AFEW International and Partners Start Implementing a New Project in Russia and Kyrgyzstan

Anke van Dam (on the right) and Daria Alexeeva presented the project in Russia. Photo: E.V.A.

Starting from January 2019, AFEW International began to implement the project St. Petersburg and Bishkek – Key Populations and HIV & TB Prevention Priorities funded through the Aidsfonds under the PITCH. The project covers key populations and HIV and tuberculosis prevention priorities in St. Petersburg, Russia and Bishkek, Kyrgyzstan.

PITCH is a strategic partnership between Aidsfonds and the Frontline AIDS (former International HIV/AIDS Alliance) working with those most affected by HIV: adolescent girls and young women, LGBTI, people who use drugs, prisoners and sex workers. The program aims to enable these groups to transform (inter)national HIV responses by strengthening their advocacy skills and capacities and promoting the innovative evidence-informed practice. This will contribute to cities in the Russian Federation and Eastern Europe and Central Asia (EECA) joining the fast-track city initiative and building political support for an HIV/AIDS response focused on key populations.

“Within this project, we are focusing on working with St. Petersburg and Bishkek and municipal level governments on HIV geographically-focused responses,” says AFEW International’s program manager Daria Alexeeva. “In this way, we are continuing our work we stared under the Fast-track Cities project in partnership with Alliance for Public Health where we are developing models of sustainable city responses to HIV and TB in key population in EECA that significantly contribute to achieving 90-90-90 HIV/TB targets for key populations.”

The project St. Petersburg and Bishkek – Key Populations and HIV & TB Prevention Priorities will work on several strategies: community based participatory research to reveal the most acute needs of the key populations, changing attitude of the decision maker towards key groups, involving key groups into the advocacy process, and experience exchange between the three countries, negotiations with the cities authorities on signing Paris Declaration and Zero TB Declaration.

People who Use Drugs Deserve Love, Respect and Support

Author: Grana Ziia, AFEW-Kyrgyzstan

Sergey Bessonov from Bishkek is the head of the organization that protects the rights of people who use drugs (PWUD) – “Harm Reduction Network Association” (HRNA). Sergey himself used drugs in the past. However, he admits that everyone has the right to make his own choice whether to stop using drugs or not.

Now Sergey dedicates his life to the community of people who use drugs. In his interview with AFEW-Kyrgyzstan, Sergey is talking about the challenges of the community of people who use drugs in Kyrgyzstan, drug policy and his future plans. Below are some of Sergey’s thoughts in direct speech.

About the desire to be heard

For a long time, the problem of drug use was solved by using strict bans: prisons, fines, and information that PWUDs are no longer members of our society, that they are somehow bad, dangerous… I myself know a lot of people who died from the overdose, I saw people who spent most of their lives in prisons for using soft drugs. These people were left without work, housing and the possibility to live the life they wanted to.

Now in Kyrgyzstan, the government started to understand that a progressive drug policy cannot be built without a community. However, it is very important for us that the community participation in the development of programs was not just for show. We want our opinion to be respected, considered and trusted. We need the possibility of professional growth.

About the professional growth

The project “Bridging the Gaps: Health and Rights for Key Populations” (BtG) started to help us a few years ago. Over the past two years, this project gave people from the community the possibility to take part in trainings on negotiation skills, legal monitoring by the community, analysis of regulatory legal acts.

These trainings helped us to develop some of our skills. Using this knowledge, people from our community started to develop their own organisations, participate in working groups with governmental representatives and implement advocacy programs.

About the new drug policy

Last year, our country started talking about changes in criminal and administrative codes. Governmental representatives finally understood that sending people who use drugs to prison instead of rehabilitation and harm reduction programs is ineffective and cruel.

During the analyses of new regulatory acts that HRNA conducted with the support of the BtG project and AFEW-Kyrgyzstan, we found some negative changes. For example, new amendments, which now started to work, increased the fine for carrying and possession of drugs twice. The new fine is unaffordable, which means that people will again be imprisoned. Now we are negotiating with international and state structures, with other NGOs and explaining to them why this novelty needs to be revised.

