School of MSM and TG Leaders

On August 12–16, the “School of MSM and TG Leaders” was held in Almaty, Kazakhstan.

The objectives of this training were: to mobilize and increase the visibility of the community in the country; to create cohesion of the community itself; to create a tolerant attitude of the general population towards LGBT people.

More than 20 novice activists from different parts of Kazakhstan got new knowledge and skills to create a safe environment, maintain health and to improve the quality of life of LGBT people in the country.

“This is one of the best training I attended because it is not just a lecture but real master classes and personal experience of successful people’’ says one of the participants of the School. Indeed, the presenters – Amir Shaykezhanov – editor of www.kok.team and Elena German – program director of the Eurasian Coalition on Male Health www.ecom.ngo shared their professional experience.

The world is changing rapidly and today the most creative and innovative thinking leaders are pushing forward. The training itself and the presentation of the material were very unusual. From the beginning, the group was immersed in a creative trance – the participants were declared heroes of the Game of Thrones universe. “Five houses” – five groups of participants were engaged in the development of their unique projects for implementation in their regions. “Video blog to increase visibility”, “Community centers to support the LGBT community”, “Live libraries for anti-discrimination of HIV-positive MSM within the community”, “Improving HIV literacy among the LGBT community”, “Legal protection of the LGBT community” – during “The School” all these projects have gone all the way from the origin of the idea to a completed project application for receiving funding from the event organizers – AFEW Kazakhstan.

“We could not choose the best or most relevant topic, since all topics are important for the community,” admitted Roman Dudnik, chairman of the jury, director of AFEW Kazakhstan. As a result, the jury members – representatives of AFEW Kazakhstan and the Kazakhstan Union of PLHIV – decided to finance all projects. Teams are ready and are going to start in September.

 

 

School for People Living with HIV

Today, the community of people living with HIV (PLWH) in Kazakhstan is actively developing – the voice of community can now be heard at all levels, up to the Ministry of Health and the Parliament.

An important role in achieving this progress belongs to the events for potential activists organized by the Kazakhstan Union of PLWH together with AFEW Kazakhstan. One of them is a series of workshops called “School for People Living with HIV”. Such workshops are aimed at developing the community of PLWH to scale up the advocacy to promote their rights and interests and ensure care and support for PLWH at the local and national levels. They are organized with financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria within the project “Building Foundation for Sustainable HIV Response in Kazakhstan”. Yagdar Turekhanov, Program Advisor at AFEW Kazakhstan, told about the progress achieved.

 

Yagdar, what is the School for PLWH and how was it established?

The first workshop of the School for PLWH was held in November 2018 and brought together over 50 PLWH from all over the country. They were “newbies” – most of them just recently learned about their HIV status and did not have any experience of working in HIV organizations. People were enrolled after a competitive selection by motivation letters. It was a basic workshop where the participants learned about HIV, its treatment, and the role of civil society. They also received support in accepting their HIV status, bolstered their self-esteem and confidence. Following the first workshop, 25 most active participants who demonstrated their leadership skills, were selected. The goal of those workshops was to train a young generation of activists and to mobilize the regions to make the PLWH community of Kazakhstan act in a more targeted and coordinated way.

How would you describe the profile of the school participants?

Most trainees of the school are people who earlier had an experience of participating in similar activities, mobilized their peers and established local NGOs, making a significant contribution to the promotion of PLWH rights, reduction of the ART prices, etc.

What is the situation with PLWH rights in Kazakhstan?

The situation is different, and currently it greatly depends on separate individuals – friendly specialists, doctors, police officers, and workers of penitentiary facilities – as well as on the bravery and knowledge of the activists. Where such people are not numerous, the situation with observing the PLWH rights is disastrous.

What should a person do in case if his or her rights are violated?

Be brave enough to talk about it. File the case. Make a precedent. For this purpose, the person may ask more experienced community members and friendly lawyers for help.

Since 2019, Kazakhstan started using the ‘test and treat’ strategy. What does it mean?

For Kazakhstan, this approach, first of all, means breaking the stereotypes, challenging the traditional perceptions and the wide-spread myths about ART. It means fighting the “bonuses schemes”, when people take therapy only to get some incentives, but not because they see the linkage between ART and better quality of life. It includes working with health professionals, who can formally observe the protocols, but in some indirect ways, with their intonations, phrases, or even directly make their patients understand that they do not believe in what they do. E.g., they can often say something like “According to the new rules, I have to prescribe therapy to you, but you can refuse, all the more so because you have pretty good test results and those drugs are chemical anyway” or “I realize that you want to give birth to a child, but still you have to think twice as your husband has HIV and even if he does not transmit the virus to you – what will be the future of your child?” We try to change this kind of approach.

