EECA INTERACT 2019

We are pleased to announce that, on the 18-19th November 2019, the first EECA INTERACT Workshop 2019 will take place in Almaty, Kazakhstan.

The EECA INTERACT 2019 Workshop builds scientific research capacity while simultaneously strengthening clinical, prevention, and research networks across the Eastern Europe and Central Asia (EECA) region. EECA INTERACT 2019 is an abstract-driven workshop focusing on factors unique to the region’s HIV, TB, and hepatitis epidemics. Bringing young and bright researchers together with top scientists, clinicians, and policymakers, EECA INTERACT 2019 aims to ignite a conversation that will build a stronger scientific base to serve the region and connect to the world.

EECA is the only region in the world where the HIV epidemic continues to rise rapidly. UNAIDS estimates point to a 57% increase in annual new HIV infections between 2010 and 2015.1 The World Health Organization has warned of a sharp rise in rate of HIV and tuberculosis coinfection, which poses a real threat to progress.2 Significant barriers to prevention and treatment services remain for people living with and affected by HIV, TB, and hepatitis across the region. For example, although the HIV epidemic in EECA is concentrated predominantly among key populations, particularly among people who inject drugs, coverage of harm-reduction and other prevention programs is insufficient to reduce new infections. The region urgently needs more effective strategies of prevention, treatment, and care and support that are tailored to the particular circumstances of individual countries.

The Amsterdam Institute of Global Health and Development (AIGHD) has over a decade of experience delivering in-country workshops and conferences that bring young researchers and established international experts together to share original research and state-of-the-art reviews on a wide range of topics. AIGHD has co-hosted the INTEREST Conference (the International Workshop on HIV Treatment, Pathogenesis, and Prevention Research in Resource-limited Settings) since its inception in 2007. The conference has grown from a small workshop to a full conference of more than 500 attendees each year.

Building on these proven results, AIGHD will collaborate closely with AFEW International and the AFEW network (AFEW) for EECA INTERACT 2019. AFEW’s deep roots and experience in the region offer a way to build sustainability into the new workshop, placing priority on local contributions. The EECA INTERACT 2019 will bring scientists, clinicians, members of civil society, and government officials together to tackle topics facing individual countries while building capacity and strengthening research and clinical networks. The two-day conference will focus on topics that are specifically relevant to EECA and dive deeply into particularities of the host country Kazakhstan, showcasing its successes, remaining challenges and responses.

The workshop objectives are:

  • To provide cutting-edge knowledge in the fields of epidemiology (modelling), treatment, pathogenesis, and prevention of HIV, TB, and viral hepatitis as well as chronic conditions;
  • To exchange ideas on providing and supporting HIV testing services and clinical care provision to adults, adolescents, and children living with HIV to achieve 90-90-90 goals;
  • To foster new research interactions among leading investigators and those who represent the potential future scientific leadership for health care and research in the region;
  • To build research and clinical capacity across EECA.

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

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

Nonexistent? We exist!

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

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

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

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

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

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

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

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

 

 

“Orange morning”

On the 28th of June, in the framework of the project Fast-Track TB/HIV Responses for key populations in EECA (Cities) Almaty city in Kazakhstan held an important event for the community of people who use psychoactive substances – a photo exhibition “Orange morning”. The event was organized in honor of the World Campaign “Support. Don’t Punish”, which is held annually on the 26 of June, on the International Anti-drugs Day.

#SupportDontPunish is a global grassroots-centered initiative in support of harm reduction activities and drug policies that prioritize public health and human rights.

The color of this protest and the need to overcome aggressive drug policies and stereotypes against people who use psychoactive substances, with a focus on women, has become orange.

Women, the characters of the photos, shared their life stories about aggressive drug policies and systems that destroy their lives. The event organizers say that the main goal of the exhibition is not to appeal to emotions, not to cause regret, sympathy, condemnation or contempt. The goal is to call for the end of this senseless war that doesn’t bring any results. The war on drugs is beneficial only to politicians, law enforcement agencies and drug mafia.

