TV_screen_still_small

Dutch Students will Learn about HIV in EECA

TV_screen_stillOn March 28, 2017, AFEW International and WEB.foundation are jointly organising the Culture Cures & Kills II symposium  in de Tolhuistuin in Amsterdam. The symposium will focus on the role of culture in prevention, treatment and care of HIV in Eastern Europe and Central Asia (EECA).

The programme is designed with and by students from different fields of study. The aim of the conference is not only to increase students’ awareness about the successes and challenges to address the HIV epidemic in EECA but also to link students to the International AIDS Conference of 2018 in Amsterdam, and explore opportunities for future research.

Students who are based in the Netherlands, can get their free tickets to symposium here. Please, mind that the seating is limited!

You can find the timetable of the symposium here.

You can find the information about the workshops of the symposium here.

Imprimir

AIDS Foundation East-West becomes AFEW International

ImprimirAIDS Foundation East-West, an international network of civil society organisations that is dedicated to improving the health of key populations, has changed its name to AFEW International.

A new logo and communication strategy have been created, and now they are part of the organisation’s identity. “With this new name we keep the recognisability and our brand as many partners in the field already know us,” says the executive director of AFEW International Anke van Dam. “With the new name we also acknowledge that we do more than HIV and AIDS. AFEW has built a track record for projects on TB, viral hepatitis and sexual and reproductive health and rights as well. AFEW strives to social inclusion of the key populations at risk and a healthy future of Eastern Europe and Central Asia!”

AFEW is dedicated to improving the health of key populations in society. With a focus on Eastern Europe and Central Asia, AFEW strives to promote health and increase access to prevention, treatment and care for major public health concerns such as HIV, TB, viral hepatitis, and sexual and reproductive health.

AFEW International is an uniquely positioned organisation as one of the few HIV, TB, hepatitis and sexual and reproductive health and rights organisations working in Eastern Europe and Central Asia. This is a region where the work is critical, as HIV and sexually transmitted infections are on the rise, sexuality education is deficient and gender-based violence goes largely unrecognized. Further, cases of multidrug resistant and extensive drug resistant tuberculosis are increasing; and there is a very high prevalence of hepatitis C. The group with the highest risk for HIV and HIV related diseases are people who use drugs. However, transmission through sexual contact is increasing and the prevalence among women and men who have sex with men is increasing.

Pharmaceuticals-Healthcare-Pill-World-Map-Earth-1185076-small

Reversing the HIV Epidemic

2016113000480016w

Source: European Centre for Disease Prevention and Control (ECDC)

HIV remains a significant public health problem in the 31 countries of the European Union and European Economic Area (EU/EEA), with around 30 000 newly diagnosed HIV infections reported each year over the last decade. In a two-day conference organised in collaboration between the Maltese Presidency of the Council of the European Union and ECDC, HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.

“This conference arose from excellent collaborative work with ECDC and Malta’s commitment and recognition of the importance of placing HIV higher up on the EU agenda during its Presidency Term” says Mr Chris Fearne, Minister for Health, Malta. “We believe that concerted efforts must include all stakeholders: including governments, healthcare providers, civil society, people living with HIV and the specialised agencies like WHO and ECDC. We believe that tackling HIV is a regional, national, corporate and individual responsibility. They all have a role to play in terms of political commitment, preventive action, universal access to healthcare, affordability and access to medicines, testing, linkage to care, focus on key populations, zero tolerance to stigma AND individual behavioural responsibility.“

He added areas of action: “Scaling up of testing is essential to reach our first 90 target. We need to make better use of various settings to enhance testing, incorporate innovative approaches to testing and reduce the barriers, especially in key populations. Knowledge of HIV status ‘in unaware persons’ might also help reduce new HIV infections – those resulting negative may then take less risks, and if linked to care should achieve viral suppression, the third 90“.

“If we take a look at the available data, we can see that Europe needs to improve its HIV response in several areas”, says ECDC Acting Director Andrea Ammon. “Currently, two out of three EU/EEA countries tell us that they do not have sufficient funding for prevention interventions. And every one in seven people living with HIV in the region are not aware of their infection. To reduce the number of new HIV infections in Europe, we need to focus our efforts in three main areas: prioritising prevention programmes, facilitating the uptake of HIV testing, for example by introducing new approaches like community-based testing or self-testing to diagnose those infected. And, of course, easier access to treatment for those diagnosed”.

Pharmaceuticals-Healthcare-Pill-World-Map-Earth-1185076Status quo of Europe’s HIV response: new ECDC report
On the occasion of the Presidency meeting, ECDC publishes an overview of achievements and gaps in the European HIV response, illustrating how countries addressed the HIV epidemic in 2016, based on their commitment outlined in the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia.

