AFEW Presents Important Assessments about EECA

AFEW International, together with its network members from Eastern Europe and Central Asia (EECA) is getting ready for AFEW’s Regional autumn school to be held in Almaty, Kazakhstan from October 30 till November 3, 2017. The autumn school will provide the platform for learning, exchange, strategizing and planning for community members and NGO partners from 10 different countries. The regional autumn school is an annual event that takes place as a part of ‘Bridging the Gaps: Health and Rights for Key Populations’ regional approach of AFEW.

One of the highlights of the autumn school’s program will be the presentation of three important assessments that AFEW International recently finalized as a part of the ‘Bridging the Gaps’ program. The final results of all assessments will be available to the general public around December of 2017.

Harm reduction friendly rehabilitation

The assessment on harm reduction friendly rehabilitation in EECA is the study that describes the state of rehabilitation services in Ukraine, Russia, Georgia and Kyrgyzstan. It presents seven international approaches for rehabilitation programs and its activities. The participants of AFEW’s autumn school will discuss the recommendations of what approach is better to adopt for developing stronger work capacity.

Migrant people who use drugs

The assessment on migrant people who use drugs (PUD) is coming from the questionnaire that was disseminated in the EECA region. A survey amongst 600 people who use drugs in Tajikistan and Kyrgyzstan showed that 43% of the respondents have experienced periods of migration to another country in the EECA region, mostly to Russia. From the qualitative interviews with migrant PUD in Russia and Kazakhstan, it is possible to assume that people have very little access to health facilities, legal documents and often little options to return to their native country. The participants of the autumn school will discuss the full assessment and come up with interventions for the coming two years to build good practices and to advocate for the rights and lives of the community members.

Shrinking space for the civil society

The assessment on shrinking space for civil society is the in-depth assessment on the space for the civil society organizations with a special focus on harm reduction and drug policy in NGO’s and community networks. The withdrawing of international funding and shrinking space for the civil society form a real threat for the fight against the further spread of HIV in the region and the rights and lives of communities. During the autumn school, the coping mechanisms will be discussed and further steps will be designed to address the conclusions.

TB and HIV – a Plague of Tajikistan Prisons

Prisoners in the yard at a colony in Dushanbe. Photo from the archives. Author – Nozim Kalandarov

Author: Nargis Hamrabaeva, Tajikistan

Around 12,000 million people are held in correctional institutions and pre-trial detention centers in Tajikistan. Approximately 100 of them have tuberculosis, and 220 live with HIV.

“HIV prevalence in prisons in Eastern Europe and Central Asia (EECA) is estimated to be between 2 and 50 times higher than that in the general population. In EECA, Tajikistan has the highest rate of HIV infection among prisoners – 7%, which is about one-fifth of all people infected with HIV in the country. Additionally, according to the estimates, the risk of contracting TB in prison is 60-100 times higher than outside prison walls. Within the prison population, there is an increased rate of tuberculosis-related mortality compared to that in the general population,” states an overview of HIV and TB in Tajikistan prisons as described by AFEW International in 2015. Now, two years later, let us see how this situation has changed.

100 TB patients

“Over the last eight months, 59 new cases of TB in penal institutions were diagnosed. All these patients are registered and receive treatment. In total, there are 100 prisoners infected with TB in Tajikistan, which is less than 1% of the prison population. Compared to the previous years, the situation has improved significantly: TB detection increased, the laboratories are being modernized, there is new equipment and adequate provision of medications,” the Head of the Medical Department of the Main Directorate of the Penal System of the Tajikistan Ministry of Justice Saidkul Sharipov is saying.

According to Mr Sharipov, a real lifesaver for them was the mobile fluorography unit that could be taken from region to region, allowing for step-by-step screening of inmates.

“Such testing is conducted every six months. For example, recently we have examined about three thousand inmates for mycobacterium tuberculosis in all cities and regions, except Dushanbe. We identified 40 suspected cases of TB that will be followed through during the secondary examination,” Mr Sharipov adds.

In total, some 500 prisoners are kept under regular medical supervision, including those who had already received treatment and have fully recovered.

The Deputy Director for Infectious Control of the Republican Center on Social Protection from TB Saydullo Saidaliev also confirms that the situation with tuberculosis is under control and TB prevalence in Tajikistan has decreased.

“In 2005, more than 300 inmates had TB, this year – only 100. The rate of new infections has also been declining: 77 cases in 2016, 59 over the last eight months. Last year, seven prisoners died from mycobacterium tuberculosis, this year we had zero deaths from TB,” Mr Saidaliev says.

