One in Sixth People Infected with HIV in Tajikistan This Year is a Migrant

Author: Nargis Hamrabayeva, Tajikistan

Approximately five thousand citizens of Tajikistan, which were found to be infected with HIV, tuberculosis and hepatitis during their stay in the territory of the Russian Federation, were declared personae non gratae for lifetime by the government of Russia in June this year. How could this expulsion of infected fellow citizens affect the Republic of Tajikistan?

Generally, after returning from Russia, migrant workers, unaware of their status, may unintentionally put the health of the members of their families at risk by spreading and transmitting infectious diseases including HIV/AIDS, believes Takhmina Khaidarova, the head of the Tajik Network of Women (TNW) Living with HIV/AIDS.

“The consequences of transmitting and spreading of infectious diseases depend solely on the will of the state. Providing that a state fully implements their commitments within the framework of the National Strategy for the Response to HIV/AIDS Epidemic for 2017-2020, it would be possible to avoid drastic consequences. If the government of a state cannot conduct awareness-building work about infectious diseases and their transmission amongst their population on adequate level, despite the fact whether or not infected migrants would be deported, the increase of the epidemic will stay high,” she considers.

According to Takhmina Khaidarova, the main problem is the low level of awareness about infectious diseases, including HIV/AIDS, before the migrants leave the country, during their stay in the host country, as well as on their return to their home country. “Migrant workers have little information and preparation, they are not aware about their status before leaving the country and they do not observe any safety measures during their stay in labour migration. After contracting infectious diseases, they return to their home country and, generally, do not undergo medical examinations; so, unaware of this, they transmit infectious diseases to their sexual partners,” says Takhmina Khaidarova.

She believes that another problem lies in the fear of stigma and discrimination, therefore, migrant workers who have returned do not undergo examination until their health deteriorates considerably.

According to figures provided by the Ministry of Health of the Republic of Tajikistan, there have been noted 384 cases of citizens infected with HIV in the first quarter of 2017, whereby one in sixth is a migrant, who had left in search of work outside the country. Presently, the total number of people living with HIV-positive status in Tajikistan is around nine thousand.

It should also be reminded that Eastern Europe and Central Asia will be a prime focus in the 22nd International HIV/AIDS Conference in 2018, which will take place in Amsterdam in July 2018.

Central Asian NGOs Built a Network for Cross-Border Control of Tuberculosis

Author: Marina Maximova, Kazakhstan

During the regional seminar-meeting held on 6-7 June in Almaty, Central Asian nongovernmental organizations established a network of partner organizations to address issues of labour migration and tuberculosis. The participants accepted draft Memorandum of cooperation between non-profit organizations to reduce the prevalence and incidence of tuberculosis among migrant workers in the countries of the region.

“This document was created in response to the need of NGOs consolidation to educate migrant workers about TB symptoms and the opportunities of free treatment and diagnostics in the framework of the project, to promote treatment compliance, to exchange information and to disseminate best practices in the countries of Central Asian region,” says a project manager of the Global Fund, a representative of Project HOPE in the Republic of Kazakhstan Bakhtiyar Babamuratov.

The event was organized by the Project HOPE in the framework of the grant from Global Fund to fight AIDS, tuberculosis and malaria. Representatives of non-governmental organizations from Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan attended the seminar .

Migrants do not want to be treated

From all the countries in the Central Asian region, Kazakhstan is accommodating the main stream of migrant workers from neighbouring countries. Migration flow continues to grow. Those who come to find a job often agree to any work, they often live in poor housing conditions and do not eat well. This results in tuberculosis development. In 2016, 753 external migrants addressed the organizations of primary health care and TB facilities of Kazakhstan and were tested for tuberculosis. In 2015, there were only 157 visits. Most migrant workers prefer not to attend medical institutions and refuse to be treated in the TB clinics or to be examined by a doctor. They consider it to be a wasting of working time, i.e. money. They have to support families left at home, therefore money is the main reason to come to a foreign country. For the same reason people do not want to spend money on health, even though a Comprehensive plan to combat tuberculosis in Kazakhstan for 2014-2020 involves activities to improve TB services for migrant workers.

