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.

Svetlana Izambaeva: “Uncovering the Topic of HIV, We Talk About Violence and Bullying”

Author: Olesya Kravchuk, AFEW International

Svetlana Izambaeva was one of the first women living with HIV in Russia who was brave enough to open her face. Now Svetlana supports other people living with HIV. In summer 2018, Svetlana Izambaeva’s Non-Profit Charitable Foundation held a gathering of adolescents living with HIV with the financial support of AFEW International and other donors. We talked with Svetlana to ask her what was interesting about this gathering in Georgia and why, when we talk about HIV, we also “uncover” other topics.

– Svetlana, could you please tell us how the idea of having a summer gathering was born? Who was able to take part in it?

– It started with our desire to support adolescents living with HIV in Kazan. Later those boys and girls, who had been participating in such meetings for five years, offered to hold a meeting with adolescents from other cities and countries. Several adolescents from Kazan dreamt about going to the seaside. Thus, those adolescents’ dream gave birth to our project #vseprosto (#itseasy). Before, we held one- or three-day workshops in the cities of Tatarstan, Ufa, Nizhny Novgorod, and Irkutsk.

We made a decision on the venue and started sharing information about the event through social media and AIDS centres. The response was immediate. We heard both from mothers of children living with HIV and from adolescents living with HIV. Every person who wanted to attend our event had to fill in a questionnaire based on which we selected the participants. An important eligibility criterion was the awareness of adolescent of his or her HIV status. This year, the meeting in Georgia brought together adolescents aged 11 years old and above from six countries – Russia, Ukraine, Armenia, Georgia, Belarus, and Kazakhstan – and nine cities of Russia – Vladivostok, Irkutsk, Ekaterinburg, Nizhny Novgorod, Kazan, Orenburg, Rostov, St. Petersburg, and Moscow.

– How was this gathering different from a traditional summer camp for children?

– Our gathering was more than a camp. We had full immersion into the topic of HIV, including all medical and psychological issues. Interactive games and quests help us to reinforce the theory. We raise the questions related to feelings, emotions, and experiences, explore guilt, resentment and pain, acceptance of diagnosis and empowerment. An important factor is that we offer many games on HIV – while playing, adolescents learn about the immune system and realize why they need to take pills strictly in accordance with their schedule. For some adolescents, this is the first time when they meet other boys and girls with HIV. At the gathering, we openly talk about HIV for ten days, which allows “recognizing” and accepting one’s diagnosis.

– What was your biggest insight during this gathering? Where there any good or maybe bad surprises for you?

– Each gathering has its own story and each one of them is special. Every time, we sit down with the team of trainers and prepare new exercises and new quest games for the adolescents. What is surprising is the depth of feelings and the extent of trust and openness among the adolescents living with HIV. They are all ready to work on their problems but not all of them are willing to do it in a group. From the very first day, we offer individual sessions with psychologists. Besides, one of the insights was that when we uncover the topic of HIV, we bring up deeper topics, such as violence, bullying, and reliance on parents. Parents or guardians may be a negative factor. There was a case when the guardian was not ready to work together all day long and also in the evening. We pay a lot of attention to building knowledge, but information is presented in the format of games and our participants have fun. Though it is just a five-minute walk to the seaside, our priority is keeping up with our agenda and the knowledge to be gained by the adolescents and their parents or guardians.

– What challenges did you encounter when planning the event and how did you cope with them?

– The main challenge was raising funds. We needed money to cover accommodation and meals for the participants, pay the trainers (though three times we did not pay either to trainers or to the logistics provider), to buy stationery, gifts, T-shirts and caps. It was important to have at least five trainers for 30 participants as we had both general activities and small group sessions. We had to find sponsors to cover our costs, and it was not easy. Besides, at our gathering we started training people who would like to conduct similar activities in their regions.

– Why is this event important? Have you achieved the goals that you wanted to achieve?

– This event is important for every adolescent – that is what they say in their comments and follow-up questionnaires. The changes happening with every boy and girl may be tracked through the diagnostic drawings that they do in the first and last days of the event. On the first day, when they are asked what they feel, think and want to do when they hear the word “HIV”, they draw scary images and write “pain, guilt, fear, do not want to talk about it.” On the last day, when answering the same question, they depict strength, confidence, freedom, easiness and desire to support their peers. The event is also important because after it they will not stop taking their therapy and will adhere to treatment. We already see the results of their blood assays. Our event is also aimed at the prevention of suicide attempts and depression.

