Peer navigators – indispensable medical assistants

Author: Marina Maximova, Kazakhstan 

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

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

Peer navigators – who are they?

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

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

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

Personal example and motivation

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

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

Trust on the Health Route

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

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

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

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

Monitoring of HIV-related stigma and discrimination

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

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

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

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

Facts abour EECA region

HIV epidemic status in Eastern Europe and Central Asia (UNAIDS, 2017)

Since the start of the epidemic:
• Over 76 million HIV-infected patients registered
• 35.0 million people died of AIDS-related illnesses
• The number of people living with HIV was 36.7 million, of which 2.1 million were children under the age of 15.
• 20.9 million people (28%) living with HIV received treatment
• 76% of pregnant women living with HIV had access to treatment to prevent transmission of the virus to the fetus
• In 2017, 1.8 million new HIV infections were reported worldwide.

Have you already registered your abstracts for the EECA INTERACT 2019 workshop?

Attention! Selected abstracts will get free registration. Please find here more information. 

School of MSM and TG Leaders

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

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

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

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

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

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

 

 

What is the indicative target of your country?

Nearly one year after the first-ever United Nations High-Level Meeting on Tuberculosis, the Stop TB Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Health Organization, call for immediate action to implement the commitments that were made by Head of States and Governments.

Targets that were agreed in the October 2018 Political Declaration of the High-Level Meeting of the General Assembly on the Fight Against Tuberculosis for 2018-2022 are:

1) to provide appropriate diagnosis and treatment to 40 million people with TB, including 3.5 million children and 1.5 million people with drug-resistant TB;

2) to reach at least 30 million people with preventive treatment, including 4 million children under the age of five, 6 million people living with HIV and 20 million other household contacts of people affected by TB;

3) to mobilize US$13 billion annually needed by 2022 for implementation;

4) to mobilize US$2 billion annually for TB research and innovation.

The Stop TB Partnership, in collaboration with Avenir Health, has produced a  breakdown of what the global 40 million and 30 million treatment targets mean for each country, using the latest estimates of TB disease burden and data on case notifications published by WHO. This country-by-country breakdown (http://www.stoptb.org/resources/countrytargets/) provides indicative targets and benchmarks that could be used to inform country dialogue, further refinement and development of official national and sub-national targets, linked to the development and updating of national strategic plans for TB and associated funding requests, including to the Global Fund.

TB is now the world’s leading infectious killer, surpassing even HIV. In 2017, TB killed 1.6 million people, including 300,000 HIV-positive people.

Several high-TB burden countries have already started to use indicative targets to plan their actions towards ending TB, and others must do so as well if we are to collectively achieve the targets of the High-Level Meeting.

“The UN High-Level Meeting in 2018 demonstrated much greater political commitment to tackling TB, but now we need to deliver. We urgently need increased international funding to fight TB, and increased domestic resource mobilization,” said Peter Sands, Executive Director of the Global Fund. “Together, we must step up the fight to diagnose and cure the millions currently being left untreated and to counter the threat of drug-resistant TB. We can only reach the goal of ending TB as an epidemic by 2030 if we act now.”

In honor of Elena Grigoryeva

The Pride Walk which will take place on the 2nd of August in Amsterdam will be dedicated to the murdered Russian LGBT and human rights activist Elena Grigoryeva.

One of the goals of Pride Parade is to draw attention to the current situation of LGBT people in countries where homosexuality is still an offence. The Pride Walk 2019 started with a manifestation at the Amsterdam Homomonument on Saturday 27 July 2019, where a photo of Grigoryeva was placed. After the manifestation, activist Kirill Khattoev, who demonstrated with Grigoryeva in the past, carried Grigoryeva’s photo at the front of the march through the city.

Who was Elena Grigoryeva?

Elena Grigoryeva was murdered near her home in Saint-Petersburg on the 21 of July probably because of her involvement in the Russian LGBT movement.

She was a brave defender of the LGBT community’s rights, who participated in various civil initiatives. Because of her activism, she had been receiving death threats for some time. Also, as acquaintances of Grigoryeva said, her name was on a list of LGBT activists published by a Russian website that called on people to take vigilante action against them. The site was designed to help users to hunt and torture Russian gay people and was recently taken down by authorities after more than a year online.

Still a problem

Across the globe, lesbian, gay, bisexual, and transgender people continue to face endemic violence, legal discrimination, and other human rights violations on account of their sexual orientation or gender identity.

AFEW pays a lot of attention to defending human rights of LGBT communities and the rights approach towards sexual orientation in the Eastern Europe and Central Asia region. In this region chronic forms of stigma, discrimination and violence based on sexual orientation are still creating huge barriers for individuals to seek medical attention and for LGBT community to access testing services and life-saving HIV, TB, viral hepatitis prevention. AFEW advocates for the equality and full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people in the EECA region.

