AFEW Builds Models for the Future with Improved TB/HIV Care

AFEW, Hivos and PharmAccess and KNCV representatives after the presentation on the Dutch congress ‘Soa.Hiv.Seks’

The ‘Improved TB/HIV Prevention & Care – Building Models for the Future’ project was presented during the Dutch National Congress ‘Soa.Hiv.Seks’ on 1 December 2017 in Amsterdam, the Netherlands. Three working models from Kazakhstan, the Philippines, and Nigeria implemented by AFEW, Hivos and PharmAccess with KNCV Tuberculosis Foundation as the lead agency were shown to the Congress audience.

HIV and TB are two of the biggest public health threats in the world. Mounting challenges associated with these mutually reinforcing diseases are both medical and socio-political. In the efforts to address many of the common challenges, AFEW, HIVOS, PharmAccess and KNCV, with support from the Dutch Ministry of Foreign Affairs, collaborate in different parts of the world via the ‘Improved TB/HIV prevention and care-building models for the future’ alliance to jointly design and pilot innovative models of cooperation between the public, private and community sectors involved in the fight against HIV and TB, to find new ways of ensuring and expanding affordable, patient-centred and high quality access to care for key affected populations.

“After the project has started in Almaty, Kazakhstan, we can observe positive changes. A patient has information about good quality care, knows where to go for treatment and support, and has a choice in seeking care in the public sector, private sector and civil society,” the executive director of AFEW International Anke van Dam is saying. “Self-support groups and client management for TB patients are being organized and the HIV and TB working group is supported by the head of the Almaty City Health Department.”

Private clinics in Kazakhstan are now engaged in the public healthcare sector. They are integrated into the national monitoring and evaluation system for public/non-public TB/HIV care provision in Almaty city.

In Kazakhstan Students Debated on HIV

Author: Marina Maksimova, Kazakhstan

Opening ceremony of the first international debate tournament in Almaty “SpeakUp: AIDS”

Over 400 students from universities of the CIS countries took part in the first international debate tournament on HIV “SpeakUp: AIDS” in Almaty, Kazakhstan.

“Almaty is the city of students and active young people, who are interested in gaining knowledge, in particular in the area of healthy lifestyle and HIV prevention. Out of 5 000 people living with HIV in Almaty one-third is young people. Our city has a tradition to conduct spectacular campaigns dedicated to the World AIDS Day. This year, it was the first time we held debates on this topic among young people,” said Murat Daribayev, deputy akim (akim  is the head of a local government in Kazakhstan and Kyrgyzstan – note of editor) of Almaty.

Among the debate participants, there was the best 2017 speaker in the world representing the international debate movement, the main judge Raffy Marshall (Oxford), students from the major higher educational institutions of the country as well as from the UK, Kyrgyzstan, Russia, Tajikistan, and Sweden. The international panel selected 120 teams to take part in debates on this critical social issue. The tournament was held in line with the British parliament model.

The right to argue

Aleksandr Semenov, a student of the law department at the Kazakh National University is not a newbie in the debate movement. For the seventh year in a row, he wins his right to take part in the debates. He got through to the final round ten times, won five tournaments and even trained other debaters.

“The debates are a separate culture. It is sort of a recharger for your brain to always keep you thinking and analyzing to be able to assess a problem from various points of view. Additionally, you have to do it as fast as possible. The topics are always different: politics, culture, religion, sports… It was the first time when we had our debates on HIV. Therefore, the first conclusion is that we cannot keep silent, we should talk about it and ruin the stereotypes. Young people may be the opinion leaders,” says Aleksandr.

There are two people on his team: he and Altynay Dzhumasheva, a student of the American University of Central Asia from Kyrgyzstan. For debaters, it is not important which country or university the team members represent, the main thing is the efficiency of their joint efforts, mutual support, ability to swiftly catch the idea voiced by the partner and develop it in an emotional and convincing manner.