Particularly alarming are the cases when a migrant worker is diagnosed with HIV/TB co-infection, and when such patient needs a serious treatment and social support. This important topic will be discussed in 2018 in the framework of the 22nd international AIDS conference – AIDS 2018 – in Amsterdam. This conference will be very special as for AFEW International and the whole region where the organization works — Eastern Europe and Central Asia.

Work at construction sites and markets

In the situation mentioned above, the participation of the NGOs in addressing of this issue has become very important. Outreach workers and volunteers – people, whom the target group trusts, – are searching for migrant workers on construction sites, at the farms, markets, in the restaurants or cafes. They tell migrants about the disease and the free treatment, convince to pass the examination and to provide social support. The results of such work are impressive.

“Within the project, implemented by Project HOPE in 2016, staff and volunteers of our public Fund helped 898 migrant workers to be tested for tuberculosis. For 25 of them the diagnosis was confirmed, and with our assistance people were able to receive free treatment. Besides, we provided migrant workers with motivational food packages. 8,312 labour migrants received information about the symptoms of tuberculosis, and now they know where to go if they are sick,” says the Director of the Public Fund Taldykorgan regional Foundation of employment promotion Svetlana Saduakasova.

These are the results of the activity of only one non-governmental organization in Kazakhstan. Nowadays, social activists are effectively working in eight regions of the country. Such results are possible to achieve only thanks to active collaboration with the non-governmental organizations from those countries where work migrants come from. The community members actively communicate with each other and exchange useful information to be aware of whether the diagnosed person came back to his home city, got registered in the TB clinic, continued to receive treatment, and so on. Only under these conditions we can achieve a complete recovery from TB for each individual and finally stop the growth of morbidity in the region.

Tatiana Vinogradova: «Only public organizations are able to work with vulnerable groups»

Tatiana Vinogradova

Author: Anastasiya Petrova, Russia

Last year a major event in the field of HIV in Russia became the adoption of the National strategies of counteraction with the spread of HIV-infection in the Russian Federation until 2020. One of the key objectives of the Strategy was the consolidation of efforts of governmental and nonprofit organizations in their fight against the epidemic. Today we discuss the implementation of this interaction in the most progressive city of Russia with the Deputy chief physician of St. Petersburg Center for prevention and control of AIDS and infectious diseases, holder of Doctoral degree in Medicine, third-generation doctor Tatiana Vinogradova.

– Tatiana, do you support the idea of implementation of cross sectoral programs on HIV prevention among vulnerable groups in cooperation with socially oriented non-profit organizations?

– In addition to the scientific-organizational work in the AIDS Center, I am responsible for the interaction with public organizations in the context of HIV-infection in Saint-Petersburg. I think, this is very important. HIV is a socially sensitive disease, and groups of HIV vulnerable people – people who inject drugs, men who have sex with men, sex workers – usually are not easy to approach. I am deeply convinced that only nonprofit organizations, organizations that deal with this issue and have experience in the field, are able to work with the key groups. Even if we have an opportunity to send “a man in a white coat” to interact with these key groups, there is no guarantee that this health worker will be accepted and will be able to perform all the necessary tasks. Nonprofit organizations have access to these closed groups, they are able to work on the principle “peer to peer.” Representatives of vulnerable groups perceive them appropriately and they are able to provide medical assistance as well. This is the most important! We can find a lot of new HIV-cases by testing a large number of people, but when we test the general population or key populations, our work is not limited with testing and identifying, we also should provide medical support. Peer consultants and employees of nonprofit organizations are the best in this field.

– How does the Center for prevention and control of AIDS and infectious diseases cooperate with NGOs? Is there any model or mechanisms?

– AIDS Center in St. Petersburg works with community organizations from the very first day of its existence. In the beginning, there was no AIDS Center in its modern sense, but there was an office based in Botkin hospital, which started this interaction. The first nonprofit organization was registered by Nikolay Panchenko. Therefore, we can say, that here in St.-Petersburg we already have thirty years of cooperation experience between public institutions and community organizations. We work together since the early 90’s.

Committee on health care through the Center for prevention and control of AIDS and infectious diseases provides financial support for the HIV prevention offices, which work in the city. Nowadays there are four such offices based on public medical institutions. These offices work in close cooperation with community organizations that employ peer consultants. Together with nonprofit organizations we conduct events, various events like testing days, for instance. Nonprofit organizations also hold round tables, press conferences, which our doctors always attend.

