Beyond Resistance: Drugs, HIV and the Civil Society in Russia

The speech given by Anya Sarang, the President of the Andrey Rylkov Foundation, at the side event Reducing the harms of drug control in Eastern Europe and Central Asia which took place during the 60th annual meeting of the Commission on Narcotic Drugs on 17 March 2017 in Vienna. 

In 2016 the UNAIDS reported that the HIV epidemic has been taken under control in most countries of the world. The countries of Eastern and Southern Africa have reached a 4% decline in new adult HIV infections, the rates of which were also relatively static in Latin America and the Caribbean, Western and Central Europe, North America and the Middle East and North Africa. At the same time, the annual numbers of new HIV infections in Eastern Europe and Central Asia increased by 57% with Russia responsible for 80% of the new cases. There are only a few countries in the world where HIV keeps rising, and Russia has the fastest rate. According to the Federal AIDS Centre, around 300 people get infected, and 60 people die of AIDS every day. As of August 2016, the number of registered HIV cases was 1,060,000 while the estimates go beyond 3 million. And according to the Ministry of Health, only 28% of patients in need receive antiretroviral therapy.

The main group affected by the HIV in the country is people who inject drugs (PWID). From 1987 to 2008 about 80% of HIV infections were related to unsterile injections and still in 2015 almost 55% of the new cases are among drug users.  Since the beginning of the epidemic, over 200,000 people with HIV have died, the primary cause of death being co-infection with tuberculosis. According to WHO, Russia is among top countries with the highest burden of TB including its multidrug-resistant forms.  Another deadly co-infection is hepatitis C: its prevalence among people who use drugs reaches 90% in some cities. And drug users are entirely excluded from any treatment programs.

The reason for such a dramatic dynamic in public health is the Russian government’s failure to address the HIV epidemic, especially among the people most affected. The Russian government is notoriously negligent to the issue of HIV, vigorously adherent to the most repressive and senseless drug policies and openly resistant to evidence-based internationally recommended harm reduction programs and opioid substitution treatment with methadone and buprenorphine. The government not only fails to provide the financial support to these programs, it explicitly opposes them in the State strategies, such as the National drug strategy. At the same time in the past several years, the international support to HIV prevention has also dramatically shrunk. Due to the aggressive line of the Russian government towards the international aid and unkept promises to allocate own resources towards the epidemic, most international donors have left the country. That resulted in 90% decrease in the coverage of needle and syringe programs. Back in 2009, we had 75 harm reduction projects reaching out to 135.000 clients, and in 2016 there are only 16 projects to reach out to 13.800 individuals which is less that half percent of the estimated number of people who inject drugs. These few remaining projects are supported by the Global Fund to Fight AIDS, tuberculosis, and malaria, but even this symbolic support expires by the end of this year, and there are no new sources on the horizon.

To make the situation even more tragically absurd, in 2016 the Russian government started to attack non-governmental organizations that provide prevention services to people who use drugs and to LGBT. In one year alone, eight AIDS organizations were registered as “Foreign Agents” based on the fact that they receive funding from the Global Fund. Inclusion into the list means four times more reporting, expenses for administrative work and increased risks of fines and administrative charges. It also means that the organizations will not be able to receive any money that comes from the governmental sources.

All of the above has created the situation when the AIDS Service NGOs are blocked from the potential governmental funding while at the same time, most international donors have terminated their support to the Russian NGOs. Some donors, including USAID and several UN agencies, had to cease their operations in Russia due to the government pressure, a supporter of advocacy and human rights initiatives in the area of public health, the Open Society Foundations have been blacklisted by the authorities. But many potential donors also believe that a) situation in Russia is hopeless, and there is no way to improve and b) that their support may exacerbate the risks for the NGOs. Our organization believes that its necessary to provide more truthful information to the international partners about the situation in Russia and possibilities to express support and solidarity.

Our team works since 2009 providing daily health services on the streets of Moscow to people who use drugs. We do outreach work to sites where drug users get together, where we give our HIV prevention materials: sterile needles and syringes, condoms, rapid tests for HIV and Hep C, peer counseling, and support as well as referral to various health institutions. We see from 10 to 30 people daily, and last year alone almost three thousand people contacted our small service. We carried out more than 300 consultations on HIV and hepatitis, and in the last three years, we received reports of 735 lives saved with Naloxone we provide to the clients to prevent deaths from overdoses. We also run a street lawyers project, helping drug users to stand for their rights and dignity, providing them with legal skills and empowerment to represent their interests in courts and state institutions. We have a team of 4 lawyers and around 20 social workers and volunteers. We also provide secretarial support to the Forum of people who use drugs in Russia and facilitate documentation and submission of reports on human rights abuse to the state parties as well as the international human rights bodies. Several strategic litigation cases that came out of the Forum’s work aim to improve the legal context in Russia with regards to access to health and justice, including a case currently under review by the European Court of Human Rights on lifting the ban on opioid substitution therapy in Russia and in Crimea.

