The 3rd regional autumn school in Bishkek

On October 29, AFEW partners came together in Bishkek, the capital of Kyrgyzstan, for 3 days to take part in the annual Autumn School, which is organized within the project “Bridging the Gaps: health and rights of key populations“.

The great energy of the participants and amazing nature gave a chance to everyone to enjoy the event and to discuss important issues on prevention and treatment of #HIV, harm reduction, migration, and financing in the region of Eastern Europe and Central Asia. Participants in the Autumn School included representatives of AFEW partners from Kazakhstan, Kyrgyzstan, Ukraine, Russia, and the Netherlands, sub-recipients of the project “Bridging the Gaps”, as well as other partners and experts including those from Great Britain and the USA.

Active space

The Autumn School quickly became an active space for discussion: about strategy, barriers, innovations, and partnership opportunities between the participating organizations. During the first day, participants shared updates on the “Bridging the Gaps” project and activities in their countries – Georgia, Kyrgyzstan, Ukraine, and Tajikistan. The afternoon session was devoted to a World Café, in which partners exchanged ideas and developed specific actions to overcome challenges that they often encounter in their work.

The second day was devoted to the topic “Stimulant use and chemsex”. Benjamin Collins, director of International HIV Partnership (IHP), which partners with medical and community activists across Europe and the Middle East for successful responses to HIV and viral hepatitis, joined the Autumn School in Bishkek to share his experience on chemsex . The topic of (problematic) chemsex was further elaborated in the presentations of Monty Moncrieff, Chief Executive of London Friend, a London charity working to promote the health and well-being of lesbian, gay, bisexual and trans (LGBT) people, and Daria Alexeeva, program director of AFEW International. Monty spoke about the London experience in harm reduction, while Daria presented materials of Nikolay Lyuchenkov, an infectious disease doctor and expert on sexual health issues from Russia, which were focused on trends and responses to chemsex in Russia and EECA region.

 

The third and final day of the conference was devoted to workshops on migration, rehabilitation and financial sustainability. Evgeniya Alekseeva, director of Public Health and Social Development Foundation “FOCUS-MEDIA”, presented analysis of NGOs funding situation in EECA region; Elena Zhirnova, manager of the project “Our Choice: Empowering Vulnerable Women in Kyrgyzstan” (AFEW-Kyrgyzstan) told about challenges and opportunities of social entrepreneurship in the country; and Fatima Yakupbayeva, co-founder of law firm “PRECEDENT” and publisher of the book “From Grant to Business Project”, shared auditing resources for launching a business model and recommendations on how to implement business ideas.

 

The session on migration started with a presentation by Rukhshona Kurbonova, coordinator of the Migrant Health Programs at International Organization for Migration in Tajikistan. She talked about labor migration in Central Asia, while Zulaika Esentaeva (IOM Kyrgyzstan) shared their experience on service-delivery by IOM Kyrgyzstan for vulnerable migrants.

The session on rehabilitation was devoted to building information campaigns. During the session, Marina Govorukhina, specialist on strategic communications and branding, author of the books “Communications in Public Organizations”, “Strategic Communications in Public Organizations”, demonstrated specific techniques of developing informational marketing campaigns for rehabilitation centers to the participants from Georgia, Kyrgyzstan and Ukraine.

Moreover, the School included a 2-day training for AFEW communication managers, during which participants focused on learning about storytelling and SMM in the context of NGOs.

 

 

Natalya Shumskaya, director of AFEW-Kyrgyzstan

I especially noted the session on new psychoactive substances. This topic is relevant for our country, as sexual ways of HIV transmission keep growing in Kyrgyzstan, and new psychoactive substance use impacts sexual behavior. For us it is a wonderful opportunity to take on the experience of those countries that have already faced similar problems, and elaborate effective strategies for preventative measures in our country.

The third day was remarkable due to the acute topic of sustainability of civil society organizations. We all see the tendency of decreasing donor support in our countries. That means that civil society should aim to ensure financial sustainability independently, and one of the opportunities is the development of social entrepreneurship. During this meeting we shared the experience of creating our own social enterprise – a beauty salon. I would like to especially point out the session by Fatima Yakupbayeva from the “Precedent” company. She gave us specific business-ideas, which could be developed by an NGO in order to earn money independently and further direct it to realization of our statutory goals.

