AFEW is Looking for a Board Member on a Voluntary Basis

AFEW International is seeking applications for the position of Board Member to attend Board meetings and provide constructive input by offering specific expertise on the subjects of AFEW International’s activities.

The Board consists of a Chairperson, Vice-Chairperson, a Treasurer and four other members. Board members are not paid any form of honorarium and thus work on a voluntary basis. Board members are elected for a three-year period which is renewable for one additional term.

The Board approves the organisation’s strategy, annual workplan and the budget, as well as advising the Managing Board on strategic issues, including fundraising. The Board meets at least four times a year (three times by teleconference and 1 time during a face to face meeting) and provides technical and strategic guidance on overall objectives, major programs, partnerships, and on monitoring & evaluation. AFEW International fully complies with the code of good practice for charitable organisations in the Netherlands; the Code Wijffels. The Board is charged with overseeing the overall operation of the organization in order to ensure good standards of transparency and accountability.

About AFEW International

AFEW International is an international network of civil society organisations that is dedicated to improving the health of key populations. AFEW International is fundamentally a humanitarian organization contributing to the development of just, compassionate, open and democratic societies, firmly based on the principles of social justice, which affirms the dignity of each human being and emphasizes the need for tolerance and co-operation.

With a focus on Eastern Europe and Central Asia (EECA), AFEW International strives to promote health and increase access to prevention, treatment and care for public health concerns such as HIV, TB, viral hepatitis, and sexual and reproductive health and rights.

Responsibilities

Board meetings – Attend Board meetings and provide constructive input to the agenda items with active participation.

Expertise – Offer her/his specific expertise in the development and implementation of AFEW International’s activities.

Funding – Provide new insights and play a role in the fundraising strategy; help looking for funding opportunities and liaise with possible donors.

Ambassador – Act as an ambassador for AFEW International and advocate of its mission at events, conferences, network meetings etc.

Qualifications

  • Experts in HIV/AIDS, viral hepatitis, TB and harm reduction.
  • Member from the communities AFEW works with, i.e. people who use drugs, sex workers, men who have sex with men, and prisoners from Eastern Europe and Central Asia. With a preference of a representative from the people who use drugs community.
  • Have a track record relevant to AFEW International’s work and client groups.
  • No conflict of interest, i.e. not belonging to a structure or organization that is funded by AFEW International or with which AFEW International has a financial relationship AFEW during their term of office.
  • Previous experience highly desirable.
  • Fluent in English (written and spoken). Russian is appreciated.

Time commitment

  • Attend a minimum of one all-day board meeting currently held in Amsterdam, and at least three telephone conferences per year.
  • Willing to serve at least one three-year term.
  • Willing to invest some time on a case-by-case basis in between Board meetings on general and specific matters.

Contact

Please send your CV (no more than 5 pages) and a letter of motivation before 15 March 2018 to AFEW’s Executive Director Anke van Dam at anke_van-dam@AFEW.nl.

HIV Risks Grow in Kazakhstan

The number of new HIV cases in Kazakhstan is still growing

Author: Marina Maximova, Kazakhstan

In Kazakhstan, the key alarming trend of the recent years is the growing sexual transmission of HIV. Before, most people in Kazakhstan contracted HIV when sharing injecting equipment, but now most infections are transmitted through sexual contacts.

A commonplace story

Zhaniya (the name is changed) learned about her positive HIV status when she got pregnant and went to the maternity clinic for the medical check-up. She got tested and could not believe her eyes when she saw the test result as she never used drugs and her husband was her first and only man. Repeated testing confirmed the positive result. The woman was afraid to tell her husband and family about her status, feeling scared, ashamed, hurt and confused. She could not remain silent either as any news are spread quickly in her village, let alone bad news. The conversation with her husband made it all clear.

“He confessed that he used to inject drugs. It was long ago, when he was still very young. Now he is sorry about that and wants to have a family and children. My husband also got tested for HIV and his result was positive too. He did not know about his disease and did not want to infect me. Now the main thing is for our baby to be born healthy. Doctors say that it is possible,” says Zhaniya.

In Kazakhstan, 99% of pregnant women living with HIV give birth to healthy children. These women often give birth to two or even three children. In the recent decade, the rate of mother-to-child transmission of HIV dropped four times.