Do you plan arranging similar events in future?

– We have already organized and held four gatherings: in 2017 – in Sochi and St. Petersburg, in 2018 – in Ureki (Georgia) and Vladivostok (Russia). We have piloted the programme, trained the trainers and we plan to launch such gatherings in Russia and open centres for adolescents in Irkutsk, Kazan, and Krasnodar region. Next year, we plan to conduct first-level training for new participants in each of the territorial units, hold a gathering in Irkutsk at the Baikal Lake and then – an international event in Armenia. Besides, we would like to hold a meeting and workshop in Moscow suburbs for a team of leaders from all our gatherings.

AIDS Conference Brought me a Job in Tajikistan

Author: Nargis Hamrabaeva, Tajikistan

Fifty-year-old Zebo from a southern region of Tajikistan – Khatlon – is a former labour migrant. At the 22nd International AIDS Conference in Amsterdam (AIDS 2018), she had the courage to speak out about what she long kept in – her HIV-positive status. Zebo once again turned the attention of the international community to the fact that labour migrants are one of the populations most vulnerable to HIV.

We interviewed her in Amsterdam, right after she delivered a speech at one of the sessions dedicated to HIV in the context of labour migration.

– Zebo, why did you decide to go to Russia to earn money? Usually that is what men do.

– In 2004, after I divorced my husband, I was left alone with three small children – my elder siblings were 9 and 6 years old, and my smallest daughter was only 3 months old. I worked as a nurse at a local maternity clinic. My children grew up, with our expenses growing along the way, and my earnings were not enough to feed them all. My ex-husband had a new family and was not helping us. Many of my countrymen went abroad to earn money and support their families. I decided to do the same. That is how my children and I found our way to Saint Petersburg.

– Isn’t it difficult for a woman to be a labour migrant?

– It is very difficult. I was desperate and went to nowhere. For the first days, we slept at the railway station or in the street. Some strangers helped us, offering food or money. Once, a woman from Tajikistan, who worked in Saint Petersburg, saw us and was so kind to give shelter to my children and me. I started baking and selling pasties, earned some money. As time passed, more people were buying our pasties: I was baking and my elder daughter was selling them at the Sadovy street market. Luckily, we had many buyers. However, I had to work my fingers to the bone.

I tried to settle my personal life again as it was very hard for me to cope with all my troubles alone. I met a young man. In the beginning, everything was fine. Then I started noticing him doing some strange things. It turned out that he was a drug user. He injected drugs. I asked him to stop but it did not help. Then I decided to break up with him. Later I heard that he felt bad and his relatives took him back to his motherland. Since then, I have never heard from this man, but my HIV status always reminds me of him.

When did you first learn that you had HIV?

– In 2015, a year after I broke up with my partner. All of a sudden, I felt bad and had a fever. My relatives called an ambulance. In the hospital, they made some tests and I was diagnosed with HIV. In a month, I felt better and went back home, but six months later it happened again. I was dwindling, with my weight going down to 34 kilos. Doctors advised me to go back to my country and get treatment. Almost all my countrymen working in Saint Petersburg had to raise money to buy airline tickets for me and my children. They knew that I was severely ill but did not know the exact diagnosis. When I came home, my family knew I had HIV. They did not really welcome me back. My relatives turned their backs on me and asked me to leave our house. My mother said that I would infect everyone, told people not to eat from the same plate with me and not to shake hands with me. I remember her yelling: “Get out of the house, aidsy!” It hurt me to hear such words, especially from my own mother. Still there are kind people in this world, so a neighbour living opposite from my parent’s house offered me to stay with her. She gave me a small room in a little building. That is where I still live.

So you had to go back to square one again?

