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 available 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 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.

Help Here and Now

“If you can help someone Here and Now, you should do it without postponing it or thinking what other people can do,” says Ekatherina Rusakova, Director of Sverdlovsk Regional Charitable Organization “Malaxit” supporting people in difficult life situations. “If every one of us helps at least one person, maybe it will drive changes in the society.”

To support these words, Malaxit implements the project “Social and legal support of people who use drugs in Yekaterinburg” with financing and support of the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia (EECA).

Ekaterina how does your organization help people who use drugs in Yekaterinburg?

Ekatherina Rusakova, Director of Sverdlovsk Regional Charitable Organization “Malachite”

Mainly we provide social and legal support to clients to eliminate regulatory and discriminatory barriers, help them to get fair court decisions and access to free rehabilitation. Besides, we provide our clients with referrals to healthcare and social support institutions of the city. Our social worker makes outreach visits to families with small children. He provides consultations on HIV and treatment, helps clients to make appointments with specialists, assists them in re-issuing documents and receiving temporary registration in the city as clients are not able to receive medical or social services without registration.

Why did you decide to apply to the Emergency Support Fund for Key Populations in EECA?

We applied to the Emergency Support Fund because the situation of PUD in our city is difficult. Many people still do not recognize that substance use is a disease. However, this condition needs comprehensive treatment, including medical assistance, psychological and social support. Moreover, efforts should be aimed not only at the person using substances, but also at such person’s family as substance abuse is a systematic, family disease.

Of course, current situation contributes to the growth of HIV and other socially significant diseases (tuberculosis), while people who use drugs remain outsiders and the society prefers not to notice them. However, it is not possible to solve this problem pretending that it does not exist, after all sooner or later it will manifest itself and, most likely, in a very negative way. That is why, in our opinion, enough attention should be paid to secondary prevention and working with the “risk groups”.

What case from your practice do you remember best of all?

Andrey, a representative of the Rehabilitation Center, Dmitriy Kadeikin, consultant, and a social worker of the project, after a lawsuit in Revda, Sverdlovsk Region

That’s a story of one of our clients. Andrey came to our project when he learned about it from his friends. Back then, there was an investigation against him based on part 2 of article 228 of the Russian Criminal Code. Our staff members signed a social support agreement with him, drafted procedural requests and collected all the necessary documents. Social worker of the project acted as a community advocate in court. A person from the rehab also took part in the court hearings. As a result of our joint efforts, Andrey got a suspended sentence with a course of rehabilitation.

What does the society think about your work?

It depends: some people support us, some don’t and it’s fine! All people cannot think the same and have the same “view of the world”. We are all different, with various views, values, attitudes, and that’s the beauty of human beings – in their differences…

Have you ever faced any challenges working with the key populations?

Speaking about the members of key populations, our target groups, they are all positive about our activities, they trust our staff members and our experience. We mostly see challenges related to new psychoactive substances, which our clients still use. That is why they can have unpredicted behaviours, treatment interruptions, etc.

How does engagement of the key populations in your activities help you in your work?

I think that when implementing such projects it is very important to engage members of the key populations. Without such engagement, it is not possible to reach PUD, who are a very closed target group, especially considering that in this group there is a very low level of trust to people.

Your example of a perfect society.

I don’t think I could give you an example of a perfect society. I tend to be realistic when looking at things, not losing myself to illusions. I do not like it when people say that somewhere there is a perfect country and a perfect society, where everything is fine, which we should strive to achieve. There are some pitfalls everywhere. It is important to realize that there are good things everywhere and we need to learn to notice and appreciate them. I am sure that we have to always start with ourselves and you can of course feel offended and be angry at our country and our authorities, but it does not bring any results. Speaking about a specific country with the approach to working with key populations that I like, for me it’s Portugal.

The project is supported by the Elton John AIDS Foundation.

 

What does good collaboration between municipalities and NGOs mean?

AFEW International (The Netherlands) was a technical partner in the Fast-Track HIV/TB Cities Project, which was implemented between 2017-2019. The main goal of the project was to develop efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in five project cities; Almaty (Kazakhstan), Balti (Moldova), Odesa (Ukraine), Sofia (Bulgaria), and Tbilisi (Georgia).

