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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.

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.

Starting from 2006, non-commercial organizations in Russia are supported by the president. This was the first year of the presidential grant competition. For 10-year existence, the system of finance distribution was quite complicated: at first the head of the state approved the list of non-commercial organizations (NCO) – the receivers of grants with his decree, and then the NCOs were included into the finance distribution system. In 2017, the procedure was simplified: grant participants may apply online. There has appeared the unified operator – presidential grant foundation.

The community dialogue platform gathered for the summer school last week in Kyrgyzstan. This summer school was organised within ‘Bridging the Gaps’ programme. The director of programs of AFEW International Janine Wildschut attended the school. After some days of serious work in which the community discussed struggles they face in Kyrgyzstan and how they can come up with a united voice, a training on burnout syndrome and how to prevent it was arranged.

A big amount of working age population in Tajikistan (where the entire population is eight million people) take part in labour migration to Russia. After their return to homeland, migrants get diagnosed with tuberculosis and HIV. Experts believe that there should be a complex of prevention activities for HIV, sexually transmitted diseases and tuberculosis among such vulnerable groups as migrants and their sexual partners.

Eastern Europe is a “perfect storm” for the spread of tuberculosis because it has high rates of incarceration, HIV infection, and injection drug use, and it has disintegrated healthcare systems, suboptimal TB diagnosis and treatment, and poor adherence rates. In addition, nearly half of all TB cases are multidrug-resistant, which requires longer, more expensive treatment than drug-susceptible TB, and leads to more adverse effects. Treatment is also less accessible in the region. And because rates of HIV infection are on the rise in Eastern Europe, where antiretroviral therapy coverage is low, the fast progression of immunosuppression leads to increases in the rate of TB and HIV coinfection.

People living with HIV can now expect to live a near-normal life expectancy, where they have access to effective antiretroviral treatment, monitoring and support. But the positive benefits of treatment can only be realised when adhered to exactly as prescribed – which for HIV, means taking treatment every day, for life. A range of factors can influence a person’s ability to stick to a drug-taking regime, so until a vaccine or a cure is found, new treatment delivery options are needed to ensure all patients can maintain high levels of antiretroviral drug concentration in their body, thereby achieving viral suppression and reducing the risk of HIV drug resistance.      

While the adoption of previous EU drug strategies and action plans has been well covered by the media, now, two years after the great migration crisis and one year after the Brexit vote, almost nobody noticed the adoption of the new EU Action Plan on Drugs. There was no press conference or press release. It seems drug policy is not a priority for decision makers these days – there are other topics occupying public attention. It’s a shame, because this is the most progressive drug policy document the EU has ever adopted. It is most needed, at a time when European drug markets have been undergoing cataclysmic changes, with the emergence of new drugs and new risks which require new responses and interventions.