– Yes, I did. A woman I know told me about AFEW-Tajikistan office in Bokhtar. I went there and they received me well, helping with food and treatment. They also had a business workshop for the members of vulnerable populations and I was able to get a credit from a microfinance organization. I bought everything I needed to open a small sales outlet in the neighbourhood. Sometimes, when I need to go to the city, my daughter takes over my duties. Children always help and support me in everything I do. My son also assists street market vendors, bringing home 15 somoni a day (less than two US dollars – ed. note). After my speech at the Amsterdam conference, Director of AFEW-Tajikistan Ikrom Ibragimov offered me to work as a consultant in the Bokhtar office of the organization. Now I will receive a salary. I am so grateful to him and to all the members of his great team. With their support, my life is getting better.

Great! One more question about Amsterdam. What does participation in the AIDS conference mean to you?

– It is my first trip far abroad. It is also the first time I take part in such a conference. I listened to many speakers and was inspired by their stories. They were openly saying that they lived with HIV for 20-25 years, taking care of their health and living active and complete lives. It gave me strength and confidence. I was startled to learn that in many countries people living with HIV are not prosecuted and other people do not avoid them. In those several days of the conference, I received more sincere hugs and handshakes than I did since I learned about my diagnosis. Why is there such a strong stigma against people living with HIV in my country? Why do people still hold to stereotypes and are afraid of us? At one of the sessions of the Amsterdam conference, I heard a slogan: “Chase the virus, not people.” It is such a good point! 

AIDS 2018: Will Decriminalisation Resolve the Problem of HIV

Maybe one of the most important sessions at the recent 22nd International AIDS Conference AIDS 2018 held in Amsterdam was the session, which raised the question why we still fail in responding to the epidemic among people who inject drugs. Participants of the session were able to consider this problem from the different points of view: science, law enforcement and community of people who use drugs.

Methadone is good for police

For over 20 years, Professor Nick Crofts from the University of Melbourne has been working to engage police in HIV response. He considers that decriminalisation is an absolute necessity to resolve the problem.

“We fail responding to the epidemic because we have failed to enlist police as partners in the response to HIV,” he says. “Changing the situation, first of all, requires changing the role of police, which will, in turn, help bringing the marginalized communities back to the society.”

In Australia, Professor Crofts and his allies were able to convince the police that such harm reduction programmes as methadone therapy and syringe exchange may benefit police as well as the rest of the community.

“We still have not introduced harm reduction courses in police academies, have not adequately educated police and have not fostered the role of peer educators, which is important not only in the traditional environment of activists, but also in such specific group as future or current police officers. Police officers may listen only to other police officers,” says Nick Crofts with a smile.

HIV for culture change

It is essential to find police officers who support the idea of harm reduction and educate them so that they can then educate their colleagues in relevant agencies.

“Find at least one or two individuals who want to do something different! Find them and give them your support!” exclaims Professor Crofts.

HIV may be a starting point to change the culture of the police. For a start, we need to engage the police, hold joint workshops with people from civil society and police, foster gender diversity in the police (to recruit more female police officers) and, finally, include harm reduction into the programme of police academies.

However, the Professor points out that it may sound pie in the sky talking about police in some countries.

“A third of them understand harm reduction, a third can understand and another third will never understand. Our goal is to find those people who understand or can understand it and work with them until they outnumber those who will never understand harm reduction,” he says.

“Narcotic ration” for Russia

Dr. M-J Milloy, the epidemiologist from Vancouver, tells about an interesting case, which occurred in his city back in the 1990s. Back then, there was already a large needle and syringe exchange programme in Vancouver and methadone was available. The epidemic among people who use drugs had successfully been curbed, but suddenly there was an unexpected outbreak of new HIV cases. How could it happen in a city with a well-developed harm reduction programme? It was explained with the fact that people could not access the necessary services when they were incarcerated.

Epidemiologists found out that incarceration was one of the key factors increasing the risk of HIV acquisition and one in five new HIV cases in Vancouver was a result of incarceration.

At the same time, experts estimate that in Russia every hour ten people are infected with HIV, while tuberculosis is the main reason of mortality among those who live with HIV. Most of them are people who inject drugs. The country does not offer evidence-based treatment to people who use drugs, i.e. there is no methadone, which, according to a recent statement from the Russian Ministry of Foreign Affairs, is a “narcotic ration.”

Compendium of good practices in the health sector response to HIV in the WHO European Region

In response to the rapidly increasing number of new HIV infections in the WHO European Region, the action plan for the health sector response to HIV in WHO European Region was endorsed at the 66th session of the WHO Regional Committee for Europe in September 2016. From December 2017 to April 2018, the WHO Regional Office for Europe collected good practices in implementation of the action plan and compiled them in this compendium.

