About Us with Us Only: Russian Specialists to Attend AIDS 2018

Author: Anastasiya Petrova, Russia

February 5th 2018 was the deadline for submission of abstracts for the 22nd International AIDS Conference (AIDS 2018). One of the key issues during AIDS 2018 will be the discussion of the response to the HIV epidemic in Eastern Europe and Central Asia (EECA) countries. Below you can see the expectations from experts and representatives from Russian NGOs who have submitted their applications for the Conference.

Yevgeniy Pisemsky

Yevgeniy Pisemsky, HIV and LGBT activist, Head of Organisation PHOENIX PLUS, Person of the Year according to Winq magazine

About the organisation

Our organisation has been active for 11 years now. The main area of activity of Phoenix Plus is support, care and prevention for MSM in relation to HIV. We also support expanding of service centres and fulfillment of human rights.

What the AIDS Conference means for me

In general, I have a positive history with AIDS Conferences. I have visited four. When I came to my first conference in Thailand, I saw a tremendous community of professionals, however, I did not feel myself part of their camp. At that time, the AIDS Conference stimulated my ambitions and I made a resolution to move forward and get something done. So we did – the conference in Mexico City was opened by the fellows from my organisation. This was such an honour! I sat there, in the middle of the conference hall, and cried remembering how it all started.

At the conference in Vienna, I met Elton John AIDS Foundation representative for the first time. Seven years passed and we are still working together. They are our main partners. This is also a result of such conferences. A conference for me is most importantly a possibility to start new acquaintances, form joint plans, and only then acquire knowledge about new technologies and innovations.

My expectations from AIDS 2018

It is very important that at the conference in Amsterdam an attempt to focus attention on EECA region, where HIV situation is worse than in Africa will be made. I would like to share success stories about what we did in Russia on self-testing and learn something new from others. I have prepared an abstract and hope to deliver an oral presentation. We will try to communicate that there are achievements in Russia as well.

Aleksey Mikhailov

Aleksey Mikhailov, Monitoring Division Manager at the International Treatment Preparedness Coalition in Eastern Europe and Central Asia, Patient Control Movement activist

About the organisation

Since 2010, we have been conducting monitoring of state procurement of ARV medications. At that time interruptions in the supply of HIV treatment medications began, and we tried to understand why that was happening. Following analysis of state procurement, we realized where interruptions come from and undertook attempts to change the situation.

What the AIDS Conference means for me

I have never been to AIDS Conferences before, this one will be my first. Since the situation with AIDS in the EECA region is currently one of the most challenging epidemiological situations in the world, the AIDS Conference is a great opportunity to put problems of the region into focus. At the same time, it is also an opportunity to discover world trends and implement them in the Russian Federation. This is probably more related to prevention, as our country has its own way of optimizing treatment.

My expectations from AIDS 2018

It is my hope that the organisers will place greater emphasis on what is going on in Russia, Ukraine and other EECA countries. Today we stand at the threshold of a revolution in treatment. Soon we will have prolonged-release medication forms. Development of enhanced dolutegravir, which can be taken once a month, is in progress. It would be vital to learn about similar research, which is for sure to be presented at the AIDS Conference.

Irina Maslova

Irina Maslova, Leader of Silver Rose – Sex Workers’ Rights Movement, CEO of Astra Charitable Women’s Foundation

About the organisation

My official position is Chief Executive Officer of Astra Foundation, where we deal with HIV prevention among women and access to HIV related services. From this position, I am able to communicate with the government from the public healthcare perspective. At the same time, I lead Silver Rose – the movement of sex workers and their supporters, which is not registered but is fighting violence and HIV spread within this vulnerable group. In the past three years, we have done a lot to reverse article 6.11 that criminalizes sex work and to improve the situation for sex workers in our country.

What the AIDS Conference means for me

AIDS Conference for me is a possibility to meet new people. It is vital for experienced specialists to be able to pass their best practices on to those who follow. We have submitted two abstracts to this Conference. The first one is based on the research conducted jointly with Trans-regional NGO Positive Dialogue and AFEW International and related to violence as an obstacle to access to prevention programmes. The second one is on analysis of a project within the framework of co-funding to the main programme of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The uniqueness of this project is that we have managed to reach the 90/90/90 goal. It would be great to share that experience.

My expectations from AIDS 2018

Today we need to talk about bringing the main donors back to Russia. The Global Fund is shutting down its operation in the country, and the government does not finance work with key groups and will not do so while sex work remains to be criminalized. Until the government starts working with this target group, sexual transmission rate will keep growing. In order for the projects for key groups to be effective, we need continuity and that is impossible without funding.

Maria Yakovleva

Maria Yakovleva, HIV activist, Director of Candle Charitable Foundation

About the organisation

We are a self-organization of people living with HIV established in 2004. We provide direct services to vulnerable groups, however currently this activity is being carried out outside projects. We provide equal counselling, social support, as well as first-aid kit and a hotline. The Foundation also provides technical assistance for the Global Fund Coordination Board Secretariat.

