Ex-Prisoner in Tajikistan Advocates Healthy Lifestyle

Umed is a participant of the START Plus programme implemented with AFEW-Tajikistan

Author: Nargis Harambaeva, Tajikistan

Umed Boev, age 41, an ex-prisoner from Tajik town of Bokhtar advocates healthy lifestyle among risk groups – people who use drugs, sex workers and ex-prisoners.

In 2001, when Umed was 24, he went to Russia to earn money. He liked partying and spent quite some money on that. In 2004, during one get-together he had a quarrel and a fight, causing another person grievous bodily harm. He was sentenced for 10 years and served his time at Novosibirsk maximum security prison.

While in confinement, Umed tried heroin for the first time. One syringe was often shared by many people. One day his fellow countrymen, who served sentence in the same prison, found out and talked to him.

“They convinced me to stop taking drugs, telling me that prayers would help. I mustered all my will power, it was extremely hard during withdrawal, but I stuck it out. I prayed hard and it really helped me. I stopped using drugs,” tells Umed.

10 years later, when Umed returned home, he was diagnosed with HIV.

“Upon return, I first worked at a construction site, then the crisis hit and the construction was put on hold. I needed money. An acquaintance of mine told me I could donate blood and get some money that way. Therefore, I went to the clinic and they did an HIV test and the result was positive. I was registered with the clinic but I did not take my diagnosis seriously, did not take antiretroviral therapy,” recalls Umed.

Timely request for help

Because of his weak immune system, soon Umed developed tuberculosis.

“In December 2015, I suddenly felt very ill, had a torturing cough for three months. In April 2016, I was taken to a hospital and diagnosed with tuberculosis. I was in a very poor state of health. I could not even walk, had no appetite. During that time, I rapidly lost 20 kilos. Only later doctors told me I turned for help just in time. Another couple of weeks and I would have died. I was treated, and recently when I had fluorography examination tuberculosis was gone. I am so happy about that,” he says.

Today Umed is a participant of the START Plus programme implemented with AFEW-Tajikistan. The purpose of the programme is to reduce the prevalence level of public health concerns like HIV, TB and viral hepatitis at penitentiary facilities and improve the quality of life of persons released from prison.

“I discovered help for people like me when I was diagnosed with tuberculosis. I came to AFEW-Tajikistan local office in Bokhtar. I received food packages as well as assistance in the form of information. Currently, they are helping with the purchase of necessary medicines,” tells Umed.

Becoming part of the Board

Umed is a member of the Board of representatives of key population groups that was organised within AFEW-Tajikistan office in Bokhtar to help persons in risk groups who are neglecting their health.

“There are four of us in the Board. I am responsible for creating awareness among key groups about infectious diseases. These groups include ex-prisoners, people who use drugs and sex workers. We help AFEW-Tajikistan, inform them about the needs of the groups, adjust assistance that is being provided so that it gains better quality and effectiveness,” says Umed.

By the way, one of the topics of the 22nd International AIDS Conference in Amsterdam is prison health. Other public health issues like HIV, hepatitis and TB in Eastern Europe and Central Asia will be also in focus during AIDS 2018.

PLWH Network Launches New Concept Clinics in Ukraine

Author: Yana Kazmirenko, Ukraine

All-Ukrainian Network of People Living with HIV (PLWH) plans to open five 100 Percent Life all-patients-friendly clinics this year. The ultimate plan is to cover the entire Eastern Europe and Central Asia (EECA) region.

The Project to create the 100 Percent Life network of clinics is a challenge for the Charitable Organisation All-Ukrainian Network of People Living with HIV/AIDS. It is considered to be the largest patient organization throughout the former Soviet Union. During the past several years, modern medical centres accessible for all patients have been opened in each region of Ukraine. Medical centres will provide treatment and social support to those frequently dealing with discrimination at regular hospitals: people living with HIV, representatives of key risk groups. HIV-positive patients will receive services free of charge, clients, in general, will receive them at below-market prices.

In autumn of 2016, a pilot clinic was opened in Poltava, and this year medical centres in Kyiv, Zaporizhia, Lviv, Chernihiv and Zhytomyr will receive their first patients. The capacity of the clinic in the capital will be 900 patients per month.

