A Chance to Find a Way Out

Methadone administration at the OST site in Oskemen

Author: Marina Maximova, Kazakhstan

Since 20 December last year, no new patients have been enrolled in the opioid substitution treatment (OST) programme in Kazakhstan. This decision based on the governmental inspection results led to concerns among civil society activists and medical professionals and to panic among people who use drugs (PUD).

I just want to live!

Her story is a cry for help. Aygul (the name was changed) from Almaty spent half of her 34 years on drugs. There was a time when she was dreaming to become a fashion designer, conquer Paris, meet her love, have children… Then, when she was 17, she tried heroin in a group of other adolescents and could not quit it. Back then she was sure that she could change everything and start her life with a clean slate. It seemed that she had all her life ahead. However, ahead of her there was only a fight for life. Drug abuse, HIV, hepatitis C…

“Due to drugs, I failed to receive an education. I spent my days in jail instead of school. As for my long-awaited love, it was the love for drugs. My dreams were buried together with my unborn babies. My window to Europe was the grilled window in the compulsory therapy department of the drug treatment centre together with other women who were as miserable and weak-willed as I was,” tells Aygul with tears in her eyes.

The only support comes from the woman’s parents who are elderly and exhausted with the daughter’s disease. Aygul hopes to enroll in the opioid substitution treatment programme and receive methadone. Now this dream is falling apart. Aygul was getting prepared, gathering documents. She found a job and believed that she would be able to start a new life. After all, she wants to live so badly!

Insight but not for all

In Almaty – the biggest city in the country – methadone-based OST has been implemented since 2017. It started later than in other cities of Kazakhstan. There was a strong public lobby against it. In less than a year, 15 people were enrolled in the programme with strict eligibility criteria, through the plan was to enroll 50 patients. Considering the estimated number of PUD – over nine thousand – the coverage was extremely low. However, even in this situation PUD and their co-dependent people had a goal and a hope – try to get in the programme and, thus, survive.

As of the end of the last year, 359 people were enrolled in the OST programme in Kazakhstan, including 31 women and 62 people living with HIV. There are success stories: 44 people found jobs, five started families and two female patients became mothers.

“The next steps were anticipated and planned to strengthen OST – approve a programme at the legislative level, launch OST in places of confinement, conduct ongoing monitoring of the patients’ health state. It is proven that methadone therapy has a positive social and psychological effect as people who receive treatment reintegrate into the society. Then, all of a sudden – the programme will not be scaled up, new patients will not be enrolled,” complains Sergey Shetnikov, Substance Abuse Consultant from the Answer NGO based in Oskemen (Ust-Kamenogorsk).

The last chance

In Kazakhstan, the OST programme was started in 2008 with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Within the period of its implementation, the programme was expanded into 13 cities. OST was included into the 2006–2010 National AIDS Programme. Its further implementation was stipulated in the National Programme “Healthy Kazakhstan 2011–2015.” Methadone is registered in the country. Staff is trained. The therapy is provided by multidisciplinary teams consisting of drug treatment doctors, psychologists, social workers, and nurses. The programme was positively assessed by the international organizations – UNODC and ICAP. It seems that there are all the prerequisites for scaling up OST…

“Apart from the recruitment of new clients being suspended, there is one more alarming trend – exclusion of clients. Thus, in Timurtau in Karaganda region the number of clients halved in three months. There are also disturbing signals from other regions of the country. How should people who have been excluded live on? Go back to heroin and jail?” asks Oksana Ibragimova, Advocacy Officer of the Kazakhstan Union of People Living with HIV.

OST for all people who need it may be the last chance for them to go back to normal life, to the society and the family, find jobs and feel that they are normal people.

The Z hour is in a month

Assessments of the OST efficiency and performance in Kazakhstan have been conducted more than once. Now an interagency committee is working, which is to issue its opinion in a month, on the eve of the 22nd International AIDS Conference in Amsterdam (AIDS 2018). Maybe, this decision will influence the attitudes of the Kazakh delegation. So far, some optimism may be derived from the opinion of Nikolay Negay, General Director of the Republican Scientific and Practical Centre of Mental Health at the Ministry of Health of the Republic of Kazakhstan.