AFEW Kazakhstan in the face of Roman Dudnik, executive director of the organization, supported the exhibition. “The greatest value of such events is that the campaign “Support. Don’t punish” is becoming more and more popular and followed in the world, and this is an excellent result,” Roman says.

A video report from the exhibition you can watch here https://youtu.be/1qS6J4gwfbw.

 

 

 

Daria Alexeeva: “The Majority of Applications to the Emergency Support Fund Come from Russia”

Author: Olesya Kravchuk, AFEW International

Starting from December 2018, organisations from 10 countries in Eastern Europe and Central Asia can receive small grants with a maximum amount of €5,000 per grant. AFEW International and Aidsfonds started awarding emergency grants in the framework of the Emergency Support Fund for Key Populations (ESF). The activities of the Fund are financed by the Elton John AIDS Foundation and Aidsfonds. With these small grants AFEW International and Aidsfonds support organisations representing key populations in surviving in difficult situations which they face due to legal barriers, stigma and discrimination, financial challenges and political restrictions. Support is given to organisations carrying out activities that ensure access to HIV prevention, treatment and/or services for key populations, or projects protecting the human rights of key populations. The total funds available in the Emergency Support Fund is equivalent of the 750,000 pound sterling.

Today we are talking with AFEW International’s program manager Daria Alexeeva about the first results of ESF’s work, and what it takes to be awarded the small grant.

– What are the first results of Emergency Support Fund’s work?

– During this first phase, our main tasks were to set up the grant application process, the selection procedure and the infrastructure for receiving and qualifying applications. All three aspects were ready by December 1, 2018. The invitation to apply for a grant from the ESF was spread widely in the networks of AFEW, Aidsfonds and the members of the Advisory Board. In December 2018 AFEW International has established a system to administer grants to applicants. On January 4th the first meeting of the Operational Team took place to review first applications. Since December 1, 2018 we received 96 applications, of which 42 (44%) were approved for grants. The total committed amount by the end of March 2019 was Euro 235.000.

– What countries are applying to the Fund the most?

– The majority of applications came from Russia. We received 45 applications from the Russian Federation and awarded 22 applications. The next most active country was Tajikistan with 15 applications, and 7 being awarded. The third one was Ukraine with 16 applications, 5 of which were awarded.

– What problems do organisations address the most?

– More than half of the awarded grants are targeting people living with HIV (PLHIV) – 55%. One third of all awarded grants went to the projects which provide support to communities of LGBTI, and one third – to communities of men having sex with men (MSM). One third of the awarded grants support projects for people using drugs (PUDs). The equal amount of the awarded grants – 21% – supports projects for sex workers and vulnerable women.

– How does the Fund help to solve the problems organisations have?

– We are helping with a broad range of emergencies. We have several goals within the Fund. The first one is contributing to decline in the annual number of new HIV infections in Eastern Europe and Central Asia (EECA). The second goal is increasing access of everyone who is living with HIV in the EECA region to treatment. The third goal is full funding of the AIDS response in EECA.

Thus, we are funding activities, which contribute to these goals. Among the grants we awarded are projects aimed at the provision of harm reduction services, HIV testing and referrals for the treatment for difficult to reach populations (MSM, LGBTI). We have funded repairing mobile units for outreach work, purchasing milk formula to secure stock for HIV positive women. We support project working for disabled PLHIV making sure they are able to adhere to their treatment regimens, and projects which help prisoners getting access to testing and treatment, and to adhere to their treatment after they are released from prisons. Besides, there are projects organising trainings of the medical staff with the goal to form a tolerant attitude towards key populations, for instance, transgender people, in order to improve access and quality to health services and antiretroviral treatment. We also support advocacy activities to raise awareness of the needs of the key population and to call for the funding increase, for instance, provide legal support to cases of rights violation in prisons to generate evidence for advocacy. There are much more issues we support that are aligned within our three goals that I have mentioned before.

– What type of applications is being rejected by the Fund?

