The First AFEW Regional Autumn School Was Conducted in Kazakhstan

Author: Marina Maximova, Kazakhstan

Representatives of 10 countries took part in the first regional autumn school organized by AFEW, which was held from 30 October to 5 November in the Oy-Karagay gorge, not far from Almaty, Kazakhstan. The school was conducted with the support of the Dutch Ministry of Foreign Affairs.

High mountains, hot sun, picturesque autumn landscapes, atmosphere of the national yurt instead of the traditional training hall – combined with the team spirit and expectations of positive changes – contributed to the creative atmosphere of the event. The school participants included representatives of the AFEW network from Kazakhstan, Kyrgyzstan, the Netherlands, Tajikistan, Ukraine, sub-grantees of the project ‘Bridging the Gaps: Health and Rights for Key Populations,’ and partner organizations. Such allies and friends are the biggest guarantee of success.

Learning to bridge the gaps

“The autumn school helps to find the answers to a range of questions and get acquainted with the new innovative practices in working with key populations,” says Dilshod Pulatov, Project Manager, ‘Bridging the Gaps’ programme, AFEW-Tajikistan.

He presented the results of the social study to assess the level of labour migration among people who use drugs. It was conducted for 18 months in Tajikistan and Kyrgyzstan. The study, which covered 600 respondents, demonstrated regional trends and showed interesting results. The main of them is that the labour migrants who use drugs do not know where they can get help and who can offer such help. In both countries, the respondents pointed out that as labour migrants they experienced problems with access to health and social services.

The results of this research study will help AFEW to scale up the access of drug users to quality HIV prevention, treatment, care, and support services and find new partners. Partnerships were created right at the discussion platform. This study proved to be interesting not only to the participants, but also to the guests invited to take part in the autumn school, including representatives of the Project HOPE in Kazakhstan.

Platform for discussion and activism

Today, ‘Bridging the Gaps’ programme is implemented by the organizations from four countries of the region. The autumn school became a platform to discuss strategies, barriers, innovations, and opportunities for cooperation.

“In our country, the biggest gap is an access of underage people who use drugs (PUD) to services. Many services are offered to adult PUD, in particular with support of the international donors. It allows them getting qualified help. At the same time, people often forget that the first experience of drug use happens under the age of 18,” tells Anastasia Shebardina, Project Manager, AFEW-Ukraine.

The project made an important contribution for radically changing the situation: it opened the only rehab centre for drug dependent adolescents in Chernivtsi and supported four civil society organizations.

In each country, there are success stories, which became possible thanks to the project implementation. So far, these are just tiny steps forward in the big scope of the existing problems. Every such step became possible thanks to project staff and activists working hard for a long time, but such victories, even if they are small, enhance personal motivation of people and allow them to set bigger goals.

“One of our achievements is developing the standards of services for PUD serving sentences in the Georgian prisons. We educate prison staff and have drafted a special training module for this purpose. In some organizations, support groups for PUD are already functioning. Rehab centre Help has opened its doors to clients. Now 12 people can stay there and get qualified help. We plan to cover all correctional facilities in the country with our activities,” shares his plans Vazha Kasrelishvili, Project Coordinator of the NGO Tanadgoma.

From knowledge sharing to new rehabilitation models

Sharing knowledge and best practices is one of the goals of the autumn school. Together, it is easier to elaborate strategies and innovative approaches, considering that the tendencies in development of the situation in the region are similar. Today, the search to fund vital projects also requires joint efforts, taking into account the reduction of the funding received from the Global Fund to Fight AIDS, Tuberculosis and Malaria and other donors in the region. So far, national governments are not ready to take over this financial burden in full scope. Despite their broad fundraising efforts, civil society organizations do not have enough grant funds aimed at scaling up access to services for key populations.

“With the support of the Ministry of Health of the Kyrgyz Republic, within our project we developed two clinical guidelines: on managing pregnancy, delivery and postnatal period of female PUD and on mental health and behaviour disorders in children and adolescents caused by the use of new psychoactive substances. We were able to open a social office for women with HIV, which offers counselling of psychologists and peer consultants. In the country, there are two rehab centres for women with HIV and drug dependence, which cooperate with friendly clinics,” tells Natalya Shumskaya, the head of the AIDS Foundation East-West in the Kyrgyz Republic.

Today, there is a need to use new, more effective rehabilitation models. This idea has been supported by all participants of the autumn school. Such models should be aimed at developing inner strength – empowerment – of each of the members of key populations.

“Maybe now it is time to change and expand our understanding of the rehabilitation concept. It is not only detox and psychology. There should be equal opportunities, in particular based on harm reduction, to accept yourself,” points out Anna Sarang, President of Andrey Rylkov Foundation, Russia.

Preparations to AIDS 2018

Participants of the autumn school also discussed preparations to the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, the Netherlands – the main event of the next year for activists of the AIDS organizations. All countries of the Eastern Europe and Central Asia are already actively preparing for the conference. How can decision makers be involved into this crucial event? What channels are most effective in communicating information about the conference? How to make this event significant? Every day, participants of the autumn school discussed these and other questions. Besides, they learned how to write abstracts for the conference and choose catchy titles for them.

