Bishkek joins Zero TB Cities International Initiative

Today, December 6, Bishkek joined Zero TB Cities international initiative aiming to reduce tuberculosis disease rate in cities, an important event happened during City Health Leadership Forum in Kiev. Vice Mayor for social issues of the city of Bishkek Tatyana Anatolievna Kuznetsova and Executive Director of Stop TB Partnership Dr. Lucica Ditiu signed this long-waited for declaration.

Vice Mayor for social issues of the city of Bishkek Tatyana Anatolievna Kuznetsova:

Early HIV detection is one of the important tasks in order to maintain and strengthen people’s health, achieving it to a large extent involves confronting stigma and discrimination.

Firstly, I would like to point out that Mayor’s Office of Bishkek acknowledges that stigma and discrimination create breeding ground for the epidemic spread. It is the social stigma and self-stigma that build barriers to HIV-testing as well as to its treatment and care.

In the beginning of this year the Mayor’s Office started active collaboration with the civil community and AFEW-Kyrgyzstan. Signing Paris Declaration and joining the initiative to facilitate activities in big cities have become the first steps of this collaboration. We commenced to design the first city program for HIV prevention that will be running for 2 years. Even though these questions largely fall into the domain of the Ministry of Health, it was important to us to make our contribution to people’s health. The document is now at Bishkek City Kenesh awaiting approval. After the paper is approved we hope to contribute about 10 million som from the municipal budget to HIV program. Expanding HIV-testing coverage is one the program priorities. According to expert estimations, about 35% of Bishkek citizen living with HIV are still unaware about their status. When we were discussing how to achieve this goal, we thought to start with ourselves. This is why the Office Administratives, including myself, and Heads of the structural departments publicly went to have their HIV-tests made during a large event as part of the World AIDS Day. This event was widely covered in social and mass media. When the authorities send such precise signals like this, citizen pay attention and stigma weakens.

Our next step together with AFEW-Kyrgyzstan is to start a large-scale training course for the employees of the local territorial departments about HIV, stigma being a keynote of the whole training course.

Next year we plan to start a working group at the City’s Healthcare Department. This group will bring together vulnerable communities and the Mayor’s Office in order to mutually discuss and plan activities within HIV prevention campaign. World Aids Day 2019 slogan is Communities Make The Difference. It is the close collaboration with the civil society and communities that will help us to eliminate stigma and discrimination in Bishkek”

Dina Masalimova, AFEW-Kyrgyzstan Programs Manager: “We would like to express our gratitude to the Mayor’s Office of the city of Bishkek for cooperation and openness to the new initiatives in healthcare. Our collaboration started in the beginning of 2019 under the framework of a PITCH project “Key populations and HIV and TB prevention priorities”. A number of meetings and panel sessions were held since then where the community and city’s healthcare representatives reported to the city authorities about difficulties and problems they face. In response, the Mayor’s Office committed to facilitate UNAIDS ambitious 90-90-90 goals by joining Paris Declaration. As the first step to implement its realization the Mayor’s Office developed a municipal program for HIV prevention together with AFEW experts. We are very glad that today the City Administration expressed their desire to step in the TB problem. It is particularly important since our research shows a large spectrum of medical and social difficulties TB patients are facing in the city. We would like to believe that signing of the ZERO TB Cities Declaration and active involvement of the Mayor’s Office of Bishkek would produce positive affect in the nearest future“.

About Zero TB Cities initiative

The purpose of the initiative is to create ‘islands of elimination’ that will contribute to lowering rates of TB and further support in implementing effective strategies on the national level.

The Initiative appeals to the local authorities to support and directly and actively participate in fighting TB in cities in close collaboration with the civil sector and other interested partners in order to achieve significant reduction of TB death rate and prevalence, develop comprehensive programs at those sites in local context, mobilize complimentary financial, technical and clinical resources, exchange the resources and experts between participating cities, as well as disseminate knowledge and generate global political will.

