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.

EECA INTERACT 2019 takes an innovative approach by bringing together experts in HIV, TB, and hepatitis to participate in the International Conference Committee developing the scientific program. The ultimate aim is a workshop that addresses the unique issues facing the region, finding paths forward to solutions for improvement. Challenges include slow implementation of harm reduction, insufficient access to treatment, and criminalisation and stigmatization of key populations. Sustainable change can be achieved if these challenges are faced head on, embracing scientific evidence and working with marginalized and stigmatized populations.

Introducing the EECA INTERACT concept in Kazakhstan for 2019 extends the sustainable goals laid out during the AIDS2018 conference in Amsterdam. AIDS2018 drew attention to the effectiveness of rights-based approaches to more effectively reach key populations, highlighting this work across the EECA region. By bringing people together, sharing knowledge, and building capacity, the EECA INTERACT 2019 will build further on this base to find tangible solutions.

Nonexistent? We exist!

On the 28th of June in the framework of Drug Policy Week at the University of Geneva a documentary film “Nonexistent? We exist!” was shown.

The film is based on the result of the Program to expand the access of vulnerable groups to HIV / AIDS prevention, treatment and care services, which was implemented in the Russian Federation in 2015-2018.

The film told about the results of work under the Program to expand the access of vulnerable groups to HIV / AIDS prevention, treatment, and care services in Russia. This author’s documentary film about how the sincere desire of people to support each other, mutual respect and respect for rights should be the foundation of a modern health care system. Especially regarding socially significant diseases, such as HIV infection.

“This film is very authentic because it was created in cooperation with the representatives of key populations”, says Maria Yakovleva, executive director of the Russian Charitable Foundation “Candle”.

“Today 1 million people with HIV positive status live in Russia. A lot of them represent key populations that are more susceptible to HIV infection: people who inject drugs, men who have sex with men, sex-workers. With the help of this film we hope to draw the attention of our international partners to the problem of HIV infection in Russia and to show them that we are still far away from solving the problem and we need any support from the world society”.

The film was created by journalists Igor Kuzmenko and Alexey Kurmanayevsky from DUNews (Drug Users News) – an independent Russian-language news channel about events in and around a community vulnerable to HIV / AIDS.

After the film, there was a discussion about advocating for the needs of people who use drugs in Russia. Participants talked about the achievements of the project and the difficulties that communities are experiencing now caused by the absence of stable funding and stiffening stigma and discrimination of key populations. Daria Alekseeva, AFEW International Program manager, told about the role the organization plays in communities’ lives in the EECA region and particularly in Russia. AFEW International in cooperation with Aidsfonds provides small grants within the framework of the Operational Assistance Fund for key populations to help communities to execute harm reduction programs and to provide services to people.

You can watch the film “Nonexistent? We exist!” here https://youtu.be/5I5ZFug1Cbg.

 

 

“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.

 

 

 

Tbilisi Pride: Conference and Non-Festive March

A priest together with a thousand of other people attacks the participants of the campaign organized by LGBT activists on May 17, 2013. Photo by Radio Svoboda

Author: Yana Kazmirenko, Ukraine

In June, Tbilisi will host a Pride Week completed by the March of Dignity. The aspiration of the LGBTI community to speak out about their rights has already caused threats from the side of radical groups. On June 18-23, LGBTI activists will make another attempt to hold Tbilisi Pride, expecting about 1,500 participants. They do not announce the exact date of the event to prevent radicals from hindering the march and intimidating the participants.

Sandro Bregadze, leader of the Georgian March movement, said that he will not allow holding a gay march in Tbilisi and threatened to punish all those who will be protecting the LGBTI activists, including law enforcers. In addition to the radical groups, the Georgian Orthodox Church is also traditionally against the Tbilisi Pride. All attempts of the LGBTI community to organise any public events have always faced their counteractions. Thus, the Georgian Orthodox Church has announced that May 17, marking the International Day Against Homophobia and Transphobia, is the Family Day and holds a festive parade on this day. In 2013, an LGBTI rally turned into a fight.

There is a variety of activities planned to be held within Tbilisi Pride 2019, including an international conference to discuss the challenges and the best practices in protecting the rights of LGBTI community in Georgia and in the region, the importance of visibility and the impact of prides on the situation of queer people. The topic of HIV transmission and prevention will be brought up during the panel discussion “Right to health and the problems of LGBTI people accessing health services.”

“The Tbilisi Pride mission is not limited to fighting for our rights. The Pride Week is also aimed at raising public recognition and mobilizing the LGBTI community. Our slogans are addressed to the government, to the society and to the community,” says Mariam Kvaratskhelia, co-organizer of Tbilisi Pride.

The pride will be concluded with a March of Dignity, which will not take a festive shape since queers have little to celebrate in Georgia today.

