World Tuberculosis Day 2020

Each year, we commemorate World Tuberculosis (TB) Day on March 24 to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global TB epidemic.

The date marks the day in 1882 when Dr Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.

TB remains the world’s deadliest infectious killer. Each day, over 4000 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. Global efforts to combat TB have saved an estimated 58 million lives since the year 2000. To accelerate the TB response in countries to reach targets – Heads of State came together and made strong commitments to end TB at the first-ever UN High Level Meeting in September 2018.

Countries in the Eastern part of the WHO European Region are most affected by the TB epidemic: 18 high-priority countries for TB control bear 85% of the TB burden, and 99% of the multidrug-resistant TB (MDR-TB) burden. These countries are Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Romania, the Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. Despite much progress in Eastern Europe, critical challenges remain as regards access to appropriate treatment regimens, patient hospitalisation, scale-up of laboratory capacity, including the use of rapid diagnostics and second-line Drug Susceptibility Testing (DST), vulnerable populations human resources, and financing.

The theme of World TB Day 2020 – ‘It’s time’ – puts the accent on the urgency to act on the commitments made by global leaders to:

  • scale up access to prevention and treatment;
  • build accountability;
  • ensure sufficient and sustainable financing including for research;
  • promote an end to stigma and discrimination, and
  • promote an equitable, rights-based and people-centered TB response.

AFEW Partnership‘s activities are also aimed on ending tuberculosis in Eastern Europe and Central Asia. For 5 last year in Kazakhstan, KNCV and  AFEW-Kazakhstan were developing a model for structural collaboration between public health (TB, HIV, primary health care) and non-public sector. AFEW International was coordinating this project.

Kazakhstan was one of the three countries selected to develop a model to strengthen engagement with non-public sector for improved quality of TB/HIV services. Almaty was chosen for the implementation of the model because it is the largest urban area in the country. The project supported the establishment of a network of NGOs that have the capacity to provide TB and HIV care to the most vulnerable populations, and build a partnership between public and non-public sectors to improve access to TB and HIV care by the development of a referral mechanism. Within the program a TB PhotoVoices Project was developed. 

Resource – WHO

 

Voices from the East

AFEW International is actively advocating for the needs to sexual and reproductive health and rights (SRHR) of the EECA region at the international arena.

On 11th March AFEW International on behalf of the partnership ‘Voices from the East’ has submitted a proposal to the Dutch Ministry of Foreign Affairs under the Policy Framework for Strengthening Civil Society for 2021-2025, Grant Instrument SRHR Partnership Fund. Under the leadership of AFEW International, the Voices from the East Partnership brought together 11 strong advocacy and service-oriented organisations and networks to improve access to SRHR for women and youth of Key Population (KP) groups and transgender people:

AFEW International; Eurasian Harm Reduction Association (EHRA); ECOM – Eurasian Coalition On Health, Rights, Gender And Sexual Diversity; Eurasian Union Of Adolescents And Youth Teenergizer; Eurasian Women’s Network On Aids (EWNA); Sex Workers Rights’ Advocacy Network (SWAN); Eurasian Network Of People Who Use Drugs (ENPUD); Dance4life; AFEW-Ukraine; AFEW-Kyrgyzstan; AFEW Kazakhstan.

The partnership plans to work with over 150 local partner organizations from across Easter Europe and Central Asia, advocating for SRHR of women and young people from key populations (living with HIV, sex workers, using drugs, LGBT, in prison) and transgender people as integral part of the Universal Health Coverage (UHC). Through capacity strengthening and mobilizing local communities of key populations the Partnership will work towards evidence-based community-led advocacy for access to high quality, inclusive, stigma-free, integrated and gender transformative SRHR services.

We will know the results of this application in the end of May 2020.

The Dutch Government Policy Framework for Strengthening Civil Society is focused on the West-Africa/Sahel, Horn of Africa, and Middle East and North Africa (MENA) regions. The Voices from the East Partnership is asking for attention to the continued health crisis in the EECA region, being the only region in the world with a growing AIDS epidemic.

Women in prison: mental health and well-being – a guide for prison staff

People in prison have a disproportionately high rate of poor mental health, and research shows these rates are even higher for women in prison. While primary care remains the responsibility of healthcare professionals, frontline prison staff play an important role in protecting and addressing mental health needs of women in prison.

Penal Reform International (PRI), in partnership with the Prison Reform Trust (PRT), has published a guide for prison and probation staff to help them understand how prison life can affect a person’s mental health, with a focus on women. The guide aims to break down the stigma and discrimination attached to poor mental health, especially for women in prison.

This guide is written to help understand how life in prison can affect a person’s mental health, with a focus on women. It describes how to recognise the signs of poor mental health and how best to respond. It also includes a checklist based on international human rights standards aimed to help with the implementation of key aspects of prison reform and advocacy initiatives in line with international standards and norms.

