Tuberculosis in the WHO European Region

Despite the notable progress achieved in the fight against Tuberculosis (TB), it still poses a public health threat in the WHO European Region. According to the latest estimates, in 2018 about 259 000 people became ill with TB (Fig. 1) and about 23 000 people lost their lives due to TB in the Region, mostly in eastern European and central Asia countries. 

In the past 10 years, the number of new TB patients has been falling at an average rate of 5% per year, which is the fastest decline among all WHO regions. However, the treatment success rate among newly diagnosed and relapsed patients was 77%, which remains one of the lowest among WHO regions.

One in five new TB patients is affected by MDR-TB

Countries in the European Region have the highest rates of multidrug-resistant TB (MDR-TB) globally. Nine European Region countries face a particularly high burden of MDR-TB. In 2018, of estimated 49 000 rifampicin resistant (RR) tuberculosis cases among notified pulmonary tuberculosis patients, 45 400 (93%) were diagnosed. The increase in detection is mainly due to improved access to rapid and quality assured diagnosis. The treatment success rate for TB and MDRTB in the Region remains below the 85% and 75% regional targets respectively (Fig. 2) although data show a slow improvement.

Around 95% of all reported MDR-TB patients were tested for resistance to second-line TB drugs in 2018, which is an increase compared to the previous year. The testing led to the detection of about 6 800 patients with extensively drug-resistant TB (XDR-TB), which accounts for about 19% of patients with MDR-TB.

One in eight new TB patients is HIV positive 
People living with HIV are 20 to 40 times more likely to develop active TB disease than people without HIV.1 HIV and TB form a deadly combination, each speeding the progress of the other. Because of the increasing trend of new HIV infections in the WHO European Region, HIV coinfection rates among TB patients also increased sharply from 8% to 13% between 2014 and 2018.  Rapid detection and appropriate treatment are vital. However, only 80% (24 365) of the estimated 30 000 TB/HIV coinfected individuals were detected in 2017, and only 73% of those diagnosed were offered antiretroviral treatment.
Strengthening Regional commitments to end TB 

The Tuberculosis Action Plan for the WHO European Region 2016-2020 (European TB Action Plan) was endorsed by the 65th WHO Regional Committee for Europe in 2015. This strategic document sets the regional goal of ending the spread of TB and MDR-TB by achieving universal access to prevention, diagnosis and treatment. Following up on the Regional Committee resolution, the final report of implementation of the European TB Action Plan will be submitted to the 70th Regional Committee in September 2020. The finalized report will be reviewed by all Member States before endorsement along with a suggestion to extend the validity of the European TB Action Plan. This vision aimed to end the TB epidemic and ensure that by 2030, no   family faces catastrophic financial costs due to TB. To monitor progress and ensure that commitments articulated in the UN High Level Political Declaration are met, a Monitoring and Evaluation Framework 2021-2030 with new indicators and targets has been prepared and submitted to all Member States for public consultation. These indicators, while regional in scope, are designed to serve as a guide to the development or adjustment of comprehensive monitoring plans at the country level.

WHO European Region comprehensive technical assistance to Member States includes supporting the development and introduction of innovations and tools, such as digital technologies, rapid molecular diagnosis of TB, new drugs and regimens for DR-TB. The WHO Regional Office for Europe seeks to ensure that all people affected by TB have equal access to the benefits of latest development, including vulnerable populations, such as prisoners, migrants, socially marginalized, children and people living with HIV.

In 2018, WHO’s Regional Office for Europe, collaborating with partners on the issue-based Coalition on Health and wellbeing, launched the United Nations Common Position Paper on Intersectoral Collaboration To End TB, HIV and Viral Hepatitis and is working with civil society, national and international partners to implement it. http://www.euro.who.int/en/publications/abstracts/unitednations-common-position-on-ending-hiv,-tb-and-viral-hepatitis-through-intersectoral-collaboration2018. Country-level assistance is vital to this process. National processes to strengthen the dialogue and action around these topics are ongoing in Portugal, Tajikistan, Georgia and Belarus. This collaboration and dialogue contributes to developing the first edition of an Operational Framework; guiding concrete action to end HIV, TB and viral hepatitis beyond the healthcare sector. These best practices are being collected at the regional level.

