The 3rd regional autumn school in Bishkek

On October 29, AFEW partners came together in Bishkek, the capital of Kyrgyzstan, for 3 days to take part in the annual Autumn School, which is organized within the project “Bridging the Gaps: health and rights of key populations“.

The great energy of the participants and amazing nature gave a chance to everyone to enjoy the event and to discuss important issues on prevention and treatment of #HIV, harm reduction, migration, and financing in the region of Eastern Europe and Central Asia. Participants in the Autumn School included representatives of AFEW partners from Kazakhstan, Kyrgyzstan, Ukraine, Russia, and the Netherlands, sub-recipients of the project “Bridging the Gaps”, as well as other partners and experts including those from Great Britain and the USA.

Active space

The Autumn School quickly became an active space for discussion: about strategy, barriers, innovations, and partnership opportunities between the participating organizations. During the first day, participants shared updates on the “Bridging the Gaps” project and activities in their countries – Georgia, Kyrgyzstan, Ukraine, and Tajikistan. The afternoon session was devoted to a World Café, in which partners exchanged ideas and developed specific actions to overcome challenges that they often encounter in their work.

The second day was devoted to the topic “Stimulant use and chemsex”. Benjamin Collins, director of International HIV Partnership (IHP), which partners with medical and community activists across Europe and the Middle East for successful responses to HIV and viral hepatitis, joined the Autumn School in Bishkek to share his experience on chemsex . The topic of (problematic) chemsex was further elaborated in the presentations of Monty Moncrieff, Chief Executive of London Friend, a London charity working to promote the health and well-being of lesbian, gay, bisexual and trans (LGBT) people, and Daria Alexeeva, program director of AFEW International. Monty spoke about the London experience in harm reduction, while Daria presented materials of Nikolay Lyuchenkov, an infectious disease doctor and expert on sexual health issues from Russia, which were focused on trends and responses to chemsex in Russia and EECA region.

 

The third and final day of the conference was devoted to workshops on migration, rehabilitation and financial sustainability. Evgeniya Alekseeva, director of Public Health and Social Development Foundation “FOCUS-MEDIA”, presented analysis of NGOs funding situation in EECA region; Elena Zhirnova, manager of the project “Our Choice: Empowering Vulnerable Women in Kyrgyzstan” (AFEW-Kyrgyzstan) told about challenges and opportunities of social entrepreneurship in the country; and Fatima Yakupbayeva, co-founder of law firm “PRECEDENT” and publisher of the book “From Grant to Business Project”, shared auditing resources for launching a business model and recommendations on how to implement business ideas.

 

The session on migration started with a presentation by Rukhshona Kurbonova, coordinator of the Migrant Health Programs at International Organization for Migration in Tajikistan. She talked about labor migration in Central Asia, while Zulaika Esentaeva (IOM Kyrgyzstan) shared their experience on service-delivery by IOM Kyrgyzstan for vulnerable migrants.

The session on rehabilitation was devoted to building information campaigns. During the session, Marina Govorukhina, specialist on strategic communications and branding, author of the books “Communications in Public Organizations”, “Strategic Communications in Public Organizations”, demonstrated specific techniques of developing informational marketing campaigns for rehabilitation centers to the participants from Georgia, Kyrgyzstan and Ukraine.

Moreover, the School included a 2-day training for AFEW communication managers, during which participants focused on learning about storytelling and SMM in the context of NGOs.

 

 

Natalya Shumskaya, director of AFEW-Kyrgyzstan

I especially noted the session on new psychoactive substances. This topic is relevant for our country, as sexual ways of HIV transmission keep growing in Kyrgyzstan, and new psychoactive substance use impacts sexual behavior. For us it is a wonderful opportunity to take on the experience of those countries that have already faced similar problems, and elaborate effective strategies for preventative measures in our country.