Stronger arguments

At the tournament, the debaters could use any of the three languages: English, Kazakh or Russian. The organizers selected several key topics. They included digitalization of the health care, drug use problems, sexual education, HIV and children, stigma and discrimination of people living with HIV. The participants were to be competent in all the topics.

“One of the rounds addressed the topic of drug addiction. What should change in the countries and in minds to give information about drugs and for drug users to have a choice of treatment and rehabilitation options? Our “opposition” team had to resist a storm of arguments from the “government.” Finally, the victory was ours! Our arguments on the need to adopt an efficient state drug policy and open state rehabilitation centres appeared to be stronger,” tells Altynay Dzhumasheva.

Counting on the young people

Debates among young people in Kazakhstan are a new instrument in response to AIDS. Organizers of the debates included the local Almaty administration, the Ministry of Health of the Republic of Kazakhstan, the Republican AIDS Center, the Health Department of Almaty, UNAIDS, and UNICEF.

Search for the new formats of HIV prevention among young people is an important topic to be discussed at the International AIDS Conference (AIDS 2018) in Amsterdam.

“Kazakhstan has already started its preparations to declare the elimination of mother-to-child transmission of HIV. We hope that information about HIV will continue to be accessible and accurate. The progress we have achieved has been to a great extent made possible thanks to people not being silent and youth being actively engaged,” HIV/AIDS Specialist from UNICEF Ruslan Malyuta is saying.

The winner of the English league of the first international debate tournament on HIV was a team from the People’s Friendship University of Russia. The best team in the Kazakh league was from the Taraz State University (Kazakhstan), and in the Russian league – from the Eurasian National University (Astana).

With Tuberculosis, it is Important to Take Medicine and Believe in Yourself

Sultanmurat from Kazakhstan wanted to get cured of tuberculosis no matter what but the treatment was difficult

Sanat Alemi is one of the civil society organizations (CSOs) supported by the Improved TB/HIV prevention & care – Building models for the future project which gives support to TB patients and their relatives. Founded in 2016 in Almaty, Kazakhstan by a group of ex multidrug-resistant or extensively drug-resistant TB patients, they quickly showed successes through their established self-support groups as well as one-to-one TB patient support. Sanat Alemi is also implementing several community-based activities such as social mobilization, advocacy, and communication to improve TB literacy among people affected by TB, TB/HIV, AIDS and other socially significant diseases (drug abuse, alcoholism, etc), aiming at reducing stigma, discrimination.

Success is possible with trust and professionals

“The social support for TB patients plays a key role in increasing adherence to the treatment. The success in treatment is possible with the combination of trust, human relationships and the support of professionals, such as a psychologist and social worker,” the current director of Sanat Alemi Roza Idrisova is saying.

A TB patient and client of Sanat Alemi Sultanmurat did not know anything about tuberculosis, except that it was a dangerous disease.

“I was horrified when I heard I had TB. I could not even imagine how I got it. I started coughing blood which was so scary, but I did not suspect that it could be TB,” he says. “I thought that the pain was caused by my liver or another internal organ. I told about this to my mother, as she is my closest relative. The other relatives reacted with understanding and this helped me a lot.”

What does not kill us makes us stronger

Sultanmurat wanted to get cured no matter what but the treatment was difficult. In the beginning, he could not tolerate the drugs, and he developed allergies.

“I struggled and tried not to miss a single day of medications and injections. I heard about Sanat Alemi from other patients and started to attend their self-support groups. Receiving support from other patients and social workers during treatment is of great help and being able to join trainings and meetings with different specialists is very useful and gives a lot of interesting information. I had the opportunity to ask questions that I had for a long time. I believe that in the future Sanat Alemi will keep the same spirit and will support many other TB patients,” Sultanmurat says. “TB completely changed my life. I started to appreciate life and learned to tolerate the sickness. I started to appreciate and love my relatives even more as they proved once again that they are there for me and that they would never give up on me during difficult times.”