Is there a place for innovations in the PLWH community of Kazakhstan?

The active part of PLWH community is, of course, open to innovations – they are ready to introduce new approaches as soon as they learn about them or come up with them. Most of the general population are kind, empathetic people who are totally unaware of the modern scientific achievements in terms of HIV prevention and treatment. They are afraid for themselves and for their loved ones, thinking that HIV is a death sentence. Many people still think that HIV is transmitted through household contacts (“I know that HIV is not transmitted through air or touch, but just in case I would better protect my children from contacts with HIV-infected people”). It looks like this situation can only be changed by young people who are in their nature more open to new things, more tolerant and less prejudiced. Efforts aimed at young people, primarily at the students of medical colleges and universities, with the involvement of PLWH community, can gradually change the status quo. By the way, it is already happening – slowly but surely.

Will there be any workshops in future? Who will be able to participate in them?

Funding of such activities is currently very doubtful – donors gradually lose their interest to Kazakhstan, while attracting government funding is so far rather challenging. However, PLWH community is looking for new opportunities. Apart from the Schools for PLWH, PLWH camping events are held on a regular basis, where people more and more often pay for their own participation. Information about such events is shared through HIV NGOs, AIDS centers, social networks and messengers. The priority is given to “novices”. More experienced PLWH community members can try on the role of trainers after passing a competitive selection.

 

 

 

 

 

EECA INTERACT 2019

We are pleased to announce that, on the 18-19th November 2019, the first EECA INTERACT Workshop 2019 will take place in Almaty, Kazakhstan.

The EECA INTERACT 2019 Workshop builds scientific research capacity while simultaneously strengthening clinical, prevention, and research networks across the Eastern Europe and Central Asia (EECA) region. EECA INTERACT 2019 is an abstract-driven workshop focusing on factors unique to the region’s HIV, TB, and hepatitis epidemics. Bringing young and bright researchers together with top scientists, clinicians, and policymakers, EECA INTERACT 2019 aims to ignite a conversation that will build a stronger scientific base to serve the region and connect to the world.

EECA is the only region in the world where the HIV epidemic continues to rise rapidly. UNAIDS estimates point to a 57% increase in annual new HIV infections between 2010 and 2015.1 The World Health Organization has warned of a sharp rise in rate of HIV and tuberculosis coinfection, which poses a real threat to progress.2 Significant barriers to prevention and treatment services remain for people living with and affected by HIV, TB, and hepatitis across the region. For example, although the HIV epidemic in EECA is concentrated predominantly among key populations, particularly among people who inject drugs, coverage of harm-reduction and other prevention programs is insufficient to reduce new infections. The region urgently needs more effective strategies of prevention, treatment, and care and support that are tailored to the particular circumstances of individual countries.

The Amsterdam Institute of Global Health and Development (AIGHD) has over a decade of experience delivering in-country workshops and conferences that bring young researchers and established international experts together to share original research and state-of-the-art reviews on a wide range of topics. AIGHD has co-hosted the INTEREST Conference (the International Workshop on HIV Treatment, Pathogenesis, and Prevention Research in Resource-limited Settings) since its inception in 2007. The conference has grown from a small workshop to a full conference of more than 500 attendees each year.

Building on these proven results, AIGHD will collaborate closely with AFEW International and the AFEW network (AFEW) for EECA INTERACT 2019. AFEW’s deep roots and experience in the region offer a way to build sustainability into the new workshop, placing priority on local contributions. The EECA INTERACT 2019 will bring scientists, clinicians, members of civil society, and government officials together to tackle topics facing individual countries while building capacity and strengthening research and clinical networks. The two-day conference will focus on topics that are specifically relevant to EECA and dive deeply into particularities of the host country Kazakhstan, showcasing its successes, remaining challenges and responses.

The workshop objectives are:

  • To provide cutting-edge knowledge in the fields of epidemiology (modelling), treatment, pathogenesis, and prevention of HIV, TB, and viral hepatitis as well as chronic conditions;
  • To exchange ideas on providing and supporting HIV testing services and clinical care provision to adults, adolescents, and children living with HIV to achieve 90-90-90 goals;
  • To foster new research interactions among leading investigators and those who represent the potential future scientific leadership for health care and research in the region;
  • To build research and clinical capacity across EECA.

