AFEW financially supported 21 case management units (social bureaus) in three countries, where around 15,000 clients (PLHIV, sex-workers, people who use drugs and prisoners) received over 150,000 psycho-social, medical, legal and prevention services from over 200 created or attracted service providers. In November 2011 a qualitative and quantitative assessment of access to medical, psycho-social services for people using drugs, sex workers and TB patients was conducted in the project regions of Kazakhstan, Kyrgyzstan and Tajikistan. Partner NGOs and government organisations conducted field work under the supervision of the external assessment coordinator. The results of the assessment illustrate that the main objectives of the project such as:
Technical Working Groups
The‘Technical working group on prevention of social-significant diseases, social support and health promotion in Sughd province of Tajikistan’, created through the project, received the status of a permanent working mechanism under Sughd province Coordination Council on HIV, TB and malaria prevention. More than 30 representatives of GOs and NGOs are included in the working group. The group’s decisions are merely advisory, but once approved by the Council they become mandatory.
Another working group created within the ACCESS project is called ‘Health promotion in Tajikistan Penal System’. It is chaired by Deputy Head of the Correctional Department, includes 15 NGO representatives, and is also a permanent coordination mechanism of the Tajikistan Ministry of Justice.
Introduction of ‘Patient School’ programme
In 2010 Kazakhstan’s National TB Centre also issued an order to implement the “Patient School” programme in all dispensaries throughout the country. Moreover, Kazakhstan’s Penal System Committee decided to implement another AFEW programme– “START Plus” – in 20 prisons throughout the republic, with a view to further expansion. This programme aims to raise awareness among inmates about HIV, tuberculosis, STIs, hepatitis and treatment adherence; to decrease risky behavior and to expand access to pre- and post-release medical and social services. Each inmate attends six individual sessions with social workers, who were also trained by AFEW at numerous educational courses throughout the Central Asian region and beyond. The goal of the sessions is to ascertain each inmate’s needs and provide relevant prevention services, medical care, psycho-social and legal support. “START Plus” is also being successfully implemented in eight prisons of Tajikistan (in 2011 alone the programme reached 5,727 prisoners) and its ‘client management’ component is included in the new reform strategy for the Kyrgyz Penal system.
This was all made possible through a number of joint events initiated and supported by AFEW, where representatives of civil society working in the field of HIV could express and address their needs and concerns to the governmental institutions The most notable and productive of these events were the Prison Forums held in Kazakhstan (2006, within TMF project), Kyrgyzstan (2008) and Tajikistan (2010) where participants could also visit local prisons. In 2009 Kyrgyzstan hosted the first Central Asian conference on the dual epidemic of HIV and TB. It brought over 100 professionals together and resulted in an appeal to the governments of the region with a concrete action list.
First, AFEW managed to achieve its principal goal of establishing collaboration and constructive dialogue between NGOs that work in the field of HIV and TB and government institutions through thematic working groups on HIV, TB and HIV/TB; a significant achievement given the typical reluctance of the governments of Central Asian states to fully cooperate with non-governmental organisations.
Second, we managed to build trust and gain recognition that AFEW’s unique programmes are changing the lives of members of vulnerable populations and those around them for the better. Programmes within the ACCESS project were officially recognised and adopted by the healthcare and prison authorities of Central Asian states. In Tajikistan, for example, the “Patient School” programme was introduced in all tuberculosis dispensaries and proved an effective method of treating patients and preventing the development of the disease into its multi-drug-resistant form. The programme equips nurses in TB dispensaries with knowledge, skills, a course syllabus and informational materials about TB and HIV, which they then convey to patients. The efficacy of this method demonstrates that the more the patient knows about TB and HIV the greater is the chance that he will approach his treatment responsibly.
* In 2010 AFEW has suspended its activities in Uzbekistan when re-registration of its representative office there was not made possible. However, AFEW remains committed to assisting in the development of evidence-based and effective measures to stem the HIV epidemic in the country. Long-term, close partnerships with national governmental and non-governmental organisations remain vitally important to AFEW’s strategy in Uzbekistan, as in other countries of Eastern Europe and Central Asia.