Dreams of the “Invisible” Women in Kyrgyzstan

Author: Grana Ziia, AFEW-Kyrgyzstan

A photo exhibition “Dreams of the Invisible Women” was held in Bishkek, Kyrgyzstan from November 25 to December 10, 2018. The exhibition, which was held in the centre of Bishkek and in the venues popular among young people, allowed women suffering from violence, discrimination, living with HIV or using drugs as well as LBT women to send a message to the society: “We are here! We also love and are loved, we deserve to be happy and have equal rights.”

The photo exhibition was initiated by Asteria Foundation with the UNAIDS support. The photo models were participants of Bridging the Gaps: Health and Rights for Key Populations project. The exhibition was held within the 16 Days of Activism Against Gender-Based Violence Campaign, and its opening was dedicated to the World AIDS Day.

“Invisible women” face violence, they become hostage to an endless cycle of abuse, guilt and discrimination. People judge them and tell them: “That’s all your fault!” Often, drugs are the only way for them to run away from their pain, shame and despair. Due to the social stigma, women from the key populations almost never seek help, they are afraid that people will not understand them and will reject them. That is why their problems are invisible for the state and for the society,” says Irena Ermolayeva, Director of the Asteria Charitable Foundation.

Asteria’s statistics confirm this situation. According to the data available, all women from vulnerable populations who have families or intimate partners are exposed to different forms of violence. However, 80% of such women do not seek any help as they are afraid to face stigma and discrimination again.

“This campaign is very important for us. It opens new opportunities for women who use drugs, lesbians, trans women, women living with HIV and women who suffer from violence and show the issue from a different perspective. The main goal of the exhibition is not to “draw” a victim and not to label women, but to focus on the fact that first of all they are human beings and, thus, should have equal rights. I hope that this campaign will change the attitude of our society to thousands of women who are the same as the heroines of our exhibition,” says Irena Ermolayeva.

“Invisible women” are first and foremost someone’s mothers, who love and are loved, someone’s friends and relatives. They need the society to stop viewing them as a problem and to recognize their right to live free, happy and safe lives. They dream to be protected by law and by the state.

Mother-to-Child Transmission of HIV in Kyrgyzstan is Minimal

Now about half of the money allocated by Kyrgyzstan for the HIV component goes to the procurement of test kits for pregnant women

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is getting prepared to receive a certificate to confirm elimination of mother-to-child transmission of HIV. In the last five years, over 95% of pregnant women were covered with prevention projects, while the new cases of vertical HIV transmission are now at the level of 2%.

Testing is an integral part of prevention

Since 2007, all pregnant women have been tested for HIV when registered in maternity care. In case of a positive result, the woman is registered with HIV treatment facilities and receives consultations on the need of antiretroviral treatment (ART).

“A good, easy-to-understand consultation leads to the woman giving her voluntary consent to the therapy initiation. There are rare cases when women refuse treatment due to the lack of knowledge or religious beliefs, but most often – due to their self-stigmatization. The share of such refusals is now less than 2%,” says Erkin Tostokov, physician working at the Prevention Unit of the Republican AIDS Centre. “There are some cases when a woman is first seen by the doctor only when she delivers her baby. For such women, we do rapid HIV testing in the maternity clinics and, if HIV is confirmed, we hand out ART drugs right there. We update our clinical protocols in line with the most recent WHO guidelines and train our doctors on a regular basis.”

Children born to HIV-positive mothers go through several stages of examination: early diagnostics to identify if the foetus is infected intra uterine; then within 4-6 weeks doctors have to exclude HIV transmission during the delivery; and the last test allows detecting the HIV status of the infant after the breastfeeding is completed. Children receive preventive ARV therapy depending on their risk level and receive monthly social benefits during the whole period until final confirmation/non-confirmation of the diagnosis (up to 18 months).

Social benefits for children living with HIV

Elena learned that she had HIV in 2011. In a while, the woman found out that she was pregnant. Back then, she was in a difficult situation: no job, no place to live, and no money. The woman felt lost because of her HIV status.

“The doctor prescribed ART and I started taking the pills, though before I refused to take the therapy because of my allergy,” Elena recalls. “When my daughter was born, she received preventive therapy for two months. When my girl was 18 months, the doctors did the last test and took her off the register as she was perfectly healthy. However, I was still scared and took her for HIV testing until she was four years old.”

Now about half of the money allocated by the state for the HIV component goes to the procurement of test kits for pregnant women. The government provides social benefits for children living with HIV and free breast milk substitutes.

