Series of webinars on TB and migrant health

TB Europe Coalition (TBEC) and the Regional Expert Group on Migration and Health (REG) are coordinating a series of 3 webinars on TB and migrant health. The webinars will address the barriers migrants face when accessing TB and healthcare services across the WHO Europe region and the challenges for service delivery.

In Europe and Central Asia migrants represent one of the key groups vulnerable to TB, as well as other infectious diseases such as HIV and hepatitis. Migrants face many barriers to accessing adequate healthcare services, both during migration and once they have arrived in a host country. This includes, but is not limited to, language barriers, cultural barriers, stigma and discrimination as well as poverty, which can have a significant impact of their physical and mental health and wellbeing. Female migrants are particularly vulnerable to specific health challenges such as gender-based violence and reproductive and sexual health issues.

Promoting the rights of migrants is key to achieving the sustainable development goals, and ensuring that “no one is left behind” irrespective of their migration status. Migration issues are cross-cutting; economic and social policies, human rights and equity issues, development agendas, and social norms are all relevant to migration health. Therefore, it is essential that any policies aimed at addressing the needs of migrant communities are multisectoral.

The webinars will take place in Russian and English with simultaneous translation.


The first webinar on Wednesday 3rd March 2021, 12pm – 13:30 EET (11 pm – 12.30 CET) will focus on TB and migrant health within an Eastern European and Central Asian (EECA) context, the second will focus on a Western European and EU Member State context, and the third will focus on service delivery.

Agenda of the first webinar:
1. Introduction (Paul Sommerfeld, TBEC Chair)
2. Overview of barriers and coping strategies in EECA, (Daniel Kashnitsky, Regional
Expert Group on Migration and Health)
3. TB and Migration in EECA – online course (Mari Chokheli, TB People)
4. Essential package of TB services among migrants in EECA: Policy framework and its
implementation in the practice (Masoud Dara, WHO Regional Office for Europe)
5. Transborder cooperation between sending and receiving countries to provide
migrants access to TB care (Rukhshona Qurbonova, IOM Tajikistan)
6. Questions & Answers.

Register for the first webinar via this link.

If you have any questions please contact:

We do our best to provide services

Ivan Anoshkin, coordinator of the street social work of NGO “Project April” (Tolyatti, Russia) talks about harm reduction activities of his organization at COVID-19 time.

For reference:

“Project April’ works in harm reduction. The main key groups are people who inject drugs and sex workers, but with changes on the drug scene and the emergence of different stimulants and salts, the organization got new client groups, particularly people practicing Chemsex. The organization employs 18 people and also has a large number of volunteers. “Project April” is recognized in Russia as a foreign agent.

Difficulties caused by COVID-19

Before the spread of the COVID-19 and the lockdown related to it, we used to receive our clients at our office every weekday. Anyone could come to get a consultation, HIV test or a harm reduction kit. We have always tried to provide the conditions for talking with our clients in a warm, comfortable atmosphere. Once the self-isolation regime was first introduced in Tolyatti in March, we had to completely close our office. However, seeing that after a few weeks it became clear that this regime could be extended over and over again, we decided that as a social organization, we cannot interrupt our activities indefinitely. Since then, one of the employees is in the office every working day to insure the provision of our regular services “on the spot”. Yet evidently, it is no longer possible for us to invite our clients to chat with them over a cup of tea, for the sake of their and our safety. Therefore, we are trying to provide our services at entrance.

Our work is largely focused on outreach and street work and in the current situation, this has had to be significantly reduced as well. For example, our employee went to a gay club every week where she developed trust relations with its visitors and maintained contacts with the community. With everything closed, this channel of communication is lost and this could negatively affect our current and potential clients. Finally, another significant obstacle that limits our activities during the crisis is a fear to cause more troubles to our clients by attracting unnecessary police attention to them.


