UNAIDS developed a guidelines for people who live with HIV.
UNAIDS developed a guidelines for people who live with HIV.
People in prison have a disproportionately high rate of poor mental health, and research shows these rates are even higher for women in prison. While primary care remains the responsibility of healthcare professionals, frontline prison staff play an important role in protecting and addressing mental health needs of women in prison.
Penal Reform International (PRI), in partnership with the Prison Reform Trust (PRT), has published a guide for prison and probation staff to help them understand how prison life can affect a person’s mental health, with a focus on women. The guide aims to break down the stigma and discrimination attached to poor mental health, especially for women in prison.
This guide is written to help understand how life in prison can affect a person’s mental health, with a focus on women. It describes how to recognise the signs of poor mental health and how best to respond. It also includes a checklist based on international human rights standards aimed to help with the implementation of key aspects of prison reform and advocacy initiatives in line with international standards and norms.
Find the guidelines here – PRI-Women-in-prison-and-mental-well-being.
Leading sexual health specialists have issued specific advice for people living with HIV about the risks posed by the coronavirus — with some urging extra precaution for patients who are not virally suppressed.
Professor Sheena McCormack, a global expert in HIV and epidemiology — the study of disease spread —says that the COVID-19 outbreak “wouldn’t have much implications at all” for people with HIV who have an undetectable viral load (meaning that the virus is suppressed) and who have a good CD4 count (the chief measure of the immune system) — beyond the risk it poses for anyone else.
Anyone with HIV who is not virally suppressed, or has a low CD4 count, should consider HIV to be a “significant comorbidity” and should avoid public transport.
“Cancel any plans to travel,” she advised, including avoiding airports and any regions with particularly high concentrations of coronavirus infections. Older HIV patients are more likely to not be virally suppressed and more likely to have a low CD4 count.
The coronavirus is a “respiratory spread virus” so coughing and close contact — which allows the virus onto your hands and you then you then touch your mouth or eyes — are the main drivers of onward infection.
You are recommended to wash hands thoroughly, regularly, and to avoid putting your fingers in your mouth.
AFEW International represented by Daria Alekseeva, Program Director and Yuri de Boer, Senior Program Manager, and Ainura Batyrbekova, Project Manager of AFEW Kazakhstan concluded a scoping mission to Tashkent from 15-17 January.
At the invitation of the Ministry of Health and with the support of the Ministry of Foreign Affairs of Uzbekistan, the team met with the Republican AIDS Center and the Municipal AIDS Center of the City of Tashkent, the Country Coordinating Mechanism (CCM) on HIV/AIDS, international organizations, as well as a broad range of community based organisations, including networks of people living with HIV.
At the center of the discussion are several proposed interventions to further develop and improve the quality of HIV testing and prevention services for key populations and support to people living with HIV. The overall aims of the proposed projects is to strength the role of civil society and key populations in inclusive health care in Uzbekistan, in particularly in motivating the most difficult to reach groups to get an HIV testing, and to further strengthen the capacity of AIDS Centers and service providers. During the meetings, all parties involved acknowledged the need to keep focus particularly on key populations (people who use drugs, men who have sex with men, transgender people, and sex workers) and use the expertise of the AIDS Centers as well as the community organizations to better access these groups. Optimized ART adherence for people on treatment was also seen as a possible outcome of joint interventions.
In the coming months, project proposals will be further developed, and formal endorsement from governmental stakeholders and the CCM will be sought.
AFEW International has already supported projects for people living with HIV in Uzbekistan, and actively involved participants from the country in the AIDS2018 conference. In addition, representatives from Uzbekistan participated in AFEW International’s community based research education project.
In early May, Kazakhstan presented and discussed a new concept of providing antiretroviral treatment (ART) to people living with HIV. The concept will be implemented in 2021–2025. Of Kazakhstan’s 19,384 patients registered in HIV care in 2018, 77% are on ART. This quite high indicator gives Kazakh doctors and civil society activists hope that the UN 90/90/90 targets will be achieved in the country.