National health authorities, national and international experts, and civil-society organizations involved in HIV prevention, treatment and care were solicited to share their practices. The practices exemplify efforts within five target areas: HIV prevention; HIV testing and treatment; reducing AIDS-related deaths; curbing discrimination; and increasing financial sustainability of the HIV/AIDS response. This first compendium of good HIV practices in the WHO European Region includes 52 practice examples from 32 Member States. The compendium is intended as a resource for relevant stakeholders in the HIV response.

Download the compendium here.

Source: WHO Europe

Awareness and Acceptability of PrEP Among Men Who Have Sex with Men in Kazakhstan

Oral pre-exposure prophylaxis (PrEP) is an antiretroviral method of HIV prevention recommended to men who have sex with men (MSM) at high risk of infection. In Kazakhstan, which has one of the fastest growing HIV epidemics globally, PrEP is not currently available. The aim of this study is to explore the possibilities for PrEP initiatives in Kazakhstan by investigating awareness and acceptability of this prevention method among MSM. This mixedmethods study employs an online survey and qualitative interviews to describe PrEP awareness and acceptability. Less than half (39.8%) of survey participants had heard of PrEP.

However, a majority (85.2%) of MSM would possibly or defi nitely use PrEP if it was available. Awareness of PrEP was positively associated with willingness to use PrEP. The main reason to be interested in PrEP was an increased feeling of protection, whereas barriers were related to the idea of taking daily medication and the potential for side effects. PrEP is an essential component of HIV combination prevention. Our findings suggest potential for PrEP programmes among MSM in Kazakhstan and possibly in other Central Asian nations, when taking into account burdens of taking PrEP as well as more structural health policy issues.

Read more of the study here.

Stigma Affects the Motivation for HIV Testing

Author: Marina Maximova, Kazakhstan

As estimated by UNAIDS, 35 million people globally died of AIDS-associated diseases since the onset of the epidemic. People living with HIV die of tuberculosis, cancers, hepatitis… Meanwhile, there is no data on how many lives are lost to stigma. Today stigma is the strongest barrier for testing among those who are not aware of their status and for receiving services among people living with HIV (PLWH).

Migrant with HIV double stigma

Salavat Kabjalelov is an outreach worker and a peer consultant in the Zabota (‘Care’) Charitable Foundation. He helps labour migrants: offers consultations on HIV, tells about the need to get tested, navigates clients for diagnostics to the AIDS Centre and to the tuberculosis clinic. Salavat can find the right words for every client. He had no citizenship or registration, no access to antiretroviral treatment (ART) and he wanted to hide not only from his problems but also from hostile stares and rough remarks of people around him.

Salavat Kabjalelov

He and his wife lived a quiet life, not seeking medical care. For migrants, the main thing is their job, not their health. Then, three years ago something tragic happened. Salavat lost his wife. The young woman died of cancer.

“I tried to arrange hospice care for my wife. I was even ready to pay for it, but it was not possible. They refused me. She was living with HIV. It appeared that it was more important to be a citizen. If you had a severe disease, it was not an argument. The good news is that now the situation in Kazakhstan is improving and migrants with HIV will be provided with ART. However, it will not bring my wife back,” complains Salavat.

Everyone goes through self-stigma

Lyubov Chubukova

Lyubov Chubukova works in the Kazakhstan Union of People Living with HIV. She is a delicate woman of strong character, who can convince people both from the tribunes of international forums and in one-on-one arguments. Twelve years of living with HIV made her a leader. She experienced stigma in a private health centre where she came when she got pregnant – young and confused. An older woman gave her an advice – to seek health services only in the AIDS Centre. However, Lyubov says that her self-stigma was even stronger. Every person who learns about having HIV faces this problem.

“I no longer consider myself a victim as it makes it impossible for me to live and grow. Good support in fighting self-stigma is trusting people and knowing your rights. You have to live on, not restricting yourself, and overcome your fears. Otherwise, you may reach the worst point,” says Lyubov.