“The Ministry of Health of Kazakhstan supports OST. It is one of the key elements of the cluster of drug treatment provision to patients with the opioid dependence. The programme is continued. In future, we hope that it will be implemented in line with the evidence-based international best practices,” he says.

Are the Rights of Most-at-Risk Adolescents in Ukraine Violated

Traditionally, there is an understanding that human right defenders organize actions, protest by the parliament, or we think of them as of those having legal education and regularly going to courts. However, every person can be a human right defender. Each specialist who provides services to vulnerable groups is, in fact, a human rights defender.

Reasons for implementing the monitoring tool

Within the last years, Ukraine has achieved great successes in fighting HIV epidemics. However, there are still many gaps that require immediate attention. First of all, there is a gap in providing prevention and treatment services for most at risk adolescents and youth, especially those who used drugs.

Starting from 2012, International Charitable Foundation “AIDS Foundation East-West” (AFEWUkraine) has been supporting the establishment of the system of services for adolescents using drugs. This work is conducted within the framework of the Bridging the Gaps project. Social bureaus, rehabilitation center and daycare centers in four cities were opened and are functioning successfully. Only in 2017, these centers and bureaus provided 21,290 services to 1,215 adolescents.

Project experience demonstrates that the rights of underage drug users are often violated, and this fact remains unknown to anyone from their close environment. Lack of response leads to repeated cases of violations, thus creating barriers in getting timely assistance, and, as a result, increases the possibility of negative consequences of drug use and unsafe behaviours. Therefore, violation of rights of underage drug users, that remains unnoticed is among the factors that contribute to increased risks of HIV infection.

Despite frequent cases of violations reported by service providers, these cases are not officially registered and publicly unknown.

That is why in 2016 AFEW-Ukraine and its partners started developing a tool for monitoring human rights violations of adolescents using drugs. The tool can be also applied to any other category of MARA, and it can be used by any specialist who works with MARA and has basic knowledge about human rights.

The overall objective of its implementation was to collect the data about cases of violations so that services providers and stakeholders could understand the scope of the problem and, based on that, improve and adjust advocacy actions on the national and local levels. Besides, use of the tool could help to provide timely response to the violations of rights of each client, offering an algorithm of actions that can facilitate it. This instrument can be used by a wide range of organizations and specialists that work with vulnerable children, adolescents and youth.

“Our task was to demonstrate that a social worker or any other professional working with key populations can stand for the rights of their clients. That it, in fact, does not require special legal education nor being a part of job description. However, specialists often do not understand that the problems faced by their clients are in fact cases of human rights violations that need special attention,” comments Anastasiya Shebardina, senior project manager from AFEW-Ukraine.

Piloting the monitoring tool

The tool for monitoring the violations of human rights of MARA consists of the directions on the use of the tool, screening questionnaire for service providers to identify the cases of violation, a template for the legal claim and online form for registering the cases of human rights violations that are filled by social workers or other specialists. The forms are filled online on the website of AFEW-Ukraine.

In each project city, AFEW-Ukraine organized introductory trainings for over 100 specialists from partner NGOs and service providers from referral network. Also, an educational webinar was organized for a wider range of participants who wished to learn more about the monitoring tool. In the nearest future, a free online course on human rights monitoring for most-at-risk youth will be developed.

Results of monitoring tool piloting

In 2017, 792 interviews with adolescents and youth were conducted with the use of screening questionnaire in 4 pilot cities. Among them, 430 adolescents were 14-18 years old. A number of cases of human rights violations, registered in an online form was 92 (12%) of all surveyed.

The results of piloting the tool demonstrate that the format for monitoring and documenting cases of human rights violations helps service providers to better recognize them and provide timely response to violations. The analysis of the documented cases allows to identify typical situations for each separate region or city and make advocacy actions more effective.

Documentation and analysis of cases with the use of monitoring tool will be continued and be used for further advocacy.