The Kyrgyz Republic is one of the countries that demonstrates the highest rate of TB prevalence in the European region. Like any other megapolis, Bishkek has higher concentration of key population groups with high risk of HIV and TB infection. By the end of 2018, estimated rates were as follow: living with TB – 76.9, deaths – 5.1 in 100,000 people. To ensure wellbeing of the population it is very important to grant access to high quality medical and social services to these population groups as well as focus at upholding human rights.

 

The EECA City Health Leadership Forum

On the 6 December 2019, the EECA City Health Leadership Forum will be organized in Kyiv, Ukraine, showcasing the results of the Fast Track HIV/TB Cities Project (2017-2019)

The Forum will focus on discussing the regional context, sharing successful HIV and Tuberculosis city response models and facilitating movement towards ending these diseases in Eastern European and Central Asian (EECA) cities. It will include a Mayors’ high-level panel discussion, presentations of successful city responses and innovation to fast-track cities to 90-90-90, which will feature the inclusion of key populations in the cities’ responses. The Forum will gather over 150 delegates from 20 countries of the EECA region, including 11 city Mayors.

The Fast-Track HIV/TB Cities Project

Launched on World AIDS Day 2014, the Fast-Track Cities initiative has grown to include more than 300 cities and municipalities that are committed to attain the UNAIDS 90-90-90 targets: 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART); and 90% of all HIV-diagnosed people receiving sustained ART will achieve viral suppression.

Alliance for Public Health (Ukraine) together with AFEW International (The Netherlands), licit (Switzerland) and Stop TB Partnership under technical guidance of UNAIDS EECA office with funding of The Global Fund initiated the regional Fast-Track HIV/TB Cities Project. The project was implemented between 2017-2019 and developed efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in five project cities; Almaty (Kazakhstan), Balti (Moldova), Odesa (Ukraine), Sofia (Bulgary), and Tbilisi (Georgia).

Amsterdam was one of the first to sign the Paris Declaration in 2014 and has introduced a comprehensive health policy for key populations. AFEW International with expertise on increasing access to health services for HIV, TB and viral hepatitis for key populations, is well-connected to the Municipal Public Health Service and police in the Netherlands. This expertise was shared in two training courses and a study tour.

International best practice suggests that collaborative city level models have been most effective in reducing HIV and TB burdens. The first training series, ‘Collaboration between municipalities and civil society – models and realities’, were designed as an exchange and sharing of experience and best practices in successful models of municipality and NGO partnerships. Five integrated work meetings and counselling sessions with selected project city stakeholders from municipality, health and social sector, NGOs and key populations were conducted by licit and AFEW International and improved key populations’ service access through better collaboration between relevant city stakeholders – most importantly, between municipalities and NGOs.

The second training series on innovative municipality funding approaches planned exchanged and adapted such approaches and income generating activities. The training replicated successful practices in the project cities through learning from experiences in Amsterdam. During this training the best international practices of public-private partnerships at city level and private funding for key population programmes offered inspiration for the participants of the training.

During the study tour different partners of AFEW International shared models, experiences and activities that demonstrated successes and challenges in increasing access to health for key populations. Project partners from Almaty, Kyiv and Tbilisi were provided the opportunity to connect to civil servants and different health actors within the Netherlands and discuss initiatives to reach out to key populations to increase their quality of life. Furthermore, representatives of municipality, police and NGOs working with key populations elaborated on different forms of collaboration, to prove that the only way to eliminate HIV and TB is if municipality, police and NGOs work together.

 

 

How KP organisations in Russia change people’s lives

Despite significant struggles and risks to their lives, HIV activists in Russia work relentlessly to create a supportive environment and improve access to HIV and health services for key populations and adolescent girls and young women.

At a recent conference in Saint Petersburg on comprehensive rehabilitation and reintegration of people who use drugs, PITCH partner Humanitarian Action together with the Government of Saint Petersburg brought together representatives from both non-governmental and governmental organisations, medical institutions, and academia.

At the conference, they shared best practices and discussed prospects for addressing the pressing needs of people who use drugs in the Russian Federation. The conference provided great opportunities to connect with representatives of civil society organisations working on HIV/AIDS and learn first-hand from experts about the latest HIV/AIDS trends and programmes to tackle the epidemic in Saint Petersburg and Russia as a whole.