BtG also provided us with an opportunity to conduct focus groups among PWUDs. We found out that not all people are aware of the new laws. This creates extortion and corruption. Now we are constantly monitoring new cases of detention of drug users and support people who use drugs.

About the alternative to prisons

According to the new offense code of Kyrgyzstan, alternative punishment that is called probation is provided for people who use drugs and who have committed any kind of offense. Therefore, now a person has an opportunity to avoid prison.

The initiative itself is very good and we now have a lot of work for its successful implementation. We have already come to the agreement with several probation services and they are letting us know if a person who uses drugs came to them.

HRNA also plans to work with judges to explain that we should punish people only for offenses, not for using drugs. People in our country still have many stereotypes towards people who use drugs. These stereotypes can influence judges’ decisions about sending a drug user to prison or probation.

About the needs of the community

People who use drugs almost always remain alone. Parents turn away from them, doctors reject to help, friends betray them, mass media use offensive words, police suspect them in all crimes. Sometimes we become the only home and friend for each other. With our examples, we show that people who use drugs deserve love and respect.

To help our community to be strong and united, the BtG project is supporting our dialogue platform. Thanks to this, we can meet, discuss and stay united. I feel that the community is getting stronger and more confident with years passing by.

Together we build a liberal healthy future in Kyrgyzstan, where every person can get help and fulfill their potential.

Why Ukrainian Key Communities Unite in One Platform

Author: AFEW-Ukraine

In many countries, different key populations unite. They do it for the better representation of their interests in the development of public policy. This is often the alliance within one community, and less frequently – of several communities.

Four key populations in Ukraine – ex-prisoners, LGBT, people who use drugs (PUDs), sex workers (SW) – have their own self-organizations, being at different stages of development. There are communities with great experience in advocacy and work with international donors, but there are those that are at the initial stage of development. They grow stronger with the support from more experienced activists.

“Despite growing importance of the community voice in decision-making processes related to access to health and social services, very often representatives of HIV-service organisations speak on behalf of key populations rather than community representatives. Having the voices of community directly heard leads to a situation where the actual needs of key communities are much better taken into account in programs planning and implementation”, says Olena Voskresenska, executive director of ICF “AIDS Foundation East-West” (AFEW-Ukraine).

In October 2015, during the meeting held within the framework of Tripartite cooperation between the Kingdom of the Netherlands, UNAIDS and civil society, community activists expressed the idea of creating a Platform. This Platform had to become an independent structure for sharing experience, dialogue and developing a common position and advocacy messages of several communities, as well as facilitating representation of communities in public bodies, working groups and other organizations. In addition, the Platform could contribute to collecting data on the needs of communities and raising new activists.

“My idea was to give communities the opportunity to advocate for their rights and change policies and to bring communities together to help each other. Also, it was important to allow communities to develop and mobilize themselves without external influence,” recalls Petro Polyantsev, a member of CKPP steering committee.

Creating the Platform

Initially, it was necessary to understand whether all key communities are interested in the Platform. Then the priorities of the Platform had to be identified. In 2016, the most active representatives of the LGBT, SW and PUD communities formed an initiative working group. Participants of the Tripartite cooperation initiative – UNAIDS, ICF “AIDS Foundation East-West” (AFEW-Ukraine) and LGBT Association “LIGA” (partners in the project “Bridging the Gaps: Health and rights for key populations”) – helped to organise group’s work and found the necessary funding for the Organizational Forum of the Country Key Populations Platform (CKPP).

“Today the priority for communities is to maintain access to services in the context of transition to state funding. By working together, communities can achieve much better results than by working just by themselves,” says Andrii Chernyshev, a member of CKPP steering committee.

The first CKPP Forum was held in January 2017. The main result of this event was a decision to establish the Country Platform as an association of key communities’ representatives. During the Forum, also representatives of the community of ex-prisoners joined the Platform.

CKPP was officially registered as a public association in December 2017. The Steering committee, representing all four communities, coordinates the work of the Platform. The main strategic issues are resolved during the CKPP Forums. Funding for Platform activities is provided through the selection of several grant programs managed by the organizations endorsed by the Steering Committee and an Advisory Group. As of today , the work of the Platform has been financially supported by the Ministry of Foreign Affairs of the Netherlands in the framework of the project “Bridging the Gaps: Health and rights for key populations”, UNAIDS, Eurasian Harm Reduction Association (EHRA), International Renaissance Foundation, the Embassy of the Netherlands in Ukraine. Such diverse funding model allows the Platform to remain independent and unbiased.