Lyubov does not hide her status. Vice versa, she often takes part in TV shows and open discussions as an expert. She is convinced that stigma affects the motivation for HIV testing. People are afraid to get tested for HIV as they are worried that their test may come back positive. At the same time, if a person living with HIV starts the therapy too late, the probability of treatment success is much lower and it can even lead to death of the patient.

Every tenth person living with HIV has suicidal thoughts

Three years ago, the Central Asian Association of People Living with HIV within the Leader of People Living with HIV Project funded by USAID for the first time in the region carried out a survey to assess the index of stigma in three Central Asian countries – Kazakhstan, Kyrgyzstan and Tajikistan.

Results of the study in Kazakhstan showed that every tenth person living with HIV had suicidal thoughts. PLWH aged 30 and above suffer most from self-stigma as well as people with small (one to nine years) history of living with HIV. Self-discrimination mainly leads to the decision not to have any more children. Every third person living with HIV in the country makes such a decision.

The study demonstrated that the experience of injecting drug use as well as the experience of imprisonment were the drivers of stigma towards people living with HIV. Most often, PLWH faced discrimination from the side of health workers (first of all, refusal to provide health care) and public officials, while discrimination from the side of their immediate social environment was far less common. Moreover, the cases of discrimination were accumulated in the first ten years of a person living with HIV.

No silence about stigma

Baurzhan Bayserkin

The first step in overcoming stigma is to break the wall of silence. Approval of regulations at the country level is a real victory. In the beginning of the year, the National Plan to Fight Stigma and Discrimination against People Living with HIV was approved in Kazakhstan.

“Stigma and discrimination related to HIV status are the major barriers for PLWH to access prevention, care and support services. To end the spread of HIV, a focus should be made on the complete eradication of discrimination, first of all in health institutions. It will allow achieving a significant reduction in the growth of HIV epidemic,” says Baurzhan Bayserkin, General Director of the Republican AIDS Centre.

Kazakhstani are going to continue this discussion at the 22nd International AIDS Conference in Amsterdam AIDS 2018.

IVF for Women with HIV in Ukraine: Bringing the Right to Have a Child Back

Svetlana Moroz (second on the right) discusses the elimination of the discriminatory norms at a round table. Photo by Positive Women NGO.

Authors: Yana Kazmirenko, Tamara Balayeva, Ukraine

In Ukraine, amendments are prepared to the regulations of the Ministry of Health (MoH) prohibiting in vitro fertilisation (IVF) for women living with HIV. Currently, HIV is in the list of diseases, which are contraindications for IVF, approved by the MoH. In Western countries, IVF has been successfully delivered to women living with HIV for a long time. Ukrainian activists strive for the prohibition on in vitro fertilisation for women living with HIV to be abolished.

In early July, a round table discussion was held in the Public Health Centre at the MoH. At AIDS 2018 in Amsterdam, activists are planning to meet with Ulana Suprun, Acting Minister of Health of Ukraine, to present their insights and explain why it is so important to abolish the outdated regulations.

Discrimination and self-stigmatization

There is no statistics on how many women living with HIV apply for IVF in Ukraine every year and are refused. Svetlana Moroz, representing the Positive Women NGO, sent relevant requests to 10 regions. So far, there have been no replies. Svetlana says that information about the attempts of women living with HIV to make IVF is shared only among civil society activists.

A woman with HIV status sought help in their organization. After long searches, she found a clinic in Kharkiv, which was ready to work with women living with HIV

“She made two attempts, which have not been successful so far. Another woman from Sloviansk used her advice and also sought assistance in this clinic, but she had a miscarriage,” tells Svetlana.

She says that some private clinics agree to make IVF to women living with HIV but do not advertise it due to the orders of the MoH. Such clinics charge their clients a double price because of the possible risks. Other health facilities use standard excuses: lack of equipment or reference to HIV being on the list of contraindications for IVF.

Apart from the MoH orders and reluctance of clinics, there is another barrier – self-stigmatization. According to Svetlana Moroz, many women living with HIV do not even try to seek assistance in IVF clinics: they know that they will face a refusal or do not know that they even have such a right.

All IVF risks are myths

Valentina Kvashenko, chief physician of the A.A. Partners Health Company also thinks that refusal to make IVF to HIV-positive women is a discriminatory practice and that concerns about the risks of HIV transmission are ungrounded. Doctors carry out all the manipulations with semen and eggs with disposable catheters and needles. In the course of deliveries, they wear gloves, glasses, and aprons. The same safety precautions are used during all standard deliveries. Usually, only one embryo is transferred to women with HIV status to reduce the potential need of invasive interventions.