What the AIDS Conference means for me

I attended the previous AIDS Conference in South Africa and that was my first International Conference. I was lost at first and only towards the end gained an understanding of how all the resources could be utilized. During the first several days I just walked around open-mouthed at the amount of communication, new information and acquaintances with representatives from organisations around the world. During the previous conference I got acquainted with professionals in AIDS services – representatives of influential organisations in our domain. I really want to go to AIDS2018. The possibility of sharing the information about what is going on in Russia is also very vital. I believe that speaking about your position is also a way of impacting the situation in the country.

My expectations from AIDS 2018

The focus of the upcoming AIDS Conference is EECA region, so the problems to be addressed there will be much closer to us. I hope there will be donors interested in projects in our region. We are also eager to find ground for dialogue with decision-makers.

HIV Risks Grow in Kazakhstan

The number of new HIV cases in Kazakhstan is still growing

Author: Marina Maximova, Kazakhstan

In Kazakhstan, the key alarming trend of the recent years is the growing sexual transmission of HIV. Before, most people in Kazakhstan contracted HIV when sharing injecting equipment, but now most infections are transmitted through sexual contacts.

A commonplace story

Zhaniya (the name is changed) learned about her positive HIV status when she got pregnant and went to the maternity clinic for the medical check-up. She got tested and could not believe her eyes when she saw the test result as she never used drugs and her husband was her first and only man. Repeated testing confirmed the positive result. The woman was afraid to tell her husband and family about her status, feeling scared, ashamed, hurt and confused. She could not remain silent either as any news are spread quickly in her village, let alone bad news. The conversation with her husband made it all clear.

“He confessed that he used to inject drugs. It was long ago, when he was still very young. Now he is sorry about that and wants to have a family and children. My husband also got tested for HIV and his result was positive too. He did not know about his disease and did not want to infect me. Now the main thing is for our baby to be born healthy. Doctors say that it is possible,” says Zhaniya.

In Kazakhstan, 99% of pregnant women living with HIV give birth to healthy children. These women often give birth to two or even three children. In the recent decade, the rate of mother-to-child transmission of HIV dropped four times.

Taking into the account the achievements of the national AIDS service, the stories of Zhaniya and other women living with HIV sound commonplace. The face of the epidemic is becoming more and more female. If earlier mostly men got infected with HIV, now the gender proportion looks more equal. The statistics is illustrated by the following trend: most men rarely go to clinics or make appointments with doctors. Women take more care of their health in general, while pregnant women twice get tested for HIV free of charge.

No sexual education in schools

Natalia Rudokvas, Director of the Answer Charitable Foundation

Another problem contributing to the increased risks of HIV is lack of relevant educational programs in schools and colleges. High school and college students have no access to the information about the routes of HIV transmission and ways to protect themselves at special classes or lectures. There are no guidelines or instructions for educators on this topic. In families, where the topic of sex is a taboo due to the peculiarities of local mentality, children fail to get any information or advice from their parents.

“When our activists make attempts to offer school lectures on the safer sex – we are told we cannot do it. For some reason, promotion of condoms and other contraceptives is considered equal to… debauchery. People blame us, saying that this is what our presentations cause,” tells Natalia Rudokvas, Director of the Answer Charitable Foundation from Ust-Kamenogorsk. She is puzzled with such attitude and hopes that this crucial topic will be discussed at the upcoming 22nd International AIDS Conference AIDS 2018.

Lack of any systematic sexuality education in past years loudly echoes today. Natalia says that people over 30 years of age more and more often seek counselling at their charitable foundation. While young people injecting drugs regularly get tested for HIV and fall under control of the health professionals, older people with “forgotten” histories of drug use stay in the shadow.

The epidemic is growing older

Baurzhan Bayserkin, General Director of the Republican AIDS Centre at the Ministry of Health of Kazakhstan

Several years ago, mostly young people aged 20-29 got infected with HIV in Kazakhstan. Now the age threshold went up to 30-39 years old. Most people got infected twelve or more months ago, and only 10% of the patients were infected within the recent nine months.

“The data received became the ground to carry out an additional epidemiological survey to determine the network of contacts and expand the list of potential risks of infection. High proportion of people who got infected long time ago demonstrates that people have low concerns about contracting HIV. The new approach shows the real picture of the morbidity and allows evaluating the efficiency of prevention measures,” sums up Baurzhan Bayserkin, General Director of the Republican AIDS Centre at the Ministry of Health of Kazakhstan.

The number of new HIV cases in Kazakhstan is still growing. As of today, there are about 29,000 of Kazakhstani and about 2,000 of foreign citizens living with HIV in Kazakhstan.