Almost all correctional institutions have special TB hospitals for 5–10 beds, as in prison settings one TB carrier could infect tens of people within a year.

HIV “enters’” prisons from outside

Mycobacterium tuberculosis and HIV are often spread in closed institutions.

Prisoners at a colony in Dushanbe. Photo from the archives. Author – Nozim Kalandarov

“Although we have not analyzed this thoroughly, one could assume that most cases of HIV infection among inmates take place within correctional institutions. Quite some detainees are imprisoned because of drug related crimes, like drug possession. People who inject drugs have a higher risk of living with HIV. Most of them serve a short term, but have the risk to be detained shortly after their release again for another short term. With the window period of detecting HIV, it is difficult to say if and when prisoners have got HIV while detained,”  the Deputy Director of the Republican AIDS Center Dilshod Saiburhanov is saying.

Inmates often learn about their HIV status in prisons, where HIV testing is offered twice a year. Currently we have 220 registered people with HIV, two of them are female, one under age, and 150 receive antiretroviral treatment.

Since 2010, the number of HIV cases among inmates has decreased: 292 were identified in 2010, while over the last nine months only 31 cases were registered – a nine-fold decrease. Screening procedures are improving every year, and 65–70% of prisoners get tested for HIV,” Mr Saiburhanov adds.

Currently, three correctional colonies in Tajikistan have the so-called “friendly offices” that distribute prevention materials – syringes, condoms and information leaflets.

HIV+TB: a particular risk

Experts note that they are especially concerned about HIV and TB co-infection, as people with HIV have a higher risk of getting TB as well.

“That is why there are cases of co-infection in Tajikistan prisons: about 25% of the total number of TB patients,” the Head of the Medical Department of the Main Directorate of the Penal System Saidkul Sharipov says.

Mr Sharipov adds that AFEW-Tajikistan is one of the few international organizations that work in Tajikistan prisons to reduce the burden of infectious diseases, such as HIV and tuberculosis.

“We have been collaborating with AFEW since 2003 to conduct HIV and TB response projects in prisons, as well as information campaigns among inmates to prevent these diseases,” Mr Sharipov says.

One of the main problems is not even the lack of costly treatment and nutrition, because international organizations help with these. It is the lack of healthcare personnel in the penal system.

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.

HIV Prevention in Key Populations: an Overview of Service-Delivery Projects in Russia

The Blue Bus mobile prevention unit, the bus of hope

Author: Anastasia Petrova, Russia

According to the World Health Organization, about half of new HIV cases occur in key populations: injecting drug users, men having sex with men and sex workers. Social stigma, violation of human rights, lack of access to the necessary services create barriers to protection of health for millions of Russian citizens. That being said, providing care to people with an HIV-positive status and those who are at risk of infection is an essential measure to safeguard health of the whole nation. By implementing service-delivery projects for key groups, non-governmental organizations play an important role in preventing the spread of the HIV epidemic both in the communities and among the general population.

The bus of hope

The Blue Bus mobile prevention unit, engaging clients in service provision

The Blue Bus of the Humanitarian Action Foundation is the first mobile prevention unit for drug users. In 2017, the project celebrates its anniversary: 20 years ago, the Blue Bus started its first journey in St. Petersburg.

Throughout these 20 years, Humanitarian Action has been true to its principles of helping those most vulnerable to the HIV epidemic. Many clients have double or even triple diagnosis: HIV, tuberculosis, hepatitis B and C, and addiction to psychoactive substances.

People are referred to service-provision programs through street outreach, mobile units and stationary needle exchange centers. Peer counsellors provide motivational counselling, assist with hospitalization to specialized medical institutions and follow-up their clients to increase retention in treatment programs.

The Blue Bus mobile prevention unit, distribution of materials, motivational counselling

Bus workers distribute sterile syringes, needles, water for injections, alcohol swabs, cotton balls, bandages, vitamins, vein ointment, naloxone, etc. People who use services are not always ready to change their behavior just like that. Talking to the project staff, they get important information on how to reduce infection risks and protect their health.

For most clients, the Blue Bus is the only safe place where they are treated with respect and understanding, and the only possibility to take a rapid test, receive primary medical counselling, get access to HIV and TB testing and treatment, be referred to public institutions and learn how to protect human rights. The team of the Blue Bus proudly values these trustful relationships between project staff and clients that have been built over the years of program implementation.