Leading by example

Linas Cepinskas (PITCH, Amsterdam): “On the ground, our partners have been doing exemplary work. Besides ongoing valuable contribution to different working groups and meetings with government authorities in Saint Petersburg, they keep on delivering excellent prevention and support services to the most affected key population groups”.

Significant policy work is being done by for instance, E.V.A., a Russian network of women living with HIV and other sexually transmitted diseases. They are engaged in the analysis of different prevention programmes across Russia. By collecting best practices and approaches, for instance, they are trying to bring government’s attention to the needs of young key populations.  One of the examples E.V.A. showed us was the community centre of Silver Rose, a sex worker-led organisation. Sex workers can bring their children to a day care while testing for HIV, TB and/or syphilis. In addition, a psychologist and a social worker are available, if needed.

Another telling example of prevention services in gay clubs and saunas is the work of the LGBT organisation Gigieya. In addition to giving out free condoms, they offer speed-testing for HIV, TB and hepatitis. This service is crucial, especially for those with lower income and less awareness of HIV, for instance, migrants. “To cater for specific groups even better, Humanitarian Action has a mobile clinic tailored to, among others, female sex workers and drug users. They also have a special fast-response brigade for people with disability, consisting of psychologists, social workers, and medical doctors“, added Linas.

 

Committed partnership

PITCH is committed to supporting community-based organisations to uphold the rights of populations most affected by HIV and engage in effective advocacy in the Russian Federation. The recent visit to Saint Petersburg illustrates some positive and inspiring results and offers new insights into ongoing and future programmes to improve local access to HIV and health services for key populations in the Russian Federation.

 

I’m changing this world

The theme of the World AIDS Day 2019 is communities. Сommunities that make an invaluable contribution to the AIDS response. Communities of people living with HIV, key populations such as gay men and other men who have sex with men, people who use drugs, sex workers, transgender people, prisoners, and communities of women and young people are all encouraging and supporting the provision of HIV-related services. Communities are a source of vital energy for an effective AIDS response and an important pillar of that response.

Representatives of these communities are very different. Some of them are already on the front line, defending their rights every day, others are just beginning their journey towards important changes – for themselves and for society. On the World AIDS day AFEW International talked to them about their experiences and goals.

 

Konstantin Bushuyev, trans*activist, Russia

About the difficulties

At some point in my work on HIV prevention among transgender people, I was faced with some frustration. There were results. But they weren’t exactly the ones I wanted. And this work did not always find support in the trans* community itself. Studies I know from NGOs in Russia show that the topic of HIV for trans*people is not a priority. The first place is occupied by issues with hormone replacement therapy for those who need it, and general difficulties with safe access to qualified medical care. And the research that I took part in at the time showed that people who took part in the survey were very indifferent to the topic of HIV prevention, given their good knowledge of other health issues. For trans*people, in my opinion, the issues of HIV prevention and treatment are most closely related to health issues in general. Trans*people very often do not seek medical help until the last moment. Because they are afraid of inadequate response from doctors, transphobia. Because they are afraid of being outed. Because they are not ready to explain again who they are. And doctors themselves often do not know what to do with such a patient. And when it comes to HIV, all these fears double, because it is an additional stigma.

About success

For me, the main success now is that I have decided not to leave activism, despite the various circumstances that have almost already led to it. Burnout, that’s the thing…

About a reason to be proud

In Krasnodar, HIV prevention activities among LGBT people have been carried out by activists for a long time. But I am proud of the fact that my work helped to drawn attention to transgender people as a separate group with its own peculiarities and needs.


Evgeniya Korotkova, Board Member, Eurasian Women’s AIDS Network, HIV+, Uzbekistan

About gratitude

I am happy to be able to speak openly about my status because I feel the great support of my family, colleagues, activists, friends and women who have experienced HIV infection. After all, each of them has invested something so that I can now talk about HIV infection without fear, without pain or humiliation. Someone can do it right away, others need time.

