UNAIDS developed a guidelines for people who live with HIV.
UNAIDS developed a guidelines for people who live with HIV.
In Tajikistan, there is an increase in the proportion of sexual transmission of HIV infection from year to year and an increase in the number of women of reproductive age among those registered with the diagnosis established for the first time. That is why in 2019 the public organization “Tajik network of women living with HIV” (TNW+) with the support of AFEW International in the framework of Bridging the Gaps project conducted a study “Key problems of sexual and reproductive health of women living with HIV in Tajikistan through the prism of human rights”.
Before the International Women’s Day on 8 March, Tahmina Khaydarova, head of TNW+ discussed with AFEW International HIV, sex, violence and gender inequality in Tajikistan.
What does sex mean for men and women in Tajikistan?
For men, sex is an opportunity to satisfy their desire, and only then is it a way of making children. For women, sex is almost always a way of making children and extending the family. As a rule, women in Tajikistan cannot talk about sex and take the initiative in sexual relations, as it is considered to be debauchery.
Generally speaking, the sexuality in Tajikistan is highly exposed to traditional gender stereotypes. It is not common here to discuss sexual relations, either in the family or in society. Some people talk about it with their partners, doctors, etc. But even if they do that that they do not really understand the meaning and significance of the concepts of “sex” and “sexual relations” and most often talk about contraception, methods of protection against unwanted pregnancy, hygiene, etc. But not more.
Does it happen because of national traditions and religion?
Yes, in many ways. However, Islam is a religion of peace and good. Islam does not talk about the abuse of women, but there are other factors that affect women’s lives. These are stereotypes, which can be connected with religion.
One of them is “a woman is obliged to take care of her husband and all members of his family, to be obedient and kind”. Therefore, girls have been brought up in a spirit of obedience since childhood. Women themselves think that men’s interests come first. One of the features of families in the republic, especially in villages, is the predominance of extended families, where several generations of adults and children live in the same house – parents, their adult sons/daughters already married, grandparents, adult sisters or brothers. As a consequence, relatives constantly interfere in the husband and wife relationship.
In the family, girls are taught to be housewives, in most cases have no education, especially in villages, and after marriage the girl becomes very dependent on her partner and family members. Without the permission of her elders and husband, a woman has no right to leave her home and receive information about sexually transmitted diseases (STDs) if she wants. A woman must stand one step behind the man in everything: in decision-making, in expressing her opinion. A woman should listen to her husband’s words, she should keep silence, this is respect. It is also rare for women to be able to decide for themselves when, how and with whom to have sex, how many children to have, etc.
At the same time, sexual violence from an intimate partner increases the risk of HIV infection. During our survey, we heard from the respondents reasoning that non-consensual sexual intercourse is a normal phenomenon, and so it should be in the family, “This is your husband: if he wants to do something then you should obey. He’s young, and that’s why you have to satisfy his desires!”
Inequality between men and women in Tajikistan is developed not only in private life, but also in public life, isn’t it?
Yes, gender inequality is one of the problems hindering sustainable development in Tajikistan. Inequality is everywhere – in access to all types of tangible and intangible resources (property, land, finance, credit, education, etc.); in decision-making in all spheres and participation in political life, and violence against women.
Why do women tolerate violence?
Because it fits within the established system of gender inequality in Tajikistan. Men provide for women, control family relations, and therefore can do, in fact, whatever they want.
But the saddest thing is that society does not sufficiently understand the importance of this problem. It is convinced that domestic violence is a private matter. It is considered that the manifestation of abuse of wife, daughter-in-law, sister, etc. or constant control over their life and behavior is not violence but a norm. At the same time, it is widely believed that a woman is to blame if her husband or his relatives use physical force against her. There are many supporters of this opinion among young people, women themselves, and especially among their mothers-in-law. Therefore, in my opinion, special attention should be drawn to solving the problems of relations between mother-in-law and daughter-in-law, the relationship to the wives of migrant workers during the period when their husbands are outside the country, early and forced marriages, etc.
Are women with HIV more vulnerable?
Definitely! Despite the fact that very often the source of HIV infection for a woman is her husband, she is subjected to violence and discrimination by her husband and his relatives. One woman said that her husband infected her, but did not consider himself guilty. Sometimes he closed the house and left his wife without food, hungry and helpless. One day he even tied her to a pole with a rope and beat her up, and then left for two days. After this she went to her parents, where she was also discriminated.
