AFEW is Looking for Digital Producers

AFEW International is looking for an organisation or individuals to produce a series of materials on knowledge and skills required for successful preparation for AIDS 2018, including but not limited to creating conference profile system, abstract development, scholarship applications submission, applying for workshops, taking part in the Global Village and Youth Program etc.

AFEW International with the support of the Dutch Ministry of Foreign Affairs is implementing a range of activities to empower CBOs, NGOs, activists, policy makers, stakeholders, researchers and clinicians from Eastern Europe and Central Asia (EECA) region to take part in the 22nd International AIDS Conference 2018 in Amsterdam AIDS 2018.

There are several barriers for the delegates from EECA region in their participation in the AIDS conferences: lack of skills on scientific writing and abstract development, costs of participation, and language barrier.

Because of these barriers, the delegates from EECA region have traditionally been disproportionally underrepresented at the AIDS conferences since its inception.

AFEW International is implementing several strategies to support delegates from EEAC region to meaningfully participate in AIDS2018.  Among them webinars and trainings on community-based participatory research for NGOs from EECA, free online resources on writing and submitting abstracts developed by AFEW International and Health[e]Foundation, and newsletters with information from the EECA region and the Netherlands on the preparation for AIDS 2018.

The application deadline is 31st August. More details about the procedure and requirements can be found here.

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.

The Need for a European Union Communication and Action Plan for HIV, TB and Viral Hepatitis

Author: Anke van Dam, AFEW International

For a couple of years, European civil society organisations advocate for a new European Communication and Action Plan for HIV. In the World Health Organisation, new HIV diagnosed infections in European region increased by 76%. These infections more than doubled in Eastern Europe and Central Asia (EECA) from 2005 to 2014. The whole European region accounted for 153 000 reported new infections in 2015 (ECDC 2017). The cumulative number of diagnosed infections in the European region increased to 2,003,674, which includes 992,297 cases reported to the joint ECDC/WHO surveillance database and 1,011,377 infections diagnosed in Russia, as reported by the Russian Federal AIDS Center.

Co-infection in the EECA region

According to ECDC monitoring and the WHO Europe HIV action plan  adopted in September 2016, these underline the high rate of tuberculosis (TB) and hepatitis B and C coinfection among people who live with HIV (PLHIV). In 2014, TB was the most common AIDS-defining illness in the eastern part of the region.

Of the estimated 2.3 million PLHIV who are co-infected with hepatitis C virus globally, 27% are living in the EECA region. An estimated 83% of HIV-positive people who inject drugs live with hepatitis C in the eastern part of the region.

Plan was prolonged

The European Union had a Communication ‘Combating HIV/AIDS in the European Union and neighbouring countries, 2009–2013’ and its associated Action Plan.

The overarching objectives of the Communication were to reduce the number of new HIV infections in all European countries by 2013, to improve access to prevention, treatment, care and support, and to improve the quality of life of people living with, affected by, or most vulnerable to HIV/AIDS in the EU and neighbouring countries. This Plan has been prolonged for another three years. It was followed up with a Commission Staff Working Document: ‘Action Plan on HIV/AIDS in the EU and neighbouring countries: 2014-2016.’’

Already during the period of the prolongation and for three years, the European civil society organisations, including AFEW International, that work in the field of HIV, are advocating for the new communication and action plan. So far without success, despite the fact that according to the evaluation, the Communication and its Action Plan were seen by stakeholders to have provided the necessary stimulus, continuous pressure and leverage for various stakeholders to advocate for and take actions against HIV/AIDS in Europe.

Response is developed

The epidemiology of the three diseases – HIV, TB and viral hepatitis – urged the European Commission to develop a ‘Response to the Communicable Diseases of HIV, Tuberculosis and Hepatitis C’ in 2016. Next to this, the European Commission changed the civil society forum on HIV and AIDS, an advisory body to the European Commission into a civil society forum on HIV, TB and viral hepatitis in 2017, in which AFEW International takes part. This combined focus from the European Commission and civil society organisations could give an impulse to meet the needs for prevention, treatment and care for the three diseases.