The importance of this event is in sharing and exchange of experience. When the financial support for our organizations is not that high, it is important to avoid duplication of activities, and, on the other hand, to consolidate our efforts in order to realize our main strategic goals. For instance, the past regional meetings allowed us to bring good practices of working with youth at risk from Ukraine to our country. We are very grateful that we didn’t have to be the pioneers in this, but rather adapt and use their experience. Also, I think that the experience of Kyrgyzstan will be useful to some of our colleagues, and they will be able to apply it in their countries.

Monty Moncrieff MBE, Chief Executive of London Friend

It’s important for people working in the region on the same issues to have the opportunity to come together and share their knowledge and experience. It helps build the data on important topics, and enables participants to share what they’re seeing locally, as well as share tips on how to address new and emerging trends. It also helps build relationships, which spark ideas for new partnerships. Even though the internet gives us great opportunities to connect and work together online it’s difficult to get that richness of connection without bringing people together in person, and doing so for a number of days provides lots of opportunities for conversations outside the formal sessions.

We can always learn from one another, and hopefully by inviting people who have been working on issues for some time in other countries we can bring the benefit of that experience. We can share leaning about what’s worked and what hasn’t for us, and hopefully that can benefit people who are only starting to see these issues emerge locally.

Evgeniya Alekseeva, PHD in medical sciences, Director of Public Health and Social Development Foundation “FOCUS-MEDIA”

Meetings such as the Autumn School are important, because they bring together people from different countries and cities, create space for discussing acute issues and situations in our field, allow to form alliances, agree about partnerships, as well as have informal conversations and take a break from the daily routine.

At the Autumn School in Bishkek, I especially noted a very interesting session on chemsex, sessions on business projects for NGOs, and on migration. I will certainly use this knowledge further while writing proposals, developing new projects and creating new ideas.

Zarina Siyakova, program coordinator of the Tajik Network of Women Living with HIV

This meeting provided me with a great opportunity to learn more about what is happening in other countries in regards to promoting prevention and treatment of HIV. I especially noted the session on chemsex, as I hadn’t had a chance to encounter this issue before. I was particularly interested in the presentation by Monty Moncrieff, as well as the presentation of Nikolay Luchenkov from Russia on chemsex in EECA.

Also, I received answers to many questions on migration that I’m interested in, and most importantly, exchanged contacts with almost all the participants. It is well known that nowadays there is a very large stream of migrants from Tajikistan to Russia, and many of them lack information about services for migrants and d existing organizations in Russia. Now our organization will be able to refer our clients to these organizations, and we won’t lose them out of sight.

If you are interested in specific presentations of the Autumn School, please send your request to autumnschool@AFEW.nl.

New UNAIDS Strategic Information Hub for Eastern Europe and Central Asia

UNAIDS Strategic Information Hub for Eastern Europe and Central Asia (UNAIDS SI Hub) has been launched on the Internet.

The purpose of this resource is to provide an online one-stop-shop for data, publications and strategic information about HIV (and related health issues) in EECA. It is publicly accessible to anyone online, but it aims to make information accessible and easy to find for specialists and policymakers working on HIV in governmental, non-governmental organizations and partners across EECA.

The address of the hub is http://eecahub.unaids.org/ and it’s managed by UNAIDS RST  in Moscow, with support from UNAIDS HQ. It currently features HIV data from the latest GAM reports, as well as published reports and presentations related to HIV in EECA. It’s possible to access the country-specific data and reports as well as reports and publications from the various menus. By selecting “data” and “factsheets”, you can generate and print Regional and Country factsheets as PDFs as well access as epidemiology slides with global and regional statistics.

The hub works in two official UN languages – English and Russian, but most of the publications will only be available in the language they are produced (and not translated into other languages by UNAIDS).

For contribution to the UNAIDS SI Hub please send your suggestions, data, publications and other materials to eecasihub@unaids.org.

HIV in prison is not a death sentence

Nowadays Kyrgyzstan is recognized as one of the most advanced countries in the world in regards to delivery of the harm reduction and HIV care and treatment programs in prisons (details here).

At the moment here, in the penitentiaries, there are 5 active programs: syringe exchange program, methadone maintenance treatment program, rehabilitation program “Atlantis”, Center for Rehabilitation and Social Adaptation “Clean zone” and “Start Plus” program.