The results show, amongst others, that HIV treatment overall starts earlier across the EU/EEA and more people receive life-saving treatment. But one in six people in the EU/EEA diagnosed with HIV are still not on treatment. Those who are on treatment, however, show how effective current HIV treatment is: almost nine out of ten people living with HIV on treatment are virally suppressed. This means the virus can no longer be detected in their blood and they cannot transmit the virus to others.
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) contributed to this overview with data on the HIV situation and prevention coverage among people who inject drugs.

EMCDDA Director Alexis Goosdeel states: “People who inject drugs have the highest proportion of late diagnosis of HIV, compared to other transmission groups. Providing voluntary testing for infectious diseases, risk behaviour counselling and assistance to manage illness at drug treatment facilities is an important additional avenue to reach this group and is among the new EU minimum quality standards for demand reduction” .

The introduction and scaling up of effective drug treatment and harm reduction measures, such as needle and syringe provision, have significantly reduced drug injecting and related HIV transmission in Europe. However, this overall positive development hides large variations between countries. Marginalisation of people who inject drugs, the lack of prevention coverage, and appearance of new drugs can trigger local HIV outbreaks, as documented in five EU countries in the recent past.

Source: European Centre for Disease Prevention and Control 

Michel_Kazatchkine_2012_small

Reasons for Drug Policy Reform

Michel_Kazatchkine_2012

Text: Michel Kazatchkine, UN secretary general special envoy on HIV/AIDS in Eastern Europe and Central Asia

Why is eastern Europe the only region in the world that still has a growing HIV epidemic? In one of the region’s countries, Russia, more than two thirds of all HIV infections, and 55% of the near 100 000 new infections reported last year, resulted from drug injection.

Some 3.2 million people in eastern Europe inject drugs, and about 1.5 million of them are in Russia. In 2007 the number of newly reported HIV cases among Russian people who inject drugs (12 538) was similar to the number in the rest of eastern Europe (12 026). But since then the numbers have diverged hugely.

Scaling up of harm reduction programmes in several countries coincided with a stabilising of HIV rates—and fewer than 7000 new cases outside Russia in 2014. In Russia, however, where access to sterile needles and syringes is low and opioid substitutes remain illegal and unavailable, the number of people who inject drugs newly infected with HIV climbed to nearly 22 500 in 2014.

Criminalisation of drug use

The reasons for Russia’s high figures include the prohibition and effective criminalisation of drug use, repressive law enforcement, and stigma around drug use. These factors lead people to inject in unsafe conditions for fear of police and arrests and result in needle sharing and overdose.

In 2015, the United Nations’ secretary general, Ban Ki-Moon, called for “careful rebalancing of the international policy on controlled drugs.”

“We must consider alternatives to criminalisation and incarceration of people who use drugs,” he said. “We should increase the focus on public health, prevention, treatment, and care.”

The World Health Organization, the United Nations Office on Drugs and Crime, and UNAIDS jointly recommend a package of harm reduction interventions as best practice to reduce the risk of acquiring, and improve treatment of, HIV, hepatitis, and tuberculosis among people who inject drugs. Such strategies, which do not require prohibition of harmful behaviours, are key to reducing death and disease because drug dependency is characterised by people’s inability to abstain.

Continue reading here.

HTC center 3_small

Ikram Ibragimov: “AFEW-Tajikistan is the Only NGO with HIV Rapid Testing Services in the Country”

Фото ИкромThe activities of AIDS Foundation East-West Tajikistan for already 15 years are directed into improving the health of key populations at higher risk of HIV infection. Last December HIV voluntary counselling and rapid testing point was opened in in the representative office of RPO AFEW-Tajikistan in the city of Qurghonteppa. Director of AFEW-Tajikistan Ikram Ibragimov tells about the achievements of the testing point and the organisation in general.

– How was the year of 2016 for AFEW-Tajikistan? What new and important things happened?

– The year was full with events. We changed the statute of the organisation, and we made the areas and directions of its activities wider. We also developed and approved the strategy of the development of the organisation for the medium term, strengthened the partnership and cooperation with governmental and non-governmental organizations in the health sector. We have our own new premises for our office. We renovated it, and have been working there for three months already. In November of the last year we elected the management of the organisation – the board, the audit committee and the director – for the years of 2017-2021. Generally speaking, I would say that 2016 was successful for us.

– Just recently you opened HIV voluntary counselling and rapid testing point in Qurghonteppa. Why did you choose this city to be the “base” for it?