Dialogue between equals

Outreach work in the Cabaret bar

NGO Positive Dialogue is one of the oldest HIV-service organizations in St. Petersburg. Since its establishment in 1996, Positive Dialogue has gained substantial experience in working with key populations. In July 2015, the organization launched HIV prevention projects for closed population groups: men having sex with men (the Positive Dialogue project) and sex workers (the Silver Rose project). Both projects are community-driven, with the main goals to promote safer sex practices among MSM and SWs, increase access to services, including HIV/STI testing, uphold human rights, strengthen communities and counteract stigma.

The outreach team of the Positive Dialogue project conducts weekly field work in the night clubs visited by MSM and the LGBT community. The clients talk to peer counsellors and ask questions about HIV and other STIs, learn about pre- and post-exposure prophylaxis, receive condoms and lubricants.

Outreach work in the Priscilla club

The Silver Rose staff members provide counselling for sex workers in their office and conduct outreach work in the local saloons and street sex work areas. The project helps the girls preserve their health and human rights, protect themselves against violence, receive contraceptives, get tested for HIV and get referrals to trusted doctors. Peer counsellors also provide psychological support and involve sex workers in client management programs.

Training on how to use a female condom

Legal components make up an important aspect of the project’s work – the so-called “street lawyers” trained by the project provide legal aid and support in cases of violations of MSM/LGBT and SWs rights. Project clients take part in educational trainings and seminars.

Particular attention is devoted to community development and mobilization, to encourage community-driven HIV responses. Project activists organize campaigns and round table discussions aimed at overcoming societal stigma.

Women plus

Social support center for women, pre-test counselling

HIV-positive women are the focus of one of the projects run by EVA Association. In October 2017, a social support center for women affected by HIV will be launched by EVA – a low-threshold service offering comprehensive individual assistance to HIV-positive women in crisis situations.

The project team unites specialists with various experiences: peer counsellors, client management officers, lawyers, psychologists. Clients will be offered counselling, rapid HIV testing with pre- and post-test counselling, and individual management of each case. Women will be able to obtain contraceptives (condoms) here and take part in self-help group sessions for women living with HIV and their family members.

Social support center for women, rapid testing for HIV

Experienced specialists working in EVA will do their best to make the center as client-friendly and as responsive to clients’ needs as possible – for example, by allowing clients to bring their children, organizing distribution of clothes for women and kids, giving out hygiene kits. EVA collaborates with the municipal public services and socially oriented NGOs, which will improve activities aimed at informing women about the existing support services, providing access to various specialists and representing women in these institutions.

The center will give special attention to the prevention of violence and dependent and co-dependent behaviours. It is pilot project, unique for the region, with a focus of preventing negative social consequences of HIV among women.

Social support center for women

Prevention projects for vulnerable groups in Russia were launched 20 years ago by our western colleagues. However, international funding for these and other social projects has been significantly reduced. Unique low-threshold HIV prevention programs are becoming as vulnerable as their clients. Some organizations manage to secure financial support from the government. Others try to change their structure. We would like to believe that projects that help thousands of people representing very closed populations to protect their health will not become extinct in Russia.

NGO-Based HIV Testing Available in Kazakhstan

President of Central Asian Association of People Living with HIV and the ‘Kazakhstan Union of People Living with HIV’ Nurali Amanzholov

Author: Marina Maksimova, Kazakhstan

From early 2018, HIV rapid testing in Kazakhstan will be available based in the non-governmental organizations (NGOs). With the President of Central Asian Association of People Living with HIV and the ‘Kazakhstan Union of People Living with HIV’ Nurali Amanzholov we are talking about advantages, mechanisms and preparatory work associated with this innovative step in fighting HIV.

– Nurali, it is well known that in Kazakhstan HIV screening test can be conducted at any regional AIDS Center. What is the reason for organizing rapid testing on NGOs’ premises?
– Nowadays, only AIDS Centers are authorized to conduct HIV testing in Kazakhstan. Every regional center has such a department. The problem is that representatives of the key populations (people, who use drugs, sex workers, men who have sex with men) prefer to avoid them. NGOs, using peer-to-peer approach, have better access to these groups, and in such a way there is more confidence. Non-governmental organizations can significantly increase the coverage of those tested for HIV, which means that the control over the epidemic will also increase. Another advantage of the proposed innovation is that it allows to identify HIV infection at an early stage, ensure timely treatment, preserve health and employability, and prevent new cases.