We invite researchers from EECA to submit their abstracts in the workshop. Selected abstracts will get free registration. Please find here more information.
Interested parties who do not have abstracts, but also wish to attend the event, can fill in an application form that will be considered by the committee. Please find here more information.

The deadline for all applications is September 20, 2019.

EECA INTERACT 2019 is organized by AFEW International, Amsterdam Institute of Global Health & Development (AIGHD), AFEW Kazakhstan and the Kazakh Scientific Center of Dermatology and Infectious Diseases.

EECA INTERACT 2019 is sponsored by Johnson & Johnson and Aidsfonds.

If you have any further questions, please contact Helena_Arntz@AFEW.nl.

 

 

“Orange morning”

On the 28th of June, in the framework of the project Fast-Track TB/HIV Responses for key populations in EECA (Cities) Almaty city in Kazakhstan held an important event for the community of people who use psychoactive substances – a photo exhibition “Orange morning”. The event was organized in honor of the World Campaign “Support. Don’t Punish”, which is held annually on the 26 of June, on the International Anti-drugs Day.

#SupportDontPunish is a global grassroots-centered initiative in support of harm reduction activities and drug policies that prioritize public health and human rights.

The color of this protest and the need to overcome aggressive drug policies and stereotypes against people who use psychoactive substances, with a focus on women, has become orange.

Women, the characters of the photos, shared their life stories about aggressive drug policies and systems that destroy their lives. The event organizers say that the main goal of the exhibition is not to appeal to emotions, not to cause regret, sympathy, condemnation or contempt. The goal is to call for the end of this senseless war that doesn’t bring any results. The war on drugs is beneficial only to politicians, law enforcement agencies and drug mafia.

AFEW Kazakhstan in the face of Roman Dudnik, executive director of the organization, supported the exhibition. “The greatest value of such events is that the campaign “Support. Don’t punish” is becoming more and more popular and followed in the world, and this is an excellent result,” Roman says.

A video report from the exhibition you can watch here https://youtu.be/1qS6J4gwfbw.

 

 

 

Kazakhstan: Reducing Stigma and Pills – Improving Adherence to Treatment

Author: Oksana Maklakova, Russia

In early May, Kazakhstan presented and discussed a new concept of providing antiretroviral treatment (ART) to people living with HIV. The concept will be implemented in 2021–2025. Of Kazakhstan’s 19,384 patients registered in HIV care in 2018, 77% are on ART. This quite high indicator gives Kazakh doctors and civil society activists hope that the UN 90/90/90 targets will be achieved in the country.

One-stop shop approach

“Of course, there is a problem with adherence to treatment in Kazakhstan. Treatment regimens change not only because some patients are resistant to certain drugs and need new combinations, but because sometimes there are interruptions in the supply of certain drugs. Optimized treatment regimens and improved quality of treatment as an objective was included in the new strategy by UNICEF and the Kazakh Scientific Centre of Dermatology and Infectious Diseases. NGOs are also working towards achieving this objective. For example, reduction to just eight universal and effective treatment regimens is planned,” says Lyubov Vorontsova, project coordinator of the Central Asian Association of People Living with HIV.

Since 2017, Kazakhstan has been implementing a “test and treat” strategy. In line with WHO guidelines, antiretroviral treatment is prescribed and provided to patients on the same day they are diagnosed with HIV, without waiting for immune status or viral load indicators. Procurement of antiretroviral drugs (ARVs) is regulated and funded by the government. However, access to ART is still a crucial issue in remote areas of Kazakhstan.

“Last year we monitored adherence to treatment in different cities of Kazakhstan. We wanted to find out, firstly, why people are afraid to start therapy, and secondly, why people drop out after they start ART. The first thing we heard is that people are scared of side effects (though in this regard modern drugs are much better than older ones). People also mentioned treatment fatigue, as ART is a life-long therapy. However, there are also remote areas where people have problems with physically accessing the drugs as they live 300 kilometres away from the AIDS centre and do not always have time and money to go and pick up their medications,” says Vorontsova.

Quitting therapy after the baby is born

People living with HIV (PLWH) in Kazakhstan, as in many other countries of eastern Europe and central Asia, are concerned about the quality of ARVs. Kazakhstan is gradually transitioning to modern regimens which are easier to tolerate, have almost no side effects and, most importantly, are more convenient to take. The biggest challenge for both doctors and civil society activists is stigma, self-stigma and discrimination.

