Red Ribbon Day kick-started the International AIDS Conference

King Willem Alexander and Queen Maxima attend the Red Ribbon Concert. Source: www.koninklijkhuis.nl

Author: Olesya Kravchuk, AFEW International

Red Ribbon Day on May 16 2018, was a kick-off to a summer focused on HIV/AIDS which culminates with the International AIDS Conference AIDS 2018 in Amsterdam, July 23-27. The events that took place during the day were aimed at raising awareness of the global AIDS epidemic, bringing people together and acknowledging the progress made in combatting the problem. Red ribbon symbolizes solidarity with people living with HIV and AIDS and was chosen as an appropriate symbol for this special day.

During the day, a “Youth Campaign Lab” was organized for youth volunteers to generate a youth-led campaign on HIV, AIDS, and SHRH. The event organized by Amsterdam Youth Force and Dance4Life turned out to be a huge success. Youth volunteers came up with brilliant ideas to raise awareness of the AIDS epidemic. At the end of the day, the ideas were presented to the Dutch princess Mabel Wisse Smit. Princess Mabel was very impressed by the creativity of the youth participants. She also stressed the importance of involving young people in solving the issue of the AIDS epidemic.

“HIV and AIDS are a huge problem among young people around the world. Of course, no one knows better how to reach young people than the young people themselves. The positive energy of these change makers was very enjoyable to see,” said princess Mabel.

The executive director of AFEW International Anke van Dam told the Queen of the Netherlands about the situation with HIV/AIDS in Eastern Europe and Central Asia

On the evening of May 16, King Willem Alexander and Queen Maxima attended the Red Ribbon Concert at AFAS Live in Amsterdam to draw attention to the persistent problem of the HIV epidemic. The concert was successful in gaining broad attention for the international AIDS response. The theme of the evening was: AIDS is not over… but it can be! It was a moment for the HIV/AIDS field and community to come together and to recognize the progress made in the fight. The concert was organized by the Dutch organizations collaborating on the AIDS2018 conference. And, it took place during the week of AIDS Memorial Day. The line-up brought together musicians and artists from across the world and from a variety of backgrounds to highlight the diversity.

At the concert, the Pop Up Aids-Expo was launched. The Royal Couple visited a pop-up expo prior to the concert to learn about the stories of people from all over the world who live with HIV. This mobile exhibition will travel through the country in the coming months. The concert and the exhibition are the preludes to the International AIDS Conference AIDS 2018 that will take place in Amsterdam this summer. The conference will bring together 20,000 people, including people living with HIV, AIDS activists, top international scientists and doctors.

AFEW on AIDS 2018: Session ‘AFEW Network’s experience in strengthening community, Monitoring and involvement in service delivery: From grassroot to policy level’

What: Session ‘AFEW Network’s experience in strengthening community, Monitoring and involvement in service delivery: From grassroot to policy level’

Where: Global Village, Eastern Europe and Central Asian Networking zone

When: July 25, 2018/16:00-17:30

Important to know: Session will be in Russian, translation to English will be provided.

This session, organized by AFEW Network, will offer an opportunity to share experience in strengthening community monitoring and involvement in service delivery: from grassroot to policy level.

During the session we will talk about creating an enabling environment by building the bridge between service beneficiaries, services, policies and successful experiences in meaningful involvement of our service beneficiaries and building strong collaborations between communities of key populations and the public system.

Through exchange and panel discussion we aim to:

  • Demonstrate the double win (for both the public system AND the communities served) when communities and service beneficiaries are involved in service delivery and policy making;
  • Share strategies and best practices from the AFEW network members that use innovative methods of information through online media that hands bigger autonomy to the service beneficiaries;
  • Share strategies and best practices to form mechanisms of community monitoring.

This session is prepared and presented in the framework of the program ‘Bridging the Gaps: health and rights for Key populations’, through the regional EECA approach by AFEW International and AFEW Network.

