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.

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.