Natalya Shumskaya: “Without a Professional Team We Would Not Have Succeeded”

Author: Grana Zia, AFEW-Kyrgyzstan

The executive director of AFEW-Kyrgyzstan Natalya Shumskaya is talking about the successes and challenges of the organisation in 2018 and the new demands for 2019.

– Natalia, what are the main achievements that AFEW-Kyrgyzstan can be proud of in 2018?

– I am really proud that the World Health Organisation (WHO) recognized the clinical guideline we developed for the management of pregnancy among women who use psychoactive substances as the best practice.

In the women’s colony, where we work in partnership with the Penal Medical Service and the Republican AIDS Centre, we managed to achieve the goal of 90-90-90: 90% of HIV-positive people are aware of their status, 90% of them take antiretroviral (ARV) therapy and reach supressed viral load. This is our common contribution to the fight against the HIV epidemic, and it is very encouraging to see such results.

I am also proud that we have managed to develop guidelines for the effective functioning of the coordination commissions on HIV infection and tuberculosis. Under this guideline, we trained over 100 representatives of regional public health commissions in all regions of Kyrgyzstan. We successfully lobbied for the participation of civil society organisations in these commissions.

Remembering 2018, I should also mention the delegation from Kyrgyzstan at the International AIDS Conference in Amsterdam AIDS 2018. We have been looking for funding for a long time, negotiating with various donors. Here is our result: 16 participants from Kyrgyzstan took part in more than 15 sessions; six delegates from Kyrgyzstan became conference speakers, and five delegates took part in poster presentations. At AIDS 2018, we even organized our own workshop for the countries of the Eastern European and Central Asian (EECA) region on community participation in decision making at all levels. I consider this a success, and, taking into the account the huge amount of work for this case, I call this a great achievement.

I am also proud that in 2018 we were able to agree with AFEW International and UN-Women in Kyrgyzstan on the opening of a rehabilitation centre and a social enterprise. It was a long process of negotiating, but we were able to take this step for the sake of healthy future for our country.

– What were your main challenges in 2018?

– I think that challenges are, first of all, opportunities. For example, in 2018 we planned the opening of a centre for teenagers for the prevention of usage of psychoactive substances. It was important for us that the state also contributed to the opening of this centre. We wanted to emphasize the importance of investing in youth development by the state. Children need our help. Unfortunately, negotiations with the mayor’s office were very long. It took us a very long time to receive a huge amount of necessary permits. We organized meetings, made concessions, but we were rejected. In early 2019, the opportunity arose to open such a centre in partnership with the State Agency for Youth, Physical Culture and Sports under the Government. They gave us a large and warm room in the heart of the city of Bishkek. Starting from March, our centre for teenagers begins its work.

– What are the main goals for AFEW-Kyrgyzstan in 2019?

– First of all, we plan to start our social entrepreneurship. We have already opened a training centre and beauty studio. We plan to train women in difficult life situations and to employ them later to work in the beauty studio. Now the important task is to think about marketing strategy and put everything on a self-sufficiency track. For us, this is a new experience. Now we will master fashionable beauty services, understand all the difficulties of accounting and business.

Another goal is to ensure stable development and financial support of our rehabilitation centre. It is being built now with the support of AFEW International. We want it to be a high-quality, multi-functional, modern and convenient for people who use drugs. We do not accept “semi-results”, and will definitely achieve all the goals.

Of course, 2019 will be for us a year of searching for new directions and programs, and strengthening advocacy activities, especially in the field of budget advocacy from the state. We want to strengthen relations with the donor community, non-governmental organisations and the state.

– Natalia, what do you think distinguishes AFEW-Kyrgyzstan from other non-governmental organisations in Kyrgyzstan?

– I think our strongest point is our employees. Due to the fact that our entire team is people with completely different education and experience, we can work in a very large range of services. Among us there are specialists in the field of HIV, tuberculosis, gender experts, researchers, business consultants. In 2017, for example, we began to develop the direction of helping women in difficult life situations. It was the first experience, but now this direction is very successful: 320 women from various key groups (single mothers, victims of gender-based violence, HIV-positive women) had training on the development of economic independence. Some of them started their business after that, someone has already come to our beauty studio as a master or coach. Without a professional team that is ready for new challenges, we would not have succeeded.

Zero Discrimination Day 2019: Message from Anke van Dam

Stigma and discrimination are obstacles that discourage people from taking an HIV test in Eastern Europe and Central Asia. Access to confidential HIV testing in the region remains a big concern. Many people only get tested after becoming ill and symptomatic. Today stigma is, unfortunately, the strongest barrier not only for testing among those who are not aware of their status but also for the treatment and care of those who live with HIV.