– What are exactly NGOs doing to introduce such service?

– Last year, with the support of the Corporate Foundation Eurasia Foundation of Central Asia, which is supported by the United States Agency for International Development (USAID), Kazakhstan Union of People Living with HIV implemented the project ‘Access to the NGO-based rapid HIV testing in Kazakhstan.’ Its goal is to create an enabling legal environment for providing HIV rapid testing services by NGOs to improve access to this service for key populations. Within the framework of the project, we analyzed the barriers during the introduction of the NGO-based rapid testing. Now we are working on the methodological recommendations and draft of the decree, which should make this initiative legal. It will contain clear operational rules of this system as well as all requirements and methods of control.

– Nurali, what kind of preparatory work is carried out to introduce this NGO-based services next year?

– Today specialists from the Republican Center for AIDS Prevention and Control together with their colleagues from Kazakhstan Union of People Living with HIV provide trainings for NGOs on how to conduct rapid testing in two pilot regions – East Kazakhstan and Pavlodar. We have already conducted trainings for the representatives of four non-governmental organizations. Specialists have taught our staff how to do an HIV rapid testing, and how to conduct pre-test and post-test counseling. They provided information about the quality control of the procedure, safety measures, recycling of consumables, talked about the observance of professional ethics. Each participant knows that if the test results are positive, the patient should be redirected to the AIDS Center for further laboratory diagnosis and confirmation of the HIV status.

Was your initiative supported by the governmental structures?

– Representatives of the Ministry of Health of the Republic of Kazakhstan, the Republican Center for AIDS Prevention and Control, leading international organizations dealing with HIV in the country are actively involved in this process. There is a good chance to include NGO-based rapid HIV testing into the national testing algorithm, which is being currently reviewed by the Ministry of Health. This will make fundraising efforts of NGOs more efficient, including attracting public funding for these services. This approach insures stability of the services, and of NGOs in general. I am sure that the topic of HIV rapid testing on NGOs’ premises deserves a separate discussion at the 22nd International AIDS Conference AIDS2018 in Amsterdam, and we are ready to share our experience there.

 

 

 

 

 

 

 

 

 

Newlyweds in Tajikistan should Know HIV Status of Partners

Author: Nargis Khamrabaeva, Tajikistan

According to the UNAIDS estimates, there is around 1.5 million people living with HIV in Eastern Europe and Central Asia. The Ministry of Health and Social Protection of the Republic of Tajikistan registered 348 new cases of HIV infection in Tajikistan in the first half of 2017. There is a compulsory rule for newly married couples in Tajikistan now: the couple has to submit not only the application for marriage to the registry office, but also the results of a comprehensive medical examination, including the test on HIV. Authorities believe that these measures will facilitate the creation of strong families and the birth of healthy children*.

We are talking about this with the medical doctor and expert in HIV field, the member of European AIDS Treatment Group (EATG), the member of online conference committee EECA 2017 (Moscow, Russia) Zoir Razzakov.

– Zoir, please tell us about the obligatory medical and HIV couple examinations for the registry offices in Tajikistan.

– The number of HIV infected women in the country has been growing lately. Many of these women acquired HIV positive status from their migrant husbands. There were many cases when women found out about their status after the marriage and before giving birth to children. For example, women have to take the HIV test prior to receiving the prenatal record. I will tell you about one example: there was a child in one family who often got sick, had temperature and doctors were unable to come up with a diagnosis. Somebody advised to take the HIV test, and it turned out the child had been infected. It also turned out that the mother of the boy was infected from her migrant spouse. Unfortunately, doctors could not save the child.

– Do you have any statistical data of the number of identified HIV-infected people through the introduction of this particular testing?

– According to the available data, the local AIDS centre detected two cases of HIV infection of those who did before-marriage testing this year. I do not know if the marriage was prohibited due to these reasons. Another question: if future spouses know about each other’s statuses and are not against creating a family, what happens then?

– Many experts note that such compulsory HIV testing contradicts with international standards on voluntary testing of the population and the basic law on HIV. What do you think?

– From some point, I consider the compulsory before-marriage testing discriminating. Suppose we find out one spouse is HIV-positive, what happens next? HIV-infected people are equal to all other citizens of Tajikistan and have equal rights.

There are some advantages of this testing, of course. Many people in the Republic of Tajikistan do not know about their status, and are not informed about the HIV infection and its ways of transmission and prevention. Migrant workers are in the risk group. They live in poor conditions in foreign countries and have to satisfy their physical and sexual needs with someone else while living away from their families.