“Of course, there is a problem with adherence to treatment in Kazakhstan. Treatment regimens change not only because some patients are resistant to certain drugs and need new combinations, but because sometimes there are interruptions in the supply of certain drugs. Optimized treatment regimens and improved quality of treatment as an objective was included in the new strategy by UNICEF and the Kazakh Scientific Centre of Dermatology and Infectious Diseases. NGOs are also working towards achieving this objective. For example, reduction to just eight universal and effective treatment regimens is planned,” says Lyubov Vorontsova, project coordinator of the Central Asian Association of People Living with HIV.
Since 2017, Kazakhstan has been implementing a “test and treat” strategy. In line with WHO guidelines, antiretroviral treatment is prescribed and provided to patients on the same day they are diagnosed with HIV, without waiting for immune status or viral load indicators. Procurement of antiretroviral drugs (ARVs) is regulated and funded by the government. However, access to ART is still a crucial issue in remote areas of Kazakhstan.
“Last year we monitored adherence to treatment in different cities of Kazakhstan. We wanted to find out, firstly, why people are afraid to start therapy, and secondly, why people drop out after they start ART. The first thing we heard is that people are scared of side effects (though in this regard modern drugs are much better than older ones). People also mentioned treatment fatigue, as ART is a life-long therapy. However, there are also remote areas where people have problems with physically accessing the drugs as they live 300 kilometres away from the AIDS centre and do not always have time and money to go and pick up their medications,” says Vorontsova.
People living with HIV (PLWH) in Kazakhstan, as in many other countries of eastern Europe and central Asia, are concerned about the quality of ARVs. Kazakhstan is gradually transitioning to modern regimens which are easier to tolerate, have almost no side effects and, most importantly, are more convenient to take. The biggest challenge for both doctors and civil society activists is stigma, self-stigma and discrimination.
“We often hear stories about people who are afraid to take pills at work as someone may see them. There have been cases when colleagues saw a person taking ARVs, then checked the name of the drug on the internet and found out that this person had HIV. As a result, he or she was fired. Of course, such incidents have a negative impact on adherence to treatment,” comments Vorontsova.
There are also problems with the information pregnant women with HIV receive in antenatal clinics. Mothers-to-be agree to start taking ARVs as it is important for their babies. This approach often leads to a situation where the woman stops treatment after delivery. She saves her child, but nobody tells her that first of all she needs the therapy to take care of her own health. To avoid such cases, Kazakhstan would like to introduce peer counselling for pregnant women.
The problem of adherence is crucial in key populations – men who have sex with men, people who use drugs, and sex workers. Due to self-stigma, many do not access health services. It is often much easier for such people to receive support from a civil society organization (CSO) than to go to a government health centre. For this reason, last year many CSOs in Kazakhstan started to actively implement testing and self-testing programmes.
In order to reach as many people living with HIV as possible with quality modern treatment, the Kazakh Ministry of Health decided to procure ARVs through international agencies. It was expected that procuring drugs at minimum prices would allow coverage of patients with new ART regimens to double in the following months, and accelerate transition from older to more modern drugs. However, this spring Almaty residents faced interruptions in the supply of the vital medication dolutegravir.
The Ministry of Health of Kazakhstan and the Pharmacy Committee held negotiations about including Kazakhstan into the voluntary license, which would reduce procurement prices for generic dolutegravir from USD 118 to USD 4.5 This would enable provision of effective therapy to all PLWH in Kazakhstan. However, the patent owner said that only low-income countries can be included in the voluntary license on such terms, and left the old price for Kazakhstan.
“Dolutegravir is really a high-quality medication. It has very few side effects. As there are interruptions in the supply of this drug, patients are transferred to other treatment regimens,” says Vorontsova.
The next delivery of dolutegravir is expected in June. The Ministry of Health will then prepare documents to submit for compulsory licensing, under which generic drugs can be procured at a lower price.
