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

World AIDS Day 2018 – Message of Anke van Dam

World AIDS Day 2018: a message of AFEW International Executive Director Anke van Dam

1 December 2018

This year’s theme for World AIDS Day is encouraging people to know their HIV status. HIV testing is very much needed for expanding treatment. Treatment is so important as that makes that no HIV is detected in blood and therefore not transmissible to other people. In the region where AFEW International works – Eastern Europe and Central Asia (EECA) – barriers to HIV testing still remain. Last year, among the 1.4 million people living with HIV in the region 73% were aware of their HIV status.

Stigma and discrimination are the obstacles that discourage people from taking an HIV test in the EECA countries. Access to confidential HIV testing in the region is still a concern. Many people only get tested after becoming ill and symptomatic. That is why we at AFEW are working on expanding the access to HIV testing. Partnering with the NGOs and CBOs in Eastern Europe and Central Asia, we ensure that people who use drugs, prisoners, sex workers, LGBT and young people have access to confidential HIV testing, and people living with HIV have access to good medical care and have great possibilities for a healthy future.

This year, the 22nd International AIDS Conference in Amsterdam AIDS 2018 reinforced our work. The focus on public health concerns as HIV, TB and viral hepatitis in the EECA region allowed us to present the challenges and the obstacles in policies, political and health care systems. With the relevant stakeholders in one spot, we had an excellent chance to facilitate the dialogue between communities, political leaders and donors for better access to treatment and for sustainable financial mechanisms.

We are continuing emphasizing on Eastern Europe and Central Asia and its public health concerns after AIDS 2018 Conference! AFEW addressed the needs for diagnostics and treatment for tuberculosis in Eastern Europe and Central Asia at a side event during the United Nations General Assembly high-level meeting on tuberculosis in New York in September and during the 49th Union World Conference on Lung Health in October in the Netherlands. Let us continue the dialogue about the healthy future for the EECA region and let the barriers to accessing HIV testing be removed.

World AIDS Day 2017 – message of Anke van Dam

World AIDS Day 2017: message of AFEW International Executive Director Anke van Dam

Let us stand still on this World AIDS Day at all the brave people living with HIV that fight for their right to health. Let us think about those living in Eastern Europe and Central Asia (EECA), where only 28% of people with the diagnosis HIV have access to ARV treatment, and less than a quarter have a zero viral load. Where the majority of people at a higher risk for HIV face stigma and discrimination. Where the costs for some generic ARVs are higher than the patented ones. Where funds for prevention, treatment and care are diminishing with the years.

AFEW International Executive Director Anke van Dam

In a world where we know how to prevent HIV, how to stop AIDS, how to treat with optimal care, we should not allow that people die of AIDS, nowhere and also not in Eastern Europe and Central Asia.

It is therefore not for nothing that AIDS2018, the 22nd International AIDS Conference in Amsterdam on 23 – 27 July 2017, has a focus on the public health concerns as HIV, TB and viral hepatitis in this specific EECA region. Next year summer, we have more than ever an opportunity to address the challenges and the obstacles in policies, political and health care systems. With the relevant stakeholders in one spot, we have an excellent chance to facilitate dialogue between communities, political leaders and donors for better access to treatment and for sustainable financial mechanisms.

AFEW is working for more than 16 years in Eastern Europe and Central Asia to improve access to health care for people who use drugs, prisoners, sex workers, LGBT and young people. From our experience and collaboration in EECA we can tell what is needed. We as AFEW with all other hard-working networks, NGOs and CBOS from the region will demonstrate our expertise, drive, motivation and willingness to curb the HIV epidemic and our wish for a healthy future for all, including the people in Eastern Europe and Central Asia.

HIV/AIDS Surveillance in Europe 2017-2016 Data Released

On 1st of December, we mark World AIDS Day (WAD) to raise awareness about HIV and its impact on individuals and societies around the globe. WAD 2017 in the WHO European Region will focus on the problem of late HIV diagnosis – the high number of people who are diagnosed with HIV at a late stage of infection with consequences for individuals’ health and survival, and for the community where HIV can transmit further.

With this message, we invite you to join us and mark the World Aids Day 2017 in your country.

On 28 November 2017, WHO/Europe and ECDC jointly released the annual report on HIV/AIDS surveillance Europe, containing the latest available surveillance data.

Similar to recent years, the highest proportion of HIV diagnoses (40%) was reported to be in men who have sex with men (MSM). However, for the first time in a number of years, several countries reported a decline in new HIV diagnoses, even after adjusting for reporting delay.