About TB

TB is a contagious disease that spreads when a person breathes in the bacteria breathed out by an infected person. This disease is mainly caused by Mycobacterium tuberculosis. About one fourth of the world’s population is infected with the latent form of the disease, and a tenth of them become ill with active TB during their lifetimes.
The symptoms depend on the organ of the body which is infected. Usually, TB affects the lungs. In this case, the major symptoms are cough with productive sputum (sometimes with blood), shortness of breath and chest pain. There are also general symptoms such as fever, night sweats, loss of weight and appetite, fatigue and general weakness. People living with HIV or other conditions that weaken their immune system (such as diabetes), people on immunosuppressant therapy, and people who use tobacco or use alcohol harmfully are at much higher risk of developing the disease.
MDR-TB is resistant to two of the most potent anti-TB drugs. This is a result of inadequate treatment of TB and/or poor airborne infection control in health care facilities and congregate settings. XDR-TB is resistant to the most important first- and second-line drugs and there are currently very limited chances of people with XDR-TB being cured. TB can affect everyone but is particularly linked to social determinants of health such as migration, imprisonment and social marginalization.

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.

So many women, so many fates

 

In Tajikistan, there is an increase in the proportion of sexual transmission of HIV infection from year to year and an increase in the number of women of reproductive age among those registered with the diagnosis established for the first time. That is why in 2019 the public organization “Tajik network of women living with HIV” (TNW+) with the support of AFEW International in the framework of Bridging the Gaps project conducted a study “Key problems of sexual and reproductive health of women living with HIV in Tajikistan through the prism of human rights”.

Before the International Women’s Day on 8 March, Tahmina Khaydarova, head of TNW+ discussed with AFEW International HIV, sex, violence and gender inequality in Tajikistan.

What does sex mean for men and women in Tajikistan?

For men, sex is an opportunity to satisfy their desire, and only then is it a way of making children. For women, sex is almost always a way of making children and extending the family. As a rule, women in Tajikistan cannot talk about sex and take the initiative in sexual relations, as it is considered to be debauchery.

Generally speaking, the sexuality in Tajikistan is highly exposed to traditional gender stereotypes. It is not common here to discuss sexual relations, either in the family or in society. Some people talk about it with their partners, doctors, etc. But even if they do that that they do not really understand the meaning and significance of the concepts of “sex” and “sexual relations” and most often talk about contraception, methods of protection against unwanted pregnancy, hygiene, etc. But not more.

Does it happen because of national traditions and religion?

Yes, in many ways. However, Islam is a religion of peace and good. Islam does not talk about the abuse of women, but there are other factors that affect women’s lives. These are stereotypes, which can be connected with religion.

One of them is “a woman is obliged to take care of her husband and all members of his family, to be obedient and kind”. Therefore, girls have been brought up in a spirit of obedience since childhood. Women themselves think that men’s interests come first. One of the features of families in the republic, especially in villages, is the predominance of extended families, where several generations of adults and children live in the same house – parents, their adult sons/daughters already married, grandparents, adult sisters or brothers. As a consequence, relatives constantly interfere in the husband and wife relationship.

In the family, girls are taught to be housewives, in most cases have no education, especially in villages, and after marriage the girl becomes very dependent on her partner and family members. Without the permission of her elders and husband, a woman has no right to leave her home and receive information about sexually transmitted diseases (STDs) if she wants. A woman must stand one step behind the man in everything: in decision-making, in expressing her opinion. A woman should listen to her husband’s words, she should keep silence, this is respect. It is also rare for women to be able to decide for themselves when, how and with whom to have sex, how many children to have, etc.

At the same time, sexual violence from an intimate partner increases the risk of HIV infection. During our survey, we heard from the respondents reasoning that non-consensual sexual intercourse is a normal phenomenon, and so it should be in the family, “This is your husband: if he wants to do something then you should obey. He’s young, and that’s why you have to satisfy his desires!”

Inequality between men and women in Tajikistan is developed not only in private life, but also in public life, isn’t it?

Yes, gender inequality is one of the problems hindering sustainable development in Tajikistan. Inequality is everywhere – in access to all types of tangible and intangible resources (property, land, finance, credit, education, etc.); in decision-making in all spheres and participation in political life, and violence against women.

Why do women tolerate violence?

Because it fits within the established system of gender inequality in Tajikistan. Men provide for women, control family relations, and therefore can do, in fact, whatever they want.

But the saddest thing is that society does not sufficiently understand the importance of this problem. It is convinced that domestic violence is a private matter. It is considered that the manifestation of abuse of wife, daughter-in-law, sister, etc. or constant control over their life and behavior is not violence but a norm. At the same time, it is widely believed that a woman is to blame if her husband or his relatives use physical force against her. There are many supporters of this opinion among young people, women themselves, and especially among their mothers-in-law. Therefore, in my opinion, special attention should be drawn to solving the problems of relations between mother-in-law and daughter-in-law, the relationship to the wives of migrant workers during the period when their husbands are outside the country, early and forced marriages, etc.

Are women with HIV more vulnerable?  