– Some of the projects are one-off events which are not carefully thought through from the sustainability point of view. For instance, conducting training for outreach workers without creating a system to support their work in the future. Besides, there are projects which are contributing to solving a real emergency situation. Some of the proposals are just weakly written. In all cases, we provide feedback and advice on how to improve the proposal if an applicant decides to submit again.

– What are ESF’s plans for the future? How many projects do you plan to support in 2019 and in the years afterwards?

– We plan to support at least 100 applications and maybe even more in the period till the end of 2020. We will continue supporting applications until the total funds that are available will be exhausted. We might be done in the middle of 2020 already. The amount of grants to be awarded depends on the size of the requested funds. In some cases, we allow a grant up to 10,000 euro, in particular when the project is contributing to solving situations which concern bigger groups of key populations or when the project is contributing to generating the evidence needed for developing prevention programs and advocacy towards national or local governments. When the emergency situation cannot be solved with 5,000 euro – then the bigger amount is awarded as well. We foresee a little fewer approved grants in the second quarter of 2019. By the way, there will be a summer break in the reviewing of applications from 8th July till 16th August due to holidays.

AFEW-Kyrgyzstan Started the Year with Rebranding

By changing the name “AIDS Foundation East-West in the Kyrgyz Republic” at the beginning of the year 2019, AFEW-Kyrgyzstan emphasized its involvement in the international AFEW Network. Another reason for changing the name and logo of the organisation is the expanding capabilities.

“Now we are working not only in the field of HIV and AIDS. We are implementing tuberculosis treatment projects, conducting large-scale researches, carrying out advocacy campaigns to protect the rights of people and for the economic empowerment of women. Therefore, the former name no longer fully reflects our goals and values,” says the Chair of the Board of AFEW-Kyrgyzstan Natalia Shumskaya.

The new logo has retained one of the key elements of the previous one – the human figure, because everything AFEW does is aimed at helping specific people. The figure also shows that AFEW-Kyrgyzstan works, involving people from the community, and for them.

Three blue and one red objects around the white pattern represent different countries since AFEW-Kyrgyzstan is a part of an international network and is ready to use the experience of foreign partners to build a healthy future in the country.

In an updated form, AFEW-Kyrgyzstan is ready to welcome its old partners again and look for new opportunities to help people from key populations.

Michel Kazatchkine: “Failure to Interact with Vulnerabilities Could Lead to an Increase in the Epidemic”

The Chair of AFEW International’s Board Michel Kazatchkine and director of the organisation Anke van Dam during the 22nd International AIDS Conference. Photo: AFEW International

The inaugural World AIDS day was held on December 1st, 1988. The epidemic was raging across Western Europe and the United States. The world was only starting to realize the existence and the magnitude of the African epidemic. HIV was virtually absent from the Russian Federation. There was no treatment for HIV infection. AIDS was a death sentence, as we, physicians, were painfully witnessing every day in hospital wards.

30 years later, while no country has been spared of HIV, we cannot overestimate the progress that has been made. Extraordinary progress in science, research, and development, that has successfully translated into large-scale prevention and treatment programs in almost all settings, globally.

21 million people are now accessing antiretroviral treatment across the world. Life expectancy of an HIV-positive person on treatment is now similar to that of HIV-negative people. And we now know that an HIV-positive person whose virus has been suppressed with treatment will no more transmit the virus to a sexual partner, meaning that antiretroviral treatment also contributes to prevention of HIV transmission and to limiting the epidemic at the population level. In the last 10 years, the number of new HIV infections and AIDS-related mortality decreased by close to 40% globally. The hope generated by the progress has led the United Nations to commit to the goal of eliminating HIV by 2030.

Yet, an objective analysis of the situation today shows that the world is off track in achieving this target. The Russian Federation and, more broadly, the Eastern European and Central Asian region, are of particular concern.

Eastern Europe in the last five years is the only region of the world where both the annual number of new cases of HIV infection and of AIDS-related deaths continues to grow. The number of new infections reported in the region increased by 30% between 2010 and 2016. Over a million people are now estimated to be living with HIV in the Russian Federation; one in five do not know their status. It is timely then, that the theme of this year’s World AIDS day is “Know your status.”