“In the recent 7-8 years, our programmes to prevent mother-to-child transmission of HIV achieved a big progress: the share of such transmission was reduced from nine to one percent,” says Aybek Bekbolotov, Deputy Director of the Republican AIDS Centre. “To a great extent, this result was achieved through the efforts of doctors working in general and maternity clinics. Now there is almost no pregnant woman whom we miss. All maternity clinics have been provided with rapid HIV tests and ART drugs. We received a strong support from UNICEF. They provided training to doctors, supported the launch of early diagnostics in newborns and rapid testing in maternity clinics. Now they help us to get prepared to receive the certificate of having eliminated mother-to-child transmission of HIV. A country can get such a certificate provided that the rate of vertical transmission is less than 2% and if over 95% of pregnant women have been covered with prevention programmes in the recent two years. There are certain requirements to indicators and procedures to calculate such data, and now we are working on meeting them.”

Support and training in the summer camp

Currently, there are 478 children with HIV registered in care, 464 of them receive treatment. Every year, summer camps are held for children living with HIV with UNICEF support. This year, this event will be brought to the international level for the first time.

“In July, there will be a one-week summer camp for children, parents, doctors and social workers from Kyrgyzstan, Kazakhstan, Tajikistan, Uzbekistan, and Turkmenistan. There will be trainers from the UK, Ukraine, Russia, Germany, Spain, the Netherlands, and Italy,” tells Aybek Bekbolotov. “The camp will include several parallel events: a forum for adolescents living with HIV and their parents, workshop for pediatric medical staff and training for psychologists and social workers.”

Medical and social workers will be trained to work with children living with HIV, while children and their parents will develop support and leadership skills and are expected to form a new community.

Persecution and Activism of Sex Workers in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

For almost a year and a half, law enforcement agencies have been persecuting sex workers in Kyrgyzstan. During this period, the number of sex workers receiving HIV prevention services in some regions of the country reduced twice. Civil society organisations registered more than 450 cases of sex workers’ rights violations by the police every year.

Extortion, detentions, and threats

In 2017, 81% of all reports of abuse and human rights violations submitted to the Shah-Aiym Sex Workers Network were complaints against police officers on extortion. Shah-Aiym documents such cases with the support of Soros Foundation-Kyrgyzstan and street lawyers of public associations all over Kyrgyzstan within the framework of the Global Fund via Soros Foundation-Kyrgyzstan. Both sources recorded 475 cases of sex workers’ rights violations by law enforcement agencies in 2016 and 459 cases in 2017. Most often, those are cases of extortion, arbitrary detention, threats, blackmailing, pressure and degrading treatment.

“The wave of mass raids started in mid-2016 when City Directorate of Internal Affairs in Bishkek announced that it was going to “clean the city by getting rid of prostitution.” They even asked local people to conduct night raids, make photos of sex workers and pass such photos on to the policemen,” tells Shahnas Islamova, head of NGO Tais Plus. “At first, press service of the Chief Directorate of Internal Affairs was reporting detentions, not even hesitating or not understanding that they were, in fact, announcing unlawful acts of the law enforcement agencies.”

In Kyrgyzstan, sex work is decriminalized, which means that it is neither an administrative nor a criminal offense. To punish sex workers, law enforcers use other provisions of the Administrative Offences Code. Most often, sex workers are detained for alleged disorderly conduct or petty crimes.

“Sex workers try to avoid court proceedings: they buy off. There are some cases when law enforcers know what a girl does to earn her living and start blackmailing her. They threaten to take photos of the girls, tell their relatives about their occupation or take them to a police station, so the girls agree to pay: the standard charge is up to 1,000 soms ($15),” tells Alina (the name is changed), a street lawyer of a civil society organization. “If girls try to defend their rights, law enforcers find other ways to detain them: they draft reports of disorderly conduct or failure to obtain registration. Those who have bad luck or are not able to buy off may be arrested for three to five days.”

According to Alina, many sex workers have gone underground: they often change their rented apartments and phone numbers. Such situation in some regions of the country hinders the access of NGOs to sex workers to conduct HIV prevention interventions: distribute condoms, offer testing, conduct awareness-raising activities, and consultations.

“Since the start of the “purge”, our organization has been monitoring the dynamics in the coverage of sex workers with prevention programmes in Bishkek,” says the head of Tais Plus NGO. “In a year and a half, the coverage has reduced twice, and in the second quarter of 2017 the actual indicator went down to 39% of the planned coverage.”

Activism in the challenging environment

Mass raids of 2016-2017 echoed almost in every region of the country. Groups of people who explained their actions with the “religious motives and interests of the society” helped law enforcers in their “fight” against sex workers. As the end of 2017 approached, things calmed down: sex workers got used to the new conditions, while the pressure from the side of police weakened a bit and the mass raids ended. However, “police marks” stipulating sex workers paying money to the law enforcers for the so-called “protection” and “permit to work” are still there.