Project coordinator of the Central Asian Association of People Living with HIV Lyubov Vorontsova

“We often hear stories about people who are afraid to take pills at work as someone may see them. There have been cases when colleagues saw a person taking ARVs, then checked the name of the drug on the internet and found out that this person had HIV. As a result, he or she was fired. Of course, such incidents have a negative impact on adherence to treatment,” comments Vorontsova.

There are also problems with the information pregnant women with HIV receive in antenatal clinics. Mothers-to-be agree to start taking ARVs as it is important for their babies. This approach often leads to a situation where the woman stops treatment after delivery. She saves her child, but nobody tells her that first of all she needs the therapy to take care of her own health. To avoid such cases, Kazakhstan would like to introduce peer counselling for pregnant women.

The problem of adherence is crucial in key populations – men who have sex with men, people who use drugs, and sex workers. Due to self-stigma, many do not access health services. It is often much easier for such people to receive support from a civil society organization (CSO) than to go to a government health centre. For this reason, last year many CSOs in Kazakhstan started to actively implement testing and self-testing programmes.

Bargaining for lives

In order to reach as many people living with HIV as possible with quality modern treatment, the Kazakh Ministry of Health decided to procure ARVs through international agencies. It was expected that procuring drugs at minimum prices would allow coverage of patients with new ART regimens to double in the following months, and accelerate transition from older to more modern drugs. However, this spring Almaty residents faced interruptions in the supply of the vital medication dolutegravir.

The Ministry of Health of Kazakhstan and the Pharmacy Committee held negotiations about including Kazakhstan into the voluntary license, which would reduce procurement prices for generic dolutegravir from USD 118 to USD 4.5 This would enable provision of effective therapy to all PLWH in Kazakhstan. However, the patent owner said that only low-income countries can be included in the voluntary license on such terms, and left the old price for Kazakhstan.

“Dolutegravir is really a high-quality medication. It has very few side effects. As there are interruptions in the supply of this drug, patients are transferred to other treatment regimens,” says Vorontsova.

The next delivery of dolutegravir is expected in June. The Ministry of Health will then prepare documents to submit for compulsory licensing, under which generic drugs can be procured at a lower price.

AIDS 2018: Prevention Focused on Key Populations

Source: www.aids2018.org

Author: Marina Maximova, Kazakhstan

Just before the 22nd International AIDS Conference in Amsterdam AIDS 2018, a new Global AIDS Update prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) was presented in Paris. The report shows that the HIV epidemic is still growing in the countries of Eastern Europe and Central Asia (EECA). In the recent year, the number of new HIV cases in the region has doubled.

Participants of AIDS 2018 debated a lot on the reasons of this trend. Experts explained it, in particular, with a lack of prevention programmes, especially among people who inject drugs (PWID). Today, they account for over half of the new HIV cases. That is why implementation of the innovative multilevel interventions aimed at HIV prevention in key populations is to be continued.

For several years already, the Global Health Research Center of Central Asia (GHRCCA) and the Social Intervention Group (SIG) of Columbia University have been implementing projects and evidence-based interventions aimed at HIV prevention among key populations in the region, in particular in Kazakhstan. The results and achievements of three of such projects were presented at a special session of AIDS 2018.

Good News from NOVA

Assel Terlikbayeva

Assel Terlikbayeva, GHRCCA Regional Director:

NOVA Project is the first intervention combining harm reduction services and microfinance for women in difficult life circumstances. In two years, about 500 women from vulnerable populations – sex workers and people who use drugs – developed their skills to reduce the risks of contracting HIV and other sexually transmitted infections. Women received professional training in sewing and hairdressing. The most active participants received micro loans to start their own businesses. About 82% of project participants were able to open savings accounts, and many of them did it in the NOVA Project. About 70% of project participants were qualified for non-repayable allowances to start their own businesses, while 36% of women were able to use this opportunity.

Renaissance is possible

Louisa Gilbert

Louisa Gilbert, PhD, GHRCCA Co-Director:

The Renaissance Project is an innovative HIV prevention intervention aimed at PWID couples. Project results are inspiring first of all for its participants. Here is some of the optimistic statistics: unsafe sexual behaviours among project participants and their sexual partners were reduced by 42%, hepatitis C incidence decreased by 69% and HIV incidence – by over a half in the harm reduction group as compared to the control group.

Throughout the project, there were 89 instances when Naloxone was successfully used to reverse overdoses: in 15 cases, the medication was used to deliver first aid and saved lives of the Renaissance Project participants and in 74 cases – of PWID partners and their immediate circle.

