Michel Kazatchkine: “Failure to Interact with Vulnerabilities Could Lead to an Increase in the Epidemic”

The Chair of AFEW International’s Board Michel Kazatchkine and director of the organisation Anke van Dam during the 22nd International AIDS Conference. Photo: AFEW International

The inaugural World AIDS day was held on December 1st, 1988. The epidemic was raging across Western Europe and the United States. The world was only starting to realize the existence and the magnitude of the African epidemic. HIV was virtually absent from the Russian Federation. There was no treatment for HIV infection. AIDS was a death sentence, as we, physicians, were painfully witnessing every day in hospital wards.

30 years later, while no country has been spared of HIV, we cannot overestimate the progress that has been made. Extraordinary progress in science, research, and development, that has successfully translated into large-scale prevention and treatment programs in almost all settings, globally.

21 million people are now accessing antiretroviral treatment across the world. Life expectancy of an HIV-positive person on treatment is now similar to that of HIV-negative people. And we now know that an HIV-positive person whose virus has been suppressed with treatment will no more transmit the virus to a sexual partner, meaning that antiretroviral treatment also contributes to prevention of HIV transmission and to limiting the epidemic at the population level. In the last 10 years, the number of new HIV infections and AIDS-related mortality decreased by close to 40% globally. The hope generated by the progress has led the United Nations to commit to the goal of eliminating HIV by 2030.

Yet, an objective analysis of the situation today shows that the world is off track in achieving this target. The Russian Federation and, more broadly, the Eastern European and Central Asian region, are of particular concern.

Eastern Europe in the last five years is the only region of the world where both the annual number of new cases of HIV infection and of AIDS-related deaths continues to grow. The number of new infections reported in the region increased by 30% between 2010 and 2016. Over a million people are now estimated to be living with HIV in the Russian Federation; one in five do not know their status. It is timely then, that the theme of this year’s World AIDS day is “Know your status.”

Breaking down the raw numbers reveals an unsettling scenario. 45% of the people who know their positive status are on treatment and 75% of these are virally suppressed.

This means that, at the end, only approximately 27% of the total estimated number of people living with HIV are virally suppressing their infection and that a large pool of people with HIV can potentially transmit the HIV infection. All this in a context where national prevention efforts are lagging behind and fragile at best.

The ministry of Health aims at increasing treatment coverage to reach 75% at the end of next year and rightly points out how important it is to urgently address some of the myths and misinformation that prevent people from accepting treatment.

The HIV epidemic in Russian Federation is largely an epidemic of so-called “key populations” and their sexual partners – people using drugs, men who have sex with men, sex workers, migrants, prisoners – often marginalized groups of the population for whom stigma, discrimination, and criminalization drive many of these people underground, away from outreach workers and so with limited access to prevention  and treatment services.

An effective response to the epidemic within the Russian Federation should, therefore, entail a focus on specific geographic areas and populations. It also means seizing many immediate opportunities to build onto the HIV platform, the “SPID centers”, to provide additional services, including diagnosis and, as much as possible, integrated treatment of tuberculosis and hepatitis, as well as prevention services including “pre-exposure prophylaxis” for men having sex with me and provision of clean needles and injection materials for people who inject drugs.

When and where this kind of efforts have been employed around the world we know the outcome: a decline in new infections, a decline in the pool of infectiousness and improved control of the epidemic in general by the authorities.

We also know that failure to engage with most vulnerable and at-risk groups of people can bring – a growing epidemic that becomes increasingly more difficult to reign in.

A recent modeling study has shown, for example, that without integration and scaling up of needle exchange programs and antiretroviral therapy, HIV prevalence would remain as high as 60% among people who inject drugs in Ekaterinburg. Scaling up of the interventions would – in contrast – significantly reduce that prevalence and deaths associated with HIV. If the interventions were to cover 50% of people in need and to also include opioid maintenance therapy with methadone, currently unavailable in the Russian Federation, over 30% of HIV infections and HIV-related deaths could be prevented in Ekaterinburg.