About open conversation

Sometimes I talk about HIV because I have thousands of people behind me who are living with HIV and they are not ready to speak for themselves because of the stigma and discrimination in society. And for the voice of the community to be heard, you have to talk and sometimes even scream. Sometimes I talk about HIV for the public to break existing stereotypes about people living with HIV and motivate them to take responsibility for their own health and HIV testing. Sometimes I talk about HIV for PLHIV who have learned about their status, I share with them my positive experiences of living with HIV. Given my personal experience of having a child without HIV, I understand that this is a question that concerns every woman living with HIV personally and affects so many areas of a woman’s life, from self-esteem to an external social environment.

I care about women and HIV first because I am a woman, mother and wife who have gone through all the hardships of living with HIV. Secondly, it is important for me to involve women living with HIV in addressing women and HIV. We know our needs and requirements better, and what actions lead to the improvement of their quality of life. Thirdly, by helping to build women’s capacity to advance their rights and improve the national response to the needs of HIV-positive and vulnerable women, we could significantly reduce the spread of HIV among the entire population and increase support for children living with or affected by HIV.

About success

My colleagues and I initiated the submission of documents to the Ministry of Justice in order to obtain the legal status of the women’s organization “Positive Women” in Uzbekistan. I very much hope that in 2020 we will have more opportunities to lobby for the interests of our members at AIDS Centers in the field of expanding access to HIV treatment for women and children, improving the quality of medical services provided to reproductive health and combating violence against women.


Yevgeniy Yuldashev, peer navigator, ex-prisoner, Kyrgyzstan

About the challenge

As an ex-prisoner, I faced different barriers on my way.However, the biggest challenge for me was my release from places of confinement. When I tried to return to the society, the society demonstrated its resistance and did not accept me as a person. It was very important for me to regain self-confidence, overcome self-stigma and learn how to respond to discrimination.

After the release from prison, working in an NGO is the best option. Here people are more open and treat you like a normal person, which is a rare case in government institutions, for example. An important part of my way was my work, thanks to which I was able to help people from key populations and heal myself.

About a reason to be proud

Most of all I am proud of the fact that now I really start seeing myself as part of the society as I have completely quit injecting drugs and methadone. I am proud that I am married and can work in an NGO. A big achievement personally for me is having the freedom to openly say that I have seven records of criminal conviction, went to penal colonies four times and spent 12 years in places of confinement.

Besides, I am very happy that now government bodies start working on creating better conditions for people who are released from places of confinement. To a great extent, it is due to the fact that our community not only continues its fruitful work with civil society organizations, but also starts interacting with government agencies and probation departments.


Ildar Guzairov, Director of Karina NGO, HIV+, Kazakhstan

About the challenge

The biggest challenge in my life was to accept my status. Till the last moment, I did not believe that it could happen to me. Only when I found myself in a hospital and almost lost one of my eyes, I finally believed that HIV exists. At that moment, I was aware that there is life-long therapy, I read a lot about it, even though I rejected my status.

About stigma 

This year, I had some difficulties overcoming stigma in places of confinement, when I was arrested and convicted with no reason. First, I couldn’t explain to the policemen that I am sick and that I need treatment and ART. Then, when I managed to explain it to them, I was labelled as “AIDSy”, “black death”, “syph”, etc. I faced all kinds of psychological pressure, including people telling me that I was going to die. It lasted for about three months.

About how to cope

Information helped me to cope with my disease. I was able to show that I was not dying, vice versa I was feeling well and had good health, better than some others! Later I was even called in for questioning, where I was asked about HIV, routes of transmission, if it can be transmitted through air or hand-shaking, how it is treated, etc. Thus I could show that people living with HIV have strong spirit and are almost undefeatable. People shouldn’t play blame games with us as it can happen to anybody. In four months, all my charges were dropped and I was released from prison.

About a reason to be proud

Most of all, I am proud that our community has knowledge and many of us can protect our legal interests at the government level. I am happy that more and more PLWH adhere to treatment and that the government tries to help us. We have a law on HIV/AIDS, a law on probation. People in places of confinement have uninterrupted access to ART, though just last year detention centres could ignore the needs of PLWH.