PWID choose trust

Nabila El-Bassel

Nabila El-Bassel, PhD, Executive Director of GHRCCA and SIG, Professor of Columbia University:

In the recent year, the number of PWID visiting pilot confidential counselling sites and going through HIV rapid testing has more than doubled. It is very important that the number of new HIV cases detected at such pilot sites has grown. Implementing evidence-based strategies in routine activities allowed scaling up PWID coverage with harm reduction and HIV testing services. It became possible through the Bridge Project.

Besides, the project enhanced the role of outreach workers in finding and recruiting new clients as well as the role of nurses in working with HIV-positive people. Implementing electronic data collection helps to improve tracking and monitoring of the services and referrals provided.

Integrated Care Centre in Almaty – a Home for Everybody

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices

Author: Marina Maximova, Kazakhstan

A month ago, the first Integrated Care Centre for people in difficult life circumstances, called Revenge, was opened in Almaty, Kazakhstan. The centre was established at the initiative of the community of people living with HIV.

Invisible People

People living with HIV (PLWH), people who use drugs (PUD), those who are released from places of confinement… Those people are often left behind and ignored. They are invisible, pinned to the wall of despair, with a trail of problems that remain unresolved for years, not believing that there is a light at the end of the tunnel. Now they know where they can find help. Where they will be understood and will not be neglected. Now the address 14A Omarov Street, Almaty is well known to many people. They pass it on to each other, realizing that for someone it might be the last hope.

“The centre was opened by the community, which is one of the factors attracting the potential clients. Here people can stay overnight or even live for a while until they are able to resolve their most pressing problems. The main thing is that here they are able to get a temporary registration, which is the main barrier in re-issuing the documents, getting “registered” with a healthcare facility, etc. The centre is a unique initiative and its launch was very well timed,” tells Roman Dudnik, Executive Director of AFEW Kazakhstan.

AFEW Kazakhstan supported the idea of opening the Revenge Centre within the Project “Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia.” Among other initiators – activists of the Kazakhstan Network of Women Living with HIV and the Revenge Social Support Fund.

I reached the lowest point of my life

Director of the newly established centre Yelena Bilokon knows about the lives of people who practice risky behaviours not by hearsay. She was using drugs, lived in the street and has been living with HIV for 22 years. Rehabilitation centres inspired her to start a new free life. She got acquainted with the rehab clients within her community activities. When she saw the premises, the joint work, the support people provided to each other and their enlightened faces, she felt that she wanted to open her own centre.

Timurtau centre was her first success. It is a crisis centre for families called My Home, which provides assistance to many women and their children who are in trouble. The Almaty project is more large-scale.

“We have clients who have not been able to access antiretroviral treatment (ART) and, thus, to reduce their viral load and even go through medical examinations for three years or more. What can we say about migrants if even our citizens cannot receive these services? The same story is with tuberculosis patients who are left without social benefits, which they are entitled to. People are not even able to find jobs. As for children, when they get into crisis situations with their parents, they also need help, sometimes even more than adults,” says Yelena Bilokon, Director of the Kazakhstan Network of Women Living with HIV.

Up to 40 calls a day

In the centre, telephones are ringing all day long. Many people need help. The centre, in fact, is also in need of help. Kitchenware, clothes, bed linen, furniture, food… All these things are brought by good people. There was a call for help in social networks – and a lot of people responded.

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices. 25 people were tested for HIV with rapid tests, 17 found jobs, 11 were examined for hepatitis and tuberculosis. It is not just statistics. Every number symbolises the struggle for someone’s health and life. Every day.

“Opening of such centre offering integrated services for vulnerable populations is an important event for our city. All the crisis centres, which existed before, had their own profiles and worked only with certain populations. People who need help cannot always find a centre offering the necessary services quickly. The Revenge Centre helps everybody,” says Alfia Denebayeva, Deputy Chief Physician of the Almaty AIDS Centre.

Workshops on case management, outreach work, stigma and discrimination delivered by medical professionals and civil society leaders help the centre clients to become volunteers. Recently a youth and adolescent club was opened in the centre, with many guests coming for the opening ceremony. In fact, they are not called guests here – those are our friends and allies, and their number is growing day by day.