It is very important that the participants developed some new ideas, concepts and thoughts, because starting from 1 December 2017 registration for AIDS 2018 will be open. It will be a new and diverse platform for discussions making decisions significant for all countries and communities.

HIV Test: the Work of Mobile Clinic in Kyiv

Tatiana shows a card of the recipient of services from Eney

Author: Yana Kazmyrenko, Ukraine

We have spent one day with the mobile clinic in Kyiv, Ukraine, that provides HIV testing for people who inject drugs. The social worker Tatiana quit using drugs and has now been diagnosing five HIV cases monthly.

Tatiana Martynyuk (54 years old) visits up to 10 apartments every day, and at least five of her clients each month turn out to be HIV positive. She works at a mobile clinic of the Eney Club in Kyiv, where she anonymously detects HIV and hepatitis C. The project has been supported by ICF Public Health Alliance for more than ten years. There are five mobile teams from the organization in Kyiv and one team always works night shifts in order to cover the sex workers’ testing.

Eney has a large base of volunteers. These people actively use drugs. They offer their friends and acquaintances to pass HIV testing which only takes 15 minutes. If the test is positive, they persuade a person to go to the City AIDS Centre and register there. Not everybody agrees, half of them reject saying that nothing is hurting, and they will not go anywhere.

We have the meeting on Shevchenko Square, the northern outskirts of Kyiv. Our first clients live not so far away. Tatiana brings them HIV tests, alcohol wipes and condoms.

Boiling shirka

Irina shows a drop of blood during testing

Sergey and Irina are meeting us in their one bedroom apartment, where everything is filled up with their belongings. The owners have been planning to renew the closet for several years already, but they have no money and energy for that. Irina, 43 years old, takes the test first. She is already receiving services from Eney.

“I tried drugs two years ago and I liked it,” she is saying, hiding her cracked hands. Ira has been working as a dishwasher, but currently she has no income as the restaurant is being closed.

The woman is getting nervous and takes a cigarette from Tania. The social worker asks Ira to do the test on her own so that she can do the test without any help in case of emergency. A drop of blood, four drops of the special liquid, and a long ten-minute waiting during which Tatiana has the time to ask what Ira knows about HIV.

“The most important thing: HIV can be in shirka (the popular name for one of the most commonly injected opiate derivates,) where a syringe was put for just a second. If in doubt – boil shirka,” Tatiana is instructing, asking other people to leave the kitchen. The HIV test result is strictly confidential.

Ira is satisfied with the test results, and she is going to wash the dishes. The 33-year-old Sergey is sitting at the table. It was he who “tricked” his female partner into trying drugs. He has been using drugs for 10 years.

Our client is not interested in getting the information about HIV: he is arguing, and saying that you can get HIV while visiting a dentist. Tatiana changes the subject and asks him to invite his friends for the check. Initially, three more people were willing to take the test, but at the end, only 28-year-old Artem came in. He has a rich biography, which includes a 10-year record of drug usage and imprisonment.

“If I want – I will take the drug. If I decide to quit it – I will quit it. I am not in the system. I earn 18,000 hryvnia (about 600 euros) on repairs and construction sites. I can do everything,” he boasts while lighting up a cigarette.

Receiving assistance from their peers

Vladimir’s wife, Inna, waiting for test results

While we are driving, Tatyana keeps telling her story: she has been injecting drugs for 25 years, and then she quit. She was tired and wanted to change her life. Her husband died, her son was drinking alcohol, and her mother is sick. At first, she found work as a street sweeper, but then she settled in Eney Club.

“I get more tired at this job than when I was sweeping the streets. Everyone needs to talk and to be heard, I need to organize things. I am not judging anyone. These people will only accept a help from a person like they are,” she shares.

It seems that with each visit to the next apartment, Tatiana challenges her willpower. She could possibly get her dose of drugs in any such place. Nevertheless, she is holding on. In her situation, one needs to have a special talent in order not to lose the spirit and to do the work with all your heart.

Needle veteran

Vladimir is having a holiday in his apartment in Obolonsky Lipky, the elite district in Kyiv. His prison sentence for the distribution and transportation of drugs has been changed into the conditional one. This was the fourth prison sentence for the 54-year old Kyiv citizen.

Tatiana helps Vladimir with a test

“I have been injecting drugs for 35 years now. I wonder how I survived. Everybody with who I started, is already dead. I prepare everything myself as I know all the recipes. I have studied the 1938 medical military handbook,” Vladimir is saying.

“Vova, you are such a fine fellow,” admires Tanya. The toothless Vova smiles and invites us to see his bathroom, where he has recently changed the tiles.

Vladimir takes the test and tells that he is going to get tooth implants and will start taking care of his health.

“I would not survive without drugs. I got all possible strains of hepatitis and in this way, I keep myself in shape,” he explains.

Vladimir’s elder brother is 59. He has been trying to quit drugs after a stroke. He smells of alcohol – he has been drinking vodka.

“That is how life used to be. In the 90s you would make a whole basin of shirka and you treat the whole district, but times changed and shirka is not the same anymore. We had loads of heroin,” he recalls with nostalgia.