Practice shows that those who go to the AIDS centre receive quality care and many are happy with it, including me. However, the main challenges for women are when they go to other health care facilities (for surgery or dentists), including primary health care (PHC). In these facilities women living with HIV (WLHIV) are most likely to experience discrimination against themselves. During focus groups, there were a lot of situations when health care workers refused to provide medical assistance to WLHIV and disclosed their status. Most of these cases were in maternity hospitals, dental clinics and during other surgeries. Therefore, most HIV-positive women are afraid to disclose their status and do not seek services from health care institutions, including primary health care services in their place of residence.
Have you talked to these doctors? What do they say about discrimination against people living with HIV?
We haven’t interviewed the health workers. However, many women believe that the reasons are in the lack of preparedness of health workers to work with PLHIV, as well as the low level of knowledge about HIV among staff. One woman, who went to the clinic, told doctors about her status. They immediately refused her services. The woman said it was a violation of her constitutional rights. But doctors said that she was ill and they could not help her anymore. Just imagine – that’s what the doctors said!
Besides in Tajikistan there is not good medical personnel who have experience working with PLHIV. A lot of professionals are leaving our country.
Let’s imagine – a woman found out about her status, she is ready to be examined, receive treatment and do everything that doctors say. Can she face any obstacles even in this case?
An antiretroviral therapy (ART) in our country is bought from the Global Fund, so there are virtually no interruptions. If a person wants to take ART, he or she can get it at all AIDS centers. But according to WHO’s recommendations, people living with HIV are assigned to PHC services and according to these requirements a person has to get the service at home. Due to the fact that in rural areas and small towns and districts everybody practically knows each other, PLHIV are afraid of disclosing their status. So there is a possibility that they will not apply to these services locally for ART services.
How difficult is it for women to accept their status?
More often it depends on their level of awareness and education – they might not know anything about HIV or have distorted information about the virus. Because HIV does not show strong symptoms in the early stages, women think that they are not sick and that the virus does not affect them. Also, accepting a diagnosis depends on a specialist working with the woman, conducting pre-test and post-test counselling.
Do you plan to use the results of your research in future work?
At the moment, the country is developing a “National Program to combat HIV/AIDS epidemic in the Republic of Tajikistan for the period 2021-2025”, and we have joined the working group on ART treatment and prevention of stigma and discrimination against PLHIV. As part of this platform, we are actively promoting the recommendations in our report.
At the same time, the research results helped us to identify and understand a number of issues, which we have not always paid due attention to before. Therefore, we will use this information in our daily work.
You can find the research here.
UNAIDS Strategic Information Hub for Eastern Europe and Central Asia (UNAIDS SI Hub) has been launched on the Internet.
The purpose of this resource is to provide an online one-stop-shop for data, publications and strategic information about HIV (and related health issues) in EECA. It is publicly accessible to anyone online, but it aims to make information accessible and easy to find for specialists and policymakers working on HIV in governmental, non-governmental organizations and partners across EECA.
The address of the hub is http://eecahub.unaids.org/ and it’s managed by UNAIDS RST in Moscow, with support from UNAIDS HQ. It currently features HIV data from the latest GAM reports, as well as published reports and presentations related to HIV in EECA. It’s possible to access the country-specific data and reports as well as reports and publications from the various menus. By selecting “data” and “factsheets”, you can generate and print Regional and Country factsheets as PDFs as well access as epidemiology slides with global and regional statistics.
The hub works in two official UN languages – English and Russian, but most of the publications will only be available in the language they are produced (and not translated into other languages by UNAIDS).
For contribution to the UNAIDS SI Hub please send your suggestions, data, publications and other materials to email@example.com.
The WHO Regional Office for Europe is collecting examples of good practices of intersectoral collaboration for HIV, tuberculosis and viral hepatitis for publication in a dedicated compendium.
This compendium will include examples of actions undertaken by sectors outside the health sector, possibly (but not necessarily) in collaboration with the health sector. The practices should be aimed at improving the outcomes or the determinants of the HIV, tuberculosis and viral hepatitis epidemics, as encouraged by the UN Common Position on ending HIV, TB and viral hepatitis through intersectoral collaboration. They should also be accompanied by impact evaluations and credible monitoring mechanisms or research.