Nonprofit organizations also participate in the Coordinating Council affiliated to the government of St. Petersburg. This Council consists of the leaders of the organizations representing each of the key groups: those who work with people who inject drugs, or who work with LGBT community, or with women, or who provide legal support. In our city, the Health Committee as well as the Committee on social policy work in cooperation with NGOs in the context of HIV infection. I do not think there is another similar model in other regions. NGOs in Saint-Petersburg receive grants and funding not only from health but also from social policy institutions. There are many offices across the city, where peer consultants officially and legally work with the vulnerable groups, provide them support and accompany them to the AIDS Center.

– It seems to me, that we have adopted a western model of interaction, is it true?

– Yes. Basically HIV-infection appeared in Russia later than in Western Europe and the United States. Why to reinvent the wheel, if there is already some experience that can be used? I remember in the late 90s – early 2000s, when the first wave of HIV-infection started, and it spreaded very quickly among people who inject drugs. In one year 10,000 cases were found. At that time, it was something terrible. People were dying. At that time, it was a fatal diagnosis. Then the first bus appeared on the basis of the AIDS Centre, and our head nurse Marina Petrova was sitting in that bus nearby the metro station Gostiny Dvor, taking blood. Back at the time there were no rapid tests, and no one could predict that they will once appear. We used test tubes. This work was done in cooperation with public organizations.

– Are there any effectiveness indicators of such an interaction and what are they?

– Our AIDS center is one of the largest AIDS centers in Russia. 35,000 patients are registered, and a lot of them come from mobile laboratories of local public organizations. There are several organizations in our city that are doing rapid testing and providing counselling about HIV infection. 80% of people, who get their diagnosis during the testing in these organizations, then go and get registered in the AIDS Center. This is very important, because it is not enough just to identify a new case. A person needs some health survey to decide if the therapy is necessary. We must provide some psychological support to help him or her deal with the stress, which is unavoidable when the person learns the diagnosis. We must motivate him or her to be followed up by a doctor. After all, if she or he will be followed up by a doctor, she or he will stay alive. This is the most important thing. If a person receives antiretroviral therapy, he or she does not transmit the virus further. A person lives, and a virus is not spreading.

– The 22nd AIDS conference – AIDS 2018 – will be held in Amsterdam, and the organizers would like to see a wide representation of people from Eastern Europe and Central Asia there. Have you participated in previous conferences and do you plan to attend the next one?

– The first AIDS conference I attended was held in Geneva in 1998. Now I plan to attend the conference in Amsterdam. I already have two ideas for the conference abstracts. During the conference, I would like to get new information about the interaction with public organizations.

EECA Organisations Supported Michel Kazatchkine

Michel Kazatchkine, United Nations Secretary-General’s Special Envoy for AIDS in Eastern Europe and Central Asia

AFEW International has reached out to organizations and networks in Eastern Europe and Central Asia with the request to sign the support letter for re-appointment of Michel Kazatchkine as United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia.

His contract/mandate as UN special envoy on HIV/AIDS for Eastern Europe and Central Asia ends on 30 June. His role in addressing three epidemics in the region (HIV/AIDS, tuberculosis, hepatitis) and to raise awareness at political and scientific level of the concerns regarding HIV, TB and viral hepatitis in the EECA region is crucial and very important, especially now as we have the opportunity to highlight the challenges and successes of the region at AIDS2018 Conference. Therefore, there is a dire need for a continuation of his support.

The letter, signed by more than 70 signatories has been sent to United Nations Secretary General António Guterres. You can read the letter here.

Harm Reduction: Redirection of Resources Needed

Why do we need action?

Harm reduction is an evidence-based and cost-effective approach to drug policy and practice that is about keeping people who use drugs, their families and communities safe and healthy.

Harm reduction is about saving lives and it works!

Yet many countries still do not provide harm reduction services. According to UNAIDS, between 2010 and 2014 only 3.3% of HIV prevention funds went to programmes for people who inject drugs.

Why now?

Harm Reduction International’s data shows that since 2014, no new countries have established needle and syringe programmes (NSP) and just three have introduced opioid substitution therapy (OST). Of 158 countries where injecting drug use is reported, over half (78) do not offer OST and more than a third (68) still do not provide NSP. In 2015, a UN target to halve HIV transmission among people who inject drugs by 2015 was missed by more than 80%.