“Currently, in most cases pimps are the ones to keep contact with police, while there are almost no girls who work on their own,” says Nadezhda Sharonova, director of the Podruga Charitable Foundation about the situation in Osh. “Recently, our street lawyer has been more and more often reporting complaints of sex workers against their pimps who beat and blackmail the girls.”

Despite the fact that civil society organizations in Kyrgyzstan offer legal support, sex workers rarely report their offenders. Representative of the Tais Plus NGO thinks that this fact is easy to explain: to go through all the legal prosecution process, one needs boldness and strength as well as certain savings – not to cover the legal expenses, but to be able not to work for a while and keep out of the law enforcers’ sight.

At the same time, the sex workers movement is growing and becoming stronger. The Shah-Aiym Network unites sex workers in Kyrgyzstan, Tajikistan, Russia. The network documents human rights violations and provides support to the victims of human rights violations, actively protects the interests of sex workers’ community and publicly campaigns against violence towards sex workers. The network ensures conditions for strengthening activists’ capacity to claim and defend their rights.

“We have seen cases when sex workers defend themselves,” says Shahnas Islamova. “For instance, at the court hearings on administrative offenses some sex workers now openly say that they are engaged into sex work and do not violate any laws, while the police has violated the law when detaining them. As a result, such sex workers have left the courtroom free from any accusations.”

Happy with HIV in Tajikistan

Tajik wedding. Source: wikimedia.org

Author: Nargis Hamrabaeva, Tajikistan

A Tadjik girl Nozanin was diagnosed with HIV after her husband-migrant returned home a few years ago. As the man has found it out, he walked out on her… Now the 40-year-old woman is happily married again.

Everything was like a fairy tale

“It happened unexpectedly, like in a fairy tale. Once I was taking care of the household, when my friend, who liked me, called. He said that he would come with a mullah (a clergyman conducting the wedding ceremony according to the Muslim canons – editor’s note) and some of our colleagues. They really came. After the religious wedding ceremony, we went to his parents,” Nozanin is saying.

This friend turned out to be a client of the Republican Network of Women Living with HIV, where Nozanin has been working. He was also HIV positive. He wanted to marry a woman with the same status and Nozanin somehow even tried to find him a suitable candidate. It turned out that the man was already in love with her…

“I never thought that I could ever get married again, especially having HIV status,” she says.

Today Nozanin considers herself to be a happy woman. Together with her husband they have a lot of plans and ideas, and they also want to give birth to a healthy child. Many couples living with HIV have the same desire.

A marriage contract is not needed

700 people in Tajikistan receive support from the Republican Network of Women Living with HIV. For the most part, these are young people who want to start a happy family.

Tahmina Haydarova, the head of the network, says that young men between the ages of 18 and 35 come to them searching for a soulmate with the same HIV status. Often these are labor migrants, former drug users or prisoners who have never been married before. Brides are usually those who have already been married. These women contracted the virus from a migrant husband or partner who used drugs.

Such brides do not ask to sign a marriage contract; they do not ask for an apartment or dacha. The most important thing for them is the timely use of antiretroviral therapy by their future spouse and a healthy life.

HIV is not a barrier

Each year the Republican Network of Women Living with HIV helps at least 5-6 young HIV positive people to find their spouses. Takhmina Haydarova is telling about 10 couples who decided to start a family with the fact that one of the spouses is HIV positive.

“If a person loves and accepts you for who you are, then HIV is not an obstacle to start a family. Today antiretroviral drugs that block the HIV are available. A person living with HIV with a suppressed viral load can start a family, give birth to a healthy child, live a full and happy life the way our clients do,” she says.

According to the Republican AIDS Center, the total number of HIV positive citizens in Tajikistan has reached 10 thousand people, one third of them are women. Since 2004, women with HIV have given birth to 1,000 children, 600 of these children have no HIV.

Bridging the Gaps in Clinical Guideline to Care in Pregnancy for Women Using Psychoactive Substances

All the regions of Kyrgyzstan already received the developed clinical guideline

The estimate number of people who use injected drugs (PWID) in Kyrgyzstan is about 25,000 people. Many of these people are women. Such is the data from the research that was conducted within the framework of the Global Fund’s grant in 2013.

Applying recommendations in practice

In 2016, Public Fund (PF) Asteria, a community based organisation that protects rights of women who use drugs in Kyrgyzstan, applied to AFEW-Kyrgyzstan seeking for a help in developing a clinical guideline to care in pregnancy for women who use drugs. Within the framework of the project Bridging the Gaps: health and rights for key populations, AFEW-Kyrgyzstan decided to support this initiative as there were no modern standards for working with women who use drugs in the country before. A working group that included an expert in narcology, an obstetrician-gynecologist, an expert in evidence-based medicine, and a representative of the community of women who use drugs was created. In January 2017, the clinical guideline “Care in pregnancy, childbirth and the puerperium for women who use psychoactive substances” was approved by the order of the Ministry of Health and became mandatory for doctors’ use.

