Study of Sex Workers’ Behaviour in Georgia

Author: Irma Kakhurashvili, Georgia

Gabriela, a 40-year-old sex worker from Tbilisi has not been tested for HIV since 2016. She is convinced that she does not have HIV. She also thinks that she knows everything about this virus. However, when asked if HIV is transmitted by mosquitoes, she says ‘yes’. In July, Gabriela is going to the bustling resort city of Batumi to earn some extra money.

“I do not think that I will get tested for HIV anytime soon as I have got a lot of work and do not have free time. Besides, from Batumi I plan to relocate to Turkey,” says the woman.

Gabriela did not participate in the recent research conducted in two cities of Georgia – Tbilisi and Batumi – to study risky and safe behaviours of sex workers.

No major changes

The Tanadgoma Centre for Information and Counselling on Reproductive Health is the first Georgian organization, which has been studying the HIV transmission among sex workers since 2002. The recent study held in 2017 covered 350 women: 200 from Tbilisi and 150 from Batumi. The goal of the researchers was to determine the prevalence of HIV, hepatitis C, gonorrhoea and syphilis among people involved in sex work. Besides, they were able to analyse the key risks associated with HIV and to collect valuable information for advocacy and policy development. The research study was conducted with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Curatio International Foundation and the Infectious Diseases, AIDS and Clinical Immunology Research Centre.

The study confirmed that 85% of women in Tbilisi and 97.3% in Batumi know about the existence of HIV/AIDS, but only 11.5% of respondents in Tbilisi and 23.4% in Batumi gave correct answers to questions about the HIV transmission. For example, some respondents like Gabriela did not know that HIV is not transmitted through the bites of mosquitoes. In general, the respondents from Tbilisi were less aware of HIV if compared to the ones from Batumi.

Georgian researchers say that there have not been major changes in the study outcomes since 2012. For instance, most women mention condoms as the main measure of protection against HIV.

The study results showed that the indicators of condom use during most recent sexual intercourse with a commercial partner have not changed in the recent 10 years (over 90% in both cities). However, sex workers rarely use condoms with their regular clients.

“I do not use condoms with my regular clients to show that I trust them, but I definitely use them with other clients. I have to suffer offences because of this, but I know that it is a sure way to protect your health,” says Gabriela.

Sex work in Georgia is illegal and often police will confiscate condoms if they decide that a woman could be doing sex work.

Sex-workers and drugs

The research study showed that sex workers are well aware of HIV transmission when sharing needles and syringes. Besides, the recent study showed some interesting results concerning drug use. The share of sex-workers who used non-injecting drugs in the last 12 months was 11% in Tbilisi and 20% in Batumi. The most widely used non-injecting drugs were sleeping pills and sedatives in Tbilisi and marijuana in Batumi.

As for the injecting drugs, 1.5% of respondents in Tbilisi and 3.3% in Batumi injected drugs in the recent 12 months The respondents used ‘vint’, ‘jeff’ and amphetamines in Tbilisi and heroin in Batumi.

“Before, we did not have such data for sex-workers,” says Nino Tsereteli, researcher and head of Tanadgoma.

Women are getting out of sight

Gabriela says that she does not inject drugs but takes some pills. The woman has no problem to buy them in a pharmacy and uses substances at least once a week.

“The issue of drugs became relevant to this key population as well. We have been working with sex-workers for 20 years in five cities in Georgia and cover 3,000 people with our services annually. As for HIV/AIDS, during the period when we conducted the study only three women in Tbilisi were diagnosed with HIV. What is bad is that sometimes as soon as a woman learns that she has HIV, she is getting out of our sight and we do not know where she is and if she continues working with clients,” says Nino Tsereteli.

Gabriela promises that in September she will get tested for HIV with the help of Tanadgoma. She is not going to change her lifestyle, but she wants to know if everything is all right with her health. In Tanadgoma, she will get recommendations not only about HIV because, according to Nino Tsereteli, another problem of sex workers in Georgia is violence. Sex workers do not always know how they can organize themselves to protect their rights, health and lives. In Tanadgoma, they can get knowledge and support of professional lawyers.