Taking into the account the achievements of the national AIDS service, the stories of Zhaniya and other women living with HIV sound commonplace. The face of the epidemic is becoming more and more female. If earlier mostly men got infected with HIV, now the gender proportion looks more equal. The statistics is illustrated by the following trend: most men rarely go to clinics or make appointments with doctors. Women take more care of their health in general, while pregnant women twice get tested for HIV free of charge.

No sexual education in schools

Natalia Rudokvas, Director of the Answer Charitable Foundation

Another problem contributing to the increased risks of HIV is lack of relevant educational programs in schools and colleges. High school and college students have no access to the information about the routes of HIV transmission and ways to protect themselves at special classes or lectures. There are no guidelines or instructions for educators on this topic. In families, where the topic of sex is a taboo due to the peculiarities of local mentality, children fail to get any information or advice from their parents.

“When our activists make attempts to offer school lectures on the safer sex – we are told we cannot do it. For some reason, promotion of condoms and other contraceptives is considered equal to… debauchery. People blame us, saying that this is what our presentations cause,” tells Natalia Rudokvas, Director of the Answer Charitable Foundation from Ust-Kamenogorsk. She is puzzled with such attitude and hopes that this crucial topic will be discussed at the upcoming 22nd International AIDS Conference AIDS 2018.

Lack of any systematic sexuality education in past years loudly echoes today. Natalia says that people over 30 years of age more and more often seek counselling at their charitable foundation. While young people injecting drugs regularly get tested for HIV and fall under control of the health professionals, older people with “forgotten” histories of drug use stay in the shadow.

The epidemic is growing older

Baurzhan Bayserkin, General Director of the Republican AIDS Centre at the Ministry of Health of Kazakhstan

Several years ago, mostly young people aged 20-29 got infected with HIV in Kazakhstan. Now the age threshold went up to 30-39 years old. Most people got infected twelve or more months ago, and only 10% of the patients were infected within the recent nine months.

“The data received became the ground to carry out an additional epidemiological survey to determine the network of contacts and expand the list of potential risks of infection. High proportion of people who got infected long time ago demonstrates that people have low concerns about contracting HIV. The new approach shows the real picture of the morbidity and allows evaluating the efficiency of prevention measures,” sums up Baurzhan Bayserkin, General Director of the Republican AIDS Centre at the Ministry of Health of Kazakhstan.

The number of new HIV cases in Kazakhstan is still growing. As of today, there are about 29,000 of Kazakhstani and about 2,000 of foreign citizens living with HIV in Kazakhstan.

 

Antonio Guterres Replied to AFEW Support Letter

Prof. Michel Kazatchkine, Special Adviser to the Joint United Nations Programme on HIV/AIDS on HIV, Tuberculosis and Hepatitis for Eastern Europe and Central Asia

AFEW International received a response to the letters we have sent to the United Nations Secretary-General Mr Antonio Guterres. We have sent two letters that can be read here and here, and asked Mr Guterres to support the position of Prof Michel Kazatchkine as UN special envoy on HIV/AIDS for Eastern Europe and Central Asia (EECA.)

83 organisations from the whole world signed the letter. We asked to reconsider the position of Prof M. Kazatchkine as UN Special Envoy for EECA, as he is in an excellent position to create a momentum to raise awareness on the disruptive situation the epidemics has caused in the region. Prof. Michel Kazatchkine played a crucial role in mobilizing local authorities, (inter)national civil society, donors, researchers and other relevant groups to come to better outcomes to the UNAIDS indicators as we see now. As a result, he enjoys great support from communities in the region.

“Mr Kazatchkine has been an unwavering champion for HIV/AIDS in Eastern Europe and Central Asia. With rising HIV infections across the region, he has served as a tireless advocate and helped to unite stakeholders across sectors to address pervasive challenges that continue to leave our most marginalized communities behind. Mr Kazatchkine is well positioned to build on this work in his new role as Special Adviser to the Joint United Nations Programme on HIV/AIDS (UNAIDS) on HIV, Tuberculosis and Hepatitis for Eastern Europe and Central Asia,” the letter is saying.

Mr Guterres also expressed the hope for the future collaboration with AFEW International.

The full version of the letter can be read here.

