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.

AFEW Kazakhstan Helps People Getting out of the Shadows

29,568 HIV cases were registered in Kazakhstan as of February 2017. According to the official data, in 2016 there were14,345 tuberculosis patients registered in the country. Usually, these people hide themselves, and are often afraid even to tell their relatives about their diagnosis. But there are also those who openly talk about their status, and who show that it is possible to get out of the shadow.

At the end of March, the photo exhibition ‘Life in the Shadow’ dedicated to the World Tuberculosis Day took place in Almaty. AIDS Foundation East-West in Kazakhstan organized this event. The exhibition featured photos of people affected by HIV and tuberculosis. Today we will tell the stories of some of them.

LEARN TO LOVE YOURSELF

After the death of her mother in 2008, Venera started to lose weight. The woman thought it was because of the grief she was experiencing, but still went to the hospital for the X-rays and medical tests. There it was discovered that Venera had an open form of tuberculosis.

Venera realized that it does not matter what your position in the society is, the tuberculosis makes everyone equal

“By that time, I was very weak and all the time felt sick in my stomach. I weighed 48 kilograms,” says Venera. “During three months I was out there with an open form of tuberculosis until they accepted me in the hospital. All I wanted at that time was to lie down and die! I was in darkness, alone, rejected by everyone. I did not believe that I would get out of that hospital alive. All the time I was sick because of the pills. My son and my sister, who, after my mother’s death, was taken to an orphanage, as I did not have time to register custody, were the only people who kept me alive. They called me, told me they needed me, asked not to die. It was the strongest motivation to live! After some time, I started to feel better and began recovering.”

A year later, Venera was diagnosed with tuberculosis and lung disintegration. At that time, the woman was pregnant. Since no one told her that during the pregnancy tuberculosis can be treated, Venera was advised to have an abortion.

“In the hospital they gave me the bed that was standing in the hallway, and soon the whole department knew I had tuberculosis,” Venera recalls. “People were scared of me. The gynaecologist was commenting something like, why people like me are even allowed to give births at all. That was such a humiliation!”

After she got out of the hospital, Venera realized that it does not matter what your position in the society is, the tuberculosis makes everyone equal. The woman became stronger and kinder, started to pay more attention to her relatives, helped those who needed help. Three years later, Venera gave birth to the healthy twins.

“I defeated tuberculosis. If you have such diagnosis, do not be not afraid and believe that you will recover!” says Venera. “Do not be scared of anyone, this is not a disgrace. Most importantly – do not refuse the treatment, otherwise you can infect your relatives and friends. Learn to love yourself!”

A DECISION TO LIVE

To those who only got to know about their diagnosis, Salavat advises to be strong and take care about their health

Salavat has been living with HIV since 2011. The man has heard something about this disease, but did not have a clear understanding of it. He thought it was somewhere far away, not here, and he could not even imagine that he could get infected.

“The doctor was calming me down, saying that people live with it, that it is not fatal, that in the future there probably will be a medicine… At first, of course, I felt bad, but I quickly overcame my fears,” Salavat says. “I made a decision to live. Now I know a lot about HIV. I am confident that I can work, and I am able to live. I know that we are the same people as everybody else, we are not infectious.”

To those who only got to know about their diagnosis, Salavat advises to be strong and take care about their health. It is very important to enjoy life, to share joy, and not to lapse into a cocoon of self-isolation.

ACCEPTING THE DIAGNOSIS

Oksana learned that she was HIV positive in the rehabilitation centre for drug addiction.

The acceptance of her diagnosis benefited Oksana’s professional and personal development

“It was scary, somehow I made myself believe that I had only five years left to live and I have to fill my last years with fun and unforgettable experience!” Oksana is saying. “Before my diagnosis, I thought that HIV is something that is far away and it is impossible to get it in Kazakhstan.”

At that time, the woman needed support, and she got it from her family. The first one who learned about her diagnosis was Oksana’s sister.