About achievements

My peers and I organize self-help groups again. Before, we used to get together at my place, up to five people at a time, and today we have 35 or more people attending our groups. My activities really changed the world, the world inside me. Now I understand people, not only from the community, but also others, much better. Once I changed the world inside me, the outside world also changed its attitude to me and now it treats me better!


Andrey Radetskiy, LGBT activist and HIV expert, Ukraine

About the challenge

Probably the biggest challenge for me is that now it is not safe to have sex in Kyiv if you do not have a regular sexual partner. After PrEP became available, we see more sexual freedom, more ways to experiment in our community. That is why many of my friends and acquaintances started using drugs and engaging in chemsex. Back in the middle of 2017, it was difficult for us to find respondents for our first pilot chemsex study in Kyiv, but now finding respondents is not a problem anymore. If I say that every second person could take part is such study, it would not be an exaggeration. Now it is super easy to get an STI in our city, though there are still some problems with the treatment. For instance, to treat syphilis, apart from the standard antibiotic, one needs a couple of other medicines, which are hard to find at the Ukrainian pharmaceutical market as such medicines are mostly produced in Russia. Earlier, we used to have outbreaks of syphilis in spring, but now they happen all the time. Many guys do not notice any symptoms and engage in self-therapy – either as they are afraid of stigma from the side of doctors or as they do not realize how serious the consequences may be.

About activism

In the recent year, I delivered many lectures on sexual education and health in Kyiv-based universities for the students studying PR, marketing, journalism, medicine, psychology and social work.

Currently, I continue holding workshops, presentations, training for MSM, trans people, sex activists and all those interested in HIV/STIs. My training events are popular and demonstrate positive changes in public opinion on LGBT, in particular through raising people’s awareness on HIV/STIs.

Before July 2019, I was coordinating the project of the national information platform for MSM called GET TEST (ALLIANCE.GLOBAL NGO).

Thanks to a number of successful information campaigns, GET TEST became one of the main information portals on health for MSM in Ukraine with a possibility of fast online registration for testing and access to prevention services in 17 regions of Ukraine.

I think I can be proud of our successful information campaign “HIV Test is Easy”, for which we engaged some celebrities, opinion leaders and bloggers. We made a number of social videos, which have tens of thousands of views and receive positive feedback.

They were presented during a morning show at UA:PBC channel on the eve of the World AIDS Day. It was the first time for ALLIANCE.GLOBAL when a project aimed at MSM was publicly presented on TV.

At the same time, I think that my biggest personal achievement this year is that I started working in one of the most famous HIV/AIDS organizations in Ukraine – Elena Pinchuk Foundation, where I manage and coordinate the activities of our education centre – dialogue hub – organizing the work of its residents, developing sex education programs for youth and implementing a number of projects to increase the visibility of LGBT community (exhibitions of LGBT painters, social bullying theatres, Gender Studies talk show, etc.). Besides, in the hub I continue delivering lectures on how to reduce the risks related to chemsex and how to prevent STIs. In particular, I inform and consult MSM community members on PrEP. These lectures are attended by the representatives of our target groups, for whom such topics are most relevant.

About a reason to be proud

For the first time, LGBT agenda was brought up publicly in the Elena Pinchuk Foundation. Before, this organization did not work with this target group. For instance, in October I organized the Gender Studies talk show, with a famous TV host publicly interviewing a transgender woman, Anastasia Eva Domani. The audience of the dialogue hub was positively interested in the talk show.

However, the most significant achievement for the community of PLWH in Ukraine was cancellation of p. 3 of the Order of the Ministry of Health dated 2008, based on which people affected with HIV (B20-B24) did not have the right to adopt or take custody of children. It became possible thanks to the lawyer Vitaliy Matveyev, whom I provided with my expert support. Together we registered the PROJECTOR NGO, which will engage in human rights, advocacy and research activities. Besides, I have been consulting Vitaliy on dealing with the criminal cases against the members of key populations in terms of HIV/AIDS as well as LGBT. Currently, the lawyer makes preparations to defend clients who faced discrimination on the grounds of their sexual orientation or against whom hate crimes were committed.

The activities of PROJECTOR NGO will also be focused on organizing research studies aimed at analysing the behaviour patterns of the groups vulnerable to HIV/AIDS.