Georgia: Problems under the Tip of the Iceberg

Lasha Tvaliashvili, the Executive Director of Organization of PLHIV Real People, Real Vision

Author: Irma Kakhurashvili, Georgia

A middle-aged man comes into a dental clinic and explains to the dentist that he is HIV-positive. The dentist refuses to treat the patient. Under the rules, the doctor must sterilize all instruments and the patient is not obligated to inform about the diagnosis, but the patient is being honest and is ‘punished’ by the dentist for it. The man asks the doctor what he is to do, where to turn. The doctor’s response is that it is none of his concern. The dentist is not aware he is being recorded with a hidden camera…

As reported by the Infectious Diseases, AIDS and Clinical Immunology Research Centre, around 600 to 700 new HIV cases are registered in Georgia annually. Although every citizen is able to receive publicly-funded free treatment, this is insufficient to end HIV. NGO Real People, Real Vision is a member of East Europe and Central Asia Union of People Living with HIV (PLHIV), which has implemented interesting projects on prevention, support and mobilization of people involved in HIV treatment. Discrimination and stigmatisation of HIV-positive people is just one of the problems obstructing prevention of HIV epidemic in Georgia. This and other topics are part of our conversation with Lasha Tvaliashvili, the initiator of multiple video-experiments and the Executive Director of Organization of PLHIV Real People, Real Vision.

Lasha, in your opinion, what is the greatest achievement in the field of HIV/AIDS treatment?

– For instance, the fact that during the past two years there has not been a single case of mother-to-child transmission. This is a result of daily efforts of the AIDS Centre, which does not even have its own building. The Centre operates under critical conditions, resulting in serious violations of rights of patients and medical staff, violation of sanitary, epidemiological and other norms. There is not enough space where an HIV-positive person could receive all services. There can be no talk of anonymity when there is one office where two physicians are seeing two patients at the same time. Government entities promised to allocate premises to the Centre but never did. Such attitude puts the existence of this strategic medical facility into question.

Is late testing the main reason for the increase in the number of new cases? Is that the only reason?

– Many patients come to the Centre already with clearly marked symptoms. Of course, timely testing followed by therapy would have protected them from various illnesses. However, lack of awareness among the population is not the only reason; it also concerns approaches of medical staff. I still hear stories about doctors, who keep treating patients for various illnesses for years, and it does not occur to them to refer patients for HIV testing.

Nevertheless, there has been a positive trend. When friends and family find out about the status of a close person, they treat that person with more sympathy than it used to be in the past. However, I am puzzled at the situation with medical staff, when sizeable finances are invested in their education… The level of discrimination and stigmatisation is high in Georgia. Several days ago, one of the micro-lending organizations requested HIV test results from its employees. Should the test be positive, the employee must leave, which is a direct stigma. Regular work at the office with zero risk of HIV transmission shall not be equivalent to cruel treatment of people.

– What stands in the way of defending rights of patients who have lost their jobs?

– The patients themselves. At first, the discriminated person feels insulted, but then emotions quiet down and he or she refuses to continue the argument in a courtroom. People are afraid of publicity of their positive status. They are not sure they will continue on living peacefully. They are afraid of complicating their public position. For reasons above, such precedents are not made public, thus increasing discrimination.

What is your view on treatment availability in Georgia from geographic standpoint?

– HIV/AIDS more frequently occur in socially lower-standing population segments. These people often live in regions without AIDS Centres. For instance, patients from Samtskhe–Javakheti region go to Tbilisi for medications once a month. The same is also true for a huge region of Kakheti, Guria, Racha, and Svaneti. Treatment must be continuous, and every month patients travel long distances. It is harder in winter when roads in mountainous areas are closed. AIDS Centres are located in big cities only – Tbilisi, Kutaisi, Zugdidi and Batumi.

Please share your experience about the lowest-budget but effective project.

– In 2012-2013, we had a project that saved 300 patients. Throughout the year our activists were on duty at the AIDS Centre. During registration of new cases, when patients were most shocked at the test results, our activists tried to explain in a non-medical language about HIV/AIDS, and further assisted in the course of treatment. Throughout the year 10% of patients diagnosed with AIDS did not return to the Centre. The project objective was not to lose those 10%. The project budget was 10 thousand US Dollars, but above that, we have found a lot of like-minded fellows and friends, some of whom even got married. This project was implemented jointly with the HIV/AIDS Patients’ Support Foundation. Currently, we are thinking about a new project – psychological and moral support for those convicted persons, who found out about their status in prison. I am confident this will be a humane and successful project.