“Later I asked her what she felt when she found out that I was HIV positive,” Oksana remembers. “Surprisingly enough, most of all she was worried about me, because the first thing I could convince her in was that I had only five years to live. About three years later, I accepted my diagnosis. I realized that I am not dying, and started to learn how to live with HIV.”

The acceptance of the diagnosis did not only benefit Oksana’s professional development, but also her personal development.

“I am happy to be busy with my favourite things, I am with a person I love and my family is very friendly. I learned how to live with HIV. You just need take more care about your health and love life!” Oksana resumes.

TO BELIEVE IN RECOVERY

After being diagnosed, Sultanamurat started to appreciate life more

The only thing Sultanmurat knew about tuberculosis was that it is a dangerous disease. When he heard his diagnosis, he became horrified.

“I experienced haemoptysis. It was scary, but I did not even suspect that it could be tuberculosis. I thought that I had some problems with my internal organs,” recalls Sultanmurat. “I really wanted to be cured, but the treatment was going very difficult. In the beginning, I did not tolerate the medicine and developed allergies. I was fighting with myself, tried not to miss a single day of taking medications and injections. Now I feel much better.”

After being diagnosed, Sultanamurat started to appreciate life more, treated people who are ill with better understanding, began to appreciate and love his relatives even more.

“I would like to tell those who are diagnosed with tuberculosis that this disease is curable, like many other diseases. The main thing is to follow the regime in everything, do not miss taking pills and eat well, move and do sports, be friendly,” Sultanmurat says. “The most important thing is to believe in the best, that is, in your recovery.”

AFEW Works Towards Ending Tuberculosis in the EECA region

World Tuberculosis Day is being recognized on the 24th of March in the whole world. This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes TB.

The theme of World TB Day 2017 is “Unite to End TB.” AFEW International‘s activities are also aimed on ending tuberculosis in Eastern Europe and Central Asia. In Kazakhstan, KNCV and AFEW-Kazakhstan are developing a model for structural collaboration between public health (TB, HIV, primary health care) and non-public sector through the DGIS-funded project in Almaty. AFEW International is coordinating this project. In March of 2016, a stakeholders meeting was organised to establish a Stop TB Partnership for Kazakhstan. This partnership reflects a close collaboration between different stakeholders, patients form an important group, working in the field of TB and HIV. 31 participants from NGOs, public TB and HIV services, and representatives of the Stop TB partnership of the Republic of Tajikistan took part in the meeting. The representatives from Tajikistan presented the value, successes and challenges of such partnership.

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

Roman Dudnik: “People with HIV and Tuberculosis are the Same as We Are”

A photo exhibition dedicated to the World Tuberculosis Day will be opened in Almaty, Kazakhstan on March 18. The purpose of this exhibition is to show that people living with HIV or tuberculosis are the same as everyone else. This exhibition is one of the first important public events held by AFEW-Kazakhstan in 2017. We are talking about this and discussing other plans for this year with the executive director of AIDS Foundation East-West in Kazakhstan, Roman Dudnik.

– How was the year of 2016 for you? What were the new and exciting things that happened?

– Even though the year of 2016 was difficult, it was successful for us. We moved to a different office. Before, we were in the small office building. Now we are in the new building with much more space. The repairs were made based on our requirements, using our colours. There is a very good energy here, and it helps to work good.
In 2016 we finished the first part of the project HIV React that is financed by USAID/Central Asia, and we got the extension for the next three years. This is our main project. It is regional: we work in Kazakhstan, Kyrgyzstan and Tajikistan. Being the part of this project, we are working in preventing HIV among injecting drug users in prisons. We also work with people living with HIV who are getting ready to be released, and those who are already released. With specially developed START plus program, we prepare a person for his release two months before it happens, and then continue to work with a person for another four months after the release. Additionally, we train medical and non-medical staff of correctional facilities and employees of non-governmental organizations. This program is unique and does not work in many countries of the world. All efforts are aimed at preventing HIV infection and supporting those who live with HIV. The main goal, of course, is to encourage a person to get tested for HIV. If the test is positive, then we send a person to the AIDS centre, and we motivate him to start treatment with antiretroviral medicine, if necessary. We also help to restore needed documents, find jobs, renew social connections. This program is unique because it has a human face. We are aimed at a specific person, at solving of his or her problems. We also try to form skills so that people can solve their problems in the future themselves.

