We do our best to provide services

Ivan Anoshkin, coordinator of the street social work of NGO “Project April” (Tolyatti, Russia) talks about harm reduction activities of his organization at COVID-19 time.

For reference:

“Project April’ works in harm reduction. The main key groups are people who inject drugs and sex workers, but with changes on the drug scene and the emergence of different stimulants and salts, the organization got new client groups, particularly people practicing Chemsex. The organization employs 18 people and also has a large number of volunteers. “Project April” is recognized in Russia as a foreign agent.

Difficulties caused by COVID-19

Before the spread of the COVID-19 and the lockdown related to it, we used to receive our clients at our office every weekday. Anyone could come to get a consultation, HIV test or a harm reduction kit. We have always tried to provide the conditions for talking with our clients in a warm, comfortable atmosphere. Once the self-isolation regime was first introduced in Tolyatti in March, we had to completely close our office. However, seeing that after a few weeks it became clear that this regime could be extended over and over again, we decided that as a social organization, we cannot interrupt our activities indefinitely. Since then, one of the employees is in the office every working day to insure the provision of our regular services “on the spot”. Yet evidently, it is no longer possible for us to invite our clients to chat with them over a cup of tea, for the sake of their and our safety. Therefore, we are trying to provide our services at entrance.

Our work is largely focused on outreach and street work and in the current situation, this has had to be significantly reduced as well. For example, our employee went to a gay club every week where she developed trust relations with its visitors and maintained contacts with the community. With everything closed, this channel of communication is lost and this could negatively affect our current and potential clients. Finally, another significant obstacle that limits our activities during the crisis is a fear to cause more troubles to our clients by attracting unnecessary police attention to them.

Innovations

Under these circumstances, we have partially switched our activities to online. We are holding our work meetings on Skype. The visits we would do to rehabilitation centres every 1-2 months, we have also temporarily transferred to online. We agreed with administration of these centers to pre-deliver them brochures and HIV self-tests, and to organise our seminar via Skype afterwards. This way, patients have an opportunity to get tested and to get immediate information and support, even in these dark times.

What is more, to our clients we started to send and deliver harm reduction kits, HIV self–tests, and, if necessary, packages with basic products and goods. Basically, we already know places where our clients continue to gather. So we deliver our kits and packages there directly, based on their precise needs. For our employees, volunteers and active participants who continue to work, we purchase masks, gloves and disinfectants.

In times of crisis like this, our clients have more demand for social and psychological support as well. For this purpose, we have a service taxi that allows our employees to come to clients to provide social assistance and products of first necessity. And if necessary, we also deliver ARV therapy to clients, with their written agreement.

Certainly, due to the self-isolation regime and the hostile atmosphere in general, the number of new clients decreases, but not as significantly as we had feared. When you have already been working with harm reduction for this many years, the members of community know you. And we should also not underestimate the power of the word of mouth, that stays efficient at all times. Even now, newcomers visit our office at the recommendation of our clients.

What’s next?

This crisis has shown us how important it is to keep in touch with our clients not only live, but online as well. This way we stay in permanent contact. Hence, in the future we are hoping to have a possibility to hire a person whose work will be devoted only to managing social media and maintaining contact with our client through messengers on a regular basis.

We also really hope to offer some financial compensation to our employees, who continue to “work in the field” at their own peril and risk, especially as some of them – as I do – have a fairly low CD4 level.

Safety measures for sex workers

Enji Shagieva, Secretary of the Russian Sex Workers’ Forum, about the Forum’s activities at COVID-19 time. 

For reference:

The Russian Sex Workers’ Forum (SW Forum) is an association which includes people with experience of sex work, active sex workers, their partners, assistants and allies. The SW Forum is a platform for constructive communication between sex workers to discuss and develop common strategies to protect health and well-being of sex workers; to provide access to evidence-based HIV/STI prevention programs; to combat violence against sex workers by clients, police and third parties; to change public opinion about sex workers and sex work for the better by the state and society (destigmatization); to waive fines for sex work; to ensure sex workers’ full access to justice; and to strengthen and develop the sex worker community and mobilize sex workers and their supporters to join forces in the above directions.

Difficulties caused by the virus

Russia has always been a difficult country for SWs, transpeople and migrants, and due to the consequences of COVID-19 the situation got even worst.

