Donbass: the HIV Epidemic Growing on Both Sides of the Border

Member of the Donbass battalion Aleksey with his wife. When he was taken captive, his wife secretly brought him medications. Photo: Mikhail Fridman

Author: Yana Kazmirenko, Ukraine

HIV is rapidly spreading in the east of Ukraine, which for over three years remains the area of military actions. For two years, pregnant women have not been tested for HIV, and medications could only be delivered illegally.

The armed conflict between Russia and Ukraine divided Donbass into two parts: areas controlled by the central Ukrainian government and the so-called Donetsk and Lugansk People’s Republics (DPR and LPR). The latter are controlled by pro-Russian separatists.

This Russian-Ukrainian conflict demonstrated the differences in the approaches of the two countries to HIV/AIDS treatment and prevention. Thus, in Russia opioid substitution treatment (OST) for people who inject drugs is banned. After Ukraine no longer supplied OST drugs to Donetsk and Lugansk, relevant programmes were also terminated in the areas not controlled by the Ukrainian government. According to experts, the war brought the region back to the 90s in terms of the spread of HIV.

Only half of those in need take the therapy

Sergey Dmitriyev, member of the Coordination Council of the All-Ukrainian Network of People Living with HIV says that there are 16 thousand HIV-positive people living in the areas of Donetsk region not controlled by the Ukrainian government. Only half of them take the therapy. In the Lugansk region, the situation is similar: 2.7 thousand people living with HIV registered, 1.4 thousand – taking the therapy.

On the territory controlled by the Ukrainian government, 13.6 thousand people with HIV positive status are registered, and over seven thousand receive the therapy. It is not surprising that the level of HIV prevalence here is 676.9 per 100 thousand people, which is 2.2 times higher than the average indicator in Ukraine. The highest rates are recorded in Dobropole (1,459.6 per 100 thousand people) and Mariupol (1,154.5).

Apart from the official statistics, the number of undetected HIV cases is at least the same as the number of cases registered as the epidemic in Donbass has long gone beyond the vulnerable populations.

AIDS centres across the border

Natalia Bezeleva, Head of the NGO “Club Svitanok”

Natalia Bezeleva, Head of the NGO “Club Svitanok,” thinks that during the three years of armed conflict only services and deliveries of medications have been re-established in the region. Currently, in the Ukraine-controlled areas , here are 22 sites to prescribe antiretroviral therapy. She remembers the deficit of antiretroviral drugs as a bad dream – her organization had to smuggle the drugs for over a year. Since 2016, the Global Fund has also joined the delivery of supplies, providing the necessary drugs, while UNICEF – the United Nations Children’s Fund – has been bringing the supplies to the “LPR” and the “DPR”.

Ms. Bezeleva illustrates failure of the established HIV/AIDS diagnostics and treatment system with the following fact: in 2014, the Donetsk regional AIDS centre remained on the territory not controlled by the Ukrainian government. Polymerase chain reaction (PCR) tests have not been transported through the newly created border, so for two years, no HIV diagnostics was done for children. Another big challenge was the deficit of doctors – most health professionals left the area of the armed conflict.

According to Ms. Bezeleva, the situation improved in 2016, when the Donetsk regional AIDS centre was opened in Slavyansk. Today, thanks to the support of the Global Fund PCR tests of adult patients are taken to Kharkiv and children’s PCR tests are delivered to Kyiv. There are also first achievements in diagnostics: in 2016, over 113 thousand people or 5.8% of the total population of the region were tested for HIV, and in the nine months of this year 84 thousand people have already been tested.

The military: testing for the contracted soldiers

A social worker visits an HIV-positive TB patient in the TB treatment clinic in Donetsk. Photo: Mikhail Fridman

Even in the peacetime, the military face the risk of infections, in particular HIV, tuberculosis and hepatitis, which is 2-5 times higher than in the general population. At war, this risk grows 50-fold.