Dina Masalimova, AFEW-Kyrgyzstan program manager, explained what kind of work is done in this field in the country, and which significant results have already been achieved.

Dina, could you please describe the programs for inmates? What do they look like?

A pilot program on needle and syringe exchange was introduced in Kyrgyzstan in 2002, in one of the prisons with a modest reach of 50 people. A year later the program was expanded to 3 prisons, and then several more. Today there are 14 syringe exchange stations (SES) in the penitentiary system. They work in all the prisons except for the facility for underage convicts. Also, syringe exchange services are provided in the 2 largest detention centers. An actual number of SES clients in 2018 amounted to over 1300 people. They received syringes either in person, or through a secondary exchange conducted by volunteers. Aside from the sterile injection equipment you can also find other protection items at the stations – alcohol wipes, condoms; and HIV blood tests are done here too. Those clients that would like to decrease or fully stop the injecting drug use are forwarded to the methadone maintenance treatment stations.

The methadone maintenance treatment program was started in the country’s prisons over 10 years ago – in 2008.  Today there are already 9 stations in the penitentiaries, and the number of clients is over 350. These programs are conducted by the State Penitentiary Service with the support of the Global Fund To Fight Aids, Tuberculosis And Malaria, as well as Center for Disease Control (CDC).

Aside from the harm reduction programs there is a program aimed at the full withdrawal from drug use in prisons. In a number of places the  “Atlantis” program based on the famous model “12 steps” is active. The program graduates can serve their remaining sentence time in the Center for Rehabilitation and Social Adaptation “Clean zone”. “Clean” means that it’s free from drugs. There is a full-scale program of rehabilitation and preparation for sober life outside of prison there.

Over the past 5 years we also were active in delivering services directly to inmates. For instance, our consultants have supported prisons’ health system by providing peer-to-peer consultations and HIV testing, as well as supported inmates before and after their release from prison. For a long time this program has been implemented with the support of USAID. Soon it will be continued thanks to the financial and technical support of ICAP (international program by Columbia University’s Mailman School of Public Health).

How are these programs created, and who delivers them?

As a rule, these programs are created based on the actual needs of the most vulnerable groups of prisoners – people living with HIV and/or using drugs. And these programs are also delivered by the representatives of these communities.

We approach the program in a flexible way and always try to improve it so that it remains relevant. For example, one of our recent additions to the program is working with the convicts that were rejected by the prison subculture. Due to the unspoken prison rules this group of prisoners has the lowest level of access to medical and social support and faces a high level of stigma and discrimination from the other convicts, and often also from the prison staff.

Could you share some results of these programs?

All the programs currently active in the country are aimed at reaching the ambitious goal 90-90-90.  Now almost all inmates in prison are being tested for HIV “at the entrance”, and a vast majority of people living with HIV are formally in treatment. Why “formally”? The viral load indicators show that quite a few of inmates don’t use it. In prisons there are a lot of myths about HIV and antiretroviral therapy, and during in-person conversations many patients admit that they simply throw medicines away. Because of that, the main goal of our project is to increase the number of convicts who live with HIV with undetectable virus load.
Over the years we achieved great results. For instance, in prison #31 the number of people who are adherent and have a suppressed virus load has grown from 15% to 68%, and in prison #16 – from 33% to 66% in the past three years. We are especially proud of two prisons – #2 and #47, where we’ve already reached the second and third “90”.

All these programs are mainly targeting male convicts. Are there any special programs for female inmates, for pregnant women?

In Kyrgyz prisons there are only 10 female inmates living with HIV. However, it is also important to consider their needs while planning measures in response to HIV-epidemic. We approach work in female prisons quite reverently and are trying to make sure our programs are gender-sensitive.  In one prison there was a women self-help group focusing on gender violence prevention. Also we partner with NGO “Asteria”, which runs a women’s center supported by AFEW-Kyrgyzstan and open for women released from prison. Many of the center’s clients are former inmates, and the help and support program includes temporary lodging, provision of food and hygiene packages, peer consulting on HIV, sexual and reproductive health and rights (SRHR) and opioid substitution treatment (OST), as well as provides access to gynecological services.

What is the prisoners’ attitude towards such programs?