First steps are successful

The activities of the Platform in the last two years were mainly focused on the development of its structure, as well as the strengthening of the communities. During this period, 163 activists from 18 regions of Ukraine took part in important and interesting events and trainings, the topics of which were determined by the participants. Communities’ members developed CKPP Regulation and the CKPP Code of Ethics which regulates the basic principles of work.

In 2018, members of the Platform presented it at the XI National LGBT Conference in Ukraine and the 22nd International AIDS Conference (AIDS 2018) in the Netherlands.

“I believe in the Country Key Populations Platform. We are already seeing the results. The government is more inclined to listen to us because we gained legitimacy by joining our forces. When people are motivated to make change happen and work together, human rights will be a reality in our country, and not just words. Only together we can save our lives,” says Vielta Parkhomenko, a member of CKPP steering committee.

The researcher Anastasia Bezverkha in the recent study “Country Key Populations Platform – from better communication to stronger voice. The case study from Ukraine” highlighted the positive changes influenced by the creation and work of the Platform.

“CKPP impacted the communication between the partners in the field in a positive way. Key population leaders became more visible and new leaders emerged. In addition, CKPP serves as an important space for communication of national decision-makers with key population leaders,” summarizes Anastasia.

The IV CKPP Forum, which was held in December 2018, was focused on developing the strategies and work plans of the Platform for 2019.

Students will Attend the Annual Conference with a Discount

The annual STD x HIV x Sex Congress organized by AIDSfonds in the Beurs van Berlage in Amsterdam, the Netherlands, this year will take place on 23 November. AFEW International gladly offers students the chance to attend the Congress for 15 euros, which is a fraction of the regular ticket price. We invite you to take part in the congress if you are a student interested in issues related to HIV/AIDS and sexual and reproductive health and rights.

About 500 professionals from various institutions such as Dutch Ministry of Foreign Affairs, Amsterdam Municipal Health Service, Public Health Ministry, national and international NGOs and research institutions take part in the Congress in Amsterdam. These professionals are committed to ending AIDS and decreasing STD infections. The Congress is also a place to learn about community-based development and new research findings and technologies. Congress tickets can be bought between 11 October and 16 November online.

The student discount is made possible by AFEW International. AFEW is a network of civil society organisations working in the Eastern European and Central Asian (EECA) region. With AFEW International’s secretariat based in Amsterdam and country-offices in Kazakhstan, Kyrgzystan, Tajikistan and Ukraine, AFEW strives to promote health and increased access to prevention, treatment and care for public health concerns such as HIV, TB, viral hepatitis and sexual reproductive health and rights. At the STD x HIV x Sex Congress, AFEW is hosting an art expo and a workshop that brings students and professionals together to discuss the future of the work field.

AIDS 2018: Prevention Focused on Key Populations

Source: www.aids2018.org

Author: Marina Maximova, Kazakhstan

Just before the 22nd International AIDS Conference in Amsterdam AIDS 2018, a new Global AIDS Update prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) was presented in Paris. The report shows that the HIV epidemic is still growing in the countries of Eastern Europe and Central Asia (EECA). In the recent year, the number of new HIV cases in the region has doubled.

Participants of AIDS 2018 debated a lot on the reasons of this trend. Experts explained it, in particular, with a lack of prevention programmes, especially among people who inject drugs (PWID). Today, they account for over half of the new HIV cases. That is why implementation of the innovative multilevel interventions aimed at HIV prevention in key populations is to be continued.

For several years already, the Global Health Research Center of Central Asia (GHRCCA) and the Social Intervention Group (SIG) of Columbia University have been implementing projects and evidence-based interventions aimed at HIV prevention among key populations in the region, in particular in Kazakhstan. The results and achievements of three of such projects were presented at a special session of AIDS 2018.