Published with the support of Better Community Business Network (BCBN) and the Eleanor Rathbone Charitable Trust.

Find the guidelines here – PRI-Women-in-prison-and-mental-well-being.

Discover your health!

In 2019 the world famous youth program Dance4Life came to Kyrgyzstan. This means that young people in the republic will now be more informed about reproductive health and healthy sexual behaviour.

One of the Dance4Life champions in Kyrgyzstan, Temirlan Irysbekov (20 y.o.), told AFEW International what this project means for him and shared interesting observations from his practice of working with adolescents.

How did you come to the Dance4Life project?

My coordinator in social organization “Red Crescent” told me about this project and offered to apply. I liked the idea because such areas as Sexual and Reproductive Health and Rights (SRHR), surfactants and HIV/AIDS are very important for society. I always wanted to help people by volunteering, conducting trainings in schools and universities, and I liked it.

What do you do for a living?

I am a part-time student at Bishkek State University, freelance programming for companies from the West. Now I work as a barista in Beeline’s office and also do an internship there as a programmer. And for the last four years, I have also been a volunteer at the “Red Crescent” in Kyrgyzstan.

What does it mean for you to be a leader, a champion of Dance4life?

In my understanding, a leader is a person who is listened to by other people, who can deliver any information beautifully and competently. At the same time, to be the Dance4life Champion is a great pride. To be the Dance4life Champion means to share information with people. This project has given me self-confidence, a motivation that drives me to help people. I can confidently support, motivate people around me.

Dance4life aims to work with young people to develop leadership and maintain reproductive health, prevent HIV and sexually transmitted infections. How do you feel about these topics in your environment? Have you and your peers been enlightened on them in school?

My friends are not well informed about the SRH content, as teachers in schools and universities do not talk about it. They don’t even know how to use contraception or how HIV is transmitted. There was a situation when I heard from friends that HIV is transmitted through saliva. I gave them a little training where I told them how HIV is actually transmitted, gave them arguments to dispel all doubts, and shared with them information about contraception.

When I was a schoolboy myself, we had only one class hour dedicated to SRH in all years. When the Red Crescent volunteers started telling us about men and women health, many became shy, turn away, and even cried. Over time, when I shared with people that it is okay to know about your health and we need to know that to protect ourselves, their points of view changed and they became interested and now they can share this knowledge with others.

Why is it important, in your opinion, to be enlightened on these topics?

During my work with various projects, I have repeatedly encountered horrific stories that could have been warned if people knew more about their health and how to keep it. At one of the medical institutions during the training we were told the story of a girl who was playing with her brother’s clothes and decided to try on his pants. At this time she noticed blood – that was a day when her first period started. At that moment, she thought she was pregnant and decided to commit suicide.

What do you remember most about Dance4Life?

At Dance4life we become not just coaches for the guys, but friends that they can trust.

One day, a guy from our team shared his problem with me: he didn’t know how to deal with alcohol addiction. He told his parents he needed money to eat or for smth else, but he actually went to the nearest store and bought himself a beer. It had been going on for a while and he didn’t know how to stop. I redirected him to a youth center with qualified psychologists. At first, I wanted to accompany him, but I realized that he should be willing to do it himself. He made me a promise to come there.

 

So many women, so many fates

 

In Tajikistan, there is an increase in the proportion of sexual transmission of HIV infection from year to year and an increase in the number of women of reproductive age among those registered with the diagnosis established for the first time. That is why in 2019 the public organization “Tajik network of women living with HIV” (TNW+) with the support of AFEW International in the framework of Bridging the Gaps project conducted a study “Key problems of sexual and reproductive health of women living with HIV in Tajikistan through the prism of human rights”.

Before the International Women’s Day on 8 March, Tahmina Khaydarova, head of TNW+ discussed with AFEW International HIV, sex, violence and gender inequality in Tajikistan.

What does sex mean for men and women in Tajikistan?

For men, sex is an opportunity to satisfy their desire, and only then is it a way of making children. For women, sex is almost always a way of making children and extending the family. As a rule, women in Tajikistan cannot talk about sex and take the initiative in sexual relations, as it is considered to be debauchery.

Generally speaking, the sexuality in Tajikistan is highly exposed to traditional gender stereotypes. It is not common here to discuss sexual relations, either in the family or in society. Some people talk about it with their partners, doctors, etc. But even if they do that that they do not really understand the meaning and significance of the concepts of “sex” and “sexual relations” and most often talk about contraception, methods of protection against unwanted pregnancy, hygiene, etc. But not more.

Does it happen because of national traditions and religion?