Agenda

3 Session of 30 min each to share and discuss experiences.

Session 1: ‘Meaningful involvement of service beneficiaries in planning, designing and monitoring of services’ experiences within the AFEW Network

  1. Creation key populations’ advisory councils in Tajikistan: Dilshod Pulatov, project manager, AFEW-Tajikistan
  2. Involving adolescents in service delivery and monitoring of services in Ukraine: Daria Kopiyevska, activist, NGO “Return to Life”, Kropyvnitsky, Ukraine
  3. Initiative groups in the provincial steering committee of Kakheti region in Georgia: Davit Kazaishvili, Public Union “Bemoni”, Georgia
  4. Supporting community steered service delivery by key populations in Kazakhstan: Roman Dudnik, Executive director AFEW Kazakhstan, Rosa Oleynikova,  Director NGO “Doverie Plus”, Sergey Schetnikov,  NGO “Answer”
  5. Discussion

 

Session 2: ‘Building equal access to prevention, treatment and care for HIV’, experiences within the AFEW Network

  1. New digital approaches to support adherence to treatment in Kazakhstan: Yagdar Turekhanov, Program technical advisor, AFEW Kazakhstan
  2. On-line consultations in Tajikistan: Zarina Davlyatova, Project specialist of AFEW-Tajikistan
  3. Interactive prevention methods for working with young drug users in Ukraine: Aleksander Mohylka, NGO “Blago”, Kharkiv, Ukraine
  4. Discussion

 

Session 3: ‘Building bridges, connecting people’, experiences within the AFEW Network

  1. Community-based participatory research: Daria Alexeeva, project manager, AFEW international       
  2. Сoordination mechanisms on HIV in Kyrgyzstan: Ulan Kadyrbekov, Director, Republican AIDS center, Kyrgyzstan
  3. Key populations platform in Ukraine: Vielta Parkhomenko, Club Eney, Kyiv, Steering Committee of the Country Key Populations Platform
  4. Discussion and closing of the session

Share Experience and Adopt New Ideas: Kyrgyzstan Heading to AIDS 2018

Author: Olga Ochneva, Kyrgyzstan

22nd AIDS Conference AIDS 2018 is an event which is particularly important for the countries of Eastern Europe and Central Asia – the region where the HIV epidemic is still growing. Representatives of governmental, non-governmental and community-based organizations from Kyrgyzstan were active in submitting applications and abstracts as well as looking for support to participate in the conference. We spoke to some of the delegates heading to AIDS 2018 and asked them how they are going to present their country at the conference. We also talked about their expectations for this major international event in the area of HIV.

Experience of preventing gender-based violence in HIV response

For three years, civil society organizations in Kyrgyzstan have been working to prevent violence against women who use drugs: 213 women attended individual sessions. They were screened for the exposure to violence, received detailed information on this issue, together with a counsellor developed safety plans, strengthened social support, and determined their goals to resolve the issues of violence and HIV.

Tatyana Musagalieva

Asteria NGO was one of the organizations implementing the Wings of Hope project to prevent gender-based violence, and Tatyana Musagalieva as a representative of this organization will present the efficiency of this rapid intervention at AIDS 2018.

“We would like to share our experience and demonstrate that this intervention is effective: it helps women to be open for medical, social services and harm reduction programs and reduces the HIV risks. I hope that the results of our work will prove the importance of preventing gender-based violence and its linkage to the risks of HIV.”

Sex-work: challenges and solutions

Ulan Tursunbayev

The needs of Kyrgyz sex-workers will be presented at AIDS 2018 by Ulukman Daryger NGO, which received support from AFEW International to carry out community-driven research.

“We are preparing a poster to present the results of our research study. We make a focus on two most pressing challenges – HIV testing and economic adaptation after sex-work,” says Ulan Tursunbayev, Director of Ulukman Daryger NGO. “After completion of the study, we have already started making first steps to resolve the issues we identified. Now we are getting prepared to submit a funding proposal within the national social contracting mechanism. There are intentions to finance a program to socialize women in difficult life circumstances from the local budget. That is why at the conference, apart from our research results, we will also present our vision of how to resolve this problem.”