Under these circumstances, we have partially switched our activities to online. We are holding our work meetings on Skype. The visits we would do to rehabilitation centres every 1-2 months, we have also temporarily transferred to online. We agreed with administration of these centers to pre-deliver them brochures and HIV self-tests, and to organise our seminar via Skype afterwards. This way, patients have an opportunity to get tested and to get immediate information and support, even in these dark times.

What is more, to our clients we started to send and deliver harm reduction kits, HIV self–tests, and, if necessary, packages with basic products and goods. Basically, we already know places where our clients continue to gather. So we deliver our kits and packages there directly, based on their precise needs. For our employees, volunteers and active participants who continue to work, we purchase masks, gloves and disinfectants.

In times of crisis like this, our clients have more demand for social and psychological support as well. For this purpose, we have a service taxi that allows our employees to come to clients to provide social assistance and products of first necessity. And if necessary, we also deliver ARV therapy to clients, with their written agreement.

Certainly, due to the self-isolation regime and the hostile atmosphere in general, the number of new clients decreases, but not as significantly as we had feared. When you have already been working with harm reduction for this many years, the members of community know you. And we should also not underestimate the power of the word of mouth, that stays efficient at all times. Even now, newcomers visit our office at the recommendation of our clients.

What’s next?

This crisis has shown us how important it is to keep in touch with our clients not only live, but online as well. This way we stay in permanent contact. Hence, in the future we are hoping to have a possibility to hire a person whose work will be devoted only to managing social media and maintaining contact with our client through messengers on a regular basis.

We also really hope to offer some financial compensation to our employees, who continue to “work in the field” at their own peril and risk, especially as some of them – as I do – have a fairly low CD4 level.

The potential impact of the COVID-19 on tuberculosis in high-burden countries

Length of quarantine, movement restrictions and disruption of TB services could spell disaster for hundreds of thousands at risk.

A modeling analysis released by the Stop TB Partnership shows that under a three-month lockdown and a protracted 10-month restoration of services, the world could see an additional 6.3 million cases of TB between 2020 and 2025 and an additional 1.4 million TB deaths during that same period.
The new study was commissioned by the Stop TB Partnership in collaboration with the Imperial College, Avenir Health and Johns Hopkins University, and was supported by USAID. The modeling was constructed on assumptions drawn from a rapid assessment done by The Stop TB Partnership on the impact of the COVID-19 pandemic and related measures on the TB response in 20 high-burden TB countries—representing 54% of the global TB burden.

The modeling focused on three high burden countries—India, Kenya, and Ukraine—and extrapolated estimates from those countries to create global estimates of the impact of COVID-19 on TB.

According to the new study, with a three-month lockdown and a protracted 10-month restoration of services, global TB incidence and deaths in 2021 would increase to levels last seen in between 2013 and 2016 respectively, implying a setback of at least five to eight years in the fight against TB.

To minimize the impact of the COVID-19 pandemic on TB, save millions of lives and get the world back on track in achieving the UNGA targets, national governments need to take immediate measures that ensure the continuity of TB diagnostic, treatment and prevention services during the lockdown period and undertake a massive catch-up effort to actively diagnose, trace, treat and prevent TB.

New WHO recommendations to prevent tuberculosis

New World Health Organization (WHO) guidance will help countries accelerate efforts to stop people with tuberculosis (TB) infection becoming sick with TB by giving them preventive treatment.

The new consolidated guidelines recommend a range of innovative approaches to scale up access to TB preventive treatment:

  • WHO recommends a scale-up of TB preventive treatment among populations at highest risk including household contacts of TB patients, people living with HIV and other people at risk with lowered” immunity or living in crowded settings.
  • WHO recommends an integration of TB preventive treatment services into ongoing case finding efforts for active TB. All household contacts of TB patients and people living with HIV are recommended to be screened for active TB. If active TB is ruled out, they should be initiated on TB preventive treatment.
  • WHO recommends that either a tuberculin skin test  or interferon-gamma release assay (IGRA) be used to test for TB infection. Both tests are helpful to find people more likely to benefit from TB preventive treatment but should not become a barrier to scale-up access. Testing for TB infection is not required before starting TB preventive treatment in people living with HIV, and children under 5 years who are contacts of people with active TB.
  • WHO recommends new shorter options for preventive treatment in addition to the widely used 6 months of daily isoniazid. The shorter options that are now recommended range from a 1 month daily regimen of rifapentine plus isoniazid to 3 months weekly rifapentine plus isoniazid, 3 months daily rifampicin plus isoniazid, or 4 months of daily rifampicin alone.