The science and the experience from many countries, particularly in Western Europe, tell us that these approaches can best be implemented in a working partnership with civil society, recognizing the additional and complementary strengths brought by community-led services. In Saint Petersburg, joint efforts of the AIDS center and civil society to bringing testing closer to people in need of it and linking people to care, have led to significant decrease in the number of new infections and increase in treatment coverage. Civil society groups, in this case, are supported by both Presidential and municipal grants.

We should be encouraged by the integrated approach formulated both in the National strategy adopted by the Russian Federation two years ago and in recent guidelines on the prevention of HIV among key affected populations. A clear progress can be noticed in some regions of the country with regards to the partnership with civil society and service provision.

The challenge for the country is to translate what is on paper and high-profile statements into concrete policies that simultaneously sustain appropriately funded programs and engage in the structural and legislative reforms needed to remove obstacles that still impede access to prevention and care. Without such an approach, HIV infection in Russia will continue to grow faster than the efforts to fight it.

Michel Kazatchkine is the Special Advisor to the Joint United Nations Program on AIDS (UNAIDS) in Eastern Europe and Central Asia

Source: kommersant.ru

Antonio Guterres Replied to AFEW Support Letter

Prof. Michel Kazatchkine, Special Adviser to the Joint United Nations Programme on HIV/AIDS on HIV, Tuberculosis and Hepatitis for Eastern Europe and Central Asia

AFEW International received a response to the letters we have sent to the United Nations Secretary-General Mr Antonio Guterres. We have sent two letters that can be read here and here, and asked Mr Guterres to support the position of Prof Michel Kazatchkine as UN special envoy on HIV/AIDS for Eastern Europe and Central Asia (EECA.)

83 organisations from the whole world signed the letter. We asked to reconsider the position of Prof M. Kazatchkine as UN Special Envoy for EECA, as he is in an excellent position to create a momentum to raise awareness on the disruptive situation the epidemics has caused in the region. Prof. Michel Kazatchkine played a crucial role in mobilizing local authorities, (inter)national civil society, donors, researchers and other relevant groups to come to better outcomes to the UNAIDS indicators as we see now. As a result, he enjoys great support from communities in the region.

“Mr Kazatchkine has been an unwavering champion for HIV/AIDS in Eastern Europe and Central Asia. With rising HIV infections across the region, he has served as a tireless advocate and helped to unite stakeholders across sectors to address pervasive challenges that continue to leave our most marginalized communities behind. Mr Kazatchkine is well positioned to build on this work in his new role as Special Adviser to the Joint United Nations Programme on HIV/AIDS (UNAIDS) on HIV, Tuberculosis and Hepatitis for Eastern Europe and Central Asia,” the letter is saying.

Mr Guterres also expressed the hope for the future collaboration with AFEW International.

The full version of the letter can be read here.

Civil Society Letter to Support the Position of Prof M. Kazatchkine as UN special Envoy on HIV/AIDS for Eastern Europe and Central Asia

To: United Nations Secretary-General Mr Antonio Guterres

Amsterdam, 22 January 2018

Re: Civil Society letter to support the position of Prof M. Kazatchkine as UN special envoy on HIV/AIDS for Eastern Europe and Central Asia dd 23 June 2017

Your Excellency Mr Guterres,

With this letter, we – undersigned civil society organizations – call on you to reconsider the position of Prof. Michel Kazatchkine as your Special Envoy on HIV/AIDS in Eastern Europe and Central Asia (EECA).

Michel Kazatchkine was recently announced to serve as special advisor to UNAIDS for HIV, tuberculosis and hepatitis C by the UNAIDS executive director Michel Sidibe.

We are happy to greet Prof. Michel Kazatchkine with his new position. We believe however that the urgency of three epidemics in the EECA region justifies a position as UN special envoy for the region. A region in which the HIV/AIDS, TB and viral hepatitis epidemics are out of control. This development concerns us deeply:

  • The annual number of new HIV infections in Eastern Europe and Central Asia increased with 60% between 2010 and 2016.
  • From all regions in the world, the EECA region is furthest away from reaching the UNAIDS 90-90-90 targets by 2020. Treatment coverage remains alarmingly low (28%), and less than a quarter of people living with HIV had suppressed viral loads (end-2016).
  • Specific populations, such as men who have sex with men, people who use drug users, sex workers, prisoners and migrants face specific human rights violations, impeding their access to prevention and health services.