 

School for People Living with HIV

Today, the community of people living with HIV (PLWH) in Kazakhstan is actively developing – the voice of community can now be heard at all levels, up to the Ministry of Health and the Parliament.

An important role in achieving this progress belongs to the events for potential activists organized by the Kazakhstan Union of PLWH together with AFEW Kazakhstan. One of them is a series of workshops called “School for People Living with HIV”. Such workshops are aimed at developing the community of PLWH to scale up the advocacy to promote their rights and interests and ensure care and support for PLWH at the local and national levels. They are organized with financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria within the project “Building Foundation for Sustainable HIV Response in Kazakhstan”. Yagdar Turekhanov, Program Advisor at AFEW Kazakhstan, told about the progress achieved.

 

Yagdar, what is the School for PLWH and how was it established?

The first workshop of the School for PLWH was held in November 2018 and brought together over 50 PLWH from all over the country. They were “newbies” – most of them just recently learned about their HIV status and did not have any experience of working in HIV organizations. People were enrolled after a competitive selection by motivation letters. It was a basic workshop where the participants learned about HIV, its treatment, and the role of civil society. They also received support in accepting their HIV status, bolstered their self-esteem and confidence. Following the first workshop, 25 most active participants who demonstrated their leadership skills, were selected. The goal of those workshops was to train a young generation of activists and to mobilize the regions to make the PLWH community of Kazakhstan act in a more targeted and coordinated way.

How would you describe the profile of the school participants?

Most trainees of the school are people who earlier had an experience of participating in similar activities, mobilized their peers and established local NGOs, making a significant contribution to the promotion of PLWH rights, reduction of the ART prices, etc.

What is the situation with PLWH rights in Kazakhstan?

The situation is different, and currently it greatly depends on separate individuals – friendly specialists, doctors, police officers, and workers of penitentiary facilities – as well as on the bravery and knowledge of the activists. Where such people are not numerous, the situation with observing the PLWH rights is disastrous.

What should a person do in case if his or her rights are violated?

Be brave enough to talk about it. File the case. Make a precedent. For this purpose, the person may ask more experienced community members and friendly lawyers for help.

Since 2019, Kazakhstan started using the ‘test and treat’ strategy. What does it mean?

For Kazakhstan, this approach, first of all, means breaking the stereotypes, challenging the traditional perceptions and the wide-spread myths about ART. It means fighting the “bonuses schemes”, when people take therapy only to get some incentives, but not because they see the linkage between ART and better quality of life. It includes working with health professionals, who can formally observe the protocols, but in some indirect ways, with their intonations, phrases, or even directly make their patients understand that they do not believe in what they do. E.g., they can often say something like “According to the new rules, I have to prescribe therapy to you, but you can refuse, all the more so because you have pretty good test results and those drugs are chemical anyway” or “I realize that you want to give birth to a child, but still you have to think twice as your husband has HIV and even if he does not transmit the virus to you – what will be the future of your child?” We try to change this kind of approach.

Is there a place for innovations in the PLWH community of Kazakhstan?

The active part of PLWH community is, of course, open to innovations – they are ready to introduce new approaches as soon as they learn about them or come up with them. Most of the general population are kind, empathetic people who are totally unaware of the modern scientific achievements in terms of HIV prevention and treatment. They are afraid for themselves and for their loved ones, thinking that HIV is a death sentence. Many people still think that HIV is transmitted through household contacts (“I know that HIV is not transmitted through air or touch, but just in case I would better protect my children from contacts with HIV-infected people”). It looks like this situation can only be changed by young people who are in their nature more open to new things, more tolerant and less prejudiced. Efforts aimed at young people, primarily at the students of medical colleges and universities, with the involvement of PLWH community, can gradually change the status quo. By the way, it is already happening – slowly but surely.

Will there be any workshops in future? Who will be able to participate in them?

Funding of such activities is currently very doubtful – donors gradually lose their interest to Kazakhstan, while attracting government funding is so far rather challenging. However, PLWH community is looking for new opportunities. Apart from the Schools for PLWH, PLWH camping events are held on a regular basis, where people more and more often pay for their own participation. Information about such events is shared through HIV NGOs, AIDS centers, social networks and messengers. The priority is given to “novices”. More experienced PLWH community members can try on the role of trainers after passing a competitive selection.

 

 

 

 

 

UNAIDS outlines progress on HIV, but decries funding cuts

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

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

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

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

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

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

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

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

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

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

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

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

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

 

EECA INTERACT 2019

We are pleased to announce that, on the 18-19th November 2019, the first EECA INTERACT Workshop 2019 will take place in Almaty, Kazakhstan.