Definitely! Despite the fact that very often the source of HIV infection for a woman is her husband, she is subjected to violence and discrimination by her husband and his relatives. One woman said that her husband infected her, but did not consider himself guilty. Sometimes he closed the house and left his wife without food, hungry and helpless. One day he even tied her to a pole with a rope and beat her up, and then left for two days. After this she went to her parents, where she was also discriminated.

Why are women with HIV afraid to visit doctors?

Practice shows that those who go to the AIDS centre receive quality care and many are happy with it, including me. However, the main challenges for women are when they go to other health care facilities (for surgery or dentists), including primary health care (PHC). In these facilities women living with HIV (WLHIV) are most likely to experience discrimination against themselves. During focus groups, there were a lot of situations when health care workers refused to provide medical assistance to WLHIV and disclosed their status. Most of these cases were in maternity hospitals, dental clinics and during other surgeries. Therefore, most HIV-positive women are afraid to disclose their status and do not seek services from health care institutions, including primary health care services in their place of residence.

Have you talked to these doctors? What do they say about discrimination against people living with HIV?

We haven’t interviewed the health workers. However, many women believe that the reasons are in the lack of preparedness of health workers to work with PLHIV, as well as the low level of knowledge about HIV among staff. One woman, who went to the clinic, told doctors about her status. They immediately refused her services. The woman said it was a violation of her constitutional rights. But doctors said that she was ill and they could not help her anymore. Just imagine – that’s what the doctors said!

Besides in Tajikistan there is not good medical personnel who have experience working with PLHIV. A lot of professionals are leaving our country.

Let’s imagine – a woman found out about her status, she is ready to be examined, receive treatment and do everything that doctors say. Can she face any obstacles even in this case?

An antiretroviral therapy (ART) in our country is bought from the Global Fund, so there are virtually no interruptions. If a person wants to take ART, he or she can get it at all AIDS centers. But according to WHO’s recommendations, people living with HIV are assigned to PHC services and according to these requirements a person has to get the service at home. Due to the fact that in rural areas and small towns and districts everybody practically knows each other, PLHIV are afraid of disclosing their status. So there is a possibility that they will not apply to these services locally for ART services.

How difficult is it for women to accept their status?

More often it depends on their level of awareness and education – they might not know anything about HIV or have distorted information about the virus. Because HIV does not show strong symptoms in the early stages, women think that they are not sick and that the virus does not affect them. Also, accepting a diagnosis depends on a specialist working with the woman, conducting pre-test and post-test counselling.

Do you plan to use the results of your research in future work?

At the moment, the country is developing a “National Program to combat HIV/AIDS epidemic in the Republic of Tajikistan for the period 2021-2025”, and we have joined the working group on ART treatment and prevention of stigma and discrimination against PLHIV. As part of this platform, we are actively promoting the recommendations in our report.

At the same time, the research results helped us to identify and understand a number of issues, which we have not always paid due attention to before. Therefore, we will use this information in our daily work.

You can find the research here

 

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.

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.

 

Russian NGOs adopt the experiences of the Netherlands

How do Dutch NGOs fundraise? What are alternative financing models? How to look for sustainable sources of income for NGOs through corporations, private donors, and through social entrepreneurship?

For answers to these and other questions, representatives of Russian NGOs went to the Netherlands. They took part in a study tour organized from 10 to 12 February in Amsterdam by AFEW International. A study tour for representatives of Russian NGOs was held as part of the EU-Russia Civil Forum and the program “Bridging the Gaps: Health and Rights for Key Populations”.

Representatives of such organizations as Aidsfonds, Mainline, De Regenboog Groep, Dance4Life, as well as the Amsterdam Dinner Foundation shared their experience with the participants.

Nowadays traditional methods no longer satisfy the needs of Russian NGOs, which face great difficulties in obtaining international institutional funding and whose needs cannot be covered by available domestic funds. Thus, alternative funding may lead to less dependence on traditional institutional donors.

The purpose of this study tour was to become familiar with alternative financing models. Participants learned about the new experience of Dutch NGOs and gained knowledge on 7 financing models that do not involve receiving funds from institutional donors.

IT’S TIME

24 of March is a World TB Day 2020.World TB Day is a big moment to sound the alarm, raise attention, and tell world leaders to follow through on their promise to diagnose and treat 40 million people with TB by 2022, as agreed at the UN High-Level Meeting (UNHLM) on TB in September 2018.

We all need to work together now on important activities to make sure that World TB Day 2020 is the biggest and most effective.

What we together can do?