Breaking down the raw numbers reveals an unsettling scenario. 45% of the people who know their positive status are on treatment and 75% of these are virally suppressed.

This means that, at the end, only approximately 27% of the total estimated number of people living with HIV are virally suppressing their infection and that a large pool of people with HIV can potentially transmit the HIV infection. All this in a context where national prevention efforts are lagging behind and fragile at best.

The ministry of Health aims at increasing treatment coverage to reach 75% at the end of next year and rightly points out how important it is to urgently address some of the myths and misinformation that prevent people from accepting treatment.

The HIV epidemic in Russian Federation is largely an epidemic of so-called “key populations” and their sexual partners – people using drugs, men who have sex with men, sex workers, migrants, prisoners – often marginalized groups of the population for whom stigma, discrimination, and criminalization drive many of these people underground, away from outreach workers and so with limited access to prevention  and treatment services.

An effective response to the epidemic within the Russian Federation should, therefore, entail a focus on specific geographic areas and populations. It also means seizing many immediate opportunities to build onto the HIV platform, the “SPID centers”, to provide additional services, including diagnosis and, as much as possible, integrated treatment of tuberculosis and hepatitis, as well as prevention services including “pre-exposure prophylaxis” for men having sex with me and provision of clean needles and injection materials for people who inject drugs.

When and where this kind of efforts have been employed around the world we know the outcome: a decline in new infections, a decline in the pool of infectiousness and improved control of the epidemic in general by the authorities.

We also know that failure to engage with most vulnerable and at-risk groups of people can bring – a growing epidemic that becomes increasingly more difficult to reign in.

A recent modeling study has shown, for example, that without integration and scaling up of needle exchange programs and antiretroviral therapy, HIV prevalence would remain as high as 60% among people who inject drugs in Ekaterinburg. Scaling up of the interventions would – in contrast – significantly reduce that prevalence and deaths associated with HIV. If the interventions were to cover 50% of people in need and to also include opioid maintenance therapy with methadone, currently unavailable in the Russian Federation, over 30% of HIV infections and HIV-related deaths could be prevented in Ekaterinburg.

The science and the experience from many countries, particularly in Western Europe, tell us that these approaches can best be implemented in a working partnership with civil society, recognizing the additional and complementary strengths brought by community-led services. In Saint Petersburg, joint efforts of the AIDS center and civil society to bringing testing closer to people in need of it and linking people to care, have led to significant decrease in the number of new infections and increase in treatment coverage. Civil society groups, in this case, are supported by both Presidential and municipal grants.

We should be encouraged by the integrated approach formulated both in the National strategy adopted by the Russian Federation two years ago and in recent guidelines on the prevention of HIV among key affected populations. A clear progress can be noticed in some regions of the country with regards to the partnership with civil society and service provision.

The challenge for the country is to translate what is on paper and high-profile statements into concrete policies that simultaneously sustain appropriately funded programs and engage in the structural and legislative reforms needed to remove obstacles that still impede access to prevention and care. Without such an approach, HIV infection in Russia will continue to grow faster than the efforts to fight it.

Michel Kazatchkine is the Special Advisor to the Joint United Nations Program on AIDS (UNAIDS) in Eastern Europe and Central Asia

Source: kommersant.ru

Online Compendium of Good Practices for the Long-Term Health of People Living with HIV Launched

Professor Jeffrey Lazarus (on the right) of ISGlobal, Hospital Clínic at the University of Barcelona. His scientific work includes leading the HIV Outcomes: Beyond Viral Suppression, the European Hep-CORE and the Hepatitis Continuum of Care consensus studies

HIV Outcomes today, on 27 November, launches an Online Compendium of Good Practices for securing the long-term health and well-being of people living with HIV.

Although people with HIV can now anticipate near-normal life expectancy, there are unique needs that must be met if their quality of life is to match that of the general population. As life expectancy for people with HIV has increased, additional unmet requirements for good long-term health and well-being have emerged.