Actions within the plan

The European civil society organisations developed a list of actions that should be included in the new communication and action plan.

Prevention needs to be scaled up: HIV can be prevented by a combination of proven public health measures. Yet two third of the European countries do not have a prevention package at scale. Pre-exposure prophylaxis (PrEP) is only provided in a couple of countries.

Treatment access needs to be scaled up: treatment and early treatment improves the health outcomes of the patient and prevents onward transmission. Therefore, countries should scale up testing and offer treatment upon diagnosis and remove barriers to testing and linkage to care. Governments should remove political, legal and regulatory barriers preventing communities most affected by HIV (people living with HIV, gay men and other men having sex with men, migrants, people using drugs, sex workers, transgender person, people in detention) to access health services.

Medicines should be affordable: the price of medicines is still a major barrier to the implementation of treatment guidelines and combination preventions strategies including pre-exposure prophylaxis (PrEP).

Community-based services as one of the components of the health system: include and recognise community base services who can deliver services closer to affected populations as important part of the health system. Invest in them.

AFEW advocates for the plan

In July 2017 the European Parliament adopted the resolution on the EU’s response to HIV, tuberculosis and viral hepatitis. This is an important step towards a communication and action plan. The EU commissioner for Health and Food Safety Mr. Andriukaitis expressed that he is in favour, and a couple of governments also feel a need for such plan. The European Commission and the Commission on Public Health Directorate are still silent though.

AFEW International, together with many governmental and non-governmental organisations, think that the International AIDS Conference in Amsterdam in July 2018 would be a wonderful opportunity and the right moment for the European Commission to present its intentions and good will to fight HIV, TB and viral hepatitis by a communication and action plan. Civil society will not stop to advocate for this. Otherwise we feel that European citizens will be left behind.

New Technologies and Youth Sexuality Education in Georgia

Author: Gvantsa Khizanishvili, Georgia

Improving access to and awareness of health issues among youth using new technologies has become a new way for non-profit sectors around the world to advance issues on their agenda. IntiMate by Bemoni is the first application of such type in Georgia, and it is an excellent example of sexuality education using innovative technologies. It is available for download both by App store and Google play. The app has been developed by Public Union Bemoni as a part of the project “Investing in Sexual and Reproductive Health Promotion and HIV Prevention among Young People in Georgia”.

Non-profit for sex education

Georgia has inadequate policies in the area of sexual and reproductive health and rights. There are strong religious and conservative powers and gender inequality in addition to a fragile civil society that especially influences the lives of adolescents and young people. Much progress has been made in recent years in advocacy to advance youth sexual and reproductive health and rights, for example. In May of 2017, the Georgian Ministry of Education and Science signed a Memorandum of Understanding with the United Nations (UN) Joint Programme for Gender Equality to assist the ongoing revision of the national curriculum and help integrate the issues of human rights, gender equality and healthy living into the educational programme. Additionally, this February, United Nations Population Fund (UNFPA) Georgia initiated an interactive learning module for evidence-based family planning called Virtual Contraception Consultation (ViC), which was introduced at Tbilisi State Medical University.

Despite these advances, there are still many gaps in advancing youth sexual and reproductive health and rights for young people. For example, there are no state supported sex education programs that exist in many countries of Eastern Europe and Central Asia including Georgia. Since there is no state supported sex education programs including information about HIV/AIDS, no information targeted specifically at young people is available, and health service providers are not equipped with the skills to meet young people’s needs for information, counselling and confidentiality of services. Therefore, the non-formal education mostly led by non-profit sector play a significant role in youth sex education.