The Network is preparing to present the Clinic Network Project at the 22nd International AIDS Conference AIDS 2018 in Amsterdam. They are convinced that such format will be highly sought in all countries of the EECA region.

“The first centre of this kind abroad will be opened in Moldvova – they have liberal legislation. Georgia and Kazakhstan are also expressing interest,” says Dmitriy Sherembey, the Chairman of the Coordination Board of Charitable Organisation All-Ukrainian Network of PLWH.

The philosophy and services of these clinics will be a drastic difference from the reality of Ukrainian AIDS centres. Below is the outline of the main differences.

Donors become investors

The Clinics Project changes the roles of donors and non-profit organisations. Under the PLWH Network, model donor organisations become investors, and non-governmental organisations (NGOs) become entrepreneurs.

“At the present time, donors award grants, and in the end, they receive a report on “why it did not work and how flawed the world is.” We are knocking this system down: each hryvnya spent on the clinic by donors continues to work after grant completion. All profit from clinics will be invested into the development of new services. The donor acts as an investor and receives profit not in monetary equivalent but in humanitarian terms,” says Mr. Sherembey.

According to calculations of the Network Head, 50 thousand dollars invested in a clinic will turn into a million within 20 years. At the same time, money spent by a patient at the clinic will turn into a service to a person who wants to live, as opposed to being just owner’s profit.

Medical staff of Poltava clinic praised for thoughtful treatment. Photo by PLWH Network

The clinic in Poltava has become profitable just six months after opening. This gives a chance to NGOs to say good-bye to the role of petitioners and enter the market of medical services, which is rated at 100 billion US dollars a year in Ukraine.

“The network of clinics will allow maintaining programmes and staff in case the Global Fund leaves Ukraine. We have been observing the negative experience of closing up programmes and discharging specialists in the Eastern European countries that have joined the European Union,” adds Yaroslav Blyakharskiy, Manager of Social Entrepreneurship Section of PLWH Network.

Medical centre is put together like Lego

Each clinic will have a different set of services, depending on the diseases in the region, what is offered by competitors and the paying capacity of the population. Three specialists will form the basis: a family doctor, an infectious disease specialist and a drug treatment specialist.

Poltava was not a random choice for the pilot project – it is a typical medium-size Ukrainian city. If the project proved to be sought after in this city, it is bound for success in other regions.

“The pilot clinic provides help in the following fields: neurology, allergology, nosology, narcology, pain and withdrawal syndrome relief. Narcology has proven to be in the highest demand,” says Mr. Blyakharskiy.

In Kyiv centre this list will be supplemented with gynecology, urology and dermatology.

Progressive standards of care

Progressive European treatment protocols will be used at 100 Percent Life medical centres. The Clinics Project is integrated into the medical reform, which is currently dismantling the Soviet-times model. Under the reform, each citizen of Ukraine will have to select a family doctor; and the Government will transfer money to the doctor for treatment of this patient. The family doctor will be able to prescribe antiretroviral therapy, which is currently received by 90 thousand patients in Ukraine.

A mobile application as your health manager

100 Percent Life medical centre will make all communications between patients and medical staff automated as much as possible. Clients will be able to install an application on their mobile phones enabling on-line arrangement of appointments, medical tests, receipt of prescriptions and seeing the entire treatment regimen. Patient’s medical record will also be available electronically. The application will allow covering 60% of all communications between the patient and the clinic.

Medical centre accommodates the patient

Poltava clinic is open until 10 p.m. seven days a week. For the PLWH Network it is vital that all categories of patients get equal access to proper quality services and treatment and do not face rejection and discrimination.

According to the research conducted by the PLWH Network, around 19% of surveyed HIV-positive patients in Ukraine have faced refusal of medical examinations that did not involve contact with blood (the research is titled Evaluation of multiple stigma faced by high risk group representatives with regards to HIV infection – editor’s note). Around 80% of patients were refused by the consulting physician.

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.