Stigma and discrimination are also a very big issue for people who use drugs and other key populations at risk for HIV in Eastern Europe and Central Asia. Discriminatory laws prohibit those groups to access health care and participate in the life of society.

Migrants are another vulnerable group who experiences stigma and discrimination on many levels. The situation worsens when migrants have HIV or use drugs. Then it is even harder for them to receive medical treatment.

It is especially important to talk about stigma and discrimination today while observing Zero Discrimination Day. We, at AFEW Network are supporting UNAIDS in highlighting the urgent need to take action against discriminatory laws. Working in Eastern Europe and Central Asia for almost 20 years, we are taking actions from our side as well. We are expanding the access to HIV testing by partnering with the non-governmental organisations and community-based organisations in the region and ensuring that people who use drugs, prisoners, sex workers, LGBTI, and young people have access to confidential HIV testing, and people living with HIV have access to good medical care and have great possibilities for a healthy future.

Ending discrimination and changing laws is our common responsibility, it is what we all can do. Everyone can contribute to ending discrimination and can try to make a difference. We all can break the wall of stigma and make this world better! Chase the virus, not people!

Olena Voskresenska: “2018 Was Very Active and Diverse for AFEW-Ukraine”

Author: Olya Kulyk, ICF “AIDS Foundation East-West” (AFEW-Ukraine)

The executive director of International Charitable Foundation “AIDS Foundation East-West” (AFEW-Ukraine) Olena Voskresenska is telling about the main achievements of organisation in 2018 and its plans for 2019.

– Olena, how was the year of 2018 for AFEW-Ukraine?

– 2018 was a very active and diverse year for AFEW-Ukraine. During the last year we strengthened and expanded our work on empowering key communities, developing community leaders and facilitating the dialogue between the communities. In our work with adolescents who use drugs within the project “Bridging the gaps: health and rights for key populations”, the special focus was on developing youth leaders. In 2018, young activists from four regions of Ukraine had a chance to develop their own projects, and small grants that we provided to them allowed young people to implement youth-led projects in their regions. Through the Country Key Populations Platform, that we continue to support, we had an opportunity to learn more about the needs of different key populations – people who use drugs, sex workers, LGBT, and ex-prisoners. We also help the communities to develop communication algorithms to ensure that the voices from the most remote areas of the country are heard by the community leaders.

Besides, at the end of the year, we started the project aimed at empowering HIV-positive women in Kyiv and Cherkassy as advocates for their rights. The project was supported by the Embassy of Norway – a new donor for our organization.

– What were the three main achievements over the past year that you can determine?

– Since 2011, AFEW-Ukraine has been working with adolescents who use drugs, and I am very proud that in 2018 we managed to expand this work to small cities and rural areas of Ukraine. It was possible thanks to the project “Underage, overlooked: Improving access to Integrated HIV Services for Adolescents Most at Risk in Ukraine” that is supported by Expertise France – Initiative 5%. The project is implemented in cooperation with Alliance of Public Health, and now services for adolescents who use drugs are developed in 28 small cities of seven regions of Ukraine. Initial project research, that is now being finalized, is the first of its kind not only in Ukraine but probably in most of the countries of Eastern Europe and Central Asia (EECA).

In 2018, AFEW-Ukraine supported the development of standards on rehabilitation for the Ministry of Social Policy. I am very proud that we managed to bring together a good team of experts for working on the standards, including a representative of the community of people who use drugs. We hope that these standards will help to improve the quality of rehabilitation services in the country, based on the best international practices, human rights approach and needs of the community. We are very much looking forward to further work in this direction not only in Ukraine but also in Georgia.

2018 was also a very important year for all HIV service organisations, as it was the year of the 22nd International AIDS Conference that took place in the Netherlands. Being a part of AFEW Network, with AFEW International Secretariat in Amsterdam, we worked hard to ensure maximum involvement of EECA participants in the conference and attracting attention to our region. I am very happy that we managed to support a large delegation of AFEW-Ukraine partners, including young activist from Kropyvnytskyi, representatives of the community of people who use drugs, and HIV-positive women from Ukraine.

– What are the plans of the Foundation for 2019?

– In 2019 we will continue working with young people in Ukraine, focusing on their active involvement in decision-making processes, including monitoring of the local budgets. I hope that we will be able to expand our work to include young detainees in our projects.