Despite these alarming developments, donors and multilateral institutions are pulling out of the region. Achieving the SDG’s on health and the promise to leave no one behind is therefore still far away in the EECA region.

Prof. Michel Kazatchkine has played a key role in highlighting the region to institutions as UN Special Envoy on HIV/AIDS in Eastern Europe and Central Asia. He played a crucial role in mobilizing local authorities, (inter)national civil society, donors, researchers and other relevant groups to come to better outcomes to the UNAIDS indicators as we see now. As a result, he enjoys great support from communities in the region.

In our letter of 23 June 2017, we asked to continue the position of Prof. Michel Kazatchkine as your Special Envoy on HIV/AIDS in Eastern Europe and Central Asia. We express our disappointment about not having received a response yet.

We understand that Prof Eric Goosby continues as UN special envoy on TB, due to the important UN High Level meeting on TB in September 2018.

At the same time, the AIDS 2018 conference in July 2018 will be a key moment for the region and for the world as well. The Dutch government acknowledges the issues and has prioritized Eastern Europe and Central Asia for the conference. We applaud their leadership as this is the moment to bring political leaders, policy makers, scientists, clinicians and community leaders together and draw attention to the urgent need to next steps. Prof. Michel Kazatchkine is helping in the process. We, the civil society organizations, look forward to your presence and support in Amsterdam next July.

We ask you to re-consider the position of Prof. Michel Kazatchkine as your Special Envoy for Eastern Europe and Central Asia, as he is in an excellent position to create a momentum to raise awareness on the disruptive situation the epidemics has caused in the region.

Please, support this letter by signing it before Monday, 29 January 5pm CeT. You can sign this letter here

Yours sincerely,

Anke van Dam,

Executive Director, AFEW International

Michel Kazatchkine Became the Special Advisor to UNAIDS

Michel Kazatchkine joined Undetectable means Untransmittable campaign

United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia (EECA) Michel Kazatchkine was recently announced to serve as special advisor to UNAIDS for HIV, tuberculosis and hepatitis C. Such announcement was made by the UNAIDS executive director Michel Sidibe. The term of Michel Kazatchkine as the Special Envoy for HIV/AIDS is coming to an end.

AFEW International is happy to greet Prof. Michel Kazatchkine with his new position. It is important to have Prof Kazatchkine continue his work as a special advisor to UNAIDS, we believe however that the urgency of three epidemics in the EECA region would have justified a position as UN special envoy for the region. The annual number of new HIV infections in EECA increased with 60% between 2010 and 2016. From all regions in the world, the EECA region is furthest away from reaching the UNAIDS 90-90-90 targets by 2020. Treatment coverage remains alarmingly low (28%), and less than a quarter of people living with HIV had suppressed viral loads (end-2016). Specific populations, such as men who have sex with men, drug users and sex workers face specific human rights violations, impeding their access to prevention and health services.

AFEW International is also hoping for the support of Prof. Michel Kazatchkine during the 22nd International AIDS Conference that will take place in Amsterdam in 2018. The largest health conference in the world will have a special focus on Eastern Europe and Central Asia. The need and the urgency to show the challenges of the EECA region during the Conference are extremely vital.

Michel Kazatchkine was appointed United Nations Secretary-General’s Special Envoy for AIDS in Eastern Europe and Central Asia in July 2012. Mr Kazatchkine has devoted thirty years of his professional life to the AIDS response. From 2007 to 2012 he served as the Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria and from 1998 to 2005 he was Director of the French National Agency for AIDS Research. Between 2005 and 2007 he served as France’s Global Ambassador for HIV and Communicable Diseases.

Civil Society Letter to Support the Position of Prof M. Kazatchkine as UN special Envoy on HIV/AIDS for Eastern Europe and Central Asia

To the United Nations Secretary-General Mr Antonio Guterres

Amsterdam, 30 November 2017

Re: Civil Society letter to support the position of Prof M. Kazatchkine as UN special envoy on HIV/AIDS for Eastern Europe and Central Asia dd 23 June 2017

Your excellency Mr Guterres,

With this letter, we – undersigned civil society organizations – call on you to reinstate the position of Prof. Michel Kazatchkine as your Special Envoy on HIV/AIDS in Eastern Europe and Central Asia (EECA).