Coalition of Communities of Kyrgyzstan: “We United to Strengthen the Voices”

The Coalition of Four Communities is developing a media campaign to eradicate hate and stigma speech

Author: Olga Ochneva, Kyrgyzstan

Community organizations are often not cooperative: each one deals with specific problems and has its own approaches to work. Nevertheless, the Coalition of Four Communities: people who use drugs (PUD), sex-workers (SW), people living with HIV (PLHIV), lesbians, gays, bisexuals and transgender people (LGBT) is developing and gaining strength in Kyrgyzstan. Consolidation began three years ago without any financial support. The goal is to make the participation of communities in solving the problems of their groups meaningful, to fight against HIV, to reduce stigma and discrimination. Below we discussed the experience of interaction, successes and plans with the representatives of the Coalition.

Four years ago, our interlocutors could not even dream of uniting all groups vulnerable to HIV.

“I said three years ago, that organisations for people who use drugs can only unite with a group of PLHIV, and probably with sex-workers organisation. The representatives of our group often have experience of imprisonment and would never join the LGBT community,” says Sergey Bessonov, leader of the IDU community organization Harm Reduction Network Association. “At the meeting earlier this year, 99% of my employees agreed to work with convicted men who have sex with men. This is the result of the gradual and systematic work on the consolidation of our groups, which we have been carrying out in recent years. People start looking at each other differently.”

The true spirit of unity

The groups began to unite in 2015, when women who use drugs (Asteria), sex-workers (Tais Plus) and the LGBT community (Labrys) took part in presenting an alternative report on the situation with all three groups at the 60th session of the CEDAW Committee on the Elimination of Discrimination against Women in Geneva. According to the members of the Coalition, they sensed the real spirit of unity during the election of a representative from the community to the governmental Coordinating Council for Public Health.

“As community organizations, we have mobilized to promote our candidate as an alternative to a candidate from AIDS-service organizations, since we have different approaches to work. Spontaneously, within two hours we managed to organize 47% of the votes,” recalls the director of the organization for women who use drugs Irena Ermolaeva. “Then the community of PLHIV and men who used drugs joined us. Although our candidate did not win, we understood that we are stronger standing together than alone, understood the real power of consolidation and were inspired by it.”

Similar problems in groups

The first activity of the Coalition was the development and submission of two project applications. At this time, a large regional network announced grants for the development of consortiums of communities. According to the representatives of the Coalition, the focus of their applications was on maintaining tolerance among groups as the basis for the future work. The Coalition has not received support but did not stop a joint activity. In 2017, the Coalition together with the Office of the Ombudsman conducted monitoring: they monitored the rights of all four communities. Later the organizations united to conduct a media campaign to eradicate hate speech and a language of hatred.

“Initially, the campaign had to be focused on the LGBT community. At the joint meeting last summer we decided to include all our communities in the campaign,” says Nazik Abylgazieva, the LGBT representative of the Labrys organization. “We made a video with famous people of the country who spoke about our problems. Our message has been heard: during three days, the video was viewed by more than 150 thousand people.”

50 representatives of different communities took part in a joint training, recalls the psychologist of the PLHIV-organization Prosvet Margarita Sabirova, and the team-building process was seen. People overcame external and internal discrimination. It became clear that groups had similar problems.

Involvement on a short notice

Now the Coalition includes seven community organizations representing women, men and young people who use drugs, PLHIV, sex-workers and the LGBT community. The Coalition is considering two more candidates. The association is not officially registered and is currently developing its strategic plan.

“Memorandums, agreements and the formal creation of consortiums do not solve the problem. If we understand each other and trust our partners, there is no need to register it legally since we are ready to help each other on a short notice, ready to get involved, to support,” claims Sergey Bessonov. “Together we already submitted several applications for our Coalition. The first joint project is aimed at bringing our communities closer together. We develop the three-year strategy of our Coalition and determine how we will interact to promote common interests.”

The Coalition received Global Fund project this year. Due to cuts of funding, it was decided to leave only one network that would work for all the groups instead of four separate national networks of communities. In the framework of this activity, communities monitor and advocate to improve the quality and access to HIV programs as well as receive technical assistance to increase community capacity and solidarity.