The above-mentioned UN Common Position was developed with an inclusive and consultative process to identify shared principles and key actionable areas within and beyond the health sector to address HIV, tuberculosis and viral hepatitis in Europe and central Asia. It was successfully launched at a side event to the UNGA in New York in November 2018 and subsequently distributed within UN system to all UN Resident Coordinators of the region.
The good practices must be submitted in either English or Russian using the form provided below. All submissions will be reviewed by the WHO Regional Office for Europe against the following criteria: relevance, sustainability, efficiency and ethical appropriateness. The authorship of each good practice will be highlighted in the compendium, which is expected to be published in 2020.
The deadline for submission is 18 November 2019. If you have any questions, please do not hesitate to contact firstname.lastname@example.org.
The Coordination Committee for the prevention and control of HIV/AIDS in Russian Federation, responsible for oversight and coordination of the implementation of the Global Fund grants in Russia, called on the Global Fund to allocate funding to support civil society organizations in their fight against HIV epidemic in Russia for the next three years.
2019 is the year of the replenishment for the Global Fund to Fight Aids, Tuberculosis and Malaria (Global Fund) and by the end of this year, based on the results of the replenishment, the Global Fund will make a decision on the allocations for the eligible countries to address HIV, TB and Malaria for the next 3-year period.
According to the 2019 Global Fund Eligibility List, the Russian Federation has met the requirement of two consecutive years of eligibility based on income classification and disease burden and is now eligible to receive an allocation of funding to support the HIV/AIDS response for the next 3 years. Since the Russian Federation is not on the OECD-DAC List of ODA recipients, according to the Global Fund’s Eligibility Policy, the Russian Federation may only be eligible for an allocation to support the HIV response efforts by non-governmental or civil society organizations and only if the country demonstrates barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology.
According to the Global Fund’s Eligibility Policy, “the eligibility for funding under this provision will be assessed by the Secretariat as part of the decision-making process for allocations. As part of its assessment, the Secretariat, in consultation with UN and other partners as appropriate, will look at the overall human rights environment of the context with respect to key populations, and specifically whether there are laws or policies which influence practices and seriously limit and/or restrict the provision of evidence-informed interventions for such populations.”
It is a well-known fact that Eastern Europe and Central Asia (EECA) is the only region in the world where the HIV epidemic continues to grow , and Russia has been considered as the “driving force” of this regional growth. According to the UNAIDS 2018 Global AIDS Update, “the HIV epidemic in Eastern Europe and Central Asia has grown by 30% since 2010, reflecting insufficient political commitment and domestic investment in national AIDS responses across much of the region. Regional trends depend a great deal on progress in the Russian Federation, which is home to 70% of people living with HIV in the region. Outside of the Russian Federation, the rate of new HIV infections is stable.
Why is the Workshop EECA INTERACT so important for the EECA region?
Alexei Alexandrov, a member of the international committee of EECA INTERACT 2019, head of Minsk regional clinical centre “Psychiatry-narcology”.
EECA INTERACT can become a model for building regional and country interaction between young and experienced researchers, medical practitioners, employees of non-governmental organizations and members of community initiatives, as well as representatives of the government.
All these specialists are involved in solving the problems of HIV infection, tuberculosis and viral hepatitis, and also related problems of drug use, criminalization, prison health, stigma and human rights. The exchange of experience by specialists from EECA countries with similar situations on HIV, TB, Hep, drug use, the results of new studies and expert assessments will allow choosing the best solutions to change the situation and begin to really implement them.
For me, EECA INTERACT is not only a meeting with new colleagues and getting acquainted with the results of their work, discussing pressing issues, forming direct contacts to continue cooperation or a network of interaction. The seminar is a continuation of the efforts that we, experts of the EECA countries, are directing to respond to the HIV epidemic in the region, implementation of those innovations that have already been tested in the world and are evidence-based.
The workshop is a step towards the development of a unified scientific, expert and practical community of our countries, united by common tasks. Everyone can have their own vision of the situation, challenges and solutions, but only joint discussion and analysis will allow finding potential points of influence for success.
How would you rate the development of clinical and research networks in the EECA region today?