Good News from NOVA

Assel Terlikbayeva

Assel Terlikbayeva, GHRCCA Regional Director:

NOVA Project is the first intervention combining harm reduction services and microfinance for women in difficult life circumstances. In two years, about 500 women from vulnerable populations – sex workers and people who use drugs – developed their skills to reduce the risks of contracting HIV and other sexually transmitted infections. Women received professional training in sewing and hairdressing. The most active participants received micro loans to start their own businesses. About 82% of project participants were able to open savings accounts, and many of them did it in the NOVA Project. About 70% of project participants were qualified for non-repayable allowances to start their own businesses, while 36% of women were able to use this opportunity.

Renaissance is possible

Louisa Gilbert

Louisa Gilbert, PhD, GHRCCA Co-Director:

The Renaissance Project is an innovative HIV prevention intervention aimed at PWID couples. Project results are inspiring first of all for its participants. Here is some of the optimistic statistics: unsafe sexual behaviours among project participants and their sexual partners were reduced by 42%, hepatitis C incidence decreased by 69% and HIV incidence – by over a half in the harm reduction group as compared to the control group.

Throughout the project, there were 89 instances when Naloxone was successfully used to reverse overdoses: in 15 cases, the medication was used to deliver first aid and saved lives of the Renaissance Project participants and in 74 cases – of PWID partners and their immediate circle.

PWID choose trust

Nabila El-Bassel

Nabila El-Bassel, PhD, Executive Director of GHRCCA and SIG, Professor of Columbia University:

In the recent year, the number of PWID visiting pilot confidential counselling sites and going through HIV rapid testing has more than doubled. It is very important that the number of new HIV cases detected at such pilot sites has grown. Implementing evidence-based strategies in routine activities allowed scaling up PWID coverage with harm reduction and HIV testing services. It became possible through the Bridge Project.

Besides, the project enhanced the role of outreach workers in finding and recruiting new clients as well as the role of nurses in working with HIV-positive people. Implementing electronic data collection helps to improve tracking and monitoring of the services and referrals provided.

Awareness and Acceptability of PrEP Among Men Who Have Sex with Men in Kazakhstan

Oral pre-exposure prophylaxis (PrEP) is an antiretroviral method of HIV prevention recommended to men who have sex with men (MSM) at high risk of infection. In Kazakhstan, which has one of the fastest growing HIV epidemics globally, PrEP is not currently available. The aim of this study is to explore the possibilities for PrEP initiatives in Kazakhstan by investigating awareness and acceptability of this prevention method among MSM. This mixedmethods study employs an online survey and qualitative interviews to describe PrEP awareness and acceptability. Less than half (39.8%) of survey participants had heard of PrEP.

However, a majority (85.2%) of MSM would possibly or defi nitely use PrEP if it was available. Awareness of PrEP was positively associated with willingness to use PrEP. The main reason to be interested in PrEP was an increased feeling of protection, whereas barriers were related to the idea of taking daily medication and the potential for side effects. PrEP is an essential component of HIV combination prevention. Our findings suggest potential for PrEP programmes among MSM in Kazakhstan and possibly in other Central Asian nations, when taking into account burdens of taking PrEP as well as more structural health policy issues.

Read more of the study here.

IVF for Women with HIV in Ukraine: Bringing the Right to Have a Child Back

Svetlana Moroz (second on the right) discusses the elimination of the discriminatory norms at a round table. Photo by Positive Women NGO.

Authors: Yana Kazmirenko, Tamara Balayeva, Ukraine

In Ukraine, amendments are prepared to the regulations of the Ministry of Health (MoH) prohibiting in vitro fertilisation (IVF) for women living with HIV. Currently, HIV is in the list of diseases, which are contraindications for IVF, approved by the MoH. In Western countries, IVF has been successfully delivered to women living with HIV for a long time. Ukrainian activists strive for the prohibition on in vitro fertilisation for women living with HIV to be abolished.

In early July, a round table discussion was held in the Public Health Centre at the MoH. At AIDS 2018 in Amsterdam, activists are planning to meet with Ulana Suprun, Acting Minister of Health of Ukraine, to present their insights and explain why it is so important to abolish the outdated regulations.