Methadone Breakthrough: Ukraine to Independently Purchase Opioid Substitution Therapy

Patient receiving OST at Kremenchug drug treatment centre, Poltava region Source: kremenchug.ua

Author: Yana Kazmirenko, Ukraine

From 2018, opioid substitution therapy (OST) programme in Ukraine is financed by the Government. Activists are asking international organizations for a backup to prevent disruptions in the supply of life-saving medications.

The Government of Ukraine plans to independently procure substitution therapy programme medications in 2018. According to the World Health Organization (WHO), over 10 thousand people received therapy last year at 178 institutions throughout the country. It is planned to double the number of patients in 2018.

Ukraine wants to beat HIV

Ukraine can be proud of its implementation of OST because this is the largest-scale coverage programme in Eastern Europe and Central Asia. Since 2005, the programme to substitute opioids with methadone or buprenorphine was financed by the Global Fund. Patients under the care of a physician received syrup or pills.

“This is a major milestone for public health care in Ukraine,” says WHO representative Martin Donoghue. “For many years WHO and partners have worked with the Government and opioid substitution therapy received the endorsement and comprehensive financial support. This attests to the fact that Ukraine wants to beat HIV.”

People who inject drugs belong to key groups who are most at risk of HIV and its transmission. The numbers are a confirmation: HIV was diagnosed for 42% among OST programme participants in Ukraine, and 21.3% of new HIV cases account for the transmission through injecting drug use. Sexual transmission still remains to be the main way of transmission – 63.9%.

Financing doubts remain

WHO recommendations indicate that to control HIV/AIDS spread among people who inject drugs 20 thousand people shall receive therapy. Ukraine intends to reach these numbers by the end of 2018.

According to Director of charitable organization Meridian and Executive Director of All-Ukrainian union of people with drug addiction VOLNA Oleg Dymaretskiy, there are 368 thousand injecting drug users in the country. The majority uses several types of drugs, including medications from pharmacies. The activist has doubts regarding the timely supply of OST medications by the Government.

“I do not believe that transition to Government financing will be fully implemented in 2018. 13 mln. Ukrainian Hryvnyas a year ago were allocated for medications for 9.6 thousand patients, but they reached them only in December 2017,” says Dymaretskiy.

NGOs requested the Global Fund to back up the supply of medications, and, according to Dymaretskiy, received a positive response. To double the number of patients, the activist suggests increasing the number of OST offices along with prescribing therapy at the level of district poly-clinics.

OST will reach prisons

Our colleague told us about another initiative of VOLNA union – start-up of a programme on continuous treatment at institutions of detention, which will include detoxification and prescription of substitution therapy. Two thousand people withdraw from OST programme every year, one in ten – due to serving a sentence in prison.

“Substitution therapy changes lives of people who use drugs. It is the first step and acknowledgment: it is beyond my power to cope with addiction, but I will change the quality of living,” summarizes Dymaretskiy.

AIDS 2018 Abstract Support for EECA: 100 Abstracts Submitted

Almost 100 researchers from Eastern Europe and Central Asia (EECA) have received mentorship and expert support through the mentorship program that was established by AFEW International together with Amsterdam Youth Force and Eurasian Harm Reduction Association (EHRA). Applicants for XXII International AIDS Conference have received support with editing, translating, and structuring their work according to the abstract requirements. Out of 100 abstracts got by the expert team, 70 received support with formatting and editing and 30 have received an additional language support (full translation into English.)

The mentorship program was developed to enhance the quality and increase submission chances for the applicants from EECA. Within the program, applicants had an opportunity to consult with experts before submitting their abstracts to the Conference Committee. AFEW International is expressing a big gratitude to the experts who were reviewing the abstracts of the EECA applicants.

“The importance of this mentorship can hardly be overestimated. We were able to significantly increase submissions from the region of Eastern Europe and Central Asia,” AFEW’s project manager Daria Alexeeva is saying. “We are excited to see the fruits of this collaboration both in form of submitted abstracts but also in form of something that is hardly quantifiable: expertise that our applicants have gained in the area of scientific writing for international events. The very communication with and guidance of the mentors was an enormous capacity building exercise for our applicants. They have trained putting their entire research projects into a concise form of an abstract of 350 words. We are confident that this training will lead to more high-quality research from EECA in the future.”