 

Georgia: Problems under the Tip of the Iceberg

Lasha Tvaliashvili, the Executive Director of Organization of PLHIV Real People, Real Vision

Author: Irma Kakhurashvili, Georgia

A middle-aged man comes into a dental clinic and explains to the dentist that he is HIV-positive. The dentist refuses to treat the patient. Under the rules, the doctor must sterilize all instruments and the patient is not obligated to inform about the diagnosis, but the patient is being honest and is ‘punished’ by the dentist for it. The man asks the doctor what he is to do, where to turn. The doctor’s response is that it is none of his concern. The dentist is not aware he is being recorded with a hidden camera…

As reported by the Infectious Diseases, AIDS and Clinical Immunology Research Centre, around 600 to 700 new HIV cases are registered in Georgia annually. Although every citizen is able to receive publicly-funded free treatment, this is insufficient to end HIV. NGO Real People, Real Vision is a member of East Europe and Central Asia Union of People Living with HIV (PLHIV), which has implemented interesting projects on prevention, support and mobilization of people involved in HIV treatment. Discrimination and stigmatisation of HIV-positive people is just one of the problems obstructing prevention of HIV epidemic in Georgia. This and other topics are part of our conversation with Lasha Tvaliashvili, the initiator of multiple video-experiments and the Executive Director of Organization of PLHIV Real People, Real Vision.

Lasha, in your opinion, what is the greatest achievement in the field of HIV/AIDS treatment?

– For instance, the fact that during the past two years there has not been a single case of mother-to-child transmission. This is a result of daily efforts of the AIDS Centre, which does not even have its own building. The Centre operates under critical conditions, resulting in serious violations of rights of patients and medical staff, violation of sanitary, epidemiological and other norms. There is not enough space where an HIV-positive person could receive all services. There can be no talk of anonymity when there is one office where two physicians are seeing two patients at the same time. Government entities promised to allocate premises to the Centre but never did. Such attitude puts the existence of this strategic medical facility into question.

Is late testing the main reason for the increase in the number of new cases? Is that the only reason?

– Many patients come to the Centre already with clearly marked symptoms. Of course, timely testing followed by therapy would have protected them from various illnesses. However, lack of awareness among the population is not the only reason; it also concerns approaches of medical staff. I still hear stories about doctors, who keep treating patients for various illnesses for years, and it does not occur to them to refer patients for HIV testing.

Nevertheless, there has been a positive trend. When friends and family find out about the status of a close person, they treat that person with more sympathy than it used to be in the past. However, I am puzzled at the situation with medical staff, when sizeable finances are invested in their education… The level of discrimination and stigmatisation is high in Georgia. Several days ago, one of the micro-lending organizations requested HIV test results from its employees. Should the test be positive, the employee must leave, which is a direct stigma. Regular work at the office with zero risk of HIV transmission shall not be equivalent to cruel treatment of people.

– What stands in the way of defending rights of patients who have lost their jobs?

– The patients themselves. At first, the discriminated person feels insulted, but then emotions quiet down and he or she refuses to continue the argument in a courtroom. People are afraid of publicity of their positive status. They are not sure they will continue on living peacefully. They are afraid of complicating their public position. For reasons above, such precedents are not made public, thus increasing discrimination.

What is your view on treatment availability in Georgia from geographic standpoint?

– HIV/AIDS more frequently occur in socially lower-standing population segments. These people often live in regions without AIDS Centres. For instance, patients from Samtskhe–Javakheti region go to Tbilisi for medications once a month. The same is also true for a huge region of Kakheti, Guria, Racha, and Svaneti. Treatment must be continuous, and every month patients travel long distances. It is harder in winter when roads in mountainous areas are closed. AIDS Centres are located in big cities only – Tbilisi, Kutaisi, Zugdidi and Batumi.

Please share your experience about the lowest-budget but effective project.

– In 2012-2013, we had a project that saved 300 patients. Throughout the year our activists were on duty at the AIDS Centre. During registration of new cases, when patients were most shocked at the test results, our activists tried to explain in a non-medical language about HIV/AIDS, and further assisted in the course of treatment. Throughout the year 10% of patients diagnosed with AIDS did not return to the Centre. The project objective was not to lose those 10%. The project budget was 10 thousand US Dollars, but above that, we have found a lot of like-minded fellows and friends, some of whom even got married. This project was implemented jointly with the HIV/AIDS Patients’ Support Foundation. Currently, we are thinking about a new project – psychological and moral support for those convicted persons, who found out about their status in prison. I am confident this will be a humane and successful project.

In Kyrgyzstan, Fines for Drug-Related Offences will Grow 30-Fold

Street lawyers of the Ranar Foundation provide legal counselling to people who use drugs

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan has adopted new legislation on drug-related crimes. Amendments have been introduced into a number of national legal codes within the broad judiciary reform in the country. The amendments will come into force starting from 2019. Initiators of the reform declare the ideas of humanisation and decriminalisation, but the practitioners and the community expect an opposite outcome.

Unaffordable fines or imprisonment

Aybek (the name is changed) has recently been released from jail. He spent three years behind the bars for 3.5 grams of hashish, which he bought for his own use.