The launch event in the European Parliament today highlights the key findings underpinning the Compendium and emphasises what makes these good practices important to people with HIV. The Compendium represents the latest output from work of the HIV Outcomes collaboration, building on the group’s road-testing of its 2017 recommendations on the long-term health, well-being and chronic care of PLHIV in Italy and Sweden this year. Looking at ways to apply the recommendations in real-world settings has provided vital insights into how to ensure they are taken up more widely. The Compendium is a resource that will inspire and support key stakeholders across Europe to meet the specific care needs of people living with HIV for the long-term.

“We cannot afford to be complacent; improvements in life expectancy for people with HIV need to be matched with improved life quality,” said Nikos Dedes, Chair of the European AIDS Treatment Group and Co-Chair of the HIV Outcomes Steering Group. “We know, from the preliminary work in Sweden and Italy, that these recommendations have the capacity to make a real difference. We need to do whatever is necessary to implement these recommendations and make sure that people with HIV in every country can benefit from this knowledge.”

During the event, co-hosted by Members of the Parliament (MEPs) Christofer Fjellner (EPP, Sweden), Karin Kadenbach (S&D, Austria) and Frédérique Ries (ALDE, Belgium), speakers will stress that the needs of people living with HIV go far beyond suppression of HIV. In a joint statement, the three MEPs from across the political spectrum said: “This is a timely reminder that there is more to life with HIV than viral suppression; proper quality of life is equally important. Now that we know what is needed, it is our duty as policymakers to press for changes to secure the long-term health of people living with HIV.” Given the upcoming European elections, the support of such a wide range of MEPs will be essential to keep the needs of people with HIV on the political radar.

During 2018, HIV Outcomes ensured that the recommendations launched last year have been fully tested and are implementable. Having identified the barriers to be overcome, in 2019 the initiative will focus on implementing the relevant recommendations in Italy and Sweden and will work to broaden the roll out of the recommendations across Europe.

For those diagnosed and treated early, HIV is now a long-term, rather than a fatal, condition. HIV Outcomes’ recommendations have been designed to address the needs generated by today’s increased life expectancy, looking to improve health outcomes and quality of life of people with HIV. The launch of the Compendium comes during European Testing Week and just ahead of World AIDS Day on 1 December.

The HIV Outcomes policy recommendations

  1. Adopt an integrated, outcomes-focused, and patient-centred approach to long-term care
  2. Expand national monitoring of long-term care and outcomes
  3. Fund studies to provide information on the long-term health of people living with HIV
  4. Combat stigma and discrimination within health systems.
  5. Upscale involvement of the HIV community in priority setting at country level

Source: www.hivoutcomes.eu / @hivoutcomes

The Advisory Board to the Emergency Support Fund for Key Populations Starts to Function

The Advisory Board to the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia (EECA) starts to function. The Fund will support Eastern European and Central Asian registered and non-registered NGOs and CBOs that represent key populations and that are surviving in difficult situations which they face due to legal barriers for key populations, stigma and discrimination, financial and social challenges and political restrictions. The activities of the Fund are implemented by AFEW International and AIDSFonds and financed by the Elton John AIDS Foundation.

The Advisory Board will ensure genuine connection to the situation in the EECA and give a guidance provision on the economic, political and epidemiological developments in the countries of the region. The Board advises the operational team of the Emergency Fund on strategic development of the Emergency Support Fund. The funding decisions will be made by the operational team.

The Advisory Board consists of eight members of the EECA region (see the table below) representing expertise in the programming and advocacy for all key populations: people living with HIV, people using drugs, young people, LGBTQ and MSM, and sex-workers.

The Advisory Board will meet once a year in person. Regular conference calls will take place every three months to revise the progress, exchange updates on the situations in the countries of EECA and adjust the Emergency Grant Fund conditions if necessary, as part of the learning process.

The first meeting of the Advisory Board will take place on 26 November 2018 in Amsterdam. During this meeting, the members of the Board will profoundly review the Emergency Fund documentation and call for proposals, eligibility criteria, evaluation process and criteria, and look at the set of relevant emergency situations. They will also share the latest updates from the EECA region and agree on one-year planning for the Board.