– Our second office is situated in Qurghonteppa. That is why we decided to open HIV voluntary counselling and rapid testing point on the premises where key groups of population are already provided with the direct services. By the way, now we are the only NGO in the country that has such service. Besides, one of the main routes of Afghan drug traffic goes through Khatlon region and that is why drug addiction level in the region is high. People who use drugs are the main target audience for us. As a rule, donors and partners work in the capital and on the North of the country. We decided to go South.

HTC center 3– What are the first results of HIV voluntary counselling and rapid testing point?

– Starting from December, 1 and up until December, 31 there were 18 people tested for HIV: 9 men and 9 women. Thanks God, there were no new cases of HIV found. People find out about our testing point from our website, media, business-cards that we disseminate, information from the clients who visit the centre themselves. Mostly, our visitors are representatives of key populations.

– At the end of 2016 you developed a draft of multilateral agreement on cooperation in the field of prevention of socially significant diseases in Khatlon region and the provision of medical, social and legal services for vulnerable groups. What does it mean?

– This agreement means the cooperation with different organisations that provide complex services (medical-psychological, social, legal and others) to key populations on many levels. The agreement is created on the existing epidemical situation with taking into consideration the socially significant diseases in Khatlon region in Tajikistan. It is planned that 46 government and non-government organisations of the region will become the members of the agreement. We strive to create favourable conditions for the clients of our social support services, so that they can get high-quality, timely and free services of certain specialists. The service should be affordable. Therefore, this memorandum is intended to lower the difficulty of access to services for key populations, and to create a basis for the integration of various services “under one roof.” This is so-called principle of “the single window.”

– What are AFEW-Tajikistan’s plans for 2017?

– As I mentioned before, last year we agreed upon the strategy of the organisational development for 2017-2019. Therefore, all our plans are directed into reaching the quality indicators of this strategy.

IMG_1446_small

Anke van Dam: “I am Looking Forward to an Exciting Year!”

 IMG_1446AFEW International executive director Anke van Dam sums up the results of 2016 and gives introduction of AFEW activities for the upcoming year of 2017.

– How was the year of 2016 for AFEW?

– 2016 was a good year for us. We started with two big projects. First one is the second phase of the project Bridging the Gaps: health and rights for key populations (BtG). This second phase lasts until the end of 2020 and allows AFEW to continue with strengthening the capacity of local organisations in the field of harm reduction, client management, service provision and human rights. In the second phase of the BtG project, AFEW will explore the opportunities for the activities for labour migrants, rehabilitation and human rights violations in Eastern Europe and Central Asia (EECA) region.  For the second project, AFEW received a grant from the Dutch Ministry of Foreign Affairs to engage Eastern Europe and Central Asia into AIDS2018 – the international AIDS conference to be held in Amsterdam in 2018. AIDS2018 gives us a chance to focus on the ongoing increase of new HIV cases, an increased number of multi-drug resistant TB cases and a high prevalence of Hepatitis C in the region. At AIDS2018 we will work hard to highlight those concerns, but also the achievements to mitigate the epidemics. One of the pillars of this engagement is strengthening the capacity of community based participatory research. We received more than 200 applications for a training which AFEW organised for 24 participants from 11 countries of EECA in November. The training is the part of a full package of activities to ensure that we have an increased participation of representatives of EECA by an increased number of abstracts and presentations. AFEW International expanded its team to six staff members. I am very pleased with my colleagues, and feel confident that we as team can build on a better future for the region.

– What were the greatest achievements and challenges for the organisation?

– I was very happy that Dutch Ministry of Foreign Affairs granted us the project AIDS2018. For me, this is the evidence that we are recognized as a leading organisation in prevention, treatment and care of HIV, TB and viral hepatitis in Eastern Europe and Central Asia. The increase of our annual budget in 2016 gave us the possibility to expand the team and therefore our contributions to projects, conferences, meetings etc. This leads to AFEW being seen as an important player in the HIV/AIDS, sexual and reproductive health field for EECA. The challenge remains to get sufficient attention and awareness for the groups that we work for: the key populations at risk for HIV, TB and viral hepatitis. People who use drugs, sex workers, LGBTI and prisoners are the ones who are still discriminated and have the least access to the health services. Budgets for these groups are small, and there is still little acknowledgement of their needs from an individual and public health perspective. AFEW will continue working hard to advocate for their rights to health, and to ensure their access to health services. Furthermore, there is still little awareness about the HIV prevalence in Eastern Europe. I hope to be able to change that with our activities for AIDS2018.

– What new things or big changes that happened in 2016 for AFEW?