After they return home, they usually do not get tested and infect their partners. This leads to conflicts in families and further divorces. Everybody should know their status. This should become a common unspoken rule for the society. It should also be a voluntary action in which people should take interest. Media should also come to the rescue. We need more informational materials, social ads on TV and radio. I would say that people have to be informed, and in this way, they will be forearmed. Forearmed means protected, and protected means safe.

– Do you think the following testing can prevent HIV spread in the country?

– This is a difficult question. Usually, when people find out about their positive status, they start denying it. During the period of denial they do not understand the importance of protection. Others take avenger’s position: they think that once they are infected, they should infect others in vain. There are also HIV-dissidents, who begin to assert that there is no such virus in nature. In any case, all of them are informed on the criminal liability for deliberate infection of others. I would suggest that a person takes HIV test twice a year, without taking into consideration whether he had unprotected sex or did some irrational thing.

*AFEW International does not support mandatory testing while getting married.

Cry for Access to Treatment for People Living with HIV in Russia

The event dedicated to the Day of Remembrance of People who Died from AIDS, Moscow, May 2015

Author: Anastasia Petrova, Russia

“Medicines for the treatment of HIV, hepatitis C, and tuberculosis are provided free of charge to all needy patients in Russia.” This phrase is the first thing we see on Pereboi.ru main page – the resource where people living with HIV in Russia can tell their stories about how they were refused treatment.

Professional patients

Pereboi.ru is one of the projects of the Patient Control – a public movement whose members are people living with HIV and other socially significant diseases, as well as their supporters. The movement has existed for seven years in Russia. The initiative group, not being an organization or legal entity, has grown into a professional community of patients who have risen to defend their rights.

In addition to direct actions, activists of the Patient Control monitor government procurement of antiretroviral therapy (ART), write complaints and make appeals to public authorities. Representatives of the community also work with pharmaceutical companies: one of the main obstacles to treatment is inflated prices for medicines.

Founded in autumn 2010, the movement’s goal is to ensure effective control of the provision of high-grade medical care and the improvement of quality of life for HIV positive people. Activists say that any person sharing their views can join them. The main concern on which activists are working is the disruptions in medical supplies for people living with HIV, hepatitis and tuberculosis in Russia.

Fighting with supply disruptions

“For more than six years there have been interruptions in medical supplies for the treatment of HIV/AIDS in Russia. Life-saving medicines, that have to be taken strictly by the clock and in a certain order are partially or completely lacking in AIDS centres,” activists are saying.

This situation is interconnected with repeated changes in the system of procurement of medicines for people living with HIV. The latest change is the transition to a centralized system in 2017. Before that, the medicines in regions were bought according to special schedules, and now the Ministry of Health of the Russian Federation is the responsible party. These changes have led to the slippages in the procurement schedule and serious supply disruptions this year.

The event by the Ministry of Health of the Russian Federation, Moscow, July 2013

At the moment, supply disruptions of medicines happen almost everywhere throughout the country. People living in different regions of Russia such as Nizhny Novgorod, Norilsk, Tomsk, Kostroma write messages to pereboi.ru almost every day. Only in 2016, the activists counted appeals from more than 30 cities. These cities are also situated in such prosperous areas as Moscow, the Leningrad and Moscow regions.

Last summer the activists of Patient Control facilitated the situation with interruptions in treatment of children and pregnant women in the AIDS centre near Moscow. 30 patients signed the petition after which the Federal Service for Surveillance in Healthcare conducted an unscheduled inspection at the AIDS centre near Moscow and in the regional Ministry of Health office.

In order to avoid the following situations, activists get updated on the formation of purchases for 2018 by raising the issue at a high authority level. On August 14, 2016 there was a meeting of patients with representatives of the Federal Service for Surveillance in Health Care and the Ministry of Health of the Russian Federation. The government informed activists about the expected additional financing in the amount of 4 billion rubles this year and the planned annual increase by 1.5 billion rubles in the budget for the purchase of medicines. However, according to the representatives of the movement this is not enough to solve the problem completely.

Improving quality

Side effects from the low-quality medicines is another issue patients are talking about. Due to the strong health issues that arise in response to therapy, people often abandon the existing treatment. A short list of the issues they face includes rash, kidney problems, lipodystrophy. It is difficult to get treatment replacement afterwards if the therapy scheme was changed according to medical or pseudo medical indications, because formally the therapy is still being provided.