The EECA INTERACT 2019 Workshop builds scientific research capacity while simultaneously strengthening clinical, prevention, and research networks across the Eastern Europe and Central Asia (EECA) region. EECA INTERACT 2019 is an abstract-driven workshop focusing on factors unique to the region’s HIV, TB, and hepatitis epidemics. Bringing young and bright researchers together with top scientists, clinicians, and policymakers, EECA INTERACT 2019 aims to ignite a conversation that will build a stronger scientific base to serve the region and connect to the world.

EECA is the only region in the world where the HIV epidemic continues to rise rapidly. UNAIDS estimates point to a 57% increase in annual new HIV infections between 2010 and 2015.1 The World Health Organization has warned of a sharp rise in rate of HIV and tuberculosis coinfection, which poses a real threat to progress.2 Significant barriers to prevention and treatment services remain for people living with and affected by HIV, TB, and hepatitis across the region. For example, although the HIV epidemic in EECA is concentrated predominantly among key populations, particularly among people who inject drugs, coverage of harm-reduction and other prevention programs is insufficient to reduce new infections. The region urgently needs more effective strategies of prevention, treatment, and care and support that are tailored to the particular circumstances of individual countries.

The Amsterdam Institute of Global Health and Development (AIGHD) has over a decade of experience delivering in-country workshops and conferences that bring young researchers and established international experts together to share original research and state-of-the-art reviews on a wide range of topics. AIGHD has co-hosted the INTEREST Conference (the International Workshop on HIV Treatment, Pathogenesis, and Prevention Research in Resource-limited Settings) since its inception in 2007. The conference has grown from a small workshop to a full conference of more than 500 attendees each year.

Building on these proven results, AIGHD will collaborate closely with AFEW International and the AFEW network (AFEW) for EECA INTERACT 2019. AFEW’s deep roots and experience in the region offer a way to build sustainability into the new workshop, placing priority on local contributions. The EECA INTERACT 2019 will bring scientists, clinicians, members of civil society, and government officials together to tackle topics facing individual countries while building capacity and strengthening research and clinical networks. The two-day conference will focus on topics that are specifically relevant to EECA and dive deeply into particularities of the host country Kazakhstan, showcasing its successes, remaining challenges and responses.

The workshop objectives are:

  • To provide cutting-edge knowledge in the fields of epidemiology (modelling), treatment, pathogenesis, and prevention of HIV, TB, and viral hepatitis as well as chronic conditions;
  • To exchange ideas on providing and supporting HIV testing services and clinical care provision to adults, adolescents, and children living with HIV to achieve 90-90-90 goals;
  • To foster new research interactions among leading investigators and those who represent the potential future scientific leadership for health care and research in the region;
  • To build research and clinical capacity across EECA.

We invite researchers from EECA to submit their abstracts in the workshop. Selected abstracts will get free registration. Please find here more information.
Interested parties who do not have abstracts, but also wish to attend the event, can fill in an application form that will be considered by the committee. Please find here more information.

The deadline for all applications is September 20, 2019.

EECA INTERACT 2019 is organized by AFEW International, Amsterdam Institute for Global Health & Development (AIGHD), AFEW Kazakhstan and the Kazakh Scientific Center of Dermatology and Infectious Diseases.

EECA INTERACT 2019 is sponsored by Johnson & Johnson, Gilead, Aidsfonds.

Venue of the event: Hotel Mercure Almaty City Center.

#EECAINTRACT2019

If you have any further questions, please contact Helena_Arntz@AFEW.nl.

 

 

“Orange morning”

On the 28th of June, in the framework of the project Fast-Track TB/HIV Responses for key populations in EECA (Cities) Almaty city in Kazakhstan held an important event for the community of people who use psychoactive substances – a photo exhibition “Orange morning”. The event was organized in honor of the World Campaign “Support. Don’t Punish”, which is held annually on the 26 of June, on the International Anti-drugs Day.

#SupportDontPunish is a global grassroots-centered initiative in support of harm reduction activities and drug policies that prioritize public health and human rights.

The color of this protest and the need to overcome aggressive drug policies and stereotypes against people who use psychoactive substances, with a focus on women, has become orange.

Women, the characters of the photos, shared their life stories about aggressive drug policies and systems that destroy their lives. The event organizers say that the main goal of the exhibition is not to appeal to emotions, not to cause regret, sympathy, condemnation or contempt. The goal is to call for the end of this senseless war that doesn’t bring any results. The war on drugs is beneficial only to politicians, law enforcement agencies and drug mafia.

AFEW Kazakhstan in the face of Roman Dudnik, executive director of the organization, supported the exhibition. “The greatest value of such events is that the campaign “Support. Don’t punish” is becoming more and more popular and followed in the world, and this is an excellent result,” Roman says.

A video report from the exhibition you can watch here https://youtu.be/1qS6J4gwfbw.