In our region, a lot of problems are associated with the traditions and imperfections of medical education. For several years I conducted training seminars “Effective Treatment of Drug Dependence” in Salzburg (organized by the Open Society Foundation), where all participants, mainly doctors, were divided into 2 groups, the Russian-speaking from EECA and the English-speaking from Southeast Asia and Africa. People from EECA were educated in the “Soviet” system, the others – in the “Western”.
I noticed a very clear difference in the methods for solving clinical problems. People from EECA went into “philosophy” and the so-called pathogenetic way of thinking, and “Western” immediately appealed to existing protocols and standards, objective data, etc. I then realized that many of our specialists need to be retrained and they should focus on evidence-based methods, and not on general considerations and “clinical points of view.” For this, we need such meetings like EECA INTERACT, where these points can be emphasized. It is important also that decision-makers participate in such events.
In Ukraine over the past 10 years, significant progress has been made in the development of clinical and research links. To some extent, a solid research infrastructure has been created, several organizations were found which can not only participate in international collaborative projects but also independently carry out research and receive funding from donors such as National Institutes of Health, CDC, WHO etc. Unfortunately, national donors are still very sparingly involved in this process.
Ministry of Health also does not understand enough how important the systematic and continuous process of conducting scientific research is, and the importance of implementation projects is underestimated.
Officials believe that only mainly state institutions have the right to make scientific research. They expect global discoveries or creation of new vaccines, effective drugs, but they do not really understand that in the modern world only a limited number of countries and companies are able to take such steps. There are no such resources in EECA countries, but this does not mean that research is not needed. Doctors should be involved in scientific projects as much as possible, because this disciplines clinical thinking, makes it possible to get acquainted with the modern scientific context.
On the 10 of September the Elton John Aids Foundation with Gilead Sciences announced the launch of a new project RADIAN. This major project aims to bring support to Eastern Europe & Central Asia, where the AIDS epidemic is on the rise.
A ground-breaking initiative
The global community now has the tools to meaningfully address new HIV infections; however, HIV is on the rise in Eastern Europe and Central Asia (EECA). To address the challenges in EECA and ensure no one is left behind in the global effort to end the HIV/AIDS epidemic, the Elton John AIDS Foundation and Gilead Sciences have partnered together in a ground-breaking initiative called RADIAN.
RADIAN is a natural evolution of the existing collaboration between the Foundation and Gilead in the EECA Key Populations (EECAKP) fund, which gave the organisations a greater understanding of the urgent needs in EECA and the necessary experience to respond. The RADIAN partnership will provide investment, support and on-the-ground resources over the next five years to support interventions and drive measurable impact in EECA.
RADIAN consists of two programs: ‘Model Cities’ and the RADIAN ‘Unmet Need’ Fund. The programme will support innovative approaches, including new models of care and expanded prevention and healthcare programmes, led by groups who are on-the-ground and part of the community. The first RADIAN ‘Model City’ will be Almaty, Kazakhstan’s largest city. Additional ‘Model Cities’ will be announced in 2020
The Radian Unmet Need Fund
The RADIAN ‘Unmet Need’ fund will support local initiatives across the EECA region and beyond the select ‘Model Cities’. Initiatives selected will focus on prevention and care, education, community empowerment, and novel partnerships. The programme will be implemented locally, working with key stakeholders and partners.
The project encourages local and regional organisations in EECA who share its vision of significantly improving the quality of care for PLHIV, addressing new HIV infections and AIDS deaths to apply for grant funding when the Request for Proposals opens in mid-October 2019. Best practices and learnings from the local implementation of RADIAN over the next five years will be used as a blueprint towards creating change across the region.
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.
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:
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.
Anke van Dam,
Executive Director, AFEW International
Author: Anastasia Petrova, Russia
This year, the issue of treatment coverage for people living with HIV has been broadly discussed in Russia on World AIDS Day. We are talking on this topic with Vinay Patrick Saldanha, Director, Regional Support Team for Eastern Europe and Central Asia (EECA), UNAIDS.
– Mister Saldanha, today at the press conference, organised by the movement Patient Control, we heard that in Russia only up to one third of all people living with HIV receive treatment. What measures are to be taken to reverse the situation?