In the area of armed conflict, there are 60 thousand of Ukrainian soldiers. According to the result of the research study conducted by the Alliance for Public Health, about 4% of the military enter the conflict area with an HIV positive status, while the percentage of HIV-positive soldiers leaving the area is doubled and reaches 8-8.5%.

Activists of civil society organizations say that the military should be covered with prevention programmes and convinced that they need to be tested. Another important issue is equipping the military first aid kits with condoms.

HIV/AIDS Surveillance in Europe 2017-2016 Data Released

On 1st of December, we mark World AIDS Day (WAD) to raise awareness about HIV and its impact on individuals and societies around the globe. WAD 2017 in the WHO European Region will focus on the problem of late HIV diagnosis – the high number of people who are diagnosed with HIV at a late stage of infection with consequences for individuals’ health and survival, and for the community where HIV can transmit further.

With this message, we invite you to join us and mark the World Aids Day 2017 in your country.

On 28 November 2017, WHO/Europe and ECDC jointly released the annual report on HIV/AIDS surveillance Europe, containing the latest available surveillance data.

Similar to recent years, the highest proportion of HIV diagnoses (40%) was reported to be in men who have sex with men (MSM). However, for the first time in a number of years, several countries reported a decline in new HIV diagnoses, even after adjusting for reporting delay.

While the data in this year’s report indicate alarming rates and increases in new diagnoses in some parts of eastern and central Europe over the last decade, at the same time there has been a tendency towards stabilising or even decreasing rates in some EU/EEA countries.

Trends by transmission mode, for example, show that the number of HIV diagnoses among MSM in the EU/EEA decreased slightly in 2016 and the number of heterosexually acquired cases has decreased steadily over the last decade.

Moreover, in the EU/EEA, the number of AIDS cases, and the number of AIDS-related deaths, has consistently declined since the mid-1990s.

The report on HIV/AIDS surveillance in Europe 2017 – 2016 data is available here.

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.

AFEW Chairman Becomes HCV Change Maker

Board Chair of AFEW International Jeffrey V. Lazarus has recently become one of the 2017 HCV Change Makers from the Economist Intelligence Unit (EIU). The Change Makers programme recognises 18 Hepatitis C Virus (HCV) innovators doing exemplary work in the programme’s three thematic areas: multi-stakeholder approaches; screening; and technology. Their ground-breaking efforts can inspire and guide their peers on the path to HCV elimination. The programme also aims to spark debate and action on HCV policy and access to care.

AFEW‘s Board Chair is awarded for his work in technology. Being the associate researcher at the Barcelona Institute for Global Health, Hospital Clínic, and affiliated professor at the Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Jeffrey Lazarus leads a large-scale digital survey of Hepatitis C patients in Europe. Together with leading stakeholders, Prof Lazarus and his colleagues now plan to repeat the survey on a regular basis, ensuring alignment with the objectives of the WHO Global Health Sector Strategy on Viral Hepatitis.

“The EIU changemaker award is a great recognition of the importance of involving patients in the hepatitis prevention, treatment and care that they need and deserve. My colleagues and I will continue to look for ways to further this agenda,” Jeffrey Lazarus is saying.

Hep-CORE’s 39 questions ask about national coordination, disease monitoring, prevention, testing and treatment. Among them: In your country, are there any HCV testing/screening sites outside of hospitals for the general population? In your country, is there a clear linkage-to-care mechanism so that people who are diagnosed with Hepatitis B and C are referred directly to a physician who can manage their care? Prof Lazarus and his team used Research Electronic Data Capture, an open-access web-based online data collection tool, to design the survey.

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.

The Need for a European Union Communication and Action Plan for HIV, TB and Viral Hepatitis

Author: Anke van Dam, AFEW International

For a couple of years, European civil society organisations advocate for a new European Communication and Action Plan for HIV. In the World Health Organisation, new HIV diagnosed infections in European region increased by 76%. These infections more than doubled in Eastern Europe and Central Asia (EECA) from 2005 to 2014. The whole European region accounted for 153 000 reported new infections in 2015 (ECDC 2017). The cumulative number of diagnosed infections in the European region increased to 2,003,674, which includes 992,297 cases reported to the joint ECDC/WHO surveillance database and 1,011,377 infections diagnosed in Russia, as reported by the Russian Federal AIDS Center.