Yes, in many ways. However, Islam is a religion of peace and good. Islam does not talk about the abuse of women, but there are other factors that affect women’s lives. These are stereotypes, which can be connected with religion.

One of them is “a woman is obliged to take care of her husband and all members of his family, to be obedient and kind”. Therefore, girls have been brought up in a spirit of obedience since childhood. Women themselves think that men’s interests come first. One of the features of families in the republic, especially in villages, is the predominance of extended families, where several generations of adults and children live in the same house – parents, their adult sons/daughters already married, grandparents, adult sisters or brothers. As a consequence, relatives constantly interfere in the husband and wife relationship.

In the family, girls are taught to be housewives, in most cases have no education, especially in villages, and after marriage the girl becomes very dependent on her partner and family members. Without the permission of her elders and husband, a woman has no right to leave her home and receive information about sexually transmitted diseases (STDs) if she wants. A woman must stand one step behind the man in everything: in decision-making, in expressing her opinion. A woman should listen to her husband’s words, she should keep silence, this is respect. It is also rare for women to be able to decide for themselves when, how and with whom to have sex, how many children to have, etc.

At the same time, sexual violence from an intimate partner increases the risk of HIV infection. During our survey, we heard from the respondents reasoning that non-consensual sexual intercourse is a normal phenomenon, and so it should be in the family, “This is your husband: if he wants to do something then you should obey. He’s young, and that’s why you have to satisfy his desires!”

Inequality between men and women in Tajikistan is developed not only in private life, but also in public life, isn’t it?

Yes, gender inequality is one of the problems hindering sustainable development in Tajikistan. Inequality is everywhere – in access to all types of tangible and intangible resources (property, land, finance, credit, education, etc.); in decision-making in all spheres and participation in political life, and violence against women.

Why do women tolerate violence?

Because it fits within the established system of gender inequality in Tajikistan. Men provide for women, control family relations, and therefore can do, in fact, whatever they want.

But the saddest thing is that society does not sufficiently understand the importance of this problem. It is convinced that domestic violence is a private matter. It is considered that the manifestation of abuse of wife, daughter-in-law, sister, etc. or constant control over their life and behavior is not violence but a norm. At the same time, it is widely believed that a woman is to blame if her husband or his relatives use physical force against her. There are many supporters of this opinion among young people, women themselves, and especially among their mothers-in-law. Therefore, in my opinion, special attention should be drawn to solving the problems of relations between mother-in-law and daughter-in-law, the relationship to the wives of migrant workers during the period when their husbands are outside the country, early and forced marriages, etc.

Are women with HIV more vulnerable?  

Definitely! Despite the fact that very often the source of HIV infection for a woman is her husband, she is subjected to violence and discrimination by her husband and his relatives. One woman said that her husband infected her, but did not consider himself guilty. Sometimes he closed the house and left his wife without food, hungry and helpless. One day he even tied her to a pole with a rope and beat her up, and then left for two days. After this she went to her parents, where she was also discriminated.

Why are women with HIV afraid to visit doctors?

Practice shows that those who go to the AIDS centre receive quality care and many are happy with it, including me. However, the main challenges for women are when they go to other health care facilities (for surgery or dentists), including primary health care (PHC). In these facilities women living with HIV (WLHIV) are most likely to experience discrimination against themselves. During focus groups, there were a lot of situations when health care workers refused to provide medical assistance to WLHIV and disclosed their status. Most of these cases were in maternity hospitals, dental clinics and during other surgeries. Therefore, most HIV-positive women are afraid to disclose their status and do not seek services from health care institutions, including primary health care services in their place of residence.

Have you talked to these doctors? What do they say about discrimination against people living with HIV?

We haven’t interviewed the health workers. However, many women believe that the reasons are in the lack of preparedness of health workers to work with PLHIV, as well as the low level of knowledge about HIV among staff. One woman, who went to the clinic, told doctors about her status. They immediately refused her services. The woman said it was a violation of her constitutional rights. But doctors said that she was ill and they could not help her anymore. Just imagine – that’s what the doctors said!

Besides in Tajikistan there is not good medical personnel who have experience working with PLHIV. A lot of professionals are leaving our country.

Let’s imagine – a woman found out about her status, she is ready to be examined, receive treatment and do everything that doctors say. Can she face any obstacles even in this case?

An antiretroviral therapy (ART) in our country is bought from the Global Fund, so there are virtually no interruptions. If a person wants to take ART, he or she can get it at all AIDS centers. But according to WHO’s recommendations, people living with HIV are assigned to PHC services and according to these requirements a person has to get the service at home. Due to the fact that in rural areas and small towns and districts everybody practically knows each other, PLHIV are afraid of disclosing their status. So there is a possibility that they will not apply to these services locally for ART services.