Artificial Respiration: will Russia End Tuberculosis by 2030

In 2016, 1.3 million people worldwide died of tuberculosis. Over the same year, 10.4 million people fell ill with tuberculosis

Author: Anastasia Petrova, Russia

March 24 is World Tuberculosis Day. Tuberculosis (TB) is the ninth leading cause of death worldwide. Russia is one of the top three countries with the highest burden of drug-resistant TB. At the first World Health Organisation Global Ministerial Conference on Ending TB held at the end of the last year in Moscow, the Russian Minister of Health Veronika Skvortsova proclaimed that Russia, supporting the global community goal, aims to end TB by 2030. Experts comment on how feasible this goal is.

Treatment is not cost efficient

Tuberculosis is called a biosocial disease as people from the most socially disadvantaged populations face the highest risk of being infected. People from low- and middle-income countries – India, Indonesia, China, Nigeria, Pakistan, Philippines and South Africa – are affected the most. Such countries cannot procure the required drugs at high prices and, as the treatment access experts point out, it is not cost effective for the pharmaceutical companies to invest in the production of drugs, which will not bring them enough income. It complicates the development and launch of new drugs, while the lack of innovative drugs leads to the development of drug-resistant forms of tuberculosis, aggravating the situation.

In 2016, 1.3 million people worldwide died of tuberculosis. Over the same year, 10.4 million people fell ill with tuberculosis.

Sustainable threat

TB morbidity rate in Russia is 58.44 cases per 100,000 people. On one hand, there has been a steady declining trend in TB mortality in the country since 2005 (except for the vulnerable populations). According to the WHO, in 2016 the mortality rate was 8.2 cases per 100,000 people a year (as compared to 16 cases in 2011). On the other hand, WHO experts observe two crucial problems in the Russian Federation: growth in TB morbidity among people living with HIV and widespread of the drug-resistant forms of TB – extensively drug-resistant tuberculosis (XDR-TB), multidrug-resistant tuberculosis (MDR-TB), and rifampicin-resistant tuberculosis (RR-TB).

According to the WHO, Russia is one of the top three countries with the highest burden of extensively and totally drug-resistant tuberculosis, with higher rates in India and China only. In 2016, the share of XDR-TB in the new TB cases in Russia was 27%, and in recurrent TB cases – 65%. It means that now there is no effective treatment for many people. Only 31% of people recover from XDR-TB. The cause of drug-resistant TB is first of all associated with treatment interruptions. The main reason of patients “dropping out” is the lack of social support.

“Patients should not only be treated but should also be provided with comprehensive social support. The treatment is long and hard, it takes over a year. It leads to many people losing their jobs. If people have no means of subsistence, they have to stop their treatment and go to work. The situation is even more complicated for people who have small children,” says Svetlana Prosvirina, member of TBpeople, the Eastern European and Central Asian network of people with experience of TB. “Such drop-outs are extremely dangerous as the bacteria which survive after the treatment interruption adjusts to the medications, which contributes to TB evolution to MDR-TB and XDR-TB.”

Coverage of people living with HIV with treatment is low

Experts agree that to curb the epidemic of tuberculosis by 2030, the government should make efforts to fight drug-resistant forms of TB and create conditions for the patients not to interrupt treatment

Tuberculosis is the main AIDS-defining disease and the leading cause of death among people living with human immunodeficiency virus. The risk of co-infection is related to the low immune function of people living with HIV, who need to receive antiretroviral therapy (ART) constantly to stabilize their immune responses. However, in Russia treatment coverage of people living with HIV remains extremely low. According to the Federal AIDS Research Centre of the Rospotrebnadzor Central Research Institute of Epidemiology, in 2017 the coverage rate was only 35.5%.

People who use drugs are also in a difficult situation. TB activists point out that TB treatment clinics often do not have a drug counsellor and sometimes do not even have a license to provide help to people who suffer from the abstinence syndrome (group of symptoms with varying combinations and severity, which develop when a person terminates using psychoactive substances or reduces the dose taken after their recurrent use, usually during a long-term and/or in high doses – editor’s note). Those symptoms make the patients refuse from further treatment, which not only leads to drug resistance but also creates pre-conditions for further transmission of the disease.

Ending TB by 2030

Experts agree that to curb the epidemic of tuberculosis by 2030, the government should make efforts to fight drug-resistant forms of TB and create conditions for the patients not to interrupt treatment.