Author: Inna Gavrilova, Ukraine
The rate of mother-to-child HIV transmission in the Republic of Uzbekistan is approaching the zero mark. In 2017, only 11 cases of such transmission were documented or 0.3% of all the HIV cases registered.
“Such trend has been observed for several years already,” says Evgeniya Korotkova from Ishonch va Hayot NGO, which has been advocating for the rights of women and children from the families affected by HIV/AIDS epidemic in Uzbekistan. “It gives me confidence that in the nearest two years our country will be able to get well prepared, do its best at the national level to successfully go through the procedure to validate the elimination of mother-to-child HIV transmission and to become the fourth country in Eastern Europe and Central Asia to receive an elimination validation certificate from the World Health Organization (WHO).”
According to Korotkova, WHO validation of the elimination of vertical HIV transmission is a rather lengthy and complicated process, but in the recent seven years, patients’ groups and civil society organizations were able to gain support from the government, which is also interested in healthy newborns who would get a good start in their lives. Only the joint efforts of civil society activists and government allowed fighting stigma and discrimination – which are the main obstacle on the way to 90-90-90 targets – in an effective and comprehensive way. It is not enough to just find all the people living with HIV (PLWH), the task is to convince them not to be afraid of their diagnosis and take the therapy.
“Stigma and discrimination remain serious obstacles on the way to HIV prevention, prevention of mother-to-child HIV transmission, expansion of HIV testing as well as enhanced access and adherence to HIV care and support,” said Evgeniya Korotkova. “The government committed to take over the procurement of all antiretroviral (ARV) drugs by 2021 to make sure all people who need treatment have access to it. At the same time, it is important for PLWH to be willing to take ARV drugs and adhere to treatment, despite stigma and discrimination, which is still present today in health institutions and in the society as a whole. We help our doctors and actively work with PLWH to ensure their adherence to ART.”
It bears reminding that the WHO officially validated the elimination of mother-to-child HIV transmission in three countries of Eastern Europe and Central Asia: Belarus, Armenia and Moldova.
There are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV. Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing policies among female sex workers in Ukraine and how these policies are understood and implemented in practice.
To analyse past and current national policies, we searched the database of the Ukrainian Parliament and the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy context, actors involved in policy formulation and implementation.
HIV testing policies are formed and implemented in the post-Soviet context through a vertical system of AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive testing policies have been strongly influenced by international donors and non-governmental organisations. Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a barrier among FSWs to access testing.
Poor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking international funding, and persisting stigma towards people living with HIV and sex workers might impede the continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute to the development and further implementation of HIV testing policies in Ukraine.
Read the full version of the research here.
Author: Oksana Maklakova, Russia
The government of the Russian Federation is planning to increase the country’s population by 5-10 million people, by attracting migrants from Ukraine, Kazakhstan, Uzbekistan and Moldova. This is what Russian policy-makers say. However, Russia is the only country in the Council of Europe which still deports foreign citizens living with HIV. Anastasia Pokrovskaya, senior research associate of the Federal AIDS Centre, says that introducing amendments to the relevant regulations could protect the health of many people and contribute to their decriminalization. As part of the Partnership Program, she was involved in drafting an expert report for a project to ensure migrant access to HIV treatment and abolish the provision on deportation of foreigners living with HIV who enter the Russian Federation.
– How many migrants come to Russia and what is the rate of HIV prevalence among them?
– According to the Ministry of Internal Affairs, in 2018 Russia issued 1,671,706 labour patents to migrants. Those are people who enter the country legally and are officially registered with the relevant authorities. To get a labour patent or a permit to stay in the country for a period exceeding three months, medical examinations, including HIV testing, are mandatory. HIV prevalence is about 100 cases per 100,000 people tested. However, this number does not reflect the real HIV prevalence as some migrants, anticipating possible test results, avoid health check-ups. They come to the country illegally, get short-term visas without getting any patents, buy fake health certificates or send another person to be tested in their place. This law on deportation of foreigners with HIV creates many opportunities for illegal activity, both among migrants and among Russian organizations which offer migrants illegal services to help them get round the law.