AFEW International with expertise on increasing access to health services for HIV, TB and viral hepatitis for key populations, is well-connected to Dutch health care providers. Within the Fast-Track HIV/TB Cities Project, videos were made to feature professionals working for municipalities, consultancies and NGOs, law enforcement agencies in the Netherlands and on an international level. What good collaboration between municipalities and NGOs means, why service-delivery for sex workers, People Who Use Drugs and LGBTQI is funded by the dutch municipality, and how this is organized? Answers on these questions are in this video.

 

 

 

Study tours help the public and non-public sectors to hear and see each other

For many years, NGOs have been engaged in study tours with visits to various organizations and institutions in other countries. While experience shows that not all study tours are equally useful – sometimes practices that work well abroad are incompatible with local realities – study tours have overall proven to provide participants with new knowledge and valuable practices that can be applied.

AFEW-Ukraine, partner in the “Bridging the Gaps: Health and Rights for Key Populations” programme, has noticed that at the local level partners benefit from sharing knowledge and experiences. Whereas each organization has its own reality and experience, NGOs all work in similar conditions. Since 2016, AFEW-Ukraine is regularly involved in the organisation of study tours for representatives of public organizations and government agencies, and colleagues working in other regions of Ukraine.

For Oleksandr Mohylka, Project Coordinator at the Compass Social House (KCF “Blago”, Kharkiv) and Nataliia Zlatopolska, Project Coordinator at the Altair Youth Friendly Center (PRCF “Public Health”, Poltava) study tours in Ukraine have proven to be an inspiration for bringing about change in their organisations and for their work with adolescents using drugs.

Where?

Oleksandr: As part of the project “Bridging the Gaps” this year, two social workers and me went to the CF “New Family” in Chernivtsi and their Psychosocial support center “Dialogue”. We wanted to know about their rehab program for teens. This was important for us because we wanted to provide rehabilitation services for adolescents who use drugs.

Nataliia: We had two trips to Kropyvnytskyi and Kharkiv. In Kropyvnytskyi we visited colleagues from the Social bureau “Lily” (CF “Return to Life”) and their partners in the city. In addition to Altair employees, we included representatives of the center for vocational training education, the department of juvenile prevention and the city center for family, children and youth.

The choice of partners for the trip was not accidental. For example, the practice has shown that our clients are mainly students of vocational schools, and through direct interaction with management, it is easier to connect with this group, to make our work process systematic to reach more people and achieve positive dynamics. Juvenile prevention redirects clients to us, and we engage them in training project leaders.

In Kharkiv, we had the opportunity to get acquainted with the experience of their Compass Center. First of all, we were interested in what tools the organization uses to work with our target audience, and how their partners’ network works.

Goal

Oleksandr: We had a very tight trip. It was interesting how the rehabilitation was organized – statutes on rehabilitation, the program, orders of local authorities etc. This is what we can apply now in our everyday work. It was interesting to learn how it all began to work, why there was a need for certain documents, what mechanisms these documents regulate, what is the role of the City Coordination Mechanism. We were also interested in the interaction of the “New Family” with the Coordination Council since this is a positive experience of interaction.

Nataliia: We had a meeting with the deputy mayor of Kropyvnytskyi for humanitarian issues, a dialogue showed that the public sector in Kropyvnytskyi understands what benefits it has from working with NGOs. Project specialists proved the importance of interacting with them with the help of numbers, statistics, cases, and stories. And we took this experience forward.

We also saw how the ideas of the project clients are implemented. We saw that they are really possible to fulfil. And these are not just dreams – it is actually possible to realize the ideas of adolescents. For example, we liked the idea of ​​sketching the addresses of Telegram drug distribution channels, not on their own, but using the resources of the city.

What was learned?