“Comprehensive support of vulnerable populations, including the patients, is required to prevent the spread of tubercle bacillus,” says Kseniya Shenina, activist, member of the TBpeople Coordination Council.

Based on the conclusions of the Russian Public Mechanism for Monitoring of Drug Policy Reform, an important pre-condition to overcome the problem is the revision of the Russian drug policy in compliance with the “Support Don’t Punish” approach. Experts believe that the country urgently needs to approve recommendations of the numerous UN bodies on drugs and HIV, including recommendations of the Committee on Economic and Social Rights. Only compliance with these conditions will make the goal of ending tuberculosis by 2030 more feasible.

Persecution and Activism of Sex Workers in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

For almost a year and a half, law enforcement agencies have been persecuting sex workers in Kyrgyzstan. During this period, the number of sex workers receiving HIV prevention services in some regions of the country reduced twice. Civil society organisations registered more than 450 cases of sex workers’ rights violations by the police every year.

Extortion, detentions, and threats

In 2017, 81% of all reports of abuse and human rights violations submitted to the Shah-Aiym Sex Workers Network were complaints against police officers on extortion. Shah-Aiym documents such cases with the support of Soros Foundation-Kyrgyzstan and street lawyers of public associations all over Kyrgyzstan within the framework of the Global Fund via Soros Foundation-Kyrgyzstan. Both sources recorded 475 cases of sex workers’ rights violations by law enforcement agencies in 2016 and 459 cases in 2017. Most often, those are cases of extortion, arbitrary detention, threats, blackmailing, pressure and degrading treatment.

“The wave of mass raids started in mid-2016 when City Directorate of Internal Affairs in Bishkek announced that it was going to “clean the city by getting rid of prostitution.” They even asked local people to conduct night raids, make photos of sex workers and pass such photos on to the policemen,” tells Shahnas Islamova, head of NGO Tais Plus. “At first, press service of the Chief Directorate of Internal Affairs was reporting detentions, not even hesitating or not understanding that they were, in fact, announcing unlawful acts of the law enforcement agencies.”

In Kyrgyzstan, sex work is decriminalized, which means that it is neither an administrative nor a criminal offense. To punish sex workers, law enforcers use other provisions of the Administrative Offences Code. Most often, sex workers are detained for alleged disorderly conduct or petty crimes.

“Sex workers try to avoid court proceedings: they buy off. There are some cases when law enforcers know what a girl does to earn her living and start blackmailing her. They threaten to take photos of the girls, tell their relatives about their occupation or take them to a police station, so the girls agree to pay: the standard charge is up to 1,000 soms ($15),” tells Alina (the name is changed), a street lawyer of a civil society organization. “If girls try to defend their rights, law enforcers find other ways to detain them: they draft reports of disorderly conduct or failure to obtain registration. Those who have bad luck or are not able to buy off may be arrested for three to five days.”

According to Alina, many sex workers have gone underground: they often change their rented apartments and phone numbers. Such situation in some regions of the country hinders the access of NGOs to sex workers to conduct HIV prevention interventions: distribute condoms, offer testing, conduct awareness-raising activities, and consultations.

“Since the start of the “purge”, our organization has been monitoring the dynamics in the coverage of sex workers with prevention programmes in Bishkek,” says the head of Tais Plus NGO. “In a year and a half, the coverage has reduced twice, and in the second quarter of 2017 the actual indicator went down to 39% of the planned coverage.”

Activism in the challenging environment

Mass raids of 2016-2017 echoed almost in every region of the country. Groups of people who explained their actions with the “religious motives and interests of the society” helped law enforcers in their “fight” against sex workers. As the end of 2017 approached, things calmed down: sex workers got used to the new conditions, while the pressure from the side of police weakened a bit and the mass raids ended. However, “police marks” stipulating sex workers paying money to the law enforcers for the so-called “protection” and “permit to work” are still there.

“Currently, in most cases pimps are the ones to keep contact with police, while there are almost no girls who work on their own,” says Nadezhda Sharonova, director of the Podruga Charitable Foundation about the situation in Osh. “Recently, our street lawyer has been more and more often reporting complaints of sex workers against their pimps who beat and blackmail the girls.”