Day prior to the meeting of the Commission on Vital and Essential Drugs (VED) on September 4, 2017 in Moscow Patient Control representatives addressed the Minister of Health of the Russian Federation. The request was to include VED in the list of contemporary drugs in 2018 for the treatment of HIV-infection and chronic hepatitis C. Following the meeting, the Commission made a decision to add six medications, four of them were also in the activists’ list. The Commission included two medicines for HIV infection treatment: dolutegravir, raltegravir for children and two for hepatitis C: dasabuvir/ombitasvir/paritaprevir/ritonavir and daclatasvir.

Activists are also working on the ways to achieve patient feedback in cases when ART was proven ineffective or had side effects. Patients along with the physicians will now be able to fill out an online form on the Federal Service for Surveillance in Health Care. This will help to improve the quality of medication control.

Treatment as prevention

The internationally recognized principle of treatment as prevention is one of the most effective and yet most underestimated ways to prevent the spread of HIV infection in Russia. The number of HIV infections in our country keeps growing and thus patients’ collaboration is extremely important.

At the Red Ribbon Award 2012 during AIDS 2012 in Washington, USA

The Patient Control movement is one of the communities in the Eastern European and Central Asian (EECA) countries dealing at a highly professional level with access to therapy of people living with HIV. SIMONA+ project is one of Patient Control initiatives aimed at systemic problem solving. This project studies access to medical and non-medical services for people living with HIV, as well as reacts to violations of patients’ rights by direct actions, press conferences and round-table discussions. Nowadays, SIMONA+ covers more than 13 entities of the Russian Federation. Its main goal is to improve the quality of HIV treatment and diagnostics, as well as to increase adherence among the representatives of key groups. Apart from serving patients’ interests, the project tries to minimize HIV spread among the general population.

The Patient Control projects are a community response to the epidemic. These projects consider the needs of people living with HIV and facilitate cooperation between specialists working in the AIDS control field. These merits have already been recognized once: at the 19th International AIDS Conference in Washington in 2012, the Patient Control initiative group was awarded the Red Ribbon Award for outstanding work concerning the AIDS epidemic. Promotion of such initiatives is declared as one of the leading goals for the 22nd International AIDS Conference, which will take place in Amsterdam next July. Representatives of the Patient Control movement plan to submit the report on their work in 2016-2018 to AIDS 2018.

Half of the HIV-Infected Population in Kyrgyzstan does not Receive any Treatment

Infectionist of the city AIDS center Erkin Bakiev knows the importance of counselling the patients on antiretroviral therapy

Author: Olga Ochneva, Kyrgyzstan

Valentina from Bishkek, Kyrgyzstan, found out about her HIV-positive status after her stay at the Russian hospital where she had several surgeries. HIV tests were negative before the surgeries. Valentina could not prove the doctor’s fault and returned home with some hope for the fallacy of diagnosis. When her diagnosis was confirmed, the woman received consulting and support from the doctors at the capital’s AIDS centre and started receiving the therapy.

“In the course of these six years, I have got acquainted with other patients, and then started working as a consultant myself,” Valentina is saying. “I can tell from my experience that most people who deny treatment are afraid of their status to be revealed and they lack information. For example, my husband is in jail now and he also has HIV. He does not receive antiretroviral therapy (ART) even though there is such a possibility in jail. Prisoners think that the therapy has severe side effects. I try to convince him, but he continues to refuse without even trying.”

People are afraid of discrimination and self-stigmatization after being diagnosed with HIV. For many years there was an information attack on HIV being a horrible deadly disease, the Deputy Director of the Republican AIDS Center Aibek Bekbolotov says. He hopes that in the nearest future it will be possible to draw people’s attention to the issue and tell them that HIV is a chronic controlled disease and when you are on treatment and have zero virus load, you cannot pass the virus on.

Today, 3,055 people in Kyrgyzstan receive ART. It makes 56% of all patients who are aware of their disease and 35% from the estimated amount of people living with HIV. According to the UNAIDS goals, the country has three years left to achieve the 90% treatment coverage of people diagnosed with HIV.

Not all doctors know about the mark

Khalida’s child was infected during the mass internal hospital infection case in the south of Kyrgyzstan in 2007-2008. At that time, the boy was admitted to intensive care unit because of an insect bite.