  • REACH OUT
    Reach out to your political leaders (Mayors, Parliamentarians, Ministers of Health, Heads of State) to request their leadership in the fight to END TB, remind them of the commitments and targets that have to be reached by the end of 2022, and request their engagement for World TB Day. This could include making a public statement, supporting an event, introducing a motion in parliament, or committing to achieve the UNHLM country targets.
  • GET SOCIAL 
    The hashtags for this year’s World TB Day are #ItsTimetoEndTB and #WorldTBDay. Start raising awareness through social media. Share your plans with us on Twitter or Facebook.
  • MAKE IT STARRY
    Reach out to celebrities, influencers, TV personalities, and other figures to ask them to join your efforts and raise awareness or wear a red arrow pin ahead of World TB Day. Stop TB partnership has a list of national celebrities, journalists and personalities that we can share with you case by case, so don’t hesitate to get in touch with us to get their contacts.
  • TEAM UP
    Team up with local TB partners to join forces in planning major World TB Day events, public mobilizations, and other activities. Stop TB partnership have a database of partners at country level – so do not hesitate to get in touch with us to be able to identify the partners with whom you want to work for these events.

Text – http://www.stoptb.org/

Drug Decriminalisation Across the World

How can we end the war on drug users? Ask the jurisdictions worldwide that have decriminalised drug use!

A new web-tool launched today shows that 49 countries and jurisdictions across the world have adopted some form of decriminalisation for drug use and possession for personal use. Experts say the number of jurisdictions turning to this policy option is likely to increase in the coming years.

Drug Decriminalisation Across the World’, an interactive map developed by Talking Drugs, Release and the International Drug Policy Consortium (IDPC), offers an overview of the different decriminalisation models – and their level of effectiveness – adopted all over the world.

Twenty-nine countries (or 49 jurisdictions) have adopted this approach in recognition that the criminalisation of people who use drugs is a failed policy, disproportionately targeting people living in poverty, people of colour and young people, and causing untold damage.

When effectively implemented, decriminalisation can contribute to improved health, social and economic outcomes for people who use drugs and their communities, as well as reduced criminal justice spending and recidivism. Further, there is no evidence that drug use increases under this model – or that it would decrease if criminalised. Decriminalisation is not a ‘soft’ policy option – it is the smart approach to reducing harms for individuals and society.

The major harms caused by the so-called ‘war on drugs’ have now been widely recognised: one in five people incarcerated for drug offences globally; more than half a million preventable deaths by overdose, HIV, hepatitis C and tuberculosis in 2016 alone; and severe human rights violations including arbitrary detentions, executions and extrajudicial killings. While this horrific situation is getting worse each year, the scale of the illicit drug market and prevalence of drug use continue to soar – at least according to the UN Office on Drugs and Crime’s latest global overview from 2019.

Niamh Eastwood, Executive Director of Release (the UK centre of expertise on drugs and drugs law), said: “What we really wanted to show here is the number and diversity of existing decriminalisation models adopted all over the world, and what the real impact is on the ground in terms of health, human rights, criminal justice and social justice outcomes”.

Ann Fordham, Executive Director of IDPC (a global network of non-government organisations that specialise in issues related to illegal drug production and use), said: “In Portugal, decriminalisation has significantly reduced health risks and harms. But that’s not the case everywhere. In Russia and Mexico, ill-designed models have exacerbated incarceration rates and social exclusion. When designing decriminalisation models, governments have to carefully review the evidence of what does and doesn’t work to ensure success”.

Imani Robinson, Editor of TalkingDrugs (online platforms dedicated to providing unique news and analysis on drug policy, harm reduction and related issues around the world), said: “The most useful element of this interactive map is that it highlights the impact of decriminalisation for communities on the ground. Many models enable the liberation of people who use drugs through a broad commitment to greater health and social gains overall and an emphasis on the provision of harm reduction education and services; others do not garner the same results. Smart drug policy is not decriminalisation by any means necessary, it is decriminalisation done right.”

Prospects for cooperation in the health sector in Uzbekistan

On January 10, 2020, AFEW International, represented by Anke van Dam, Executive Director, and Daria Alexeeva, Program Director, met with Ambassador of Uzbekistan in Benelux countries Dilier Hakimov.

AFEW International is considering possibilities to implement two projects in Uzbekistan. The first one is to develop and improve the quality of HIV testing and prevention services for key populations and support people living with HIV.

The second project, entitled “Strengthening civil society in inclusive health care in Uzbekistan”, is currently under consideration by the European Commission and is on the reserve list of projects.

At the end of the meeting, the parties agreed on a schedule for the AFEW International delegation to visit Tashkent on 15-16 January 2020. AFEW International’s team will have negotiations with the Republican AIDS Center, as well as with representatives of some international organizations, which may act as donors for the implementation of projects of the non-governmental organization in Uzbekistan.

AFEW International already has experience in working in Uzbekistan: the organization supported several projects in the country through ESF, as well as was involved in preparations for the AIDS2018 conference. In addition, representatives from Uzbekistan participated in AFEW International’s community based research education project.