– Is this typical only for Russia? What’s the situation in other countries?
– Initially about 60 countries applied the rule: if you fall ill or cross the border with HIV, you have to leave the country. However, there are now only nine countries, including Russia, where such regulations still exist. Other countries, such as the United States, Armenia and Ukraine, abolished such legislation in the last 5-10 years.
– What is the goal of your project?
– Our goal is to show why this approach should be changed in the first place; to demonstrate the demographic and epidemiological premises for abolishing deportation provisions. We have developed a document providing medical and legal justifications why we need to amend the legislation. We state that this provision should be repealed because it does not bring any benefits. Firstly, it is clear that it will not help us to end the HIV epidemic. In terms of new HIV cases we are ahead of many neighbouring countries from which migrants come to Russia. Secondly, in reality this law does not work anyway. People stay in the country, but go underground and continue living in the ‘grey zone’. As a result, they remain sick and infect others while their disease progresses, as they have no access to treatment. Meanwhile, they cannot go back to their home countries to get treatment because they are afraid they will not be able to return.
– What is the current response to such challenges?
– There are some NGOs which help deliver services to such people. According to the law, we are not able to ensure comprehensive medical check-ups or provide relevant health assistance to migrants. The biggest challenge is that we are not able to provide them with antiretroviral therapy (ART). This is the biggest issue. Russian citizens can access ART free of charge. However, our government is not ready to allocate funding to treat foreigners, for obvious reasons.
– So there are economic reasons for not abolishing the regulations?
– Probably. There are concerns about financial and administrative consequences. International agreements should be signed between governments. It is difficult for us to use the experience of other countries in addressing the issues of HIV and migrants, as the Global Fund to Fight AIDS, Tuberculosis and Malaria and other international charities which could take over some functions in this regard do not operate in Russia. Even if the country abolishes the regulation on deportation of foreigners living with HIV and such people get the right to stay in our country legally, they could still receive ART at home. All AIDS centres in neighbouring countries accept migrants who are registered for HIV care, and provide them with ART medications for several months. However, to get registered for HIV care, people have to leave Russia and then come back, which is currently not possible due to the travel ban on foreigners living with HIV. Thus, we will have to find our own solutions to this situation. There are some options currently being discussed, but it needs time. The final decision should be made by policy-makers, but unless they are informed about this issue they will not resolve it. We have to speak about it and suggest possible solutions. Only then could the laws be revised. I am sure that in our society there will be people who oppose such amendments, as they think migrants are bad for our country. However, those people often forget that migrants are a unique labour resource and in a way a demographic resource which modern Russia really needs.
AFEW International’s program manager Daria Alexeeva recently took part in the unofficial lunch with the mayor of the Dutch city Assen (Drenthe province) Marco Out and also public debates. Daria had an opportunity to talk to the Dutch audience about public health issues in Eastern Europe and Central Asia (EECA).
The Dutch title of the events was Europa’s Rafelende Randen which translates into English as Europe’s Fraying Edges. The idea behind the events is to inform people in Assen and Drenthe about international developments through the eyes of female human and social rights activists. Daria Alexeeva was talking mainly about the situation with HIV/AIDS, sex workers and trafficking in the EECA region.
“It is important for the Dutch public to know what challenges Eastern Europe and Central Asia are facing in the sphere of public health,” says Daria. “The programs that we are implemented in EECA are being financed via the money of the Dutch taxpayers. Thus, it is important to realize that their money is targeted towards something as important as fighting HIV and AIDS in the EECA region. Besides, this region is bordering Western Europe, and good neighbours always help each other.”
Besides the public health topics, the guests of the meeting – female activists from Russia, Poland and Lithuania – were talking also about Chechnya and the work of the Memorial organisation, developments in Poland and Ukraine and LGBTI in the Baltic countries.