“When the guideline was approved, we realized that it is not enough to simply distribute it among the doctors. It was necessary to organize a comprehensive training for the family doctors, obstetrician-gynecologists and other specialists so that they could not only apply the developed recommendations in practice, but also share their experience with their colleagues,” said Chinara Imankulova, project manager of the Bridging the Gaps: health and rights of key populations at AFEW-Kyrgyzstan.

In April 2017, trainings were organized for the teachers of Kyrgyz State Medical Institute for postgraduate students. The manuals for teachers with presentations have been developed so that in the future trained teachers could deliver reliable information to the course participants. This approach gives an opportunity to train all healthcare professionals in the country and provides them with an access to the protocol.

In August 2017, trainings were offered to obstetrician-gynecologists of the centers of family medicine and obstetrical institutions. During the trainings, specialists got acquainted with the latest research in this field, studied the peculiarities of pregnancy, prenatal and postnatal period of women, who use drugs, as well as ways to avoid or minimize the risks of drug exposure to women and children.

“Two or three years ago, when our pregnant women who use drugs visited doctors, they were afraid that doctors would force them to have an abortion. In September 2017, our client Victoria, who at that time was on methadone therapy, visited the obstetrician-gynecologist. Victoria gave birth to a healthy girl, and doctors treated Victoria and her child very well. Moreover, the doctor even helped Victoria to get methadone so she could spend enough time in the hospital for rehabilitation after the childbirth,” said Tatiana Musagalieva, a representative of PF Asteria.

Women should not be discriminated

During the trainings, 100 specialists who are working in the republic of Kyrgyzstan were trained. Doctors from the regional centers were also invited for the training. It is very important to provide access to quality medical services for women who use drugs in the rural areas. Doctors also learned to get rid of their stigma towards women who use drugs and always treat them with respect. A class on stigma and discrimination was taught by women from the community of drug users. They told the participants of the training their stories, talked about how difficult it was when doctors refused to treat them or insulted them. This part was useful in reducing stigma and discrimination among doctors, in showing them that women who use drugs are just like the others.

“Before the training I met several pregnant women who use drugs. To be honest, I was not sure that they could give birth to healthy children. Having received the clinical protocol, and with the knowledge I have got in the training, I realized that these women should not be discriminated. I learned about scientific recommendations for conducting pregnancy in the situations that cannot do harm to either mother or child. This helped me a lot,” said the participant of the training, obstetrician-gynecologist Kaliyeva Burul.

All the regions of the republic already received the developed clinical guideline. Doctors who have been trained, share their experiences with their colleagues and help women who use drugs to safely plan their pregnancies and give births to healthy children. AFEW-Kyrgyzstan continues to monitor the work of specialists who have been trained, and monitors if all health specialists have access to the guideline. In the future, AFEW-Kyrgyzstan will continue to work on improving the quality of life of people who use drugs, and will monitor the usage of this protocol by doctors.

Bridging the Gaps Returned the Faith

Tahmina’s story is one of the positive stories of women in Tajikistan, who, due to the social and legal support of the project Bridging the Gaps: Health and Rights for Key Populations 2.0, again received hope and planned positive changes in their lives.

Family issues pushed to drugs

“When I studied in the 4th grade, my parents already had five children. This is the usual situation in Tajik families in the rural areas. Due to the frequent childbirth and burdensome care for five young children at the same time, my mother often fell ill. I had to drop out of school and take care of everything by myself,” Tahmina is saying.

Tahmina was taking care of all the things in the house, raised her brothers and sisters, helped them with school. Because of the health problems, her mother was constantly in hospitals. Her father spent days at work and came home late at night.

In one of such evenings, when the father was late at work and the mother was in the hospital, Tahmina’s uncle – her father’s brother – visited their house. Asking little Tahmina to come out of the house with him, the uncle raped her. Some time later, the neighbour found unconscious Tahmina and brought her to the hospital. Long investigations started, her mother and father were almost having nervous break-downs because the relatives of the girl started to hate her and blamed her for everything.

“Policemen always came to our house and asked me strange questions. I remember that when I came to the courtroom and saw my uncle there, I just fainted,” Tahmina is saying. “My uncle eventually was sent to prison and I became the cast-away for many of the relatives from my father’s side. Trying to save me from them, my parents sent me to the relatives from my mother’s side. I was always traveling to Dushanbe or to the other cities of the country.”

The girl started to meet different people, became friends with other girls in Qurghonteppa. During one of the meetings, the girls offered Tahmina to smoke cigarettes and then marihuana. They introduced Tahmina to Azam (the name is changed) who turned to be the big drug-dealer in Qurghonteppa.