The board panel of experts consisted of:

Anna Szczegielniak, Youth Coalition

Catriona Ester, independent consultant

Chris Obermeyer, Fulbright Public Policy Fellow, Ministry of Health of Ukraine, Public Health Center

Daniel Kashnitsky, Eurasian Harm Reduction Association (EHRA)

Eliza Kurcevic, Eurasian Harm Reduction Association (EHRA)

Gayane Arustamyan, Eurasian Harm Reduction Association (EHRA)

Gennady Roshchupkin, Eurasian Coalition on Men’s Health (ECOM)

Jill Owczarzak, John Hopkins Bloomberg School of Public Health in Baltimore

Julian Hows, Development Research Advocacy Governance (DRAG)

Katherine Kooij, National Institute for Public Health and the Environment (RIVM), the Netherlands

Lela Serebryakova, Eurasian Harm Reduction Association (EHRA)

Mariam Uberi, BEARR Trust

Roman Ivasiy, All-Ukrainian Charitable Organization FULCRUM

Ulla Pape, University of Bremen

Heather Stacey, Stand International

Janet Gunn, BEARR Trust

Michael Rasell, BEARR Trust

Karen Kraan, Flowz

Anna Sarang, Andrey Rylkov Foundation for Health and Social Justice

Alexandra Volgina, GNP+

Bridging the Gaps Returned the Faith

Tahmina’s story is one of the positive stories of women in Tajikistan, who, due to the social and legal support of the project Bridging the Gaps: Health and Rights for Key Populations 2.0, again received hope and planned positive changes in their lives.

Family issues pushed to drugs

“When I studied in the 4th grade, my parents already had five children. This is the usual situation in Tajik families in the rural areas. Due to the frequent childbirth and burdensome care for five young children at the same time, my mother often fell ill. I had to drop out of school and take care of everything by myself,” Tahmina is saying.

Tahmina was taking care of all the things in the house, raised her brothers and sisters, helped them with school. Because of the health problems, her mother was constantly in hospitals. Her father spent days at work and came home late at night.

In one of such evenings, when the father was late at work and the mother was in the hospital, Tahmina’s uncle – her father’s brother – visited their house. Asking little Tahmina to come out of the house with him, the uncle raped her. Some time later, the neighbour found unconscious Tahmina and brought her to the hospital. Long investigations started, her mother and father were almost having nervous break-downs because the relatives of the girl started to hate her and blamed her for everything.

“Policemen always came to our house and asked me strange questions. I remember that when I came to the courtroom and saw my uncle there, I just fainted,” Tahmina is saying. “My uncle eventually was sent to prison and I became the cast-away for many of the relatives from my father’s side. Trying to save me from them, my parents sent me to the relatives from my mother’s side. I was always traveling to Dushanbe or to the other cities of the country.”

The girl started to meet different people, became friends with other girls in Qurghonteppa. During one of the meetings, the girls offered Tahmina to smoke cigarettes and then marihuana. They introduced Tahmina to Azam (the name is changed) who turned to be the big drug-dealer in Qurghonteppa.

“During a year and a half, he was keeping me locked in one of his apartments. Sometimes late at night, he would take me to the restaurants,” the woman recalls. “Taking all of this into consideration, he was still sending money to my parents. He taught me how to use drugs. This is how I became addicted to heroin. After some time, Azam’s interest to me faded away and I found myself on the street. Because at that moment my life totally depended on heroin, I started to steal and do sex work so that I could get a doze. As a result, I went to prison.”

The key visit to AFEW-Tajikistan

In 2013, Tahmina went to prison because of the theft. Being imprisoned for a quarter of her term, she got free because of the amnesty. When she went back home, the woman again faced the threats from her father’s relatives side. She had to leave her home and started to live on the streets again. After many unpleasant adventures, Tahmina met people who use drugs whom she knew before, and she started to use again.

Once, Tahmina met Bahriddin whom she knew before. He was also using drugs, but, to Tahmina’s surprise, he changed, and was looking good and happy. It turned out that Bahriddin started to work in the public organisation AFEW-Tajikistan as a peer consultant. He told Tahmina about how he succeeded to change, and he also mentioned the help and services that his organisation is providing. Tahmina got interested in that and decided to visit the drop-in center for the drug users and see everything by herself.