The wives of the two brothers, Inna and Irina, also use drugs. During the test, Inna tells Tatiana to hurry up. She did not have time for injecting the dose, and now she cannot wait to get it.

Improving personal life

“Can you imagine this? I woke up in the morning and noticed that I lost my tooth and ate it in my sleep,” Marta is saying. She works as a hairdresser and has colorful hair.

Marta has been using drugs since she was 12. She says that drugs in Kyiv in the 80s were an element of prestige like a cherry VAZ 2109 (car model.) There was a seven-year break in her history. She started using drugs all over again when she had found out that her first love was HIV positive.

“He died, and I went crazy. In general, I cannot live without injecting. It is an addiction,” she explains.

Marta tries to take the test once a year, and she is going to improve her personal life.

“Tania, please, give me more condoms. My friends have been searching for a fiancée for me. I imagine him taking drugs, but not being a goner; I want him to have an apartment, as I would like to give birth to a child,” she continues.

Tania asks Marta to take her friend for the testing next time. A woman with a dark hair bandage is nervously waiting for her friend. She has recently become a widow, her husband died because of an overdose.

The social base of drug users is expanding

After the test, Tatyana immediately agrees to meet with the next client

After three visits, the social worker is tired, but there are still some addresses from the other side of the city.

“Our program helps them to be safe and control their health. I would also like to add some food arrangements – some of them do not have any food for weeks,” Tania is saying.

The harm reduction program among people who inject drugs in Eney Club started in 2001. The annual coverage was more than 6000 people in 2016. Out of these number, 80% of people have been tested for HIV. Now, the average level of HIV detection among clients is 3.5%, where 80% of people have been placed on dispensary records. The level of drug usage has been growing in Kyiv. There appeared separate subgroups among the people who use drugs. Veterans of the Donbas conflict and immigrants from the Eastern Ukraine form such subgroups.

Drug Treatment Systems in Prisons in Eastern Europe Discussed by AFEW Board Member

Council of Europe Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs published a new publication “Drug Treatment Systems in Prisons in Eastern and Southeastern Europe”. The publication sheds light into the situation of drug users among criminal justice populations and corresponding health care responses in ten countries in Eastern and Southeastern Europe: Albania, Bosnia-Herzegovina, Georgia, Kosovo, Macedonia, Moldova, Montenegro, Russia, Serbia, and Ukraine. AFEW‘s board member Vladimir Mendelevich is one of the contributors of the publication. 

The research project on drug-treatment systems in prisons in Eastern and South-East Europe looks in detail into the situation of drug users among criminal justice populations and the corresponding health-care responses in nine countries in Eastern and South-East Europe – Albania, Bosnia-Herzegovina, Georgia, Moldova, Montenegro, Russia, Serbia, “the former Yugoslav Republic of Macedonia” and Ukraine – and Kosovo. It was conducted between 2013 and 2016, and is a first attempt to collect relevant data on drug use among prison populations and the related responses in the nine countries and Kosovo.

Although the places chosen are quite heterogeneous in size, structure, legislation, economy, culture and language, they are all in a process of economic, social and cultural transition. This has triggered reforms of some of their prison systems and policies but it has also led to financial and political instability and lack of leadership due to frequent changes in the prison systems’ top management.

The full publication can be downloaded here.

Hepatitis A Prevails in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

Hepatitis Prevention Month to commemorate the World Hepatitis Day was organised for the first time in the history of Kyrgyzstan by the Ministry of Health in July this year. Over the recent years, the list of registered and allowed for import medications to treat hepatitis C has been expanded, the new clinical treatment protocol has been approved and a six-year target program to counteract viral hepatitis was adopted. Hepatitis is one of the leading causes of death among people living with HIV and higher-risk populations. Without a doubt, the discussion of availability of hepatitis diagnosis and treatment, introduction of treatment guidelines and implementation of the national viral hepatitis interventions will be an important part of the International AIDS Conference in Amsterdam in 2018. We discussed the reasons for the increased attention to the problem of hepatitis in KyrgyzstanIn with Nurgul Ibraeva, Chief Officer of the Department of Health Services and Medications Policy of the Kyrgyz Ministry of Health.

Statistics and the real picture

“The problem of viral hepatitis in Kyrgyzstan is growing every year. Blood-borne hepatitis B and C remain a challenging concern, as patients consult the doctors whey they already have advanced illness and complications, such as liver cirrhosis and cancer. During the Hepatitis Prevention Month, we raised awareness in the population about the need to get tested and offered discounted tests that were supported by private laboratories. Many people in Kyrgyzstan find the price for hepatitis testing (around $50) challenging, so patients often discover their disease at an advanced stage,” Nurgul Ibraeva says. “Following the official statistics, in the last five years 11,000–22,000 people with viral hepatitis were registered on an annual basis. Health services provide treatment to more than 2,000 patients with parenteral hepatitis (hepatitis B, C and D – author’s note), but we believe that the actual number of those infected is much higher: more than 250,000 people.”

Prevalence of hepatitis A is the highest. It accounts for 96% of the registered cases, with blood-borne hepatitis B coming second. According to the National Immunization Schedule, since 2000, hepatitis B vaccine is administered to all newborns free-of-charge. As a result, hepatitis B incidence had a fourfold decrease over the last 16 years. Currently, our health services register around 300–400 new cases of hepatitis B among adults annually, while incidence among children dropped to several isolated cases.