New ways to raise awareness

The IntiMate app aims to improve knowledge of young people around issues of sexual and reproductive health and rights including HIV/AIDS. With the goal to spark the conversation around the issues, by containing easily comprehensible, fun, attractive content and to encourage participation of young people in prevention of HIV/AIDS. Containing quiz games, video information, definitions, calendar, list of youth friendly services among others, now young people in Georgia will have access reliable information on sexual health and wellbeing at their fingertips. Launched in July 2017, it already has already attracted international media attention.

Russia is Dancing for Life

Author: Anastasia Petrova, Russia

“Congratulations to “FOCUS-MEDIA” and dance4life for the victory in presidential grants competition!” This was the message Ekaterina Artemenko, the coordinator of projects in Moscow “FOCUS Media” foundation, got from her colleague around midnight on July 31. The happy news spread quickly and all danc4life project members knew about it the next day. The initiative was supported this year by the Presidential Grant Foundation.

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.

Coordination committee summed up the results of the first competition on 31 July, 2017. There were 970 NCOs-winners from 79 regions in the winner list, which is around 15% of all applications. There were 6,623 projects that participated in the competition. Three Russian NCOs, included in the register as “foreign agents,” are among presidential grants recipients. Operator has distributed grants with the total sum of 2.25 billion Russian Rubles within the first competition. The most financed project among the 12 grant departments was “Citizen Health Protection, Promotion of Healthy Lifestyle.”

Recognition of merit

Public Health and Social Development Foundation “FOCUS -MEDIA” celebrated its 20th anniversary last year. “We are happy to have received this grant, but frankly, we are also a bit surprised,” the employees of the foundation are saying.

There is a lot of work ahead even after receiving the grant. Financing will allow to run the project dance4life in 14 Russian cities. It will also include a module on tobacco addiction prophylaxis and anti-tobacco campaigns. Besides, the project will include additional component in the form of helping teenagers and young people with HIV. They will be able to volunteer in the project and take part in all of the activities.

Dancing is a universal language

Dance4life project, which won the grant, is a unique international initiative. The initiative aims at promotion of healthy lifestyle among young people, preservation and promotion of reproductive health, HIV infection prevention and many more socially important diseases. More than two million people from 20 different countries have been a part of the programme over the years of its existence.

The project started in 2005 in Russia. It began after “FOCUS Media” Foundation director Evgenia Alekseeva met the Dutch creator of the project Ilco van der Linde. After this meeting, she decided to take this international initiative to Russia. “FOCUS Media” Foundation existed for seven years by that time, dealt with health protection and, in particular, with AIDS prophylaxis among youth. That is why the aim of the project (which includes the prophylaxis of socially important diseases, addiction formation and strengthening young people) coincided with the foundation’s activity.

Now dance4life is a project with 12-year-old history in Russia, and it runs in more than 14 regions. During the years of its activity, it managed to involve around 220,000 young people, who say that dance4life has changed their lives. The keys to the uniqueness of the project are youth culture, energy and creativity that help spread the information on preserving health and taking responsibility for one’s life. Dancing as a part of the project is a universal language, connecting dance4life participants from all over the world.

The results will be presented on AIDS 2018

There were some guests in the ““FOCUS -MEDIA” Foundation office a week before receiving the news about winning the grant. Yulia Koval-Molodtsova, a former project coordinator in Russia and now an associate in the main dance4life office in the Netherlands, came to Russia to talk about the new working models.

After running the same programme since 2005, the international dance4life team has been working on the analysis and improvement of the project methodology. While the old working model made an accent on youth education, the new programme aims at self-realization of society. Now the programme invites young people on a journey: from relationship with oneself, to the relationships with partners and society in general. The components of HIV and sexually-transmitted infections (STI) prophylaxis, issues of contraception and gender equality are now skillfully connected with such important for young people topics: self-knowledge, establishment of personal boundaries, and control of social stereotypes. The principles of work have not changed: to inspire, teach, involve and celebrate. Due to the “peer to peer” approach, young people become the driving force of the project.