TB preventive treatment is an affordable intervention that can prevent families from sliding into poverty and preserve the health and economy of whole communities. WHO anticipates that as new and safer drugs come onto the markets, and as prices fall, it will become a highly-cost effective way to save millions of lives.


World Tuberculosis Day 2020

Each year, we commemorate World Tuberculosis (TB) Day on March 24 to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global TB epidemic.

The date marks the day in 1882 when Dr Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.

TB remains the world’s deadliest infectious killer. Each day, over 4000 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. Global efforts to combat TB have saved an estimated 58 million lives since the year 2000. To accelerate the TB response in countries to reach targets – Heads of State came together and made strong commitments to end TB at the first-ever UN High Level Meeting in September 2018.

Countries in the Eastern part of the WHO European Region are most affected by the TB epidemic: 18 high-priority countries for TB control bear 85% of the TB burden, and 99% of the multidrug-resistant TB (MDR-TB) burden. These countries are Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Romania, the Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. Despite much progress in Eastern Europe, critical challenges remain as regards access to appropriate treatment regimens, patient hospitalisation, scale-up of laboratory capacity, including the use of rapid diagnostics and second-line Drug Susceptibility Testing (DST), vulnerable populations human resources, and financing.

The theme of World TB Day 2020 – ‘It’s time’ – puts the accent on the urgency to act on the commitments made by global leaders to:

  • scale up access to prevention and treatment;
  • build accountability;
  • ensure sufficient and sustainable financing including for research;
  • promote an end to stigma and discrimination, and
  • promote an equitable, rights-based and people-centered TB response.

AFEW Partnership‘s activities are also aimed on ending tuberculosis in Eastern Europe and Central Asia. For 5 last year in Kazakhstan, KNCV and  AFEW-Kazakhstan were developing a model for structural collaboration between public health (TB, HIV, primary health care) and non-public sector. AFEW International was coordinating this project.

Kazakhstan was one of the three countries selected to develop a model to strengthen engagement with non-public sector for improved quality of TB/HIV services. Almaty was chosen for the implementation of the model because it is the largest urban area in the country. The project supported the establishment of a network of NGOs that have the capacity to provide TB and HIV care to the most vulnerable populations, and build a partnership between public and non-public sectors to improve access to TB and HIV care by the development of a referral mechanism. Within the program a TB PhotoVoices Project was developed. 

Resource – WHO


It’s TIME to end TB

24 of March – World Tuberculosis (TB) Day. The theme of World TB Day 2020 – ‘It’s TIME’. TIME to put the accent on the urgency to act on the commitments made by global leaders; TIME to scale up access to prevention & treatment; TIME to promote equitable, rights-based & people-centered TB response; TIME to ensure sufficient & sustainable financing including for research; TIME to promote an end to stigma & discrimination.

In support of the global #ItsTimetoEndTB campaign, AFEW International talked to people who faced TB and asked them to reflect on TIME in the context of their life stories.

Saule, volunteer of Sanat Alemi

When I found out about my diagnosis, it was like TIME had stopped for me. During the treatment, I was scared, I thought I was going to die. Fortunately, my roommates were very supportive, they kept saying that TB is curable and that life goes on.

I can not forget the moment when I moved to another department of the hospital for chronic patients. I stayed there for 2 years. It was very scary. It seemed to me that it’s impossible to cure TB since my tests were always positive. Nevertheless, after a hard struggle, I defeated the disease.