Inmates perceive this program in a very positive way. Slowly but surely our team managed to win their trust and involve them into the dialogue about their health. It’s important to understand that health is far from the first priority for a person in prison. Unfortunately, current conditions of prisons make basic survival the main priority, and HIV is perceived as a far removed problem for many of them. Our peer consultants have their own experience of living with HIV in a prison, so they can show by their own example how one could solve upcoming problems.

Could you name the main current problem for prisoners with HIV in Kyrgyzstan?

One of the main problems is the lack of medical staff in the penitentiary system. In a number of large prisons in the country there are no doctors with higher medical degree. All the work on supporting prisoners’ health is put on the shoulders of a small team of paramedics. Of course, very often they have no time or knowledge needed to perform quality work on supporting inmates with HIV. We also try to help in such cases. For example, in prison #16 there was no doctor for a whole year, and our organization set up weekly visits of a doctor from the Republican AIDS center in order to support the patients.

It is often said that many prisoners don’t trust prison staff, including health workers…

Yes, it’s a separate and quite serious problem, and the consequence of it is the unwillingness of prison inmates to follow doctors’ recommendations. Our consultants serve as a certain “bridge”, which helps to build trust-based relationships between doctors and patients. For instance, with the patients’ agreement they take the results of viral load and cd-4 tests and thoroughly explain their meaning to the patients, e.g. the influence of the therapy on those indicators etc. We try to find individual approach to everyone. For many people the possibility to have a family and healthy children when they reach undetectable viral load becomes the best motivation for treatment.

It seems that peer-to-peer consulting is a really life-saving tool when it comes to fighting for the health of prisoners living with HIV, isn’t it?

Александр Certainly! We have so many stories that prove it. For instance, the story of Alexander. He learned about his positive HIV-status in 2013. His prison mates gave him a clear verdict that he would die soon. Needless to say, he was in great shock. He didn’t have any access to information, and doctors didn’t explain much. On the verge of desperation he started to use more drugs. He looked at the people with positive HIV-status around him, and they were dying one after another. He also waited for his turn.
In 2016 peer consultants from the Action against HIV project started to come to the prison. One of them – Evgeniy – really impressed him. He was living with HIV himself, but he didn’t look like he was dying at all, quite the contrary. During one conversation with a peer consultant Alexander got more information than in the previous 3 years of his life with positive HIV-status. At that moment he told himself: “Enough. I choose life”. He started treatment and quite soon reached undetectable viral load.

14 billion $ to save 16 million lives

In an unprecedented show of global solidarity, donors at the Global Fund’s Sixth Replenishment Conference pledged US$14.02 billion for the next three years – the largest amount ever raised for a multilateral health organization, and the largest amount by the Global Fund. The funds will help save 16 million lives and end the epidemics of AIDS, tuberculosis and malaria by 2030. 

Outstanding support

Many donors significantly increased their pledges, citing the urgency to take decisive action. The United States Congress signaled outstanding support with US$1.56 billion a year, maintaining a 33% portion of all contributions. France increased its contribution by 20% to €1.296 billion including the additional US$60 million announced by President Macron.

Other major donors all stepped up the fight: The United Kingdom pledged £1.4 billion for the coming three-year period, a 16% increase; Germany pledged €1 billion, a 17.6% increase; Canada pledged CAD930 million, a 16% increase, the European Union pledged €550 million, a 16% increase; Japan contributed US$840 million and other longstanding donors contributed as well. Further expanding its donor base, the Global Fund also welcomed 20 new and returning public donors.

Private donors pledged more than US$1 billion for the first time ever, an extraordinary achievement led by the Bill & Melinda Gates Foundation’s pledge of US$700 million, subsequently complemented by the additional pledge of US$6o million, and (RED)’s pledge of US$150 million, alongside longstanding supporters such as Sri Dato Dr Tahir, Comic Relief and Takeda. Six new private donors also joined, including Children’s Investment Fund Foundation and the Rockefeller Foundation, and 11 partners committed other resources to expand innovation and impact.

A proven mechanism for maximizing impact

The Global Fund partnership is a proven mechanism for maximizing impact. Health programs supported by the Global Fund have saved more than 32 million lives since its inception in 2002, and provided prevention, treatment and care services to hundreds of millions of people.