– In 2016, AFEW expanded its profile of capacity building organisation. We also offered capacity strengthening in community based research. I am proud of our e-learning modules on this topic. Our members of the AFEW network are developing themselves with specific specialisations. AFEW-Ukraine is building up a lot of expertise around young drug users; AFEW-Kyrgyzstan strengthens the capacity of key populations with regards to advocacy and active involvement in governmental bodies; AFEW-Tajikistan increases access to testing and treatment, they managed to get a licence for community based counselling and testing for HIV; AFEW-Kazakhstan is expanding its expertise on prison health. A big change of 2016 was the move to our new office. Now we have working space with a beautiful view on the river IJ in Amsterdam.

IMG_1438– What are the plans for the organisation for 2017?

– We changed our name into AFEW International, and we will no longer spell out AFEW. The reason behind this change is that we do much more than AIDS and HIV, however AFEW as a brand is well known. That is why we keep it as AFEW. A new logo will be presented soon. We have developed a new strategic plan 2017 – 2019, and it is the basis of our work in the coming years. We prepared a communication strategy that gives us guidance to promote AFEW and its work. 2017 must be the year when AFEW leaves its modesty behind, and becomes visible as the leader for the region. The preparations for AIDS2018 will take a lot of our energy. Many activities are planned to bring many representatives of governments, civil society, universities and other institutions to Amsterdam in 2018. I am really excited about the cultural fund that we have established. Cultural initiatives that address stigma and discrimination will be financially supported to present before and during the international AIDS conference. On March 28, we will organise ‘Culture Cures and Kills II’ – a symposium for students of all kind of studies about the challenges and successes of the fight against HIV, TB and viral hepatitis in EECA. This symposium will raise awareness about the diseases in this region among the younger generation, the upcoming young professionals. I hope that many get interested and want to find a job in this field and in EECA. Furthermore, after three years of being a network we, all AFEW members, will evaluate the network construction and discuss how we want to work together in the future. All members have developed and strategized their activities. How does this fit in the bigger picture of AFEW? The aim is a better understanding and added value to the network. I am looking forward to an exciting year!

hiv-death-rate-globally_small

Nearly two-thirds of European HIV cases are now in Russia

hiv-death-rate-globally

Source: ria.ru

The annual number of new cases of HIV increased by at least 8% in 2015 in the whole of the World Health Organization (WHO) European region, and by 60% in the last decade, according to last month’s annual surveillance report by the European Centre for Disease Control (ECDC) and WHO Europe.

A continued increase in new diagnoses in Russia was responsible for most of the increase. The previous year, as aidsmap.com reported, 60% of European-region new cases were in Russia. In 2015 this increased to 64% of all cases.

The 98,177 diagnoses recorded last year in Russia equate to one HIV diagnosis for every 1493 Russians each year. In comparison, the 55,230 diagnoses recorded in the rest of the WHO region represent one diagnosis for every 13,157 people – one-ninth as many per head.

The number of new HIV diagnoses in Russia has increased 15% in one year, 57% since 2010, and 133% since 2006. Russia admitted this year that more than a million of its citizens have HIV. This is 0.8% of its adult population and is at least the same number as the US in a country with 45% of the US population. At the current rate of increase, this prevalence will double to 1.6% in the next 12 years.

Excluding Russia, 46% of infections in the WHO Europe region were ascribed to heterosexual sex, 26% to sex between men, and 13% to injecting drug use – and less than 1% to mother-to-child transmission. In the last ten years, infections in men who have sex with men (MSM) have increased by 38% and in heterosexuals by 19%, but have fallen in injecting drug users by 38%. In Russia, heterosexual sex is the cause ascribed to half of all recorded cases and a third to injecting drug use.

WESTERN, CENTRAL AND EASTERN EUROPE

In western Europe (which also includes Israel and Greece for WHO’s purposes), and in the European Union (plus Norway, Switzerland and Iceland), the number of new cases of HIV have remained almost static. In western Europe about 30,000 new cases have been reported each year from 2010 to 2014 and in the EU 32,500. An apparent slight decline in 2015 (10% in western Europe and 8% in the EU/EEA) may be due mainly to delays in 2015 reports arriving.

Central Europe – which includes the former communist countries running from Poland down to the Balkans, and also Cyprus and Turkey – remains a low-prevalence area for HIV, but saw a 78% increase in infections from 2010. However, there are signs that a feared acceleration of HIV in these countries may have slowed, with only a 4% increase registered between 2014 and 2015, though this does conceal larger increases in infections in gay men in some countries, including Bulgaria and the Czech Republic. However, many of these countries still have the lowest rate of new infections in Europe, with Macedonia (one infection per 83,000 people last year) and Slovakia (one per 62,500) reporting the lowest rates.