While the data in this year’s report indicate alarming rates and increases in new diagnoses in some parts of eastern and central Europe over the last decade, at the same time there has been a tendency towards stabilising or even decreasing rates in some EU/EEA countries.

Trends by transmission mode, for example, show that the number of HIV diagnoses among MSM in the EU/EEA decreased slightly in 2016 and the number of heterosexually acquired cases has decreased steadily over the last decade.

Moreover, in the EU/EEA, the number of AIDS cases, and the number of AIDS-related deaths, has consistently declined since the mid-1990s.

The report on HIV/AIDS surveillance in Europe 2017 – 2016 data is available here.

UNAIDS Regional Director for Eastern Europe & Central Asia Address

wad2016_day_hp_2_jpg1 December 2016, UNAIDS — Dear colleagues!

On the occasion of World AIDS Day, 1 December 2016, on behalf of the UNAIDS Regional Office for Eastern Europe and Central Asia, I am pleased to share some important updates on the new UNAIDS global report and key events and initiatives in the HIV response in our region.

This week UNAIDS launched our new global report ‘Get on the Fast-Track: The life-cycle approach to HIV’ showing that countries are getting on the Fast-Track, with an additional one million people accessing treatment globally in just six months (January to June 2016). By June 2016, approximately 18.2 million [16.1 million–19.0 million] people living with HIV had access to the life-saving treatment, including 910 000 children – double the number five years earlier. If these efforts are sustained and increased, the world will be on track to achieve the target of 30 million people on treatment by 2020. Please see the full report here.

On 3 November 2016, Ministries of Health from 12 countries of Eastern Europe and Central Asia adopted the Minsk Statement on ‘HIV and Tuberculosis: Treatment for All’, calling for expanded and rapidly scaled-up access to affordable, quality-assured medicines for HIV and TB. Please see more information about the meeting and the adopted Statement here.

The Government of Ukraine has announced that in 2017 it will double funding from the national budget for HIV and TB treatment, and fully finance the national opioid substitution therapy programme for people who inject drugs – a key population in Ukraine that is at higher risk of HIV infection. Please see more information here.

The first National AIDS Conference in Kazakhstan ‘HIV: Yesterday, Today, Tomorrow’ was held in Almaty on 12-13 October 2016. Over 170 representatives of government, academia, health sector and civil society groups from different regions of Kazakhstan joined the event and discussed the importance of measures to be taken to put Kazakhstan on the Fast-Track. Please see more information here.

On the occasion of the International Day of Youth, a series of activities were organized by the Youth Foundation of Armenia to raise awareness among young people about healthy lifestyles and HIV prevention. One of the main events was a concert in Yerevan on 17 November 2016, attended by over 10.000 youth. Information about HIV testing and prevention was shared through social videos, leaflets and other materials throughout the day.

In Tajikistan, the Minister of Health called for people to know their HIV status during the first ever public event on HIV prevention in Dushanbe. The event, in support of the ‘Hands up for #HIVprevention’ campaign, united more than 500 representatives of the Government of Tajikistan, health professionals, celebrities and young people. Please see more information here.

In the Russian Federation, the next phase of the national campaign ‘#StopHIVAIDS’ will be launched on 28 November in Moscow, under the leadership of Svetlana Medvedeva’s Foundation for Social and Cultural Initiatives. As part of this campaign, a series of activities will take place across Russia from 28 November to 4 December, including open lectures in schools, vocational schools and universities. The campaign will feature the Russian Minister of Health, Veronika Skvortsova, Minister of Education, Olga Vasilieva, Minister of Communications and Mass Media, Nikolai Nikiforov, the Head of Rospotrebnadzor, Anna Popova, and various non-governmental organizations. Please see more information about the campaign here.

22Please join the UNAIDS World AIDS Day Hands Up for #HIVprevention campaign. The campaign is focused on different aspects of HIV prevention, offering space for people to express their views on what they think needs to be done to strengthen HIV prevention efforts. You can upload your photo/video on the special campaign event page on Facebook or Twitter. Thank you for helping us in raising awareness and reaching wider audiences. We encourage you to join the campaign!

I would like to end this letter with a video message by Michel Sidibé, UNAIDS Executive Director on the occasion of World AIDS Day 2016.

Sincerely,

Vinay P. Saldanha
UNAIDS Regional Director for Eastern Europe & Central Asia