Despite the fact that civil society organizations in Kyrgyzstan offer legal support, sex workers rarely report their offenders. Representative of the Tais Plus NGO thinks that this fact is easy to explain: to go through all the legal prosecution process, one needs boldness and strength as well as certain savings – not to cover the legal expenses, but to be able not to work for a while and keep out of the law enforcers’ sight.

At the same time, the sex workers movement is growing and becoming stronger. The Shah-Aiym Network unites sex workers in Kyrgyzstan, Tajikistan, Russia. The network documents human rights violations and provides support to the victims of human rights violations, actively protects the interests of sex workers’ community and publicly campaigns against violence towards sex workers. The network ensures conditions for strengthening activists’ capacity to claim and defend their rights.

“We have seen cases when sex workers defend themselves,” says Shahnas Islamova. “For instance, at the court hearings on administrative offenses some sex workers now openly say that they are engaged into sex work and do not violate any laws, while the police has violated the law when detaining them. As a result, such sex workers have left the courtroom free from any accusations.”

AIDS 2018 March in Amsterdam

AFEW International received the invitation to join AIDS 2018 march in Amsterdam, and we are sharing this message with you. Please fill in the form below in case you are planning to join the march:

Hello everybody,

In a couple of months the International AIDS Conference 2018 will be held in Amsterdam. We are excited and are looking forward to work together with activists all over the world and make this event one to be remembered.

As you might know from previous conferences, traditionally there will be a march or demonstration of HIV and AIDS activists. This year the march will take place just before the official opening of the conference at the RAI Amsterdam Convention Centre in the afternoon of Monday, 23rd of July 2018. With this email we would like to introduce us to you and ask you to join us in the march/demonstration to raise our voices for and with people living with HIV.

We are aware that we might be a little ahead of time. But it gives us together with you more time to activate more people and to organise a good march in cooperation with the local authorities. Please forward this email to more organisations, people, living with HIV or relatives and friends you know and who might like to become part or support the march. 

For some organisational matters we kindly ask you to let us know if you and your organization are interested in updates or possibly want to get  involved. You can do so by filling out an online form: https://goo.gl/forms/ahKbXV9xO2gRSmnd2

You will soon hear from us again (if you want).

Kind regards,
Alexander P. &
Hans V.  &
Alexander S.

Source: www.aidsactioneurope.org

Do we Treat or Harm: how Ukraine is Fighting against Tuberculosis

Olga Klimenko in the children’s ward of the tuberculosis dispensary. Photos from the personal archive

Author: Yana Kazmyrenko, Ukraine

At the entrance to any public polyclinic in Ukraine, an announcement is greeting a patient: visit a doctor is possible after a fluorography only. The obligatory lungs X-ray maintains a semblance of the fight against tuberculosis. In Ukraine, most of the patients get to know their status very late. The country has not been able to take the tuberculosis epidemic under control for more than twenty years. Ukraine has the world record of multidrug-resistant forms of tuberculosis and is still treating patients, sending them to prolonged isolation in overcrowded dispensaries.

Olga Klimenko – an activist of TBpeople – Eurasian Network of People who have had tuberculosis – was diagnosed with this desease in 2015. By the time of hospitalization, she was sick for at least six months. In 2016, Olga published a book The world inside me. Confession of the tubercular woman in which she described her life experience with the disease.

Now Olga is trying to help patients with this diagnose. On the webpage of her community in Facebook The world inside me, requests appear every day: to transfer money for the purchase of inaccessible drugs, which for the most part are not licensed in Ukraine, to purchase washing machines for tuberculosis dispensaries or diapers for recumbent patients. Last month, Olga was “coaching” 34 patients.

“I do not know when and where I contracted tuberculosis. No one knows. Everyone remembers the last long-lasting flu after which he or she felt weakened and broken down. Ukrainians usually do not go to the doctor, we go to the drug store and buy a full set of antiviral drugs. We remove symptoms, but do not cure diseases,” says Olga.

During the treatment, Olga had good and bad times. The most difficult was the separation from her daughter: the girl was sent to a special boarding school for children who were in contact with infected people, where her homegrown girl spent six months with children from dysfunctional families. Olga still did not forgive doctors who did not tell her that after two weeks from the start of the treatment she was not contagious anymore.