In eastern Europe, which comprises all the former Soviet states (including Lithuania, Latvia and Estonia, which are in the EU) if Russia is excluded, the annual number of new diagnoses has stayed flat or fallen slightly (by 9%) since 2010, though the percentage due to heterosexual sex has more than doubled to 65% of the total and the proportion due to injecting drug use has fallen to 26% of the total. The slight overall fall in eastern Europe conceals big increases in some countries with relatively low HIV prevalence, including Georgia with a 48% increase since 2010, Cyprus with a 95% increase, and Belarus with a 116% increase.

INFECTIONS IN MEN WHO HAVE SEX WITH MEN

In western and central Europe the epidemic is increasingly concentrating in men who have sex with men. In the last ten years, the proportion of infections due to heterosexual sex in western Europe has fallen by 41% and to injecting drugs by 48%, while the proportion due to sex between men has increased by 7%.

The proportion ascribed to sex between men in eastern Europe is still only 4% – but this in fact represents a tenfold increase. In some states such as Belarus and Estonia, infections in MSM were regarded as scarcely existing ten years ago – which means that the 58 cases recorded in Belarus and the 18 in Estonia last year represent proportionally big increases. In Russia sex between men still officially only accounts for a tiny proportion of new HIV cases – 1.5%. However, WHO does not regard Russian data as “consistent” and excludes it from some of its analyses.

The increases in infections in gay men seem to be starting to occur in some countries further east than previously. Georgia, for instance, saw a nearly 50% increase in the annual HIV diagnosis total from 2010 to 2015, a 12-fold increase in gay men, and a threefold increase in MSM from 2014. Belarus saw a 166% increase in HIV cases and a fourfold increase in gay men. Ukraine reports similar increases in gay men against a background of falling diagnoses in other groups. Increases in MSM infections were also reported from the central Asian countries of Kazakhstan and Kyrgyzstan. These increases are from a very low base, though, and may just represent that more men testing HIV-positive are prepared to admit they caught HIV from other men.

OTHER CHANGES IN INDIVIDUAL COUNTRIES

One country that has seen big relative increases in HIV is Turkey. The 2956 cases reported last year represent a 5.5-fold increase over diagnoses in 2010 and a 62% increase in one year. Because Turkey is a populous country (75 million), this still represents a low rate of infection (one per 37,000 head of population per year, less than a third of the UK’s rate), but Turkey may be a country whose HIV epidemic is worth watching.

In the EU, Latvia and Estonia had the highest rates. While Estonia’s formely explosive needle-driven epidemic continues to shrink, new HIV cases have increased by 43% since 2010 in Latvia. Notably, Latvia has been till very recently the only WHO Europe country whose national HIV treatment guidelines still recommended treatment should not start till CD4 counts had fallen below 200 cells/mm3.

Western European countries that saw increases in recent years include Malta, where the new HIV diagnosis figures leaped by more than 50% last year and have risen more than fourfold since 2010, though the absolute number of people with HIV in this small island country is still low, at about 300 people in total.

Another country that has seen significant increases since 2010 is Ireland, with a 47% increase relative to 2010 and a 43% increase from 2014 to 2015 – again, mostly in gay men.

The UK still reported by far the largest number of new cases of HIV of any country in western Europe to ECDC – 6078 reported to ECDC last year, way ahead of France, with the second highest number at 3943. However, the annual diagnosis figure has fallen since 2005, as we reported last September, including for the first time a tiny (1%) decrease in diagnoses in gay men. The diagnosis rate per head of population, one per 10,638 people, was second only to Luxembourg’s in western Europe in 2014, but in 2015 was overtaken by Portugal, Ireland and Malta.

One needs to be cautious about saying HIV cases have fallen in specific countries because there is such variation in the number of delayed reports sent to ECDC. However, since 2010 there have been significant falls in HIV diagnoses, exceeding the falls seen in the UK, in France, Spain and Italy.

In France there appears to have been a significant drop of 30% in diagnoses notified between 2014 and 2015, and a 40% drop in gay men. Fewer than 1000 HIV cases were reported in French gay men last year, a third as many as in the UK. In contrast reported diagnoses have risen by 36% in Germany since 2010 (33% in gay men) and this country reported nearly as many new HIV cases as France last year.

eastern-europe-and-c-asia

Source: UNAIDS

MIGRANTS, LATE DIAGNOSES, AND AIDS

Over a quarter (27%) of new diagnoses in the WHO Europe region were in people not born in the country where they were diagnosed. While two-thirds of this 27% represent people from outside Europe, primarily high-prevalence countries, infections in migrants from outside Europe fell by 29% in the last ten years while infections in intra-European migrants increased by 59%.