They say TIME heals. But it doesn’t. TIME is not able to cure, we cure ourselves by thinking about good things, doing daily routine, trying to distract yourself from bad thoughts, agreeing with what happened, giving ourselves the attitude – to stop suffering, accepting the fact that our life goes on.

I really want to forget those moments, memories that I experienced during my illness. And I am happy that I defeated TB, with the help and support of my parents and my daughter.

 Igor, volunteer of Sanat Alemi

Disease always changes a person. Many things you start to look at in a new way, rethink TIME, your life. When I got sick, I didn’t have any strength or desire to get out of my hospital bed. But I was lucky to have people around who supported me and made me to believe in myself, helped me to cope with the disease.

TIME of TB treatment became special for me. It changed me from the inside. I became stronger, learned to deal with difficulties. When you are ill, you realize that TIME has to be appreciated and spent as effectively as possible. You try not to waste it on trifles. “Yesterday” cannot be returned, so you analyze every moment you have lived and try to use TIME rationally and purposefully in the fight against the disease.

Tuberculosis is my life experience that has taught me to cope with difficulties and achieve my goal. Tuberculosis is curable, the main thing is not to lose heart and to set up yourself to get positive results!

Danat, volunteer of Sanat Alemi

When I found out about my diagnosis, I didn’t believe in that, because I had never complained about my health before. It was like TIME had stopped for me, bad thoughts kept me going. I was thinking I will never survive, and in general, I felt like my life was over. Thank God, there were people around who supported me morally and kept me alive.

The disease changed me a lot. I became stronger, more demanding to myself, I became more religious. Because of the prescribed therapy, I was able to get better. During the treatment TIME, my life values changed: I began to appreciate every moment of my life.

The fears related to the disease are behind me because I now know that TB is curable. People should be more informed about TB. This will help to detect the disease at an early stage and solve the problem of discrimination against people with TB!

Tuberculosis in the WHO European Region

Despite the notable progress achieved in the fight against Tuberculosis (TB), it still poses a public health threat in the WHO European Region. According to the latest estimates, in 2018 about 259 000 people became ill with TB (Fig. 1) and about 23 000 people lost their lives due to TB in the Region, mostly in eastern European and central Asia countries. 

In the past 10 years, the number of new TB patients has been falling at an average rate of 5% per year, which is the fastest decline among all WHO regions. However, the treatment success rate among newly diagnosed and relapsed patients was 77%, which remains one of the lowest among WHO regions.

One in five new TB patients is affected by MDR-TB

Countries in the European Region have the highest rates of multidrug-resistant TB (MDR-TB) globally. Nine European Region countries face a particularly high burden of MDR-TB. In 2018, of estimated 49 000 rifampicin resistant (RR) tuberculosis cases among notified pulmonary tuberculosis patients, 45 400 (93%) were diagnosed. The increase in detection is mainly due to improved access to rapid and quality assured diagnosis. The treatment success rate for TB and MDRTB in the Region remains below the 85% and 75% regional targets respectively (Fig. 2) although data show a slow improvement.

Around 95% of all reported MDR-TB patients were tested for resistance to second-line TB drugs in 2018, which is an increase compared to the previous year. The testing led to the detection of about 6 800 patients with extensively drug-resistant TB (XDR-TB), which accounts for about 19% of patients with MDR-TB.

One in eight new TB patients is HIV positive 
People living with HIV are 20 to 40 times more likely to develop active TB disease than people without HIV.1 HIV and TB form a deadly combination, each speeding the progress of the other. Because of the increasing trend of new HIV infections in the WHO European Region, HIV coinfection rates among TB patients also increased sharply from 8% to 13% between 2014 and 2018.  Rapid detection and appropriate treatment are vital. However, only 80% (24 365) of the estimated 30 000 TB/HIV coinfected individuals were detected in 2017, and only 73% of those diagnosed were offered antiretroviral treatment.
Strengthening Regional commitments to end TB 