In 2018, the International AIDS Conference will take place in Amsterdam, the Netherlands. The largest health conference in the world will have a special focus on Eastern-Europe and Central Asia, a region in which the HIV/AIDS, TB and viral hepatitis epidemics are out of control. This development concerns us deeply:

• The annual number of new HIV infections in Eastern Europe and Central Asia increased with 60% between 2010 and 2016;
• From all regions in the world, the EECA region is furthest away from reaching the UNAIDS 90-90-90 targets by 2020. Treatment coverage remains alarmingly low (28%), and less than a quarter of people living with HIV had suppressed viral loads (end-2016);
• Specific populations, such as men who have sex with men, drug users and sex workers face specific human rights violations, impeding their access to prevention and health services.

Despite these alarming developments, donors and multilateral institutions are pulling out of the region. Achieving the SDGs on health and the promise to leave no one behind is therefore still far away in the EECA region.

Prof. Michel Kazatchkine has played a key role in highlighting the region to institutions as UN Special Envoy on HIV/AIDS in Eastern Europe and Central Asia. He played a crucial role in mobilizing local authorities, (inter)national civil society, donors, researchers and other relevant groups to come to better outcomes to the UNAIDS indicators as we see now. As a result, he enjoys great support from communities in the region.

In our letter of 23 June 2017, we asked to continue the position of Prof. Michel Kazatchkine as your Special Envoy on HIV/AIDS in Eastern Europe and Central Asia. We express our disappointment about not having received a response yet. At the same time, we understand that Mr Eric Goosby continues as UN special envoy on TB, due to the important UN High Level meeting on TB in September 2018.

The AIDS 2018 conference in July 2018 will be a key moment for the region and for the world as well. The Dutch government acknowledges the issues and has prioritized the region for the conference. We applaud their leadership as this is the moment to bring political leaders, policy makers, scientists, clinicians and community leaders together and draw attention to the urgent need to next steps.

We strongly urge you to reinstate the position of Prof. Michel Kazatchkine as your Special Envoy for Eastern Europe and Central Asia, or at the very least use your influence to ensure that Prof Kazatchkine may continue his work at UN level, as he is in an excellent position next year to create a momentum to raise awareness on the disruptive situation the epidemics has caused in the region.

Yours sincerely,

Anke van Dam,
AFEW International

Please, support this letter by signing it before 30 November 2017 5pm CeT. You can sign this letter here

Drug Policy, Diplomacy and Global Public Health Course Offered

Drug Policy, Diplomacy and Global Public Health Course is offered from 24 to 26 October 2017. Course Directors: Professor Michel Kazatchkine and Professor Thomas Zeltner.

Negotiating the health dimension of drug policies

  • Intensive three-day course with renowned faculty and leading practitioners
  • Combine theory and practice through lectures, high-level panels and exercises
  • Meet in the world’s global health capital
  • Organised by the Global Health Centre at the Graduate Institute, led by Professor Ilona Kickbusch

The United Nations General Assembly Special Session on the World Drug Problem held in April 2016 in New York was a clear demonstration of the growing momentum in favour of drug policy reform. Even though the outcome document raised some promising points, it has been criticised for containing almost no operational outcomes or actions to address the challenges, tensions and contradictions currently existing in international drug control.

Countries are facing challenges due to the horizontal nature of the drug issue that goes far beyond law-enforcement and prohi­bition. Some innovative reforms are already being implemented since the UNGASS 2016. What should the new direction be for the future UN governance of international drug policy? How can different actors contribute to a global process that truly advances laws, policies and international cooperation and finally ensures that drug policies help instead of harming the health and welfare of mankind? How can countries develop a coordinated response, in compliance with international drug control rules, when their ministries of health tend to treat users, while their ministries of interior and justice tend to criminalise them? How can the UN have a meaningful and impactful role in addressing drug policy issues? And what should the role of civil society and user networks be in the international debate on drug policies?