Oleksandr: It was after the trip to Chernivtsi that we made a firm decision that we would do a rehabilitation program. And we realized that we should do our own program, not the same as in Chernivtsi. The drug scene and, accordingly, the behaviour of adolescents and the consequences of using drugs change. Thanks to the trip to Chernivtsi, we now better understand how to take into account the unique experience of our colleagues and to make our rehabilitation program maximally meet modern challenges. We have already presented our idea to the Coordinating Council of Kharkiv. In the new City drug program, the development and support of a rehabilitation center for youth are now registered on the basis of our Social home! We were inspired by their experience and success; we saw that this is all real in our country. Moreover, now, apart from the “Dialogue”, no one is doing rehabilitation separately for teenagers in Ukraine. We always say that in Ukraine we have the experience of a successful rehabilitation center for adolescents and that we learn from them and are ready to contribute.

Nataliia: We “brought” new work tools home – for example, a step-by-step mechanism for referral clients from our city partners (educational and law enforcement agencies, social services, etc.) to us. In Kropyvnytskyi, if one of the key partners discovers a teenager who is probably using drugs, he or she will immediately be redirected to the social bureau “Lily”. And we studied communication mechanisms, registration log and so on. We also liked the practice of the leaders’ school. In addition, we spied on the work in the organizations themselves, how employees interact and were inspired by their atmosphere.

Results

Oleksandr: Study tours with partners to colleagues from Ukraine are a very high-quality mechanism for obtaining of well-deserved trust from government bodies and our main partners – the police, social services, educational and medical institutions. Such joint actions help them understand that we are doing real things, we are doing things that government agencies are not doing because of limited resources, instructions or something else. But the main thing is that we complement their work very well. We let them know that we are ready to help and train. We noticed that upon returning, even the level of relations changed, as well as the number of redirects to the Center. At the same time, during such study tours, we ourselves see how government bodies work and what kind of help they need.

Nataliia: Study tours help the public and non-public sectors to hear and see each other. Employees of various services in different cities may have different views, but this does not prevent them from communicating and sharing experiences and thoughts. They can understand what powerful resources we have, and that we really bridge the gaps in their work, too. Previously, for example, various myths were circulating about NGOs in our city that interfere with the organization’s work. After this visit, all questions of officials were removed, and the level of mutual trust continues to grow.

With the organisation of study tours, AFEW-Ukraine thus fosters in-country processes and partnerships to reinforce results in line with Bridging the Gaps Theory of Change. The organisation contributes to deliver and advocate continuously for strengthening services and upholding human rights for adolescents who use drugs in Ukraine.

 

 

The EECA City Health Leadership Forum

On the 6 December 2019, the EECA City Health Leadership Forum will be organized in Kyiv, Ukraine, showcasing the results of the Fast Track HIV/TB Cities Project (2017-2019)

The Forum will focus on discussing the regional context, sharing successful HIV and Tuberculosis city response models and facilitating movement towards ending these diseases in Eastern European and Central Asian (EECA) cities. It will include a Mayors’ high-level panel discussion, presentations of successful city responses and innovation to fast-track cities to 90-90-90, which will feature the inclusion of key populations in the cities’ responses. The Forum will gather over 150 delegates from 20 countries of the EECA region, including 11 city Mayors.

The Fast-Track HIV/TB Cities Project

Launched on World AIDS Day 2014, the Fast-Track Cities initiative has grown to include more than 300 cities and municipalities that are committed to attain the UNAIDS 90-90-90 targets: 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART); and 90% of all HIV-diagnosed people receiving sustained ART will achieve viral suppression.

Alliance for Public Health (Ukraine) together with AFEW International (The Netherlands), licit (Switzerland) and Stop TB Partnership under technical guidance of UNAIDS EECA office with funding of The Global Fund initiated the regional Fast-Track HIV/TB Cities Project. The project was implemented between 2017-2019 and developed efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in five project cities; Almaty (Kazakhstan), Balti (Moldova), Odesa (Ukraine), Sofia (Bulgary), and Tbilisi (Georgia).

Amsterdam was one of the first to sign the Paris Declaration in 2014 and has introduced a comprehensive health policy for key populations. AFEW International with expertise on increasing access to health services for HIV, TB and viral hepatitis for key populations, is well-connected to the Municipal Public Health Service and police in the Netherlands. This expertise was shared in two training courses and a study tour.