Mikhail Golichenko: “HIV Epidemic in Russia is an Epidemic of Powerlessness”

Mikhail Golichenko is a lawyer and Senior Policy Analyst at the Canadian HIV/AIDS Legal Network

Author: Anastasia Petrova, Russia

We discussed the human rights issues in the context of HIV in Russia with Mikhail Golichenko. Mikhail Golichenko is a lawyer and Senior Policy Analyst at the Canadian HIV/AIDS Legal Network — organization, which has a special consultative status at the United Nations Economic and Social Council. Previously, Mikhail was a Legal Officer with the UNODC Country Office in Moscow. His work is focused on the promotion of human rights and addressing legal barriers to accessing health rights and effective HIV/AIDS prevention and care programs for prisoners and people who inject drugs. He holds a Candidate of Sciences degree (PhD equivalent) in Law.

– The International AIDS Candlelight Memorial Day was marked recently. What is this day about for you?

– It is a good occasion to reflect on the victims of HIV and at the same time think about our role in making sure that people who died of this disease did not die in vain.

In Tolyatti, in 2012, if I am not mistaken, on this day people traditionally went to a park, they handed out condoms, HIV awareness-raising materials, lit candles. It was all happening near the monument to the glorious heroes of the Great Patriotic War. Tolyatti is a small city and there are not many locations to hold public campaigns. It happened that during the campaign the bowl with condoms was put near the eternal fire and this fact was misinterpreted by mass media. As a result, the campaign organizers were fined for holding a mass event in close vicinity to the monument to the Great Patriotic War heroes. That is a local law in Tolyatti.

It shows that we are on different sides of the processes: the society is aware of the problem and the state doing nothing to start considering this problem from the right perspective.

Could you please tell us about the human rights situation in Russia and its implications for the HIV epidemic?

The key factor in the development of HIV epidemic in Russia is human rights violations, which make certain populations more vulnerable to HIV. People who use drugs, sex workers, men who have sex with men (MSM), transgender persons and migrants do not have access to adequate prevention, care and support for HIV and other socially significant diseases.

Rights are the social clothes of a modern person. They are represented by the laws imposing obligations on the state. The set of human rights keeps people warm and protects them from any aggressive impacts of the social environment. Some populations, such as people who use drugs, had part of their clothes removed. So, in fact, these people have to stay naked when it is minus forty degrees Celsius outside. Of course, they get sick. We should not cherish any illusions: even if we have sterile needles and syringes on every street corner tomorrow, it will surely improve the situation, but not much. We will still have repressions, persecution of people who use drugs, which prevent people from seeking health services.

There is a similar situation with sex workers. They know that they should use condoms. However, they know that if they get beaten up by a client who insists on having sex without a condom, nobody will protect them. Police will, first of all, blame the sex worker for being involved in sex work. Sometimes it is easier not to use condoms hoping not to get infected than being beaten up knowing that it makes no sense to seek protection in the police.

As for MSM, it is the same. Now the website PARNI-PLUS, which published information on HIV prevention among men who have sex with men, has been closed. There are almost no similar sources of information in Russia. Where will people who live with their sexual identities take this information? Their vulnerability and stigma will grow. There is a direct linkage. HIV epidemic in Russia is an epidemic of powerlessness.

– Could you tell about your speech in the Committee on the Rights of Persons with Disabilities? After it, a recommendation was made to revise the approach to the drug policy in Russia…

– There have already been many such recommendations. The Committee on Economic, Social and Cultural Rights, then the Human Rights Committee, the Committee on Women’s Rights, the Committee on the Rights of Persons with Disabilities, now there will be the Committee Against Torture. The committees realize that the drug policy in Russia is one of the drivers of systematic violations and issue those recommendations.

In my opinion, the main recommendation was given in October 2017, when the Committee on Economic, Social and Cultural Rights recommended Russia to decriminalize drug possession with no intent to distribute. The same goes for scaling up harm reduction services, legalizing substitution treatment, distributing truthful information on drugs, preventing overdoses, implementing substitution treatment for pregnant women, stopping tortures of drug users in police, in particular discontinuing the practice of using withdrawal syndrome to get evidence from detainees. Russia does not really follow all those recommendations, but the constant pressure will gradually give its results.

Our main tool is the attempt to involve government authorities in a dialogue so that people feel a certain need to introduce some changes. There is a set of clear recommendations, which are to be followed. It will certainly work. Where human rights are violated, there is no sustainability, there is a space for internal conflict, and there is no development.

What measures, in your opinion, does Russia need to take to stop the HIV epidemic?