These figures are a call to action.

By contrast, each year governments spend over $100 billion on drug control strategies that have little effect on demand for drugs or on those who profit from the drug trade. At the UN General Assembly Special Session on Drugs in 2016, governments showed a new willingness to rethink these approaches. But now they must rebalance their spending.

What are we calling for?

We are calling on governments to redirect 10% of the resources currently spent on ineffective punitive responses to drugs and invest it in harm reduction by 2020.

What we will this achieve?

Even this small redirection of funding could achieve big results.

A 10% redirection of funding from drug control to harm reduction by 2020 would:

  • End AIDS among people who inject drugs by 2030.
  • Cover annual hepatitis C prevention need for people who inject drugs. Globally. Twice over.
  • Pay for enough naloxone to save thousands upon thousands of lives every year from opiate overdose.
  • Ensure effective advice, healthcare and emergency responses in the face of newly emerging challenges.
  • Strengthen networks of people who use drugs to provide peer services and campaign for their rights.
What will happen if we don’t act now?

If the adoption of harm reduction in new countries continues at the current pace, it will be 2026 before every country in need has even one or two harm reduction programmes. In the meantime, thousands, if not millions, of lives will be lost.

Source: Harm Reduction International

The Photo Exhibition ‘Life in the Shadow’ was Shown in the Netherlands

Author: Olesya Kravchuk, AFEW International

Last week the photo exhibition ‘Life in the Shadow’ was brought to the Netherlands by public Foundation ‘AIDS Foundation East-West in Kazakhstan.’ It was possible to see the images of people affected by HIV and tuberculosis during Wolfheze workshops in the Hague on 31 May – 2 June.

The main goal of the exhibition is to reduce stigma and discrimination against people with HIV and tuberculosis.

“We were very lucky with the opportunity to bring the exhibition to the Netherlands and show it to the bigger number of people,” the project manager of AFEW Kazakhstan Kristina Zhorayeva is saying. “Our models were very brave to show their faces and share their personal stories. They wanted to tell people that they are not different and they also have dreams and hopes.”

At the end of March the photo exhibition ‘Life in the Shadow’ was shown in Almaty, Kazakhstan. Some people from Kazakhstan saw the images for the first time in the Netherlands though.

“I have heard about this exhibition from AFEW, and today I saw it in the Netherlands even though it was displayed in my native Almaty,” the head doctor of one of the private clinics of Almaty Galiya Tulebayeva is smiling. “I look at these pictures of the patients with pleasure. It is great to see that there are smiles on their faces and they are in positive mood.”

As of February 2017, in Kazakhstan there were registered 29,568 HIV cases. According to the official data, in 2016 there were 14,345 tuberculosis patients registered in the country.

Visitors reviews of the photo exhibition ‘Life in the Shadow’

Jamshid Gadoev, WHO Country Office for Combating Tuberculosis, Hepatitis and HIV-AIDS in Uzbekistan:

– Only brave people can show themselves in such a way. They got sick and went through the processes that other people are going through now and do not hesitate to show all of this. On each photo I see a smile. Probably, they are happy with their treatment and are glad that they were rescued. They seem to be happy with their lives.

We also published a book and made a video about what tuberculosis patients feel before, during and after their treatment. We asked our patients to associate tuberculosis with some color, and children were asked to associate it with color and with the animal. Many people said that the disease for them is associated with red, yellow or black. Children usually said that their illness is a red teddy bear. Adults told that for them tuberculosis is black and is associated with the sound of a trumpet. After treatment, these associations often change and colors become brighter.

Alexei Bobrik, WHO technical specialist on HIV, tuberculosis and hepatitis, WHO Country Office, Ukraine:

– To overcome the burden of these diseases, it is necessary to talk about this problem so that the population knows about it, and the negative attitude towards the diseases decreases with time. It is necessary to communicate information, so that there is no stigma and discrimination. We must know that normal people are vulnerable to these serious diseases as well.

AFEW Kazakhstan Helps People Getting out of the Shadows

Author: Olesya Kravchuk, AFEW International

29,568 HIV cases were registered in Kazakhstan as of February 2017. According to the official data, in 2016 there were14,345 tuberculosis patients registered in the country. Usually, these people hide themselves, and are often afraid even to tell their relatives about their diagnosis. But there are also those who openly talk about their status, and who show that it is possible to get out of the shadow.