“In 2014, Aybek was caught with drugs and was told to pay a fine of 30,000 Kyrgyz Soms (375 euros) and was let go. Soon, he was seized again for a similar offence. The fine was left in force and in addition, Aybek was sentenced to three years of imprisonment,” the street lawyer of the Ranar Foundation Denis Kucheryaviyis telling. “Now Aybek lives in our social dormitory. He has no passport and he has no job. During his years in prison, he was able to pay only 30% of the fine. He has been told he cannot get his passport unless he pays the whole sum. How can he find a job with no documents? Recently, we learned that he was put on a wanted list due to his failure to pay the fine, so now he faces the threat of imprisonment again.”

According to the Criminal Code currently in force, possession of drugs with no intent to sell in big amounts exceeding one gram for heroin and three grams for hashish is now punished with a fine of 250 to 650 euros or with imprisonment for a term of up to five years. In the new Criminal Code, the fines will be increased up to 3,250-3,750 euros.

“There will be a huge increase in fines. The minimum fine will be 3,250 euros. Will a person injecting drugs be able to pay such a sum at least once in his life?” asks Sergey Bessonov, Executive Director of the Harm Reduction Network Association. “An alternative to paying the fine is deprivation of liberty for up to five years, though the fine will not “disappear” completely and will only move to another category of 1,250-1,750 euros. Now Aybek does not know how to pay 375 euros, and starting from 2019 people will be released after years in prison with fines, which will be 3-5 times higher.”

Humanisation or criminalisation

Fines for the small amounts of drugs (up to 1 gram of heroin and up to 3 grams of hashish) will also be increased. The administrative fine will grow 30-fold: from 12-25 euros to 370-750 euros.

Sergey Bessonov: “We need alternative punitive measures and effective treatment programmes”

“The punishment for the small amounts of drugs will be toughened in the Code of Administrative Offences depending on the number of similar offences during a year. For the first offence, the fine will amount to 2,000 Kyrgyz Soms (23 euros); for the second offence, an administrative arrest for five days will be applied; for the third offence, the fine will amount to 650 euros. In the new Code of Offences, the punishment will not be toughened and there will be no criminal record. Probably this is what the humanisation is about,” assumes Sergey Bessonov. “However, if we look at the practice, most people are seized with the amount of heroin 1.2 -1.5 g which is considered to be a big amount and falls under provisions of the Criminal Code. After the fines are increased, there is a probability that the number of people seized with small amounts of drugs will be growing. The worst thing is that violation of the Code of Offences may also lead to the imprisonment in case if the fine is not paid on time. A person will have two months to pay 370 euros. After this term, the fine will be doubled and the payment period will be extended by one more month. After this month is over, if the fine is still not paid, article 351 of the Criminal Code will come into force meaning from 2.5 to 5 years of imprisonment.”

Currently, Sergey Bessonov and the lawyers of his organisation desperately fight not only for Aybek to stay free, but also to change the legislative amendments proposed. They are due to come into force in one year so there is still a chance to collect evidence that such amendments will lead to the criminalisation of people who use drugs.

“Introducing heavy fines may lead to the growth of corruption practices and increase in the number of prison population, which will have a negative impact on the national budget. Now we are making attempts to show the evidence of all the risks to people developing the new codes,” says Sergey Bessonov. “We need alternative punitive measures and effective treatment programmes. Members of the community were not able to take part in the development of the new codes, but we hope that our voices will be heard. We are doing our best at the national level and we also plan to tell about the recent developments in the drug policy to the international community at AIDS 2018 Conference.”

Methadone Breakthrough: Ukraine to Independently Purchase Opioid Substitution Therapy

Patient receiving OST at Kremenchug drug treatment centre, Poltava region Source: kremenchug.ua

Author: Yana Kazmirenko, Ukraine

From 2018, opioid substitution therapy (OST) programme in Ukraine is financed by the Government. Activists are asking international organizations for a backup to prevent disruptions in the supply of life-saving medications.

The Government of Ukraine plans to independently procure substitution therapy programme medications in 2018. According to the World Health Organization (WHO), over 10 thousand people received therapy last year at 178 institutions throughout the country. It is planned to double the number of patients in 2018.

Ukraine wants to beat HIV

Ukraine can be proud of its implementation of OST because this is the largest-scale coverage programme in Eastern Europe and Central Asia. Since 2005, the programme to substitute opioids with methadone or buprenorphine was financed by the Global Fund. Patients under the care of a physician received syrup or pills.

“This is a major milestone for public health care in Ukraine,” says WHO representative Martin Donoghue. “For many years WHO and partners have worked with the Government and opioid substitution therapy received the endorsement and comprehensive financial support. This attests to the fact that Ukraine wants to beat HIV.”

People who inject drugs belong to key groups who are most at risk of HIV and its transmission. The numbers are a confirmation: HIV was diagnosed for 42% among OST programme participants in Ukraine, and 21.3% of new HIV cases account for the transmission through injecting drug use. Sexual transmission still remains to be the main way of transmission – 63.9%.