Ukraine is breaking records

Olga’s story is typical for Ukraine where the epidemic of tuberculosis is spreading for several years. More than 30 thousand of Ukrainians are diagnosed with a not active tuberculosis and more than 10 thousand – with an active form. Every day 90 people get their status. These figures are underestimated: according to the World Health Organization (WHO), every fourth patient in the country stays undiagnosed.

Back in 1995, WHO announced that Ukraine has exceeded the epidemic threshold – 50 cases per 100,000 people. Since then, the situation has only worsened – the conflict in the East of the country forced 1.5 million residents of Lugansk and Donetsk regions to resettle. In these regions, there were 15% of Ukrainians who were diagnosed with tuberculosis. Every fifth TB patient is HIV-positive.

Tuberculosis for export

The resettlers are at risk of tuberculosis in Ukraine. Photo by UNIAN

Compared to the other post-Soviet countries, indicators of Ukraine look particularly depressing. If in Ukraine the incidence rate according to the data for 2016 was 67.6 per 100 thousand people, in Belarus it was at the level of 39.9, in Kazakhstan – 52.2, in Poland – 17. The European average is 12 people per 100,000 population.

In the top 20 countries of the world, tuberculosis has already become an exotic disease. The epidemic in Ukraine frightens the neighbors – about 5 million Ukrainians work in the EU countries and Polish media write that a visa-free regime with the EU will allow tuberculosis to migrate to Europe. Warsaw is even discussing the possibility of medical control on the border with Ukraine.

Resistant mycobacteria

Director of the Public Health Center of the Ministry of Health of Ukraine Vladimir Kurpita says that the prevalence of multidrug-resistant tuberculosis (MDR-TB) is the main feature of the Ukrainian epidemic.

Many patients refuse to continue treatment the moment they start feeling better. They do not want to spend at least six months in the dispensary and to be unemployed, staying on the verge of poverty. Due to discontinued treatment the health situation worsens – mycobacteria becomes resistant to drugs. To treat this form, more toxic drugs should be used, the duration of treatment gets longer and it becomes several times more expensive. Now in Ukraine, 85% of the funds allocated for tuberculosis are spent for treatment of multidrug-resistant tuberculosis.

According to Kurpita, treatment of regular tuberculosis lasts six months and costs the state about 30 euros, compared to the treatment of a complicated form of infection, which takes up to 20 months, and the price for that reaches 400 thousand euros. Currently, there are 1.2 thousand cases of such highly resistant bacteria diagnosed in Ukraine. In this sad rating, only India overtakes Ukraine.

Family doctors will start to treat tuberculosis

Experts agree that it is possible to defeat tuberculosis if compulsory hospitalization will be replaced by outpatient treatment. This step may reduce the chance for reinfection in the hospital. Now patients at different stages of recovery are getting treatment in hospital rooms for 5-7 people for years, and they have the risk of catching a nosocomial infection at any time.

A health reform that is currently ongoing in Ukraine, involves the transfer of patients with non-active tuberculosis under the responsibility of family doctors. The last ones are supposed to get extra paid for each of the cured patients.

“The main idea is that doctors will be in closer contact with patients, will know their health history. Responsible people will receive their pills and will lead a familiar lifestyle,” explains Olga Klimenko.

She dreams for three Ukraine-wide days off not because of some celebration but because of a mass medical examination for the all Ukrainians so that people could find out that they have some dangerous disease before it gets to the last stage.

Post-Soviet Countries Need a Single Document on HIV in the Field of Migration

Presidium of the seminar

Author: Marina Maximova, Kazakhstan

In the post-Soviet countries, there is no single document that would regulate the issues of HIV prevention, diagnosis, and treatment for migrants as well as their legal status. Migrant workers do not get the adequate services in the countries where they work which inevitably leads to the decline of their health status and to the growth of the HIV epidemic in the region. This message was the main one in the discussion at the sub-regional technical seminar in Astana, Kazakhstan on February 19-20, 2018. The event was organized by the United Nations Population Fund (UNFPA) in cooperation with the Joint United Nations Program on HIV/AIDS (UNAIDS) with the support of the Ministry of Foreign Affairs of the Kingdom of the Netherlands.