Discrimination and self-stigmatization

There is no statistics on how many women living with HIV apply for IVF in Ukraine every year and are refused. Svetlana Moroz, representing the Positive Women NGO, sent relevant requests to 10 regions. So far, there have been no replies. Svetlana says that information about the attempts of women living with HIV to make IVF is shared only among civil society activists.

A woman with HIV status sought help in their organization. After long searches, she found a clinic in Kharkiv, which was ready to work with women living with HIV

“She made two attempts, which have not been successful so far. Another woman from Sloviansk used her advice and also sought assistance in this clinic, but she had a miscarriage,” tells Svetlana.

She says that some private clinics agree to make IVF to women living with HIV but do not advertise it due to the orders of the MoH. Such clinics charge their clients a double price because of the possible risks. Other health facilities use standard excuses: lack of equipment or reference to HIV being on the list of contraindications for IVF.

Apart from the MoH orders and reluctance of clinics, there is another barrier – self-stigmatization. According to Svetlana Moroz, many women living with HIV do not even try to seek assistance in IVF clinics: they know that they will face a refusal or do not know that they even have such a right.

All IVF risks are myths

Valentina Kvashenko, chief physician of the A.A. Partners Health Company also thinks that refusal to make IVF to HIV-positive women is a discriminatory practice and that concerns about the risks of HIV transmission are ungrounded. Doctors carry out all the manipulations with semen and eggs with disposable catheters and needles. In the course of deliveries, they wear gloves, glasses, and aprons. The same safety precautions are used during all standard deliveries. Usually, only one embryo is transferred to women with HIV status to reduce the potential need of invasive interventions.

“There is no need in “prohibiting” regulations, due to which people are not able to perform their reproductive functions and become parents,” says Valentina, adding that HIV may be transmitted from mother to child, but only if the woman is not taking antiretroviral therapy (ART).

She gives statistics to prove her words: in 1996-1997, when there was no access to antiretroviral drugs in Ukraine, HIV was transmitted from mother to child in 60% of cases. Now this rate is less than 10%. Even this percentage only relates to children born to women who do not receive ART. Besides, the IVF procedure reduces the risk of virus transmission to a minimum.

Litigation for the right to IVF

If the letter to the Ministry of Health will not give a result and will not allow to promptly introduce amendments to the regulations, the activists have a second option – legal action.

“We will work on creating a legal case. The fact is that the MoH regulations contradict the laws of Ukraine, which do not prohibit in vitro fertilization for HIV-positive women. If nothing else works, we will find a woman living with HIV who is ready to go all the way and defend her rights in court,” explains Svetlana Moroz.

It is expected that draft amendments to the regulations will be ready and presented to the Ministry of Health in late November. While the old regulations are still in force, Svetlana gives recommendations to women who are refused the IVF services.

“Always demand official refusals. With the doctor’s words only, you will not be able to file a lawsuit in court and all the more to win it. Secondly, seek assistance in human rights organizations. For example, our organization is ready to provide free lawyers’ services to women, help them to prepare the required documents and in general offer all the necessary legal support,” sums up Svetlana.

After the discriminatory regulations are abolished, Ukrainian women living with HIV will have a right to participate in the state-funded IVF program for childless couples.

Study of Sex Workers’ Behaviour in Georgia

Author: Irma Kakhurashvili, Georgia

Gabriela, a 40-year-old sex worker from Tbilisi has not been tested for HIV since 2016. She is convinced that she does not have HIV. She also thinks that she knows everything about this virus. However, when asked if HIV is transmitted by mosquitoes, she says ‘yes’. In July, Gabriela is going to the bustling resort city of Batumi to earn some extra money.

“I do not think that I will get tested for HIV anytime soon as I have got a lot of work and do not have free time. Besides, from Batumi I plan to relocate to Turkey,” says the woman.

Gabriela did not participate in the recent research conducted in two cities of Georgia – Tbilisi and Batumi – to study risky and safe behaviours of sex workers.