The third day was remarkable due to the acute topic of sustainability of civil society organizations. We all see the tendency of decreasing donor support in our countries. That means that civil society should aim to ensure financial sustainability independently, and one of the opportunities is the development of social entrepreneurship. During this meeting we shared the experience of creating our own social enterprise – a beauty salon. I would like to especially point out the session by Fatima Yakupbayeva from the “Precedent” company. She gave us specific business-ideas, which could be developed by an NGO in order to earn money independently and further direct it to realization of our statutory goals.

The importance of this event is in sharing and exchange of experience. When the financial support for our organizations is not that high, it is important to avoid duplication of activities, and, on the other hand, to consolidate our efforts in order to realize our main strategic goals. For instance, the past regional meetings allowed us to bring good practices of working with youth at risk from Ukraine to our country. We are very grateful that we didn’t have to be the pioneers in this, but rather adapt and use their experience. Also, I think that the experience of Kyrgyzstan will be useful to some of our colleagues, and they will be able to apply it in their countries.

Monty Moncrieff MBE, Chief Executive of London Friend

It’s important for people working in the region on the same issues to have the opportunity to come together and share their knowledge and experience. It helps build the data on important topics, and enables participants to share what they’re seeing locally, as well as share tips on how to address new and emerging trends. It also helps build relationships, which spark ideas for new partnerships. Even though the internet gives us great opportunities to connect and work together online it’s difficult to get that richness of connection without bringing people together in person, and doing so for a number of days provides lots of opportunities for conversations outside the formal sessions.

We can always learn from one another, and hopefully by inviting people who have been working on issues for some time in other countries we can bring the benefit of that experience. We can share leaning about what’s worked and what hasn’t for us, and hopefully that can benefit people who are only starting to see these issues emerge locally.

Evgeniya Alekseeva, PHD in medical sciences, Director of Public Health and Social Development Foundation “FOCUS-MEDIA”

Meetings such as the Autumn School are important, because they bring together people from different countries and cities, create space for discussing acute issues and situations in our field, allow to form alliances, agree about partnerships, as well as have informal conversations and take a break from the daily routine.

At the Autumn School in Bishkek, I especially noted a very interesting session on chemsex, sessions on business projects for NGOs, and on migration. I will certainly use this knowledge further while writing proposals, developing new projects and creating new ideas.

Zarina Siyakova, program coordinator of the Tajik Network of Women Living with HIV

This meeting provided me with a great opportunity to learn more about what is happening in other countries in regards to promoting prevention and treatment of HIV. I especially noted the session on chemsex, as I hadn’t had a chance to encounter this issue before. I was particularly interested in the presentation by Monty Moncrieff, as well as the presentation of Nikolay Luchenkov from Russia on chemsex in EECA.

Also, I received answers to many questions on migration that I’m interested in, and most importantly, exchanged contacts with almost all the participants. It is well known that nowadays there is a very large stream of migrants from Tajikistan to Russia, and many of them lack information about services for migrants and d existing organizations in Russia. Now our organization will be able to refer our clients to these organizations, and we won’t lose them out of sight.

If you are interested in specific presentations of the Autumn School, please send your request to autumnschool@AFEW.nl.

Children’s health is a top priority

In Atyrau, Kazakhstan, the incidence rates of tuberculosis among children (0-14 years old) and adolescents (15-17 years old) are significantly higher than the national average: the incidence of tuberculosis in 2017 here is 1.5 times higher than the average around the country.

For this very reason, the project on Implementation of Highly Effective Measures of Prevention and Treatment of Tuberculosis among Children and Adolescents, the purpose of which is to improve the organization of activities on TB prevention among adolescents and children, is ongoing here, in Atyrau. The project is implemented by the international organization Project HOPE – Kazakhstan within the framework of the Social Investment Program of Tengizchevroil LLP, in cooperation with the National Scientific Center of Phthisiopulmonology of the Ministry of Health of the Republic of Kazakhstan.