We just need to remember that we are people. No laws are needed. There is a Constitution and it is enough. Safe coexistence is a value without which we cannot live. It is possible only with love, mutual understanding and help.

The Latest Global Prison Trends Publication Launched

Source: www.russellwebster.com

Last week, on 15 May 2018, Penal Reform International launched its annual flagship publication, Global Prison Trends 2018, at the UN Commission on Crime Prevention and Criminal Justice.

This is the fourth edition in their annual Global Prison Trends series and explores:

  • Trends in the use of imprisonment, including the use of pre-trial detention as an automatic response to suspects; the ongoing challenge of prison overcrowding; and the steady growth in the number of life-sentenced prisoners around the world.
  • Prison populations, such as the specific needs of women, children and LGBTI prisoners.
  • Developments and challenges in prison management, including record levels of prisoner violence in a number of prison systems; healthcare challenges and shortages of qualified healthcare staff; and the need to address violent extremism and prevent radicalisation in the prison system.
  • The role of technology in criminal justice and prison systems, such as the use of ‘telemedicine’ to provide mental healthcare and treatment, and the rise in access to online education and training.
  • The expansion of prison alternatives, including community service orders and electronic monitoring, and a growing trend in the use of restorative justice.

A Special Focus section looks at the rehabilitation and reintegration of offenders in the era of sustainable development.

Here you can find ten key facts that are of particular interest about the report.

Source: www.russellwebster.com

The needs of women living with HIV/AIDS in the Kyrgyz Republic

Community-based participatory research report “The needs of women living with HIV/AIDS in the Kyrgyz Republic”

Women and girls with HIV infection are culturally, socially, biologically and economically more vulnerable than men. The lack of reliable statistics, misconceptions about HIV transmission routes, stigma and discrimination on the part of society lead to the fact that HIV-positive women face many problems.

For several years in the Kyrgyz Republic, there has been a trend towards increased sexual transmission of HIV. The most vulnerable groups, along with injecting drug users (IDU), are women. HIV infection affects a whole range of problems – psychological, social and spiritual. Women, living in the conditions of “traditional culture”, are in a more difficult situation; gender inequality, which exists in the initial ethno-cultural environment, strengthens their social and economic problems. Women in particular, whose HIV status creates obstacles for the realization of basic needs, are particularly vulnerable in this regard, and therefore it has a negative impact on their quality of life. At present, services for HIV positive people (HPP) in the Kyrgyz Republic are universal, not taking into account the gender, which often limits access to legal, social, psychological and medical support for women living with HIV (WLH).

Despite the urgency of the problem, in the Kyrgyz Republic there was no systematic study conducted to reveal the needs of WLH, identifying factors that affect the quality of their lives and the barriers to obtaining services.

Read the research here.

The AFEW Culture Initiative Presents EECA Food and Art Night in Amsterdam

The first edition of PLOV ARTxFOODxCINEMA is coming to Amsterdam on 29 of May. Culinary experiences and cinematographic impressions of Eastern Europe, the Caucasus and Central Asia will come together during the event organised by the AFEW Culture Initiative in collaboration with the partners IDFA and Studio/K.

During the event, visitors will taste food from Eastern Europe and Central Asia (EECA): traditional Russian okroshka beetroot and kefir soup and traditional Asian plov (pilaf) dish. After dinner the documentary “Debut” by Anastasiya Miroshnichenko (Belarus, 2017) will be shown. The movie is about women who are detained in a Belarus prison for first-time offenders.

“The PLOV evenings are great for those interested in a new cultural food experience, who would like to learn more about Eastern Europe and Central Asia, and public health issues of the region through the eyes of the artists,” says AFEW International Project Officer Judith Kreukels.

During the whole duration of the PLOV ARTxFOODxCINEMA event, there will be the possibility to see the artworks of artists-in-residence who come from the EECA region and stay in Amsterdam now.

Tickets to the event cost €20,00 for dinner and documentary, €15,00 for dinner only, and €9,50 for documentary only. Tickets to PLOV ARTxFOODxCINEMA can be reserved Studio /K by the telephone number 020 692 0422. Tickets can be purchased at the Studio /K on the evening itself.

