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.

The AFEW Culture Initiative Presents EECA Food and Art Night in Amsterdam

The first edition of PLOV ARTxFOODxCINEMA is coming to Amsterdam on 29 of May. 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.

During the event, visitors will taste food from Eastern Europe and Central Asia (EECA): traditional Russian okroshka beetroot and kefir soup and traditional Asian plov (pilaf) dish. After dinner the documentary “Debut” by Anastasiya Miroshnichenko (Belarus, 2017) will be shown. The movie is about women who are detained in a Belarus prison for first-time offenders.

“The PLOV evenings are great for those interested in a new cultural food experience, who would like to learn more about Eastern Europe and Central Asia, and public health issues of the region through the eyes of the artists,” says AFEW International Project Officer Judith Kreukels.

During the whole duration of the PLOV ARTxFOODxCINEMA event, there will be the possibility to see the artworks of artists-in-residence who come from the EECA region and stay in Amsterdam now.

Tickets to the event cost €20,00 for dinner and documentary, €15,00 for dinner only, and €9,50 for documentary only. Tickets to PLOV ARTxFOODxCINEMA can be reserved Studio /K by the telephone number 020 692 0422. Tickets can be purchased at the Studio /K on the evening itself.

TIME

16:00 — 22:00 – Open atelier and ongoing artistic showcase.
18:00 — 20:00 – Two-course dinner.
20:00 — 21:30 – Documentary screening, followed by Q&A.

ART 

Four visual artists-in-residence will showcase their ongoing artistic projects:
— Hanna Zubkova (Minsk/Paris)
— Hassan Kurbanbaev (Tashkent)
— Ilya Fedotov-Fedorov (Moscow)
— Lado Darakhvelidze (Kutaisi/Arnhem)

FOOD 

Two courses menu:
— Okroshka beetroot and kefir soup.
— Plov (pilaf) dish.
There is an option of a vegetarian menu.

PROJECT BACKGROUND

The AFEW Culture Initiative was established in 2017 as a cultural and artistic ramification of AFEW International. The AFEW Culture Initiative offers an innovative alternative to intertwine the worlds of public health, culture and visual arts as a means to stimulate a much-needed dialogue on challenges such as HIV/AIDS, tuberculosis or viral hepatitis, as well as their impact on the lives of sex workers, substance users, imprisoned persons or LGBQTI, among others.

Martine de Schutter Scholarship Fund Launched

AFEW International sets up Martine de Schutter Scholarship Fund that allows participants from Eastern Europe and Central Asia (EECA) to attend the 22nd International AIDS Conference (AIDS 2018). Martine’s commitment to the international fight against AIDS and her unwavering support to the Eastern European region has set an example for us to follow. That is why AFEW International established the Scholarship Fund named after Martine de Schutter – our friend and fellow activist.

As of today, Martine de Schutter Fund raised 103.000 EUR to cover the additional scholarships of the EECA applicants to come to Amsterdam for AIDS 2018. A part of the Martine de Schutter Fund has been distributed to the applicants from EECA through the established Scholarship Committee of the International AIDS Society (IAS) of which 45 are regular scholarships and 20 – for speakers who will be invited from the EECA region. AFEW thanks Gilead, Janssen Cilag, Deutsche AIDS-Stiftung and Aidsfonds for their contribution to this Fund.

Martine de Schutter was a strong advocate for human rights. For about 10 years she managed the European network AIDS Action Europe, which connects more than 400 AIDS organizations throughout Europe and Central Asia. Martine worked with dedication and passion to keep the AIDS problem on the agenda at the European Union and to connect all organisations working on the same issues in Eastern Europe. In 2014, Martine became the Program Leader for Bridging the Gaps: Health and Rights for Key Populations program. She travelled a lot and her last trip was to AIDS 2014 Conference in Melbourne on the MH17 plane that was shot down and crashed.

 

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.

AIDS 2018: Call for Journalists

The International AIDS Conference is the largest conference on any global health issue in the world. First convened during the peak of the AIDS epidemic in 1985, it continues to provide a unique forum for the intersection of science, advocacy, and human rights. Each conference is an opportunity to strengthen policies and programmes that ensure an evidence-based response to the epidemic. The 22nd International AIDS Conference (AIDS 2018) will be hosted in Amsterdam, Netherlands 23-27 July 2018.

The theme of AIDS 2018 is “Breaking Barriers, Building Bridges”, drawing attention to the need of rights-based approaches to more effectively reach key populations, including in Eastern Europe and Central Asia and the North-African/Middle Eastern regions where epidemics are growing. AIDS 2018 aims to promote human rights-based and evidence-informed HIV responses that are tailored to the needs of particularly vulnerable communities – including people living with HIV, displaced populations, men who have sex with men, people in closed settings, people who use drugs, sex workers, transgender people, women and girls and young people–and collaborate in fighting the disease beyond country borders.