On the eve of Tbilisi Pride, its organizers issued a statement, directly saying that the state authorities use LGBTI people as a cover. The authors say that they are not going to hide and live double lives.

The statement reads, “Violence is committed against us in our families, in schools, on the street and at work. We are attacked at home and expelled from families. They’re killing us! As a result of such hate and aggression, our sisters and brothers have to seek asylum in other places. (…) We are concerned about the poverty, unemployment, occupation and social inequality in Georgia. We are used as scapegoats to draw people’s attention away from the important social problems everyone should care about!”

Mariam hopes that after the Pride Week the community will be better mobilized.

“We already see many community members going public. Some of them agreed to become heroes of our videos, others will come to the Tbilisi Pride. Every year, the number of our supporters grows. We show to the government that there are many of us, that we are strong and that we have to be taken into account,” sums up Kvaratskhelia.

In Georgia, most LGBTI people have to hide their orientation, as they are afraid of facing violence from the side of their families and being judged by the church.

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.

Rehabilitation in a Dutch Way: Learning to Take Responsibility for Yourself and for Others

Author: Olesya Kravchuk, AFEW International

The ferry boat brings people to the island Texel in the Netherlands several times per day. Just a few minutes’ walk from the ferry stop there are several cosy houses. Near one of the houses, there is a hedge, behind which there are three goats. They are not afraid of visitors, and immediately come up to you and check you out. Residents of the house clean its territory and cook dinner. It is the usual Dutch routine, but the atmosphere is somehow different…

For more than 40 years already de Skuul Foundation (Stichting de Skuul) has been working on the island. It is an independent institution that specialises in assisting in the rehabilitation of people who take drugs. They also help those who have alcohol and gambling addictions.

“The fact that our residents are on the island creates a special atmosphere. In this way, they stay in a neutral environment,” says Aglaia Westra who works as a therapist at the Foundation. She has been working here for six years. “There are usually 16 residents who live here, and they live in a mini-society. They form the groups of eight people, and everyone has a task for every day. Someone, for example, goes to buy food, someone cleans the territory, and someone cooks food. That is how they learn to take responsibility for themselves and for others.”

The main thing is not to lose touch with reality

The clients of the Foundation come here after the referral of their general practitioner. De Skuul is financed via the insurance companies, local government and business representatives. In order to get into the rehabilitation programme, you need to go through the detox programme already at home. The first four weeks of their stay in De Skuul, its residents stay only on the island. After four weeks you can (and even have to) go home for the weekend. Foundation employees say that it is very important not to lose touch with reality. During the rehabilitation programme, its participants work with a psychotherapist. They also have visiting teachers who teach them singing, drawing and other crafts. The programme starts every day at 9 am and lasts until five in the evening. In the evening, the Foundation’s residents live their normal lives: they jog, read and walk by at the Wadden Sea that surrounds the island.

There are also rules here: violence and cruelty, drugs and alcohol, and mobile phones are prohibited. It is necessary to respect others and to be present during all activities within the rehabilitation programme. Violation of these rules leads to the end of rehabilitation.

“We have group sessions. Usually, it starts with one person is talking, and it becomes more like a monologue,” tells Aglaya. “We believe that everyone builds their own way while experiencing their own feelings and emotions. We use the principle of self-help and trust residents in how they lead their lives and what they do in their free time. The most important thing is that we teach responsibility. It is like a kindergarten, where you can try everything and learn again.”

The period after rehabilitation is harder than the period before it

The Foundation’s clients say that they came here to get acquainted with themselves again and to get away from their addiction. They say only good things about the rehabilitation programme. The hardest part starts when you return back home.

“I came here only yesterday,” says Linda from the Netherlands (the name is changed) with the tears in her eyes. “This is not my first rehabilitation programme, and I very much hope that this programme will help me. Working with yourself during the rehabilitation period is not that hard. Then you follow the same pattern at home. Later though it comes the time when you go back to your old habits. I think it very important to combine treatment with reality, and de Skuul is doing this.”

Every year about 50 people are being treated in the Foundation. On average, de Skuul accepts one new person per week. Each resident stays in the programme on average for 3-6 months. Each resident himself decides when his rehabilitation ends. After the programme, if necessary, ex-residents can always call Foundation employees and ask for help. Every six weeks, former residents come to the Foundation if they want to share their experiences and hear the stories of others.

Treatment based on commitment and not punishment

The rehabilitation centre Kentra24 in the city of Sint-Oedenrode in the Dutch province of Brabant is located in an old monastery. On the windows here, there is old religious stained glass, and in the inner monastery courtyard you can meet your new friends. Young people between the ages of 12 and 24 years old who cannot control their stimulants or gambling addiction have their rehabilitation here. The rehabilitation programme includes preventive, outpatient, clinical and online assistance. At the same time here there can be 40 clients for whom about 80 employees provide services. Not all customers in the centre spend nights here, some only have a daily programme. Both boys and girls are undergoing rehabilitation.