At the end of March, the photo exhibition ‘Life in the Shadow’ dedicated to the World Tuberculosis Day took place in Almaty. AIDS Foundation East-West in Kazakhstan organized this event. The exhibition featured photos of people affected by HIV and tuberculosis. Today we will tell the stories of some of them.

LEARN TO LOVE YOURSELF

After the death of her mother in 2008, Venera started to lose weight. The woman thought it was because of the grief she was experiencing, but still went to the hospital for the X-rays and medical tests. There it was discovered that Venera had an open form of tuberculosis.

Venera realized that it does not matter what your position in the society is, the tuberculosis makes everyone equal

“By that time, I was very weak and all the time felt sick in my stomach. I weighed 48 kilograms,” says Venera. “During three months I was out there with an open form of tuberculosis until they accepted me in the hospital. All I wanted at that time was to lie down and die! I was in darkness, alone, rejected by everyone. I did not believe that I would get out of that hospital alive. All the time I was sick because of the pills. My son and my sister, who, after my mother’s death, was taken to an orphanage, as I did not have time to register custody, were the only people who kept me alive. They called me, told me they needed me, asked not to die. It was the strongest motivation to live! After some time, I started to feel better and began recovering.”

A year later, Venera was diagnosed with tuberculosis and lung disintegration. At that time, the woman was pregnant. Since no one told her that during the pregnancy tuberculosis can be treated, Venera was advised to have an abortion.

“In the hospital they gave me the bed that was standing in the hallway, and soon the whole department knew I had tuberculosis,” Venera recalls. “People were scared of me. The gynaecologist was commenting something like, why people like me are even allowed to give births at all. That was such a humiliation!”

After she got out of the hospital, Venera realized that it does not matter what your position in the society is, the tuberculosis makes everyone equal. The woman became stronger and kinder, started to pay more attention to her relatives, helped those who needed help. Three years later, Venera gave birth to the healthy twins.

“I defeated tuberculosis. If you have such diagnosis, do not be not afraid and believe that you will recover!” says Venera. “Do not be scared of anyone, this is not a disgrace. Most importantly – do not refuse the treatment, otherwise you can infect your relatives and friends. Learn to love yourself!”

A DECISION TO LIVE

To those who only got to know about their diagnosis, Salavat advises to be strong and take care about their health

Salavat has been living with HIV since 2011. The man has heard something about this disease, but did not have a clear understanding of it. He thought it was somewhere far away, not here, and he could not even imagine that he could get infected.

“The doctor was calming me down, saying that people live with it, that it is not fatal, that in the future there probably will be a medicine… At first, of course, I felt bad, but I quickly overcame my fears,” Salavat says. “I made a decision to live. Now I know a lot about HIV. I am confident that I can work, and I am able to live. I know that we are the same people as everybody else, we are not infectious.”

To those who only got to know about their diagnosis, Salavat advises to be strong and take care about their health. It is very important to enjoy life, to share joy, and not to lapse into a cocoon of self-isolation.

ACCEPTING THE DIAGNOSIS

Oksana learned that she was HIV positive in the rehabilitation centre for drug addiction.

The acceptance of her diagnosis benefited Oksana’s professional and personal development

“It was scary, somehow I made myself believe that I had only five years left to live and I have to fill my last years with fun and unforgettable experience!” Oksana is saying. “Before my diagnosis, I thought that HIV is something that is far away and it is impossible to get it in Kazakhstan.”

At that time, the woman needed support, and she got it from her family. The first one who learned about her diagnosis was Oksana’s sister.

“Later I asked her what she felt when she found out that I was HIV positive,” Oksana remembers. “Surprisingly enough, most of all she was worried about me, because the first thing I could convince her in was that I had only five years to live. About three years later, I accepted my diagnosis. I realized that I am not dying, and started to learn how to live with HIV.”

The acceptance of the diagnosis did not only benefit Oksana’s professional development, but also her personal development.

“I am happy to be busy with my favourite things, I am with a person I love and my family is very friendly. I learned how to live with HIV. You just need take more care about your health and love life!” Oksana resumes.

TO BELIEVE IN RECOVERY

After being diagnosed, Sultanamurat started to appreciate life more

The only thing Sultanmurat knew about tuberculosis was that it is a dangerous disease. When he heard his diagnosis, he became horrified.