HIV rates continue to grow in EECA only

The seminar became a platform for a dialogue between representatives of governments, international and non-governmental public organizations from Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Russia, Uzbekistan and interested regional partners.

Extraordinary and Plenipotentiary Ambassador of the Kingdom of the Netherlands to the Republic of Kazakhstan, the Kyrgyz Republic and the Republic of Tajikistan Dirk Jan Kop

“The incidence of HIV is predominantly stabilizing around the world. Even if the indicators are very high, they do not grow. However, in Central Asia and Eastern Europe (EECA), HIV incidence is increasing. HIV is not a problem of marginalized groups only. HIV is closer than you think. It must and can be stopped, also it must be stopped in Central Asia,” says Extraordinary and Plenipotentiary Ambassador of the Kingdom of the Netherlands in the Republic of Kazakhstan, the Kyrgyz Republic and the Republic of Tajikistan Dirk Jan Kop.

This concern was supported by all the participants after considering the situation, strategies used in different countries, best practices, main priorities for the effective response to the HIV epidemic among labor migrants.

The way HIV affects labor migration

Labor migration and HIV prevalence are increasing. This already became a stable trend of the region. There are numerous examples where migrant workers with HIV have no access to antiretroviral therapy in the places of temporary residence. Legislation of some countries provides for the deportation of foreign citizens with HIV. Migrant workers often experience stigma and discrimination.

UNFPA Regional Director for EECA countries Alanna Armitage

“Recent epidemiological surveillance data in Uzbekistan and Tajikistan have shown that the prevalence of HIV among people returning from labor migration is 2-4 times higher than among the general population. Migrant workers from Central Asian countries face serious challenges in access to the full information and adequate HIV prevention, care and treatment services,” said UNFPA Regional Director for EECA countries Alanna Armitage.

Experts unanimously admit that better access to HIV prevention and treatment in Central Asian countries is the key to elimination of the HIV epidemic.

Aid for migrants with HIV started in Kazakhstan

In 2018, HIV-positive migrants in Kazakhstan begin to receive aid with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Treatment and laboratory testing will be provided to 150 people.

“Kazakhstan is a country with a low HIV prevalence. Last year, more than 16,000 foreigners were tested for HIV. 0.2% HIV cases were found. If we take the vulnerable groups only, this figure among foreigners will reach nine percent,” says the vice-minister of health of the Republic of Kazakhstan Lyazzat Aktayeva.

In a country where migrants with HIV do not have to be deported, 61 thousand people were tested. This is a heavy burden on the national budget. So far, migrant workers have no legal status and opportunities to receive even a minimal medical service are very limited. Therefore, we need new strategies for working with this category of the population and not only within a single country.

First shot in the battle

The participants called the seminar the first shot in the battle for an overall strategy for the prevention, diagnosis, and treatment of migrants in the post-Soviet space. The creation of a special structure located in Russia as the biggest receiving country of migrant workers was approved to regulate this process.

Recommendations of the seminar will be presented for discussions at the forthcoming international conferences on HIV/AIDS, which will take place this year: The VI International AIDS Conference for Eastern Europe and Central Asia (April, Moscow) and 22nd International AIDS Conference AIDS 2018 (July, Amsterdam).

Happy with HIV in Tajikistan

Tajik wedding. Source: wikimedia.org

Author: Nargis Hamrabaeva, Tajikistan

A Tadjik girl Nozanin was diagnosed with HIV after her husband-migrant returned home a few years ago. As the man has found it out, he walked out on her… Now the 40-year-old woman is happily married again.

Everything was like a fairy tale

“It happened unexpectedly, like in a fairy tale. Once I was taking care of the household, when my friend, who liked me, called. He said that he would come with a mullah (a clergyman conducting the wedding ceremony according to the Muslim canons – editor’s note) and some of our colleagues. They really came. After the religious wedding ceremony, we went to his parents,” Nozanin is saying.

This friend turned out to be a client of the Republican Network of Women Living with HIV, where Nozanin has been working. He was also HIV positive. He wanted to marry a woman with the same status and Nozanin somehow even tried to find him a suitable candidate. It turned out that the man was already in love with her…

“I never thought that I could ever get married again, especially having HIV status,” she says.