“Immunization brings its fruit. According to the Ministry of Health regulation, health workers exposed to blood should be vaccinated, yet no funds are allocated for it, and not every health worker can afford a vaccine,” Nurgul Ibraeva is saying. “Unfortunately, there is no vaccine against hepatitis C. Even if you use means of protection and take the necessary precautions, there is always a risk. Some health care staff remain untested, and it is our estimate that around 1000 health workers have hepatitis C.”

According to the Republican AIDS Center and the Research and Production Association “Preventive medicine” of the Kyrgyz Ministry of Health, in 2014–2015, the share of health personnel with hepatitis C in the general HCV prevalence amounted to 2.5%. The same percentage is attributed to the general public.

Hepatitis C prevalence is the highest among people who inject drugs (PWID). In 2010, 50% of all hepatitis C cases was registered among PWID. By 2015, this share dropped to 35%. Inmates are also among those especially vulnerable to hepatitis C. Over the last six years, 24–53% of all cases were identified in correctional institutions.

“Needle exchange services and opioid substitution therapy are available in Kyrgyzstan, including prisons,” Nurgul Ibraeva is telling. “Prevention programs strive to break the chain of transmission, but the share of infections remains high, even though we managed to stabilize the situation.”

As is the case with other population groups, key populations are still inadequately covered by diagnostic services. According to the official data, from 100 to 200 new cases of hepatitis C are annually registered in Kyrgyzstan. However, the estimated number of people with hepatitis C is much higher: 101,960 cases among the general population and more than 11,000 cases among people who use injecting drugs.

Availability of treatment

In April 2014, the coalition of non-governmental organizations under the initiative of the “Partner Network” Association of Harm Reduction Programs successfully lobbied changes in the Kyrgyz patent legislation. This allowed Kyrgyzstan to import and license generic medications to treat hepatitis C. Currently, a 12-week treatment course on the basis of an officially registered drug costs $615 for a generic and $1500 for the original.

“We have access to several licensed medications produced in China, Egypt and India,” Nurgul Ibraeva says. “If earlier treatment for one patient amounted to $15 000–20 000, today patients can choose medications they can afford. With the expansion of the list of available drugs, producers have been lowering their prices. Yet, patients still have to pay for treatment, which is a challenge for key populations.”

All imported medications have been included in the Essential Medicines List, which is a pre-requisite for the potential state procurement in the future. A Target Program to Address Viral Hepatitis for the period till 2022 has been approved, yet it does not guarantee treatment and does not have financial backing for the planned activities. At the same time, only among people living with HIV, the prevalence of parenteral viral hepatitis exceeds 14%. Over the past six years, the registered number of people with HIV and hepatitis C co-infection increased twofold and reached 701 cases in 2015. Advocates succeeded to include annual hepatitis C treatment for 100 people with HIV into the State Program for HIV Control. Treatment will be financed by the government for the period of five years. Besides, this year a Clinical Protocol for Diagnosis, Treatment and Prevention of Viral Hepatitis B, C and D has been approved. The document is aligned with the latest WHO recommendations and treatment regimens based on direct acting antiviral drugs that are widely available on the market.

Almaty is the first city in Central Asia to sign the Paris Declaration

Paris Declaration in Almaty was signed by Deputy Akim of Almaty city Murat Daribaev and UNAIDS Director in the Republic of Kazakhstan Alexander Goleusov

Author: Marina Maximova, Kazakhstan

The world movement, which already includes more than 70 major cities around the world, has reached Central Asia. The first city, whose authorities signed Paris Declaration with an appeal to stop AIDS epidemic on July 20, 2017, was Almaty. Signing of the declaration became possible and was organized within the framework of the project “Fast-Track TB/HIV Responses for Key Populations in EECA cities”, implemented by AIDS Foundation East-West in Kazakhstan.

Almaty is the largest city in Kazakhstan. It is cultural, financial and economic centre of the republic with a population of more than 1.7 million people. For many years it was the capital of the country. The megapolis, along with Pavlodar and Karaganda regions, has the highest rate of HIV infection in the country. Therefore, signing Paris Declaration gives Almaty opportunity and hope to improve the sad situation.

“This fact will undoubtedly attract city residents’ attention to HIV issues. People will get tested more actively, and will start their treatment in time if necessary. Almaty will participate in international health events and will have access to the most advanced achievements and developments in the field of HIV and AIDS. The best world practices will be included into the City Improvement Plan on HIV and tuberculosis until 2023. This will stop the growth of HIV epidemic and improve population’s health,” Valikhan Akhmetov, the head of the Almaty Public Health Department said during the ceremony of signing the declaration.

Sexual transmission of HIV increases

Today, there are more than five thousand registered HIV cases in the city. A quarter of the cases is observed among internal and cross-border migrants. For many years, the main route of transmission was parenteral. To stabilize the situation, the Akimat (regional executive body in Kazakhstan – editor’s comment) has introduced harm reduction programs targeted to key populations: people who inject drugs, sex workers, men who have sex with men. There are 18 syringe exchange points in the city and six friendly cabinets at polyclinics. This year, despite strong public confrontation, site for substitution therapy has been launched.