Roman Dudnik: “The HIV/TB CITIES Project led to a more open dialogue between NGOs and the municipality of Almaty”

Roman Dudnik, Executive Director of the Public Foundation AIDS Foundation East-West in Kazakhstan

Author: Marina Maximova, Kazakhstan

It has been a year since the project Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia (HIV/TB CITIES) has been operating in Almaty, Balti, Odesa, Sofia, and Tbilisi. Different countries, contexts, mentalities and different… results. Roman Dudnik, Executive Director of the Public Foundation AIDS Foundation East-West in Kazakhstan is telling about the project implementation in Almaty, Kazakhstan.

– Roman, one of the results of project implementation is a major and important outcome not only for the city, but also for Kazakhstan in general – the Almaty akimat (regional executive body in Kazakhstan editor’s note) has signed the Paris Declaration. That is a high standard. Do you manage to keep up with it?

– In summer 2017, Almaty became the first city in Central Asia joining the Paris Declaration to end the AIDS epidemic. It is a crucial step for the city as along with Pavlodar, Karagandy and East Kazakhstan regions it has the highest rate of HIV prevalence in the republic. That is why we really need to take popular actions and measures, which will help us to draw attention to this problem and stop the growth of the HIV epidemic. The declaration was signed not only “for the record” as they say. There is an interest to this topic from the side of the municipality and it does not fade. Using this momentum, we hope to implement our project in the most effective way and make further, not less ambitions steps – develop an effective city model of HIV and tuberculosis (TB) response and increase the share of municipal funding allocated for the prevention programs among key populations.

– Do you feel any support from the side of government authorities? How tricky is the East?

– I worked in Russia for years and I saw the attitude of government officials to civil society organizations there… Fortunately, in Kazakhstan the situation is entirely different. I was even surprised that mazhilis (lower house of the Kazakhstan Parliament – editor’s note) deputies can meet with non-governmental organizations (NGOs) or people from akimat can refer to NGOs as their partners. If at first it seemed that akims (heads of the local executive bodies in Kazakhstan and Kyrgyzstan – editor’s note) are out of reach, and the topics of HIV and harm reduction are not their top priorities, the HIV/TB CITIES Project has changed the perception of priorities and significance of this issue, and it is not only my perspective. Here if people commit to something, they do it. Maybe they are not very loud and showy about it, but they surely reach good results. Several years ago, 18 confidential counseling points were opened in Almaty, where people can get tested for HIV and other diseases, receive relevant specialists’ consultations and awareness-raising materials or exchange syringes. Today they are already funded from the municipal budget and supported by the local authorities.

Public officials in Almaty are very busy people with a lot of things to take care of. Not all of them know about the scope of HIV problem, they do not have time for it. They need information and are grateful when they receive it, in particular from NGOs. In this chain, we became allies. The first achievement of the HIV/TB CITIES Project was the development of an order to create an HIV/TB City Task Force at the Health Department of Almaty. Here an order is equal to a law: it is strictly implemented and controlled. All meetings of the Task Force, which are held every quarter, are recorded, and its decisions are implemented with no time-consuming bureaucracy. One of the outcomes is that medical professionals now more actively attend training workshops on HIV prevention, stigma and discrimination, which are held by community leaders.

With the participants for the community platform “The city with no fences between people”

Roman, what are the other activities, which marked the first year of the Project implementation and what are you plans for the nearest future?

– With the support of Almaty AIDS Centre , an assessment was made of the HIV and TB situation and the needs of key groups. Through focus groups, the main factors were identified, which influence reducing the HIV morbidity in every key population. It will allow developing an effective model of response to the epidemic. A memorable event was the city community festival Art Energy Almaty. Work in Progress. Our community platform was called “The city with no fences between people.” It was the time when a lot of fences between buildings and near the roads were dismantled in Almaty to make the city more free and open. Our message – that the main fences usually exist between people, and we are the ones who can ruin them – got together people living with HIV, LGBT, people with drug use history and sex workers at our platform. It was the most popular platform. Our visitors liked listening to frank stories with open faces. We have already launched an operational research of the model stipulating low-threshold access to HIV testing and treatment for people who inject drugs. We plan introducing rapid oral HIV tests. Besides, preparations are in progress for the Almaty akimat to sign one more important document to demonstrate the political commitment to ending TB – the Zero TB Declaration.

Do you plan to take part in the XXII International AIDS Conference (AIDS 2018) in Amsterdam?

– Yes, of course. I am sure that this forum will become a platform for intensive knowledge sharing and discussing the efforts of governmental, non-governmental and international organisations in response to the HIV epidemic. We have got our messages and suggestions to come up with.

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’

Author: Olesya Kravchuk, AFEW International

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).