Nearly half of all new diagnoses (48%) were in people with CD4 counts below 350 cells/mm3. The proportion of these late diagnoses was 55% in heterosexuals and 37% in gay men. It was also 64% in those over 50 years old. Over a quarter (28%) were diagnosed with CD4 counts below 200 cells/mm3, and 12% had an AIDS-related condition at diagnosis.

Regarding diagnoses of AIDS (in both newly-diagnosed people and the already diagnosed), there were 14,579 reported in the WHO European region last year. Diagnosis of any AIDS-related condition was extremely rare in central and western Europe – only one person per half a million head of population in central Europe, and one person per quarter million in western Europe. In contrast one person per 10,000 head of population had an AIDS diagnosis in eastern Europe, including Russia. This means that AIDS diagnoses in eastern Europe were more common than HIV diagnoses in all western European countries bar Ireland, Luxembourg and Malta.

INTERPRETING THE FIGURES

ECDC’s figures always need to be interpreted with caution. Russia, with its huge preponderance of HIV cases, reports a much more limited and more irregular set of figures to ECDC than most other countries. The efficiency of HIV surveillance and the proportion of late reports vary widely from one country to another.

The proportion of people diagnosed also varies widely. If testing rates increase in a country, then it may look as if new infections are increasing when they are not. Some countries, including large western European ones like the UK and Germany, do not collect centralised, verifiable figures for HIV tests. In those that do, testing rates vary hugely. In Kosovo, for instance, just three HIV cases were reported last year – but that is probably because only 1312 tests were conducted, representing 0.07% of the population. In contrast, Russia performed over 28 million tests – meaning it tested more than 20% of its adult population. Generally, HIV testing rates are higher in eastern Europe than they are in central and western Europe. This tends to mean that higher testing rates compensate for lower reporting rates.

It is in central European countries like Poland (0.62% of the adult population tested) and Serbia (0.71%) that low rates of testing imply low rates of diagnosis – meaning that there may be considerably more people with HIV in these countries than appears to be the case.

REFERENCE

The 2015 ECDC/WHO Europe HIV/AIDS Surveillance Report can be downloaded here.

Source: www.aidsmap.com

img_0927_small

Bridging the Gaps in Women’s Hostel in Kyrgyzstan

img_0956

Leila and Sofia live in women hostel in Bishkek

Five-year-old Sofia is playing with her mother’s telephone. The girl is sitting on the floor and is listening to the music. She is switching between the songs, watching videos, and trying to find her favourite track. There are four beds in a small room. At some moment, the girl puts the phone away and asks: “Mom, what will Santa bring me?”

“What would you like, dear?” she hears from her mother, and the broad smile appears on her face. “I would like him to bring me a kitten. I will feed it with milk.”

When the girl is smiling, she has cute dimples on her cheeks. She brings a toy – plastic alphabet with the buttons. She presses the letters and repeats them. Sometimes she gets the letters wrong, and then the mother asks her to do it again.

TELLS ABOUT HIV TO NEW FRIENDS

Sofia and her forty-year-old mother Leila live in the hostel that operates in the centre of adaptation and socialization of women – injecting drug users in the public fund Asteria in Bishkek, Kyrgyzstan. Leila was recently released from prison.

img_0927

Leila is teaching Sofia an alphabet

“I do not have any relatives; I was raised in the orphanage. I got to prison when I was pregnant, and my daughter was born there,” Leila tells. “Now I work in the kitchen or wash the floors. Recently I went to Turkey, and wanted to find a job there, but I do not know Turkish language, and that is why it did not happen. By education, I am a seamstress and a pastry chef, but it is hard to find a job because I am HIV-positive. I am being asked about my diagnosis all the time, and I always have to go through medical examinations. Now I have found a job as a nursemaid, but I do not have anyone to leave my daughter with. She has to go to kindergarten, but all of them here are not free of charge. I will have to spend almost whole salary to cover the pay for kindergarten… I am currently waiting for the cash advance to pay.”

Leila says that she tells her new friends about her diagnosis, even though she does not always want to do it.

“I think, people with my disease should talk about it, and warn others as well. Now I also bring other people to get tested. I am telling them they have to do it, and that it is free of charge,” Leila says. “Of course, people treat me different when I tell them about my diagnosis. Yes, it is unpleasant, but I am happy that in this way I do something nice to others. Everybody should know such things.”

PRAYING FOR ASTERIA

Leila is worried that the hostel in Asteria can be closed. In that case, the woman can end up on the street. She does not have anywhere to go to.

