The Central Asian Republics have not been as hard hit by the HIV epidemic when compared with Eastern Europe. However, given their location along the drug trafficking routes between Asia and Western Europe, there is cause for concern as new cases continue to rise across the region. As of the end of 2009, in the four Central Asian Republics where AFEW has carried out programme activities (Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan), over 30,000 individuals have been officially registered as living with HIV, with experts putting the real figure close to much higher.
These figures are expected to increase further in the years to come due to the rapidly growing number of people who use drug. At the same time, low rates of TB detection and poor TB treatment adherence are helping to fuel the growth of the region’s HIV/TB epidemic. The interaction of these epidemics in the region has serious implications for public healthcare, since statistically a quarter of deaths among TB patients is HIV-related and people living with HIV are 20 more likely to develop TB. In the Central Asian context, there is a clear need not just to step up HIV prevention, treatment, care and support, but also to establish an integrated HIV/TB response.
In order to do just this, AFEW and its partners have launched a five-year Dialogue on HIV and TB Project. AFEW is implementing project activities in Kazakhstan, Kyrgyzstan and Tajikistan. All managing organisations have a strong history of conducting outreach work with people at risk of HIV or affected by HIV in Central Asia. This new project aims to scale up these best-practice activities to the regional and national levels.
The overarching aim of the Dialogue on HIV and TB Project is to reduce HIV and TB among key populations (people who inject drugs, sex workers, migrants, men who have sex with men, prisoners and people living with HIV). Specifically, activities will evolve around three pillars: evidence-based planning, targeted outreach services and regional and national working groups.
Evidence-based planning: One of the biggest problems that organisations face when addressing HIV and TB in this region is the lack of up-to-date information and accurate data on people in target groups. Throughout the project, the consortium will conduct continuous research among target groups in all four countries to establish why certain behaviours and situations persist (for instance, why some people who inject drugs continue to share needles or why some people with TB do not access treatment). As evidence is collected and regularly updated, the consortium will amend its activities in each country.
Targeted outreach services: Where research suggests that essential services are absent or inadequate for certain target groups, the consortium will work with local governments and civil groups to introduce or improve them. The project focuses specifically on outreach work and these services will include:
Regional and Country Working Groups: A regional committee and four country-level committees will be formed to oversee the programme’s development, trouble-shoot problems that occur and offer expert advice on implementation. Participants will include people living with HIV and TB patients, civil society leaders, managers of HIV and TB projects, as well as representatives of international agencies (such as USAID, UNAIDS, WHO and the International Organisation for Migration (IOM) and national governments. Members of the committees will be called upon to promote the projects methods, approaches and results in their networks.
While collaborating with its partners on the key areas outlined above, AFEW plasy a special role in leading the programme’s prison activities based on its long experience of implementing HIV projects in the region’s penitentiary systems. AFEW also trains its partners in the client management approaches that it has successfully implemented in both the civil and prison settings of Central Asia.
Overall, the Dialogue on HIV and TB Project is designed to be highly flexible in its activities in order to allow space for fast adjustments to changing environmental and political contexts. Throughout the five-year period, target group coverage and geographic reach will be expanded, modifying activities based on lessons learned and data from research, monitoring and evaluation.
FOCUS GROUPS & RESULTS PER COUNTRY:
Focus: Prisoners of 5 penal colonies in Chui region and 1 in Jalal-Abad region
Results: 6420 prisoners reached and informed about HIV, TB and drug use through individual counseling and group mini-training sessions. The Project also provided a unique experience to educate non-medical prison staff and make them aware of how to protect themselves at work and improve preventative measures in prisons.
The Project established connections between prison health care system and civil AIDS and TB Centers. The project strengthened the partnership network of social, medical and legal organizations involved in rendering support to the target group. The Project was the first to liaise with penal inspectorates and successfully motivated all the clients to get registered with the inspectorates to avoid legal problems.
*Kyrgyzstan’s budget in this project amounted to $432,992
Focus: Current and former prisoners of colonies in the following sites: Almaty, Karaganda, Taldykorgan, Shymkent and Ust-Kamenogorsk.
Results: 813 new prisoners were reached with programme interventions with a total of 1110 prisoners reached in the reporting period. Among them 62 received VCT services and 58 received TB testing services. 14 IDUs participated in self-help group workshops. 210 clients had been included into the transitional case management programme, 134 passed four main sessions of the programme.
*Kazakhstan’s budget in this project amounted to $391,349
Focus: Current and former prisoners in Dushanbe, Khatlon and Sughd provinces.
Results: In Dushanbe, Khatlon and Sughd provinces (pilot regions), inmates are covered by individual and/or group counseling sessions on HIV, TB and risky behaviours. Inmates received transitional client management services.
*Tajikistan’s budget in this project amounted to $710,484. Note that this project has been prolonged in Tajikistan with financial support from Population Services International (PSI) in the amount of $150,000