As demand for sex services has fallen sharply and the risks of COVID-19 infection have increased, some sex workers have stopped working. It is no longer easy to reach this key group since sex workers are less likely to work on the street and more likely to stay in rooms that are not accessible. Many sex workers are losing contact. Some sex workers continue to provide sex services and put themselves at risk of infection. In addition, they are at increased risk of becoming victims of crime or falling prey to police raids, and thus falling prey to police brutality. Due to the epidemic, crimes against sex workers – robbery, theft, beating, fraud, threats, blackmail, extortion – have multiplied.

Due to the quarantine, some sex workers cannot return to their homes and some are left without means of subsistence and housing. It is especially difficult for migrants to return to their homes. They have to live in one small apartment for several people, which multiplies the risk of infection with coronavirus.

Organizations working with SWs have cancelled outreach visits to places where SWs still continue their activities, at their own risk. HIV testing and the distribution of condoms have been stopped. Sex workers still need condoms, as well as protective masks, antiseptics and wet wipes, and some need food and financial means.

There are also certain problems that sex workers’ clients may also be carriers of coronavirus and break quarantine, putting sex workers at risk of infection.

Due to quarantine, HIV positive sex workers have no access to ARV therapy. Due to lack of money, inability to pay rent, hormone treatment, condoms and lubricants, someone went to work online, on webcams. But it is also difficult there, because high income requires a large number of online customers. Beginners don’t have them. And because of the influx of new people, those who have long been earning on the webcam, began to earn less.

Innovations

Because of the Coronavirus pandemic, there has been an increased emphasis in the community on prevention education and protection against coronavirus. Through social networks, special groups, personal profiles, chat rooms and groups of various messengers, the forum informs SWs about what measures to take to minimize the risks of infection, both during everydayl life and during the provision of sex services. We have sent out several special documents with visual content to prevent coronavirus infection. In addition, volunteers and employees of some projects cooperating with the SW Forum purchased personal protective equipment (masks and antiseptics) and distributed it to sex workers using their own funds. Information was also distributed among sex workers on how to quickly make their own protective masks and antiseptics.

We are constantly working with the media, organising interviews with sex workers about the problems associated with the pandemic, how they comply with safety measures and what safety measures clients require.

A lawyer of the SW Forum has developed a memo on receiving social benefits from the government for families with children and the unemployed. Sex workers are encouraged to apply for social benefits if they fall into the privileged category of citizens.

We keep SWs informed about the pandemic news, new risks, prevention measures and risks of administrative penalties. At the request of one SW from St. Petersburg, the info manager of the SW Forum informed the special services that a citizen who violated the quarantine applied for services. Thus, the SW Forum helps sex workers to demonstrate their active position and combat the spread of coronavirus.

Today, the SW Forum is attempting to obtain operational funding to provide financial assistance to those SW who are particularly affected by the Coronavirus, as well as food packages or temporary accommodation.

 

 

 

The ViiV Healthcare Global HIV and COVID-19 Emergency Response Fund

ViiV Healthcare announced £3 million global fund to research the impact of COVID-19 on the HIV community and fill gaps in prevention, treatment and care during the pandemic.

ViiV Healthcare announced the creation of the Global HIV and COVID-19 Emergency Response Fund. The £3 million fund will make available critical financial resources for research projects to study the medical and scientific impact COVID-19 is having on people living with HIV and community-based grants to help address specific challenges to the HIV community created by the global pandemic.

The ViiV Healthcare Global HIV and COVID-19 Emergency Response Fund will be divided equally between two programmes and grants will be available through a request for proposal (RFP) process. The Research Emergency Response Fund will make available up to £1.5 million to support scientific research about the impact of COVID-19 on people living with HIV. The Community Emergency Response Fund will make available up to £1.5 million to support community-based activities that address the specific challenges faced by people living with HIV during this pandemic.

Research Emergency Response Fund
To help improve the understanding and management of the COVID-19 pandemic in people living with HIV, ViiV Healthcare is inviting research proposals within three priority areas of interest that include epidemiology and real-world data, healthcare systems management initiatives in COVID-19 environments, and biomarkers indicative of disease susceptibility, severity, and progression.

Successful proposals will be awarded grants from the £1.5 million Research Emergency Response Fund to undertake independent research through ViiV Healthcare’s existing Investigator Sponsored Studies (ISS) programme.  Requests for proposals will be open from 27 April through 18 May. The proposals will be reviewed by an internal ViiV Healthcare scientific panel and successful applicants notified by 5 June.

Community Emergency Response Fund
ViiV Healthcare will seek applications from community organisations to support their work in addressing the specific challenges that have arisen for people living with HIV or affected by HIV as a result of the COVID-19 pandemic. Through the £1.5 million Community Emergency Response Fund, grants will be made available to support ongoing access to critical HIV prevention, care and outreach services, differentiated models of service delivery, short term payments for critical community staff, and community monitoring and feedback on the impact of COVID-19 to HIV services and support.  The Community Emergency Fund is not intended for the purchase of pharmaceutical products.