“Most of our clients are in the centre voluntarily, but sometimes someone comes after a court decision,” says Judith who works in the centre. “We want the parents of young people who have treatment with us to be also involved in the rehabilitation process. But those adolescents who are already over 18 decide themselves how much they want to involve their parents.”

There are four groups of clients in the centre. The first group is those who undergo a detox, and all the other groups are undergoing rehabilitation. Young clients of the centre have four phases of rehabilitation: zero phase is the most strict one, the third phase is the one during which there is more freedom. For example, during the zero phase it is impossible to leave the territory of the centre, but in the third phase this can already be earned as a reward. Moving to the next phase is possible by showing good behaviour and progress in the rehabilitation process. Usually, the clients stay in the centre for 3-4 months.

“Our treatment is based on commitment and not punishment. Each of our clients has his own goal and is working towards achieving this goal,” continues Judith. “If the goal is achieved, the client gets the reward. For instance, this can be some additional time online, or purchase of the new bike, or visit of the parents with a favourite pet, or additional phone call, and much more.”

Not to have an addiction is already a success

Each of those clients who stay in the centre overnight has their own private room, where other clients are not allowed. For communication, there is a joint living room with a kitchen, where clients prepare their own food. The rehabilitation programme also includes sports at the local gym, creative workshops, work on various projects, setting goals for the week and homework. There are rules: customers cannot freely use their phones or computers.

“I decided to come here because I realised that my life was going all wrong,” says 20-year-old Jan (the name is changed). “Because I used drugs, I started to close up and drifted away from my parents and my younger sister. It feels like I lost three years of my life. After the rehabilitation programme I plan to finish school, start working and living independently. It is my goal.”

The staff of the centre understands that after the rehabilitation programme some of their clients will still use drugs or alcohol and they are loyal to this.

“After all, the main thing is not to stop taking drugs, but to know why you are doing this,” says centre employee Steve. “If there is such understanding and after the programme a person will take drugs or alcohol sometimes, and not have an addiction – this is already a success.”

Uzbekistan Eliminates Vertical HIV Transmission

Evgeniya Korotkova from Ishonch va Hayot NGO, photo from the personal archive

Author: Inna Gavrilova, Ukraine

The rate of mother-to-child HIV transmission in the Republic of Uzbekistan is approaching the zero mark. In 2017, only 11 cases of such transmission were documented or 0.3% of all the HIV cases registered.

“Such trend has been observed for several years already,” says Evgeniya Korotkova from Ishonch va Hayot NGO, which has been advocating for the rights of women and children from the families affected by HIV/AIDS epidemic in Uzbekistan. “It gives me confidence that in the nearest two years our country will be able to get well prepared, do its best at the national level to successfully go through the procedure to validate the elimination of mother-to-child HIV transmission and to become the fourth country in Eastern Europe and Central Asia to receive an elimination validation certificate from the World Health Organization (WHO).”

According to Korotkova, WHO validation of the elimination of vertical HIV transmission is a rather lengthy and complicated process, but in the recent seven years, patients’ groups and civil society organizations were able to gain support from the government, which is also interested in healthy newborns who would get a good start in their lives. Only the joint efforts of civil society activists and government allowed fighting stigma and discrimination – which are the main obstacle on the way to 90-90-90 targets – in an effective and comprehensive way. It is not enough to just find all the people living with HIV (PLWH), the task is to convince them not to be afraid of their diagnosis and take the therapy.

“Stigma and discrimination remain serious obstacles on the way to HIV prevention, prevention of mother-to-child HIV transmission, expansion of HIV testing as well as enhanced access and adherence to HIV care and support,” said Evgeniya Korotkova. “The government committed to take over the procurement of all antiretroviral (ARV) drugs by 2021 to make sure all people who need treatment have access to it. At the same time, it is important for PLWH to be willing to take ARV drugs and adhere to treatment, despite stigma and discrimination, which is still present today in health institutions and in the society as a whole. We help our doctors and actively work with PLWH to ensure their adherence to ART.”

It bears reminding that the WHO officially validated the elimination of mother-to-child HIV transmission in three countries of Eastern Europe and Central Asia: Belarus, Armenia and Moldova.

Mariias Frolova: “The Most Important Thing is Working Together”

Author: Olya Kulyk, ICF “AIDS Foundation East-West” (AFEW-Ukraine)

Last year, AFEW-Ukraine gathered young activists of the project “Bridging the Gaps: Health and Rights for Key Populations” from four cities of Ukraine in a Summer Camp. One of the goals was to teach teenagers to design projects and prepare their own applications for funding. The projects created during the camp later were sent to AFEW-Ukraine’s competition of small grants.