Sultanmurat would like to say to other TB patients that this disease is curable like many other diseases. The most important thing is to follow the treatment, take pills without interruption, eat well and do sports. It is also important to be friendly, always and everywhere provide support and assistance to other people with TB. The most important thing is to believe in the best, in your recovery and do not forget that what does not kill us makes us stronger.

AFEW Presents Important Assessments about EECA

AFEW International, together with its network members from Eastern Europe and Central Asia (EECA) is getting ready for AFEW’s Regional autumn school to be held in Almaty, Kazakhstan from October 30 till November 3, 2017. The autumn school will provide the platform for learning, exchange, strategizing and planning for community members and NGO partners from 10 different countries. The regional autumn school is an annual event that takes place as a part of ‘Bridging the Gaps: Health and Rights for Key Populations’ regional approach of AFEW.

One of the highlights of the autumn school’s program will be the presentation of three important assessments that AFEW International recently finalized as a part of the ‘Bridging the Gaps’ program. The final results of all assessments will be available to the general public around December of 2017.

Harm reduction friendly rehabilitation

The assessment on harm reduction friendly rehabilitation in EECA is the study that describes the state of rehabilitation services in Ukraine, Russia, Georgia and Kyrgyzstan. It presents seven international approaches for rehabilitation programs and its activities. The participants of AFEW’s autumn school will discuss the recommendations of what approach is better to adopt for developing stronger work capacity.

Migrant people who use drugs

The assessment on migrant people who use drugs (PUD) is coming from the questionnaire that was disseminated in the EECA region. A survey amongst 600 people who use drugs in Tajikistan and Kyrgyzstan showed that 43% of the respondents have experienced periods of migration to another country in the EECA region, mostly to Russia. From the qualitative interviews with migrant PUD in Russia and Kazakhstan, it is possible to assume that people have very little access to health facilities, legal documents and often little options to return to their native country. The participants of the autumn school will discuss the full assessment and come up with interventions for the coming two years to build good practices and to advocate for the rights and lives of the community members.

Shrinking space for the civil society

The assessment on shrinking space for civil society is the in-depth assessment on the space for the civil society organizations with a special focus on harm reduction and drug policy in NGO’s and community networks. The withdrawing of international funding and shrinking space for the civil society form a real threat for the fight against the further spread of HIV in the region and the rights and lives of communities. During the autumn school, the coping mechanisms will be discussed and further steps will be designed to address the conclusions.

NGO-Based HIV Testing Available in Kazakhstan

President of Central Asian Association of People Living with HIV and the ‘Kazakhstan Union of People Living with HIV’ Nurali Amanzholov

Author: Marina Maksimova, Kazakhstan

From early 2018, HIV rapid testing in Kazakhstan will be available based in the non-governmental organizations (NGOs). With the President of Central Asian Association of People Living with HIV and the ‘Kazakhstan Union of People Living with HIV’ Nurali Amanzholov we are talking about advantages, mechanisms and preparatory work associated with this innovative step in fighting HIV.

– Nurali, it is well known that in Kazakhstan HIV screening test can be conducted at any regional AIDS Center. What is the reason for organizing rapid testing on NGOs’ premises?
– Nowadays, only AIDS Centers are authorized to conduct HIV testing in Kazakhstan. Every regional center has such a department. The problem is that representatives of the key populations (people, who use drugs, sex workers, men who have sex with men) prefer to avoid them. NGOs, using peer-to-peer approach, have better access to these groups, and in such a way there is more confidence. Non-governmental organizations can significantly increase the coverage of those tested for HIV, which means that the control over the epidemic will also increase. Another advantage of the proposed innovation is that it allows to identify HIV infection at an early stage, ensure timely treatment, preserve health and employability, and prevent new cases.

– What are exactly NGOs doing to introduce such service?