“Today’s Global Fund replenishment result is an incredible achievement,” said Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation. “This is a big day in the history of AIDS, tuberculosis and malaria – and one that no one expected two decades ago when the diseases were at their peak. Thank you to all the donors who increased their contributions. We hope others are inspired to follow their lead and support the Global Fund to continue its life-saving work.”

The Global Fund and the EECA region

AFEW International hopes that the Global Fund will address the high needs for prevention, treatment and care for HIV and TB in the EECA region and that the available funds allow the countries in Eastern Europe and Central Asia to pledge for support.

EECA region is the only region in the world where both new HIV cases and AIDS-related deaths are rising dramatically. That’s why the support of the Global Fund might be an important element toward helping change the trajectory of HIV across the region.

 

 

Good practices of intersectoral collaboration for HIV, tuberculosis and viral hepatitis

The WHO Regional Office for Europe is collecting examples of good practices of intersectoral collaboration for HIV, tuberculosis and viral hepatitis for publication in a dedicated compendium.

This compendium will include examples of actions undertaken by sectors outside the health sector, possibly (but not necessarily) in collaboration with the health sector. The practices should be aimed at improving the outcomes or the determinants of the HIV, tuberculosis and viral hepatitis epidemics, as encouraged by the UN Common Position on ending HIV, TB and viral hepatitis through intersectoral collaboration. They should also be accompanied by impact evaluations and credible monitoring mechanisms or research.

The above-mentioned UN Common Position was developed with an inclusive and consultative process to identify shared principles and key actionable areas within and beyond the health sector to address HIV, tuberculosis and viral hepatitis in Europe and central Asia. It was successfully launched at a side event to the UNGA in New York in November 2018 and subsequently distributed within UN system to all UN Resident Coordinators of the region.

The good practices must be submitted in either English or Russian using the form provided below. All submissions will be reviewed by the WHO Regional Office for Europe against the following criteria: relevance, sustainability, efficiency and ethical appropriateness. The authorship of each good practice will be highlighted in the compendium, which is expected to be published in 2020.

The deadline for submission is 18 November 2019. If you have any questions, please do not hesitate to contact daram@who.int. 

Mass media as partners in counteracting HIV/AIDS epidemic

Mass media play a major role in fighting for human rights, especially when it comes to population groups vulnerable to HIV. Through the wide media coverage of successful human rights defence cases implemented by community and civil society, the government can see that the community of People Living with HIV (PLHIV) and people vulnerable to HIV can and should be an equal partner and an ally in fighting HIV/AIDS epidemic.

This helps with forming a positive image of PLHIV and representatives of other key populations in the society, decreases stigma and discrimination, raises their self-esteem and self-significance and gives motivation for further activities and professional growth.

Thanks to the coverage of successful practices in mass media, a large number of PLHIV, people who use drugs (PWUD) and representatives of other vulnerable groups gain opportunity to get basic human rights knowledge, action plans and tools, which allow them to solve problems related to violation of human rights due to HIV in their own regions independently.

Liudmila Vins, project manager of LUNa Social Support Centre, legal adviser of Interregional Center for Human Rights in Yekaterinburg, has applied to the Emergency Support Fund for key populations in EECA for a grant. The goal of her project is to change the legal environment and public opinion towards people living with HIV and representatives of groups vulnerable to HIV through mass media.

Liudmila, what is the core of your project?

Our way of working is as follows – our lawyer together with partners, street lawyers from the regions, collects successful legal practices and strategically important cases, prepares the gathered materials for media publications, provides a legal evaluation and an algorithm for solving the problem. An info manger writes articles based on the cases for mass media and our own media resources, passes information about these cases to journalists through mailing lists, social media, and connects media and people featured in the cases in order to prepare further materials.

Could you tell us about the intermediate project results?

Yes, the project has substantially helped us to develop the informational part of our work and also gave a start to a new project of educating Russian NGOs on working with media. We found 17 cases, which resulted in 33 publications. Each case contained a story of at least one person – the leading story character, and at least 2 more people connected to the story, close relatives of the leading character. In total 51 people were featured in the stories.

Please share the most interesting and remarkable moments of the project.

The most remarkable example of support within this project is Olga’s story (the name is changed). We published it on our website.