“During a year and a half, he was keeping me locked in one of his apartments. Sometimes late at night, he would take me to the restaurants,” the woman recalls. “Taking all of this into consideration, he was still sending money to my parents. He taught me how to use drugs. This is how I became addicted to heroin. After some time, Azam’s interest to me faded away and I found myself on the street. Because at that moment my life totally depended on heroin, I started to steal and do sex work so that I could get a doze. As a result, I went to prison.”

The key visit to AFEW-Tajikistan

In 2013, Tahmina went to prison because of the theft. Being imprisoned for a quarter of her term, she got free because of the amnesty. When she went back home, the woman again faced the threats from her father’s relatives side. She had to leave her home and started to live on the streets again. After many unpleasant adventures, Tahmina met people who use drugs whom she knew before, and she started to use again.

Once, Tahmina met Bahriddin whom she knew before. He was also using drugs, but, to Tahmina’s surprise, he changed, and was looking good and happy. It turned out that Bahriddin started to work in the public organisation AFEW-Tajikistan as a peer consultant. He told Tahmina about how he succeeded to change, and he also mentioned the help and services that his organisation is providing. Tahmina got interested in that and decided to visit the drop-in center for the drug users and see everything by herself.

When she just came to AFEW-Tajikistan’s drop-in center, Tahmina was surprised that even though she had a dirty dress and flip-flops were barely covering her bloody feet, she was greeted very warmly. She was offered some tea and the workers talked with her about her health.

“I was very skinny and dirty, and I could not remember the last time I took shower or bath,” Tahmina is remembering that day now.

The social workers helped Tahmina with taking care of herself. They also helped her to come back to her parents’ house, arranged the documents for her and sent her to the doctors so that she could be checked and her health could be improved.

To see the sun again

Since summer 2017, Tahmina comes to the drop-in center very regularly. She is also taking part in self-help groups of people who use drugs. She learned the basics of her personal hygiene, HIV prevention and sexually transmitted infections (STI.) She got to know how to cope with the drug use and the possibilities to live sober. During one of the meetings, Tahmina got to know about opioid-substitution treatment (OST.) The friendly and warm atmosphere, respect and the possibility to get methadone for free inspired Tahmina to change her life.

Since August of the same year, Tahmina started to take part in OST programme that is located in the drug center where she would never go by herself. Nowadays, Tahmina is taking methadone and continues to take part in self-help groups. She found many friends who understand her and are ready to support her.

“With the support of AFEW-Tajikistan, during half of the year, I changed for better. I believed the peer consultants and social workers and started to help my mother, and I have not done so since I left home. AFEW helped me to gain the trust in myself again. My eyes are shining like it was before, I again see the sun and I want to live!” Tahmina is finishing her story with the smile on her face.

Only in 2017, 688 female drug users and vulnerable women in the Republic of Tajikistan were provided with the prevention and social services within the project Bridging the Gaps: Health and Rights for Key Populations 2.0 that is financed by the Ministry of the Foreign Affairs of the Netherlands.

“Kyianka+”: Understanding the Lives of Ukrainian Women Living with HIV

Author: Yana Kazmirenko, Ukraine

Vera Varyga (in the center) is often sharing the success of Kyianka+

Members of “Kyianka+” self-help group conduct regular meetings to exchange positive emotions, share success stories and learn how to resist psychological abuse.

Vera Varyga, leader and founder of the “Kyianka+” self-help group for women living with HIV, receives at least three anonymous phone calls a day to their hotline phone number +38 (067) 239 69 36 from women who have just learned about their HIV status. This hotline number is promoted at the HIV testing locations. Vera’s words may have a significant influence on the future lives of these women and their ability to accept their status and move on.

“Kyianka+” group, operating with support from ICF “AIDS Foundation East-West” (AFEW-Ukraine), was created three years ago, and has already helped more than 150 women. Women living with HIV attend monthly meetings, participate in master classes and get psychological counselling.

“It was very difficult for me to accept my HIV status. I received my first psychological assistance from another woman living with HIV only two years after I was diagnosed. During my first self-help group session, I cried a lot, but women supported me, believed in me and showed me that I am not an outcast. Now, in my groups, I see other girls crying like I was,” says Vera.

In the district hospital of Kharkiv region, Vera had to deal with cruel and unfriendly attitude from staff, which was typical of the Ukrainian provincial medical facilities back in the early 2000s. People diagnosed with HIV were perceived as socially dangerous elements, almost criminals.

Today Vera is a role model – a self-assured woman, a mother of two healthy boys, a beloved wife. She is very friendly, laughs a lot and loves her coral lipstick.

Difficulty of disclosure

At “Kyianka+” sessions, women share their concerns and success stories, trying to find their own way to get on with their lives.