Name
Organisation
Position
Vladimir Mayanovsky
ECUO/Eastern Europe
and CentralAsian
 network of PLWHIV
Member of the management board
Ilya Lapin
CCM of the GF grant in Russian Federation) http://rusaids.net/ru/
PLWHIV representative with the voting power
Grigory Vergus
International Treatment
preparedness
Coalition in EECA, ITPCru
Regional Coordinator
Vitaly Djuma
Eurasian Coalition on Male Health (ECOM)
Executive Director
Igor Gordon
Eurasian Harm Reduction Association EHRA
Programs team lead
Svitlana Moroz
Eurasian Women’s Network on AIDS
Head of the Board
Nurali Amanzholov
Association of legal entities Central Asian Association of People Living with HIV
CEO
Yana Panfilova
Adolescent’s network
Teenergizer
CEO & Founder

 

Under 16 and Above: Protecting the Rights of Adolescents and Preventing HIV

Author: Yana Kazmirenko, Ukraine

Shortage of HIV prevention programmes for young people was one of the key topics discussed at the 22nd International AIDS Conference (AIDS 2018). At the conference, AFEW-Ukraine presented its best practices in HIV response among young people. Since 2012, it has been supporting the initiatives aimed at most-at-risk adolescents within the Bridging the Gaps: Health and Rights for Key Populations project funded by the Dutch Ministry of Foreign Affairs.

Gaps analysis

Over the course of project implementation, social welfare centres for adolescents who use psychoactive substances were established in Kharkiv, Poltava, Kropyvnytskyi and Chernivtsi and a rehabilitation day care centre for such young people was opened in Chernivtsi. In 2017 only, over 12 hundred adolescents received 21,290 services in those four cities.

Olena Voskresenska, Director of AFEW-Ukraine, recalls that when the project just started, a gap analysis was conducted. It turned out that there were a lot of programmes for adults who use drugs, while few donors were supporting similar activities for adolescents. It was considered that this population does not make a considerable contribution to the HIV epidemic. Thus, both most-at-risk adolescents and generally schoolchildren and students of vocational training centres remained out of focus.

“Of all the countries involved in Bridging the Gaps project, Ukraine is unique in terms of the activities implemented for under-age drug users. We work with non-injecting drug users trying to prevent them from switching to injecting drugs,” says Olena.

Children do not use drugs

One of the main achievements of AFEW-Ukraine is developing a tool to monitor the violations of human rights of most-at-risk adolescents. Questionnaires are used to collect data on adolescents’ rights violations, providing urgent response and legal support. Iryna Nerubaieva, AFEW-Ukraine Project Manager, thinks that in the Ukrainian society there is a strong belief: children cannot use drugs and they do not use them.

“This community is invisible and unheard. Most often, adolescents do not know about their rights, do not know that they have any rights or how these rights are to be protected,” says Iryna.

Adolescents – mostly high schoolers and students of vocational training centres – are brought to the community centres by their friends. Often they are referred by social welfare institutions, departments of juvenile services and even police.

Currently, AFEW-Ukraine works in four cities of Ukraine: Kharkiv, Chernivtsi, Kropyvnytskyi and Poltava. Besides, thanks to the cooperation with Alliance for Public Health, since 2017 the activities for adolescents, including monitoring of human rights violations, have been conducted in five more cities of Ukraine.

Testing as a prevention tool

At the conference, Yevheniia Kuvshynova, Executive Director of Convictus Ukraine, implementing partner of AFEW-Ukraine and Alliance for Public Health, told about the Voice of Adolescents project, which covers 717 adolescents.

The Underage, Overlooked: Improving Access to Integrated HIV Services for Adolescents Most at Risk in Ukraine project is aimed at teenagers who use drugs and live in small towns and villages in seven regions of Ukraine. Adolescents from Kyiv attend the Street Power youth club. In this club, teenagers who use psychoactive substances and practice risky injecting and sexual behaviours can watch films, play computer games and receive social support.

According to Yevheniia, most of them use non-injecting drugs and HIV testing for them is rather a prevention tool. So far, no HIV cases have been detected. Adolescents are tested for hepatitis C and B as well as sexually transmitted infections.