Co-infection in the EECA region

According to ECDC monitoring and the WHO Europe HIV action plan  adopted in September 2016, these underline the high rate of tuberculosis (TB) and hepatitis B and C coinfection among people who live with HIV (PLHIV). In 2014, TB was the most common AIDS-defining illness in the eastern part of the region.

Of the estimated 2.3 million PLHIV who are co-infected with hepatitis C virus globally, 27% are living in the EECA region. An estimated 83% of HIV-positive people who inject drugs live with hepatitis C in the eastern part of the region.

Plan was prolonged

The European Union had a Communication ‘Combating HIV/AIDS in the European Union and neighbouring countries, 2009–2013’ and its associated Action Plan.

The overarching objectives of the Communication were to reduce the number of new HIV infections in all European countries by 2013, to improve access to prevention, treatment, care and support, and to improve the quality of life of people living with, affected by, or most vulnerable to HIV/AIDS in the EU and neighbouring countries. This Plan has been prolonged for another three years. It was followed up with a Commission Staff Working Document: ‘Action Plan on HIV/AIDS in the EU and neighbouring countries: 2014-2016.’’

Already during the period of the prolongation and for three years, the European civil society organisations, including AFEW International, that work in the field of HIV, are advocating for the new communication and action plan. So far without success, despite the fact that according to the evaluation, the Communication and its Action Plan were seen by stakeholders to have provided the necessary stimulus, continuous pressure and leverage for various stakeholders to advocate for and take actions against HIV/AIDS in Europe.

Response is developed

The epidemiology of the three diseases – HIV, TB and viral hepatitis – urged the European Commission to develop a ‘Response to the Communicable Diseases of HIV, Tuberculosis and Hepatitis C’ in 2016. Next to this, the European Commission changed the civil society forum on HIV and AIDS, an advisory body to the European Commission into a civil society forum on HIV, TB and viral hepatitis in 2017, in which AFEW International takes part. This combined focus from the European Commission and civil society organisations could give an impulse to meet the needs for prevention, treatment and care for the three diseases.

Actions within the plan

The European civil society organisations developed a list of actions that should be included in the new communication and action plan.

Prevention needs to be scaled up: HIV can be prevented by a combination of proven public health measures. Yet two third of the European countries do not have a prevention package at scale. Pre-exposure prophylaxis (PrEP) is only provided in a couple of countries.

Treatment access needs to be scaled up: treatment and early treatment improves the health outcomes of the patient and prevents onward transmission. Therefore, countries should scale up testing and offer treatment upon diagnosis and remove barriers to testing and linkage to care. Governments should remove political, legal and regulatory barriers preventing communities most affected by HIV (people living with HIV, gay men and other men having sex with men, migrants, people using drugs, sex workers, transgender person, people in detention) to access health services.

Medicines should be affordable: the price of medicines is still a major barrier to the implementation of treatment guidelines and combination preventions strategies including pre-exposure prophylaxis (PrEP).

Community-based services as one of the components of the health system: include and recognise community base services who can deliver services closer to affected populations as important part of the health system. Invest in them.

AFEW advocates for the plan

In July 2017 the European Parliament adopted the resolution on the EU’s response to HIV, tuberculosis and viral hepatitis. This is an important step towards a communication and action plan. The EU commissioner for Health and Food Safety Mr. Andriukaitis expressed that he is in favour, and a couple of governments also feel a need for such plan. The European Commission and the Commission on Public Health Directorate are still silent though.

AFEW International, together with many governmental and non-governmental organisations, think that the International AIDS Conference in Amsterdam in July 2018 would be a wonderful opportunity and the right moment for the European Commission to present its intentions and good will to fight HIV, TB and viral hepatitis by a communication and action plan. Civil society will not stop to advocate for this. Otherwise we feel that European citizens will be left behind.