No major changes

The Tanadgoma Centre for Information and Counselling on Reproductive Health is the first Georgian organization, which has been studying the HIV transmission among sex workers since 2002. The recent study held in 2017 covered 350 women: 200 from Tbilisi and 150 from Batumi. The goal of the researchers was to determine the prevalence of HIV, hepatitis C, gonorrhoea and syphilis among people involved in sex work. Besides, they were able to analyse the key risks associated with HIV and to collect valuable information for advocacy and policy development. The research study was conducted with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Curatio International Foundation and the Infectious Diseases, AIDS and Clinical Immunology Research Centre.

The study confirmed that 85% of women in Tbilisi and 97.3% in Batumi know about the existence of HIV/AIDS, but only 11.5% of respondents in Tbilisi and 23.4% in Batumi gave correct answers to questions about the HIV transmission. For example, some respondents like Gabriela did not know that HIV is not transmitted through the bites of mosquitoes. In general, the respondents from Tbilisi were less aware of HIV if compared to the ones from Batumi.

Georgian researchers say that there have not been major changes in the study outcomes since 2012. For instance, most women mention condoms as the main measure of protection against HIV.

The study results showed that the indicators of condom use during most recent sexual intercourse with a commercial partner have not changed in the recent 10 years (over 90% in both cities). However, sex workers rarely use condoms with their regular clients.

“I do not use condoms with my regular clients to show that I trust them, but I definitely use them with other clients. I have to suffer offences because of this, but I know that it is a sure way to protect your health,” says Gabriela.

Sex work in Georgia is illegal and often police will confiscate condoms if they decide that a woman could be doing sex work.

Sex-workers and drugs

The research study showed that sex workers are well aware of HIV transmission when sharing needles and syringes. Besides, the recent study showed some interesting results concerning drug use. The share of sex-workers who used non-injecting drugs in the last 12 months was 11% in Tbilisi and 20% in Batumi. The most widely used non-injecting drugs were sleeping pills and sedatives in Tbilisi and marijuana in Batumi.

As for the injecting drugs, 1.5% of respondents in Tbilisi and 3.3% in Batumi injected drugs in the recent 12 months The respondents used ‘vint’, ‘jeff’ and amphetamines in Tbilisi and heroin in Batumi.

“Before, we did not have such data for sex-workers,” says Nino Tsereteli, researcher and head of Tanadgoma.

Women are getting out of sight

Gabriela says that she does not inject drugs but takes some pills. The woman has no problem to buy them in a pharmacy and uses substances at least once a week.

“The issue of drugs became relevant to this key population as well. We have been working with sex-workers for 20 years in five cities in Georgia and cover 3,000 people with our services annually. As for HIV/AIDS, during the period when we conducted the study only three women in Tbilisi were diagnosed with HIV. What is bad is that sometimes as soon as a woman learns that she has HIV, she is getting out of our sight and we do not know where she is and if she continues working with clients,” says Nino Tsereteli.

Gabriela promises that in September she will get tested for HIV with the help of Tanadgoma. She is not going to change her lifestyle, but she wants to know if everything is all right with her health. In Tanadgoma, she will get recommendations not only about HIV because, according to Nino Tsereteli, another problem of sex workers in Georgia is violence. Sex workers do not always know how they can organize themselves to protect their rights, health and lives. In Tanadgoma, they can get knowledge and support of professional lawyers.

Shrinking Civil Society Space Hinders NGO Activities in EECA

The results of the assessment proved to be the basis for rewarding discussions during AFEW Regional autumn school in Almaty, Kazakhstan last year where the first findings were presented

Author: Aïcha Chaghouani, The Netherlands

Different trends of more restrictive legislation hinder the development of a healthy, independent and diverse civil society in Eastern Europe and Central Asia (EECA). Shrinking civil society space in the EECA countries is making the work of many non-governmental organisations more difficult.

NGOs play a crucial role in the development of effective HIV/AIDS responses. Non-governmental organisations meaningfully involve community key population groups for a better understanding of their needs. The experts are saying that the limited space that NGOs are allowed to maneuver in, is threatening the effectiveness of national and regional policies to contain and stop the growth of the HIV epidemic in the region.

AFEW’s assessment of the situation

Many NGOs in the EECA region, especially those working with key populations and in the field of harm reduction, are currently facing significant challenges. International donors are withdrawing from the region while most local governments are unwilling and/or failing to take over. The withdrawal of funds together with the shrinking civil society space are threatening the investments made and progresses achieved in the last decades in the field of HIV/AIDS.