New model of work will be approved during this year. The pilot project is running in two regions. In Nizhny Novgorod, where the project is successfully running from the start, they work in cooperation with local schools. The new contacts will be established from scratch in Kolomna, a city in Moscow region, where dance4life is just starting. The model of the project is universal and can be used for both learning and leisure purposes of young people.

Even though the project will be financed by the Presidential Foundation till the end of 2018, the managers of the project would like to sum up the first results of work by next summer. The results of work and experience in the area of HIV/AIDS among youth will be introduced on the International AIDS Conference in 2018. The focus of this conference will be on Eastern European and Central Asian countries.

Tuberculosis and HIV are the “Imported” Diseases of Migrants

Author: Nargis Hamrabayeva, Tajikistan

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.

A 32-year-old labour migrant from Tajikistan named Shody has just returned from Russia. The doctors have diagnosed him with tuberculosis. The man states that he spent six years working in Russia. He went back home only a couple of times during that period.

The fear of deportation – reason for tuberculosis

“I worked at the construction site. Along with several other fellow countrymen we lived in damp and cold premises. A year ago, I started feeling weak, suffered from continuous coughing, but did not seek any medical advice. First of all, I did not have spare money, and secondly, I was afraid to lose my job. If I was diagnosed with tuberculosis, I would have been deported. Who would take care of my family then? Every day I felt weaker and weaker and I had to buy the ticket home,” told the migrant. Now Shody gets the necessary treatment according to the anti-tuberculosis programme, and his health is getting better.

A few years ago, the results of the research on tuberculosis spread prevention were revealed in Dushanbe. These results have shown that hundreds of Tajik migrants return from Russia with tuberculosis.

Experts say that around 20%, or every fifth patient, from the newly diagnosed patients turn out to be labour migrants.

“For instance, in 2015, 1007 people (which is 19.7% cases from the entire number of patients diagnosed with tuberculosis) were labour migrants. In 2016 there were 927 or more than 17%,” Zoirdzhon Abduloyev, the deputy director of the Republican Centre of Population Protection from Tuberculosis in Tajikistan says.

According to him, the research has shown that most of the migrants became infected during their labour migration period.

“The main factors that lead to the spread of this disease among migrants are the poor living conditions. Big amounts of people in small areas, unsanitary conditions and poor nutrition, late visits to the doctors, and most importantly the fear of deportation from Russia,” says Abduloyev.

HIV is “brought” due to the migration

Many experts say the same thing about the spread of HIV in Tajikistan. That “it is being brought from there, due to the migration.”

Dilshod Sayburkhanov, deputy director of the Republican HIV/AIDS centre in Tajikistan, says that big number of Tajik migrants go to work in countries with significantly higher HIV prevalence rate compared to Tajikistan. Usually these are seasonal migrations, and after the end of the season migrants come home.

“Official statistical data shows the dynamical growth of the number of people who have been in labour migration among the new cases of HIV in Tajikistan. In 2015, there were 165 people diagnosed with HIV, whose tests were marked under the labour migrant category. Among them there were 151 men and 14 women, which is 14.3% from the whole number of new HIV cases. In 2016 – 155 (14.8%), in the first half of 2017 – 82 people (13.1%). In 2012, 65 migrants (7.7%) were diagnosed as HIV-positive,” says Sayburkhanov.

Statistics demonstrates the connection between international Tajik labour migration and the growth of new identified HIV cases, according to him.

Ulugbek Aminov, state UNAIDS manager in Tajikistan, also agrees with this. He thinks that migration and HIV are closely connected and result in a social phenomenon.

“There is an assumption that migrants, being in tough emotional and physical conditions, can behave insecurely in terms of HIV and thus have risks of the virus transmission in destination countries. Tajikistan HIV import issue is still in need of an in-depth study,” believes Ulugbek.