“After the scandal with the infection, doctors started mandatory HIV testing of children. My son was seven when he was diagnosed with HIV. We started receiving therapy, even though my husband and mother-in-law were against it. The boy is 12 now, and he is aware of his disease,” says Khalida. “Earlier we went to Osh regional AIDS centre. We currently receive treatment at the regional hospital where we live. In order to get additional treatment, we need to take a referral from the AIDS centre. I know other parents who deny that the diagnosis is written on the medical card. They occasionally meet doctors who do not know about the special mark on the referral and they can ask about the meaning of the mark in front of everbody.”

Decentralization of ART services to the primary level happened in almost all regions of Kyrgyzstan. It has become more convenient for patients to receive the service. Nevertheless, service in small regional hospitals sometimes jeopardizes the confidentiality of the therapy, as we can see with the mark or mentioning HIV openly on the medical card.

“We received several complaints on confidentiality disclosure. There are not many of them, but one or two such cases quickly spread in the community. They can cause distrust in service providers,” notes Aibek Bekbolotov. “On the primary level, the qualification of doctors in these issues is slightly lower, but we are constantly working on improvements in this area.”

The number of ART involved patients grows every year. Since 2012, the patient coverage has increased fivefold. In many respects, this was due to the introduction of WHO recommendations in the country. They expand the indications for the administration of ART therapy and seek to cover the treatment of all diagnosed patients.

30 out of 100 patients stop taking medicines

The indicators of adherence to treatment in the country improve every year. There is a wider range of medicines, which allows to lower the number of pills, the frequency of taking medications and to reduce side effects. Nowadays, about 60% of all patients, who take ART, achieve efficacy in treatment, that is, the suppressing of viral load to an undetectable level.

“Out of 100 patients who are annually connected to the therapy, 20-30 people stop taking medicine during the first six months. This is the most difficult period during which the possibility of side effects is higher,” says Aibek Bekbolotov. “If people continue the therapy for a year, the interruption rate will be no more than 10%. In vulnerable groups, such as drug users and sex workers, there are many everyday worries about finding a livelihood. It is harder for them to continue the treatment because of their life conditions.”

The evaluation of the effectiveness of treatment is carried out twice a year in accordance with the viral load indicators. Doctors interview their patients, look at the regularity of receiving medicines, remnants of medicines, and the general condition of patients.

“It is the regimen. I know that I need to take medicines. It also happens that I can miss a day or two, because I feel really bad after taking them,” says Valentina. “Doctors are not interested in how strictly I follow the regimen. Their job is basically to give out the medicine. I was tested for viral load in April, but I still have not received the results.”

At the beginning of this year there were difficulties with the purchase of test systems in Kyrgyzstan, the deputy director of the Republican AIDS Centre is saying. Therefore, the examination for viral load in the first quarter of the year was practically not carried out. Until 2016, there was only one laboratory in the country where the viral load was determined. Nowadays there are two such laboratories.

In Kyrgyzstan, they always work on the patient adherence to treatment. ART is purchased from the Global Fund. On the state budget, drugs are purchased for the treatment of opportunistic infections. Nearly 50 NGOs in the country work in the HIV sector.

90-90-90 Strategy was Discussed in Tajikistan

Civil sector representatives together with the heads of the AIDS prevention and control centers in Tajikistan worked out practical steps for the implementation of the voluntary counselling and testing (VCT) service in the activities of public organizations. They talked about this during the meeting National strategies of expanding access to HIV testing. Response measures for the implementation of UNAIDS strategy 90-90-90. Republican public organization AFEW Tajikistan shared its successes on September 6, talking about the work of its HIV voluntary counselling and rapid testing point in Qurghonteppa.

“Thanks to this meeting, now I have a vision of how to organize a VCT office in a public organization, where to start, what documents should be prepared and what services should be consulted beforehand. This meeting with its practical exercises, in my opinion, united us with the partners. This can influence the personal growth of each participant,” the director of Tajikistan Network of Women Living with HIV in Dushanbe Tahmina Haydarova is saying.

During the meeting, 50 representatives of state, public and international organizations from Gorno-Badakhshan Autonomous Region, Khatlon and Sughd Region, and the city of Dushanbe talked about the interaction of state and public organizations in providing integrated and coordinated services to key populations in the field of HIV, TB/HIV. They also got acquainted with the main provisions of new UNAIDS strategy 90-90-90, key activities of the National Program to Counteract the HIV/AIDS Epidemic in the Republic of Tajikistan for 2017-2020, and AFEW Tajikistan experience in integrating services and introducing VCT.