“I should not be complaining; we have everything here. The main thing is the roof over your head,” the woman smiles and hugs her daughter. “I am very comfortable here. We receive medical treatment, there is a place to sleep, to do laundry. Every Sunday we go to church. In the church I always pray for this house, for people who help us here, and ask God that the organization has donors.”

img_0999

The head of Asteria Iren Ermolaeva shows the rules of the hostel

Leila says that she would like to move from the hostel in the future, but she does not have such possibility yet. She dreams of her own home, family, and work. She also wishes that the hostel will never close. People who work in Asteria have the same desire.

“We indeed often have problems with financing. Every year we do not know what to expect in the next one,” the head of the public fund Asteria Iren Ermolaeva says. “Our public fund is working since 2007, and the hostel – since 2009. We would like to have the whole range of services, but there is not enough financing these days. We know how to find the approach to women, we know how to create friendly atmosphere so that a woman would want to change her life for better herself, and we would like to use this knowledge. We feel sorry for our clients, and we would like to help them more.”

DREAMING ABOUT OWN HOUSE

Workers of Asteria also dream about purchasing the house where they will place the centre of adaptation and socialization of women – injecting drug users and the hostel. They have already found funds for the future house renovation, but cannot find money for its purchase.

“Then we would be able to have social entrepreneurship, maybe some little farm. In that way, we could at least not depend on donors in food,” the coordinator of the social services of the fund Tatiana Musagalieva is saying. “Until now, we rented all three houses for our centre.”

img_0978

Asteria workers Iren Ermolaeva (on the right) and Tatiana Musagalieva say that their organisation often has problems with financing

Thanks to “Bridging the Gaps: Health and Rights for Key Populations” project from Public Foundation “AIDS Foundation East-West in the Kyrgyz Republic”, in 2016 Asteria could support four beds in the hostel. The project also helped with medicine and warm food.

“People often come to us to eat, to do laundry,” Iren Ermolaeva says. “Around 300 women come through our centre during one year. Leila, for instance, came here after she was released from prison. She has got all the necessary services, clothes, shoes, and got medical examinations. Leila was imprisoned for five years, and, now, due to the conditions that we have, she adapts and integrates into society. In this way, she becomes more confident in herself, can find a job and build her future.”

img_0039_small

Compass Centre in Kharkiv, Ukraine: when Policeman Becomes an Uncle

img_0039“I come here often,” Senior Inspector of the Juvenile Prevention Department of National Police of Kharkiv region, Ukraine, Andrii Stadnik is sitting by the table in the centre Compass of Kharkiv City Charitable Foundation Blago. He is smiling and pointing at the table. “Look, here I even have my own cup to drink from…”

Andrii Stadnik started to work in police in 1998. He says he is very happy with his job now. In Compass he meets many children who are grateful for not being send to prison, and he likes to be able to help them. The regulars of the centre even call him uncle Andrii, and this shows very good relations between people in the Ukrainian culture.

18 years old Oleksandr (Sasha) is sitting in front of Andrii, at the same table. Sasha is one of the main characters in the film that was made about the centre Compass a few years ago. Once he was detained by Andrii Stadnik and stayed under police control for some time. Now, after the client management program at Compass, Olexandr is doing much better. He even found a job as a security guard. “Now I somehow feel as Andrii’s colleague,” Sasha smiles.

“The criminal juvenile cases decreased tremendously last years, due to the approach when juvenile police is collaborating with a youth centre that offers client management. These alternative supporting ways are more constructive and more effective,” Senior Inspector of the Juvenile Prevention Department is telling us. “Previously there were 2000 cases per year, and now it is 362. The formulas of substances that circulate on the streets change so fast that young people can often not be prosecuted, but by giving youth an option and an alternative for other options, young people have less problems and also cause less problems for the society they live in.”

img_0036There are 492.000 children in the region in total. 897 families are under juvenile department control in Kharkiv region in Ukraine. The Juvenile Police checks these families, sees how they are doing, and if there are cases of child abuse, financial problems, and so on. Kharkiv Juvenile police is also inviting colleagues from other smaller cities or villages, and teaches them how to work with the Centre Compass. Through this cooperation they found out that young people from the region have difficulties with coming to the Centre since Kharkiv is too far for them. That is why now once a week a social worker of the Centre travels to the villages to counsel young people in need there.

Kharkiv City Charitable Foundation Blago has a long history of working with key populations, including people who use drugs, sex workers, men having sex with men and street children. The organisation started to work with adolescents using drugs since 2012 within the framework of “Bridging the Gaps: Health and Rights of Key Populations” project, through ICF “AIDS Foundation East-West” (AFEW-Ukraine.) Bridging the Gaps project supported the opening of the centre Compass that specifically serves vulnerable adolescents and young people, focusing on youth using drugs. The centre offers psychological counseling services, medical help, testing for HIV, hepatitis B and C. It is a daycare facility with social workers, psychologists and medical workers. The centre is providing case management services to youth using drugs, and also works with youth in prisons, and vocational schools.