The trend of the HIV infection spread has changed dramatically in recent years. Today, the sexual transmission is already 65%. Infection, as doctors say, is now targeting general population, but people are still not aware of it and live as if it has nothing to do with them.

“It is very difficult for people from secured families and those who have good jobs to accept the positive HIV status. Women who live in a civil marriage, refuse to name their sexual partners. There can be another situation: imagine a girl coming to us with her mother, who claims that her daughter is a pure child, and she simply cannot have HIV infection,” Alfiya Denebaeva, deputy head physician of the Center for Prevention and Control of AIDS in Almaty is saying.

Some pregnant HIV-positive women do not take antiretroviral therapy (ART) because of the disbelief. Several years ago, there were cases in the city where mothers who did not believe in HIV-infection refused to take medicine, and their infants then died. Now there is an occasion to discuss this topic at the 22nd International AIDS Conference AIDS 2018 in Amsterdam, in which participants from Kazakhstan will also take part.

Regardless of what was mentioned before, Kazakhstani doctors manage to achieve high results. 99 percent of HIV-positive women give births to healthy children. There are several cases when HIV-positive women become mothers for the second and even third time. It is mostly possible thanks to mandatory two-time testing of every pregnant woman when timely diagnosis and starting of ART is possible to establish.

Almost 90% of PLHIV, who need treatment, receive ART

Regional Director of UNAIDS in Eastern Europe and Central Asia Vinay Saldana

In Almaty, testing and treatment of HIV infection is possible at the expense of the city and republican budgets. Back in 2009, the country was the first in Central Asia to start purchasing ARV drugs for adults and children. Today Almaty is the leader: more than 88% of people living with HIV (PLHIV) in need of ART, receive this treatment. This figure is higher than the same figure in the republic by eight percent. The megapolis is much closer to achieving AIDS targets 90-90-90 than any other city in the country: 90% of people living with HIV should be aware of their HIV status; 90% of people who are aware of their positive HIV status should receive antiretroviral treatment; and 90% of people receiving treatment should have a suppressed viral load that will allow them to stay healthy and reduce the risk of HIV transmission.

Another statistic data is showing the advantages of life-saving therapy. The effectiveness of treatment for PLHIV is more than 76%. Thanks to the early beginning of ART, there has been a 20% decrease in new tuberculosis cases among HIV-positive people. This is a very important achievement because the combination of HIV and tuberculosis infections is the main cause of death among PLHIV. Over the past year, this number has increased by 20%. The main reasons for this are late detection of HIV and amnestied patients, who arrive home from places of detention in critical condition. In every third case, the death was inevitable due to the specifics of the damage of the immune system and other organs. Mostly it was cancer or general body atrophy.

“Thanks to United Nations assistance, Kazakhstan has developed a new mechanism for purchasing ARV drugs. Only three years ago, we were spending several thousand dollars per year for a single patient. Now this cost is reduced to the minimum. Therefore, previously we could not advise people living with HIV to start treatment immediately, but now this treatment is available to everyone,” Vinay Saldana, Regional Director of UNAIDS in Eastern Europe and Central Asia is saying.

AFEW Shared Techniques of Relaxation in Kyrgyzstan

The community dialogue platform gathered for the summer school last week in Kyrgyzstan. This summer school was organised within ‘Bridging the Gaps’ programme. The director of programs of AFEW International Janine Wildschut attended the school. After some days of serious work in which the community discussed struggles they face in Kyrgyzstan and how they can come up with a united voice, a training on burnout syndrome and how to prevent it was arranged.

“For many community leaders life is hectic and full of stress. First of all, they do their work with their full heart, which makes them also more sensitive for the stories and troubles of people they help. Secondly, the community members were mostly not trained as managers and leaders of NGOs, and now they are carrying this responsibility with big feeling of commitment. Besides, daily life in Kyrgyzstan for many people consists of a lot of struggle: family responsibilities, economic challenges and little time for relaxation,” Janine Wildschut shares. “This results in feelings of stress, little division of private life and work and little awareness of spending time on hobbies or personal time. Besides, within NGOs there is not much awareness of the need for staff to relax, take holiday time, have some breaks or breathing exercises. Women seem to have more pressure than men, as women are the main caretakers of the household.”

Thіs summer school gave the community members an opportunity to become more aware of stress factors. For one week they were thinking more about themselves, exchanged their worries and learned relaxation techniques.

“As I am not drinking or taking drugs at the moment, I do not know how to relax since that normally was my relaxation,” says one participant of the training who stopped to use drugs. Most of the participants of the summer school also feel that it is very important to be together during such studies since it is the only opportunity for them to gather together outside of official gatherings.

Janine Wildschut shared her experience with stress and burnout. Some of her lessons were taken as eye opener for many.

“When your system stresses up, it “tells” you to run harder, and that is the moment to stop yourself and slow down completely,” Janine said. “To have a boss that understands that this is important and supports you taking a break sometimes is also very important. As the problems around you are a fact of life, you are the only one that can change how you handle this: with stress or by contributing the best you can, but not more than you can.”