Developing harm reduction friendly rehabilitation remains a priority for us, and we will stimulate the changes in current rehabilitation practices in Ukraine and Georgia with our local partners. Also, we are very much looking forward to closer working with HIV-positive women in Ukraine, disseminating the successful model of immediate intervention that was already tested in Kyiv, to Cherkasy, and potentially other regions of the country. In 2019 we are also planning to revise our strategic plan, which will define the priorities of AFEW-Ukraine’s work for the upcoming several years.

Anke van Dam: “AFEW will Continue to be the Bridge Builder”

Author: Olesya Kravchuk, AFEW International


Anke van Dam on AIDS 2018 Conference

AFEW International executive director Anke van Dam sums up the results of 2018 and gives introduction of AFEW activities for the upcoming year of 2019.

Anke, how was the year of 2018 for AFEW International?

– It has been an amazing year for us! In the first half year our team prepared very carefully and intensely for the 22nd International AIDS Conference AIDS 2018 – the biggest event in AFEW’s lifetime. It is the biggest health conference in the world and this time it was a very important event for Eastern Europe and Central Asia (EECA). We got to successfully highlight AFEW and EECA region during the Conference. Next to this major event for us, we also had our project activities, like Bridging the Gaps project, Fast-Track TB/HIV Responses for Key Populations in EECA Cities project, Improved TB/HIV Prevention and Care – Building Models for the Future project, the project with Andrey Rylkov Foundation. We were involved in the City Health Conferences, and in the STI.HIV.Seks Dutch national congress. AFEW was also in New York to addressing the needs for diagnostics and treatment for tuberculosis in Eastern Europe and Central Asia at a side event during the United Nations General Assembly high-level meeting on tuberculosis in September and during the 49th Union World Conference on Lung Health in October in the Netherlands.

Taking into consideration that AIDS 2018 Conference was so important for the region where AFEW works, what were the outcomes of this event for EECA?


Anke van Dam on AIDS 2018 Conference

– Eastern Europe and Central Asia were really in the spotlight, with so many partner organisations and colleagues we shared our successes and challenges to stop new HIV cases in the region. You could hear Russian everywhere, in the Global Village, corridors, network meetings! Herewith some figures: compared with the International AIDS Conference 2016 that took place in South Africa, the EECA representation during AIDS 2018 Conference in Amsterdam increased from 3.9% to 10.5% at all activities included in the official programme. We had 16 speakers from the EECA region, which represented 5% of all speakers, and this is a big success. Thanks to the promotion of AIDS 2018 to the EECA region and thanks to AFEW’s community based participatory research project, the number of abstracts submitted from the region were triple to the number submitted for AIDS 2016. In total, there were 627 abstracts submitted. AFEW International organized mentors’ support to the partners, and that is why the quality of the abstracts improved substantially, which increased the chance of acceptance. Thus, 187 abstracts from the EECA region were accepted which marks a six-fold increase when compared to the previous conference. In total, 604 delegates from EECA visited the AIDS2018 – an almost five times increase in comparison to AIDS 2016 and AIDS 2014.

AFEW has invited some Conference participants with Martine de Schutter Scholarship Fund that was established not long before AIDS 2018. How many EECA participants got the scholarships to come to Amsterdam?

– It was very important for AFEW to ensure that many partners and colleagues were able to come to Amsterdam to get to learn about the state of the art in HIV prevention, treatment and care, and to get in touch with other (Western) activists, scientists and clinicians, AFEW used the AIDS 2018 as another opportunity to be the bridge between East and West. The amount of scholarships that International AIDS Society (IAS) awarded to the EECA region has increased dramatically both in comparison to the previous conference, and also to the AIDS 2010 in Vienna. In total IAS has granted 149 scholarships to delegates from the EECA region, and that was 13% of all IAS scholarships. Of this amount, 62 scholarships were funded by AFEW International. We have contributed 85,000 EUR to the IAS scholarship fund. On top of that, AFEW International has disbursed directly at least 57 more scholarships to Community-based participant research project (CBPR) participants, journalist, (young) researchers, activists, and governmental official delegates supported through AFEW offices. There was an increase in participation from the Central Asia in comparison to AIDS 2010, with total increase of 18 delegates from Kazakhstan, Kyrgyzstan and Tajikistan. That was mainly thanks to increased scholarship support to these specific countries.


Anke van Dam on AIDS 2018 Conference

What are AFEW’s plans for the year of 2019?