Young people are going to AIDS 2018 to gain knowledge

Renata Bayazitova

The only organization in the country working with young people who use drugs will also be prominently present at the conference. Renata Bayazitova, Project Coordinator of the Ganesha NGO will deliver a poster presentation to show the results of the assessment of services for young female drug users.

“I will present the country situation in terms of the number, quality and effectiveness of the services for young female drug users offered by governmental and non-governmental organizations. This assessment was carried out by the community and showed major gender and age-related gaps. I hope that participation in the conference will help me get new information, learn practical ways to adjust services to our young people, and share the experience with other youth organizations.”

Treatment is a priority

Margarita Sabirova

Prosvet Charity Fund will represent the Kyrgyz organizations working with people living with HIV (PLWH) at AIDS 2018. The Fund provides consultations on adherence to antiretroviral therapy as well as legal and psychological counselling, navigates clients to various services, offers support in rehabilitation and reintegration in the society, and strives for better quality of the services for PLWH.

“My expectations from the conference are to get information about the new methods of HIV/AIDS treatment based on the latest achievements of modern medicine,” says Margarita Sabirova, the psychologist of the Prosvet Charity Fund. “It would be good to learn about the experience of other countries in terms of the interaction of civil society sector with governmental agencies, to see the contribution of different governments to the activities of civil society organizations and their response to HIV.”

Sixteen delegates supported by AFEWKyrgyzstan

Natalya Shumskaya

Thanks to the support of donors (Dutch Ministry of Foreign Affairs, USAID, GIZ, UN Women, WHO), AFEW-Kyrgyzstan was able to support 16 delegates providing them with an opportunity to attend the conference. Those are representatives of AIDS centres, municipal bodies, healthcare coordinators, researchers, community leaders of key populations and AFEW-Kyrgyzstan staff members.

“The delegates will present the experience of AFEW Network in strengthening community monitoring and community involvement in service delivery will tell about the HIV prevention, treatment, care and support in Kyrgyz prisons. There will be poster presentations dedicated to the country’s experience in economic empowerment of women vulnerable to HIV as well as HIV prevention through opioid substitution therapy. I will speak about the assessment of opportunities of female leaders of the community of people who use drugs and their impact on the access to and quality of HIV programs,” tells Natalya Shumskaya, director of AFEW‑Kyrgyzstan. “Participation in AIDS 2018 is a unique opportunity for all of us to get acquainted with the best practices in HIV diagnostics, prevention, treatment and care as well as present our own experience. Kyrgyzstan has an extensive experience as our country has implemented innovative HIV prevention approaches both in public health care and in penal institutions.”

Ukrainian Youth Will Tell Everyone about HIV

Yana Panfilova and Dany Stolbunov from the Ukrainian organization Teenergizer! will perform on 21 July in CREA Theater, Amsterdam. The performance will take place within AIDS 2018 Conference.

The documentary theatre play ‘Don’t Tell Anyone’ aims to draw attention to the issues and stigma which HIV+ teenagers in Ukraine are facing. The performance is a story about two adolescents who are looking for the answers to their questions: “What does it mean to be born with HIV in Ukraine?”, “What do children feel when they have to hide their diagnosis because of the fear to be judged and isolated?”. The documentary theater performance will make the audience feel how it is to live with HIV in Eastern Europe and Central Asia (EECA), and why it is important to let voices of young people living with HIV from EECA be heard at the global level.

Teenergizer! is an organization created by adolescents for adolescents. The organisation creates world where every teenager can realize full potential; world free of discrimination in all areas, including live with HIV; world in which the rights of all young people are fully respected. AFEW is a unique network of organisations working in EECA for 16 years to improve health of people living with HIV, people using drugs, men who have sex with men, LGBTQI, sex-workers, prisoners, and youth at risk for HIV.

Date and time: 21 July, 15:00

Location: CREA, Nieuwe Achtergracht 170, 1018 WV Amsterdam https://goo.gl/maps/ZtDnCLvbwuF2

Language: Russian (English subtitles and translation during the discussion)

Facebook event: https://www.facebook.com/events/408902859584252/

Free entrance

AFEW on AIDS 2018: Workshop ‘Migration in EECA: access to health care for all?’