How difficult is it for women to accept their status?

More often it depends on their level of awareness and education – they might not know anything about HIV or have distorted information about the virus. Because HIV does not show strong symptoms in the early stages, women think that they are not sick and that the virus does not affect them. Also, accepting a diagnosis depends on a specialist working with the woman, conducting pre-test and post-test counselling.

Do you plan to use the results of your research in future work?

At the moment, the country is developing a “National Program to combat HIV/AIDS epidemic in the Republic of Tajikistan for the period 2021-2025”, and we have joined the working group on ART treatment and prevention of stigma and discrimination against PLHIV. As part of this platform, we are actively promoting the recommendations in our report.

At the same time, the research results helped us to identify and understand a number of issues, which we have not always paid due attention to before. Therefore, we will use this information in our daily work.

You can find the research here

 

How to help migrants?

According to UNAIDS (www.unaids.org)[1], Russia has the second highest number of labour migrants in the world after the USA. Rostov region is one of the areas where this number is constantly growing. One of the reasons is its geographical position – Rostov region has the biggest borderline with Ukraine. Due to this fact as well as certain developments related to the armed conflict in Donetsk and Lugansk regions, many migrants from Ukraine with different statuses are coming to Rostov region, in addition to the labour migrants from Central Asia.

Are there any special services for migrants in Rostov-on-Don? How is HIV prevention implemented among migrants? Where can migrants seek help without endangering themselves? AFEW International asked these questions to Vyacheslav Tsunik, President of Rostov-on-Don Regional NGO “KOVCHEG – AntiAIDS” and Manager of the Project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”.

Significant financial support to carry out surveys and provide services to migrants within this project was provided by AFEW International, which, in particular, facilitated coordination with the Central Asian organisations to provide effective support to migrants when they leave their countries of origin and come to Russia.

For reference

Labour migrants are one of the populations most vulnerable to HIV in the world, which is explained by a number of factors. The data of numerous studies show that people coming from the Central Asia have a very low knowledge of infectious diseases: HIV/AIDS, hepatitis B and C. The situation is further aggravated with the low social and economic status of the migrants from Central Asia and the neighbouring countries, lack of access to health services, low level of social support and high prevalence of depression caused by such people living away from their families. High isolation of this social group often leads to HIV transmission inside this community, in particular through contacts with female sex workers, who come from the same countries.

Vyacheslav, how accessible is health care for the labour migrants in Rostov-on-Don?

Health care is provided to the labour migrants who officially live in Russia, in particular in Rostov region, based on their insurance certificates, which they buy when registering their patents. Without certificates, people can access health care on a paid basis, while emergency care if a person’s life is under threat in cases of heart attacks, strokes, catastrophes or accidents is provided to everyone, even with no documents, free of charge and is covered by the state.

How well informed are labour migrants about the problem of HIV?

Surveys among the labour migrants showed that they are not well informed about HIV. In our opinion, the reason is lack of preventive information provided to them in educational institutions in their home countries and when they come to work in Russia.

Do migrants practice any risky behaviours?

In fact, the prevalence of risky behaviours among migrants is approximately the same as among all young people. If we talk about the migrants who come from Asia, e.g. from Tajikistan and Uzbekistan, they have less risky behaviour due to their national customs and traditions. They mostly socialize with their fellow countrymen and they also have respect to older people and certain traditions, which restrict their risky behaviours. As for people from Ukraine and Moldova, they are closer to us, Russians, in terms of their culture and so the situation among them is similar to ours. There are young people who practice high-risk behaviour in terms of HIV. Mainly, they represent key populations. Their share in the total number of migrants is not so big, but they exist and some of them are clients of our organisation. They are not ready to quit their behaviour models.

Are there any differences in the behaviours of HIV-positive and HIV-negative migrants?

There is really a difference in the behaviours of migrants with HIV and those who do not have HIV.

Migrants living with HIV are a closed group. They are not ready to talk about their disease with their family members or their countrymen. Usually, they seek help in HIV organisations only in life-threatening situations or sometimes when they need to stock up their ARVs if there is a danger of treatment interruption.

In Russia, if migrants test positive for HIV, they cannot access free antiretroviral (ARV) therapy as they are foreign citizens. How is this issue resolved?

The situation with supply of ARVs is regulated by relevant provisions. In Russia, government covers ARV therapy only for the citizens. That is why migrants are not able to access free treatment as they are not Russian citizens. However, our organisation has contacts with community organisations in a number of neighbouring countries. We can help people who come to us and assist them is getting support services and ARVs from the countries of their origin.

Currently you are implementing the project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”. Please tell us more about it.

The goal of our project is to slow down the transmission of HIV through raising the awareness of HIV among migrants and creating services aimed at HIV prevention in migrant populations.

