-places” that lend themselves to romantic notions of a free existence. Questions are posed to them about God, love and freedom, but these boys would much rather just be skating – for many of them it has grown into an obsession. They may be unfazed by painful falls, but narrow-mindedness really gets to them. One of them was bullied because of his hairstyle, and he explains that Georgians simply won’t accept people who look different. Many of their friends share their bleak vision of their country. The way they see it, Georgia is all about the old rather than the new. They get no acknowledgement here, so they spend their evenings throwing Molotov cocktails at a concrete slope. Their tattoos are “a diary you can’t escape from. You tattoo what you feel; what’s important for you at that moment.” The portraits of the skaters are based on a series of photos by David Meskhi, one of the three directors. This impression of their daily lives is intercut with news footage of demonstrations in Georgia.”

[Georgian language, English subtitles]

TICKETS

– Open atelier/showcase space is free of charge.
– Ticket €20,00 for dinner + documentary.
– Ticket €15,00 for dinner only.
– Ticket €9,50 for documentary only.

* Ask about student discounts when reserving.
** Cineville Pass discounts accepted [only pay for dinner option].

For reservations, please call 020 692 0422 (Studio /K) or email the AFEW Culture Initiative at judith_kreukels@AFEW.nl.

Subscribe to AFEW Culture Initiative‘s newsletter here, follow their Facebook and Instagram.

Georgian Youth for Music and Harm Reduction

For the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day during 4GB festival

Author: Irma Kakhurashvili, Georgia

4GB is an annual electronic music festival which has been held in Georgia since 2011. The festival is dedicated to the memory of DJ Giorgi Bakanidze – one of the Georgian club music pioneers. This year, 4GB was held in an abandoned Cosmic Constructions Centre near the Saguramo village. Apart from the high-quality lineup, sound systems and headliners performing on stage, 4GB festival had another prominent feature – for the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day. Mandala – Harm Reduction youth project team members did their best to make sure that more than one hundred participants of the festival stay healthy. Thanks to this project, drug and alcohol intoxication, overdoses and other risky situations were brought to naught.

Information as weapons

Information about the new project first appeared in social networks. Several days before opening of the festival, organizers announced that due to the growing number of drug-related deaths (last month, seven young people died in Georgia – author’s note) they decided to protect their guests and music lovers with the help of Mandala – Harm Reduction.

With the financial support of Doctors of the World (France), 20 young volunteers, who received harm reduction training, were engaged in the project.

“Last month, several young people died of drugs, and we thought that in such circumstances our initiative will be very timely. We still remember the last-year GEM FEST, where 22-year-old Natia Tavartkiladze died of drug intoxication in Anaklia. Therefore, our goal was to give all people, especially young ones, objective information about health, drug use and personal safety,” says Temur Khatiashvili, Project Coordinator.

20 young volunteers, who received harm reduction training, were engaged in the project

According to Temur, the awareness-raising materials distributed at the festival were specially developed for young people – pocket-size brochures with the original design, which used simple language to describe a number of popular club drugs, their potential harms, and universal overdose prevention and safety rules. The brochure included a matrix showing the compatibility of different low- and high-risk drugs and a map of the festival territory marking the tent offering harm reduction services. In the friendly atmosphere of the tent, all interested people could receive consultations, get free condoms, drinking water and hematogen (nutrition bar that is often considered to be a medicinal product and is used to treat or prevent low blood levels of iron and vitamin B12 – editor’s note).

Project to be continued

The 4GB festival had a happy end. Participants of the Mandala – Harm Reduction project coordinated their efforts with the ambulance team, which they contacted over the radio in case of need.

The 4GB organizers welcomed Mandala – Harm Reduction as it clearly demonstrated that such project is important for thousands of people who are brought together by such large-scale music event. Participants of the festival were also positive about the project.

21-year-old Tamar Ninua thinks that today electronic music is the fastest growing youth culture in the world, and such projects are especially important for people who may use drugs, not being fully conscious of the consequences of their unsafe behaviours. In such cases, access to timely assistance is very important.

“Despite of the high health risk, people still use various substances. The festival is not an exception. The efforts of Mandala volunteers helped to mitigate the risks. Many young people lose self-control in the euphoria of the festival. The Mandala volunteers, who were easy to recognize as they were wearing kind of a uniform, were moving around in an organized way and were promptly responding to any cases who might need help,” says Tamar.