What: Seminar Migration in Eastern Europe and Central Asia: access to health care for all?

Where: E 105-108 @ RAI Amsterdam

When: 26 July, 2018/16:30-18:00 

Important to know: This workshop will offer translation facilities English – Russian.

This workshop, organized by AFEW Network, will offer a unique opportunity to not just talk about migration, HIV and key populations but also to hear a real-life experience about migration.

We will discuss the general situation on access to health for migrants and the political commitment within Eastern Europe and Central Asia (EECA), the essential package for migrant health for EECA and the situation of migrant’s access to TB/ HIV programs specifically in Tajikistan.

AFEW Network will highlight its research on People Who Use Drugs, including their regional mobility, and raise more clarity on the issue of the labor migration situation and access to prevention, treatment and care for Key Populations in Tajikistan, Kyrgyzstan and Russia. Also, a specific model for NGO service implementation will be presented by AFEW Tajikistan, where women in labor migration and wives of migrants are reached with various HIV, TB, HCV prevention, treatment and care interventions.

Through exchange and panel discussion we aim:

  • To inform all on the Universal Health Coverage when it comes to labor migrants in Eastern Europe and Central Asia;
  • to develop concrete actions that can be used within the existing platforms to advocate for further action and commitment at government level andto get key populations (PWUD, SW, LGBT/ MSM) and access to health modules in official migrant training protocols;
  • to study and discuss the role of NGOs and their collaboration with public (health) systems.

This session is prepared and presented in the framework of the program ‘Bridging the Gaps: health and rights for Key populations’, through the regional EECA approach by AFEW International and AFEW Network.

Agenda

  1. Introduction: Janine Wildschut, Director of Programmes AFEW International
  2. Meet a person with experience: Ms. Alimahmadova Zebo
  3. The essential package for migrant health and the political commitment: opportunities and challenges in EECA: Ms. Elena Vovc, WHO Technical Officer, HIV, STIs and Viral Hepatitis program
  4. Tajik migrants and access to HIV and TB services. IOM experience to address health needs of migrants: Ms. Rukhshona Qurbonova, IOM Tajikistan Migration Health Programme Coordinator
  5. Women and labor migration. The role of NGOs in health care, social and legal support of female migrant workers: Ms. Zarina Davlyatova, Project manager AFEW-Tajikistan
  6. Discussion:

    • What can we do to developing regional approaches on HIV prevention and health promotion among labour migrants with emphasis to the needs of specific groups as PWUDs living in EECA?
    • Options for cross border collaboration and between public and NGO bodies.• Set priorities and any immediate action.
  7. Conclusion

Building Bridges Between East and West – AFEW Releases its 2017 Annual Report

AFEW International releases its 2017 Annual Report ‘Building Bridges Between East and West.’ The report highlights AFEW Network’s key activities in the region of Eastern Europe and Central Asia.

“‘Building bridges’ stands at the core of AFEW’s work. During its more than 15 years of working in Eastern Europe and Central Asia (EECA), AFEW has aimed to connect the East and the West by introducing and sharing expertise on prevention, treatment and care for HIV, tuberculosis and viral hepatitis,” says Anke van Dam, executive director of AFEW.

AFEW Network will use AIDS 2018 with its focus on Eastern Europe and Central Asia as a springboard to address the three epidemics of HIV, viral hepatitis and TB including multi-drug resistant TB. We will renew our advocacy strategy, work with partners to ensure additional and better healthcare services for all and lead efforts to ensure that the Sustainable Development Goals and other multilateral efforts result in a better future for the people of Eastern Europe and Central Asia.

The English version of our Annual Report is available here (download PDF.) The Russian version of the Report can be read here (download PDF.)

Chase the virus, not the people! Campaign at AIDS 2018

Eastern Europe and Central Asia (EECA) remains the only region in the world where new HIV cases and AIDS deaths continue to grow rapidly. Low access to treatment, repressive legislation, stigma and discrimination of key populations, as well as the unwillingness of states to finance and ensure the sustainability of prevention programs in the EECA region, hinder an effective response to the epidemic.