In 2016 our organization has been registered as a Foreign Agent, and we were subjected to a fine for not volunteering ourselves into the registry. There was some skepticism concerning our ability to continue the work with this status, but we didn’t want to lose our services because of the bureaucratic inadequacy of the Ministry of Justice. We have challenged their decision in court which surprisingly supported us by finding the Ministry’s decision illegal and lifting the fine. We are still listed as a Foreign Agent, but we also fight this decision by the legal means including, if necessary in the European Court of Human Rights. With the help of our partners and supporters, we have generated a fiscal security fund to sustain our work in case of financial sanctions on behalf of the Ministry. We have also received a lot of support for our cause from the mass media and the general public, including the recently started parliamentary debates on the inadequacy of application of the Foreign Agents law to the AIDS prevention NGOs.

Our experience and the experience of like-minded organizations demonstrate that it is still possible to provide AIDS and drug services in Russia, even in the context of political suppression of the NGO work. The only and the most important condition is the commitment to the protection of rights and health of our community. We are learning by doing and hope to develop creative approaches and a practical model of operations for organizations or groups who find themselves in similar politically restricted circumstances not only in Russia but other countries of our region.

We believe that the western NGOs and governmental organizations should not ‘give up on Russia.’ In fact, now more than ever we need the support and solidarity to continue our work and keep saving lives, health, and dignity, despite the political oppression.

Roman Dudnik: “People with HIV and Tuberculosis are the Same as We Are”

A photo exhibition dedicated to the World Tuberculosis Day will be opened in Almaty, Kazakhstan on March 18. The purpose of this exhibition is to show that people living with HIV or tuberculosis are the same as everyone else. This exhibition is one of the first important public events held by AFEW-Kazakhstan in 2017. We are talking about this and discussing other plans for this year with the executive director of AIDS Foundation East-West in Kazakhstan, Roman Dudnik.

– How was the year of 2016 for you? What were the new and exciting things that happened?

– Even though the year of 2016 was difficult, it was successful for us. We moved to a different office. Before, we were in the small office building. Now we are in the new building with much more space. The repairs were made based on our requirements, using our colours. There is a very good energy here, and it helps to work good.
In 2016 we finished the first part of the project HIV React that is financed by USAID/Central Asia, and we got the extension for the next three years. This is our main project. It is regional: we work in Kazakhstan, Kyrgyzstan and Tajikistan. Being the part of this project, we are working in preventing HIV among injecting drug users in prisons. We also work with people living with HIV who are getting ready to be released, and those who are already released. With specially developed START plus program, we prepare a person for his release two months before it happens, and then continue to work with a person for another four months after the release. Additionally, we train medical and non-medical staff of correctional facilities and employees of non-governmental organizations. This program is unique and does not work in many countries of the world. All efforts are aimed at preventing HIV infection and supporting those who live with HIV. The main goal, of course, is to encourage a person to get tested for HIV. If the test is positive, then we send a person to the AIDS centre, and we motivate him to start treatment with antiretroviral medicine, if necessary. We also help to restore needed documents, find jobs, renew social connections. This program is unique because it has a human face. We are aimed at a specific person, at solving of his or her problems. We also try to form skills so that people can solve their problems in the future themselves.

– Working in three countries in Central Asia with the same groups of population in HIV React project, can you observe the common tendencies?

– The general trends in all three countries are that HIV in places of detention exists, and the number of new cases of HIV transmission is increasing. Convicts is the group that requires intense attention and constant work. There is a very high level of stigma from prison staff. Of course, the reason for this is a lack of information, and this is what we are trying to correct through the trainings. The most successful project is implemented in Kyrgyzstan, where the criminal executive system is more open and sympathetic to such activities. In Kazakhstan and Tajikistan it is a little more difficult, but despite this, we manage to work and implement all planned activities within the framework of the project.

– Besides this, what were other projects that you worked on in 2016? 

– Since January we started with the new City Health project with the financial support of the Global Fund, where the main grant recipient is the International Charitable Foundation “Alliance for Public Health”. The project works in five cities of the EECA region. We are responsible for work in Almaty. Implementing this project, we will involve the city administration in the prevention of HIV infection among vulnerable groups: injecting drug users, men who have sex with men, and sex workers. We plan to create a city council on HIV/AIDS. We know that the project is not simple, but it is interesting for us. For Almaty, the project is very important, since it is the most populated city in the country, and the problem of HIV infection is especially relevant here. It will be important for us to make this a successful model and to duplicate this experience to other cities and countries.