– Last year, with the support of the Corporate Foundation Eurasia Foundation of Central Asia, which is supported by the United States Agency for International Development (USAID), Kazakhstan Union of People Living with HIV implemented the project ‘Access to the NGO-based rapid HIV testing in Kazakhstan.’ Its goal is to create an enabling legal environment for providing HIV rapid testing services by NGOs to improve access to this service for key populations. Within the framework of the project, we analyzed the barriers during the introduction of the NGO-based rapid testing. Now we are working on the methodological recommendations and draft of the decree, which should make this initiative legal. It will contain clear operational rules of this system as well as all requirements and methods of control.

– Nurali, what kind of preparatory work is carried out to introduce this NGO-based services next year?

– Today specialists from the Republican Center for AIDS Prevention and Control together with their colleagues from Kazakhstan Union of People Living with HIV provide trainings for NGOs on how to conduct rapid testing in two pilot regions – East Kazakhstan and Pavlodar. We have already conducted trainings for the representatives of four non-governmental organizations. Specialists have taught our staff how to do an HIV rapid testing, and how to conduct pre-test and post-test counseling. They provided information about the quality control of the procedure, safety measures, recycling of consumables, talked about the observance of professional ethics. Each participant knows that if the test results are positive, the patient should be redirected to the AIDS Center for further laboratory diagnosis and confirmation of the HIV status.

Was your initiative supported by the governmental structures?

– Representatives of the Ministry of Health of the Republic of Kazakhstan, the Republican Center for AIDS Prevention and Control, leading international organizations dealing with HIV in the country are actively involved in this process. There is a good chance to include NGO-based rapid HIV testing into the national testing algorithm, which is being currently reviewed by the Ministry of Health. This will make fundraising efforts of NGOs more efficient, including attracting public funding for these services. This approach insures stability of the services, and of NGOs in general. I am sure that the topic of HIV rapid testing on NGOs’ premises deserves a separate discussion at the 22nd International AIDS Conference AIDS2018 in Amsterdam, and we are ready to share our experience there.

 

 

 

 

 

 

 

 

 

Improving TB/HIV Prevention and Care in Kazakhstan

Kristina from Almaty, Kazakhstan was diagnosed with HIV when she was in prison. At first, the woman got scared because she did not know how to live with this diagnosis. Now the woman is the volunteer of the organisation ‘Doverie Plus.’ She advises girls on how to be adherent to the treatment, motivates to start the treatment, and conducts other various activities.

“My life was pretty hard until I met Alla and Roza from the fund ‘Doverie Plus.’ They explained me a lot and supported me. Before I met them, I did not know anything about antiretroviral therapy (ART) therapy, and how it affects HIV virus. They told me I had to take it, and I was taking it, but every day I took it in a different time, without knowing that I had to take it in the same time every day. Now I know that I have to have the regime with my medicine and I have to take it every day in the same time. I achieved a viral load of less than 500 copies. Before meeting Alla and Roza, I was often tired of my life. After our talks, I felt much better. I want to live, I am living, and I will be living,” Kristina says.

Public Fund ‘Doverie Plus’ is working within the project ‘Improved TB/HIV Prevention & Care – Building Models for the Future.’ The fourth year of the project is starting in October 2017. Launched three years ago, the project is aimed at establishing an effective partnership between public and non-public TB and HIV care providers in Almaty, Kazakhstan.

STOP TB partnership is established

“The project is unique in terms of the community involvement, strengthening, increasing capacity of community based NGOs, and building strong inter-sectorial collaboration in Almaty. All big achievements are built from little efforts. The little effort was done to improve the access to services for key populations on the city level and we succeeded,” the Executive Director of Public Foundation “AIDS Foundation East-West in Kazakhstan” Roman Dudnik is sharing. “We have a strong NGO Network, and it is linking with all existent service providers. In the end, all people in need have the possibility to get services related to HIV and TB. We plan to develop this approach further, and we want to increase the capacity and knowledge level of all stakeholders, including NGOs, state and private medical clinics. This project should become the best practice model for other cities of Kazakhstan and our neighboring countries.”