– There are exciting developments for 2019. During AIDS 2018 Conference we have got the grant from Elton John AIDS Foundation (EJAF). Within this grant, with Aidsfonds in the lead, we have established the Emergency Support Fund for Key Populations in the EECA region. We are currently accepting the applications for emergency grants from 10 countries in Eastern Europe and Central Asia. With these small grants we are supporting organisations representing key populations in surviving in difficult situations which they face due to legal barriers, stigma and discrimination, financial challenges and political restrictions. Besides that, we are continuing the activities within Bridging the Gaps project, Fast-Track TB/HIV Responses for Key Populations in EECA Cities project, Improved TB/HIV Prevention and Care – Building Models for the Future project, and our activities in Russia. Recently, we have got the approval to start activities in the framework of the PITCH project, which will give us opportunities to continue working with the EECA cities, and to expand our activities in Russia further. Not long ago we have got 16,000 EUR of donation to Martine de Schutter Scholarship Fund from ViiV Healthcare UK Ltd. This financing will be used as an effective tool for the EECA scientists, clinicians, community professionals and activists for bringing challenges of EECA region on international agenda and learning from their peers through participation in the international conferences. AFEW will start with EECA INTERACT, a platform for (young) researchers in the EECA region to present their studies. AFEW will continue to be the bridge builder between communities and authorities, between communities and health care providers and between East and West for a better health in the EECA region.

Why Ukrainian Key Communities Unite in One Platform

Author: AFEW-Ukraine

In many countries, different key populations unite. They do it for the better representation of their interests in the development of public policy. This is often the alliance within one community, and less frequently – of several communities.

Four key populations in Ukraine – ex-prisoners, LGBT, people who use drugs (PUDs), sex workers (SW) – have their own self-organizations, being at different stages of development. There are communities with great experience in advocacy and work with international donors, but there are those that are at the initial stage of development. They grow stronger with the support from more experienced activists.

“Despite growing importance of the community voice in decision-making processes related to access to health and social services, very often representatives of HIV-service organisations speak on behalf of key populations rather than community representatives. Having the voices of community directly heard leads to a situation where the actual needs of key communities are much better taken into account in programs planning and implementation”, says Olena Voskresenska, executive director of ICF “AIDS Foundation East-West” (AFEW-Ukraine).

In October 2015, during the meeting held within the framework of Tripartite cooperation between the Kingdom of the Netherlands, UNAIDS and civil society, community activists expressed the idea of creating a Platform. This Platform had to become an independent structure for sharing experience, dialogue and developing a common position and advocacy messages of several communities, as well as facilitating representation of communities in public bodies, working groups and other organizations. In addition, the Platform could contribute to collecting data on the needs of communities and raising new activists.

“My idea was to give communities the opportunity to advocate for their rights and change policies and to bring communities together to help each other. Also, it was important to allow communities to develop and mobilize themselves without external influence,” recalls Petro Polyantsev, a member of CKPP steering committee.

Creating the Platform

Initially, it was necessary to understand whether all key communities are interested in the Platform. Then the priorities of the Platform had to be identified. In 2016, the most active representatives of the LGBT, SW and PUD communities formed an initiative working group. Participants of the Tripartite cooperation initiative – UNAIDS, ICF “AIDS Foundation East-West” (AFEW-Ukraine) and LGBT Association “LIGA” (partners in the project “Bridging the Gaps: Health and rights for key populations”) – helped to organise group’s work and found the necessary funding for the Organizational Forum of the Country Key Populations Platform (CKPP).

“Today the priority for communities is to maintain access to services in the context of transition to state funding. By working together, communities can achieve much better results than by working just by themselves,” says Andrii Chernyshev, a member of CKPP steering committee.

The first CKPP Forum was held in January 2017. The main result of this event was a decision to establish the Country Platform as an association of key communities’ representatives. During the Forum, also representatives of the community of ex-prisoners joined the Platform.

CKPP was officially registered as a public association in December 2017. The Steering committee, representing all four communities, coordinates the work of the Platform. The main strategic issues are resolved during the CKPP Forums. Funding for Platform activities is provided through the selection of several grant programs managed by the organizations endorsed by the Steering Committee and an Advisory Group. As of today , the work of the Platform has been financially supported by the Ministry of Foreign Affairs of the Netherlands in the framework of the project “Bridging the Gaps: Health and rights for key populations”, UNAIDS, Eurasian Harm Reduction Association (EHRA), International Renaissance Foundation, the Embassy of the Netherlands in Ukraine. Such diverse funding model allows the Platform to remain independent and unbiased.