Financing doubts remain

WHO recommendations indicate that to control HIV/AIDS spread among people who inject drugs 20 thousand people shall receive therapy. Ukraine intends to reach these numbers by the end of 2018.

According to Director of charitable organization Meridian and Executive Director of All-Ukrainian union of people with drug addiction VOLNA Oleg Dymaretskiy, there are 368 thousand injecting drug users in the country. The majority uses several types of drugs, including medications from pharmacies. The activist has doubts regarding the timely supply of OST medications by the Government.

“I do not believe that transition to Government financing will be fully implemented in 2018. 13 mln. Ukrainian Hryvnyas a year ago were allocated for medications for 9.6 thousand patients, but they reached them only in December 2017,” says Dymaretskiy.

NGOs requested the Global Fund to back up the supply of medications, and, according to Dymaretskiy, received a positive response. To double the number of patients, the activist suggests increasing the number of OST offices along with prescribing therapy at the level of district poly-clinics.

OST will reach prisons

Our colleague told us about another initiative of VOLNA union – start-up of a programme on continuous treatment at institutions of detention, which will include detoxification and prescription of substitution therapy. Two thousand people withdraw from OST programme every year, one in ten – due to serving a sentence in prison.

“Substitution therapy changes lives of people who use drugs. It is the first step and acknowledgment: it is beyond my power to cope with addiction, but I will change the quality of living,” summarizes Dymaretskiy.

AIDS 2018 Abstract Support for EECA: 100 Abstracts Submitted

Almost 100 researchers from Eastern Europe and Central Asia (EECA) have received mentorship and expert support through the mentorship program that was established by AFEW International together with Amsterdam Youth Force and Eurasian Harm Reduction Association (EHRA). Applicants for XXII International AIDS Conference have received support with editing, translating, and structuring their work according to the abstract requirements. Out of 100 abstracts got by the expert team, 70 received support with formatting and editing and 30 have received an additional language support (full translation into English.)

The mentorship program was developed to enhance the quality and increase submission chances for the applicants from EECA. Within the program, applicants had an opportunity to consult with experts before submitting their abstracts to the Conference Committee. AFEW International is expressing a big gratitude to the experts who were reviewing the abstracts of the EECA applicants.

“The importance of this mentorship can hardly be overestimated. We were able to significantly increase submissions from the region of Eastern Europe and Central Asia,” AFEW’s project manager Daria Alexeeva is saying. “We are excited to see the fruits of this collaboration both in form of submitted abstracts but also in form of something that is hardly quantifiable: expertise that our applicants have gained in the area of scientific writing for international events. The very communication with and guidance of the mentors was an enormous capacity building exercise for our applicants. They have trained putting their entire research projects into a concise form of an abstract of 350 words. We are confident that this training will lead to more high-quality research from EECA in the future.”

The board panel of experts consisted of:

Anna Szczegielniak, Youth Coalition

Catriona Ester, independent consultant

Chris Obermeyer, Fulbright Public Policy Fellow, Ministry of Health of Ukraine, Public Health Center

Daniel Kashnitsky, Eurasian Harm Reduction Association (EHRA)

Eliza Kurcevic, Eurasian Harm Reduction Association (EHRA)

Gayane Arustamyan, Eurasian Harm Reduction Association (EHRA)

Gennady Roshchupkin, Eurasian Coalition on Men’s Health (ECOM)

Jill Owczarzak, John Hopkins Bloomberg School of Public Health in Baltimore

Julian Hows, Development Research Advocacy Governance (DRAG)

Katherine Kooij, National Institute for Public Health and the Environment (RIVM), the Netherlands

Lela Serebryakova, Eurasian Harm Reduction Association (EHRA)

Mariam Uberi, BEARR Trust

Roman Ivasiy, All-Ukrainian Charitable Organization FULCRUM

Ulla Pape, University of Bremen

Heather Stacey, Stand International

Janet Gunn, BEARR Trust

Michael Rasell, BEARR Trust

Karen Kraan, Flowz

Anna Sarang, Andrey Rylkov Foundation for Health and Social Justice

Alexandra Volgina, GNP+

AIDS 2018 Early Programme Preview

In addition to a strong abstract-driven programme, the 22nd International AIDS Conference (AIDS 2018) will offer symposia, workshops and interactive sessions developed by an international committee of HIV scientists, global leaders, policy makers, researchers and advocates.

Here is a first glimpse of what you can expect in Amsterdam, which you can also browse in our preview of the conference programme. See an overview of the early programme preview below.

Improving treatment and care outcomes

  • Updates on ART options and outcomes, with a particular focus on treatment across the lifespan and in key and vulnerable populations.
  • Addressing NCDs in resource-limited settings.
  • Presenting new data on co-infections and looking at old, and new, threats in infectious diseases in the context of HIV.