The meeting National strategies of expanding access to HIV testing. Response measures for the implementation of UNAIDS strategy 90x90x90 was held within Bridging the Gaps: Health and Rights for Key Populations project that is funded by the Dutch Ministry of Foreign Affairs.

Improving TB/HIV Prevention and Care in Kazakhstan

Kristina from Almaty, Kazakhstan was diagnosed with HIV when she was in prison. At first, the woman got scared because she did not know how to live with this diagnosis. Now the woman is the volunteer of the organisation ‘Doverie Plus.’ She advises girls on how to be adherent to the treatment, motivates to start the treatment, and conducts other various activities.

“My life was pretty hard until I met Alla and Roza from the fund ‘Doverie Plus.’ They explained me a lot and supported me. Before I met them, I did not know anything about antiretroviral therapy (ART) therapy, and how it affects HIV virus. They told me I had to take it, and I was taking it, but every day I took it in a different time, without knowing that I had to take it in the same time every day. Now I know that I have to have the regime with my medicine and I have to take it every day in the same time. I achieved a viral load of less than 500 copies. Before meeting Alla and Roza, I was often tired of my life. After our talks, I felt much better. I want to live, I am living, and I will be living,” Kristina says.

Public Fund ‘Doverie Plus’ is working within the project ‘Improved TB/HIV Prevention & Care – Building Models for the Future.’ The fourth year of the project is starting in October 2017. Launched three years ago, the project is aimed at establishing an effective partnership between public and non-public TB and HIV care providers in Almaty, Kazakhstan.

STOP TB partnership is established

“The project is unique in terms of the community involvement, strengthening, increasing capacity of community based NGOs, and building strong inter-sectorial collaboration in Almaty. All big achievements are built from little efforts. The little effort was done to improve the access to services for key populations on the city level and we succeeded,” the Executive Director of Public Foundation “AIDS Foundation East-West in Kazakhstan” Roman Dudnik is sharing. “We have a strong NGO Network, and it is linking with all existent service providers. In the end, all people in need have the possibility to get services related to HIV and TB. We plan to develop this approach further, and we want to increase the capacity and knowledge level of all stakeholders, including NGOs, state and private medical clinics. This project should become the best practice model for other cities of Kazakhstan and our neighboring countries.”

The project ‘Improved TB/HIV Prevention & Care – Building Models for the Future’ is aimed at increasing government recognition of the role and quality of the non-public sector for TB/HIV service delivery, providing TB/HIV services according to agreed standards, encouraging civil society to be the active participant in monitoring quality of services, ensuring that clients have affordable options and trust in service provision, stronger linkages between government, project and civil society.

“During three years of our work, we achieved understanding of the integrated TB/HIV care model among key stakeholders and gained strong political commitment and support from healthcare department of Almaty through establishment of the platform for partners’ dialogue,” a project manager of AFEW Kazakhstan Kristina Zhorayeva is saying. “We also established STOP TB partnership for the effective coordination and collaboration between all partners working in TB and HIV areas. Private clinics are now integrated with TB and project services, and thus the number of private clinics that are eligible to provide tuberculosis care is increasing. Besides, healthcare authorities of Almaty recognized the importance of project interventions directed to strengthening the role of local NGOs in provision of TB and HIV care. With their understanding, we have created the working group on HIV and TB.”

Created first NGO in the city for TB patients

One of the biggest achievements of the project is the creation of community based NGO. It is the first NGO in Almaty city aiming its activity on TB patients and their environment. Their start up showed successful work on self-support group and client management for TB patients. The Public Foundation ‘Sanat Alemi’ has the following activities: social mobilization, advocacy, communication of people affected by tuberculosis, TB/HIV, AIDS and other socially significant diseases, reducing stigma, discrimination and develop commitment to effective prevention methods, diagnostic, drug management and treatment.

The founders of ‘Sanat Alemi’ are people who were successfully cured of multi-drug-resistant tuberculosis and extensively drug-resistant TB. In addition, one of the founders is an independent expert on TB, has extensive experience in treatment, drug supply, monitoring and organization of TB-based activities nationally.

“The social support for tuberculosis patients plays a key role in increasing adherence to the treatment. The success in treatment is possible with the combination of trust, human relationships and the support of professionals, such as a psychologist and social worker,” the director of public foundation Sanat Alemi Roza Idrisova is saying.

The project ‘Improved TB/HIV Prevention & Care – Building Models for the Future’ is implemented with the support from the Dutch Government (DGIS), KNCV and its partners, AFEW International, HIVOS and PharmAccess.