First steps are successful

The activities of the Platform in the last two years were mainly focused on the development of its structure, as well as the strengthening of the communities. During this period, 163 activists from 18 regions of Ukraine took part in important and interesting events and trainings, the topics of which were determined by the participants. Communities’ members developed CKPP Regulation and the CKPP Code of Ethics which regulates the basic principles of work.

In 2018, members of the Platform presented it at the XI National LGBT Conference in Ukraine and the 22nd International AIDS Conference (AIDS 2018) in the Netherlands.

“I believe in the Country Key Populations Platform. We are already seeing the results. The government is more inclined to listen to us because we gained legitimacy by joining our forces. When people are motivated to make change happen and work together, human rights will be a reality in our country, and not just words. Only together we can save our lives,” says Vielta Parkhomenko, a member of CKPP steering committee.

The researcher Anastasia Bezverkha in the recent study “Country Key Populations Platform – from better communication to stronger voice. The case study from Ukraine” highlighted the positive changes influenced by the creation and work of the Platform.

“CKPP impacted the communication between the partners in the field in a positive way. Key population leaders became more visible and new leaders emerged. In addition, CKPP serves as an important space for communication of national decision-makers with key population leaders,” summarizes Anastasia.

The IV CKPP Forum, which was held in December 2018, was focused on developing the strategies and work plans of the Platform for 2019.

AFEW-Kyrgyzstan Started the Year with Rebranding

By changing the name “AIDS Foundation East-West in the Kyrgyz Republic” at the beginning of the year 2019, AFEW-Kyrgyzstan emphasized its involvement in the international AFEW Network. Another reason for changing the name and logo of the organisation is the expanding capabilities.

“Now we are working not only in the field of HIV and AIDS. We are implementing tuberculosis treatment projects, conducting large-scale researches, carrying out advocacy campaigns to protect the rights of people and for the economic empowerment of women. Therefore, the former name no longer fully reflects our goals and values,” says the Chair of the Board of AFEW-Kyrgyzstan Natalia Shumskaya.

The new logo has retained one of the key elements of the previous one – the human figure, because everything AFEW does is aimed at helping specific people. The figure also shows that AFEW-Kyrgyzstan works, involving people from the community, and for them.

Three blue and one red objects around the white pattern represent different countries since AFEW-Kyrgyzstan is a part of an international network and is ready to use the experience of foreign partners to build a healthy future in the country.

In an updated form, AFEW-Kyrgyzstan is ready to welcome its old partners again and look for new opportunities to help people from key populations.

AFEW-Kyrgyzstan Uses the Experience of Foreign Colleagues

216 adolescents were registered for using psychoactive substances in 2017, according to the Narcology Center in Bishkek. Representatives of the police services in Bishkek stated that there is also a high possibility that 1,031 teenagers, who were registered for committing different offences in 2018, had an experience of using psychoactive substances or are at a high risk of starting to do so. However, this data does not show the real situation. In Kyrgyzstan, there are still no complete official data on the exact number of adolescents who use psychoactive substances.

This is related to several factors. One of them is that the drug policy of the country is still strict and aimed to punish. Parents and children who face the problem of using psychoactive substances are afraid of getting help from medical specialists because the doctors will add teenager’s name to the special database. In the future, being in this database will not allow this teenager to be enrolled at the university or to get a high-paid job.

Another issue is that the country is lacking ways to support such adolescents. There is also a lack of a comprehensive program for the prevention of drug use among teenagers. The combination of all these factors does not allow the country’s specialists to work effectively with adolescents and to carry out preventive work.

Bridging the Gaps: health and rights of key populations (BtG) project, implemented by AFEW-Kyrgyzstan, intends to apply international experience to help adolescents who use psychoactive substances in Kyrgyzstan. BtG has regional exchange platforms, where specialists from EECA can share with each other their experience concerning harm reduction and rehabilitation issues. It helps the project to meet contemporary challenges. AFEW-Kyrgyzstan is aiming at creating a multifunctional mechanism that will help adolescents who use psychoactive substances and a professional system for preventive teenagers from using it.

The protocol is approved by the Ministry of Health

The clinical protocol ‘Mental and behavioural disorders due to the usage of new psychoactive substances among children and adolescents’ was developed with the support of AFEW-Kyrgyzstan and approved by the Ministry of Health in 2017. Professional narcologists and members of the community of people who use psychoactive drugs and other specialists developed the protocol.