What do we do? Firstly, we train peer consultants from among migrants. Secondly, we provide medical and social support to HIV-positive migrants, giving them access to health services. Thirdly, we have meetings and negotiations with the representatives of diasporas concerning implementation of the prevention tools among migrants in Rostov region and coordinate service provision with the NGOs in the countries of origin of those people who seek our help.

Our organisation, “KOVCHEG – AntiAIDS”, is a community-based organisation of people living with HIV, representatives of vulnerable populations, PLWH, sex workers, LGBT and migrants. For instance, with our current project we trained a peer consultant from the migrant community. This is a woman from Ukraine living with HIV. Another peer consultant that we have, who works with people who use drugs, is also a citizen of Ukraine. Besides, when we carried out a survey among migrants, we had a volunteer supporting us – Ravshan from Uzbekistan – who is a student of a university in Rostov region.

Within the project for migrants, we organized the process to deliver HIV services. In particular, we have rapid testing, pre- and post-test counselling, if necessary provision of ARVs from our reserve stock, medical assays and support in receiving consultations from infectious disease doctors, tests for immune status and viral load, prescription of medications and treatment monitoring. We also inform migrants about the existing legal opportunities to acquire Russian citizenship with HIV status and facilitate people with HIV in obtaining temporary residence permits and Russian citizenship.

How and where do you share information about the services available?

Migrants can access our informational leaflets in the places, which they visit, such as the migration departments, health institutions, which issue the required health certificates to them, pre-deportation detention centres, and higher educational institutions we cooperate with. We use QR codes, allowing migrants to download any information on their smartphones and use it when necessary. As a result, it brings clients to our consultants, who can provide them with any additional information needed.

Name one of your most important recent activities?

Recently, we appealed to the Public Monitoring Commission and asked it to help us access the migrants in pre-deportation detention centres. The Public Monitoring Commission sent an official request to the Ministry of Internal Affairs. We visited the detention centres, met with the migrants living with HIV who stayed there and agreed with the administration of such centres that we would have further access to such migrants living with HIV. We are planning to seek financial opportunities for people living with HIV to receive consultations from infectious disease doctors, get tested for their immune status and viral load and access ARVs for the period of their stay in such institutions. Besides, we are working on developing an appeal to the government officials about the need to provide this category of people with HIV treatment at the expense of the state.

[1]Migrant populations and HIV/AIDS: the development and implementation of programmes: theory, methodology and practice / UNAIDS, UNESCO.

What should be a Primary Care?

In 2019 Anke van Dam, executive director of AFEW International, became a member of advisory board of European Forum for Primary Care (EFPC) to bring knowledge and vast expertise about the EECA region and a great network of contacts with organizations, institutes, agencies and professionals to the EFPC.

Which level does primary care (PC) in the EECA region have nowadays and how to improve that Prof. Jan De Maeseneer, Former Chair of European European Forum for Primary Care, professor emeritus at Ghent University, talked to AFEW International.

Jan, what are the features of a strong primary care (PC)?

We can speak of a strong primary care system when primary care is accessible for a large range of problems, coordinates care on a continuous basis, provides a broad range of health care services in partnership with informal care givers and operates with supportive governance structures, with appropriate financial resources and investments in the development of the primary care workforce. Effective primary care not only prevents diseases at early stages, but also stimulates people to take up healthier life-styles. Overall health is considered within primary care in a more holistic matter, paying attention not only to biomedical and mental health needs, but also to other causes of ill health, such as social determinants (e.g. housing conditions, employment). This makes primary care more person- centred than disease-centred.

PC of which country/region is the most developed nowadays?

Mostly it’s Europe. The countries with relatively strong primary care are Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, some regions in Spain and Belgium, and the United Kingdom. Especially I like the examples of Denmark, Estonia, and Finland. These countries have «primary care zones». They look at the population 100-200 000 people and try to install a PC system at that level. That enables give a high degree of participation of all stakeholders. At that scale cooperation is easy, and there is an oversight of population’s health needs, to be addressed. The scale is not too big but big enough to have a “critical mass” for effective intervention for different kinds of problems.

And what about the EECA region?

A good primary care needs democracy. Unfortunately, the former “Semashko” Soviet Union healthcare system (HCS) with policlinics, lacking family physicians, and with doctors that earn very little money don’t allow to set up a good PC. I appreciate the development of Kazakhstan – recently they rediscovered the importance of family physicians. Also, I was very surprised by Kyrgiz Republic. Last year I had the opportunity to lecture for 5th year medical students in Bishkek. In discussion on patients’ stories, they demonstrated a high commitment and patient-centeredness, and excellent skills in clinical decision making. EFPC is trying now to help countries in the EECA region to establish better inter-professional training for primary care, using primary care practices in local communities

It’s important for countries in the region to work together and to build their own PC systems. In Eastern Europe Estonia and Lithuania are doing well. Belarus is not the best example, because of the political situation. It is difficult to combine strong primary care with political dictatorship. In Russia I see some nice things. In Saint Petersburg, for example, there are good departments of family medicine with person-centered approach. But it’s still a difficult country. Good PC is possible only in countries with freedom of speech, human rights, democracy and respect for diversity.