The response to HIV in Eastern Europe and Central Asia will only be successful if decriminalization, destigmatization, zero discrimination and demedicalization are recognized as key needs of the communities. These aspects require comprehensive support from the global community, enhanced partnerships and immediate action by all stakeholders.

One of the AIDS 2018 objectives is to spotlight the state of the epidemic and the HIV response in Eastern Europe and Central Asia. It’s the right time and place to attract the attention of the whole world to the region and communities’ actions and to support them.

Therefore we, the team of regional community networks*, are joining forces in the campaign at AIDS 2018. Our slogan – Chase the virus, not people! Our goal is to present to the world the impact of repressive, discriminatory laws and practices of their application, as well as stigma against key populations and people living with HIV. To achieve obligations to create an enabling legal environment and to involve key populations and people living with HIV in decision-making processes. We are ready to show the negative consequences of the reduction in international support and to seek global assistance to mobilize resources for stabilizing the HIV/AIDS epidemic in the EECA region.

“Chase the virus, not people!” campaign aims at the common needs of all key populations and focuses on achieving the goals in general and for each community in particular.

The campaign key attribute is handcuffs, as a symbol of limited freedom and actions.

Support the campaign and the EECA region at AIDS 2018 and join its actions!

 How to support and join the campaign:

– insert the logo of our campaign into one of the slides of your presentation at the conference;

– bring handcuffs and put them on during the campaign events (number of handcuffs from organizers is limited);

– join the campaign during the March, the opening of the Global Village, the opening/closing sessions, plenaries on July 24 and 26, and the activities in EECA Networking Zone in the Global Village (pavilion 515);

– support flash mob – every day (time will be announced) in different parts of the Global Village;

– take a picture in handcuffs at the conference and place a photo with the hashtag of the campaign in social networks:

#chasethevirus

#chasevirus

#chasethevirusnotpeople

#chasevirusnotpeople.

Check the schedule of the campaign events and activities at www.chasevirus.org starting from July 7, 2018.

It’s time for joint actions!

*EECA communities team: Eurasian Coalition on Male Health (ECOM), East Europe and Central Asia Union of People Living with HIV (ECUO), EECA Sex Workers’ Alliance, Eurasian Harm Reduction Association (EHRA), Eurasian Network of People Who Use Drugs (ENPUD), Eurasian Union of Adolescents and Youth “Teenergizer”, Eurasian Women’s Network on AIDS (EWNA), Sex Workers’ Rights Advocacy Network (SWAN). Organizational partner – AFEW International (the Netherlands).

 

 

Sex-Workers in Russia – for Effective HIV Prevention

In 2015, the Sex-Workers’ Rights Advocacy Network in Central and Eastern Europe and Central Asia (SWAN) conducted a study ‘Failures of Justice’

Author: Anastasia Petrova, Russia

Sex-workers are one of the groups that are vulnerable to HIV. There are no government programs aimed at working with this category in Russia. According to Russian Federal Consumer Rights Protection and Human Health Control Service, over the past two years the way of sexual transmission of HIV has become more prominent: in 50.3% of instances, the positive status was received during heterosexual contacts. According to a study conducted by the Open Health Institute in 2017, the percentage of sex workers with HIV varies from 1.3% to 8.9%, depending on the region. In cases when sex work is combined with drug use, up to 15% of people become HIV-positive.

Epidemic of Violence

Sex-workers are vulnerable to HIV for a number of reasons. They have limited access to medical, legal and social services, information and prevention means. However, the most significant factor is violence from partners, clients, administrators, and police officers.

In 2015, the Sex-Workers’ Rights Advocacy Network in Central and Eastern Europe and Central Asia (SWAN) conducted a study ‘Failures of Justice’. The community on its own studied violence against sex workers. The study showed that 28% of girls in Russia were physically abused, and 4.8% – sexually abused by the police.