The Tuberculosis Action Plan for the WHO European Region 2016-2020 (European TB Action Plan) was endorsed by the 65th WHO Regional Committee for Europe in 2015. This strategic document sets the regional goal of ending the spread of TB and MDR-TB by achieving universal access to prevention, diagnosis and treatment. Following up on the Regional Committee resolution, the final report of implementation of the European TB Action Plan will be submitted to the 70th Regional Committee in September 2020. The finalized report will be reviewed by all Member States before endorsement along with a suggestion to extend the validity of the European TB Action Plan. This vision aimed to end the TB epidemic and ensure that by 2030, no   family faces catastrophic financial costs due to TB. To monitor progress and ensure that commitments articulated in the UN High Level Political Declaration are met, a Monitoring and Evaluation Framework 2021-2030 with new indicators and targets has been prepared and submitted to all Member States for public consultation. These indicators, while regional in scope, are designed to serve as a guide to the development or adjustment of comprehensive monitoring plans at the country level.

WHO European Region comprehensive technical assistance to Member States includes supporting the development and introduction of innovations and tools, such as digital technologies, rapid molecular diagnosis of TB, new drugs and regimens for DR-TB. The WHO Regional Office for Europe seeks to ensure that all people affected by TB have equal access to the benefits of latest development, including vulnerable populations, such as prisoners, migrants, socially marginalized, children and people living with HIV.

In 2018, WHO’s Regional Office for Europe, collaborating with partners on the issue-based Coalition on Health and wellbeing, launched the United Nations Common Position Paper on Intersectoral Collaboration To End TB, HIV and Viral Hepatitis and is working with civil society, national and international partners to implement it.,-tb-and-viral-hepatitis-through-intersectoral-collaboration2018. Country-level assistance is vital to this process. National processes to strengthen the dialogue and action around these topics are ongoing in Portugal, Tajikistan, Georgia and Belarus. This collaboration and dialogue contributes to developing the first edition of an Operational Framework; guiding concrete action to end HIV, TB and viral hepatitis beyond the healthcare sector. These best practices are being collected at the regional level.

About TB

TB is a contagious disease that spreads when a person breathes in the bacteria breathed out by an infected person. This disease is mainly caused by Mycobacterium tuberculosis. About one fourth of the world’s population is infected with the latent form of the disease, and a tenth of them become ill with active TB during their lifetimes.
The symptoms depend on the organ of the body which is infected. Usually, TB affects the lungs. In this case, the major symptoms are cough with productive sputum (sometimes with blood), shortness of breath and chest pain. There are also general symptoms such as fever, night sweats, loss of weight and appetite, fatigue and general weakness. People living with HIV or other conditions that weaken their immune system (such as diabetes), people on immunosuppressant therapy, and people who use tobacco or use alcohol harmfully are at much higher risk of developing the disease.
MDR-TB is resistant to two of the most potent anti-TB drugs. This is a result of inadequate treatment of TB and/or poor airborne infection control in health care facilities and congregate settings. XDR-TB is resistant to the most important first- and second-line drugs and there are currently very limited chances of people with XDR-TB being cured. TB can affect everyone but is particularly linked to social determinants of health such as migration, imprisonment and social marginalization.

Women in prison: mental health and well-being – a guide for prison staff

People in prison have a disproportionately high rate of poor mental health, and research shows these rates are even higher for women in prison. While primary care remains the responsibility of healthcare professionals, frontline prison staff play an important role in protecting and addressing mental health needs of women in prison.

Penal Reform International (PRI), in partnership with the Prison Reform Trust (PRT), has published a guide for prison and probation staff to help them understand how prison life can affect a person’s mental health, with a focus on women. The guide aims to break down the stigma and discrimination attached to poor mental health, especially for women in prison.

This guide is written to help understand how life in prison can affect a person’s mental health, with a focus on women. It describes how to recognise the signs of poor mental health and how best to respond. It also includes a checklist based on international human rights standards aimed to help with the implementation of key aspects of prison reform and advocacy initiatives in line with international standards and norms.