“The developed clinical protocol gives the recommendations to emergency medical doctors, toxicologists, family doctors, resuscitators, psychiatrists and narcologists,” says Elmira Kaliyeva, a participant of the working group that developed the protocol.

Having developed the protocol, AFEW-Kyrgyzstan began trainings for narcologists, doctors of family medicine centres, teachers of the Kyrgyz State Medical Institute for post graduates and juvenile inspectors in Bishkek and Osh.

Working for the future

The representatives of the UN Children’s Fund (UNICEF) got interested in the protocol too and the BtG work and approached AFEW-Kyrgyzstan with a proposal to teach doctors in remote areas of Bishkek to work with this protocol. The proposal of UNICEF gave the opportunity to expand the circle of specialists familiar with the protocol. In addition, this cooperation will allow AFEW-Kyrgyzstan to be confident that all the work done in the framework of the BtG project will continue in the country for many years.

Waiting for the city hall’s help

Establishing cooperation with government partners to ensure stable and long-term support for adolescents who use drugs was the next task of the project. In June 2018, within BtG project, AFEW-Kyrgyzstan supported a round table organized by the city administration for the presentation of the Comprehensive City Program Prevention of Juvenile Offenses for 2018-2020.

Deputies promised to consider the proposed Comprehensive City Program which also includes recommendations that were listed in the developed clinical protocol. The adoption of the program will allow to create a cross-sectorial system of cooperation in the country, where the various departments can work together and redirect children who use psychoactive substances to help them as efficiently as possible.

Opening a centre for teenagers

The round table also became a platform for discussing the urgent need of opening a specialized centre to support children and adolescents who use psychoactive substances.

“We are in favour of building a modern centre that is capable of providing quality support to adolescents and is able to give parents verified and necessary information. This centre will become a model for working with adolescents from a key group as well as an educational and methodological centre for social pedagogues, juvenile inspectors and psychologists,” says Natalya Shumskaya, head of AFEW-Kyrgyzstan.

Taking into consideration that Kyrgyzstan’s culture is very traditional, there is a common misconception that people who use psychoactive substances are not good members of the society. This stigma leads to several issues. For example, teenagers are scared to talk with someone about the use of psychoactive substances. They are afraid of being expelled from the school or being suspected in crimes only due to their experience of using psychoactive substances.

“The center is also going to work on increasing the level of acceptance of psychoactive substances use among the society. This will lead to more effective support from the side of adults and to less risky behavior of adolescents as they got all proper information they need. It is the first step that can lead to final abstinence,” says Chinara Imankulova, manager of BtG project in AFEW-Kyrgyzstan.

AFEW-Kyrgyzstan specialists already developed a project of such centre. The centre will also work with those who have never used psychoactive substances and with children who are in high risk of starting using them. The prevention work will include helping teenagers to organize their leisure activity and to give them information that usage of psychoactive substances is not shameful, however it is important to ask yourself whether you are aware of the risks and if you really want to do so, to find solid information and to ask for help of professionals.

Creating the centre and the approval of the Comprehensive City Program will help thousands of teenagers to make healthy choices for a happy life.

Michel Kazatchkine: “Failure to Interact with Vulnerabilities Could Lead to an Increase in the Epidemic”

The Chair of AFEW International’s Board Michel Kazatchkine and director of the organisation Anke van Dam during the 22nd International AIDS Conference. Photo: AFEW International

The inaugural World AIDS day was held on December 1st, 1988. The epidemic was raging across Western Europe and the United States. The world was only starting to realize the existence and the magnitude of the African epidemic. HIV was virtually absent from the Russian Federation. There was no treatment for HIV infection. AIDS was a death sentence, as we, physicians, were painfully witnessing every day in hospital wards.

30 years later, while no country has been spared of HIV, we cannot overestimate the progress that has been made. Extraordinary progress in science, research, and development, that has successfully translated into large-scale prevention and treatment programs in almost all settings, globally.

21 million people are now accessing antiretroviral treatment across the world. Life expectancy of an HIV-positive person on treatment is now similar to that of HIV-negative people. And we now know that an HIV-positive person whose virus has been suppressed with treatment will no more transmit the virus to a sexual partner, meaning that antiretroviral treatment also contributes to prevention of HIV transmission and to limiting the epidemic at the population level. In the last 10 years, the number of new HIV infections and AIDS-related mortality decreased by close to 40% globally. The hope generated by the progress has led the United Nations to commit to the goal of eliminating HIV by 2030.