According to the study, the above statistics directly correlate with the HIV incidence rate among sex workers. Persecution by the police deprives sex workers of the opportunity to work in safe conditions, choose clients, or use condoms at every contact.

Unique HIV prevention project

Involving community representatives in the project work is the basis for effective prevention. In addition to highlighting services of prevention of HIV and sexually transmitted infections (STIs), a lot of emphasis is placed on strengthening the community and increasing the legal literacy of sex workers

The Silver Rose, a movement of sex workers and their supporters, has been fighting against violence since 2003. Today, the movement unites 450 sex worker leaders in more than 35 regions of the Russian Federation. Under the guidance of the leader Irina Maslova, the Silver Rose, using their own resources, are implementing a unique for Russia HIV prevention project aimed at this key group. The girls are provided with condoms, referrals to trusted doctors, and psychological and legal assistance; they are taught how to protect themselves from HIV and violence.

For instance, during March – December 2017, the Silver Rose implemented on its own the project ‘Bridging the Gaps’ in the framework of the Program on Expanding Access of Vulnerable Groups to HIV/AIDS Prevention, Treatment and Support Services in the Russian Federation. 1509 people were tested for HIV in the course of the 9 months’ work.

Involving community representatives in the project work is the basis for effective prevention. In addition to highlighting services of prevention of HIV and sexually transmitted infections (STIs), a lot of emphasis is placed on strengthening the community and increasing the legal literacy of sex workers. Girls must learn to defend themselves in the face of a constant threat of violence.

“Now this is not a project any more, but a program instead,” says Irina Maslova, referring to the continuity with which the movement helps sex workers. “These processes continue, even if funding ends. Now, at the completion of projects supported with grants of the Global Fund to Fight AIDS, we are thinking about the transition to self-financing.”

Current Legislation Does Not Solve Problems

As of today, the legislation of the Russian Federation triggers and promotes discrimination of sex workers as well as human rights violations. Sex work is punished under administrative and criminal codes. The Code on Administrative Offenses prohibits “Prostitution” (Article 6.11) and “Receiving income from prostitution if this income is associated with another person’s prostitution activity” (Article 6.12).

However, this discriminatory legislation poses more problems than it solves since it deprives sex workers of fundamental rights and freedoms, including freedom of assembly on issues of healthcare and HIV prevention. Sex workers remain vulnerable to humiliation and violence from clients, as well as to abuse from the police.

For this very reason, introducing amendments to the legislation and repeal of Article 6.11 have long been the main goal of the work of the Silver Rose movement in general and Irina Maslova in particular. After all, the repeal of the mentioned article, according to experts, will promote the observance of the rights of sex workers since they will not be afraid to turn to the police for help in cases of maltreatment or violence from clients. Decriminalization will also help sex workers self-organise to protect their rights, health and life.

Vladimir Kurpita: “Dnipro Will Become the Third City in Ukraine to Join the Fast-Track Cities Initiative”

Vladimir Kurpita thinks that the Fast-Track Cities initiative allows drawing public attention and raising additional funding for the HIV response

Author: Yana Kazmirenko, Ukraine

To learn about the benefits for the Ukrainian cities joining the Fast-Track Cities initiative and about the expectations from AIDS 2018 conference to be held in Amsterdam, read the interview with Vladimir Kurpita, Head of the Public Health Centre of the Ministry of Health of Ukraine. According to him, though Ukraine is one of the leading countries in terms of the number of people living with HIV, the government does its best to cover such people with treatment.

– What successes and challenges of Ukraine related to HIV response will be presented at the XXII International AIDS Conference in Amsterdam (AIDS 2018)?

– Today Ukraine is the second country in the European region with the biggest number of people living with HIV. Only Russia is ahead of us. In our country, there are over 230 thousand people living with HIV, while 146 thousand have been diagnosed with HIV and receive care. The HIV epidemic in Ukraine is a problem of big cities, industrial metropolises and is still concentrated in the key populations (people who inject drugs, men who have sex with men, sex workers). The issue of HIV is in the focus of attention in our country. Currently, the seventh national HIV programme is implemented, which is a result of the effective cooperation among the international partners, governmental agencies, and civil society organizations. The governmental policies may be illustrated with the fact that Ukraine is one of the few post-Soviet countries where prevention programmes, in particular, the opioid substitution treatment programme, are funded from the national and local state budgets.