The future of prevention

  • Exploring different perspectives on why combination prevention, while highly effective, is not available in many settings.
  • Understanding key population community-led health services (KP-CLHS) as an effective tool in the prevention toolbox.
  • Exploring the future of PrEP as part of combination prevention, taking into account funding concerns, uncertain treatment access for many people, lessons learned to date regarding PrEP implementation, and design issues for future trials.

Understanding HIV pathogenesis

  • State-of-the-art updates on broadly neutralizing antibodies (bNabs) and their use in the development of a potential vaccine and a cure.
  • Understanding HIV persistence and community participation as keys to developing a cure for HIV, long-term remission off ART.
  • Opportunities to tackle the virus at the moment of transmission, recruit the host and manipulate the environment in the fight to end HIV transmission.

Key and vulnerable populations

  • The evolving landscape of drugs, drug policy and harm reduction in the context of rising HIV transmission and political resistance.
  • Empowering young people to access services and make healthier choices through comprehensive sexuality education (CSE).
  • Training implementers to play an active role in changing gender norms.

Insights-driven programming

  • New approaches to using big data to strengthen national HIV responses and deliver improved and effective focused programming.
  • How new innovative approaches to big data allow us to better reach the right audience with the right intervention.
  • Exploring ethical issues in the use of state-of-the-art methodologies and interventions to tailor interventions to local populations.

Under prioritized epidemics

  • Advancing human rights and legal reforms with a focus on sexual minorities, prisoners, people who use drugs and transgender people in Eastern Europe and Central Asia.
  • New approaches on how to address the needs of children and adolescents living with HIV from Ukraine, featuring perspectives by healthcare providers and policy makers.
  • Insights on political leadership to advocating for the needs of vulnerable communities, with country examples including Kyrgyzstan and Senegal.

Source: AIDS 2018

Blind Response: Experts Offer Different HIV Estimates in Russia

National campaign: HIV testing in a train carriage, 2017

Author: Anastasia Petrova, Russia

According to the UNAIDS, Russia ranks third based on the rate of the new HIV cases in the world after South Africa and Nigeria. However, there are inconsistencies in the data on HIV incidence dynamics in the country provided by different offices.

Mixed opinions

In May 2017, it became clear that there are some discrepancies in the data on the growth rate of new HIV cases in Russia presented by different government offices. Comparing statistics for the previous years, Veronika Skvortsova, Russian Minister of Health announced that in 2016 HIV incidence dropped down twofold.

“We had the total of 86.8 thousand new cases of HIV, while a year ago, in 2015, there were over 100 thousand. Thus, the number of HIV cases fell down by 15%,” said Veronika Skvortsova.

However, Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre presented different data, which, vice versa, demonstrate a growing number of HIV cases in the country. The scientist told about the growth of HIV incidence by 5.3%. According to the recent data of the Russian Federal AIDS Centre presented shortly before the World AIDS Day, in the first 10 months of 2017 regional AIDS centres reported 79,075 new cases of HIV. This is 2.9% more than during the same period of 2016. This data shows the continuing growing trend in HIV incidence.

Such discrepancies became visible to the public, so the Ministry of Health offered relevant explanations on its official website. In the article dated 17 May 2017, it is written that “in his report, Dr. Pokrovskiy presents the results of scientific epidemiological monitoring of the Institute of Epidemiology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) based on the positive laboratory tests for HIV and not the statistical data on HIV incidence for the previous year. The incidence, however, shows the number of people with the confirmed diagnosis (not the number of laboratory tests).”

Thus, according to the Ministry of Health, the calculation method used by Rospotrebnadzor is less accurate considering that one person tested for HIV several times is calculated as several new cases. Some experts, however, say that both statistical approaches may be used as there is a growth of the HIV incidence in the country, but the rate of such growth is decreasing.

“Positive” statistics

Veronika Skvortsova, the Russian Minister of Health

The data on the total number of people living with HIV in Russia is also not quite clear. The Rospotrebnadzor report mentioned above states that as of 1 November 2017 there were 924,608 Russian citizens living with HIV. As for the Ministry of Health data, we have not received any reply to our official request on the number of people living with HIV as of the date of this article. The Ministry fails to submit such data to the UNAIDS to prepare annual reports on the HIV epidemic in the region.

However, some data suggest that the number of people living with HIV in Russia is much higher. Thus, 25,000 Russian citizens were tested in the course of the famous free anonymous testing campaign run by the Ministry of Health in a train carriage, which was held from 7 July to 28 October 2017. Out of them, 375 results were positive. If such statistics is extended to the general population, up to 1.5% of people in Russia may be diagnosed with HIV.

Creating a register

Experts say that the country needs an accurate estimate of the number of people living with HIV.

“The first and the most important goal is to understand the situation and have full information on the number of people living with HIV, the treatment regimens they use and the need in medicines,” says Sergey Krayevoy, Deputy Minister of Health.