The project ‘Improved TB/HIV Prevention & Care – Building Models for the Future’ is aimed at increasing government recognition of the role and quality of the non-public sector for TB/HIV service delivery, providing TB/HIV services according to agreed standards, encouraging civil society to be the active participant in monitoring quality of services, ensuring that clients have affordable options and trust in service provision, stronger linkages between government, project and civil society.

“During three years of our work, we achieved understanding of the integrated TB/HIV care model among key stakeholders and gained strong political commitment and support from healthcare department of Almaty through establishment of the platform for partners’ dialogue,” a project manager of AFEW Kazakhstan Kristina Zhorayeva is saying. “We also established STOP TB partnership for the effective coordination and collaboration between all partners working in TB and HIV areas. Private clinics are now integrated with TB and project services, and thus the number of private clinics that are eligible to provide tuberculosis care is increasing. Besides, healthcare authorities of Almaty recognized the importance of project interventions directed to strengthening the role of local NGOs in provision of TB and HIV care. With their understanding, we have created the working group on HIV and TB.”

Created first NGO in the city for TB patients

One of the biggest achievements of the project is the creation of community based NGO. It is the first NGO in Almaty city aiming its activity on TB patients and their environment. Their start up showed successful work on self-support group and client management for TB patients. The Public Foundation ‘Sanat Alemi’ has the following activities: social mobilization, advocacy, communication of people affected by tuberculosis, TB/HIV, AIDS and other socially significant diseases, reducing stigma, discrimination and develop commitment to effective prevention methods, diagnostic, drug management and treatment.

The founders of ‘Sanat Alemi’ are people who were successfully cured of multi-drug-resistant tuberculosis and extensively drug-resistant TB. In addition, one of the founders is an independent expert on TB, has extensive experience in treatment, drug supply, monitoring and organization of TB-based activities nationally.

“The social support for tuberculosis patients plays a key role in increasing adherence to the treatment. The success in treatment is possible with the combination of trust, human relationships and the support of professionals, such as a psychologist and social worker,” the director of public foundation Sanat Alemi Roza Idrisova is saying.

The project ‘Improved TB/HIV Prevention & Care – Building Models for the Future’ is implemented with the support from the Dutch Government (DGIS), KNCV and its partners, AFEW International, HIVOS and PharmAccess.

Kazakh Beauties Played Football for the Sake of Fighting with AIDS

Many students, young workers and musicians decided to check their HIV status

Author: Marina Maximova, Kazakhstan

Football, rock, celebrities! Youth initiative called #ЖОКСПИД2030 (#NOAIDS2030) is taking place in Kazakhstan. The founders of this initiative are the Republican AIDS Centre, the Central Asian Association of People Living with HIV (PLH), and the Kazakh Union of people living with HIV.

“With this #ЖОКСПИД2030 initiative, we want to save the memory of those who died from the epidemic. We want to draw the attention of public and youth in particular to the deaths, stigma and discrimination of people living with HIV. We want to give an opportunity to think about the problem that may affect anyone. This is why people should take responsibility for their health and the health of their close ones,” says Nurali Amanzholov, the president of the Central Asian Association of people living with HIV and Kazakh Union of people living with HIV.

Beauties on… the football field

The initiative started in May 2017 on the International AIDS Candlelight Memorial with a mini-football blitz tournament in Almaty. The members of the team were not professional sportsmen and muscular men, but delicate and the most beautiful girls in the country – the finalists of the beauty contests, popular singers and journalists. However, girls’ mentors were real football professionals, including sportsman-composer Abdulkarim Karimov and renowned players Zharko Markovich and Bauyrzhan Turysbek from Kayrat team.