Local journalists quickly noticed this material; they immediately reacted and published a number of articles about the fact that a woman in detention facility doesn’t receive treatment for HIV-infection. The news travelled fast: one journalist made a lot of requests to government agencies and received a positive decision from government officials. The result was that this woman received medication the same day.

You started your social support activities for vulnerable groups in 2009. How have the statistics changed since then?

At that time harm reduction programs were developing actively. However, the issue of defending the rights of PWUD was still unresolved, so starting from 2012 I began to develop street lawyers programming in Yekaterinburg. The need for this kind of support is very high now. In 2012 legal assistance was given to 100 people per year, and there was one street lawyer. Currently we work with 5 street lawyers, and we give this kind of support to people on a regular basis.

Who are the street lawyers?

These are people from the key populations community who are taught the basics of human rights defense. So, they can provide basic support with human rights defense, and then, if necessary, pass on cases to professional lawyers.

What is the attitude of the key populations’ representatives towards your activities?

We have a good connection with our target group, they are happy to receive our support. However, there are certain difficulties. For example, a person can disappear for a period of time while being under our supervision. Then (s) he appears again in a month, and we have to start from the beginning.

Why do you think it is so important to involve representative of key populations in such work?

Almost all of our staff members except for two are people from the key populations/PWUD community. I have been in remission for a long time myself. I think that a different approach is simply not effective. Nobody can truly understand PWUD as well as a person who has gone through it too, and most importantly, who was able to overcome it and solve a problematic situation successfully.

When people are doing something for the society, they often have an ideal example of such society in mind. Do you have one?

I don’t have examples of an ideal situation in any country. There are drawbacks everywhere. When it comes to talking about the approach to working with PWUD in Russia, I reply that there’s simple no such work. Those few NGOs that provide harm reduction programs, can’t reach all the PWUD to the full extent. For me the ideal situation is when the system of social support is developed in the country, there are harm reduction programs, access to quality treatment, and there is no stigma and discrimination within the society.

Support. Do not punish!

In June 2019, dozens of cities in the EECA region hosted the campaign «Support. Do not punish». Activists took to the streets to publicly protest against repressive drug policies.

This action, which is held annually all over the world, is a great chance to once again draw attention to this unresolved problem. How it was in the EECA region in 2019 you can read here.

Plans for 2020

Are you part of a collective, network or organisation advocating for drug policies that prioritise health and human rights? Are you planning to join the 2020 Support. Don’t Punish Global Day of Action and have an outstanding plan to build momentum? If your answer is “yes” then this call for applications might be for you!

Through this call, the Support. Don’t Punish campaign aims to identify and support local partners (up to 7) with funding of between USD 2,000 – 4,000 for strategic, creative and collaborative projects building up to the 2020 Global Day of Action that advance drug policy reform, bolster harm reduction and build bridges with/within/between communities disproportionately affected by the “war on drugs” (e.g. people who use drugs, farmers of crops deemed illicit, youth, ethnic minorities, LGBTQ+, among many others).

You can apply for the grant here.

What is “Support. Do not punish”?

Support. Don’t Punish is a global grassroots-centred initiative in support of harm reduction and drug policies that prioritise public health and human rights. The campaign seeks to put harm reduction on the political agenda by strengthening the mobilisation capacity of affected communities and their allies, opening dialogue with policy makers, and raising awareness among the media and the public.

The campaign’s yearly high point is the Global Day of Action, which takes place on, or around, 26th June (the International Day Against Drug Abuse and Illicit Trafficking). Historically, this date has been used by governments to showcase their drug control “achievements” in coercive terms. The campaign’s Global Day of Action seeks to reclaim and shift that day’s narrative. And so, every year, an increasing number of  activists in dozens of cities all over the world join this unique and multifaceted show of force for reform and harm reduction.

The Support. Don’t Punish campaign aligns with the following key messages

  • The drug control system is broken and in need of reform
  • People who use drugs should no longer be criminalised
  • People involved in the drug trade at low levels, especially those involved for reasons of subsistence or coercion, should not face harsh or disproportionate punishments
  • The death penalty should never be imposed for drug offences
  • Drug policy should focus on health, well-being and harm reduction
  • Drug policy budgets need rebalancing to ensure health and harm reduction-based responses are adequately financed.