TIME

16:00 — 22:00 – Open atelier and ongoing artistic showcase.
18:00 — 20:00 – Two-course dinner.
20:00 — 21:30 – Documentary screening, followed by Q&A.

ART 

Four visual artists-in-residence will showcase their ongoing artistic projects:
— Hanna Zubkova (Minsk/Paris)
— Hassan Kurbanbaev (Tashkent)
— Ilya Fedotov-Fedorov (Moscow)
— Lado Darakhvelidze (Kutaisi/Arnhem)

FOOD 

Two courses menu:
— Okroshka beetroot and kefir soup.
— Plov (pilaf) dish.
There is an option of a vegetarian menu.

PROJECT BACKGROUND

The AFEW Culture Initiative was established in 2017 as a cultural and artistic ramification of AFEW International. The AFEW Culture Initiative offers an innovative alternative to intertwine the worlds of public health, culture and visual arts as a means to stimulate a much-needed dialogue on challenges such as HIV/AIDS, tuberculosis or viral hepatitis, as well as their impact on the lives of sex workers, substance users, imprisoned persons or LGBQTI, among others.

Martine de Schutter Scholarship Fund Launched

AFEW International sets up Martine de Schutter Scholarship Fund that allows participants from Eastern Europe and Central Asia (EECA) to attend the 22nd International AIDS Conference (AIDS 2018). Martine’s commitment to the international fight against AIDS and her unwavering support to the Eastern European region has set an example for us to follow. That is why AFEW International established the Scholarship Fund named after Martine de Schutter – our friend and fellow activist.

As of today, Martine de Schutter Fund raised 103.000 EUR to cover the additional scholarships of the EECA applicants to come to Amsterdam for AIDS 2018. A part of the Martine de Schutter Fund has been distributed to the applicants from EECA through the established Scholarship Committee of the International AIDS Society (IAS) of which 45 are regular scholarships and 20 – for speakers who will be invited from the EECA region. AFEW thanks Gilead, Janssen Cilag, Deutsche AIDS-Stiftung and Aidsfonds for their contribution to this Fund.

Martine de Schutter was a strong advocate for human rights. For about 10 years she managed the European network AIDS Action Europe, which connects more than 400 AIDS organizations throughout Europe and Central Asia. Martine worked with dedication and passion to keep the AIDS problem on the agenda at the European Union and to connect all organisations working on the same issues in Eastern Europe. In 2014, Martine became the Program Leader for Bridging the Gaps: Health and Rights for Key Populations program. She travelled a lot and her last trip was to AIDS 2014 Conference in Melbourne on the MH17 plane that was shot down and crashed.

 

EECA Success on the Road to AIDS 2018

Author: Olesya Kravchuk, AFEW International

The total of 603 abstracts from Eastern Europe and Central Asia (EECA) were submitted to 22nd International AIDS Conference AIDS 2018 to be held in July in Amsterdam, the Netherlands. 182 abstracts out of them were selected for the abstract book, posters and oral presentations.

These results were achieved with the support of AFEW International, Dutch Ministry of Foreign Affairs and in partnership with EECA regional networks EHRA, ECOM, ECUO and GNP+.

“It is a great success, and we can see that especially by comparing it with the previous AIDS conferences. In comparison to the AIDS 2016 Conference that took place in Durban, South Africa, the amount of submitted abstract has more than tripled, and the number of accepted abstracts has increased by almost six times,” says AFEW International Project Manager of AIDS 2018 EECA Daria Alexeeva. “124 abstracts were submitted to AIDS 2016, and 31 were accepted. The acceptance rate has increased this year as well – 31% against 25%.”

The special group of 25 EECA organizations whom AFEW International supported with on- and offline training program on community-based participatory research and funded their local community-based researches, has shown even greater results. Eight of the abstracts that were developed based on their researches were accepted. 13 scholarships were awarded.

Besides, a special EECA communities networking zone was secured at the Global Village of the Conference. Challenges and successes of the region will be featured there. EECA regional networks and community organisations will use the zone to jointly advocate for financial sustainability for the AIDS response in the EECA region, vanishing legal barriers for effective prevention programs and increasing meaningful participation of the communities in decision and policy making.