International best practice suggests that collaborative city level models have been most effective in reducing HIV and TB burdens. The first training series, ‘Collaboration between municipalities and civil society – models and realities’, were designed as an exchange and sharing of experience and best practices in successful models of municipality and NGO partnerships. Five integrated work meetings and counselling sessions with selected project city stakeholders from municipality, health and social sector, NGOs and key populations were conducted by licit and AFEW International and improved key populations’ service access through better collaboration between relevant city stakeholders – most importantly, between municipalities and NGOs.

The second training series on innovative municipality funding approaches planned exchanged and adapted such approaches and income generating activities. The training replicated successful practices in the project cities through learning from experiences in Amsterdam. During this training the best international practices of public-private partnerships at city level and private funding for key population programmes offered inspiration for the participants of the training.

During the study tour different partners of AFEW International shared models, experiences and activities that demonstrated successes and challenges in increasing access to health for key populations. Project partners from Almaty, Kyiv and Tbilisi were provided the opportunity to connect to civil servants and different health actors within the Netherlands and discuss initiatives to reach out to key populations to increase their quality of life. Furthermore, representatives of municipality, police and NGOs working with key populations elaborated on different forms of collaboration, to prove that the only way to eliminate HIV and TB is if municipality, police and NGOs work together.

 

 

HIV in prison is not a death sentence

Nowadays Kyrgyzstan is recognized as one of the most advanced countries in the world in regards to delivery of the harm reduction and HIV care and treatment programs in prisons (details here).

At the moment here, in the penitentiaries, there are 5 active programs: syringe exchange program, methadone maintenance treatment program, rehabilitation program “Atlantis”, Center for Rehabilitation and Social Adaptation “Clean zone” and “Start Plus” program.

Dina Masalimova, AFEW-Kyrgyzstan program manager, explained what kind of work is done in this field in the country, and which significant results have already been achieved.

Dina, could you please describe the programs for inmates? What do they look like?

A pilot program on needle and syringe exchange was introduced in Kyrgyzstan in 2002, in one of the prisons with a modest reach of 50 people. A year later the program was expanded to 3 prisons, and then several more. Today there are 14 syringe exchange stations (SES) in the penitentiary system. They work in all the prisons except for the facility for underage convicts. Also, syringe exchange services are provided in the 2 largest detention centers. An actual number of SES clients in 2018 amounted to over 1300 people. They received syringes either in person, or through a secondary exchange conducted by volunteers. Aside from the sterile injection equipment you can also find other protection items at the stations – alcohol wipes, condoms; and HIV blood tests are done here too. Those clients that would like to decrease or fully stop the injecting drug use are forwarded to the methadone maintenance treatment stations.

The methadone maintenance treatment program was started in the country’s prisons over 10 years ago – in 2008.  Today there are already 9 stations in the penitentiaries, and the number of clients is over 350. These programs are conducted by the State Penitentiary Service with the support of the Global Fund To Fight Aids, Tuberculosis And Malaria, as well as Center for Disease Control (CDC).

Aside from the harm reduction programs there is a program aimed at the full withdrawal from drug use in prisons. In a number of places the  “Atlantis” program based on the famous model “12 steps” is active. The program graduates can serve their remaining sentence time in the Center for Rehabilitation and Social Adaptation “Clean zone”. “Clean” means that it’s free from drugs. There is a full-scale program of rehabilitation and preparation for sober life outside of prison there.

Over the past 5 years we also were active in delivering services directly to inmates. For instance, our consultants have supported prisons’ health system by providing peer-to-peer consultations and HIV testing, as well as supported inmates before and after their release from prison. For a long time this program has been implemented with the support of USAID. Soon it will be continued thanks to the financial and technical support of ICAP (international program by Columbia University’s Mailman School of Public Health).

How are these programs created, and who delivers them?

As a rule, these programs are created based on the actual needs of the most vulnerable groups of prisoners – people living with HIV and/or using drugs. And these programs are also delivered by the representatives of these communities.

We approach the program in a flexible way and always try to improve it so that it remains relevant. For example, one of our recent additions to the program is working with the convicts that were rejected by the prison subculture. Due to the unspoken prison rules this group of prisoners has the lowest level of access to medical and social support and faces a high level of stigma and discrimination from the other convicts, and often also from the prison staff.