“There is no need in “prohibiting” regulations, due to which people are not able to perform their reproductive functions and become parents,” says Valentina, adding that HIV may be transmitted from mother to child, but only if the woman is not taking antiretroviral therapy (ART).

She gives statistics to prove her words: in 1996-1997, when there was no access to antiretroviral drugs in Ukraine, HIV was transmitted from mother to child in 60% of cases. Now this rate is less than 10%. Even this percentage only relates to children born to women who do not receive ART. Besides, the IVF procedure reduces the risk of virus transmission to a minimum.

Litigation for the right to IVF

If the letter to the Ministry of Health will not give a result and will not allow to promptly introduce amendments to the regulations, the activists have a second option – legal action.

“We will work on creating a legal case. The fact is that the MoH regulations contradict the laws of Ukraine, which do not prohibit in vitro fertilization for HIV-positive women. If nothing else works, we will find a woman living with HIV who is ready to go all the way and defend her rights in court,” explains Svetlana Moroz.

It is expected that draft amendments to the regulations will be ready and presented to the Ministry of Health in late November. While the old regulations are still in force, Svetlana gives recommendations to women who are refused the IVF services.

“Always demand official refusals. With the doctor’s words only, you will not be able to file a lawsuit in court and all the more to win it. Secondly, seek assistance in human rights organizations. For example, our organization is ready to provide free lawyers’ services to women, help them to prepare the required documents and in general offer all the necessary legal support,” sums up Svetlana.

After the discriminatory regulations are abolished, Ukrainian women living with HIV will have a right to participate in the state-funded IVF program for childless couples.

Children with Tuberculosis and HIV Do Not Have Access to Education in Tajikistan

Children with HIV and TB do not have access to education in Tajik schools

Author: Nargis Hamrabaeva, Tajikistan

10-year-old Zarina (the name is changed) is from Dushanbe. The girl has a double diagnosis: HIV and tuberculosis. Zarina has never studied anywhere.

Her mother learned she was HIV-positive during the pregnancy. She received her HIV-positive status from her husband. The girl’s father died of AIDS several years ago, and her mother got married again. The stepfather did not accept Zarina, and that is why she lives with her grandmother.

When Zarina turned seven, the grandmother sent her to the first grade in one of the schools in Dushanbe, but the director said the school could not accept the girl, explaining that “she was sick and could infect other children with tuberculosis.”. Therefore, Zarina has not been studying anywhere for three years. The guardianship and trusteeship bodies never asked why the girl did not go to school.

The dialogue that never happened

Human rights activists found out about Zarina’s case and tried to help the family. The representatives of the Tajik network of women living with HIV and the public fund Your Choice approached the officials of the Ministry of Education to find out whether there was a mechanism for providing access to education for such children, but they faced a wall of misunderstanding.

“We were asked to leave the office. The Ministry representatives said that we lied, that there were no such cases, that all children were receiving education, and that we, representatives of non-governmental organizations, only traveled abroad and tarnished the country’s image before the international community. The dialogue never happened,” says Larisa Aleksandrova, representative of the public fund Your Choice.

According to her, children with a double diagnosis of HIV and tuberculosis do not have access to compulsory secondary education in Tajikistan.

“The revealed fact confirms that education officials improperly monitor and keep track of children who do not attend school due to tuberculosis, and they also do not provide these children with the opportunity to receive education at home, the so-called family form of education or homeschool. Although, according to the Health Code, the authorized body in the field of education is obliged to develop programs for getting education at home or in the hospital,” says Larisa Aleksandrova.

With discrimination and without statistics

Larisa Aleksandrova, representative of the public fund Your Choice

The human rights activists are sure that Zarina’s case makes the situation with discrimination of children living with HIV in an educational institution clear.

“The Law on education states that educators should keep track of children of preschool and school age, and monitor their education prior until they complete the compulsory education. In Tajikistan, a nine-year education is compulsory. However, the Law does not define the mechanism for identifying children not covered by compulsory education,” says Larisa Aleksandrova.