The project initiators are optimistic and say that in the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia. They hope that they will receive support not only from different harm reduction charities but also from the mayors’ offices.

It is not that easy

In the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia

“We will try to improve this project and will learn to overcome the barriers that we face. E.g., festival organizers said that we could by no means hand out syringes. They said that young people might see it as an incentive for using drugs. However, we insisted until the end that this service is necessary. Besides, they were against the distribution of naloxone but we were able to prove that having a highly effective medication to deal with overdoses is vital,” told Mariam Ubilava, project volunteer and coordinator.

According to Mariam, the project is aimed at preserving the health of each festival participant, at mitigating the negative consequences of substance use and achieving behaviour changes.

“We noticed one more problem. When some young people saw us, they were more eager to practice risky behaviours, hoping for our help. Thus, they reduced their own responsibility, shifting it on us. That is why we will have to think how to prevent it from happening in future and find a balance,” says Mariam.

Such projects as Mandala – Harm Reduction are widely implemented at various music events all over the world, such as Amsterdam Open Air, Lollapalooza Paris, Tomorrowland, etc.

Integrated Care Centre in Almaty – a Home for Everybody

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices

Author: Marina Maximova, Kazakhstan

A month ago, the first Integrated Care Centre for people in difficult life circumstances, called Revenge, was opened in Almaty, Kazakhstan. The centre was established at the initiative of the community of people living with HIV.

Invisible People

People living with HIV (PLWH), people who use drugs (PUD), those who are released from places of confinement… Those people are often left behind and ignored. They are invisible, pinned to the wall of despair, with a trail of problems that remain unresolved for years, not believing that there is a light at the end of the tunnel. Now they know where they can find help. Where they will be understood and will not be neglected. Now the address 14A Omarov Street, Almaty is well known to many people. They pass it on to each other, realizing that for someone it might be the last hope.

“The centre was opened by the community, which is one of the factors attracting the potential clients. Here people can stay overnight or even live for a while until they are able to resolve their most pressing problems. The main thing is that here they are able to get a temporary registration, which is the main barrier in re-issuing the documents, getting “registered” with a healthcare facility, etc. The centre is a unique initiative and its launch was very well timed,” tells Roman Dudnik, Executive Director of AFEW Kazakhstan.

AFEW Kazakhstan supported the idea of opening the Revenge Centre within the Project “Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia.” Among other initiators – activists of the Kazakhstan Network of Women Living with HIV and the Revenge Social Support Fund.

I reached the lowest point of my life

Director of the newly established centre Yelena Bilokon knows about the lives of people who practice risky behaviours not by hearsay. She was using drugs, lived in the street and has been living with HIV for 22 years. Rehabilitation centres inspired her to start a new free life. She got acquainted with the rehab clients within her community activities. When she saw the premises, the joint work, the support people provided to each other and their enlightened faces, she felt that she wanted to open her own centre.

Timurtau centre was her first success. It is a crisis centre for families called My Home, which provides assistance to many women and their children who are in trouble. The Almaty project is more large-scale.

“We have clients who have not been able to access antiretroviral treatment (ART) and, thus, to reduce their viral load and even go through medical examinations for three years or more. What can we say about migrants if even our citizens cannot receive these services? The same story is with tuberculosis patients who are left without social benefits, which they are entitled to. People are not even able to find jobs. As for children, when they get into crisis situations with their parents, they also need help, sometimes even more than adults,” says Yelena Bilokon, Director of the Kazakhstan Network of Women Living with HIV.

Up to 40 calls a day

In the centre, telephones are ringing all day long. Many people need help. The centre, in fact, is also in need of help. Kitchenware, clothes, bed linen, furniture, food… All these things are brought by good people. There was a call for help in social networks – and a lot of people responded.

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices. 25 people were tested for HIV with rapid tests, 17 found jobs, 11 were examined for hepatitis and tuberculosis. It is not just statistics. Every number symbolises the struggle for someone’s health and life. Every day.

“Opening of such centre offering integrated services for vulnerable populations is an important event for our city. All the crisis centres, which existed before, had their own profiles and worked only with certain populations. People who need help cannot always find a centre offering the necessary services quickly. The Revenge Centre helps everybody,” says Alfia Denebayeva, Deputy Chief Physician of the Almaty AIDS Centre.