 

Anke van Dam is a member of the advisory board of the European Forum for Primary Care

Anke van Dam, executive director of AFEW International has been elected as a member of the advisory board of the European Forum for Primary Care.

What is The European Forum for Primary Care?

The European Forum for Primary Care (EFPC) was initiated in early 2005 by a group of interested parties from several countries.

The basic aim of the Forum is to improve the European population’s health by promoting strong Primary Care. This is done by monitoring the state of Primary Care in the European countries, by collecting information on conditions that matter for strong Primary Care, and by exchanging experiences.

The Forum connects three groups of interested parties: the health care field, health policy makers, and the producers and evaluators of health care information. These interested parties work at three levels: the local or district level, the national level, and the supra-national level. By linking policy practice and research the Forum intends to stimulate policy making based on vision and evidence as much as it intends to support PC practice oriented towards quality and equity.

The membership of AFEW International

Anke van Dam: «The membership to the advisory board of the European Forum of Primary Care allows AFEW to learn from primary health care providers in European Countries and further the best practices to ensure equity in health and bring those to Eastern Europe and Central-Asia. What does it mean and what are the conditions when we talk about access to health services, gender and inequality per diseases? This is all discussed in the EFPC and the necessary role of primary care. AFEW International brings knowledge and vast expertise about the EECA region and a great network of contacts with organizations, institutes, agencies and professionals to the EFPC.

With the help of European Forum of Primary Car AFEW International hopes to build the bridge and to facilitate exchange, linking and learning between professionals from East and West».

 

The Coordination Committee called on the Global Fund to support the fight against HIV epidemic in Russia

The Coordination Committee for the prevention and control of HIV/AIDS in Russian Federation, responsible for oversight and coordination of the implementation of the Global Fund grants in Russia, called on the Global Fund to allocate funding to support civil society organizations in their fight against HIV epidemic in Russia for the next three years.

2019 is the year of the replenishment for the Global Fund to Fight Aids, Tuberculosis and Malaria (Global Fund) and by the end of this year, based on the results of the replenishment, the Global Fund will make a decision on the allocations for the eligible countries to address HIV, TB and Malaria for the next 3-year period.

According to the 2019 Global Fund Eligibility List, the Russian Federation has met the requirement of two consecutive years of eligibility based on income classification and disease burden and is now eligible to receive an allocation of funding to support the HIV/AIDS response for the next 3 years. Since the Russian Federation is not on the OECD-DAC List of ODA recipients, according to the Global Fund’s Eligibility Policy, the Russian Federation may only be eligible for an allocation to support the HIV response efforts by non-governmental or civil society organizations and only if the country demonstrates barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology.

According to the Global Fund’s Eligibility Policy, “the eligibility for funding under this provision will be assessed by the Secretariat as part of the decision-making process for allocations. As part of its assessment, the Secretariat, in consultation with UN and other partners as appropriate, will look at the overall human rights environment of the context with respect to key populations, and specifically whether there are laws or policies which influence practices and seriously limit and/or restrict the provision of evidence-informed interventions for such populations.”

It is a well-known fact that Eastern Europe and Central Asia (EECA) is the only region in the world where the HIV epidemic continues to grow , and Russia has been considered as the “driving force” of this regional growth. According to the UNAIDS 2018 Global AIDS Update, “the HIV epidemic in Eastern Europe and Central Asia has grown by 30% since 2010, reflecting insufficient political commitment and domestic investment in national AIDS responses across much of the region. Regional trends depend a great deal on progress in the Russian Federation, which is home to 70% of people living with HIV in the region. Outside of the Russian Federation, the rate of new HIV infections is stable.

 

 

For people living with HIV in Belarus

Since July 19, 2019, a new version of article 157 “Transmission of Human Immunodeficiency Virus” of the Criminal Code of Belarus has been enforced. Despite the approved amendments to this article, it still contributes to vulnerability of the key populations, in particular serodiscordant couples (where one of the partners has HIV). However, a solution has been found, thanks to which the amendment will be able to serve for the benefit of people living with HIV.

For reference

There is a number of important provisions in the new version of article 157 of the Criminal Code of Belarus.