It is important to consider that migrants often represent vulnerable to HIV groups of population (for example people who inject drugs), and not knowing their pre-migration HIV status complicates the future process of HIV monitoring. Apart from that, the chances for migrant to receive the necessary specialized treatment go down. The treatment would prevent the spread of HIV to migrant wives and partners in their home country.

“Therefore, experts’ first priority task is the timely identification and quality monitoring of the disease in the countries where migrant live and transfer to, until the return of the migrant back home,” notes Ulugbek Aminov.

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.

The Path to the Self-Financing of the HIV Programmes in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

A significant reduction of funding for the programs against HIV infection was registered during the recent years in Kyrgyzstan. Last year the news that the Global Fund – the main donor of the HIV and tuberculosis programmes in the country – cuts their funding, got into the headlines.

Needs and opportunities

Funding for HIV programmes from the Global Fund over the past two years in the country has actually decreased by 30%, from $7.5 million in 2014 to $5 million in 2016 and 2017. The trend continues to grow: in the application for 2018-2020 only $3.7 million per year were pre-approved, and that is one more million less than before.

“$7.8 million per year are divided in the new Global Fund application between HIV and tuberculosis, but previously such amount of money was allocated only for HIV. Notice that reduction of funding comes amid the growth of demands. The situation with HIV in the country is now getting close to the concentrated phase, and the number of people on treatment over the past two years has grown almost twice,” said the head of Harm reduction programmes association “Partner Network” Aybar Sultangaziyev. “We have enough funds for this year, but in the next three years we expect the budget gap to grow. Only for persons who need treatment – about 6,000 people – we need $3.5 million by 2020, but for HIV we only have $3.7 million allocated in the budget.”

From donor to national funding

The general global trend of reducing grant support and the rise of Kyrgyzstan in the qualification of the World Bank from the level of countries with low income to the level of countries with lower middle income encourages the transition of the country to national funding. It is a difficult process for the state, because from the very beginning the prevention programmes in the country (about 15 years) were funded by international donors.

Ulan Kadyrbekov

“Previously money from the state budget was allocated only to support infrastructure and salaries of the AIDS-service employees,” Director of the Republican AIDS-center Ulan Kadyrbekov says. “Starting from the year before last, the state started to allocate 20 million soms ($289 thousand) annually for HIV programmes. The condition of awarding $11 million grant for HIV from the Global Fund for the next three years was the state contribution of 15% of the whole grant amount. Nowadays we set the national program on overcoming HIV in the Kyrgyz Republic until 2021 and in the budget we have allocated these 15% of the national contribution.”

Until the last November it was not clear if Kyrgyzstan receives the Global Fund money or not. This fact became the main argument for the civil sector in their work on promotion of national funding.

“In fact, the result of our work was the development of the roadmap, i.e. the transition plan to national funding, which comes as an addition to the National program on overcoming HIV,” says Aybar Sultangaziev. “In addition to already allocated budget we have received further 23 mln. soms ($333 thousand) in 2018 and 50 million soms ($725 thousand) per year starting from 2019. It is still not enough. In fact, we requested up to 4.5 times more in 2018 and 2.5 times more starting from 2019 from the state budget.”

Now the National program for overcoming HIV in the Kyrgyz Republic until 2021 and Roadmap for the transition to national funding are submitted to the Government of Kyrgyzstan. The program must be approved this August. It will become known if this money is included in the Republican budget by the end of 2017.

Costs saving and optimization

Upon the condition that the government will fulfill the financial obligations under the National program until 2021 and the country will receive donor funds, there still will be a deficit in the amount of $1.5 million per year. Global Fund’s money has not been finally divided between programme activities. It will be decided which expenditure headings will be underfunded in the nearest future.