It is planned to introduce a Federal Register of People Living with HIV in Russia to analyse the scope of medicines needed and to systematize the statistics. Such database will be administered by the Ministry of Health. Apart from the diagnosis, records will also be made on the health state of the patients, medicines prescribed to them and other data allowing to see the full picture of their health. Thanks to such register, a person relocating within the country will be able to get help in any region.

In Kyrgyzstan, the New Year Started with Reduced Funding for the HIV Response

Author: Olga Ochneva, Kyrgyzstan

Since January 2018, HIV and tuberculosis programmes in Kyrgyzstan are funded from the new, significantly reduced grant of the Global Fund. There were six months of discussions concerning cost optimization and reduction, taking into account the growing deficit of funds that the country is facing in the nearest three years. The cost-saving mode has already been introduced, first of all affecting the prevention programmes.

Services and coverage are retained

In 2018-2020, Kyrgyzstan will receive 23.4 million US dollars for HIV and tuberculosis response from the Global Fund. For the reference, the previous Global Fund grant stipulated allocation of 20.8 million US dollars for the period twice shorter. The country decided to cut the expenditures gradually. The first six-month cost-saving period started in January 2018. According to Oksana Katkalova, the representative of the UNDP country office, which administers the Global Fund grants in Kyrgyzstan, treatment and diagnostics have been defined as the priorities and prevention interventions have been significantly cut down due to the reduced number of partner organisations.

“The money will be mainly used to purchase anti-tuberculosis and antiretroviral medicines (antiretroviral therapy or ART is a method of HIV treatment) as the number of people who need treatment is growing,” says Oksana Katkalova, HIV Grant Coordinator, UNDP. “We try to retain the services and the coverage, while optimising and reducing the administrative costs.”

Since the beginning of the year, two methadone maintenance treatment (MMT) sites have been closed, with patients referred to the nearest sites. The MMT clients will no longer receive the community support of some non-governmental organisations (NGOs), which used to be financed by the Global Fund. The number of implementing NGOs which receive funding has been diminished. Two NGOs working with people living with HIV (PLWH) in Bishkek and Osh will not be funded, with their services being consolidated and handed over to the organisations, which still get the funding. In smaller towns, services for different key populations have also been consolidated.

“One organisation working with different key populations is quite a good option for smaller regions. It allows saving costs for administrative personnel,” explains Oksana Katkalova. “When in a small town there are two organisations, one working with sex workers and the other one – with people who inject drugs (PWID), each with a coverage of 100-200 people, it makes sense to consolidate those services in one organisation if there is a shortage of resources. Our implementing partners – NGOs – have been selected through tender procedures and now have set coverage indicators, which mostly have been raised. However, they can and should engage outreach workers and peer counsellors for different key populations to reach the required coverage.”

Gender component reduced

The number of needle and syringe exchange points (NSPs) has been reduced from 21 to 15. Two of them used to operate in NGOs as service delivery sites. One of such sites was located in the Asteria residential community centre for women who inject drugs, with the Global Fund grant partly covering rental, personal services (accommodation, laundry, shower, meals, and hygiene packages) as well as the package of basic prevention services and consultations of an STI doctor.

“Unfortunately, the gender component for women who inject drugs has been excluded from the Global Fund project: diagnostics and treatment of sexually transmitted infections, hygiene packages and personal services are no longer available,” tells Irena Yermolayeva, director of the Asteria Charitable Foundation. “The Soros Foundation-Kyrgyzstan and the AIDS Foundation East-West in Kyrgyzstan agreed to cover the rental costs and partly the services for six months. We are doing our best to retain our residential project.”

Two sites in each of the medical and penal systems were closed in 2018

Financial support of the four national networks has also been reduced. Now there will be one network promoting the rights and interests of all the key populations. Medical professionals working with PLWH also feel the shortage of funding. They receive benefits in addition to their salaries from the donor funds. Currently, the strategy of bonus reduction is continued, with shrinking resources, and the amount of the remaining benefits will depend on achieving the performance indicators. It is also planned to reduce payments to the medical personnel engaged in the MMT programme, but it is more complicated as in this case donor funds are the only source of financing. Just to remind that so far, the government has not allocated any money for the methadone maintenance treatment programme.

The programme aimed at the ART adherence improvement has also been cut. Before, all adherent patients used to get monthly motivation payments of 8 US dollars, while since January this year only children receive the allowances of about 14 US dollars, which are to be reduced by 2020.

By 2020, up to 30% of ART costs are to be covered by the state

The country will face even more funding cuts in the following two and a half years of project implementation. It is expected that four more MMT sites will be closed during this period. While in 2017, support within the Global Fund grant was provided to 26 NGOs, it is anticipated that by the end of 2020 only 10 of them will remain.