“The high incidence of tuberculosis in this region may have several reasons, explained Bakhtiyar Babamuradov, the Project HOPE Representative in Kazakhstan. One of them is a low coverage of new-borns by the BCG vaccination, as parents refuse vaccination for personal reasons and religious beliefs. In addition, low levels of alertness and awareness of kindergarten and school personnel, as well as of the parents, about the symptoms of tuberculosis lead to delayed treatment at the medical facilities. Therefore, the important components of the project include increasing the health and non-health personnel alertness to the symptoms of tuberculosis, as well as raising the public awareness about the necessity of tuberculosis prevention. Media is also actively involved in the work”.

According to the test results, 85 teachers, lecturers and educators of preschool and educational institutions, who had participated in the seminar on Prevention of Tuberculosis among Children and Adolescents have demonstrated a 40% improvement of knowledge level (from 51% up to 92%).

“Alliance for supporting youth affected by the problem of tuberculosis” by Sanat Alemi

Fight against tuberculosis among the youth of Kazakhstan plays an important role in the work of AFEW Kazakhstan, and in particular, the Sanat Alemi public foundation. In the framework of the “TB/HIV Prevention & Care – Building Models for the Future” project in March 2019, the “Alliance for supporting youth affected by the problem of tuberculosis” was presented in the country. The main goal of the alliance is to comprehensively support young people with TB, as well as increase their adherence to treatment, and improve the quality of life.

Consultations and trainings are regularly held for members of the Alliance; sports events and joint trips aimed to unite children who until recently didn’t even know with each other are organized to promote a healthy lifestyle. Such active events contribute to rapprochement and building communication among children and adolescents.

EECA INTERACT is a step towards the development of unified community

Why is the Workshop EECA INTERACT so important for the EECA region?

Alexei Alexandrov, a member of the international committee of EECA INTERACT 2019, head of Minsk regional clinical centre “Psychiatry-narcology”.

EECA INTERACT can become a model for building regional and country interaction between young and experienced researchers, medical practitioners, employees of non-governmental organizations and members of community initiatives, as well as representatives of the government.

All these specialists are involved in solving the problems of HIV infection, tuberculosis and viral hepatitis, and also related problems of drug use, criminalization, prison health, stigma and human rights. The exchange of experience by specialists from EECA countries with similar situations on HIV, TB, Hep, drug use, the results of new studies and expert assessments will allow choosing the best solutions to change the situation and begin to really implement them.

For me, EECA INTERACT is not only a meeting with new colleagues and getting acquainted with the results of their work, discussing pressing issues, forming direct contacts to continue cooperation or a network of interaction. The seminar is a continuation of the efforts that we, experts of the EECA countries, are directing to respond to the HIV epidemic in the region, implementation of those innovations that have already been tested in the world and are evidence-based.

The workshop is a step towards the development of a unified scientific, expert and practical community of our countries, united by common tasks. Everyone can have their own vision of the situation, challenges and solutions, but only joint discussion and analysis will allow finding potential points of influence for success.

 

How would you rate the development of clinical and research networks in the EECA region today?

Sergii Dvoriak, a member of the international committee of EECA INTERACT 2019, M.D., D.Med.Sci, founder and senior scientist, UIPHP, professor at the department of social work, ALSRT.

In our region, a lot of problems are associated with the traditions and imperfections of medical education. For several years I conducted training seminars “Effective Treatment of Drug Dependence” in Salzburg (organized by the Open Society Foundation), where all participants, mainly doctors, were divided into 2 groups, the Russian-speaking from EECA and the English-speaking from Southeast Asia and Africa. People from EECA were educated in the “Soviet” system, the others – in the “Western”.

I noticed a very clear difference in the methods for solving clinical problems. People from EECA went into “philosophy” and the so-called pathogenetic way of thinking, and “Western” immediately appealed to existing protocols and standards, objective data, etc. I then realized that many of our specialists need to be retrained and they should focus on evidence-based methods, and not on general considerations and “clinical points of view.” For this, we need such meetings like EECA INTERACT, where these points can be emphasized. It is important also that decision-makers participate in such events.