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

Author: Olga Ochneva, Kyrgyzstan

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

Experience of preventing gender-based violence in HIV response

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

Tatyana Musagalieva

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

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

Sex-work: challenges and solutions

Ulan Tursunbayev

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

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

Young people are going to AIDS 2018 to gain knowledge

Renata Bayazitova

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

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

Treatment is a priority

Margarita Sabirova

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

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

Sixteen delegates supported by AFEWKyrgyzstan

Natalya Shumskaya

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

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

Ukrainian Youth Will Tell Everyone about HIV

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

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

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

Date and time: 21 July, 15:00

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

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

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

Free entrance

Dutch Organisations Ask the Prime Minister of the Netherlands to Lead the UN High-Level Meeting

Prime Minister of the Netherlands Mark Rutte

AFEW International co-signed the letter to the Prime Minister of the Netherlands Mark Rutte. This letter is a request to lead Dutch delegation at the UN High-Level Meeting on Tuberculosis that will take place in New York on 26 September 2018.

“The Netherlands is an international leader in the fight against life-threatening epidemics, such as tuberculosis. Dutch companies, universities and social organizations make the difference with their knowledge and expertise in the field of health worldwide. 2018 is the year in which the Netherlands can present itself internationally as a member of the UN Security Council and as a participant in the G20, with global health as its theme. This year, the International AIDS Conference and the International Tuberculosis Conference will also take place in Amsterdam and The Hague.

We hope that he will strengthen this position of the Netherlands internationally by leading the Dutch delegation at the High-Level Meeting on Tuberculosis at the United Nations General Assembly in New York on 26 September. Tuberculosis is the deadliest infectious disease in the world with 1.7 million deaths per year. Multidrug-resistant forms of tuberculosis are responsible for a large part of the deaths due to antibiotic resistance. The disease is curable. Dutch expertise and research on antibiotic resistance, drug development and diagnostics are of great importance to stop this disease. International agreements and commitments at the High-Level Meeting on Tuberculosis will contribute to strengthening Dutch Research and Development for new diagnostics, vaccines and medicines. In addition, the work of Dutch NGOs will contribute significantly to the worldwide achievement of the outcomes of the summit,” written in the letter.

16 Dutch organisations are letting Mark Rutte know that to stop this disease, the political action is needed worldwide. They are asking Prime Minister of the Netherlands to represent the Dutch business community, universities and civil society during the High-Level Meeting on Tuberculosis and thus strengthen the leading Dutch role in international health.

AFEW International is Finding New Possibilities in Russia

Anke van Dam meeting with the representatives of the Fund for Resocialization of the Republic of Tatarstan

Author: Olesya Kravchuk, AFEW International

AFEW International continues looking for possibilities of helping key populations at risk for HIV, tuberculosis and viral hepatitis and community organisations in the Russian Federation. AFEW’s executive director Anke van Dam visited a couple of NGOs and community-based organisations during her recent visit to Moscow and Kazan.

In Kazan, Anke van Dam visited Fund for Resocialization of the Republic of Tatarstan. This fund for the first time in Russia successfully tested the model of purposeful employment of those who went through all stages of rehabilitation. For more than three years, the Fund for Resocialization offers employment to people who were using drugs, who are working on modern production of ventilation systems.

“What Daniyar, the director of the Fund for Resocialisation is doing, is amazing. He gives people with a history of drug use and sometimes of imprisonment as well, a chance to earn their own living again. With the job they regain their self-esteem, which helps them to get in touch with their family and participate actively in society again,” says Anke van Dam.

The Fund for Resocialization of the Republic of Tatarstan is engaged in the resocialization of people dependent on the psychoactive substances

The Fund for Resocialization of the Republic of Tatarstan, is engaged in the development and implementation of the state regional program for the resocialization of people who use drugs.