When she just came to AFEW-Tajikistan’s drop-in center, Tahmina was surprised that even though she had a dirty dress and flip-flops were barely covering her bloody feet, she was greeted very warmly. She was offered some tea and the workers talked with her about her health.

“I was very skinny and dirty, and I could not remember the last time I took shower or bath,” Tahmina is remembering that day now.

The social workers helped Tahmina with taking care of herself. They also helped her to come back to her parents’ house, arranged the documents for her and sent her to the doctors so that she could be checked and her health could be improved.

To see the sun again

Since summer 2017, Tahmina comes to the drop-in center very regularly. She is also taking part in self-help groups of people who use drugs. She learned the basics of her personal hygiene, HIV prevention and sexually transmitted infections (STI.) She got to know how to cope with the drug use and the possibilities to live sober. During one of the meetings, Tahmina got to know about opioid-substitution treatment (OST.) The friendly and warm atmosphere, respect and the possibility to get methadone for free inspired Tahmina to change her life.

Since August of the same year, Tahmina started to take part in OST programme that is located in the drug center where she would never go by herself. Nowadays, Tahmina is taking methadone and continues to take part in self-help groups. She found many friends who understand her and are ready to support her.

“With the support of AFEW-Tajikistan, during half of the year, I changed for better. I believed the peer consultants and social workers and started to help my mother, and I have not done so since I left home. AFEW helped me to gain the trust in myself again. My eyes are shining like it was before, I again see the sun and I want to live!” Tahmina is finishing her story with the smile on her face.

Only in 2017, 688 female drug users and vulnerable women in the Republic of Tajikistan were provided with the prevention and social services within the project Bridging the Gaps: Health and Rights for Key Populations 2.0 that is financed by the Ministry of the Foreign Affairs of the Netherlands.

AIDS 2018 Early Programme Preview

In addition to a strong abstract-driven programme, the 22nd International AIDS Conference (AIDS 2018) will offer symposia, workshops and interactive sessions developed by an international committee of HIV scientists, global leaders, policy makers, researchers and advocates.

Here is a first glimpse of what you can expect in Amsterdam, which you can also browse in our preview of the conference programme. See an overview of the early programme preview below.

Improving treatment and care outcomes

  • Updates on ART options and outcomes, with a particular focus on treatment across the lifespan and in key and vulnerable populations.
  • Addressing NCDs in resource-limited settings.
  • Presenting new data on co-infections and looking at old, and new, threats in infectious diseases in the context of HIV.

The future of prevention

  • Exploring different perspectives on why combination prevention, while highly effective, is not available in many settings.
  • Understanding key population community-led health services (KP-CLHS) as an effective tool in the prevention toolbox.
  • Exploring the future of PrEP as part of combination prevention, taking into account funding concerns, uncertain treatment access for many people, lessons learned to date regarding PrEP implementation, and design issues for future trials.

Understanding HIV pathogenesis

  • State-of-the-art updates on broadly neutralizing antibodies (bNabs) and their use in the development of a potential vaccine and a cure.
  • Understanding HIV persistence and community participation as keys to developing a cure for HIV, long-term remission off ART.
  • Opportunities to tackle the virus at the moment of transmission, recruit the host and manipulate the environment in the fight to end HIV transmission.

Key and vulnerable populations

  • The evolving landscape of drugs, drug policy and harm reduction in the context of rising HIV transmission and political resistance.
  • Empowering young people to access services and make healthier choices through comprehensive sexuality education (CSE).
  • Training implementers to play an active role in changing gender norms.

Insights-driven programming

  • New approaches to using big data to strengthen national HIV responses and deliver improved and effective focused programming.
  • How new innovative approaches to big data allow us to better reach the right audience with the right intervention.
  • Exploring ethical issues in the use of state-of-the-art methodologies and interventions to tailor interventions to local populations.

Under prioritized epidemics

  • Advancing human rights and legal reforms with a focus on sexual minorities, prisoners, people who use drugs and transgender people in Eastern Europe and Central Asia.
  • New approaches on how to address the needs of children and adolescents living with HIV from Ukraine, featuring perspectives by healthcare providers and policy makers.
  • Insights on political leadership to advocating for the needs of vulnerable communities, with country examples including Kyrgyzstan and Senegal.