“I experienced haemoptysis. It was scary, but I did not even suspect that it could be tuberculosis. I thought that I had some problems with my internal organs,” recalls Sultanmurat. “I really wanted to be cured, but the treatment was going very difficult. In the beginning, I did not tolerate the medicine and developed allergies. I was fighting with myself, tried not to miss a single day of taking medications and injections. Now I feel much better.”

After being diagnosed, Sultanamurat started to appreciate life more, treated people who are ill with better understanding, began to appreciate and love his relatives even more.

“I would like to tell those who are diagnosed with tuberculosis that this disease is curable, like many other diseases. The main thing is to follow the regime in everything, do not miss taking pills and eat well, move and do sports, be friendly,” Sultanmurat says. “The most important thing is to believe in the best, that is, in your recovery.”

PrEP: effective and empowering

Author: Marieke Bak

Pre-exposure prophylaxis (PrEP) is a new HIV prevention method that consists of a daily pill taken by HIV-negative people to reduce their risk of becoming infected with HIV. PrEP is highly effective in preventing HIV transmission, as scientific research shows. A large international study among gay men and transgender women, the so-called iPrEx trial suggested that PrEP can reduce the risk of HIV infection by at least 92% when the pills are taken consistently. PrEP is also effective when used by heterosexual men and women, as well as by people who inject drugs.

Although PrEP is more expensive than other HIV prevention methods, it can be a cost-effective tool, especially when delivered to people at high risk of HIV. By preventing the costs of lifetime HIV treatment, PrEP may even lead to healthcare savings, especially when the drug patents expire and the cost drops.

Moreover, PrEP is the first method of HIV prevention that is directly under the control of the at-risk individual. This is in contrast with treatment as prevention (TasP), which is dependent upon partners’ HIV treatment adherence to ensure suppressed viral load. Besides, because PrEP separates the act of prevention from the sexual encounter, it can be used without sexual partners knowing and provides additional protection when condoms are not used consistently.

The World Health Organization now recommends that PrEP should be offered as a choice to key populations affected by HIV as well as to anyone else at substantial risk of HIV infection.

TRANSFORMING HIV INFECTION

PrEP is a pill consisting of anti-retroviral drugs that needs to be taken every day in order to be effective. Currently, the only drug approved for use as PrEP is sold by Gilead Sciences and is called Truvada, which consists of a combination of tenofovir and emtricitabine (TDF/FTC). Truvada was first approved for prevention in 2012 in the United States of America.

In contrast to PEP, or post-exposure prophylaxis, PrEP is taken before exposure to HIV to prevent any possible transmission. PrEP works by blocking an enzyme called HIV reverse transcriptase, thereby preventing HIV from establishing itself in the body. While PEP can be thought of as a “morning-after pill” for HIV prevention, PrEP can be compared to the contraceptive pill that is taken every day. Similarly, PrEP may transform HIV infection just like the pill transformed family planning.

The most common side effects of Truvada for PrEP are nausea, vomiting, dizziness, headache and fatigue, although these symptoms usually resolve within a few weeks. Some people in trials also experienced small changes in kidney function or a decrease in bone mineral density. An updated version of Truvada was created that contains a new form of tenofovir, which is thought to be safer for bones and kidneys. At the moment, the so-called “Discover study”, is being set up in North America and Europe to investigate the new PrEP medicine called Descovy.

By the way, PrEP does not protect from sexually transmitted diseases (STDs). Fears that PrEP might be used as a “party drug” exist. However, in the iPrEx study as well as in a meta-analysis by the World Health Organisation, it was shown that PrEP does not lead to an increase in the number of STDs and has no effect on condom use. Rather, PrEP reduces the fear and anxiety that often comes with sexual activity for those at high risk of HIV.

However, because PrEP is not 100% effective and because it does not protect from STDs, it should not be used as a standalone prevention method. According to WHO guidance, PrEP should be offered as part of so-called “combination prevention” which includes the use of condoms as well as regular follow-ups and HIV testing.

PREP IN EASTERN EUROPE AND CENTRAL ASIA

Despite the recommendation to offer PrEP to people at high risk of HIV infection, the global availability of PrEP remains limited. The PrEP target set by UNAIDS in their strategy on ending the HIV pandemic is to get three million people on PrEP by 2020. However, only 2% of this target had been reached in June 2016.