Aybar Sultangaziev

“We expect that deficits will be covered by funding from the other donors and by reduction of preventive measures,” Aybar Sultangaziev is saying. “For example, it is likely that we will close social centers. Nowadays six social centers are already closed, we excluded the treatment of STIs (sexually transmitted infections – ed.), we also partly excluded diagnosis and treatment of opportunistic infections, we decreased the number of condoms and syringes for distribution. There are other donors for HIV in our country, the largest of which is the USAID project Flagship. It allocates about $700 thousand a year on drug users. With this money we are able to cut funds from the budget of the Global Fund for this group. Now we have a narrower task of responding to the epidemic. Therefore, the only must have budget items are methadone and antiretroviral (ARV) drugs. We are trying to increase or at least keep these budget lines at the same level.”

Another step in cost optimization and in the transition to national funding is the transfer of control of Global Fund grants from the current recipient – UNDP – to the Ministry of health. Experts predict that it will happen no earlier than during the second half of 2018, as the Ministry of health needs to get prepared.

“Nowadays the treatment is provided by the Global Fund. Even after funds were allocated in the national budget, we still cannot use them for the purchase of ARVs for key vulnerable groups, because there is no mechanism for procurement of drugs and for social procurement. Our priority is to provide all the necessary documents for these procedures,” Ulan Kadyrbekov said. “Thanks to funds reallocation and optimum employment of resources, the National programme for the next three years will be able to slow down the spread of HIV. Even now we have good chances to reach the 2020 UNAIDS goals of 90-90-90. The process of transition to national funding and running programs in the face of cutbacks of donor funding is a great challenge. The Ministry of Health has already submitted the preliminary topics of presentations at the conference AIDS 2018 in Amsterdam, I think, by July of the next year we will have a great practical experience to share.”

How Kyiv Fights the HIV/AIDS Epidemic

Author: Yana Kazmirenko, Ukraine

The adoption of the Fast-Track Cities strategy resulted in launching of the HIV express-testing in all outpatient clinics in Ukraine’s capital. The strategy also allowed to increase the number of people who receive antiretroviral therapy.

The struggle against HIV/AIDS epidemic in Kyiv strengthened since the mayor Vitaliy Klitschko, signed the declaration in Paris. Apart from that, Kyiv was included into the Fast-Track Cities programme in April 2016 as a measure to fight AIDS. According to this programme, 90% of the citizens in 2020 should know about the disease, 90% of the infected ones should be getting treatment, and the treatment should be effective for 90% of the patients.

In the latest United Nations agency report on HIV/AIDS (UNAIDS) and UN-Habitat as of 2015, the Ukraine’s capital entered the list of 27 most HIV/AIDS infected cities in the world. Alexander Yurchenko, the head physician at Kyiv AIDS centre, hopes that Kyiv will not be included into the newest rating. The programme has seen first success. 800 medical workers were trained, and every outpatient clinic in Kyiv received express-tests. The result of the test is available in as little as 20 minutes. There were 2,500 more individuals (compared with the previous year) who had tested their blood in a year.

A record amount of 555 people was included into the dispensary registration with the help of express-testing only over the first quarter of 2017. To compare: only 1300 people were registered in 2016, according to Yurchenko.

In his opinion, the situation in Ukraine’s capital with a population of three million people has improved. There were only around 5,000 people getting treatment in 2012, and now there are more than 7,000. It is planned to give treatment to 12,000 people by the end of the year.

Migrants and HIV

Yurchenko attributes Kyiv’s high position in the world ratings of HIV spread due to its attractiveness for migrants. 400,000 people come to work in the capital daily.

“Men who have sex with men (MSM) also tend to come to Kyiv, as it is hard for them to even live in such regional centre as Cherkassy. They attract a lot of attention in smaller cities. In the capital, they can find work, hide themselves, and find partners,” continues the interviewee.

The prevailing factor of HIV spread in Kyiv in 2012 was an injecting way of transmission. Now the predominant way has shifted to sexual transmission.

For instance, the story of the oldest patient in the capital of Ukraine. The man admitted that his wife was refusing sexual intercourse with him and he had to use the services of sex workers.

“Doctor, now I know what I will die from,” the old patient said jokingly, after he heard his diagnosis.