Source: AIDS 2018

Blind Response: Experts Offer Different HIV Estimates in Russia

National campaign: HIV testing in a train carriage, 2017

Author: Anastasia Petrova, Russia

According to the UNAIDS, Russia ranks third based on the rate of the new HIV cases in the world after South Africa and Nigeria. However, there are inconsistencies in the data on HIV incidence dynamics in the country provided by different offices.

Mixed opinions

In May 2017, it became clear that there are some discrepancies in the data on the growth rate of new HIV cases in Russia presented by different government offices. Comparing statistics for the previous years, Veronika Skvortsova, Russian Minister of Health announced that in 2016 HIV incidence dropped down twofold.

“We had the total of 86.8 thousand new cases of HIV, while a year ago, in 2015, there were over 100 thousand. Thus, the number of HIV cases fell down by 15%,” said Veronika Skvortsova.

However, Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre presented different data, which, vice versa, demonstrate a growing number of HIV cases in the country. The scientist told about the growth of HIV incidence by 5.3%. According to the recent data of the Russian Federal AIDS Centre presented shortly before the World AIDS Day, in the first 10 months of 2017 regional AIDS centres reported 79,075 new cases of HIV. This is 2.9% more than during the same period of 2016. This data shows the continuing growing trend in HIV incidence.

Such discrepancies became visible to the public, so the Ministry of Health offered relevant explanations on its official website. In the article dated 17 May 2017, it is written that “in his report, Dr. Pokrovskiy presents the results of scientific epidemiological monitoring of the Institute of Epidemiology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) based on the positive laboratory tests for HIV and not the statistical data on HIV incidence for the previous year. The incidence, however, shows the number of people with the confirmed diagnosis (not the number of laboratory tests).”

Thus, according to the Ministry of Health, the calculation method used by Rospotrebnadzor is less accurate considering that one person tested for HIV several times is calculated as several new cases. Some experts, however, say that both statistical approaches may be used as there is a growth of the HIV incidence in the country, but the rate of such growth is decreasing.

“Positive” statistics

Veronika Skvortsova, the Russian Minister of Health

The data on the total number of people living with HIV in Russia is also not quite clear. The Rospotrebnadzor report mentioned above states that as of 1 November 2017 there were 924,608 Russian citizens living with HIV. As for the Ministry of Health data, we have not received any reply to our official request on the number of people living with HIV as of the date of this article. The Ministry fails to submit such data to the UNAIDS to prepare annual reports on the HIV epidemic in the region.

However, some data suggest that the number of people living with HIV in Russia is much higher. Thus, 25,000 Russian citizens were tested in the course of the famous free anonymous testing campaign run by the Ministry of Health in a train carriage, which was held from 7 July to 28 October 2017. Out of them, 375 results were positive. If such statistics is extended to the general population, up to 1.5% of people in Russia may be diagnosed with HIV.

Creating a register

Experts say that the country needs an accurate estimate of the number of people living with HIV.

“The first and the most important goal is to understand the situation and have full information on the number of people living with HIV, the treatment regimens they use and the need in medicines,” says Sergey Krayevoy, Deputy Minister of Health.

It is planned to introduce a Federal Register of People Living with HIV in Russia to analyse the scope of medicines needed and to systematize the statistics. Such database will be administered by the Ministry of Health. Apart from the diagnosis, records will also be made on the health state of the patients, medicines prescribed to them and other data allowing to see the full picture of their health. Thanks to such register, a person relocating within the country will be able to get help in any region.

In Kyrgyzstan, the New Year Started with Reduced Funding for the HIV Response

Author: Olga Ochneva, Kyrgyzstan

Since January 2018, HIV and tuberculosis programmes in Kyrgyzstan are funded from the new, significantly reduced grant of the Global Fund. There were six months of discussions concerning cost optimization and reduction, taking into account the growing deficit of funds that the country is facing in the nearest three years. The cost-saving mode has already been introduced, first of all affecting the prevention programmes.