  • Knowingly exposing another person to HIV is punished with a fine or an arrest or imprisonment for up to three years.
  • If an individual, who knows about being infected with HIV, transmits HIV to another person recklessly or with indirect intent, this offense is punished with imprisonment for the term from two to seven years.
  • The action stipulated by the second part of this article committed against two or more persons, or a person who is known to be a minor, or with direct intent, is punished with imprisonment for the term from five to 13 years.

Besides, the amendment to this article says that the individual committing the actions stipulated in the first and second parts of the article may be relieved from the criminal liability in case if the other person, who was exposed to HIV or was infected with HIV, had been in advance warned about the fact that such individual had HIV and voluntarily agreed to perform any acts, which led to HIV exposure.

Avoiding prosecution

Before this amendment was enforced, the People PLUS Republican Public Association in cooperation with the Republican Center for Hygiene and Epidemiology held a round table to develop a set of measures, which would allow people to fully use the amendments in laws and protect themselves from the criminal prosecution. It resulted in the development of a road map and other documents regulating the fact of warning, which would lead to the enforcement of this amendment. Such documents include.

– New form “How to warn another person that I have HIV”

– Form to warn a contact person of a patient with HIV

– Memo on HIV prevention

Anatoliy Leshenok, Director of the People PLUS Republican Public Association

“When preparing the documents, we tried to take into account any possible circumstances and potential barriers,” says Anatoliy Leshenok, Deputy Director of the People PLUS Republican Public Association. “For example, the Investigative Committee, commenting on the amendment, pointed out that it is important to understand what is the procedure to check in which state an individual gave his or her consent to have a contact with a person living with HIV, to check if he or she had enough information, etc. The Notary Chamber suggested to register informed consent as a confirmation of consent for the contact with a person living with HIV. The Republican Center for Hygiene and Epidemiology developed a new notification form to be used when registering people with HIV diagnoses for follow-up, provided explanations on the amendment to article 157 of the Criminal Code of Belarus and told that it is possible to come to them with a partner to register the fact of warning of HIV exposure. A memo on HIV notification has also been developed and will be published within our project. It will be given to the partners of HIV-positive people. The memo contains contact details of the organizations providing services to PLWH as well as legal consultations.”

Who is at risk?

In the recent 6 months, there were 55 criminal cases initiated in Belarus based on article 157 of the Criminal Code. This number is similar to the one that was registered in 2018. However, it should be noted that 28 cases out of this total number were opened based on the first part of this article, where there is no fact of HIV transmission, but only a perceived risk.

“Recently, we were defense witnesses at a court hearing, when the defendant was charged with putting five sexual partners at risk of HIV,” tells Anatoliy. “The defendant did not transmit HIV to any of those partners – he took ARVs and had an undetectable viral load. The court took into the consideration the scientific consensus statement on HIV transmission, the answer of a WHO representative and the reply from the Professor of the Infectious Disease Department of the Belarus State University on the risk of HIV transmission by a person with suppressed viral load. However, the verdict of the court was that there was still a risk of HIV transmission, so the sentence remained unchanged – 18 months at standard regime penal colony. Just imagine – 18 months of imprisonment for not transmitting HIV to anyone!”

In fact, article 157 put a question mark over the existence of serodiscordant couples, who often live together for many years and even have children. Usually, within such criminal cases charges are brought against a husband or a wife, while the “victim” clearly states in court that he or she has no complaints to the spouse and that he or she was consciously taking risk to conceive a child with a loved one.

Drawbacks of this article also relate to the fact that criminal cases are initiated with no complaints from the victim.

“When making amendments in article 157, we were suggesting more radical changes – to fully exclude responsibility for exposure to HIV from this article – but the society is so far not ready for such changes,” continued Anatoliy. “Currently, the cases initiated based on this article are reviewed, where the sentences directly state that the partner was informed about HIV and consciously agreed to the actions, which led to HIV transmission or exposure to HIV. According to the Code of Criminal Procedure, the review of such cases is initiated by penal colonies and prisons, and if a person is not imprisoned, such person should file a relevant request for review with a court.”

First successes

Approval of the amendment to article 157 of the Criminal Code “Transmission of HIV” together with the set of enforcement measures, which were implemented through the grant from the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia (EECA), allowed talking about the first successes of the activists in HIV response in Belarus. Now hundreds of people can have the record of their conviction expunged, with many more who will be able to avoid criminal prosecution.