Workshops on case management, outreach work, stigma and discrimination delivered by medical professionals and civil society leaders help the centre clients to become volunteers. Recently a youth and adolescent club was opened in the centre, with many guests coming for the opening ceremony. In fact, they are not called guests here – those are our friends and allies, and their number is growing day by day.

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 Chance to Find a Way Out

Methadone administration at the OST site in Oskemen

Author: Marina Maximova, Kazakhstan

Since 20 December last year, no new patients have been enrolled in the opioid substitution treatment (OST) programme in Kazakhstan. This decision based on the governmental inspection results led to concerns among civil society activists and medical professionals and to panic among people who use drugs (PUD).

I just want to live!

Her story is a cry for help. Aygul (the name was changed) from Almaty spent half of her 34 years on drugs. There was a time when she was dreaming to become a fashion designer, conquer Paris, meet her love, have children… Then, when she was 17, she tried heroin in a group of other adolescents and could not quit it. Back then she was sure that she could change everything and start her life with a clean slate. It seemed that she had all her life ahead. However, ahead of her there was only a fight for life. Drug abuse, HIV, hepatitis C…

“Due to drugs, I failed to receive an education. I spent my days in jail instead of school. As for my long-awaited love, it was the love for drugs. My dreams were buried together with my unborn babies. My window to Europe was the grilled window in the compulsory therapy department of the drug treatment centre together with other women who were as miserable and weak-willed as I was,” tells Aygul with tears in her eyes.

The only support comes from the woman’s parents who are elderly and exhausted with the daughter’s disease. Aygul hopes to enroll in the opioid substitution treatment programme and receive methadone. Now this dream is falling apart. Aygul was getting prepared, gathering documents. She found a job and believed that she would be able to start a new life. After all, she wants to live so badly!

Insight but not for all

In Almaty – the biggest city in the country – methadone-based OST has been implemented since 2017. It started later than in other cities of Kazakhstan. There was a strong public lobby against it. In less than a year, 15 people were enrolled in the programme with strict eligibility criteria, through the plan was to enroll 50 patients. Considering the estimated number of PUD – over nine thousand – the coverage was extremely low. However, even in this situation PUD and their co-dependent people had a goal and a hope – try to get in the programme and, thus, survive.

As of the end of the last year, 359 people were enrolled in the OST programme in Kazakhstan, including 31 women and 62 people living with HIV. There are success stories: 44 people found jobs, five started families and two female patients became mothers.

“The next steps were anticipated and planned to strengthen OST – approve a programme at the legislative level, launch OST in places of confinement, conduct ongoing monitoring of the patients’ health state. It is proven that methadone therapy has a positive social and psychological effect as people who receive treatment reintegrate into the society. Then, all of a sudden – the programme will not be scaled up, new patients will not be enrolled,” complains Sergey Shetnikov, Substance Abuse Consultant from the Answer NGO based in Oskemen (Ust-Kamenogorsk).

The last chance

In Kazakhstan, the OST programme was started in 2008 with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Within the period of its implementation, the programme was expanded into 13 cities. OST was included into the 2006–2010 National AIDS Programme. Its further implementation was stipulated in the National Programme “Healthy Kazakhstan 2011–2015.” Methadone is registered in the country. Staff is trained. The therapy is provided by multidisciplinary teams consisting of drug treatment doctors, psychologists, social workers, and nurses. The programme was positively assessed by the international organizations – UNODC and ICAP. It seems that there are all the prerequisites for scaling up OST…

“Apart from the recruitment of new clients being suspended, there is one more alarming trend – exclusion of clients. Thus, in Timurtau in Karaganda region the number of clients halved in three months. There are also disturbing signals from other regions of the country. How should people who have been excluded live on? Go back to heroin and jail?” asks Oksana Ibragimova, Advocacy Officer of the Kazakhstan Union of People Living with HIV.

OST for all people who need it may be the last chance for them to go back to normal life, to the society and the family, find jobs and feel that they are normal people.

The Z hour is in a month

Assessments of the OST efficiency and performance in Kazakhstan have been conducted more than once. Now an interagency committee is working, which is to issue its opinion in a month, on the eve of the 22nd International AIDS Conference in Amsterdam (AIDS 2018). Maybe, this decision will influence the attitudes of the Kazakh delegation. So far, some optimism may be derived from the opinion of Nikolay Negay, General Director of the Republican Scientific and Practical Centre of Mental Health at the Ministry of Health of the Republic of Kazakhstan.