Services and coverage are retained

In 2018-2020, Kyrgyzstan will receive 23.4 million US dollars for HIV and tuberculosis response from the Global Fund. For the reference, the previous Global Fund grant stipulated allocation of 20.8 million US dollars for the period twice shorter. The country decided to cut the expenditures gradually. The first six-month cost-saving period started in January 2018. According to Oksana Katkalova, the representative of the UNDP country office, which administers the Global Fund grants in Kyrgyzstan, treatment and diagnostics have been defined as the priorities and prevention interventions have been significantly cut down due to the reduced number of partner organisations.

“The money will be mainly used to purchase anti-tuberculosis and antiretroviral medicines (antiretroviral therapy or ART is a method of HIV treatment) as the number of people who need treatment is growing,” says Oksana Katkalova, HIV Grant Coordinator, UNDP. “We try to retain the services and the coverage, while optimising and reducing the administrative costs.”

Since the beginning of the year, two methadone maintenance treatment (MMT) sites have been closed, with patients referred to the nearest sites. The MMT clients will no longer receive the community support of some non-governmental organisations (NGOs), which used to be financed by the Global Fund. The number of implementing NGOs which receive funding has been diminished. Two NGOs working with people living with HIV (PLWH) in Bishkek and Osh will not be funded, with their services being consolidated and handed over to the organisations, which still get the funding. In smaller towns, services for different key populations have also been consolidated.

“One organisation working with different key populations is quite a good option for smaller regions. It allows saving costs for administrative personnel,” explains Oksana Katkalova. “When in a small town there are two organisations, one working with sex workers and the other one – with people who inject drugs (PWID), each with a coverage of 100-200 people, it makes sense to consolidate those services in one organisation if there is a shortage of resources. Our implementing partners – NGOs – have been selected through tender procedures and now have set coverage indicators, which mostly have been raised. However, they can and should engage outreach workers and peer counsellors for different key populations to reach the required coverage.”

Gender component reduced

The number of needle and syringe exchange points (NSPs) has been reduced from 21 to 15. Two of them used to operate in NGOs as service delivery sites. One of such sites was located in the Asteria residential community centre for women who inject drugs, with the Global Fund grant partly covering rental, personal services (accommodation, laundry, shower, meals, and hygiene packages) as well as the package of basic prevention services and consultations of an STI doctor.

“Unfortunately, the gender component for women who inject drugs has been excluded from the Global Fund project: diagnostics and treatment of sexually transmitted infections, hygiene packages and personal services are no longer available,” tells Irena Yermolayeva, director of the Asteria Charitable Foundation. “The Soros Foundation-Kyrgyzstan and the AIDS Foundation East-West in Kyrgyzstan agreed to cover the rental costs and partly the services for six months. We are doing our best to retain our residential project.”

Two sites in each of the medical and penal systems were closed in 2018

Financial support of the four national networks has also been reduced. Now there will be one network promoting the rights and interests of all the key populations. Medical professionals working with PLWH also feel the shortage of funding. They receive benefits in addition to their salaries from the donor funds. Currently, the strategy of bonus reduction is continued, with shrinking resources, and the amount of the remaining benefits will depend on achieving the performance indicators. It is also planned to reduce payments to the medical personnel engaged in the MMT programme, but it is more complicated as in this case donor funds are the only source of financing. Just to remind that so far, the government has not allocated any money for the methadone maintenance treatment programme.

The programme aimed at the ART adherence improvement has also been cut. Before, all adherent patients used to get monthly motivation payments of 8 US dollars, while since January this year only children receive the allowances of about 14 US dollars, which are to be reduced by 2020.

By 2020, up to 30% of ART costs are to be covered by the state

The country will face even more funding cuts in the following two and a half years of project implementation. It is expected that four more MMT sites will be closed during this period. While in 2017, support within the Global Fund grant was provided to 26 NGOs, it is anticipated that by the end of 2020 only 10 of them will remain.

“So far, the smallest budget has been allocated for 2020 as it is planned that by this time the government will cover up to 30% of expenditures for the ART medicines; besides, we hope to have additional savings,” says Oksana Katkalova. “If during this period the government allocates significantly more funds, they can be used to purchase more ARTs, tests or, for example, to pay bonuses to the medical personnel engaged in HIV prevention, treatment, care and support programmes. Then we will be able to re-distribute part of the donor funds to cover prevention interventions. Every six months, we will adjust the expenditures for interventions and negotiate them in the format of a country dialogue. We hope that there will be a gradual increase in the scope of domestic funding.”