Could you share some results of these programs?

All the programs currently active in the country are aimed at reaching the ambitious goal 90-90-90.  Now almost all inmates in prison are being tested for HIV “at the entrance”, and a vast majority of people living with HIV are formally in treatment. Why “formally”? The viral load indicators show that quite a few of inmates don’t use it. In prisons there are a lot of myths about HIV and antiretroviral therapy, and during in-person conversations many patients admit that they simply throw medicines away. Because of that, the main goal of our project is to increase the number of convicts who live with HIV with undetectable virus load.
Over the years we achieved great results. For instance, in prison #31 the number of people who are adherent and have a suppressed virus load has grown from 15% to 68%, and in prison #16 – from 33% to 66% in the past three years. We are especially proud of two prisons – #2 and #47, where we’ve already reached the second and third “90”.

All these programs are mainly targeting male convicts. Are there any special programs for female inmates, for pregnant women?

In Kyrgyz prisons there are only 10 female inmates living with HIV. However, it is also important to consider their needs while planning measures in response to HIV-epidemic. We approach work in female prisons quite reverently and are trying to make sure our programs are gender-sensitive.  In one prison there was a women self-help group focusing on gender violence prevention. Also we partner with NGO “Asteria”, which runs a women’s center supported by AFEW-Kyrgyzstan and open for women released from prison. Many of the center’s clients are former inmates, and the help and support program includes temporary lodging, provision of food and hygiene packages, peer consulting on HIV, sexual and reproductive health and rights (SRHR) and opioid substitution treatment (OST), as well as provides access to gynecological services.

What is the prisoners’ attitude towards such programs?

Inmates perceive this program in a very positive way. Slowly but surely our team managed to win their trust and involve them into the dialogue about their health. It’s important to understand that health is far from the first priority for a person in prison. Unfortunately, current conditions of prisons make basic survival the main priority, and HIV is perceived as a far removed problem for many of them. Our peer consultants have their own experience of living with HIV in a prison, so they can show by their own example how one could solve upcoming problems.

Could you name the main current problem for prisoners with HIV in Kyrgyzstan?

One of the main problems is the lack of medical staff in the penitentiary system. In a number of large prisons in the country there are no doctors with higher medical degree. All the work on supporting prisoners’ health is put on the shoulders of a small team of paramedics. Of course, very often they have no time or knowledge needed to perform quality work on supporting inmates with HIV. We also try to help in such cases. For example, in prison #16 there was no doctor for a whole year, and our organization set up weekly visits of a doctor from the Republican AIDS center in order to support the patients.

It is often said that many prisoners don’t trust prison staff, including health workers…

Yes, it’s a separate and quite serious problem, and the consequence of it is the unwillingness of prison inmates to follow doctors’ recommendations. Our consultants serve as a certain “bridge”, which helps to build trust-based relationships between doctors and patients. For instance, with the patients’ agreement they take the results of viral load and cd-4 tests and thoroughly explain their meaning to the patients, e.g. the influence of the therapy on those indicators etc. We try to find individual approach to everyone. For many people the possibility to have a family and healthy children when they reach undetectable viral load becomes the best motivation for treatment.

It seems that peer-to-peer consulting is a really life-saving tool when it comes to fighting for the health of prisoners living with HIV, isn’t it?

Александр Certainly! We have so many stories that prove it. For instance, the story of Alexander. He learned about his positive HIV-status in 2013. His prison mates gave him a clear verdict that he would die soon. Needless to say, he was in great shock. He didn’t have any access to information, and doctors didn’t explain much. On the verge of desperation he started to use more drugs. He looked at the people with positive HIV-status around him, and they were dying one after another. He also waited for his turn.
In 2016 peer consultants from the Action against HIV project started to come to the prison. One of them – Evgeniy – really impressed him. He was living with HIV himself, but he didn’t look like he was dying at all, quite the contrary. During one conversation with a peer consultant Alexander got more information than in the previous 3 years of his life with positive HIV-status. At that moment he told himself: “Enough. I choose life”. He started treatment and quite soon reached undetectable viral load.