The Community Emergency Response Fund will support existing grantees of ViiV Healthcare’s Positive Action or Government Affairs (GA) or Global Public Health (GPH). Requests for proposals will be open from 27 April through 15 May. The proposals will be reviewed by an internal ViiV Healthcare panel and successful applicants notified by 25 May.

More information here.

EECA’s reponse to COVID-19

Alexander Chebin, project coordinator at the Regional Public Foundation “New Life”, Yekaterinburg, Russia.

For reference

“New Life” Foundation has been working in Yekaterinburg in the field of AIDS prevention and control, assistance to different categories of population since 2011. The key groups are (ex) prisoners, migrants, drug users, sex workers, people affected by HIV, tuberculosis, hepatitis.

Difficulties due to the virus

Currently, we have suspended our activities on fast HIV and hepatitis outreach testing, activities in rehabilitation centers, penal inspections, police departments, federal enforcement agency system and other organizations.

Since the introduction of the country’s self-isolation regime, representatives of our key groups have found themselves in new realities – for example, their level of anxiety has significantly increased, including with regard to treatment and care. Also we have received many requests for psychological support. Due to changing economic circumstances, people have developed a lot of fears – they are afraid of losing their jobs and uncertainty in the future. We have already analyzed our work during 2 weeks of self-isolation. The number of requests through the means of communication increased several times. Our employees conduct consultations, provide psychological support and accompany participants “by phone”, through various messengers. This is especially important for people released from prisons, who do not have the skills to apply to government agencies using Internet resources.

Innovations

Fortunately, in a pandemic, our work does not stop. However, due to the virus and quarantine measures, we had to go online and interact with our participants remotely, through communications channels.

Due to the new rules of patient’s admission, the management of the AIDS Centre decided to involve volunteers to help in the delivery of life-saving antiretroviral therapy. Thus, since March 30, our employees have been actively involved in this process. Our two staff members take calls and consult people on how to register delivery. With the help of the Foundation’s car with a driver health workers are delivered to clients. Also, 3 employees and 1 “New Life”s volunteer drive their cars to deliver ARV therapy.

In addition, the Foundation does not stop providing legal and social assistance to people, doing it remotely. Also, we accompany people released from prison to medical organizations, help to deliver food packages, clothes. In case of emergency, one of our employees collects the kits for participants at our drop-in centre and delivers them to their homes with all necessary security measures.

In the future, we plan to go back to the way we used to work, assess and reflect on our experience in the pandemic and perhaps make adjustments to some aspects of our work.

 

EACS & BHIVA Statement on risk of COVID-19 for people living with HIV

COVID-19 & HIV

So far there is no evidence for a higher COVID-19 infection rate or different disease course in people living with HIV (PLWH) than in HIV-negative people.

Current evidence indicates that the risk of severe illness increases with age, male sex and with certain chronic medical problems such as cardiovascular disease, chronic lung disease and diabetes. Although people living with HIV who are on treatment with a normal CD4 T-cell count and suppressed viral load may not be at an increased risk of serious illness, many people living with HIV have other conditions that increase their risk.

Indeed, almost half of people living with HIV in Europe are older than 50 years and chronic medical problems, such as cardiovascular and chronic lung disease, are more common in people living with HIV. It has to be assumed that immune suppression, indicated by a low CD4 T-cell count (<200/µl), or not receiving antiretroviral treatment, will also be associated with an increased risk for a more severe disease presentation. For patients with low CD4-counts (<200/ml), or who experience a CD4-decline during a COVID-19 infection, remember to initiate opportunistic infection (OI) prophylaxis. More information regarding recommendations for prophylaxis and treatment of specific opportunistic infections can be found in the BHIVA and EACS guidelines for the treatment of HIV/AIDS. Smoking is a risk factor for respiratory infections; smoking cessation should therefore be encouraged for all patients. Influenza and pneumococcal vaccinations should be kept up to date.

First reports from China suggest a growing evidence for potential COVID-19 vertical transmission [1]. So far clinical outcome of the newborn however, has been very good. Existing national guidelines should be followed in terms of reducing risk and managing symptoms; examples are listed below [2-4].