“According to statistics, you will die from cardiac ischemia, but we will control and monitor your HIV,” Yurchenko remembers his dialogue with the patient.

Surviving thanks to the Foundations

Kyiv’s mayor Vitaliy Klitschko stressed that one of the main responsibilities that Kyiv took within the framework of the Fast-Track Cities programme is the provision of sufficient amount of antiretroviral medicines for treatment of people diagnosed with HIV/AIDS.

There would be significant progress in the implementation of the Fast-Track strategy if the government did not delay the supplies of medicines for antiretroviral therapy. This leads to patients receiving one month course of treatment instead of six or three months’ courses.

The variety of options in treatment schemes (around 38 of them) does not yet allow to pass the dispensing of medicines to the family doctors’ level. Yurchenko promised that there will be two or three variants of treatment made, and they will be passed on to the outpatient clinics as soon as the government supplies of medicines are in full scope.

Now patients literally survive at the expense of international and private foundations. On July 11, Kyiv has become the first Eastern European city where HIV-positive patients received dolutegravir (sixth generation medicine for antiretroviral therapy) at the expense of the Elena Pinchuk ANTI AIDS Foundation. The yearly course of medications will cost $170. This allows to increase the number of people who will receive the life-saving treatment in as early as 2018 at no additional cost.

The adoption of the law on mandatory HIV testing* can also bring the capital closer to the standards implemented by Fast-Track Cities. Alexander Yurchenko says that this law might be enacted by the end of the year.

As estimated by the experts, the number of HIV/AIDS infected people in the capital is 23,000 inhabitants. This is the tenth of the estimated figures in Ukraine – 250,000. There were 304,914 officially registered new cases of HIV infection in Ukraine since 1987. Since that time, there were 42,987 deaths from AIDS. The regions most affected with HIV infection, apart from Kyiv, are Dnipropetrovsk, Kyiv, Donetsk, Mykolayiv and Odesa regions.

*AFEW International is not aware of the law on mandatory HIV testing and will advocate against such law.

One in Sixth People Infected with HIV in Tajikistan This Year is a Migrant

Author: Nargis Hamrabayeva, Tajikistan

Approximately five thousand citizens of Tajikistan, which were found to be infected with HIV, tuberculosis and hepatitis during their stay in the territory of the Russian Federation, were declared personae non gratae for lifetime by the government of Russia in June this year. How could this expulsion of infected fellow citizens affect the Republic of Tajikistan?

Generally, after returning from Russia, migrant workers, unaware of their status, may unintentionally put the health of the members of their families at risk by spreading and transmitting infectious diseases including HIV/AIDS, believes Takhmina Khaidarova, the head of the Tajik Network of Women (TNW) Living with HIV/AIDS.

“The consequences of transmitting and spreading of infectious diseases depend solely on the will of the state. Providing that a state fully implements their commitments within the framework of the National Strategy for the Response to HIV/AIDS Epidemic for 2017-2020, it would be possible to avoid drastic consequences. If the government of a state cannot conduct awareness-building work about infectious diseases and their transmission amongst their population on adequate level, despite the fact whether or not infected migrants would be deported, the increase of the epidemic will stay high,” she considers.

According to Takhmina Khaidarova, the main problem is the low level of awareness about infectious diseases, including HIV/AIDS, before the migrants leave the country, during their stay in the host country, as well as on their return to their home country. “Migrant workers have little information and preparation, they are not aware about their status before leaving the country and they do not observe any safety measures during their stay in labour migration. After contracting infectious diseases, they return to their home country and, generally, do not undergo medical examinations; so, unaware of this, they transmit infectious diseases to their sexual partners,” says Takhmina Khaidarova.

She believes that another problem lies in the fear of stigma and discrimination, therefore, migrant workers who have returned do not undergo examination until their health deteriorates considerably.