Yet, an objective analysis of the situation today shows that the world is off track in achieving this target. The Russian Federation and, more broadly, the Eastern European and Central Asian region, are of particular concern.

Eastern Europe in the last five years is the only region of the world where both the annual number of new cases of HIV infection and of AIDS-related deaths continues to grow. The number of new infections reported in the region increased by 30% between 2010 and 2016. Over a million people are now estimated to be living with HIV in the Russian Federation; one in five do not know their status. It is timely then, that the theme of this year’s World AIDS day is “Know your status.”

Breaking down the raw numbers reveals an unsettling scenario. 45% of the people who know their positive status are on treatment and 75% of these are virally suppressed.

This means that, at the end, only approximately 27% of the total estimated number of people living with HIV are virally suppressing their infection and that a large pool of people with HIV can potentially transmit the HIV infection. All this in a context where national prevention efforts are lagging behind and fragile at best.

The ministry of Health aims at increasing treatment coverage to reach 75% at the end of next year and rightly points out how important it is to urgently address some of the myths and misinformation that prevent people from accepting treatment.

The HIV epidemic in Russian Federation is largely an epidemic of so-called “key populations” and their sexual partners – people using drugs, men who have sex with men, sex workers, migrants, prisoners – often marginalized groups of the population for whom stigma, discrimination, and criminalization drive many of these people underground, away from outreach workers and so with limited access to prevention  and treatment services.

An effective response to the epidemic within the Russian Federation should, therefore, entail a focus on specific geographic areas and populations. It also means seizing many immediate opportunities to build onto the HIV platform, the “SPID centers”, to provide additional services, including diagnosis and, as much as possible, integrated treatment of tuberculosis and hepatitis, as well as prevention services including “pre-exposure prophylaxis” for men having sex with me and provision of clean needles and injection materials for people who inject drugs.

When and where this kind of efforts have been employed around the world we know the outcome: a decline in new infections, a decline in the pool of infectiousness and improved control of the epidemic in general by the authorities.

We also know that failure to engage with most vulnerable and at-risk groups of people can bring – a growing epidemic that becomes increasingly more difficult to reign in.

A recent modeling study has shown, for example, that without integration and scaling up of needle exchange programs and antiretroviral therapy, HIV prevalence would remain as high as 60% among people who inject drugs in Ekaterinburg. Scaling up of the interventions would – in contrast – significantly reduce that prevalence and deaths associated with HIV. If the interventions were to cover 50% of people in need and to also include opioid maintenance therapy with methadone, currently unavailable in the Russian Federation, over 30% of HIV infections and HIV-related deaths could be prevented in Ekaterinburg.

The science and the experience from many countries, particularly in Western Europe, tell us that these approaches can best be implemented in a working partnership with civil society, recognizing the additional and complementary strengths brought by community-led services. In Saint Petersburg, joint efforts of the AIDS center and civil society to bringing testing closer to people in need of it and linking people to care, have led to significant decrease in the number of new infections and increase in treatment coverage. Civil society groups, in this case, are supported by both Presidential and municipal grants.

We should be encouraged by the integrated approach formulated both in the National strategy adopted by the Russian Federation two years ago and in recent guidelines on the prevention of HIV among key affected populations. A clear progress can be noticed in some regions of the country with regards to the partnership with civil society and service provision.

The challenge for the country is to translate what is on paper and high-profile statements into concrete policies that simultaneously sustain appropriately funded programs and engage in the structural and legislative reforms needed to remove obstacles that still impede access to prevention and care. Without such an approach, HIV infection in Russia will continue to grow faster than the efforts to fight it.

Michel Kazatchkine is the Special Advisor to the Joint United Nations Program on AIDS (UNAIDS) in Eastern Europe and Central Asia

Source: kommersant.ru

Under 16 and Above: Protecting the Rights of Adolescents and Preventing HIV

Author: Yana Kazmirenko, Ukraine

Shortage of HIV prevention programmes for young people was one of the key topics discussed at the 22nd International AIDS Conference (AIDS 2018). At the conference, AFEW-Ukraine presented its best practices in HIV response among young people. Since 2012, it has been supporting the initiatives aimed at most-at-risk adolescents within the Bridging the Gaps: Health and Rights for Key Populations project funded by the Dutch Ministry of Foreign Affairs.

Gaps analysis

Over the course of project implementation, social welfare centres for adolescents who use psychoactive substances were established in Kharkiv, Poltava, Kropyvnytskyi and Chernivtsi and a rehabilitation day care centre for such young people was opened in Chernivtsi. In 2017 only, over 12 hundred adolescents received 21,290 services in those four cities.