Besides, on her trip in Kyrgyzstan, AFEW’s director of programs conducted a focus group about community advocacy to see if change in this area is occurring, what is required to have a greater involvement of the community, and how the dialogue platform contributes to that. Janine also interviewed community NGOs on the situation of shrinking space for CSOs in Eastern Europe and Central Asia. The situation in Kyrgyzstan nowadays is stable. Wider coalitions are initiated and hard work is done with the government to show the invaluable work that NGOs are doing.

Injectable Antiretroviral Drugs – a ‘Remarkable Milestone’

Long-lasting antiretroviral drugs injected monthly present a ‘remarkable milestone’ in treatment options for people living with HIV.

A long-lasting injectable antiretroviral treatment (ART) containing cabotegravir and riviliprine, administered at four- or eight-week intervals, is both as safe and effective at maintaining viral suppression as the same drug combination taken orally.

The results from the LATTE-2 study, an ongoing phase 2b clinical trial, were presented at the International AIDS Conference (IAS) on HIV Science last week in Paris, and published in the Lancet. It is the first study to investigate the safety and efficacy of a long-acting ART for HIV.

In the study, patients were brought to viral suppression with oral ART in an ‘induction phase’, and those who achieved viral suppression were randomly selected to three arms for maintenance therapy. After 96 weeks, viral suppression was maintained in 84% of patients receiving oral treatment, 87% in patients receiving the injectable contraceptive every four weeks, and by 94% in the eight-week group.

Cabotegravir is an investigational integrase inhibitor (INSTI) that has a long half-life, meaning it is active in the body for longer. It is also being considered for use in other clinical trials as a pre-exposure prophylaxis (PrEP).

Rilpivirine is a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI), developed to counteract mutations associated with HIV drug resistance in this class, and is approved for use only in combination with other antiretroviral drugs.

What are the benefits of long-lasting ART?

People living with HIV can now expect to live a near-normal life expectancy, where they have access to effective antiretroviral treatment, monitoring and support. But the positive benefits of treatment can only be realised when adhered to exactly as prescribed – which for HIV, means taking treatment every day, for life.

A range of factors can influence a person’s ability to stick to a drug-taking regime, so until a vaccine or a cure is found, new treatment delivery options are needed to ensure all patients can maintain high levels of antiretroviral drug concentration in their body, thereby achieving viral suppression and reducing the risk of HIV drug resistance.

In this study, participants revealed they felt free from their illness, with lead study author Joseph Eron Jr., M.D., saying at a press conference: “It’s surprising to me – patients at our site that are on the study – how much they appreciate not having to take pills. I think that’s something that I really didn’t calculate. There’s this kind of feeling of freeness from being bound to oral therapy every day.”

Mark Boyd, MD, of the University of Adelaide and David Cooper, MBBS, of the University of New South Wales, in an accompanying Lancet commentary said that the long-acting antiretroviral was a “remarkable milestone” for HIV therapeutics – but at some point there will be a “trade-off between the convenience of not having to adhere to oral therapy and the inconvenience and discomfort associated with injectable long-acting ART. It is possible that injectable ART will be more attractive the less one must be injected.”

Some people may find taking oral medication every day more convenient than having to see a healthcare professional to be injected on a monthly basis. Boyd and Cooper continued, “This is compounded by the fact that health-care systems are generally not configured to facilitate regular, recurrent injections in a timely and convenient way to people who are well. Changing this will take innovation, political will, and time.”

Nevertheless, the authors conclude that “long-acting injectables such as the cabotegravir plus rilpivirine regimen might represent the next revolution in HIV therapy by providing an option that circumvents the burden of chronic daily dosing.”

Source: AVERT

The EU Adopts Its Most Progressive Drug Action Plan Ever

Author: Peter Sarosi

Although it was without much fanfare that the European Commission, in July 2017, published the new Action Plan on Drugs (2017-2020), the drug policy community should celebrate it as a great achievement both for its progressive content and for the meaningful involvement of civil society in its preparation.

If there is a sign that the European Union is getting through difficult times, it’s the limited attention its new public policy initiatives receive. While the adoption of previous EU drug strategies and action plans has been well covered by the media, now, two years after the great migration crisis and one year after the Brexit vote, almost nobody noticed the adoption of the new EU Action Plan on Drugs. There was no press conference or press release. It seems drug policy is not a priority for decision makers these days – there are other topics occupying public attention. It’s a shame, because this is the most progressive drug policy document the EU has ever adopted. It is most needed, at a time when European drug markets have been undergoing cataclysmic changes, with the emergence of new drugs and new risks which require new responses and interventions.