At the moment, Truvada for PrEP has been approved in the United States, Canada, Australia, Peru, South Africa, Kenya, Zimbabwe, Israel, and the European Union. Approval is pending in Brazil and Thailand. In the European Union, PrEP has been approved by the European Medicines Agency (EMA) although the implementation of PrEP programmes is the responsibility of each member state separately. To date, only France and Norway have made PrEP available as part of their healthcare system. Scotland recently announced that it will do the same.

In Eastern Europe and Central Asia (EECA), PrEP is not available yet. However, demonstration projects are currently being set up in Georgia, Ukraine and Azerbaijan. These pilot studies consist of several phases. In Georgia, the first stage of PrEP implementation included a training session for those involved in the pilot, as well as the conducting of a needs assessment among Georgian men who have sex with men (MSM) and capacity building for local NGOs, before the actual start of the pilot in 2017. In Central Asian countries, there seems to be less interest in PrEP, although the Ministry of Health of Kyrgyzstan is planning to start an evaluation on the possibilities of introducing PrEP in the country.

Challenges of introducing PrEP in EECA may include the cost of PrEP, but also the high levels of stigma and discrimination in some countries. However, with HIV incidence in EECA rising by 57% between 2010 and 2015, treatment alone will not stop the epidemic. Given its proven effectiveness, providing PrEP to key populations can be a significant step in controlling the explosive growth of the HIV epidemic in this region.

AFEW International Announces Culture Fund for the Students

AFEW International with the support of the Dutch Ministry of Foreign Affairs is announcing a Culture Fund for providing support to all sorts of cultural materials and exhibitions to address stigma and discrimination related to HIV, diversity and other related issues in general, and particularly in the EECA region.

Through the means of arts and culture, the Culture Fund will attract attention of the Dutch people and international community of policy makers, donors, stakeholders, researchers and clinicians who will visit International AIDS Conference in Amsterdam next year, to the issues, challenges and achievement of the EECA region in response to AIDS epidemic.

There are several barriers for the delegates from EECA region to participation in the AIDS conferences: lack of skills on scientific writing and abstract development, costs of participation, language barrier, and quite low interest of the region to the Conference in general.

With our project, we address these barriers, and the Culture Fund will become a specific means to motivate arts and culture communities in the EECA region to attend the conference and thus attract attention of diverse groups of conference visitors including Dutch public to the EECA region and the current state of the AIDS epidemic and response to it.

Meanwhile, we are forming a Think Tank of talented and motivated people who will help us to develop Culture Fund concept; create detailed planning which will identify number of potential recipients of the funds for developing arts and culture pieces; determine criteria for selection of the ideas and initiatives submitted; develop management structure; describe activities and climax event(s); and plan for evaluation; and join coordination group to make it work.

We invite students who are based in the Netherlands to join our Task Force. By the 18th of April we expect to receive a A4 Letter with your vision of the Culture Fund. You can send your suggestions at info@AFEW.nl. More details on what to include in your letter you can find here.

Communities will be Educated how to Analyse Data and how to Act

Two new modules for the program community-based participant research CBPR [e] Education that is supporting and strengthening the research capacity of organizations acting on behalf of and representing the interests of communities in Eastern Europe and Central Asia (EECA) are released online today.

The program consists of the number of activities, including training for community-based participatory research, small grants program, workshop on dissemination and abstract writing and workshop on presenting research findings on AIDS2018 Conference.

AFEW International gives program participants the opportunity to take part in online e-learning modules for further development of their research skills. The modules are also available for others who are interested in community-based participatory research. Course that costs 75 euros, includes 7 modules on the preparation and conduct of community-based participatory research.

The first module announced today is Data Analysis. Analyzing data is necessary to make sense of the outcomes of the study and to answer the research questions. Analyzing data will help working towards a way of representing the data to a larger public.

The second module is called Bringing about social change: translating knowledge into action. After the data is collected and analyzed, the participant is ready to write the reports and to disseminate the results to others. It is the time now to determine how the participant can bring social change that will benefit the community. The evaluation of the research will be also discussed in this module.

Later on, everyone will be able to participate in the webinar on data analysis, which will be held in late spring or summer of 2017.