According to figures provided by the Ministry of Health of the Republic of Tajikistan, there have been noted 384 cases of citizens infected with HIV in the first quarter of 2017, whereby one in sixth is a migrant, who had left in search of work outside the country. Presently, the total number of people living with HIV-positive status in Tajikistan is around nine thousand.

It should also be reminded that Eastern Europe and Central Asia will be a prime focus in the 22nd International HIV/AIDS Conference in 2018, which will take place in Amsterdam in July 2018.

Central Asian NGOs Built a Network for Cross-Border Control of Tuberculosis

Author: Marina Maximova, Kazakhstan

During the regional seminar-meeting held on 6-7 June in Almaty, Central Asian nongovernmental organizations established a network of partner organizations to address issues of labour migration and tuberculosis. The participants accepted draft Memorandum of cooperation between non-profit organizations to reduce the prevalence and incidence of tuberculosis among migrant workers in the countries of the region.

“This document was created in response to the need of NGOs consolidation to educate migrant workers about TB symptoms and the opportunities of free treatment and diagnostics in the framework of the project, to promote treatment compliance, to exchange information and to disseminate best practices in the countries of Central Asian region,” says a project manager of the Global Fund, a representative of Project HOPE in the Republic of Kazakhstan Bakhtiyar Babamuratov.

The event was organized by the Project HOPE in the framework of the grant from Global Fund to fight AIDS, tuberculosis and malaria. Representatives of non-governmental organizations from Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan attended the seminar .

Migrants do not want to be treated

From all the countries in the Central Asian region, Kazakhstan is accommodating the main stream of migrant workers from neighbouring countries. Migration flow continues to grow. Those who come to find a job often agree to any work, they often live in poor housing conditions and do not eat well. This results in tuberculosis development. In 2016, 753 external migrants addressed the organizations of primary health care and TB facilities of Kazakhstan and were tested for tuberculosis. In 2015, there were only 157 visits. Most migrant workers prefer not to attend medical institutions and refuse to be treated in the TB clinics or to be examined by a doctor. They consider it to be a wasting of working time, i.e. money. They have to support families left at home, therefore money is the main reason to come to a foreign country. For the same reason people do not want to spend money on health, even though a Comprehensive plan to combat tuberculosis in Kazakhstan for 2014-2020 involves activities to improve TB services for migrant workers.

Particularly alarming are the cases when a migrant worker is diagnosed with HIV/TB co-infection, and when such patient needs a serious treatment and social support. This important topic will be discussed in 2018 in the framework of the 22nd international AIDS conference – AIDS 2018 – in Amsterdam. This conference will be very special as for AFEW International and the whole region where the organization works — Eastern Europe and Central Asia.

Work at construction sites and markets

In the situation mentioned above, the participation of the NGOs in addressing of this issue has become very important. Outreach workers and volunteers – people, whom the target group trusts, – are searching for migrant workers on construction sites, at the farms, markets, in the restaurants or cafes. They tell migrants about the disease and the free treatment, convince to pass the examination and to provide social support. The results of such work are impressive.

“Within the project, implemented by Project HOPE in 2016, staff and volunteers of our public Fund helped 898 migrant workers to be tested for tuberculosis. For 25 of them the diagnosis was confirmed, and with our assistance people were able to receive free treatment. Besides, we provided migrant workers with motivational food packages. 8,312 labour migrants received information about the symptoms of tuberculosis, and now they know where to go if they are sick,” says the Director of the Public Fund Taldykorgan regional Foundation of employment promotion Svetlana Saduakasova.

These are the results of the activity of only one non-governmental organization in Kazakhstan. Nowadays, social activists are effectively working in eight regions of the country. Such results are possible to achieve only thanks to active collaboration with the non-governmental organizations from those countries where work migrants come from. The community members actively communicate with each other and exchange useful information to be aware of whether the diagnosed person came back to his home city, got registered in the TB clinic, continued to receive treatment, and so on. Only under these conditions we can achieve a complete recovery from TB for each individual and finally stop the growth of morbidity in the region.