Most beautiful girls in the country – the finalists of the beauty contests, popular singers and journalists – played football during the event

Beauty does not only heal, but also attacks. Girls played desperately, boldly, with an excitement, no one wanted to give in the victory. Neither spoiled makeup, nor broken fingernails, or even injured knees could get the girls to stop playing even for a minute. Women’s football is beautiful and strong. This was exactly what men, who liked the tournament, thought about it.

“Girls played dramatically and proved that they can play this manly game not worse than guys. I especially noted the fearless goalkeepers,” said Abdulkarim Karimov, who could not keep his emotions and sympathies to himself.

In this stubborn struggle, the team of journalists won the first place; show-business representatives placed the second, “Miss Almaty” and “Miss Kazakhstan” teams placed the third.

Media is everywhere

“#ЖОКСПИД2030 initiative is yet another opportunity to demonstrate the readiness and the will to counteract the future spread of HIV infection. We can stop and even reverse the epidemic with a set of measures: prophylaxis, providing access to treatment for all who need it, fighting stigma, and, of course, the active involvement of public attention to the problem of HIV infection,” Bauyrzhan Bayserkin, the CEO of the Republican Center for AIDS Prevention and Control notes.

#ЖОКСПИД2030 initiative is another opportunity to demonstrate the readiness and the will to counteract the future spread of HIV infection

It will not be possible to attract public attention without media. Therefore, some participants of the initiative were journalists. Media employees were on the training in Astana where they were taught by media trainers and experts about professional media coverage on HIV topics: the usage of correct terminology, interviewing ethics of people living with HIV, and selecting actual informational materials. Participants received a lot of important information from volunteers and outreach-employees who provide legal and social support to people living with HIV and drug users.

Practically a quarter of all HIV infection cases are infected young people aged 20-29. What should the prophylaxis for this age group be like, so that it would not leave anybody indifferent and eventually stop the epidemic spread? This important topic will be discussed on the 22nd International AIDS 2018 Conference in Amsterdam.

Rock songs on dombra

Immortal songs of Victor Tsoi – 80s rock legend – sounded in new adaptation on the musician’s birthday (the idol of millions would have been 55). It was also the anniversary of the “Needle” movie made in Almaty. The performers were not professionals, but amateurs. However, this fact did not lower the emotional heat and expression. Victor Tsoi’s greatest hits were performed with the accompaniment of guitars, the orchestra and even in the genre of opera. Rock songs played on Kazakh national instrument dombra was the most spectacular performance.

Tsoi’s hits were performed Rock songs on Kazakh national instrument dombra

In this creative and positive atmosphere, the organizers of the republican initiative #ЖОКСПИД2030 introduced a commissar to the participants. Ali Okapov, the popular singer and musician has become the commissary.

“To be a commissary on such an important social campaign is a great honour for me. As well as to promote healthy lifestyle ideology among young people. Future starts today. These are not just words. The future belongs to young people, but we should build it now, and it is definitely the future without HIV!” Ali Okapov is saying.

“Almaty – the city without HIV” is another recent event within the framework of the initiative. It was organized by Almaty HIV Centre, Public Foundation «AIDS Foundation East-West in Kazakhstan», Kazakh Union of people living with HIV, social foundation “Doverie Plus” (“Trust Plus”.) People living with HIV told their stories in the atmosphere of openness and trust. Young people took part in the quiz on the knowledge of HIV infection. The doctors informed about the preventive measures. The event ended in massive HIV express-testing. Many students, young workers and musicians decided to check their HIV status. The live queue did not even pay attention to the intense southern sunlight.

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.

AFEW’s Intern Researches PrEP in Kazakhstan

Is Kazakhstan prepared for pre-exposure prophylaxis (PrEP)? Master student majoring in International Public Health at VU University in Amsterdam Marieke Bak was finding the answer to this question during her recent internship with AFEW International. For this reason, she spent five months in Almaty, Kazakhstan, doing her research.