Published with the support of Better Community Business Network (BCBN) and the Eleanor Rathbone Charitable Trust.

Find the guidelines here – PRI-Women-in-prison-and-mental-well-being.

How to help migrants?

According to UNAIDS ([1], Russia has the second highest number of labour migrants in the world after the USA. Rostov region is one of the areas where this number is constantly growing. One of the reasons is its geographical position – Rostov region has the biggest borderline with Ukraine. Due to this fact as well as certain developments related to the armed conflict in Donetsk and Lugansk regions, many migrants from Ukraine with different statuses are coming to Rostov region, in addition to the labour migrants from Central Asia.

Are there any special services for migrants in Rostov-on-Don? How is HIV prevention implemented among migrants? Where can migrants seek help without endangering themselves? AFEW International asked these questions to Vyacheslav Tsunik, President of Rostov-on-Don Regional NGO “KOVCHEG – AntiAIDS” and Manager of the Project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”.

Significant financial support to carry out surveys and provide services to migrants within this project was provided by AFEW International, which, in particular, facilitated coordination with the Central Asian organisations to provide effective support to migrants when they leave their countries of origin and come to Russia.

For reference

Labour migrants are one of the populations most vulnerable to HIV in the world, which is explained by a number of factors. The data of numerous studies show that people coming from the Central Asia have a very low knowledge of infectious diseases: HIV/AIDS, hepatitis B and C. The situation is further aggravated with the low social and economic status of the migrants from Central Asia and the neighbouring countries, lack of access to health services, low level of social support and high prevalence of depression caused by such people living away from their families. High isolation of this social group often leads to HIV transmission inside this community, in particular through contacts with female sex workers, who come from the same countries.

Vyacheslav, how accessible is health care for the labour migrants in Rostov-on-Don?

Health care is provided to the labour migrants who officially live in Russia, in particular in Rostov region, based on their insurance certificates, which they buy when registering their patents. Without certificates, people can access health care on a paid basis, while emergency care if a person’s life is under threat in cases of heart attacks, strokes, catastrophes or accidents is provided to everyone, even with no documents, free of charge and is covered by the state.

How well informed are labour migrants about the problem of HIV?

Surveys among the labour migrants showed that they are not well informed about HIV. In our opinion, the reason is lack of preventive information provided to them in educational institutions in their home countries and when they come to work in Russia.

Do migrants practice any risky behaviours?

In fact, the prevalence of risky behaviours among migrants is approximately the same as among all young people. If we talk about the migrants who come from Asia, e.g. from Tajikistan and Uzbekistan, they have less risky behaviour due to their national customs and traditions. They mostly socialize with their fellow countrymen and they also have respect to older people and certain traditions, which restrict their risky behaviours. As for people from Ukraine and Moldova, they are closer to us, Russians, in terms of their culture and so the situation among them is similar to ours. There are young people who practice high-risk behaviour in terms of HIV. Mainly, they represent key populations. Their share in the total number of migrants is not so big, but they exist and some of them are clients of our organisation. They are not ready to quit their behaviour models.

Are there any differences in the behaviours of HIV-positive and HIV-negative migrants?

There is really a difference in the behaviours of migrants with HIV and those who do not have HIV.

Migrants living with HIV are a closed group. They are not ready to talk about their disease with their family members or their countrymen. Usually, they seek help in HIV organisations only in life-threatening situations or sometimes when they need to stock up their ARVs if there is a danger of treatment interruption.

In Russia, if migrants test positive for HIV, they cannot access free antiretroviral (ARV) therapy as they are foreign citizens. How is this issue resolved?

The situation with supply of ARVs is regulated by relevant provisions. In Russia, government covers ARV therapy only for the citizens. That is why migrants are not able to access free treatment as they are not Russian citizens. However, our organisation has contacts with community organisations in a number of neighbouring countries. We can help people who come to us and assist them is getting support services and ARVs from the countries of their origin.

Currently you are implementing the project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”. Please tell us more about it.