In Ukraine over the past 10 years, significant progress has been made in the development of clinical and research links. To some extent, a solid research infrastructure has been created, several organizations were found which can not only participate in international collaborative projects but also independently carry out research and receive funding from donors such as National Institutes of Health, CDC, WHO etc. Unfortunately, national donors are still very sparingly involved in this process.

Ministry of Health also does not understand enough how important the systematic and continuous process of conducting scientific research is, and the importance of implementation projects is underestimated.

Officials believe that only mainly state institutions have the right to make scientific research. They expect global discoveries or creation of new vaccines, effective drugs, but they do not really understand that in the modern world only a limited number of countries and companies are able to take such steps. There are no such resources in EECA countries, but this does not mean that research is not needed. Doctors should be involved in scientific projects as much as possible, because this disciplines clinical thinking, makes it possible to get acquainted with the modern scientific context.

 

 

 

 

RADIAN for the EECA region

On the 10 of September the Elton John Aids Foundation with Gilead Sciences announced the launch of a new project RADIAN. This major project aims to bring support to Eastern Europe & Central Asia, where the AIDS epidemic is on the rise.

A ground-breaking initiative

The global community now has the tools to meaningfully address new HIV infections; however, HIV is on the rise in Eastern Europe and Central Asia (EECA). To address the challenges in EECA and ensure no one is left behind in the global effort to end the HIV/AIDS epidemic, the Elton John AIDS Foundation and Gilead Sciences have partnered together in a ground-breaking initiative called RADIAN.

RADIAN is a natural evolution of the existing collaboration between the Foundation and Gilead in the EECA Key Populations (EECAKP) fund, which gave the organisations a greater understanding of the urgent needs in EECA and the necessary experience to respond. The RADIAN partnership will provide investment, support and on-the-ground resources over the next five years to support interventions and drive measurable impact in EECA.

Model Cities

RADIAN consists of two programs: ‘Model Cities’ and the RADIAN ‘Unmet Need’ Fund. The programme will support innovative approaches, including new models of care and expanded prevention and healthcare programmes, led by groups who are on-the-ground and part of the community. The first RADIAN ‘Model City’ will be Almaty, Kazakhstan’s largest city. Additional ‘Model Cities’ will be announced in 2020

The Radian Unmet Need Fund

The RADIAN ‘Unmet Need’ fund will support local initiatives across the EECA region and beyond the select ‘Model Cities’. Initiatives selected will focus on prevention and care, education, community empowerment, and novel partnerships. The programme will be implemented locally, working with key stakeholders and partners.

The project encourages local and regional organisations in EECA who share its vision of significantly improving the quality of care for PLHIV, addressing new HIV infections and AIDS deaths to apply for grant funding when the Request for Proposals opens in mid-October 2019. Best practices and learnings from the local implementation of RADIAN over the next five years will be used as a blueprint towards creating change across the region.

Peer navigators – indispensable medical assistants

Author: Marina Maximova, Kazakhstan 

Over the past three years, express HIV testing in key populations in the East Kazakhstan region of Kazakhstan increased by a third. Peer navigators play a very important role in this success.

Today among key populations, including people who use drugs, sex workers, men who have sex with me, etc. there is a major increase in infection in the country. Representatives of these groups usually don’t come to AIDS centers and medical facilities for testing, but, as experience has shown, they easily visit non-governmental public organizations (NGOs) or ask peer navigators for such services.

Peer navigators – who are they?

The term “peer navigators” is very popular among social activists. People living with HIV (PLHIV) become voluntary medical assistants and help professionals to care about patients. They do express testing for HIV infection in peri-gingival fluid, provide counseling, and, if necessary, accompany PLHIV to AIDS centers for complete testing.