COVID-19 treatment: antiretrovirals & further options

Expedited research and publication are welcomed with the caveat that results may be disseminated pre-publication and/or published without usual peer review. There is ongoing discussion and research around some HIV antiretrovirals which may have some activity against COVID-19. The first randomised clinical trial with lopinavir/ritonavir demonstrated no benefit over standard care in 199 hospitalised adults with severe COVID-19 [5]. There is no evidence to support the use of other antiretrovirals, including protease inhibitors; indeed, structural analysis demonstrates no darunavir binding to COVID-19 protease. A recent case series on hydrochloroquine, with or without azithromycin, was not able to demonstrate a clear clinical benefit, despite in vitro inhibition of SARS-CoV-2, due to methodological issues [6]; although the same group has postulated an infection control benefit of more rapid viral clearance there was a lack of control arm for comparison [7]. One small RCT demonstrated trends for reduced time to clinical recovery and short-term radiological improvement for hydroxychloroquine [8], though another showed no benefit in terms of viral clearance, clinical or radiological endpoints [9]. Despite lack of evidence, indeed no acute viral infection has ever been successfully treated with either product [10], the FDA has issued an Emergency Use Authorisation to allow hydroxychloroquine and chloroquine products to be used for certain hospitalised patients with COVID-19 [11] while awaiting results from randomised trials. A further potential drug candidate for treatment of COVID19 is remdesivir which was originally developed for Ebola therapy. Remdesivir has broad in vitro antiviral activity against SARS-CoV-2 [12]. First cases where COVID19 patients were treated with remdesivir suggest potential clinical benefit. The results from ongoing clinical trials are eagerly awaited.

Currently no evidence is available to justify switching a patient from their usual antiretroviral therapy. Additionally there is no evidence to support HIV-negative people taking antiretrovirals outside the context of pre-exposure prophylaxis (PrEP) to prevent HIV acquisition – PrEP should be taken as directed and there is no current evidence that PrEP is effective against COVID-19.

COVID-19 data collection & resources

A COVID-19 drug interactions website (www.covid19-druginteractions.org) has been developed for the experimental drugs being trialed to treat COVID-19 in different parts of the world. EACS and BHIVA are happy to announce that they have agreed to financially support this very useful website.

We would like to highlight two resources for reporting COVID-19 cases:

  • The NEAT ID Foundation has developed a ‘data dashboard’ to monitor COVID-19 case numbers, hospitalisations and mortality in people living with HIV at European and country level. The data will be available for public viewing via ww.NEAT-ID.org and if your centre has not signed up, you can do so via this link.
  • The Lean European Open Survey on SARS-CoV-2 Infected Patients (LEOSS) launched by the German Society for Infectious Diseases (DGI) and ESCMID’s Emerging Infections Task Force (EITaF) an open register based on anonymous questionnaires and they are keen to collaborate with other registries. See https://leoss.net, contact them by email at info@leoss.net and the register can be accessed here https://leoss.net/statistics

The coronavirus outbreak is rapidly evolving. EACS and BHIVA will continue to share any updates to specific guidance for people living with HIV. Wishing you all well. Stay healthy.

 

References

  1. Zeng L, et al. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatr 2020; DOI: 10.1001/jamapediatrics.2020.0878.
  2. www.rki.de
  3. https://www.cdc.gov/coronavirus/2019-ncov/index.html
  4. https://www.gov.uk/government/collections/wuhan-novel-coronavirus
  5. Cao B, Wang Y, Wen D et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med 2020; doi: 10.1056/NEJMoa2001282.
  6. Gautret P et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study. Int J Antimicrob Agents. 2020 Mar 20:105949. doi:10.1016/j.ijantimicag.2020.105949.
  7. https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf; accessed 31st March 2020
  8. Chen Z, Hu J, Zhang Z et al. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. medRxiv 2020.03.22.20040758; doi: https://doi.org/10.1101/2020.03.22.20040758
  9. Chen J, Liu D, Li L et al. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). J Zhejiang Univ. 2020; Mar. (DOI 10.3785/j.issn. 1008-9292.2020.03.03
  10. Guastalegname M, Vallone A. Could chloroquine /hydroxychloroquine be harmful in Coronavirus Disease 2019 (COVID-19) treatment? Clin Infect Dis. 2020 Mar 24. pii: ciaa321. doi: 10.1093/cid/ciaa321.
  11. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-daily-roundup-march-30-2020; accessed 21st March 2020
12. Wang M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020 Mar;30(3):269-271

 

Voices from the East

AFEW International is actively advocating for the needs to sexual and reproductive health and rights (SRHR) of the EECA region at the international arena.