The goal of our project is to slow down the transmission of HIV through raising the awareness of HIV among migrants and creating services aimed at HIV prevention in migrant populations.

What do we do? Firstly, we train peer consultants from among migrants. Secondly, we provide medical and social support to HIV-positive migrants, giving them access to health services. Thirdly, we have meetings and negotiations with the representatives of diasporas concerning implementation of the prevention tools among migrants in Rostov region and coordinate service provision with the NGOs in the countries of origin of those people who seek our help.

Our organisation, “KOVCHEG – AntiAIDS”, is a community-based organisation of people living with HIV, representatives of vulnerable populations, PLWH, sex workers, LGBT and migrants. For instance, with our current project we trained a peer consultant from the migrant community. This is a woman from Ukraine living with HIV. Another peer consultant that we have, who works with people who use drugs, is also a citizen of Ukraine. Besides, when we carried out a survey among migrants, we had a volunteer supporting us – Ravshan from Uzbekistan – who is a student of a university in Rostov region.

Within the project for migrants, we organized the process to deliver HIV services. In particular, we have rapid testing, pre- and post-test counselling, if necessary provision of ARVs from our reserve stock, medical assays and support in receiving consultations from infectious disease doctors, tests for immune status and viral load, prescription of medications and treatment monitoring. We also inform migrants about the existing legal opportunities to acquire Russian citizenship with HIV status and facilitate people with HIV in obtaining temporary residence permits and Russian citizenship.

How and where do you share information about the services available?

Migrants can access our informational leaflets in the places, which they visit, such as the migration departments, health institutions, which issue the required health certificates to them, pre-deportation detention centres, and higher educational institutions we cooperate with. We use QR codes, allowing migrants to download any information on their smartphones and use it when necessary. As a result, it brings clients to our consultants, who can provide them with any additional information needed.

Name one of your most important recent activities?

Recently, we appealed to the Public Monitoring Commission and asked it to help us access the migrants in pre-deportation detention centres. The Public Monitoring Commission sent an official request to the Ministry of Internal Affairs. We visited the detention centres, met with the migrants living with HIV who stayed there and agreed with the administration of such centres that we would have further access to such migrants living with HIV. We are planning to seek financial opportunities for people living with HIV to receive consultations from infectious disease doctors, get tested for their immune status and viral load and access ARVs for the period of their stay in such institutions. Besides, we are working on developing an appeal to the government officials about the need to provide this category of people with HIV treatment at the expense of the state.

[1]Migrant populations and HIV/AIDS: the development and implementation of programmes: theory, methodology and practice / UNAIDS, UNESCO.

A chance to be heard

Participants from Kazakhstan with AFEW International

Participants from Kazakhstan with AFEW International

Stigma and discrimination are recognized as some of the most commonly identified barriers to fight the tuberculosis (TB) epidemic. Reducing TB stigma is essential because it hinders care seeking, contact tracing, outbreak investigations, treatment initiation, adherence and quality of care. Moreover, it deprives people with TB of their rights and the respect of others.

In collaboration with partners on global, regional and national levels, KNCV Tuberculosis Foundation has developed two stigma reduction packages within TB Photovoice project and piloted them in communities and health care facilities providing TB and TB/HIV in Kazakhstan, the Philippines and Nigeria, funded by the Dutch Ministry of Foreign Affairs.

In Kazakhstan the initiative was implemented by AFEW-Kazakhstan, Sanat Alemi, and Doverie Plus.

For reference

Kazakhstan is one of the 20 high-burden countries for multidrug-resistant TB (MDR-TB). The country has made great progress towards eliminating TB in recent years, with diagnosis, successful treatment and notification rates exceeding the WHO recommenrdations and the estimated incidence.

In may 2018, 12 professional participated in a “Training of trainers” course to learn how to implement TB Photovoices, 9 of whom facilitated the intervention with patients in the end. The group included 6 psychologists, a social worker and a doctor

The TB Photovoice intervention was implemented with 9 (ex-) TB patients – with a mixture of drug-susceptible and drug-resistant TB – some of whom were still on treatment at the time.