“Another important work of peer navigators is to increase the motivation of PLHIV for the constant and systematic use of special antiretroviral therapy (ARVs), which is extremely necessary for our patients to improve their health, – says Marina Zhigolko, head of the East Kazakhstan Center for the Prevention and Control of AIDS. With the participation of volunteers, in recent years, PLHIV adherence to treatment has quadrupled. Today, more than 80 % of these people take rescue therapy and can work fruitfully, have families, give birth to healthy children”.

Today in the East Kazakhstan region there are 20 peer navigators. In the framework of the USAID Flagman project, they are provided with rapid tests, tablets for record-keeping, disposable syringes, lubricants, and promo materials.

Personal example and motivation

Sergey Baranyuk, a peer navigator from the Answer public foundation, packs a backpack in the morning and sets off on his route to work “in the field”. He is an ex-prisoner, has been living with HIV for many years, he used drugs. Today Sergey has a family, a job, and he helps other people to overcome the life situation he had before. His life experience helps him to convince those who, for various reasons, fall out of medical control and are not tested for HIV.

“The express test for peri-gingival fluid is convenient to use,” says Sergey. It can be done on a bench in a park, in a car, at home. After 15-20 minutes, a person already knows his HIV status. While he is waiting for the result, a peer navigator can talk to him about the risks of behaviour, ways of transmitting HIV infection and precautions. ”

Trust on the Health Route

Over three years, with the joint work of peer navigators and health visitors in the East Kazakhstan region, the number of PLHIV on follow-up has doubled. People come for medical monitoring of health, testing and medication. Peer navigator work not only in the regional center, but also in villages. For example, some villages of Glubokovsky, Shemonaikhinsky, Ulan districts, as well as Ridder-city are also under the control of public activists.

Many people prefer to come for testing at an NGO. For this, for example, the public funds “Answer” and “Kuat” have specially equipped rooms. Here people can talk frankly and do a test.

The first six months are the most important in the work of peer navigators. After some time, patients start to understand the importance of treatment themselves. But before peer navigator should find a person from the risky behaviour group and convinces him to find out his HIV status and, if necessary, start treatment.

“Navigators are our ears, eyes and foot,” says Neil Mamyrbekova, head of the treatment department at the Semey AIDS Center. «One doctor is not able to single-handedly cover patients, set them up for treatment, and convince them in the possibility to start a new life. A person must come to us prepared, therefore navigators are our main assistants. They are trusted!»

Monitoring of HIV-related stigma and discrimination

The ways in which HIV-related stigma and discrimination are manifested and experienced are complex and varied. Many different measures from different perspectives are currently used to monitor HIV-related stigma and discrimination.

To better understand the status of HIV-related stigma and discrimination and progress towards their elimination, support advocacy for addressing HIV-related stigma and discrimination and highlight data gaps, UNAIDS is coordinating the development of summary measures of HIV-related stigma and discrimination. Please see the concept note for more background information.
Starting on 19 August 2019 for a period of three weeks, various elements of the draft measures will be discussed. A few key questions will guide the moderated discussion each week. Inputs and recommendations from each week will be shared at the start of the following week and used to inform the next element of the measures to be discussed.
To participate in the consultation please read more information here.

Through the 2016 Political Declaration on HIV and AIDS, the global community committed to eliminating HIV-related stigma and discrimination by 2020 “for the equal enjoyment of all human rights and equal participation in civil, political, social, economic and cultural life, without prejudice, stigma or discrimination of any kind” of people living with, at risk of and affected by HIV.
The proposal is to develop one summary measure of HIV-related stigma and discrimination and four accompanying summary measures of stigma and discrimination experienced by sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people related to factors other than HIV. This will make it possible to capture the diverse forms of stigma and discrimination that may be experienced by key populations most affected by HIV that may not be directly due to HIV but that have important impact on the HIV response.