For many years, Convictus has been working with adults who inject drugs providing services to 11 thousand people. Working with adolescents is different: they are tested only starting from 14 years of age, with a social worker and a doctor involved.

“One of our priorities is building a network and a map of services, so that adolescents could go to any organization of the network and receive services from our partners. If a person coming to us needs more in-depth support, we provide such support and also help him or her with clothes as we maintain a clothing bank,” tells Yevheniia.

Convictus is planning to develop a School of Leadership and a sexual health programme for girls, which are to close more gaps in the system of HIV prevention among most-at-risk adolescents in Ukraine.

HIV on AIDS 2018: Global Extent, Impact and the Way Forward

The issues of stigma, discrimination and human rights violations were broadly discussed during the AIDS 2018 conference which was held in Amsterdam, Netherlands in July 2018. The conference sessions explored the political, economic and sociological manifestations of HIV related stigma, discrimination and human rights violations on the global level articulated by the civil society.

Global Network of People living with HIV presented their report on HIV stigma and discrimination in the world of work which included findings from people living with HIV (PLHIV) stigma index. The report was written based on the information provided by 13 country teams who implemented the PLHIV Stigma Index.

Stigma index as a tool

Addressing stigma-affected people living with HIV is a global priority. Stigma, defined as “the co‐occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised,” has a negative impact on the health of PLHIV and contributes to the psychosocial stress, coercion and violence, job loss, and social exclusion. PLHIV, gay men and other men who have sex with other men (MSM), transgender individuals, sex workers, and people who use drugs (PWUD) – often referred to as key populations – are at the intersection of HIV‐related stigma and prejudice against their identities, occupations or behaviors that are often exacerbating their experiences of stigma and discrimination.

The PLHIV stigma index provides the evidence on stigma and discrimination that has been essential for informing HIV policy, PLHIV rights advocacy efforts, and stigma‐reduction interventions.  Stigma index is a research tool by which PLHIV capture data on their experiences of stigma and discrimination. As of November 2017, more than 100,000 PLHIV had been interviewed in over 50 languages by 2 000 trained PLHIV interviewers.

Stigma is complex

Stigma and discrimination remain a significant HIV risk factor for the key populations all over the world and mostly for people living with HIV as stigma directly and negatively affects health outcomes. At the International AIDS 2018 Conference, the participants reviewed new developments in the effort to combat stigma and discrimination, report results from researches and analyses of interventions and effective anti-stigma programs. The implications of the studies were discussed as they relate to the development of ongoing efforts to reduce HIV-related stigma and discrimination around the globe.

The construction of stigma is complex. Therefore, anti-stigma interventions must take this into account. Stefan Baral, M.D., Johns Hopkins University, presented a cross-country analysis of intersectional stigma among MSM, including perceived stigma, enacted stigma, and anticipated stigma related to family, community, and the health system.

As national AIDS programs and the international community grow efforts to implement plans for the universal access to HIV prevention, treatment, care and support, participants of the AIDS response should work together to overcome the main obstacles to achieving this goal.

MSM with depression have higher risk of stigma

Expressions of stigma in this analysis included a broad range of behaviors, such as family exclusion, rejection by friends, family gossip, verbal harassment, being afraid in public, being afraid to seek care, avoiding seeking care, poor treatment by health care workers, health care worker gossip, police not providing protection, blackmail, and even physical harm. Harassment and gossip were noted as important forms of enacted stigma that must be addressed, and intersecting identities were found to raise the risk of experiencing high stigma. MSM with depression, for example, had a higher risk of being stigmatized. These intersecting identities represent a critical target for all types of stigma reduction, particularly anticipated health care stigma.

In many countries and communities, HIV stigma and subsequent discrimination can lead to the same devastating effects as the disease itself: a break with a spouse and/or family, social ostracism, loss of work and property, exclusion from school, denial of medical services, lack of care, support, and violence. These consequences or the fear of them mean that people will not be very willing to be tested for HIV, disclose their HIV status to others, or seek treatment, care and support.