Why good PC is especially important for people living with HIV?

Usually in countries of the EECA region if a person has one of 3 diseases – HIV, TB or Hep, most of the health care resources focus on them. There is no general comprehensive, integrated Primary Care.

PC functions very well when you integrate the care and treatment for those diseases in the broader primary health care system (HCS) as World Health Assembly has clearly stated in resolution 62.12 (in 2009). In Africa I met people who had, for example, 5 diseases, so they had 5 different vertical programs of treatment and 5 different doctors who even didn’t speak with each other. Wise HCS is when you integrate these 5 approaches into one, because, for example, diabetes can be easily an (indirect) consequence of HIV treatment.

Is there a difference between European and the EECA region’s approaches in treatment of HIV+ people?

In western countries HIV/AIDS patients are patients like all the others, they are treated in PC. When primary care providers have problems, they refer patients to the secondary care. Such approach also avoids stigmatizing of people, because when they are treated differently, are included in a separate program, there is a huge risk of stigma. Also, the integrated approach is more cost effective.

How to change people’s minds, also doctors’, towards people with HIV?

Well, first of all, you need to retrain family physicians and other primary care providers. In Russia doctors have limited, if any, training in patient-doctor communication, are not familiar with a human rights approach. For example, in the undergraduate training in my university (Ghent University), there are 55 hours of practicing doctor-patient communications with videotaping, simulated and real patients. Also, it’s necessary to train a sufficient number of family physicians for Primary Care: this requires 3 years of full-time post-graduate training, with specific programs and standards. Besides, it’s important to inform and educate population.

People should understand that every person deserves our respect, and we shouldn’t stigmatize others because they have certain diseases. It’s an open culture in a country, and it is a responsibility of the government and civil society.

What is the goal of EFPC in the region?

EFPC has several goals everywhere, including the EECA region. They are:

– to provide a one-stop information hub and building a substantial collection of information and data over time;

– to guide the development of innovative interventions based on the principles of equity, access, quality, person- and people centeredness, cost-effectiveness, innovation and sustainability.

– to connect four groups of interested parties: patients, citizens and civil society organizations.

– to share communication and information;

– to establish networking and training.

Today we have a good contact with countries from the region, people join our meetings. On the 27 September 2020, we will have a big conference in Ljubljana and in the future possibly also a conference in Central Asia. We want to create a regional platform for exchanging experiences. We hope to bring together health care providers and governments so they can learn from each other how to organize service that reflects people needs.

 

 

 

 

AFEW International and ICAP at Columbia University to improve HIV services in prisons in Kyrgyzstan and Tajikistan

In 2020, AFEW and ICAP at Columbia University will partner to implement «Technical Assistance to Central Asian National HIV Programs to Achieve and Sustain HIV Epidemic Control under the President’s Emergency Plan for AIDS Relief (PEPFAR)» in Kyrgyzstan and Tajikistan, a project funded by PEPFAR through the US Centers for Disease Control and Prevention (CDC). In Kyrgyzstan the project will be implemented by AFEW Kyrgyzstan; in Tajikistan, by NGO SPIN Plus with technical support of AFEW Kazakhstan.

With this project, the partners will strive to reach two important goals:

1) improving the 90-90-90 targets for people who inject drugs (PWID) and people living with HIV (PLHIV) in prisons in Kyrgyzstan and Tajikistan, using new technologies and services;

2) facilitating and improving collaboration between general public health care facilities and health care services within the penitentiary system, ensuring continuity of HIV-related services to people being released from prisons.

AFEW International will be the lead agency working with its in-country AFEW partners and local partners to implement this project in Kyrgyzstan and Tajikistan,” said Daria Alekseeva, Program Director of AFEW International. “We have a proven track record and evidence that working as a regional EECA network has encouraged the exchange of context-specific approaches that help to find appropriate local solutions and models of best practice. We combine local Central Asian knowledge and expertise, exchanging this within the wider EECA region, as well as the added advantage of an international, Netherlands-based Secretariat, contributing to international expertise and innovation. AFEW International – together with AFEW Kyrgyzstan and AFEW Kazakhstan, which will provide technical support to activities in Tajikistan – will aggregate lessons learned from ICAP’s previous work in Kazakhstan and combine those lessons with the methodological approach gained through the past experience of working in prisons in Central Asia to produce practical guidelines and training modules. AFEW International will look for possibilities to pilot this model in Kyrgyzstan and Tajikistan, where political and technical conditions may allow.”