“It is resocialization that will allow us to establish new links with the society, to consolidate, to approve and apply the knowledge and principles obtained at the stage of rehabilitation in the social environment. We all know that for people who use or used drugs it is not easy to find jobs. They often have problems with their relatives, and some of them even do not have their own housing. Many of those who had treatment, again find themselves in the surrounding that provokes drugs use soon after they left the hospital,” states on the Fund’s website.

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

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

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

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

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

Civic Campaign Cup for People

The Diversity House and Civic Info Centre opened in St. Petersburg during the World Cup. Source: http://cupforpeople.spb.ru/

The Diversity House and Civic Info Centre opened in St. Petersburg during the World Cup on June 16 and will be open until July 16, 2018, as a part of civic campaign Cup for People.

The project is implemented by the Fare network, an international umbrella of organisations and ethnic minority groups, LGBT+ fans working to fight discrimination and promote diversity, and the Cup for People, a network of grassroot initiatives and civic activists created before the World Cup in St. Petersburg in order to use the World Cup in the city as an opportunity to enhance communication among people from different countries, both guests and locals, on the human rights, inclusion and civil society topics.

The Diversity House and Civic Info Centre will work every day between June 16 and July 16 as an open and safe space for everybody to celebrate diversity and meet people using football to create awareness and change for inclusion, protection of human rights and development of civil society.  The Diversity Houses will feature a football exhibition, World Cup match-viewings, lectures, discussions, festivals, and meetings with local supporters and residents. See the programme here.

The Civic Info Centre will be an information point within the Diversity House, which will provide assistance to the international and Russian guests as well as journalists concerning the available civil society organizations and activities in St. Petersburg. They will also disseminate safety guidelines and help for guests, organize dialogues and network with locals. Alternative tours with the human rights and civil society focus will take place.

Guests of the World Cup in St. Petersburg are invited:

  • To visit the Diversity House and Civic Info Centre any time to ask questions about social and cultural life of St. Petersburg and Russia, to watch the Exhibition on the Inclusion in Football and translation of the football matches
  • To participate in our public events on different topics, see the program here.
  • To organize a public event on your country or your field of interest in our space.
  • To come with our excursions and walks in English by guides among the thematic experts and grassroots activists on different aspects of cultural and civil society life in St. Petersburg: on creative spaces, street art, social problems, charitable projects, etc. check here.
  • To check the Map for People, a St. Petersburg map of responsible consumption, which will show, where to eat and make shopping by supporting local and ethically, environmentally and socially responsible enterprises, click here.
  • To check the bars in St. Petersburg, which are especially safe for women, click here.
  • To support the Diversity House and all the activities of the Cup for People financially, click here.
  • To use the Fare Diversity Guide, a comprehensive online resource combining travel advice and important information including historical context, Do’s and Don’ts and what to expect in each of the 11 host cities, including specific guidance and safety advice for the LGBT community and ethnic minorities traveling to Russia. The WhatsApp hotline is being set up to help support visiting minorities in Russia with issues of discrimination to report or who require other urgent help: + 79169481108.

Time: June 16 — July 16, 12:00 — 23:00

Place: St. Petersburg, Berthold center, Grazhdanskaya str., 13-15, enter through the yard

Source: http://cupforpeople.spb.ru/

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

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

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

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

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

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

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

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

 How to support and join the campaign:

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

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

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

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

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

#chasethevirus

#chasevirus

#chasethevirusnotpeople

#chasevirusnotpeople.

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

It’s time for joint actions!

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

 

 

Sex-Workers in Russia – for Effective HIV Prevention

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

Author: Anastasia Petrova, Russia

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

Epidemic of Violence

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

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

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

Unique HIV prevention project

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

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

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

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

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

Current Legislation Does Not Solve Problems

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

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

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

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

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

Author: Yana Kazmirenko, Ukraine

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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