AFEW International’s experts Janine Wildschut and Magdalena Dabkowska conducted a mixed-methods research to explore the process of shrinking civil society space in the EECA countries, how this affects NGOs and how they are coping with it. With this research, AFEW has gained more insights and learned how NGOs are currently dealing with those challenges. The research is part of AFEW’s regional approach within Bridging the Gaps: health and rights of key populations project.

Coping strategies and regional exchange

The ultimate aim of the research was to assess the coping strategies in a context of shrinking space of civil society in EECA.

“I believe that these coping strategies are vital in the current circumstances and demonstrate the big resilience of the communities and NGOs working with key populations,” says AFEW’s director of programmes Janine Wildschut.

The research was conducted in Kazakhstan, Kyrgyzstan, Poland, Tajikistan, Russia and Uzbekistan.  This mixed-method research consisted of a general primary assessment of the whole region, semi-structured interviews with NGOs and donors, and a survey.

AFEW’s experts believe that by mapping different strategies AFEW is able to facilitate a regional exchange of success and failure stories in which NGOs can learn from each other’s experiences. The identification of different strategies helps organizations to develop more comprehensive coping mechanisms in the current contexts.

“We hope to raise more awareness with donors about the situation of NGOs in the shrinking space of civil society, and will offer coping tools to NGOs,” says Janine Wildschut.

Fight, hide or unite

The outcomes of the research identified three main resilience strategies NGOs adopted in order to overcome the challenges. They are: fight – opposing the authorities, hide – opposing, allying or neutral but out of sight and silent, and unite – allying with the authorities. All interviewed NGOs had different reasons to choose one of these three paths.

AFEW International’s experts Janine Wildschut and Magdalena Dabkowska conducted a mixed-methods research to explore the process of shrinking civil society space in the EECA countries, how this affects NGOs and how they are coping with it

“We want to be more diplomatic. If you are being too much of an activist, you can also just break your organization,” an NGO employee from Tajikistan said.

For some organizations, it was possible to create alliances with the local or national authorities and still continue their work while for others, creating these alliances meant stopping or changing part of their core activities.

“We believe that it is actually ethically wrong to be in alliance with this government. We also do not try to be invisible for them. We do not do anything illegal so we do not hide anything,” a Russian NGO employee said. “There is no law we are violating so there is nothing to hide. If they want to change or stop us we just go to court. We have a lot of strategic activities including cases against the government.”

Further discussion 

Which out of ‘fight, hide or unite’ positions is the most suitable for an NGO, depends on the characteristics of the organization, the context it is operating in and the beliefs of its employees.

“The different paths identified by the assessment could serve as a fruitful basis for further discussion and to build strategic plans on how to deal in such situations. AFEW can facilitate a valuable exchange of best-practices between NGOs. Besides, the discussion can serve as a way to grow awareness and understanding about why a certain NGO takes a specific position, which can prevent undesired conflicts between civil society organisations themselves,” says Janine Wildschut from AFEW International.

The results of the assessment proved to be the basis for rewarding discussions during AFEW Regional autumn school in Almaty, Kazakhstan last year where the first findings were presented. In spring of 2018, the official report will be published and will be available online.

In Kyrgyzstan, the New Year Started with Reduced Funding for the HIV Response

Author: Olga Ochneva, Kyrgyzstan

Since January 2018, HIV and tuberculosis programmes in Kyrgyzstan are funded from the new, significantly reduced grant of the Global Fund. There were six months of discussions concerning cost optimization and reduction, taking into account the growing deficit of funds that the country is facing in the nearest three years. The cost-saving mode has already been introduced, first of all affecting the prevention programmes.

Services and coverage are retained

In 2018-2020, Kyrgyzstan will receive 23.4 million US dollars for HIV and tuberculosis response from the Global Fund. For the reference, the previous Global Fund grant stipulated allocation of 20.8 million US dollars for the period twice shorter. The country decided to cut the expenditures gradually. The first six-month cost-saving period started in January 2018. According to Oksana Katkalova, the representative of the UNDP country office, which administers the Global Fund grants in Kyrgyzstan, treatment and diagnostics have been defined as the priorities and prevention interventions have been significantly cut down due to the reduced number of partner organisations.

