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 and Aidsfonds.

 

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.

Good practices of intersectoral collaboration for HIV, tuberculosis and viral hepatitis

The WHO Regional Office for Europe is collecting examples of good practices of intersectoral collaboration for HIV, tuberculosis and viral hepatitis for publication in a dedicated compendium.

This compendium will include examples of actions undertaken by sectors outside the health sector, possibly (but not necessarily) in collaboration with the health sector. The practices should be aimed at improving the outcomes or the determinants of the HIV, tuberculosis and viral hepatitis epidemics, as encouraged by the UN Common Position on ending HIV, TB and viral hepatitis through intersectoral collaboration. They should also be accompanied by impact evaluations and credible monitoring mechanisms or research.

The above-mentioned UN Common Position was developed with an inclusive and consultative process to identify shared principles and key actionable areas within and beyond the health sector to address HIV, tuberculosis and viral hepatitis in Europe and central Asia. It was successfully launched at a side event to the UNGA in New York in November 2018 and subsequently distributed within UN system to all UN Resident Coordinators of the region.

The good practices must be submitted in either English or Russian using the form provided below. All submissions will be reviewed by the WHO Regional Office for Europe against the following criteria: relevance, sustainability, efficiency and ethical appropriateness. The authorship of each good practice will be highlighted in the compendium, which is expected to be published in 2020.

The deadline for submission is 18 November 2019. If you have any questions, please do not hesitate to contact daram@who.int. 

Mass media as partners in counteracting HIV/AIDS epidemic

Mass media play a major role in fighting for human rights, especially when it comes to population groups vulnerable to HIV. Through the wide media coverage of successful human rights defence cases implemented by community and civil society, the government can see that the community of People Living with HIV (PLHIV) and people vulnerable to HIV can and should be an equal partner and an ally in fighting HIV/AIDS epidemic.

This helps with forming a positive image of PLHIV and representatives of other key populations in the society, decreases stigma and discrimination, raises their self-esteem and self-significance and gives motivation for further activities and professional growth.

Thanks to the coverage of successful practices in mass media, a large number of PLHIV, people who use drugs (PWUD) and representatives of other vulnerable groups gain opportunity to get basic human rights knowledge, action plans and tools, which allow them to solve problems related to violation of human rights due to HIV in their own regions independently.

Liudmila Vins, project manager of LUNa Social Support Centre, legal adviser of Interregional Center for Human Rights in Yekaterinburg, has applied to the Emergency Support Fund for key populations in EECA for a grant. The goal of her project is to change the legal environment and public opinion towards people living with HIV and representatives of groups vulnerable to HIV through mass media.

Liudmila, what is the core of your project?

Our way of working is as follows – our lawyer together with partners, street lawyers from the regions, collects successful legal practices and strategically important cases, prepares the gathered materials for media publications, provides a legal evaluation and an algorithm for solving the problem. An info manger writes articles based on the cases for mass media and our own media resources, passes information about these cases to journalists through mailing lists, social media, and connects media and people featured in the cases in order to prepare further materials.

Could you tell us about the intermediate project results?

Yes, the project has substantially helped us to develop the informational part of our work and also gave a start to a new project of educating Russian NGOs on working with media. We found 17 cases, which resulted in 33 publications. Each case contained a story of at least one person – the leading story character, and at least 2 more people connected to the story, close relatives of the leading character. In total 51 people were featured in the stories.

Please share the most interesting and remarkable moments of the project.

The most remarkable example of support within this project is Olga’s story (the name is changed). We published it on our website.

Local journalists quickly noticed this material; they immediately reacted and published a number of articles about the fact that a woman in detention facility doesn’t receive treatment for HIV-infection. The news travelled fast: one journalist made a lot of requests to government agencies and received a positive decision from government officials. The result was that this woman received medication the same day.

You started your social support activities for vulnerable groups in 2009. How have the statistics changed since then?

At that time harm reduction programs were developing actively. However, the issue of defending the rights of PWUD was still unresolved, so starting from 2012 I began to develop street lawyers programming in Yekaterinburg. The need for this kind of support is very high now. In 2012 legal assistance was given to 100 people per year, and there was one street lawyer. Currently we work with 5 street lawyers, and we give this kind of support to people on a regular basis.

Who are the street lawyers?

These are people from the key populations community who are taught the basics of human rights defense. So, they can provide basic support with human rights defense, and then, if necessary, pass on cases to professional lawyers.

What is the attitude of the key populations’ representatives towards your activities?

We have a good connection with our target group, they are happy to receive our support. However, there are certain difficulties. For example, a person can disappear for a period of time while being under our supervision. Then (s) he appears again in a month, and we have to start from the beginning.

Why do you think it is so important to involve representative of key populations in such work?

Almost all of our staff members except for two are people from the key populations/PWUD community. I have been in remission for a long time myself. I think that a different approach is simply not effective. Nobody can truly understand PWUD as well as a person who has gone through it too, and most importantly, who was able to overcome it and solve a problematic situation successfully.

When people are doing something for the society, they often have an ideal example of such society in mind. Do you have one?

I don’t have examples of an ideal situation in any country. There are drawbacks everywhere. When it comes to talking about the approach to working with PWUD in Russia, I reply that there’s simple no such work. Those few NGOs that provide harm reduction programs, can’t reach all the PWUD to the full extent. For me the ideal situation is when the system of social support is developed in the country, there are harm reduction programs, access to quality treatment, and there is no stigma and discrimination within the society.

The project is supported by the Elton John AIDS Foundation and Aidsfonds.

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.