“For example, we conduct role plays during which we model HIV-status disclosure to different people: mothers, partners, children, bosses or health workers. Mothers usually face the most difficult task of telling their sons or daughters about their status. Preparation for such disclosure takes more than a year, and we recommend having a psychologist present: it is hard for a mother not to burst out crying in such a situation,” Vera explains.

Vera is proud of the atmosphere in her group: all the girls get along well, not least because of the set of rules that they developed together:

  1. Confidentiality: nothing discussed in the group can be shared outside of the group.
  2. Attendance is not allowed for women who currently use drugs – they have other values. If they succeed in quitting – they are always welcome.
  3. No criticizing: all women are free to express their opinions.
  4. No medical advice or recommendations: treatment can only be prescribed by a doctor.
  5. The group is for mutual support: you get help and you give help.

All responsibility is on her

Men and women react differently when they hear about HIV-positive status. Men usually need a clear plan, while women often feel panic and become depressed. In our culture, the challenges of solving health problems and thinking about the future of the family often fall upon women.

“Our task is to teach a woman to love and respect herself, to find time for treatment and to make her health a priority. It is like an emergency situation in a plane: first put on your mask, and then put a mask on your child,” Vera says.

Traditions are another area of concern for Ukrainian women: what will the parents say? How will children, neighbours, colleagues react? Is my husband going to leave me? Women have to deal with stigma: everything they had thought about HIV before becomes part of their personal story.

Teaching to share and to help

Anna Lilina, a 30-year-old woman from Kyiv, was diagnosed with HIV when she was three months’ pregnant. Doctors’ prescriptions saved her daughter from getting HIV. Back in the municipal AIDS Center, Anna learned about the self-help group, but she only went there later, when in trouble. She and her daughter were thrown on the street by her boyfriend, whom she had met at the hospital.

Anna Lilina took part in a photo shoot that raised awareness about violence

“My relatives gave me money to pay for the first and last months of the apartment rent. He suggested I moved in with him and spent the money to renovate his house and fix his car. When the money was gone, he forced me out into the street in winter,” Anna says.

Anna needed support and sympathy. Therefore, two years ago, she came to the self-help group.

“After every self-help group session, I get so much energy that it feels I have wings and I can fly, but with every stressful situation, I return to the ground, and feel depressed,” Anna confesses.

It is not only positive impressions that women share at the group. They also started exchanging clothes, baby formulas, information about babysitters and apartments for rent, vacancies and tickets to theatres.

Professional training courses in manicure, floristry, office-management and the English language help these women to change their lives and start making an income. Master classes are also an important part of the therapy, through which women do not only develop new skills and get a profession, but also make steps towards opening up.

Anna remembers how she tried to convince a guy who infected her to start taking antiretroviral therapy. He, however, was saying that AIDS is an invention of American doctors who want to make money. He did start taking the therapy, but only after he had fainted and had to be hospitalized.

“I do not mind anymore that I have HIV. I have met real friends and learned how to be happy about simple things. Volunteer work and organizing help for people in need – this is my new talent, and in the future I would like to become a social worker,” Anna shares.

The number of women in need of Anya and Vera’s help will only increase, as in April 2016 Kyiv joined the Fast-Track Cities initiative to accelerate and scale-up AIDS response, one of the goals of which to ensure that by 2020 ninety per cent of people living with HIV know their status and receive therapy.

Who needs you?

Group master class on felting toys

“Kyianka+” members have a secret Facebook chat to share their thoughts and concerns. The online group allows participants to interfere and help each other in critical situations. Among the most discussed are postings about psychological abuse, especially in discordant couples with an HIV-positive woman and HIV-negative man.

Vera says that her clients often have difficulties with setting the boundaries and counteracting manipulation. If a woman does not make it clear that her status is not a humiliation, her partner’s manipulative actions may reach new levels. For example, he may decide to take charge of the family budget.

“I was stunned by the stories of our clients. To avoid a break-up, one woman’s husband was threatening his wife to tell everyone about her status. Another man said he would disclose this information at their son’s school. In another family, a husband and wife had not invested time to discuss the situation, and once, during a picnic with close friends, they had a fight. The man got drunk and yelled: who needs you now, you AIDS-ridden cow? This story echoed deeply in me – back in the day when I was pregnant, a doctor yelled at me in a similar way: you are ridden with AIDS, and you still want to have a baby?” Vera shares her emotions.

She is certain that with this one phrase that man said everything he thought about his partner and their relations. It is possible to forgive him afterwards, but it is not possible to trust him again. This breaks up the family, and all his reassurances and pleads for forgiveness are in vain – the couple had to discuss the situation earlier. After the picnic the couple broke up, and now they are undergoing therapy.

The Facebook post about blackmailing had a lot of responses: the participants shared links to study psychological tricks of manipulators, and the women who had similar experiences helped others with advice and recommendations on how to stand firm and raise their self-esteem.