“The Ministry of Health of Kazakhstan supports OST. It is one of the key elements of the cluster of drug treatment provision to patients with the opioid dependence. The programme is continued. In future, we hope that it will be implemented in line with the evidence-based international best practices,” he says.

Coalition of Communities of Kyrgyzstan: “We United to Strengthen the Voices”

The Coalition of Four Communities is developing a media campaign to eradicate hate and stigma speech

Author: Olga Ochneva, Kyrgyzstan

Community organizations are often not cooperative: each one deals with specific problems and has its own approaches to work. Nevertheless, the Coalition of Four Communities: people who use drugs (PUD), sex-workers (SW), people living with HIV (PLHIV), lesbians, gays, bisexuals and transgender people (LGBT) is developing and gaining strength in Kyrgyzstan. Consolidation began three years ago without any financial support. The goal is to make the participation of communities in solving the problems of their groups meaningful, to fight against HIV, to reduce stigma and discrimination. Below we discussed the experience of interaction, successes and plans with the representatives of the Coalition.

Four years ago, our interlocutors could not even dream of uniting all groups vulnerable to HIV.

“I said three years ago, that organisations for people who use drugs can only unite with a group of PLHIV, and probably with sex-workers organisation. The representatives of our group often have experience of imprisonment and would never join the LGBT community,” says Sergey Bessonov, leader of the IDU community organization Harm Reduction Network Association. “At the meeting earlier this year, 99% of my employees agreed to work with convicted men who have sex with men. This is the result of the gradual and systematic work on the consolidation of our groups, which we have been carrying out in recent years. People start looking at each other differently.”

The true spirit of unity

The groups began to unite in 2015, when women who use drugs (Asteria), sex-workers (Tais Plus) and the LGBT community (Labrys) took part in presenting an alternative report on the situation with all three groups at the 60th session of the CEDAW Committee on the Elimination of Discrimination against Women in Geneva. According to the members of the Coalition, they sensed the real spirit of unity during the election of a representative from the community to the governmental Coordinating Council for Public Health.

“As community organizations, we have mobilized to promote our candidate as an alternative to a candidate from AIDS-service organizations, since we have different approaches to work. Spontaneously, within two hours we managed to organize 47% of the votes,” recalls the director of the organization for women who use drugs Irena Ermolaeva. “Then the community of PLHIV and men who used drugs joined us. Although our candidate did not win, we understood that we are stronger standing together than alone, understood the real power of consolidation and were inspired by it.”

Similar problems in groups

The first activity of the Coalition was the development and submission of two project applications. At this time, a large regional network announced grants for the development of consortiums of communities. According to the representatives of the Coalition, the focus of their applications was on maintaining tolerance among groups as the basis for the future work. The Coalition has not received support but did not stop a joint activity. In 2017, the Coalition together with the Office of the Ombudsman conducted monitoring: they monitored the rights of all four communities. Later the organizations united to conduct a media campaign to eradicate hate speech and a language of hatred.

“Initially, the campaign had to be focused on the LGBT community. At the joint meeting last summer we decided to include all our communities in the campaign,” says Nazik Abylgazieva, the LGBT representative of the Labrys organization. “We made a video with famous people of the country who spoke about our problems. Our message has been heard: during three days, the video was viewed by more than 150 thousand people.”

50 representatives of different communities took part in a joint training, recalls the psychologist of the PLHIV-organization Prosvet Margarita Sabirova, and the team-building process was seen. People overcame external and internal discrimination. It became clear that groups had similar problems.

Involvement on a short notice

Now the Coalition includes seven community organizations representing women, men and young people who use drugs, PLHIV, sex-workers and the LGBT community. The Coalition is considering two more candidates. The association is not officially registered and is currently developing its strategic plan.

“Memorandums, agreements and the formal creation of consortiums do not solve the problem. If we understand each other and trust our partners, there is no need to register it legally since we are ready to help each other on a short notice, ready to get involved, to support,” claims Sergey Bessonov. “Together we already submitted several applications for our Coalition. The first joint project is aimed at bringing our communities closer together. We develop the three-year strategy of our Coalition and determine how we will interact to promote common interests.”

The Coalition received Global Fund project this year. Due to cuts of funding, it was decided to leave only one network that would work for all the groups instead of four separate national networks of communities. In the framework of this activity, communities monitor and advocate to improve the quality and access to HIV programs as well as receive technical assistance to increase community capacity and solidarity.

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.