If you are a journalist and interested to learn more, please register at http://www.aids2018.org/Media-Centre. There are still opportunities for scholarships. You can also subscribe to newsletters to support your work in-country. For further questions, please contact media@aids2018.org

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.

Civil Society of Kyrgyzstan in the Fight for Availability and Affordability of Medicines

Director of the Partner Network Association Aibar Sultangaziev

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is gradually switching to state drug provision system. Some of the tuberculosis medicine will be purchased out of the budgetary funds this year, and some of the antiretroviral (ARV) medicines – starting from the next year. Respective financial resources are planned to be allocated in the budget. At the same time, the question regarding the national legislation remains. A number of important documents is currently under the review. We discussed how these documents consider patients’ needs as well as the results of the analysis regarding the availability of medicines for HIV, hepatitis C and tuberculosis treatment with Aibar Sultangaziev, the representative of public council at the Ministry of Health and the Director of the Partner Network Association.

– Your organization and you personally are actively researching medicine availability and affordability. What are your successes so far?

– We started our work in 2009 with the issue of intellectual property. A respective study was conducted and, on the basis of the facts of high cost on brand medicines used for hepatitis C treatment, we advocated for the amendments to the Patent Law. In 2015, the Law was adopted; it also included the flexible provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Due to this, it became possible to bring more generic medicine into the country. To date, seven medicines have been registered. We keep the cost of hepatitis C treatment at the lowest level in the region: from 615 US dollars for a 12-week course.

Back then, the legislation lagged far behind the needs. We developed an intra-organizational strategy for ensuring the availability of medicines and started to work in several directions. In 2014, we approved the clinical guidelines for the treatment of hepatitis C that became a clinical protocol in 2016 that included a full range of medicine available within the country. Hepatitis C treatment was added to the State Program on HIV/AIDS, and from 2018 onwards, 150 people living with HIV (PLHIV) will receive it free of charge annually. We participated in the revision of protocols on HIV treatment, and now they include modern and inexpensive medicine, such as dolutegravir, darunavir, rilpivirine.

– The Essential Drugs List (EDL) is currently undergoing a revision. It is an important document related to the availability and affordability of medicines and holding public procurement. Did you participate in its elaboration?

“For the availability and affordability of hepatitis C treatment!” Campaign on amendments to the Patent Law

– In 2015, we conducted a study on five diseases: HIV, tuberculosis, hepatitis C, oncological diseases, conditions after transplantation, and found out what medicines for their treatment were registered in the country or included to the EDL and clinical protocols. We identified the differences between the WHO recommendations and the situation in the country, and then submitted a List of necessary medicines to the Ministry of Health (MoH). All of them were added to the EDL and will be approved soon after several amendments to the Law on Circulation of Medicines are introduced. By the way, the Law provides a List of medicines that can be imported and used in the country without registration. This List is used for socially significant diseases, and, as part of the working group of the MoH, we are currently working to determine the procedure for its formation.

– Will it allow the pharmacological companies not to register medicine in Kyrgyzstan?

– Registration is needed. However, in cases when the government urgently needs medicines that are not available on the market, it will be possible to legalize them by the decision of the commission without registration. Of course, there are criteria: medicine must be of high quality, prequalified by the WHO, etc. This list already exists. Last year in November, together with UNDP, (the organization manages grants of the Global Fund in the country – author’s remark), we submitted a list of 12 essential tuberculosis and antiretroviral medicines for the Ministry of Health to consider the possibility of importing them. This is a matter of political will and one commission’s meeting, but there has been no progress with the documents yet. That is why we are preparing a new regulation so that another commission could formalize it via a new procedure.

– Does it mean that practically all conditions for public procurement are in place?

Activists’ campaign to support the amendments to the Patent Law allowing the import of generic medicines to the country

– A lot has been done but the risks still remain. We have to make every effort to regulate the process by autumn. The point is that this year the state’s responsibility is to purchase 10% of second-line tuberculosis medicines, none of which has yet been registered in the country. In 2019, the state should purchase 20% of the required amount of ARV medicines, and in 2020 the share will increase up to 30%. Not all pharmacological companies enter the national small market, and those that do, inflate prices. We are determined to promote the possibility of medicine purchase through international mechanisms. For example, if Kyrgyzstan purchases medicines through UNICEF, one can expect a 5-7-fold decrease of the cost since UNICEF places a single long-term order that covers several countries with the medicine producers.

– What other plans do you have and what is the ultimate goal of your work?

– We carry out constant monitoring of procurement. Price regulation remains one of the priority tasks. We want people to have unhindered access to inexpensive and effective treatment, and the state to provide medicines for socially significant diseases.

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.

How to Become AIDS 2018 Participant

To register for the 22nd International AIDS Conference with the standard fee is possible before May 18. After this date, the registration will be possible only with the higher fee. Deadline to submit a visa application and to request a Letter of Invitation is June 1.

We are presenting this and other information on how to register for the Conference in our new video. Especially for you, we explained online registration in details and answered your questions.

Will see you in Amsterdam in July!