“The money will be mainly used to purchase anti-tuberculosis and antiretroviral medicines (antiretroviral therapy or ART is a method of HIV treatment) as the number of people who need treatment is growing,” says Oksana Katkalova, HIV Grant Coordinator, UNDP. “We try to retain the services and the coverage, while optimising and reducing the administrative costs.”

Since the beginning of the year, two methadone maintenance treatment (MMT) sites have been closed, with patients referred to the nearest sites. The MMT clients will no longer receive the community support of some non-governmental organisations (NGOs), which used to be financed by the Global Fund. The number of implementing NGOs which receive funding has been diminished. Two NGOs working with people living with HIV (PLWH) in Bishkek and Osh will not be funded, with their services being consolidated and handed over to the organisations, which still get the funding. In smaller towns, services for different key populations have also been consolidated.

“One organisation working with different key populations is quite a good option for smaller regions. It allows saving costs for administrative personnel,” explains Oksana Katkalova. “When in a small town there are two organisations, one working with sex workers and the other one – with people who inject drugs (PWID), each with a coverage of 100-200 people, it makes sense to consolidate those services in one organisation if there is a shortage of resources. Our implementing partners – NGOs – have been selected through tender procedures and now have set coverage indicators, which mostly have been raised. However, they can and should engage outreach workers and peer counsellors for different key populations to reach the required coverage.”

Gender component reduced

The number of needle and syringe exchange points (NSPs) has been reduced from 21 to 15. Two of them used to operate in NGOs as service delivery sites. One of such sites was located in the Asteria residential community centre for women who inject drugs, with the Global Fund grant partly covering rental, personal services (accommodation, laundry, shower, meals, and hygiene packages) as well as the package of basic prevention services and consultations of an STI doctor.

“Unfortunately, the gender component for women who inject drugs has been excluded from the Global Fund project: diagnostics and treatment of sexually transmitted infections, hygiene packages and personal services are no longer available,” tells Irena Yermolayeva, director of the Asteria Charitable Foundation. “The Soros Foundation-Kyrgyzstan and the AIDS Foundation East-West in Kyrgyzstan agreed to cover the rental costs and partly the services for six months. We are doing our best to retain our residential project.”

Two sites in each of the medical and penal systems were closed in 2018

Financial support of the four national networks has also been reduced. Now there will be one network promoting the rights and interests of all the key populations. Medical professionals working with PLWH also feel the shortage of funding. They receive benefits in addition to their salaries from the donor funds. Currently, the strategy of bonus reduction is continued, with shrinking resources, and the amount of the remaining benefits will depend on achieving the performance indicators. It is also planned to reduce payments to the medical personnel engaged in the MMT programme, but it is more complicated as in this case donor funds are the only source of financing. Just to remind that so far, the government has not allocated any money for the methadone maintenance treatment programme.

The programme aimed at the ART adherence improvement has also been cut. Before, all adherent patients used to get monthly motivation payments of 8 US dollars, while since January this year only children receive the allowances of about 14 US dollars, which are to be reduced by 2020.

By 2020, up to 30% of ART costs are to be covered by the state

The country will face even more funding cuts in the following two and a half years of project implementation. It is expected that four more MMT sites will be closed during this period. While in 2017, support within the Global Fund grant was provided to 26 NGOs, it is anticipated that by the end of 2020 only 10 of them will remain.

“So far, the smallest budget has been allocated for 2020 as it is planned that by this time the government will cover up to 30% of expenditures for the ART medicines; besides, we hope to have additional savings,” says Oksana Katkalova. “If during this period the government allocates significantly more funds, they can be used to purchase more ARTs, tests or, for example, to pay bonuses to the medical personnel engaged in HIV prevention, treatment, care and support programmes. Then we will be able to re-distribute part of the donor funds to cover prevention interventions. Every six months, we will adjust the expenditures for interventions and negotiate them in the format of a country dialogue. We hope that there will be a gradual increase in the scope of domestic funding.”