“So far, the smallest budget has been allocated for 2020 as it is planned that by this time the government will cover up to 30% of expenditures for the ART medicines; besides, we hope to have additional savings,” says Oksana Katkalova. “If during this period the government allocates significantly more funds, they can be used to purchase more ARTs, tests or, for example, to pay bonuses to the medical personnel engaged in HIV prevention, treatment, care and support programmes. Then we will be able to re-distribute part of the donor funds to cover prevention interventions. Every six months, we will adjust the expenditures for interventions and negotiate them in the format of a country dialogue. We hope that there will be a gradual increase in the scope of domestic funding.”

Roman Dudnik: “The HIV/TB CITIES Project led to a more open dialogue between NGOs and the municipality of Almaty”

Roman Dudnik, Executive Director of the Public Foundation AIDS Foundation East-West in Kazakhstan

Author: Marina Maximova, Kazakhstan

It has been a year since the project Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia (HIV/TB CITIES) has been operating in Almaty, Balti, Odesa, Sofia, and Tbilisi. Different countries, contexts, mentalities and different… results. Roman Dudnik, Executive Director of the Public Foundation AIDS Foundation East-West in Kazakhstan is telling about the project implementation in Almaty, Kazakhstan.

– Roman, one of the results of project implementation is a major and important outcome not only for the city, but also for Kazakhstan in general – the Almaty akimat (regional executive body in Kazakhstan editor’s note) has signed the Paris Declaration. That is a high standard. Do you manage to keep up with it?

– In summer 2017, Almaty became the first city in Central Asia joining the Paris Declaration to end the AIDS epidemic. It is a crucial step for the city as along with Pavlodar, Karagandy and East Kazakhstan regions it has the highest rate of HIV prevalence in the republic. That is why we really need to take popular actions and measures, which will help us to draw attention to this problem and stop the growth of the HIV epidemic. The declaration was signed not only “for the record” as they say. There is an interest to this topic from the side of the municipality and it does not fade. Using this momentum, we hope to implement our project in the most effective way and make further, not less ambitions steps – develop an effective city model of HIV and tuberculosis (TB) response and increase the share of municipal funding allocated for the prevention programs among key populations.

– Do you feel any support from the side of government authorities? How tricky is the East?

– I worked in Russia for years and I saw the attitude of government officials to civil society organizations there… Fortunately, in Kazakhstan the situation is entirely different. I was even surprised that mazhilis (lower house of the Kazakhstan Parliament – editor’s note) deputies can meet with non-governmental organizations (NGOs) or people from akimat can refer to NGOs as their partners. If at first it seemed that akims (heads of the local executive bodies in Kazakhstan and Kyrgyzstan – editor’s note) are out of reach, and the topics of HIV and harm reduction are not their top priorities, the HIV/TB CITIES Project has changed the perception of priorities and significance of this issue, and it is not only my perspective. Here if people commit to something, they do it. Maybe they are not very loud and showy about it, but they surely reach good results. Several years ago, 18 confidential counseling points were opened in Almaty, where people can get tested for HIV and other diseases, receive relevant specialists’ consultations and awareness-raising materials or exchange syringes. Today they are already funded from the municipal budget and supported by the local authorities.

Public officials in Almaty are very busy people with a lot of things to take care of. Not all of them know about the scope of HIV problem, they do not have time for it. They need information and are grateful when they receive it, in particular from NGOs. In this chain, we became allies. The first achievement of the HIV/TB CITIES Project was the development of an order to create an HIV/TB City Task Force at the Health Department of Almaty. Here an order is equal to a law: it is strictly implemented and controlled. All meetings of the Task Force, which are held every quarter, are recorded, and its decisions are implemented with no time-consuming bureaucracy. One of the outcomes is that medical professionals now more actively attend training workshops on HIV prevention, stigma and discrimination, which are held by community leaders.

With the participants for the community platform “The city with no fences between people”

Roman, what are the other activities, which marked the first year of the Project implementation and what are you plans for the nearest future?

– With the support of Almaty AIDS Centre , an assessment was made of the HIV and TB situation and the needs of key groups. Through focus groups, the main factors were identified, which influence reducing the HIV morbidity in every key population. It will allow developing an effective model of response to the epidemic. A memorable event was the city community festival Art Energy Almaty. Work in Progress. Our community platform was called “The city with no fences between people.” It was the time when a lot of fences between buildings and near the roads were dismantled in Almaty to make the city more free and open. Our message – that the main fences usually exist between people, and we are the ones who can ruin them – got together people living with HIV, LGBT, people with drug use history and sex workers at our platform. It was the most popular platform. Our visitors liked listening to frank stories with open faces. We have already launched an operational research of the model stipulating low-threshold access to HIV testing and treatment for people who inject drugs. We plan introducing rapid oral HIV tests. Besides, preparations are in progress for the Almaty akimat to sign one more important document to demonstrate the political commitment to ending TB – the Zero TB Declaration.

Do you plan to take part in the XXII International AIDS Conference (AIDS 2018) in Amsterdam?

– Yes, of course. I am sure that this forum will become a platform for intensive knowledge sharing and discussing the efforts of governmental, non-governmental and international organisations in response to the HIV epidemic. We have got our messages and suggestions to come up with.