“People living with HIV in prisons are less likely to be on antiretroviral therapy (ART) when compared to general population. They are also less likely to adhere to the prescribed treatment regimen and, therefore, are often viremic,” said Anna Deryabina, ICAP Regional Director for Central Asia. “Lower ART initiation and viral load suppression rates among prisoners are due to many factors, including structural factors, such as lack of trained health care personnel in prisons and limited adherence support and treatment monitoring. Also, lack of coordination between general and prison-based health care services and fragmented service delivery systems lead to many people living with HIV being lost to follow-up and discontinuing treatment after being released from prisons. ICAP has been very effective in improving the quality of HIV services provided to people living with HIV treatment facilities outside of prisons. We really hope that AFEW’s deep knowledge and understanding of subcultures and norms inside the prisons, as well as their experience working with the prison-based health care systems will allow this project to effectively improve the quality of services and HIV outcomes for people living with HIV in prisons.”

“AFEW-Kyrgyzstan is pleased to launch this joint project with ICAP. Under the Project, our organization will be responsible for the implementation of the component to achieve the 90-90-90 goal in the penitentiary system,” said Dina Masalimova, AFEW-Kyrgyzstan Programs Manager. “We plan to work in almost all large prisons in Chui Oblast. Our activities will be aimed at expanding HIV testing coverage with the provision of quality pre- and post-test peer counseling, motivation to start therapy, and adherence development. In addition, we will focus on ensuring that people do not stop their treatment even after release.”

This project is very important to maintaining an effective response to the HIV infection in the country, as 5-10% of all PLHIV in the country are in the prison system. With the high turnover of the prison population, this number can be easily multiplied by half per year.

“We are happy to work in a team with such a highly professional organization as ICAP,” said Masalimova. “It is planned that ICAP specialists will be responsible for medical aspects of providing assistance to PLHIV, and our organization will take over the community element and peer-to-peer support.”

In Kyrgyzstan, AFEW-KG will recruit and train a team of peer navigators representing each layer of the prison sub-population (with a special focus on prison outcasts and pre-release prisoners) in order to identify those who practice risky behaviors and haven’t been tested for HIV in the past six months. AFEW-KG will work with newly identified PLHIV to motivate them to start antiretroviral therapy and take all of the necessary tests. The peer consultants will work as liaisons between patients and prison doctors to ensure that patients are prescribed ART, are adherent to treatment, and that relationships between prison doctors and patients are built on mutual trust.

In addition, AFEW-KG will provide a series of counseling sessions for at least 200 prisoners who are PWID on the benefits of starting methadone-assisted treatment (MAT) and dispelling the myths related to the therapy.

“We believe that this collaboration will yield excellent results and that by the end of 2020 we will be able to see tangible progress on each of the 90-90-90 goals in prisons,” said Masalimova.

 

A chance to be heard

Participants from Kazakhstan with AFEW International

Participants from Kazakhstan with AFEW International

Stigma and discrimination are recognized as some of the most commonly identified barriers to fight the tuberculosis (TB) epidemic. Reducing TB stigma is essential because it hinders care seeking, contact tracing, outbreak investigations, treatment initiation, adherence and quality of care. Moreover, it deprives people with TB of their rights and the respect of others.

In collaboration with partners on global, regional and national levels, KNCV Tuberculosis Foundation has developed two stigma reduction packages within TB Photovoice project and piloted them in communities and health care facilities providing TB and TB/HIV in Kazakhstan, the Philippines and Nigeria, funded by the Dutch Ministry of Foreign Affairs.

In Kazakhstan the initiative was implemented by AFEW-Kazakhstan, Sanat Alemi, and Doverie Plus.

For reference

Kazakhstan is one of the 20 high-burden countries for multidrug-resistant TB (MDR-TB). The country has made great progress towards eliminating TB in recent years, with diagnosis, successful treatment and notification rates exceeding the WHO recommenrdations and the estimated incidence.

In may 2018, 12 professional participated in a “Training of trainers” course to learn how to implement TB Photovoices, 9 of whom facilitated the intervention with patients in the end. The group included 6 psychologists, a social worker and a doctor

The TB Photovoice intervention was implemented with 9 (ex-) TB patients – with a mixture of drug-susceptible and drug-resistant TB – some of whom were still on treatment at the time.

The final products (photos, quotes and stories) were launched and shared with the broader Almaty community in advocacy exhibitions and were also reproduced into banners, desc calendars, bads, T-shirts, and postcards to use in heath facilities when counselling new TB patients.