The three-year Action Plan translates the goals of the seven-year EU Drug Strategy (2013-20)into concrete actions with clear responsibilities and performance indicators. This is the second action plan relating to the current drug strategy, the previous one (2013-16) having been evaluated by external evaluators, RAND and EY in 2016. The evaluation report, which also included civil society views, highlighted some very significant shortcomings of EU drug policies. It pointed out that among the five pillars of the EU drug strategy, demand and harm reduction significantly lags behind in terms of progress made in the period of the previous Action Plan. According to the evaluation, “there is room for improvement in implementation and access to risk and harm reduction measures across various Member States and… stakeholders from civil society expressed concerns about the extent and quality of these measures.“ Interviewed by the evaluators, these civil society representatives reported scaling down and closure of harm reduction programs, increasing rates of hepatitis C and HIV infections and high rates of overdose deaths among injecting drug users in some member states. Harm reduction should be expanded beyond injecting drug users, including drug checking and other safer nightlife initiatives. The report also emphasised that discussion about new cannabis policies, within and outside of the European Union, is missing at the European level.

The new Action Plan has been prepared with the involvement of the Commission’s expert group, the Civil Society Forum on Drugs. This diverse group of more than 40 NGOs represents various fields, perspectives and ideological approaches. As one of the Core Group members of the Forum, I had the pleasure of coordinating civil society responses to the evaluation of the old Action Plan and the preparation of the new. It has been the first time in the history of the European Union that civil society has been systematically and meaningfully involved in this process, with a significant impact on the final document.

These are a few highlights of the fields where civil society could have a significant impact:

HARM REDUCTION

Unlike the previous AP, this document lays great emphasis on scaling-up access to harm reduction programs – and not only the mainstream programs, such as opiate substitution and needle and syringe programs, but novel interventions such as naloxone distribution, drug consumption rooms, and drug checking are also mentioned. This is the first time that the EU has officially recognised these innovative programs. Another impact of the involvement of civil society can be seen in the list of performance indicators. These indicators were often vague in previous documents, but are much clearer now, for example by adopting indicators from the WHO’s technical guidelines, recommending the distribution of at least 200 sterile needles per injecting drug user per year. These indicators make governments more accountable.

GENDER, AGE AND OTHER FACTORS

The lack of gender- and age-specific services is a huge barrier to access to any kind of treatment or harm reduction programs in the EU. In many, mostly Western-European, member states, there is an increasingly ageing population of drug users who need other kinds of social and health support than those aimed at young people. Underage kids also need different services than adult people. Specific services for women and LGBTQ comunities are equally missing from many member states. Prisoners and asylum seekers often don’t have access to even the basic services which are widely available in the community. This AP addresses this problem and aims to close this gap. At least partly. There are still no specific interventions targeting LGBTQ people in the age of chemsex for example.

HUMAN RIGHTS

To integrate international human rights standards into drug policies has been a civil society demand for a long time. Last year’s UN report on the human rights impact of drug policies was a big success for civil society advocacy. Now our demands have also been met by the EU – this AP aims to create and implement tailored human rights guidelines and impact assessment tools for policy makers. This gives civil society an incredibly important opportunity to address system-wide incoherence when it comes to repressive law enforcement, criminally underfunded services and the human rights of people who use drugs.

CIVIL SOCIETY INVOLVEMENT

Although in most member states civil society plays a key role in implementing drug policies by providing services, there is a great diversity in how the same organisations are involved in policy formulation and evaluation. Only a few member states have formal mechanisms for civil society involvement. Objective 9 of the new AP requires not only the involvement of the Civil Society Forum on Drugs in the formulation, implementation, monitoring and evaluation of drug policies at the European level, but also the involvement of civil society in policy making at a national level. The AP also mentions that civil society should be involved in the preparations for the upcoming UN high level meeting on drugs, to be held in Vienna in 2019.  The CSF has created a working group to facilitate this process. What is still missing from the AP, despite our recommendations, is a reference to the need to involve people who use drugs in decision-making. Shame.

TACKLING PSYCHIATRIC DISORDERS 

Members of the Forum from several member states reported a gap in tackling psychiatric co-morbidites, also known as dual diagnosis, among people with drug dependence. The number of people suffering from this problem is increasing, but member states are not creating specific treatment resources to meet needs. We therefore welcome the Commission’s inclusion, under action 2.6, of the promotion of comprehensive community care, creating specialised resources to ensure continuity in treatment for these users.

QUALITY STANDARDS

The CSF has a thematic working group on quality standards, which produced a paper highlighting the challenges and gaps in implementing these services. It recommended the introduction of clear indicators to measure the implementation of quality standards for demand reduction. Action 3.10 require member states to involve civil society in the implementation of these quality standards. Although the AP does not mention it, the CSF is in the opinion that standards should be implemented and monitored with the meaningful involvement of service clients.

ALTERNATIVES TO COERCIVE SANCTIONS

While civil society almost unanimously supports it, there is unfortunately no consensus among member states about the decriminalisation of drug use. However, the AP requires member states to apply alternatives to coercive sanctions. The CSF recommends to member states that alternatives to coercive sanctions should include, where appropriate, a Restorative Justice approach, recognised to reduce reoffending and increase the satisfaction of victims. Moreover, alternatives to prison should be correctly evaluated in order to avoid a “net-widening” effect – that is, punishing more actions and persons than before. These measures should be gender-specific, and should ensure that prison is used as a last resort and punitive measures are not used for the simple use or possession of drugs per se. We therefore welcome the inclusion of “increasing monitoring and evaluations” as indicators within action 5.22.