On 11th March AFEW International on behalf of the partnership ‘Voices from the East’ has submitted a proposal to the Dutch Ministry of Foreign Affairs under the Policy Framework for Strengthening Civil Society for 2021-2025, Grant Instrument SRHR Partnership Fund. Under the leadership of AFEW International, the Voices from the East Partnership brought together 11 strong advocacy and service-oriented organisations and networks to improve access to SRHR for women and youth of Key Population (KP) groups and transgender people:

AFEW International; Eurasian Harm Reduction Association (EHRA); ECOM – Eurasian Coalition On Health, Rights, Gender And Sexual Diversity; Eurasian Union Of Adolescents And Youth Teenergizer; Eurasian Women’s Network On Aids (EWNA); Sex Workers Rights’ Advocacy Network (SWAN); Eurasian Network Of People Who Use Drugs (ENPUD); Dance4life; AFEW-Ukraine; AFEW-Kyrgyzstan; AFEW Kazakhstan.

The partnership plans to work with over 150 local partner organizations from across Easter Europe and Central Asia, advocating for SRHR of women and young people from key populations (living with HIV, sex workers, using drugs, LGBT, in prison) and transgender people as integral part of the Universal Health Coverage (UHC). Through capacity strengthening and mobilizing local communities of key populations the Partnership will work towards evidence-based community-led advocacy for access to high quality, inclusive, stigma-free, integrated and gender transformative SRHR services.

We will know the results of this application in the end of May 2020.

The Dutch Government Policy Framework for Strengthening Civil Society is focused on the West-Africa/Sahel, Horn of Africa, and Middle East and North Africa (MENA) regions. The Voices from the East Partnership is asking for attention to the continued health crisis in the EECA region, being the only region in the world with a growing AIDS epidemic.

Women in prison: mental health and well-being – a guide for prison staff

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.

Published with the support of Better Community Business Network (BCBN) and the Eleanor Rathbone Charitable Trust.

Find the guidelines here – PRI-Women-in-prison-and-mental-well-being.

How to help migrants?

According to UNAIDS (www.unaids.org)[1], Russia has the second highest number of labour migrants in the world after the USA. Rostov region is one of the areas where this number is constantly growing. One of the reasons is its geographical position – Rostov region has the biggest borderline with Ukraine. Due to this fact as well as certain developments related to the armed conflict in Donetsk and Lugansk regions, many migrants from Ukraine with different statuses are coming to Rostov region, in addition to the labour migrants from Central Asia.

Are there any special services for migrants in Rostov-on-Don? How is HIV prevention implemented among migrants? Where can migrants seek help without endangering themselves? AFEW International asked these questions to Vyacheslav Tsunik, President of Rostov-on-Don Regional NGO “KOVCHEG – AntiAIDS” and Manager of the Project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”.

Significant financial support to carry out surveys and provide services to migrants within this project was provided by AFEW International, which, in particular, facilitated coordination with the Central Asian organisations to provide effective support to migrants when they leave their countries of origin and come to Russia.

For reference

Labour migrants are one of the populations most vulnerable to HIV in the world, which is explained by a number of factors. The data of numerous studies show that people coming from the Central Asia have a very low knowledge of infectious diseases: HIV/AIDS, hepatitis B and C. The situation is further aggravated with the low social and economic status of the migrants from Central Asia and the neighbouring countries, lack of access to health services, low level of social support and high prevalence of depression caused by such people living away from their families. High isolation of this social group often leads to HIV transmission inside this community, in particular through contacts with female sex workers, who come from the same countries.

Vyacheslav, how accessible is health care for the labour migrants in Rostov-on-Don?

Health care is provided to the labour migrants who officially live in Russia, in particular in Rostov region, based on their insurance certificates, which they buy when registering their patents. Without certificates, people can access health care on a paid basis, while emergency care if a person’s life is under threat in cases of heart attacks, strokes, catastrophes or accidents is provided to everyone, even with no documents, free of charge and is covered by the state.

How well informed are labour migrants about the problem of HIV?

Surveys among the labour migrants showed that they are not well informed about HIV. In our opinion, the reason is lack of preventive information provided to them in educational institutions in their home countries and when they come to work in Russia.

Do migrants practice any risky behaviours?

In fact, the prevalence of risky behaviours among migrants is approximately the same as among all young people. If we talk about the migrants who come from Asia, e.g. from Tajikistan and Uzbekistan, they have less risky behaviour due to their national customs and traditions. They mostly socialize with their fellow countrymen and they also have respect to older people and certain traditions, which restrict their risky behaviours. As for people from Ukraine and Moldova, they are closer to us, Russians, in terms of their culture and so the situation among them is similar to ours. There are young people who practice high-risk behaviour in terms of HIV. Mainly, they represent key populations. Their share in the total number of migrants is not so big, but they exist and some of them are clients of our organisation. They are not ready to quit their behaviour models.