This virtual consultation aims to encourage broad participation, particularly of people living with and affected by HIV, gay men and other men who have sex with men, transgender people, young people, sex workers, people who use drugs and women, from all regions. Contributions through this consultation will be used to inform the development of the measure(s) and ensure they are people-centered, reflecting the lived experiences and realities of people, and meaningful to inform programmatic action.
A summary of inputs and recommendations from the consultation will be shared in September 2019. 

School of MSM and TG Leaders

On August 12–16, the “School of MSM and TG Leaders” was held in Almaty, Kazakhstan.

The objectives of this training were: to mobilize and increase the visibility of the community in the country; to create cohesion of the community itself; to create a tolerant attitude of the general population towards LGBT people.

More than 20 novice activists from different parts of Kazakhstan got new knowledge and skills to create a safe environment, maintain health and to improve the quality of life of LGBT people in the country.

“This is one of the best training I attended because it is not just a lecture but real master classes and personal experience of successful people’’ says one of the participants of the School. Indeed, the presenters – Amir Shaykezhanov – editor of www.kok.team and Elena German – program director of the Eurasian Coalition on Male Health www.ecom.ngo shared their professional experience.

The world is changing rapidly and today the most creative and innovative thinking leaders are pushing forward. The training itself and the presentation of the material were very unusual. From the beginning, the group was immersed in a creative trance – the participants were declared heroes of the Game of Thrones universe. “Five houses” – five groups of participants were engaged in the development of their unique projects for implementation in their regions. “Video blog to increase visibility”, “Community centers to support the LGBT community”, “Live libraries for anti-discrimination of HIV-positive MSM within the community”, “Improving HIV literacy among the LGBT community”, “Legal protection of the LGBT community” – during “The School” all these projects have gone all the way from the origin of the idea to a completed project application for receiving funding from the event organizers – AFEW Kazakhstan.

“We could not choose the best or most relevant topic, since all topics are important for the community,” admitted Roman Dudnik, chairman of the jury, director of AFEW Kazakhstan. As a result, the jury members – representatives of AFEW Kazakhstan and the Kazakhstan Union of PLHIV – decided to finance all projects. Teams are ready and are going to start in September.

 

 

New collaboration of AFEW International

We are happy to announce that AFEW International represented by executive director Anke Van Dam became a consultant of an international project “Optimizing HIV prevention portfolios targeting people who inject drugs using dynamic economic modeling” awarded with NIH grant.

As one of the significant contributors AFEW International will act as a liaison to the key networks, organizations, and partners in the countries in the region of Eastern Europe and Central Asia. We will help the project team access data and the best level expertise for undertaking modeling in EECA. As well as we will provide consultations and feedback on the modeling process in the EECA region.

The overarching aim of the project “Optimizing HIV prevention portfolios targeting people who inject drugs using dynamic economic modeling” is to optimize HIV prevention strategies for people who inject drugs (PWID) in 108 countries worldwide using dynamic economic modeling based on multiple large data sources.

The project will:

1) Develop an epidemic model to estimate the impact of HIV prevention portfolios among PWID for every country with available HIV prevalence data among PWID (108 countries), based on data from multiple large systematic reviews.

2) Externally validate the model in 9 key countries with the highest numbers of HIV-positive PWID (including Russia and Ukraine)

3) Develop a user-friendly and web-based multi-platform portal for dissemination of the epidemic economic model and associated data.

The research team of the project consists of:

Natasha Martin, DPhil, Associate Professor, a leading economic infectious disease modeler (University of California);

Steffanie Strathdee, PhD, Professor and a leading epidemiologist focusing on HIV among PWID with 500 publications;

Javier Cepeda, PhD, Assistant Professor, an economic modeler with expertise in cost data collection among PWID;

Peter Vickerman, DPhil, Professor, a leading modeler of HIV transmission among high-risk groups including PWID, MSM and FSWs (the University of Bristol);

Louisa Degenhardt, PhD, Professor, an epidemiologist with over a decade of experience in conducting global systematic reviews on IDU and health harms among PWID (the University of New South Wales);

Sarah Larney, PhD (the UNSW team).