Today Nozanin considers herself to be a happy woman. Together with her husband they have a lot of plans and ideas, and they also want to give birth to a healthy child. Many couples living with HIV have the same desire.

A marriage contract is not needed

700 people in Tajikistan receive support from the Republican Network of Women Living with HIV. For the most part, these are young people who want to start a happy family.

Tahmina Haydarova, the head of the network, says that young men between the ages of 18 and 35 come to them searching for a soulmate with the same HIV status. Often these are labor migrants, former drug users or prisoners who have never been married before. Brides are usually those who have already been married. These women contracted the virus from a migrant husband or partner who used drugs.

Such brides do not ask to sign a marriage contract; they do not ask for an apartment or dacha. The most important thing for them is the timely use of antiretroviral therapy by their future spouse and a healthy life.

HIV is not a barrier

Each year the Republican Network of Women Living with HIV helps at least 5-6 young HIV positive people to find their spouses. Takhmina Haydarova is telling about 10 couples who decided to start a family with the fact that one of the spouses is HIV positive.

“If a person loves and accepts you for who you are, then HIV is not an obstacle to start a family. Today antiretroviral drugs that block the HIV are available. A person living with HIV with a suppressed viral load can start a family, give birth to a healthy child, live a full and happy life the way our clients do,” she says.

According to the Republican AIDS Center, the total number of HIV positive citizens in Tajikistan has reached 10 thousand people, one third of them are women. Since 2004, women with HIV have given birth to 1,000 children, 600 of these children have no HIV.

Spices – New Threat for the Tajik Youth

Photo source: http://brosaem.info

Author: Nargis Hamrabaeva, Tajikistan

While several years ago Tajikistan was concerned with young people being into opiates and stronger synthetic drugs, today there are concerns about the new-generation drugs – so-called spices.

Spicy naswar

The official reports of law enforcement agencies fail to contain any data on the seizure of spices. However, a quick survey among the young people showed that those smoking blends have long been popular in the country.

Spices are the smoking blends, which contain dry herbs and roots. The dried components themselves are not dangerous, but to make the smokers feel a more intense euphoria, the producers add cannabinoids, which are strong narcotic substances. 

“For what I know, earlier spices were distributed in the nightclubs, but now they are mostly sold in the internet and through the grapevine. I also heard that sometimes naswar – the type of smokeless tobacco typical for Central Asia, containing tobacco and alkali (hydrated lime), which is popular among many local people – is processed in the same way as the spices,” says Aziz, a student from Dushanbe.

“Rich kids” having fun

Our anonymous respondent who has 20 years of experience working at law enforcement agencies said that it would not be right to say that young people in Tajikistan are addicted to spices, but this threat should not be disregarded.

“Yes, spices can be easily accessed, but their price is higher than the price of marijuana which young people have traditionally been smoking and continue smoking now. After the heroin “rush” at the turn of the century, many people who use drugs have been massively switching to marijuana and opiates. They strongly believe that marijuana is not more harmful than cigarettes,” he says.

According to him, spices are mostly used in nightclubs by those, who have enough money for it – the so-called “rich kids.”

“They think that spices do not cause addiction and that they can quit using them whenever they want as opposed to opiates and heroin,” says the law enforcer.

Spices do not have the euphoric effects they used to

However, Dr. Mahmadrahim Malakhov who studied the sociocultural aspects of the substance use in Tajikistan, says that the dependence develops much quicker when using spices than when using natural marijuana.

Meanwhile, the exact number of people who use drugs in Tajikistan is not known. Doctors say that few people who use drugs seek medical assistance when they want to quit. They are the ones who are included in the official statistics, which shows that there are a little more than 7 thousand people who use drugs in the country.

Last year, Tajik law enforcers seized about 4.5 tons of narcotic drugs, which is 29.8% more than the year before.

“In particular, 110 kg of heroin, 1.2 tons of raw opium, 2.4 tons of hashish and 742 kg of cannabis drugs were seized. The offences of 52 criminal groups consisting of 115 individuals were investigated and terminated, including five organized transnational groups,” said Murtazo Khaidarzoda, Deputy Head of the Drug Control Agency of the Republic of Tajikistan at the press conference.