Are there any differences in the behaviours of HIV-positive and HIV-negative migrants?

There is really a difference in the behaviours of migrants with HIV and those who do not have HIV.

Migrants living with HIV are a closed group. They are not ready to talk about their disease with their family members or their countrymen. Usually, they seek help in HIV organisations only in life-threatening situations or sometimes when they need to stock up their ARVs if there is a danger of treatment interruption.

In Russia, if migrants test positive for HIV, they cannot access free antiretroviral (ARV) therapy as they are foreign citizens. How is this issue resolved?

The situation with supply of ARVs is regulated by relevant provisions. In Russia, government covers ARV therapy only for the citizens. That is why migrants are not able to access free treatment as they are not Russian citizens. However, our organisation has contacts with community organisations in a number of neighbouring countries. We can help people who come to us and assist them is getting support services and ARVs from the countries of their origin.

Currently you are implementing the project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”. Please tell us more about it.

The goal of our project is to slow down the transmission of HIV through raising the awareness of HIV among migrants and creating services aimed at HIV prevention in migrant populations.

What do we do? Firstly, we train peer consultants from among migrants. Secondly, we provide medical and social support to HIV-positive migrants, giving them access to health services. Thirdly, we have meetings and negotiations with the representatives of diasporas concerning implementation of the prevention tools among migrants in Rostov region and coordinate service provision with the NGOs in the countries of origin of those people who seek our help.

Our organisation, “KOVCHEG – AntiAIDS”, is a community-based organisation of people living with HIV, representatives of vulnerable populations, PLWH, sex workers, LGBT and migrants. For instance, with our current project we trained a peer consultant from the migrant community. This is a woman from Ukraine living with HIV. Another peer consultant that we have, who works with people who use drugs, is also a citizen of Ukraine. Besides, when we carried out a survey among migrants, we had a volunteer supporting us – Ravshan from Uzbekistan – who is a student of a university in Rostov region.

Within the project for migrants, we organized the process to deliver HIV services. In particular, we have rapid testing, pre- and post-test counselling, if necessary provision of ARVs from our reserve stock, medical assays and support in receiving consultations from infectious disease doctors, tests for immune status and viral load, prescription of medications and treatment monitoring. We also inform migrants about the existing legal opportunities to acquire Russian citizenship with HIV status and facilitate people with HIV in obtaining temporary residence permits and Russian citizenship.

How and where do you share information about the services available?

Migrants can access our informational leaflets in the places, which they visit, such as the migration departments, health institutions, which issue the required health certificates to them, pre-deportation detention centres, and higher educational institutions we cooperate with. We use QR codes, allowing migrants to download any information on their smartphones and use it when necessary. As a result, it brings clients to our consultants, who can provide them with any additional information needed.

Name one of your most important recent activities?

Recently, we appealed to the Public Monitoring Commission and asked it to help us access the migrants in pre-deportation detention centres. The Public Monitoring Commission sent an official request to the Ministry of Internal Affairs. We visited the detention centres, met with the migrants living with HIV who stayed there and agreed with the administration of such centres that we would have further access to such migrants living with HIV. We are planning to seek financial opportunities for people living with HIV to receive consultations from infectious disease doctors, get tested for their immune status and viral load and access ARVs for the period of their stay in such institutions. Besides, we are working on developing an appeal to the government officials about the need to provide this category of people with HIV treatment at the expense of the state.

[1]Migrant populations and HIV/AIDS: the development and implementation of programmes: theory, methodology and practice / UNAIDS, UNESCO.

What should be a Primary Care?

In 2019 Anke van Dam, executive director of AFEW International, became a member of advisory board of European Forum for Primary Care (EFPC) to bring knowledge and vast expertise about the EECA region and a great network of contacts with organizations, institutes, agencies and professionals to the EFPC.

Which level does primary care (PC) in the EECA region have nowadays and how to improve that Prof. Jan De Maeseneer, Former Chair of European European Forum for Primary Care, professor emeritus at Ghent University, talked to AFEW International.

Jan, what are the features of a strong primary care (PC)?

We can speak of a strong primary care system when primary care is accessible for a large range of problems, coordinates care on a continuous basis, provides a broad range of health care services in partnership with informal care givers and operates with supportive governance structures, with appropriate financial resources and investments in the development of the primary care workforce. Effective primary care not only prevents diseases at early stages, but also stimulates people to take up healthier life-styles. Overall health is considered within primary care in a more holistic matter, paying attention not only to biomedical and mental health needs, but also to other causes of ill health, such as social determinants (e.g. housing conditions, employment). This makes primary care more person- centred than disease-centred.