“For the past five months, I have had the opportunity to do an internship at AFEW International,” says Marieke. “From the start, I felt very welcome in this inspiring organisation and it was great to experience what it is like to work for an NGO. As part of my internship, I went to Kazakhstan to explore the potential implementation of a new HIV prevention method among men who have sex with men. The interviews were incredibly interesting and I learned a lot from the people I met. Moreover, I had the opportunity to do some travelling, which made me fall in love with the region. I hope to go back there someday and I will keep following the work of AFEW with much interest.”

The global HIV/AIDS epidemic remains a major public health issue. Among the countries with the fastest accelerating incidence rates is Kazakhstan, which is characterised by a concentrated epidemic among key populations. Addressing the epidemic requires effective primary prevention, but current methods are often of limited use. PrEP is a new method of HIV prevention consisting of a daily pill combining two anti-retroviral drugs, which has been found very effective when taken consistently. Generally, men who have sex with men (MSM) are seen as the target group for PrEP. As the most developed country in Central Asia, it seems that Kazakhstan could act as a frontrunner in providing PrEP. However, in order to inform the implementation of PrEP, there is a need to understand the awareness and attitudes of MSM towards this new method.

The aim of Marieke Bak’s study was to explore the possibilities for future PrEP initiatives in Kazakhstan by investigating the potential of this prevention method among men who have sex with men. You can find the report on the study findings here.

The Photo Exhibition ‘Life in the Shadow’ was Shown in the Netherlands

Last week the photo exhibition ‘Life in the Shadow’ was brought to the Netherlands by public Foundation ‘AIDS Foundation East-West in Kazakhstan.’ It was possible to see the images of people affected by HIV and tuberculosis during Wolfheze workshops in the Hague on 31 May – 2 June.

The main goal of the exhibition is to reduce stigma and discrimination against people with HIV and tuberculosis.

“We were very lucky with the opportunity to bring the exhibition to the Netherlands and show it to the bigger number of people,” the project manager of AFEW Kazakhstan Kristina Zhorayeva is saying. “Our models were very brave to show their faces and share their personal stories. They wanted to tell people that they are not different and they also have dreams and hopes.”

At the end of March the photo exhibition ‘Life in the Shadow’ was shown in Almaty, Kazakhstan. Some people from Kazakhstan saw the images for the first time in the Netherlands though.

“I have heard about this exhibition from AFEW, and today I saw it in the Netherlands even though it was displayed in my native Almaty,” the head doctor of one of the private clinics of Almaty Galiya Tulebayeva is smiling. “I look at these pictures of the patients with pleasure. It is great to see that there are smiles on their faces and they are in positive mood.”

As of February 2017, in Kazakhstan there were registered 29,568 HIV cases. According to the official data, in 2016 there were 14,345 tuberculosis patients registered in the country.

Visitors reviews of the photo exhibition ‘Life in the Shadow’

Jamshid Gadoev, WHO Country Office for Combating Tuberculosis, Hepatitis and HIV-AIDS in Uzbekistan:

– Only brave people can show themselves in such a way. They got sick and went through the processes that other people are going through now and do not hesitate to show all of this. On each photo I see a smile. Probably, they are happy with their treatment and are glad that they were rescued. They seem to be happy with their lives.

We also published a book and made a video about what tuberculosis patients feel before, during and after their treatment. We asked our patients to associate tuberculosis with some color, and children were asked to associate it with color and with the animal. Many people said that the disease for them is associated with red, yellow or black. Children usually said that their illness is a red teddy bear. Adults told that for them tuberculosis is black and is associated with the sound of a trumpet. After treatment, these associations often change and colors become brighter.

Alexei Bobrik, WHO technical specialist on HIV, tuberculosis and hepatitis, WHO Country Office, Ukraine:

– To overcome the burden of these diseases, it is necessary to talk about this problem so that the population knows about it, and the negative attitude towards the diseases decreases with time. It is necessary to communicate information, so that there is no stigma and discrimination. We must know that normal people are vulnerable to these serious diseases as well.