Olena Voskresenska, Director of AFEW-Ukraine, recalls that when the project just started, a gap analysis was conducted. It turned out that there were a lot of programmes for adults who use drugs, while few donors were supporting similar activities for adolescents. It was considered that this population does not make a considerable contribution to the HIV epidemic. Thus, both most-at-risk adolescents and generally schoolchildren and students of vocational training centres remained out of focus.

“Of all the countries involved in Bridging the Gaps project, Ukraine is unique in terms of the activities implemented for under-age drug users. We work with non-injecting drug users trying to prevent them from switching to injecting drugs,” says Olena.

Children do not use drugs

One of the main achievements of AFEW-Ukraine is developing a tool to monitor the violations of human rights of most-at-risk adolescents. Questionnaires are used to collect data on adolescents’ rights violations, providing urgent response and legal support. Iryna Nerubaieva, AFEW-Ukraine Project Manager, thinks that in the Ukrainian society there is a strong belief: children cannot use drugs and they do not use them.

“This community is invisible and unheard. Most often, adolescents do not know about their rights, do not know that they have any rights or how these rights are to be protected,” says Iryna.

Adolescents – mostly high schoolers and students of vocational training centres – are brought to the community centres by their friends. Often they are referred by social welfare institutions, departments of juvenile services and even police.

Currently, AFEW-Ukraine works in four cities of Ukraine: Kharkiv, Chernivtsi, Kropyvnytskyi and Poltava. Besides, thanks to the cooperation with Alliance for Public Health, since 2017 the activities for adolescents, including monitoring of human rights violations, have been conducted in five more cities of Ukraine.

Testing as a prevention tool

At the conference, Yevheniia Kuvshynova, Executive Director of Convictus Ukraine, implementing partner of AFEW-Ukraine and Alliance for Public Health, told about the Voice of Adolescents project, which covers 717 adolescents.

The Underage, Overlooked: Improving Access to Integrated HIV Services for Adolescents Most at Risk in Ukraine project is aimed at teenagers who use drugs and live in small towns and villages in seven regions of Ukraine. Adolescents from Kyiv attend the Street Power youth club. In this club, teenagers who use psychoactive substances and practice risky injecting and sexual behaviours can watch films, play computer games and receive social support.

According to Yevheniia, most of them use non-injecting drugs and HIV testing for them is rather a prevention tool. So far, no HIV cases have been detected. Adolescents are tested for hepatitis C and B as well as sexually transmitted infections.

For many years, Convictus has been working with adults who inject drugs providing services to 11 thousand people. Working with adolescents is different: they are tested only starting from 14 years of age, with a social worker and a doctor involved.

“One of our priorities is building a network and a map of services, so that adolescents could go to any organization of the network and receive services from our partners. If a person coming to us needs more in-depth support, we provide such support and also help him or her with clothes as we maintain a clothing bank,” tells Yevheniia.

Convictus is planning to develop a School of Leadership and a sexual health programme for girls, which are to close more gaps in the system of HIV prevention among most-at-risk adolescents in Ukraine.

Students will Attend the Annual Conference with a Discount

The annual STD x HIV x Sex Congress organized by AIDSfonds in the Beurs van Berlage in Amsterdam, the Netherlands, this year will take place on 23 November. AFEW International gladly offers students the chance to attend the Congress for 15 euros, which is a fraction of the regular ticket price. We invite you to take part in the congress if you are a student interested in issues related to HIV/AIDS and sexual and reproductive health and rights.

About 500 professionals from various institutions such as Dutch Ministry of Foreign Affairs, Amsterdam Municipal Health Service, Public Health Ministry, national and international NGOs and research institutions take part in the Congress in Amsterdam. These professionals are committed to ending AIDS and decreasing STD infections. The Congress is also a place to learn about community-based development and new research findings and technologies. Congress tickets can be bought between 11 October and 16 November online.

The student discount is made possible by AFEW International. AFEW is a network of civil society organisations working in the Eastern European and Central Asian (EECA) region. With AFEW International’s secretariat based in Amsterdam and country-offices in Kazakhstan, Kyrgzystan, Tajikistan and Ukraine, AFEW strives to promote health and increased access to prevention, treatment and care for public health concerns such as HIV, TB, viral hepatitis and sexual reproductive health and rights. At the STD x HIV x Sex Congress, AFEW is hosting an art expo and a workshop that brings students and professionals together to discuss the future of the work field.