PC of which country/region is the most developed nowadays?

Mostly it’s Europe. The countries with relatively strong primary care are Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, some regions in Spain and Belgium, and the United Kingdom. Especially I like the examples of Denmark, Estonia, and Finland. These countries have «primary care zones». They look at the population 100-200 000 people and try to install a PC system at that level. That enables give a high degree of participation of all stakeholders. At that scale cooperation is easy, and there is an oversight of population’s health needs, to be addressed. The scale is not too big but big enough to have a “critical mass” for effective intervention for different kinds of problems.

And what about the EECA region?

A good primary care needs democracy. Unfortunately, the former “Semashko” Soviet Union healthcare system (HCS) with policlinics, lacking family physicians, and with doctors that earn very little money don’t allow to set up a good PC. I appreciate the development of Kazakhstan – recently they rediscovered the importance of family physicians. Also, I was very surprised by Kyrgiz Republic. Last year I had the opportunity to lecture for 5th year medical students in Bishkek. In discussion on patients’ stories, they demonstrated a high commitment and patient-centeredness, and excellent skills in clinical decision making. EFPC is trying now to help countries in the EECA region to establish better inter-professional training for primary care, using primary care practices in local communities

It’s important for countries in the region to work together and to build their own PC systems. In Eastern Europe Estonia and Lithuania are doing well. Belarus is not the best example, because of the political situation. It is difficult to combine strong primary care with political dictatorship. In Russia I see some nice things. In Saint Petersburg, for example, there are good departments of family medicine with person-centered approach. But it’s still a difficult country. Good PC is possible only in countries with freedom of speech, human rights, democracy and respect for diversity.

Why good PC is especially important for people living with HIV?

Usually in countries of the EECA region if a person has one of 3 diseases – HIV, TB or Hep, most of the health care resources focus on them. There is no general comprehensive, integrated Primary Care.

PC functions very well when you integrate the care and treatment for those diseases in the broader primary health care system (HCS) as World Health Assembly has clearly stated in resolution 62.12 (in 2009). In Africa I met people who had, for example, 5 diseases, so they had 5 different vertical programs of treatment and 5 different doctors who even didn’t speak with each other. Wise HCS is when you integrate these 5 approaches into one, because, for example, diabetes can be easily an (indirect) consequence of HIV treatment.

Is there a difference between European and the EECA region’s approaches in treatment of HIV+ people?

In western countries HIV/AIDS patients are patients like all the others, they are treated in PC. When primary care providers have problems, they refer patients to the secondary care. Such approach also avoids stigmatizing of people, because when they are treated differently, are included in a separate program, there is a huge risk of stigma. Also, the integrated approach is more cost effective.

How to change people’s minds, also doctors’, towards people with HIV?

Well, first of all, you need to retrain family physicians and other primary care providers. In Russia doctors have limited, if any, training in patient-doctor communication, are not familiar with a human rights approach. For example, in the undergraduate training in my university (Ghent University), there are 55 hours of practicing doctor-patient communications with videotaping, simulated and real patients. Also, it’s necessary to train a sufficient number of family physicians for Primary Care: this requires 3 years of full-time post-graduate training, with specific programs and standards. Besides, it’s important to inform and educate population.

People should understand that every person deserves our respect, and we shouldn’t stigmatize others because they have certain diseases. It’s an open culture in a country, and it is a responsibility of the government and civil society.

What is the goal of EFPC in the region?

EFPC has several goals everywhere, including the EECA region. They are:

– to provide a one-stop information hub and building a substantial collection of information and data over time;

– to guide the development of innovative interventions based on the principles of equity, access, quality, person- and people centeredness, cost-effectiveness, innovation and sustainability.

– to connect four groups of interested parties: patients, citizens and civil society organizations.

– to share communication and information;

– to establish networking and training.

Today we have a good contact with countries from the region, people join our meetings. On the 27 September 2020, we will have a big conference in Ljubljana and in the future possibly also a conference in Central Asia. We want to create a regional platform for exchanging experiences. We hope to bring together health care providers and governments so they can learn from each other how to organize service that reflects people needs.