 

UNAIDS outlines progress on HIV, but decries funding cuts

The Joint United Nations Programme on HIV/AIDS (UNAIDS) released its latest report on the status of the HIV epidemic and the global response ahead of the 10th International AIDS Society Conference on HIV Science (IAS 2019), taking place this week in Mexico City.

The report highlights the impact community programmes have had in successfully expanding access to HIV treatment, supporting adherence and preventing new infections. However, it also shows that this progress is slowing and has been uneven, and that global funding for the HIV/AIDS response has fallen for the first time.

“We urgently need increased political leadership to end AIDS,” said UNAIDS interim executive director Gunilla Carlsson. “This starts with investing adequately and smartly and by looking at what’s making some countries so successful. Ending AIDS is possible if we focus on people, not diseases, create road maps for the people and locations being left behind, and take a human rights-based approach to reach people most affected by HIV.”

Some countries are meeting or exceeding the UNAIDS 90-90-90 targets – 90% of people living with HIV knowing their status, 90% of those diagnosed being on antiretroviral therapy and 90% of those on treatment having viral suppression by 2020 – while others are falling behind.

Global progress stood at 79% knowing their status, 78% on treatment and 86% with viral suppression in 2018. However, when looking at the proportion of all people living with HIV worldwide – not just the proportion of the previous subset – the figures are less impressive, with just 62% being on treatment and 53% having viral suppression.

But these figures mask some notable disparities. Nearly 90% of people in Western and Central Europe and North America know their HIV status and are on treatment, but only about 80% of those have an undetectable viral load. In Asia and Latin America, the proportions tested and on treatment are lower, but almost everyone on treatment has achieved viral suppression. Eastern Europe and Central Asia, the Middle East and North Africa, and Western and Central Africa are falling behind on all three measures.

Globally, new infections and AIDS-related deaths continue to decline, but less steeply than before. At the same time, the number of people on HIV treatment continues to rise and appears on track to meet the 2020 target. According to UNAIDS global estimates, in 2018:

  • 37.9 people worldwide were living with HIV;
  • 23.3 million (62%) had access to antiretroviral therapy;
  • 1.7 million newly acquired HIV;
  • 770,000 died from AIDS-related illnesses.

This represents a 16% drop in new infections since 2010, with most of the progress seen in Eastern and Southern Africa. But incidence has increased in some regions including Eastern Europe and Central Asia (up 29%), the Middle East and North Africa (up 10%) and Latin America (up 7%).

The report shows that members of key populations and their sexual partners now account for more than half (54%) of the 1.7 million people who newly acquired HIV in 2018. These groups include men who have sex with men, transgender people, sex workers, people who inject drugs and prisoners. In Eastern Europe and Central Asia and in the Middle East and North Africa, these populations are thought to account for 95% of new infections. Here too, the distribution of who bears the brunt of the epidemic varies widely by region.

Despite the availability of antiretrovirals that can prevent mother-to-child HIV transmission, just 82% of pregnant women have access to them, resulting in 160,000 new infections among children – well short of the target of less than 40,000.

Regarding HIV prevention, the report says that only around 300,000 people worldwide – including 130,000 in the US – are using pre-exposure prophylaxis (PrEP), although this is at best a rough estimate. Similarly, although people who inject drugs account for a high proportion of new HIV infections in some regions, many lack access to adequate harm reduction services.

Although it is harder to gauge progress in this area, the report notes that stigma, discrimination, criminalisation, harassment and violence remain problems for many people living with HIV.

 

Kazakhstan: Reducing Stigma and Pills – Improving Adherence to Treatment

Author: Oksana Maklakova, Russia

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.

One-stop shop approach

“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.

Quitting therapy after the baby is born

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.

Project coordinator of the Central Asian Association of People Living with HIV Lyubov Vorontsova

“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.

Bargaining for lives

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.