You can find more information about the course here.

Source: Graduate Institute Geneva

Reasons for Drug Policy Reform

Michel_Kazatchkine_2012

Text: Michel Kazatchkine, UN secretary general special envoy on HIV/AIDS in Eastern Europe and Central Asia

Why is eastern Europe the only region in the world that still has a growing HIV epidemic? In one of the region’s countries, Russia, more than two thirds of all HIV infections, and 55% of the near 100 000 new infections reported last year, resulted from drug injection.

Some 3.2 million people in eastern Europe inject drugs, and about 1.5 million of them are in Russia. In 2007 the number of newly reported HIV cases among Russian people who inject drugs (12 538) was similar to the number in the rest of eastern Europe (12 026). But since then the numbers have diverged hugely.

Scaling up of harm reduction programmes in several countries coincided with a stabilising of HIV rates—and fewer than 7000 new cases outside Russia in 2014. In Russia, however, where access to sterile needles and syringes is low and opioid substitutes remain illegal and unavailable, the number of people who inject drugs newly infected with HIV climbed to nearly 22 500 in 2014.

Criminalisation of drug use

The reasons for Russia’s high figures include the prohibition and effective criminalisation of drug use, repressive law enforcement, and stigma around drug use. These factors lead people to inject in unsafe conditions for fear of police and arrests and result in needle sharing and overdose.

In 2015, the United Nations’ secretary general, Ban Ki-Moon, called for “careful rebalancing of the international policy on controlled drugs.”

“We must consider alternatives to criminalisation and incarceration of people who use drugs,” he said. “We should increase the focus on public health, prevention, treatment, and care.”

The World Health Organization, the United Nations Office on Drugs and Crime, and UNAIDS jointly recommend a package of harm reduction interventions as best practice to reduce the risk of acquiring, and improve treatment of, HIV, hepatitis, and tuberculosis among people who inject drugs. Such strategies, which do not require prohibition of harmful behaviours, are key to reducing death and disease because drug dependency is characterised by people’s inability to abstain.

Continue reading here.

AFEW Takes Part in 21st International AIDS Conference ‘ACCESS EQUITY RIGHTS NOW’

Screen-Shot-2015-12-11-at-1.05.03-PM-1024x478

AIDS Foundation East-West (AFEW) is taking part in 21st International AIDS Conference (AIDS 2016), on 18-22 July 2016 in Durban, South Africa. Visitors of AFEW booth in EUROzone of the Global Village will have the opportunity to leave a wish to be taken to the 22nd International AIDS Conference that will take place in 2018 in Amsterdam, the Netherlands.

“I am very glad to welcome our colleagues and friends to AFEW booth, – said Anke van Dam, executive director of AFEW. – We would like to share the results of our work in Eastern Europe and Central Asia and also invite them to come to the next conference in Amsterdam. AFEW is asked to engage EECA in the AIDS 2018 conference, and for us it is very important that many people from the region will be present to show their key activities there.”

On July 19 Anke van Dam will host a question and answer session about the road to AIDS 2018 starting at 15:00 at AFEW booth. Dutch Ambassador for Sexual and Reproductive Health and Rights & HIV/AIDS Mr. Lambert Grijns and UN Secretary-General Special Envoy on HIV/AIDS in Eastern Europe and Central Asia Mr. Michel Kazatchkine will be taking part in it.

On Wednesday, 20 July the executive director of AFEW will talk about youth friendly services in Ukraine at an expert panel that will discuss activities for young key populations at 11:30. On Thursday, 21 July Anke van Dam will tell about the migrants during “Migrants and Access to Health” panel that will start at 16:00 in the EUROzone in the Global Village.

AIDS 2016 conference in South Africa will focus on the latest issues in HIV science, policy and practice and will also seek to share key research findings, lessons learned, best practices, as well as identify gaps in knowledge. The conference will feature abstract-driven sessions, a daily plenary session, a variety of symposia sessions, professional development workshops, and independently organized satellite meetings. In addition, the programme will include a number of activities, such as the Global Village and the Youth Programme, which are an integral aspect of the International AIDS Conference.