 

 

 

 

AFEW International and ICAP at Columbia University to improve HIV services in prisons in Kyrgyzstan and Tajikistan

In 2020, AFEW and ICAP at Columbia University will partner to implement «Technical Assistance to Central Asian National HIV Programs to Achieve and Sustain HIV Epidemic Control under the President’s Emergency Plan for AIDS Relief (PEPFAR)» in Kyrgyzstan and Tajikistan, a project funded by PEPFAR through the US Centers for Disease Control and Prevention (CDC). In Kyrgyzstan the project will be implemented by AFEW Kyrgyzstan; in Tajikistan, by NGO SPIN Plus with technical support of AFEW Kazakhstan.

With this project, the partners will strive to reach two important goals:

1) improving the 90-90-90 targets for people who inject drugs (PWID) and people living with HIV (PLHIV) in prisons in Kyrgyzstan and Tajikistan, using new technologies and services;

2) facilitating and improving collaboration between general public health care facilities and health care services within the penitentiary system, ensuring continuity of HIV-related services to people being released from prisons.

AFEW International will be the lead agency working with its in-country AFEW partners and local partners to implement this project in Kyrgyzstan and Tajikistan,” said Daria Alekseeva, Program Director of AFEW International. “We have a proven track record and evidence that working as a regional EECA network has encouraged the exchange of context-specific approaches that help to find appropriate local solutions and models of best practice. We combine local Central Asian knowledge and expertise, exchanging this within the wider EECA region, as well as the added advantage of an international, Netherlands-based Secretariat, contributing to international expertise and innovation. AFEW International – together with AFEW Kyrgyzstan and AFEW Kazakhstan, which will provide technical support to activities in Tajikistan – will aggregate lessons learned from ICAP’s previous work in Kazakhstan and combine those lessons with the methodological approach gained through the past experience of working in prisons in Central Asia to produce practical guidelines and training modules. AFEW International will look for possibilities to pilot this model in Kyrgyzstan and Tajikistan, where political and technical conditions may allow.”

“People living with HIV in prisons are less likely to be on antiretroviral therapy (ART) when compared to general population. They are also less likely to adhere to the prescribed treatment regimen and, therefore, are often viremic,” said Anna Deryabina, ICAP Regional Director for Central Asia. “Lower ART initiation and viral load suppression rates among prisoners are due to many factors, including structural factors, such as lack of trained health care personnel in prisons and limited adherence support and treatment monitoring. Also, lack of coordination between general and prison-based health care services and fragmented service delivery systems lead to many people living with HIV being lost to follow-up and discontinuing treatment after being released from prisons. ICAP has been very effective in improving the quality of HIV services provided to people living with HIV treatment facilities outside of prisons. We really hope that AFEW’s deep knowledge and understanding of subcultures and norms inside the prisons, as well as their experience working with the prison-based health care systems will allow this project to effectively improve the quality of services and HIV outcomes for people living with HIV in prisons.”

“AFEW-Kyrgyzstan is pleased to launch this joint project with ICAP. Under the Project, our organization will be responsible for the implementation of the component to achieve the 90-90-90 goal in the penitentiary system,” said Dina Masalimova, AFEW-Kyrgyzstan Programs Manager. “We plan to work in almost all large prisons in Chui Oblast. Our activities will be aimed at expanding HIV testing coverage with the provision of quality pre- and post-test peer counseling, motivation to start therapy, and adherence development. In addition, we will focus on ensuring that people do not stop their treatment even after release.”

This project is very important to maintaining an effective response to the HIV infection in the country, as 5-10% of all PLHIV in the country are in the prison system. With the high turnover of the prison population, this number can be easily multiplied by half per year.

“We are happy to work in a team with such a highly professional organization as ICAP,” said Masalimova. “It is planned that ICAP specialists will be responsible for medical aspects of providing assistance to PLHIV, and our organization will take over the community element and peer-to-peer support.”

In Kyrgyzstan, AFEW-KG will recruit and train a team of peer navigators representing each layer of the prison sub-population (with a special focus on prison outcasts and pre-release prisoners) in order to identify those who practice risky behaviors and haven’t been tested for HIV in the past six months. AFEW-KG will work with newly identified PLHIV to motivate them to start antiretroviral therapy and take all of the necessary tests. The peer consultants will work as liaisons between patients and prison doctors to ensure that patients are prescribed ART, are adherent to treatment, and that relationships between prison doctors and patients are built on mutual trust.

In addition, AFEW-KG will provide a series of counseling sessions for at least 200 prisoners who are PWID on the benefits of starting methadone-assisted treatment (MAT) and dispelling the myths related to the therapy.

“We believe that this collaboration will yield excellent results and that by the end of 2020 we will be able to see tangible progress on each of the 90-90-90 goals in prisons,” said Masalimova.