EVALUATING ALTERNATIVE POLICIES

The external evaluators of the previous Action Plan on Drugs pointed out that “the omission of a discussion on recent trends in cannabis policy was noted by a wide range of stakeholders and represented one of the most frequent items raised when exploring whether there are any issues not covered by the Strategy.” We recommended that the Commission provide a comprehensive analysis of developments relating to cannabis policy models (eg. cannabis social clubs in Spain) and their impacts, as we originally requested. The final text of the AP is not as progressive as we had hoped: it only asks the EMCDDA to provide an update about cannabis laws in the EU. Upcoming EU presidencies need to create platforms and organise forums to enable civil society, the scientific community, and decision-makers to discuss alternative policies and their impact.

Is this document a breakthrough in European drug policy reform? No. I believe we can expect the real breakthroughs to happen at national and local level. But it is clearly a step in the right direction. What is really concerning is the lack of political commitment and adequate funding to implement the action plan. The weakness of EU action plans is that the Commission itself has no significant drug policy budget; it is therefore up to the member states to provide funding for most interventions. And several member states are far from committed to scaling-up services – not even committed to continue funding existing services. What we have seen in recent years is programs being curtailed or shut down, especially in the Eastern part of the EU. It is our role to remind EU institutions and member states that broken promises do not only undermine trust in democratic institutions, but also endanger the health and well-being of future generations.

Source: Drug Reporter

Harm Reduction: Redirection of Resources Needed

Why do we need action?

Harm reduction is an evidence-based and cost-effective approach to drug policy and practice that is about keeping people who use drugs, their families and communities safe and healthy.

Harm reduction is about saving lives and it works!

Yet many countries still do not provide harm reduction services. According to UNAIDS, between 2010 and 2014 only 3.3% of HIV prevention funds went to programmes for people who inject drugs.

Why now?

Harm Reduction International’s data shows that since 2014, no new countries have established needle and syringe programmes (NSP) and just three have introduced opioid substitution therapy (OST). Of 158 countries where injecting drug use is reported, over half (78) do not offer OST and more than a third (68) still do not provide NSP. In 2015, a UN target to halve HIV transmission among people who inject drugs by 2015 was missed by more than 80%.

These figures are a call to action.

By contrast, each year governments spend over $100 billion on drug control strategies that have little effect on demand for drugs or on those who profit from the drug trade. At the UN General Assembly Special Session on Drugs in 2016, governments showed a new willingness to rethink these approaches. But now they must rebalance their spending.

What are we calling for?

We are calling on governments to redirect 10% of the resources currently spent on ineffective punitive responses to drugs and invest it in harm reduction by 2020.

What we will this achieve?

Even this small redirection of funding could achieve big results.

A 10% redirection of funding from drug control to harm reduction by 2020 would:

  • End AIDS among people who inject drugs by 2030.
  • Cover annual hepatitis C prevention need for people who inject drugs. Globally. Twice over.
  • Pay for enough naloxone to save thousands upon thousands of lives every year from opiate overdose.
  • Ensure effective advice, healthcare and emergency responses in the face of newly emerging challenges.
  • Strengthen networks of people who use drugs to provide peer services and campaign for their rights.
What will happen if we don’t act now?

If the adoption of harm reduction in new countries continues at the current pace, it will be 2026 before every country in need has even one or two harm reduction programmes. In the meantime, thousands, if not millions, of lives will be lost.

Source: Harm Reduction International

Join AFEW at Harm Reduction International Conference in Montréal

AFEW International is taking part in 25th Harm Reduction International Conference that will take place in Montréal, Canada next week. AFEW’s executive director Anke van Dam and program director Janine Wildschut will take part in the side event on harm reduction.

The side event ‘Future Proofing Harm Reduction’ is supported by the Dutch Funded Harm Reduction Programs – Bridging the Gaps, PITCH and the Alliance Integrated Harm Reduction Programme (AIHRP). These three alliances are represented by Aidsfonds, International HIV/AIDS Alliance, International Network of People Who Use Drugs, AFEW International, and the Mainline Foundation. The side event will take place on Monday, 15th May, 2-3.30 pm at Mansfield II, Entry hall, Centre Mont-Royal.

AFEW will be represented by the talk by AFEW International’s program director Janine Wildschut with the talk ‘Shrinking space for civil society in the EECA region’ and AFEW Kyrgyzstan’s director Natalya Shumskaya who will talk about women who use drugs in Kyrgyzstan. More detailed program of the side event can be found here.

Harm reduction goes much further than HIV prevention, and contributes significantly to the quality of life of people who use drugs and to the realization of the Sustainable Development Goals (SDG). This side event, moderated by the Dutch Ambassador for Sexual and Reproductive Health and Rights and HIV/AIDS Lambert Grijns, will share examples from the variety of grassroots harm reduction projects currently funded by the Netherlands. Current challenges in harm reduction funding beyond HIV and framing programmes within the context of the SDGs will be discussed.

The theme of this year’s Harm Reduction International Conference is ‘At the Heart of the Response’, and the programme includes presentations, panels, workshops and dialogue space sessions on innovative harm reduction services, new or ground-breaking research, effective or successful advocacy campaigns and key policy discussions or debates.