2136950249_b3e5f6a6fa_b_small

Improving Outcomes for People Living with HIV

2136950249_b3e5f6a6fa_bThis is a call to action for European governments, international organisations, patient organisations, and the wider health community to align on a new HIV policy agenda that addresses the crucial unmet needs of people living with HIV (PLHIV) – to ensure they can live longer in good health, and participate fully in society and the economy.

Current HIV policy frameworks rightly focus on prevention, diagnosis and effective treatment (viral suppression), but do not go beyond this to address other health and social challenges faced by PLHIV. In Europe, where viral suppression should increasingly be the norm, it is vital that policy makers and healthcare providers recognize these challenges and respond.

An integrated approach is needed to improve:

  • Health outcomes – by addressing the increased risk that PLHIV will develop other medical problems (co-morbidities) – including mental health issues.
  • Social outcomes – in particular by combating stigma and discrimination, and ensuring that PLHIV are able to secure and retain employment and housing.

Effective action to improve outcomes, and reduce the health burden and costs associated with HIV, can bring meaningful economic benefits and reduce demands on European healthcare systems.

We call on the EU and Member States to:

1. Revisit the Dublin Declaration on Partnership to Fight HIV/AIDS, and ensure that its monitoring adopts a ‘life-long’ approach to the health and social inclusion of PLHIV.

2. Identify and agree on policy indicators necessary to monitor and assess country performance in improving health and social outcomes for PLHIV.

3. Adopt in 2017 an integrated EU Policy Framework on HIV/AIDS, viral hepatitis and TB – thereby extending the focus of the EU Action Plan on HIV/AIDS, which comes to an end in 2016.

Background

Whilst important progress has been made in the global response to HIV/AIDS, with the European Union (EU) playing an instrumental role, the European region – and in particular Eastern Europe – now has the fastest growing HIV epidemic globally. 29,992 people were diagnosed with HIV in the EU/EEA in 2014. At the same time, PLHIV are living longer, which has created new challenges relating to the prevention, treatment, and management of co-morbidities.

With the EU Action Plan on HIV/AIDS expiring at the end of 2016, and the Dublin Declaration on Partnership to fight HIV/AIDS now more than a decade old, European governments and the EU institutions have an opportunity to make progress on their political commitment to fighting both the transmission of HIV, as well as its health and social impacts – including the Sustainable Development Goals (SDGs).

Continuing challenges include the strengthening of prevention programmes, reducing late diagnoses, ensuring equity and universality of access, and the social consequences of HIV that stem from stigma and discrimination. Governments and health systems must respond to the fact that PLHIV are living longer. We must ensure that PLHIV remain in good health as they grow older, and can lead successful, productive and rewarding lives. This aspiration should motivate the HIV response in all European countries – not only those that already perform well in relation to the UNAIDS targets for diagnosis, treatment and viral suppression.

The Beyond Viral Suppression Initiative

The Beyond Viral Suppression initiative arises out of a shared recognition among leading HIV experts that there are crucially important issues relating to the health and social inclusion of PLHIV that have to date received insufficient attention from policy makers and healthcare providers, and which must now form part of our HIV response.

In an era when ageing populations and health system sustainability are central challenges for all European countries, the initiative will also aim to inform debates about cost-effective strategies for co-morbidity prevention and management, whilst ensuring patient-centered healthcare delivery. Our recommendations should therefore be of high relevance both to policy makers and the wider health community.

The steering group is co-chaired by: Nikos Dedes, the Founder of Positive Voice (the Greek association for PLHIV) and a Board member of the European AIDS Treatment Group (EATG); Professor Jane Anderson of Homerton University Hospital NHS Foundation Trust in London; and Professor Jeffrey Lazarus of ISGlobal, Hospital Clínic at the University of Barcelona, and CHIP, Rigshospitalet, University of Copenhagen. The initiative is enabled by sponsorship provided by Gilead Sciences and ViiV Healthcare.

The initiative is developing a performance assessment of HIV services ‘beyond viral suppression’ – focusing on: access to appropriate health services; health outcomes – co-morbidity and co-infection prevention, and health-related quality of life; and social outcomes.

A research team supported by a study group of leading academics will seek to identify the policy indicators necessary to assess countries’ performance at improving health and social outcomes ‘beyond viral suppression’. Our aim is thereby to complement the work of other initiatives focusing on HIV prevention, diagnosis, and access to high quality treatment and care.