The final products (photos, quotes and stories) were launched and shared with the broader Almaty community in advocacy exhibitions and were also reproduced into banners, desc calendars, bads, T-shirts, and postcards to use in heath facilities when counselling new TB patients.

Symbat Sapargalieva, social worker of Sanat Alemi NGO, participant of the PhotoVoices Project

When I found out that I had tuberculosis, I felt so ashamed. There were many negative thoughts in my head. I denied my disease and was pulling away from my family and friends.

I was happy to take part in the PhotoVoices Project and then realized that I have a self-stigma. This project helped me to understand that my friends did not turn their backs on me, it was me who isolated myself from them. There was an exercise called Lifeline with TB, when I had to write down all my negative and positive thoughts. I wrote down only negative ones as I could not find any positive sides of the disease. However, two weeks after I was able to find something good about TB.

I mean, when you realize your problem deep inside and bring it out, it is such a relief. After a while, I set some goals for myself and got a job with a civil society organization to help people who were the same as me. Half of my dreams have already come true!

The main thing I realized is that if you want to change people’s opinion, change yourself. The PhotoVoices Project gave me my voice and a chance to be heard.

Sholpanata Kaldarov, student of the International IT University, participant of the PhotoVoices Project and the Self-Stigma Project, volunteer of Sanat Alemi NGO

When I was invited to take part in the PhotoVoices Project, I was still receiving my TB therapy. I said yes right away as I thought that photos could somehow provide psychological support and motivation to people who just learned that they had TB and also myself, of course.

When I was found to have TB, doctors checked everyone I had contacts with. I felt worse not even because of my own diagnosis, but because all people who were in contact with me had to be checked. Back then, I lived in a student dormitory, and even though my form of TB excluded the transmission of infection, doctors still checked about 100 students from the dormitory and 20 of my group mates. Afterwards, these people had to come to the clinic for special medical check-ups every six months. I felt guilty, so I gradually pulled away from my friends. I had self-stigma.

In the PhotoVoices Project, I experienced a lot of emotions. Before the photo is taken, you remember your past and drag the disease through yourself again. In the beginning, it was difficult to focus on details, but then I felt better and learned to openly talk about my disease.

In our group, there were patients, who already completed their treatment. Talking to them, I heard how they were able to overcome the disease. Gradually, I felt confident that I would also be able to finish my treatment successfully.

I want to thank this project, it really helps the patients who isolated themselves after the disease and lost their self-esteem.

Amanzhan Abubakirov, Teaching Assistant at the Phthisiopulmonology Department of the Kazakh National Medical University named after S.D. Asfendiyarov

Once, the head of our department invited me to take part in a project on stigma. I heard the term “stigma” before, but to be honest did not really know how it can be manifested and how it affects people. It was something new for me, so I agreed to participate.

In the course of the project, I realized that for a long time I was stigmatizing both myself and my patients. Sure, I was kind to them and treated them well, but I thought that I was a doctor and that I was better than them. I have to admit that I feel so ashamed for it.

During the project, we took part in such exercises as “Our Imperfection – Their Imperfection”, “Cross the Line” and so on. Thanks to such exercises, we were able to feel what patients feel, we were able to be in their shoes.

This project really changed my perspective, my view of the world. As a result, I built friendly relations with the patients who stay in our hospital for a long time. I stopped using any terms, which can stigmatize the patients.

More often, I talk to the patients’ relatives, tell them about stigma and ask them to provide more support to the patients.

Besides, I talk to the medical staff working at our department. As I also work at the Medical University, I devote special hours during my classes to talk about stigma and discrimination to my students.

I want to deliver the message that all people are equal, no one is better or worse. However, people with TB are real heroes. Every day, they take a lot of medicines with numerous side effects. Their spouses leave them, their friends turn their back on them, but they continue their fight.

Thank you everyone who fights TB!