The issue of detecting new HIV patients who are not aware of their diagnosis is on our agenda. In particular, we change the testing algorithms and are ready to intensively promote self-testing. A significant achievement is the fact that people already know that they can live with HIV.

 – Today, over 90 thousand people receive HIV treatment in Ukraine, and it is expected that this coverage will be increased to 196 thousand people by 2020. What will help to make it happen?

– As of 1 April 2018, over 98 thousand people received HIV treatment in Ukraine. We are actively scaling up access to treatment. Currently, the therapy is offered in more than 300 healthcare institutions and in 100 places of confinement. In 2014-2016, there were certain problems with access to antiretroviral treatment at the local level, but now the situation has been improved.

Ukrainian patients have access to innovative drugs. Besides, the cost of treatment is reduced through the use of generic drugs. Today, the average cost of treatment course is less than USD 200 a year. Now the treatment is easier both for the doctor and the patient. If the treatment is initiated on time, one pill a day will be enough.

The healthcare reform in Ukraine stipulates that testing and prescription of the first treatment scheme may be provided by the family doctor or the general practitioner. Of course, such changes require some time. There is a need to overcome fears and concerns from the side of patients and improve the level of knowledge and expertise among doctors. However, without changing the existing standards we will not be able to provide treatment to such high number of patients.

– The WHO guidelines state that to control the HIV/AIDS epidemic among people who inject drugs, 20 thousand people should receive opioid substitution therapy. Now there are 11 thousand people who receive such therapy in Ukraine…

– Opioid substitution treatment (OST) is the most effective method to prevent HIV among people who inject opioid drugs. In the recent several years, Ukraine made a big progress in scaling up the OST programmes: approaches in the government policies were changes, the number of healthcare institutions offering such treatment was increased, and we were the first in our region who started providing OST using the state budget funds. However, OST is still a high-threshold treatment method as only narcologists may prescribe it and to be prescribed with the therapy one needs to be registered with drug treatment facilities. The patients are concerned about their security and confidentiality, they are afraid that their data may be given to law enforcement bodies. Besides, it should be mentioned that OST is a therapy to treat opioid dependence. Changing drug scene, with the growing use of stimulants, salts and other synthetic drugs, requires application of other methods in addition to methadone and buprenorphine. That is why the goal of the state policy is not to increase the number of patients, but to provide access to OST to all patients who need such therapy and are eligible.

Currently, together with our colleagues from the National Police, the Ministry of Justice, the Ministry of Health, civil society and international organizations we work to change the approaches and implement innovative models to scale up OST (e.g., in places of confinement) and study the experience of pilot projects in some regions of our country, where OST programmes are managed by family doctors.

 – In Ukraine, Kyiv and Odesa joined the Fast-Track Cities initiative to accelerate the AIDS response. Have they achieved any results?

– The Fast-Track Cities initiative allows drawing public attention and raising additional funding for the programme. When the mayor of Kyiv, Vitali Klitschko, is talking about the response to the HIV epidemic, people trust him, they seek care, get tested, start treatment, and thus the municipal authorities are able to control the epidemic. It is also important that both in Kyiv and in Odesa the local authorities approved new plans and objectives for the municipal AIDS programmes and allocated additional funding from the municipal budgets. Besides, participation in this initiative allowed attracting additional funding from the international donors.

 – What other Ukrainian cities are going to join the initiative?

– Hopefully, the next city to join the initiative will be Dnipro (former Dnipropetrovsk – author’s note). Dnipropetrovsk region is already leading in terms of the number of patients who receive treatment. In the region, there are 15 thousand people who are on treatment, which is 1/6 of all the patients in Ukraine.

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

Author: Nargis Khamrabaeva, Tajikistan

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

Protection of rights regardless of the status

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

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

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

Undisclosed  information is a threat to unofficial wives

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

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

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

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

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

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