EECAAC 2018: Treatment or Epidemic

The problems of EECA were discussed at the VI Eastern Europe and Central Asia AIDS Conference in Moscow on 8 – 20 April 2018

Author: Anastasia Petrova

Russia accounts for two-thirds of the new HIV cases in Europe and Central Asia. This is what the UNAIDS data show. One of the key factors contributing to the further spread of the epidemic is low treatment coverage: only one-third of people who need treatment get it. This fact, as well as other problems of the region, were discussed at the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) held in Moscow on 8 – 20 April 2018.

“What should be done to make sure that every HIV positive person has access to high-quality modern treatment from the day he is diagnosed with HIV in any place of our huge country? Maybe we should all – activists, business, government – honestly recognize that the AIDS war is lost, should join our efforts and reconsider where we are and where we go,” said Aleksandr Chebin, the activist of the Patient Control Movement, Yekaterinburg.

Patients demand treatment

“A special program was adopted in Russia to prevent the spread of the virus in the country, which allowed significantly increasing HIV/AIDS patients’ coverage with treatment services,” told Olga Golodets, Deputy Prime Minister of the Russian Federation at the EECAAC 2018 opening ceremony. However, experts say that the measures taken are not enough.

According to Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre, only 35.5% of people living with HIV in Russia receive treatment. Even those who are registered in HIV care are not guaranteed treatment. In early 2018, fifteen regions of the country have reported stock-outs of antiretrovirals (ARVs).

On activists’ of the Patient Control Movement made attempts to voice this message at the opening ceremony T-shirts there was a message STOP, STOCK-OUTS!

Activists of the Patient Control Movement made attempts to voice this message at the opening ceremony. During the speech of Olga Golodets, people present at the ceremony stood up and took their coats off. Red letters on their snow-white T-shirts read STOP, STOCK-OUTS! This silent protest was a way for the patients to express their indignation with access to treatment in the country.

“Fight with HIV is a joint fight, which includes civil society and the volunteers who are now standing in front of us,” said the public official about the protest.

Disease of the system

According to experts from the International Treatment Preparedness Coalition in EECA (ITPCru), stock-outs are a systematic problem in Russia.

“The Ministry of Health announces tenders too late, and then the suppliers fail to supply drugs to the regions in time,” said Natalia Yegorova, Monitoring and Advocacy Officer, ITPCru.

Svetlana Prosvirina representing SIMONA+ project mentioned that according to the survey held by the patients’ community, 50% of patients of the AIDS centres faced problems when receiving their antiretroviral therapy (ART), such as stock-outs and frequent changes of treatment regimens.

“Apart from the stock-outs, we also identified other barriers in access to the health services: location of the AIDS centres, queues, long list of medical examinations to be completed before ART initiation (which is a significant barrier for injecting drug users), long-term before treatment start – 1 to 3 months, and health care system-related problems, such as stock-outs of ARV drugs and diagnostic tools,” told Svetlana.

Tim Martino, Deputy Director of UNAIDS called Russia to adopt the international ‘test and treat’ strategy. This approach stipulates treatment initiation not waiting for the immune status going down. Such strategy proved effective in the African states. However, it is still ignored in Russia.

Vinay P. Saldanha, UNAIDS Regional Director for Eastern Europe & Central Asia explained that to cover all patients with treatment the price of a yearly course per patient should not exceed USD 100

Timofey Nizhegorodtsev, expert of the Russian Federal Antimonopoly Service delivered a speech at the session “Strategies to Enhance Access to ARVT and Drugs to Treat Comorbidities in the EECA in the Light of Current State of Affairs.”

“Currently, a draft law on public health is prepared, which will allow local producers to manufacture the required drugs at affordable prices,” he said

Price reduction is the key

Only a sharp price reduction will make it possible to provide all people in need with treatment in the country, experts say. Vinay P. Saldanha, UNAIDS Regional Director for Eastern Europe & Central Asia explained that to cover all patients with treatment the price of a yearly course per patient should not exceed USD 100.

“Only in this case, the Russian Federation has a chance to achieve the 90-90-90 targets and meet the commitment to end the HIV epidemic by 2030,” pointed out Mr. Saldanha.

The key results of EECAAC 2018, as well as the actions to be taken, are included to the Final Statement of the VI Conference. The document is currently to be adopted by the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor) and will be published before the end of April.