Vera is very happy to see this meaningful participation of women. She hopes that her clients will eventually leave their worries behind and start living full lives, and that the most active of them will help organize such groups in every Ukrainian city.

AFEW Tajikistan’s Offers the Range of Unique Services

Success with harm reduction has recently been achieved in Tajikistan. HIV epidemic amongst injecting drug users also seems to stabilize and even decline. Unfortunately, HIV is still increasing as now it also enters wider community around people who use drugs (PUD) and other key populations. Sexual transmission of HIV is rising, and women is the most vulnerable group in this new wave of HIV infections. Besides, in Tajikistan there are other health related issues with tuberculosis, hepatitis and sexual and reproductive health. These are the observations of AFEW International’s director of the programs Janine Wildschut who visited Tajikistan last week to monitor the work of ‘Bridging the Gaps: health and rights for key popualtions’ programme.

Empowering women is the aim

Within ‘Bridging the Gaps’ programme, AFEW Tajikistan with its partners are focusing on service delivery mainly for female drug users, female prisoners, wives and spouses of PUD. Through the Comprehensive Service Delivery Centre in Qurghonteppa, AFEW Tajikistan is delivering a broad range of services for vulnerable groups, where all groups are welcome.

“We face the issues with health and with the rights of individuals. We want to empower women to take care about themselves, and it is very important to support them in speaking out for their interest and needs,” Janine is saying. “AFEW Tajikistan offers the unique opportunity to have HIV test on the base of the NGO. They also offer wider psycho social support and client management for women based on their needs.”

In Tajikistan Janine also conducted assessment amongst PUD that have labor migration experience. With the support of Open Society Institute Tajikistan, AFEW Tajikistan is supporting labour migrating women returnees with client management. During the focus groups, different women were asked about their needs, quality of services they received, ideas for further improvements and their lives.

Starting vocational training

Janine Wildschut also conducted interviews with NGO partners about the situation for civil society in Tajikistan, spoke with governmental partners within the health department and penitentiary system and worked with AFEW Tajikistan staff on the development and strategies within the next years of the ‘Bridging the Gaps’ programme.

“During the focus group, opioid substitution therapy (OST) clients expressed the uniqueness of the service centre in Qurghonteppa. The biggest challenge for people is to travel every day to the OST point to pick up their methadone, since some of them live quite far and have little resources to spend on transportation,” Janine noticed. “Located nearby, AFEW branch is of big help since they can, after picking up OST, go for health checkup, self-support group or use some other support. Nowadays they are experiencing less discrimination and not such bad treatment of public health facilities because with the AFEW partner network and the AFEW referral vouchers, the attitude and climate in the health facilities in Khatlon region improved a lot. Besides, the support of social workers decreased the level of self-stigma which makes people less fearful to visit  public health services.”

The biggest challenge people still face is the lack of work and education. For that reason, AFEW Tajikistan is considering the option of starting vocational training and enterprise. These plans will be developed in collaboration with experts and micro credit organizations that are part of the partner network.

Almaty is the first city in Central Asia to sign the Paris Declaration

Paris Declaration in Almaty was signed by Deputy Akim of Almaty city Murat Daribaev and UNAIDS Director in the Republic of Kazakhstan Alexander Goleusov

Author: Marina Maximova, Kazakhstan

The world movement, which already includes more than 70 major cities around the world, has reached Central Asia. The first city, whose authorities signed Paris Declaration with an appeal to stop AIDS epidemic on July 20, 2017, was Almaty. Signing of the declaration became possible and was organized within the framework of the project “Fast-Track TB/HIV Responses for Key Populations in EECA cities”, implemented by AIDS Foundation East-West in Kazakhstan.

Almaty is the largest city in Kazakhstan. It is cultural, financial and economic centre of the republic with a population of more than 1.7 million people. For many years it was the capital of the country. The megapolis, along with Pavlodar and Karaganda regions, has the highest rate of HIV infection in the country. Therefore, signing Paris Declaration gives Almaty opportunity and hope to improve the sad situation.

“This fact will undoubtedly attract city residents’ attention to HIV issues. People will get tested more actively, and will start their treatment in time if necessary. Almaty will participate in international health events and will have access to the most advanced achievements and developments in the field of HIV and AIDS. The best world practices will be included into the City Improvement Plan on HIV and tuberculosis until 2023. This will stop the growth of HIV epidemic and improve population’s health,” Valikhan Akhmetov, the head of the Almaty Public Health Department said during the ceremony of signing the declaration.