AFEW Supports International Viral Hepatitis Elimination Meeting

The International Viral Hepatitis Elimination Meeting (IVHEM) will take place in Amsterdam on the 17-18th November 2017. The registration for the meeting is already opened and the program is announced. Since many AFEW International’s strategical activities are aimed at eliminating viral hepatitis in Eastern Europe and Central Asia (EECA), AFEW is glad to share the information about this event.

IVHEM is a global forum for the exchange of practical experiences for translating diagnostic and therapy advances of viral hepatitis into broad applications that accelerate progress toward elimination of viral hepatitis as a public health threat by 2030. Community organisations, researchers, public health practitioners and clinicians will come to Amsterdam for the meeting. The program includes practical examples of innovative intervention studies, country elimination programs and novel funding mechanisms testing and treatment, all focusing on meeting the 2030 targets.

With prevalence as high at 80-90%, Eastern Europe and Central Asia has some of the highest rates of hepatitis C among people who inject drugs in the world. AFEW has a broad approach towards groups in society that are at risk for HIV, TB and viral hepatitis and who have limited access to health services in the EECA region. Challenges in the region remain the same for many decades: instance repressive drug policies; stigma and discrimination of injecting drug users, people who live with HIV, sex workers and inmates; poor access to prevention and treatment of HIV, TB and viral hepatitis; inadequate coverage of treatment and affordable medicaments. Besides, international donor funding for harm reduction programs is decreasing.

You can find the flyer about the International Viral Hepatitis Elimination Meeting here. You can register for the meeting here, and find a program here.

EECA Organisations Supported Michel Kazatchkine

Michel Kazatchkine, United Nations Secretary-General’s Special Envoy for AIDS in Eastern Europe and Central Asia

AFEW International has reached out to organizations and networks in Eastern Europe and Central Asia with the request to sign the support letter for re-appointment of Michel Kazatchkine as United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia.

His contract/mandate as UN special envoy on HIV/AIDS for Eastern Europe and Central Asia ends on 30 June. His role in addressing three epidemics in the region (HIV/AIDS, tuberculosis, hepatitis) and to raise awareness at political and scientific level of the concerns regarding HIV, TB and viral hepatitis in the EECA region is crucial and very important, especially now as we have the opportunity to highlight the challenges and successes of the region at AIDS2018 Conference. Therefore, there is a dire need for a continuation of his support.

The letter, signed by more than 70 signatories has been sent to United Nations Secretary General António Guterres. You can read the letter here.

Call for Abstracts: Hepatitis-C Community Summit in Amsterdam

hep-c

AFEW International is glad to announce the call for abstracts for Hepatitis-C Community Summit that will take place in Amsterdam in April of 2017.

With the new medicines now available an opportunity exists to completely eradicate hepatitis C.  However,  a crucial factor for success will be the involvement of people living with hepatitis C. Also it will require pharmaceutical companies, governments, doctors, and health purchasers to come together to ensure these medicines are quickly available to all.

Please submit your abstract about innovative approaches, community initiatives, successful advocacy examples, successful ‘from research to practice’ examples before the 19th of February. You will be informed about acceptance at the end of February.

The meeting takes place in the heart of Amsterdam. A number of well known speakers already confirmed their participation.
You can find more information at www.hepatitiscommunitysummit.eu

The team of supporting organisations:

Correlation Network Hepatitis C Initiative

European Aids Treatment Group (EATG)

European African Treatment Advocates Network (EATAN)

European Network of People Who Use Drugs (EuroNPUD)

European Lever Patient Association (ELPA)

International Doctors for Healthier Drug Policy (IDHDP)

Aids Foundation East West

Alliance for Public Health, Ukraine

Fixpunkt, Germany

Hepatitis Info, Nederland

Prometheus Foundation, Greece