The number of children with tuberculosis and HIV who do not have access to education in the country is not known. The Ministry of Education of Tajikistan said that they do not keep such statistics.

Study of Sex Workers’ Behaviour in Georgia

Author: Irma Kakhurashvili, Georgia

Gabriela, a 40-year-old sex worker from Tbilisi has not been tested for HIV since 2016. She is convinced that she does not have HIV. She also thinks that she knows everything about this virus. However, when asked if HIV is transmitted by mosquitoes, she says ‘yes’. In July, Gabriela is going to the bustling resort city of Batumi to earn some extra money.

“I do not think that I will get tested for HIV anytime soon as I have got a lot of work and do not have free time. Besides, from Batumi I plan to relocate to Turkey,” says the woman.

Gabriela did not participate in the recent research conducted in two cities of Georgia – Tbilisi and Batumi – to study risky and safe behaviours of sex workers.

No major changes

The Tanadgoma Centre for Information and Counselling on Reproductive Health is the first Georgian organization, which has been studying the HIV transmission among sex workers since 2002. The recent study held in 2017 covered 350 women: 200 from Tbilisi and 150 from Batumi. The goal of the researchers was to determine the prevalence of HIV, hepatitis C, gonorrhoea and syphilis among people involved in sex work. Besides, they were able to analyse the key risks associated with HIV and to collect valuable information for advocacy and policy development. The research study was conducted with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Curatio International Foundation and the Infectious Diseases, AIDS and Clinical Immunology Research Centre.

The study confirmed that 85% of women in Tbilisi and 97.3% in Batumi know about the existence of HIV/AIDS, but only 11.5% of respondents in Tbilisi and 23.4% in Batumi gave correct answers to questions about the HIV transmission. For example, some respondents like Gabriela did not know that HIV is not transmitted through the bites of mosquitoes. In general, the respondents from Tbilisi were less aware of HIV if compared to the ones from Batumi.

Georgian researchers say that there have not been major changes in the study outcomes since 2012. For instance, most women mention condoms as the main measure of protection against HIV.

The study results showed that the indicators of condom use during most recent sexual intercourse with a commercial partner have not changed in the recent 10 years (over 90% in both cities). However, sex workers rarely use condoms with their regular clients.

“I do not use condoms with my regular clients to show that I trust them, but I definitely use them with other clients. I have to suffer offences because of this, but I know that it is a sure way to protect your health,” says Gabriela.

Sex work in Georgia is illegal and often police will confiscate condoms if they decide that a woman could be doing sex work.

Sex-workers and drugs

The research study showed that sex workers are well aware of HIV transmission when sharing needles and syringes. Besides, the recent study showed some interesting results concerning drug use. The share of sex-workers who used non-injecting drugs in the last 12 months was 11% in Tbilisi and 20% in Batumi. The most widely used non-injecting drugs were sleeping pills and sedatives in Tbilisi and marijuana in Batumi.

As for the injecting drugs, 1.5% of respondents in Tbilisi and 3.3% in Batumi injected drugs in the recent 12 months The respondents used ‘vint’, ‘jeff’ and amphetamines in Tbilisi and heroin in Batumi.

“Before, we did not have such data for sex-workers,” says Nino Tsereteli, researcher and head of Tanadgoma.

Women are getting out of sight

Gabriela says that she does not inject drugs but takes some pills. The woman has no problem to buy them in a pharmacy and uses substances at least once a week.

“The issue of drugs became relevant to this key population as well. We have been working with sex-workers for 20 years in five cities in Georgia and cover 3,000 people with our services annually. As for HIV/AIDS, during the period when we conducted the study only three women in Tbilisi were diagnosed with HIV. What is bad is that sometimes as soon as a woman learns that she has HIV, she is getting out of our sight and we do not know where she is and if she continues working with clients,” says Nino Tsereteli.

Gabriela promises that in September she will get tested for HIV with the help of Tanadgoma. She is not going to change her lifestyle, but she wants to know if everything is all right with her health. In Tanadgoma, she will get recommendations not only about HIV because, according to Nino Tsereteli, another problem of sex workers in Georgia is violence. Sex workers do not always know how they can organize themselves to protect their rights, health and lives. In Tanadgoma, they can get knowledge and support of professional lawyers.