Sexual transmission of HIV increases

Today, there are more than five thousand registered HIV cases in the city. A quarter of the cases is observed among internal and cross-border migrants. For many years, the main route of transmission was parenteral. To stabilize the situation, the Akimat (regional executive body in Kazakhstan – editor’s comment) has introduced harm reduction programs targeted to key populations: people who inject drugs, sex workers, men who have sex with men. There are 18 syringe exchange points in the city and six friendly cabinets at polyclinics. This year, despite strong public confrontation, site for substitution therapy has been launched.

The trend of the HIV infection spread has changed dramatically in recent years. Today, the sexual transmission is already 65%. Infection, as doctors say, is now targeting general population, but people are still not aware of it and live as if it has nothing to do with them.

“It is very difficult for people from secured families and those who have good jobs to accept the positive HIV status. Women who live in a civil marriage, refuse to name their sexual partners. There can be another situation: imagine a girl coming to us with her mother, who claims that her daughter is a pure child, and she simply cannot have HIV infection,” Alfiya Denebaeva, deputy head physician of the Center for Prevention and Control of AIDS in Almaty is saying.

Some pregnant HIV-positive women do not take antiretroviral therapy (ART) because of the disbelief. Several years ago, there were cases in the city where mothers who did not believe in HIV-infection refused to take medicine, and their infants then died. Now there is an occasion to discuss this topic at the 22nd International AIDS Conference AIDS 2018 in Amsterdam, in which participants from Kazakhstan will also take part.

Regardless of what was mentioned before, Kazakhstani doctors manage to achieve high results. 99 percent of HIV-positive women give births to healthy children. There are several cases when HIV-positive women become mothers for the second and even third time. It is mostly possible thanks to mandatory two-time testing of every pregnant woman when timely diagnosis and starting of ART is possible to establish.

Almost 90% of PLHIV, who need treatment, receive ART

Regional Director of UNAIDS in Eastern Europe and Central Asia Vinay Saldana

In Almaty, testing and treatment of HIV infection is possible at the expense of the city and republican budgets. Back in 2009, the country was the first in Central Asia to start purchasing ARV drugs for adults and children. Today Almaty is the leader: more than 88% of people living with HIV (PLHIV) in need of ART, receive this treatment. This figure is higher than the same figure in the republic by eight percent. The megapolis is much closer to achieving AIDS targets 90-90-90 than any other city in the country: 90% of people living with HIV should be aware of their HIV status; 90% of people who are aware of their positive HIV status should receive antiretroviral treatment; and 90% of people receiving treatment should have a suppressed viral load that will allow them to stay healthy and reduce the risk of HIV transmission.

Another statistic data is showing the advantages of life-saving therapy. The effectiveness of treatment for PLHIV is more than 76%. Thanks to the early beginning of ART, there has been a 20% decrease in new tuberculosis cases among HIV-positive people. This is a very important achievement because the combination of HIV and tuberculosis infections is the main cause of death among PLHIV. Over the past year, this number has increased by 20%. The main reasons for this are late detection of HIV and amnestied patients, who arrive home from places of detention in critical condition. In every third case, the death was inevitable due to the specifics of the damage of the immune system and other organs. Mostly it was cancer or general body atrophy.

“Thanks to United Nations assistance, Kazakhstan has developed a new mechanism for purchasing ARV drugs. Only three years ago, we were spending several thousand dollars per year for a single patient. Now this cost is reduced to the minimum. Therefore, previously we could not advise people living with HIV to start treatment immediately, but now this treatment is available to everyone,” Vinay Saldana, Regional Director of UNAIDS in Eastern Europe and Central Asia is saying.

Open Call for Applications for Eurasian Gender Academy 2017 Announced

An open call for applications to participate in the second Eurasian Gender Academy 2017 is announced.

Eurasian Gender Academy  is developed in response to the pressing need to address the persistent gender inequalities and human rights violations that put Women, Girls and Transgender (WG/TG) at a greater risk of, and more vulnerable to HIV, hepatitis and tuberculosis. This event is conducted in the framework of RCNF-funded Project “Eastern European Regional Platform for Accelerated Action for Women, Girls and Transgender in in HIV/AIDS Context”.

The 2nd Eurasian Gender Academy 2017 focuses on actions in four areas, outlined below:

  1. Integrating gender analysis into assessment, programme design, implementation and monitoring of organizational and national public health responses and strategies;
  2. Strengthening the capacity of participants to systemically integrate and apply gender sensitive, gender oriented, gender budgeted, gender transforming programs, services and activities at organizational and national levels;
  3. Ensuring inclusion of gender aspects in funding appeals and proposals;
  4. Developing and implementing gender-responsive advocacy and lobby.

Eurasian Gender Academy program is rooted in a broad-based gender equity and human rights approach and reflects a number of principles, including participation, evidence-informed, tailored and ethical responses, partnership, the engagement of boys and men, leadership, multisectorality and accountability.

You can find more information about the program, application and selection process here.