18-year-old Mariias Frolova is a leader of the youth community centre “Compass” from the Community Organisation “Kharkiv charitable fund “Blago”. “Compass” is a centre for adolescents who use drugs. AFEW-Ukraine supports four of such centres in Ukraine. Mariias is telling about the projects of her team.

Mariias, please tell us why did you decide to create the projects for youth?

– I decided to develop projects for youth when I participated in the camp for project leaders of Bridging the Gaps project. After training, I thought that I could do something useful for myself or for other young people.

In “Compass” we often get together, play and discuss things. Our team got the idea of ​​watching films together and discussing them later. Initially, we wanted to choose educational films – about diseases, human rights and so on, so that we learn more. Then as a bonus, we added fiction films. We needed some extra equipment – a beamer, screen, and speakers.

AFEW-Ukraine supported the purchase of this equipment.

Our second project is called “QR code”. The project helps adolescents to learn more about their rights. One day our friend asked: “What would I do if I did not know about “Compass?” This made us think that not everyone knows about the centre and how cool it is, as this is the place for the adolescents to get help. We needed to inform adolescents that they can come to “Compass” while facing different situations in their lives. Now QR codes are popular. Through scanning them, you can get access to different information, so we decided to use them for informing youth about their rights and inviting them to the centre.

Who is the target audience for your projects and how do you inform about them?

– We locate our QR codes in schools and lyceums of Kharkiv. By scanning the QR code (there are six of them), adolescents are directed to the information about “Compass”, information about HIV, reproductive health, psychoactive substances and police. After reading the information, teenagers are offered to answer online questions on these topics. After passing the quest with six different topics and completing the task, participants receive an invitation to “Compass” and get a ticket to our cinema.

 Target group of the projects is youth of 14-19 years old, usually from not very rich families, often having limited access to leisure activities. Therefore, free movie screening is very attractive for them.

What are your achievements in projects implementations?

– Since October, we had 13 film screenings with 105 participants, followed by interesting in-depth discussions. 

Due to QR codes project, more people began to visit “Compass”. 64 people received invitations to come to the centre and the cinema. Some visitors to our cinema stay here for services… Since November last year, we received more than 260 answers to our online questionnaires.

QR codes and movie screening stimulate youth to learn more about HIV, drug use, reproductive health issues. Those who come to watch the movie, are also involved in discussions about safer behaviours. Social workers from the centre are invited for facilitating discussions and can immediately respond to any question or provide individual or group counselling if needed.

How did you benefit from creating and implementing projects?

– It was a great experience. After the projects I mentioned above, we developed a new one, submitted it to one big organization and won a grant that will allow us to have a gym in our centre.

I am confident that the most important thing is to work together. We can have different opinions, which can sometimes create problems, but instead of arguing we have to decide on everything together.

AFEW International Releases Report on Its Activities for AIDS 2018 Conference

AFEW Network (AFEW)  has a long history of working to link the “east” with the “west” so when the decision was made to hold the 22nd International AIDS conference (AIDS 2018) in Amsterdam, the city that is home to AFEW International, the secretariat of AFEW Network, it was clear that AFEW could have an important role in leveraging the conference to bring global attention to the crisis situation in Eastern Europe and Central Asia (EECA). Starting from 2016, with the support of the Dutch Ministry of Foreign Affairs (MoFA), various strategies (fostering linking, learning and dialogue; developing creative solutions to unresolved challenges; influencing leaders, policymakers and donors; addressing stigma, discrimination and criminalization of people affected by HIV) were undertaken as to empower communities from the EECA to take part in AIDS 2018.

Leading up to and during AIDS 2018, AFEW International engaged in a range of activities to promote EECA at the conference and to promote the conference in EECA. An independent evaluator examined the impact of the implemented activities and factors that contributed to the successes and analyzed the challenges. In the report, you can read what were the key activities and lesson learned.

The short version of the report can be read here.

The full version of the report can be read here.

Research: ‘Virus Carriers’ and HIV Testing: Navigating Ukraine’s HIV Policies and Programming for Female Sex Workers

Background

There are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV. Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing policies among female sex workers in Ukraine and how these policies are understood and implemented in practice.

Methods

To analyse past and current national policies, we searched the database of the Ukrainian Parliament and the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy context, actors involved in policy formulation and implementation.

Results

HIV testing policies are formed and implemented in the post-Soviet context through a vertical system of AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive testing policies have been strongly influenced by international donors and non-governmental organisations. Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a barrier among FSWs to access testing.

Conclusion

Poor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking international funding, and persisting stigma towards people living with HIV and sex workers might impede the continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute to the development and further implementation of HIV testing policies in Ukraine.

Read the full version of the research here.