Symbat Sapargalieva, social worker of Sanat Alemi NGO, participant of the PhotoVoices Project

When I found out that I had tuberculosis, I felt so ashamed. There were many negative thoughts in my head. I denied my disease and was pulling away from my family and friends.

I was happy to take part in the PhotoVoices Project and then realized that I have a self-stigma. This project helped me to understand that my friends did not turn their backs on me, it was me who isolated myself from them. There was an exercise called Lifeline with TB, when I had to write down all my negative and positive thoughts. I wrote down only negative ones as I could not find any positive sides of the disease. However, two weeks after I was able to find something good about TB.

I mean, when you realize your problem deep inside and bring it out, it is such a relief. After a while, I set some goals for myself and got a job with a civil society organization to help people who were the same as me. Half of my dreams have already come true!

The main thing I realized is that if you want to change people’s opinion, change yourself. The PhotoVoices Project gave me my voice and a chance to be heard.

Sholpanata Kaldarov, student of the International IT University, participant of the PhotoVoices Project and the Self-Stigma Project, volunteer of Sanat Alemi NGO

When I was invited to take part in the PhotoVoices Project, I was still receiving my TB therapy. I said yes right away as I thought that photos could somehow provide psychological support and motivation to people who just learned that they had TB and also myself, of course.

When I was found to have TB, doctors checked everyone I had contacts with. I felt worse not even because of my own diagnosis, but because all people who were in contact with me had to be checked. Back then, I lived in a student dormitory, and even though my form of TB excluded the transmission of infection, doctors still checked about 100 students from the dormitory and 20 of my group mates. Afterwards, these people had to come to the clinic for special medical check-ups every six months. I felt guilty, so I gradually pulled away from my friends. I had self-stigma.

In the PhotoVoices Project, I experienced a lot of emotions. Before the photo is taken, you remember your past and drag the disease through yourself again. In the beginning, it was difficult to focus on details, but then I felt better and learned to openly talk about my disease.

In our group, there were patients, who already completed their treatment. Talking to them, I heard how they were able to overcome the disease. Gradually, I felt confident that I would also be able to finish my treatment successfully.

I want to thank this project, it really helps the patients who isolated themselves after the disease and lost their self-esteem.

Amanzhan Abubakirov, Teaching Assistant at the Phthisiopulmonology Department of the Kazakh National Medical University named after S.D. Asfendiyarov

Once, the head of our department invited me to take part in a project on stigma. I heard the term “stigma” before, but to be honest did not really know how it can be manifested and how it affects people. It was something new for me, so I agreed to participate.

In the course of the project, I realized that for a long time I was stigmatizing both myself and my patients. Sure, I was kind to them and treated them well, but I thought that I was a doctor and that I was better than them. I have to admit that I feel so ashamed for it.

During the project, we took part in such exercises as “Our Imperfection – Their Imperfection”, “Cross the Line” and so on. Thanks to such exercises, we were able to feel what patients feel, we were able to be in their shoes.

This project really changed my perspective, my view of the world. As a result, I built friendly relations with the patients who stay in our hospital for a long time. I stopped using any terms, which can stigmatize the patients.

More often, I talk to the patients’ relatives, tell them about stigma and ask them to provide more support to the patients.

Besides, I talk to the medical staff working at our department. As I also work at the Medical University, I devote special hours during my classes to talk about stigma and discrimination to my students.

I want to deliver the message that all people are equal, no one is better or worse. However, people with TB are real heroes. Every day, they take a lot of medicines with numerous side effects. Their spouses leave them, their friends turn their back on them, but they continue their fight.

Thank you everyone who fights TB!

 

 

 

 

 

Russian NGOs adopt the experiences of the Netherlands

How do Dutch NGOs fundraise? What are alternative financing models? How to look for sustainable sources of income for NGOs through corporations, private donors, and through social entrepreneurship?

For answers to these and other questions, representatives of Russian NGOs went to the Netherlands. They took part in a study tour organized from 10 to 12 February in Amsterdam by AFEW International. A study tour for representatives of Russian NGOs was held as part of the EU-Russia Civil Forum and the program “Bridging the gaps the Gaps: Health and Rights for Key Populations”.

Representatives of such organizations as Aidsfonds, Mainline, De Regenboog Groep, Dance4Life, as well as the Amsterdam Dinner Foundation shared their experience with the participants.

Nowadays traditional methods no longer satisfy the needs of Russian NGOs, which face great difficulties in obtaining international institutional funding and whose needs cannot be covered by available domestic funds. Thus, alternative funding may lead to less dependence on traditional institutional donors.

The purpose of this study tour was to become familiar with alternative financing models. Participants learned about the new experience of Dutch NGOs and gained knowledge on 7 financing models that do not involve receiving funds from institutional donors.