– A hard and fast decision is to be taken on adopting the ‘test and treat’ strategy. In line with the World Health Organization (WHO) guidelines, which have already been used for several years, all people with the HIV status should get uninterrupted and high-quality treatment. At the same time, treatment guidelines issued by the Russian Ministry of Health state that priority in treatment should be given to the patients with the immune status below 500 СD4 cells. Thus, with the limited access to drugs, doctors have to prescribe therapy to those who have the weakest immunity and open the so-called waiting lists. In many regions, the situation is critical.
Now in Russia there are mass HIV testing campaigns. However, to motivate people to get tested the second part of the strategy – the ‘treat’ component – should also be offered. If a person is concerned as he had some questionable contacts or he knows that his sexual partner is HIV positive, it means a direct risk of infection. It would be very good for such person to check his HIV status. However, if he knows in advance that he would not get treatment and that the AIDS centres have the “waiting lists,” he will not be highly motivated to get tested. To remove those questions from the agenda, all national governments should adopt the ‘test and treat’ policy. I am happy to say that in Eastern Europe and Central Asia there are quite a few countries, which have already announced following this policy: Armenia, Ukraine, and Kazakhstan. They treat all patients who test positive: the patient can seek and get help. If Russia wants to achieve the 90/90/90 target by the end of 2020, the decision to ‘test and treat’ is to be taken in 2018.
– A year ago, Russia adopted the State Strategy to Combat the Spread of HIV through 2020. How do you assess its effectiveness?
– The very fact that there is such a strategy is a great achievement. For many years, the epidemiological situation remained complicated due to the lack of a strategy. For the first time, the government issued an important state document calling to urgently accelerate the measures to combat HIV. It is very good that such measures are to be taken not only by the government, but also by the society, mass media, private sector and trade unions.
However, it would be good if people who prepared the Strategy would define clear and measurable targets for each year: what should be the reduction in the new HIV cases, how many patients are to be enrolled to treatment. The five-year goals are defined but how is it possible to split them and follow up on the achievement of interim targets each year?
– Vadim Pokrovsky said that the Strategy does not have a strong financial background…
– It is a question of state priorities. I think that Russia, having the resources and knowing how to distribute them in the best way, is able to find the sufficient funding to combat HIV. This is not just about the budget increase. There are high-quality drugs, which are less expensive than those procured in Russia. Thus, apart from allocating two or three times more money from the state budget, the cost of drugs may also be reduced. In the last two years, thanks to the pro-active approach of the Ministry of Health, an unprecedented reduction in the cost of HIV treatment in Russia was observed. Such price reduction strategy shall be continued until all patients have access to drugs. My estimate is that in the EECA region the cost of treatment should not exceed 200 US dollars per patient.
– Speaking about price reduction, do you mean compulsory licensing?
– This as well. When compulsory licenses were discussed for the first time, the Russian government represented by the Ministry of Health was concerned that the foreign pharmaceutical companies may leave our country, stop the clinical trials and Russia would be excluded from the innovations. I know over 15 countries in the world, which issued compulsory licences for HIV drugs. In none of those cases, none of the pharmaceutical companies ceased their activities in such countries. Vice versa, such policy led to sharper price declines and scaled up access to treatment. That is why I strongly welcome the discussion of this question at all levels.
One option is to issue a license to produce drugs in the country and another is to facilitate the procurement of quality drugs from abroad at lower prices. Thus, Brazil, for example, for 20 years was famous for producing most “first line” drugs for its citizens. However, three years ago, even before the WHO guidelines were issued, it was the first country to make a decision to treat all people living with HIV. After all the costs were calculated, it became clear that such coverage could not be reached if only locally produced medicines are used. Then the country started purchasing generic medicine from Indian brand producers for 400 US dollars per patient a year. It is a very interesting example of how access to high-quality medicine may be ensured without violating the patent rights.
– Surely, you will take part in the XXII International AIDS Conference in Amsterdam next year. What are your plans for this event?
– We have a joint plan for two very important conferences: VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) and the XXII International AIDS Conference (AIDS 2018) in Amsterdam next year. As UNAIDS, we are co-organizers of the ЕССААС 2018 and members of the AIDS 2018 Committee. We encourage specialists and mass media representatives to not only take an active part but also to build kind of a strategic bridge between those conferences. We would like the international participants to intensively share their experience at ECCAAC 2018 and representatives of the EECA region to broadly present their developments at AIDS 2018.