 


Konstantin, coach, 17, HIV+, Ukraine

About the challenge

The hardest challenge for me was losing a close friend of mine. I was in a lot of pain, I felt loneliness and I had nothing. But I coped with it. I don’t think that I could do that without the help of a psychologist at school. The specialist helped me to put everything in its place. I am very grateful to him.

About a reason to be proud

Activism has become a part of my life. I am proud of my activity in Teenergizer and everything I have done in such a short time. My role in the organization is to conduct and organize training. I think it’s important to involve new people in health care because many people still live with the notion that HIV is a sentence, that HIV positive person is necessarily a drug user. But if we look at HIV-positive teenagers, mostly we will not see this. But parents of HIV positive young people indeed had such problems.

 


Rahim, migrant, PWUD, Russia

About the challenge

The main and most difficult challenge for me is drugs. These drugs drag and eat you up, you live in them, breathe them…and there is nothing else around you. I had the strength to run away from them to the other side of the country. I am proud that I had the strength to do so, and I was able to give up my addiction to terrible substances. Now I am happy – I have a sunshine over me, I have home. I found an abandoned house where nobody lived for 5 years, made repairs, and now I have a house in Russia.

About openness

I talk about myself openly so everyone can see how difficult life can be sometimes. I want people who use drugs to be not afraid to talk about themselves. I guess I’m one of the first people in Russia who speaks with an open face about addiction when I’m in it. But I’m not afraid of that. If you don’t say anything, if you keep quiet, nothing will ever change. I live without a passport, without a homeland, without a flag, and I dream of living like a normal person.

About plans

Next year I’m planning to start farming, get chickens, ducks, goats and rams. I want me to have a home, a family, a wife I love. I really want “salts” to disappear from Russia, they kill people.

 

RADIAN grants are now open for grant seekers

Since the 21 of November RADIAN grants for both the ‘Model Cities’ (Almaty only) and ‘Unmet Need’ funds are open for grant seekers to submit concept notes.

The RADIAN ‘Unmet Need’ fund will support local initiatives across the EECA region and beyond the select ‘Model Cities’. Initiatives selected will focus on prevention and care, education, community empowerment, and novel partnerships. The programme will be implemented locally, working with key stakeholders and partners.

The Fund is welcoming concept notes for evidence-informed solutions implementing in Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Estonia, Georgia, Kosovo, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Montenegro, Republic of Moldova, Russian Federation, North Macedonia, Romania, Serbia, Slovenia, Tajikistan, Turkmenistan, Ukraine, or Uzbekistan. The Fund welcomes concept notes for multi-country projects.

You can join for a webinar on applying for a RADIAN Unmet Need Fund grant. This webinar will guide applicants through the RADIAN Unmet Need Fund Opportunity Announcement and application process, and offer an opportunity for participants to ask questions on the Opportunity Announcement and application process.

The webinar will be held on December 3rd 2019 11:00-12:30 (GMT). Please register for the webinar here.

Applications to implement Model Cities in Almaty are now open as well. The programme will support innovative approaches, including new models of care and expanded prevention and healthcare programmes, led by groups who are on-the-ground and part of the community.

The first RADIAN ‘Model City’ will be Almaty, Kazakhstan’s largest city. The RADIAN Model Cities Fund is looking to support programmes centred around existing health system infrastructure that deliver measurable impact in the response to HIV in Almaty. Organisations who share Radian’s vision of significantly improving the quality of care for PLHIV, addressing new HIV infections and AIDS deaths in Almaty can apply for grant funding. A detailed Opportunity Announcement, including eligibility and selection criteria can be downloaded below. Additional ‘Model Cities’ will be announced in 2020.

HOW TO APPLY

RADIAN grants for both the ‘Model Cities’ (Almaty only) and ‘Unmet Need’ funds are now open for grant seekers to submit concept notes. All concept notes must be in English.

Applicants whose Concept Notes are selected to move forward to the Application stage will be notified by the Foundation and will be requested to submit an Application with further details on their solution. A detailed Opportunity Announcement for each fund, including eligibility and selection criteria, can be downloaded below.

 

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.