– Working in three countries in Central Asia with the same groups of population in HIV React project, can you observe the common tendencies?

– The general trends in all three countries are that HIV in places of detention exists, and the number of new cases of HIV transmission is increasing. Convicts is the group that requires intense attention and constant work. There is a very high level of stigma from prison staff. Of course, the reason for this is a lack of information, and this is what we are trying to correct through the trainings. The most successful project is implemented in Kyrgyzstan, where the criminal executive system is more open and sympathetic to such activities. In Kazakhstan and Tajikistan it is a little more difficult, but despite this, we manage to work and implement all planned activities within the framework of the project.

– Besides this, what were other projects that you worked on in 2016? 

– Since January we started with the new City Health project with the financial support of the Global Fund, where the main grant recipient is the International Charitable Foundation “Alliance for Public Health”. The project works in five cities of the EECA region. We are responsible for work in Almaty. Implementing this project, we will involve the city administration in the prevention of HIV infection among vulnerable groups: injecting drug users, men who have sex with men, and sex workers. We plan to create a city council on HIV/AIDS. We know that the project is not simple, but it is interesting for us. For Almaty, the project is very important, since it is the most populated city in the country, and the problem of HIV infection is especially relevant here. It will be important for us to make this a successful model and to duplicate this experience to other cities and countries.

– A year ago you had a school of tolerance, the goal of which was to reduce stigma on the part of health care providers. Please, tell us if you can see the results of this school?

– It is difficult and too early to talk about the results. Stigma and discrimination are big problems for Kazakhstan and whole Central Asia, and this is one of our main areas of work. One school of tolerance cannot solve this issue. Without any doubt, there is a big difference in how people come to the training, and what they think after three or five days of the training. In our training, we focus on the personal qualities of a person, perform the situations when the participant himself acts as a client or the representative of a vulnerable group, and is experiencing everything what the client is experiencing by himself. Human intolerance was formed long ago, and one year of work cannot change it. Nevertheless, there is already some progress in this field.

– On the 18th of March you will have the photo exhibition dedicated to the World Tuberculosis Day. Please, tell us more about it.

– The exhibition is intersecting with the topic of stigma and discrimination. We invite everybody to come and see it. It will be held from 18 to 31 of March in the gallery June 24. During the exhibition, there will be master classes, lectures, and talks with people who are depicted on the photos. On the photos, there are 15 Kazakhstani people who live with HIV, or who were cured of tuberculosis. The name of the exhibition Life in the Shadow speaks for itself, because due to the human ignorance, the heroes of our photos should hide their diagnosis from others and live with their problem alone in fear. Now they have opened their faces for the exhibition and they are not afraid to share their experiences. By each photo, there is a written piece with the story of the person: what he was going through, what he was thinking about. The purpose of the exhibition is to shed light on everyday life of people affected by HIV and tuberculosis. They are just like us. The only difference is that they know their diagnosis and they have to fight for their health. Myths and prejudices about HIV and tuberculosis make them hide this part of their lives. Although, the understanding and support of others is what helps them to defeat the disease. The exhibition is positive; people are smiling on the photos. We made only colour photos that show people in everyday life: in the flower shop, in the metro, during painting. During the exhibition, we will tell the visitors about HIV and tuberculosis, tolerance. We will also distribute flyers with the information about where you can bring, for example, bags with clothes that are no longer needed and help people who live with HIV in such a way.

– Even though it is almost the end of the first quarter of 2017, I still would like to ask you about the plans of AFEW-Kazakhstan for this year.

– We plan to work with our projects further. In April, we will be having big regional training about gender violence. We already invited a very good professional in this field to be our trainer. This is a new topic for us, and everything new is interesting for us.