– A year ago you had a school of tolerance, the goal of which was to reduce stigma on the part of health care providers. Please, tell us if you can see the results of this school?

– It is difficult and too early to talk about the results. Stigma and discrimination are big problems for Kazakhstan and whole Central Asia, and this is one of our main areas of work. One school of tolerance cannot solve this issue. Without any doubt, there is a big difference in how people come to the training, and what they think after three or five days of the training. In our training, we focus on the personal qualities of a person, perform the situations when the participant himself acts as a client or the representative of a vulnerable group, and is experiencing everything what the client is experiencing by himself. Human intolerance was formed long ago, and one year of work cannot change it. Nevertheless, there is already some progress in this field.

– On the 18th of March you will have the photo exhibition dedicated to the World Tuberculosis Day. Please, tell us more about it.

– The exhibition is intersecting with the topic of stigma and discrimination. We invite everybody to come and see it. It will be held from 18 to 31 of March in the gallery June 24. During the exhibition, there will be master classes, lectures, and talks with people who are depicted on the photos. On the photos, there are 15 Kazakhstani people who live with HIV, or who were cured of tuberculosis. The name of the exhibition Life in the Shadow speaks for itself, because due to the human ignorance, the heroes of our photos should hide their diagnosis from others and live with their problem alone in fear. Now they have opened their faces for the exhibition and they are not afraid to share their experiences. By each photo, there is a written piece with the story of the person: what he was going through, what he was thinking about. The purpose of the exhibition is to shed light on everyday life of people affected by HIV and tuberculosis. They are just like us. The only difference is that they know their diagnosis and they have to fight for their health. Myths and prejudices about HIV and tuberculosis make them hide this part of their lives. Although, the understanding and support of others is what helps them to defeat the disease. The exhibition is positive; people are smiling on the photos. We made only colour photos that show people in everyday life: in the flower shop, in the metro, during painting. During the exhibition, we will tell the visitors about HIV and tuberculosis, tolerance. We will also distribute flyers with the information about where you can bring, for example, bags with clothes that are no longer needed and help people who live with HIV in such a way.

– Even though it is almost the end of the first quarter of 2017, I still would like to ask you about the plans of AFEW-Kazakhstan for this year.

– We plan to work with our projects further. In April, we will be having big regional training about gender violence. We already invited a very good professional in this field to be our trainer. This is a new topic for us, and everything new is interesting for us.

Looking for the Consultant for the Cities TB/HIV Regional Project

LogoAFEW3Consultant for the development of a situation assessment tool in the framework of the Cities TB/HIV Regional project, funded by the Global Fund

It is well known, that the HIV/AIDS epidemic in Eastern Europe and Central-Asia is still driven by most affected key populations, which are concentrated in urban areas. On average, the share of representatives of key population among all PLHA is assumed to be up to 70 percent, while the majority of them are PWID (about 80% of all HIV-infected representatives of key populations). Despite the paramount role of key populations in the development of HIV epidemics in the region, reaching them with key services remains low. The overall coverage of essential HIV prevention services of PWID, sex workers (SW) and men having sex with men (MSM) in Bulgaria, Georgia, Kazakhstan, Moldova, and Ukraine is around 40% (at the level of 50% for PWID and SWs and 16% for MSM).

City level data reveals that from about 18,000 PLHA 5,665 are receiving ART, which corresponds with 20% coverage in Almaty, 22% in Beltsi, 29% in Odesa, 54% in Sofia and 82% in Tbilisi. Given the overall low access to ART, access of key populations is assumed to be even lower, but data is largely unavailable. Out of 5 project cities only Almaty and Odesa could provide disaggregated data on ART access by key population.  Similarly, the results of TB and MDR treatment in the 5 project targeted cities are poor, with low treatment success even for new TB cases and relapses, not reaching the targeted 90% (highest in Almaty – 85.4%, lowest in Odessa – 54.2%), while the MDR TB treatment outcome is even worse, from extremely low in Odesa (47.5%) to 69.9% in Almaty.

Three main areas of programmatic/other gaps have been identified as handles for strategy development and interventions in the proposed regional project for selected cities:

  • Programmatic and data gaps: reaching key populations, HIV and TB treatment cascade gaps; low treatment efficiency and effectiveness, increase of MR-TB and repeated treatment cases; slow transition to the patient-oriented model of health care delivery and to out-patient ambulatory care; weak integration between HIV and TB services; gaps in essential city level data.
  • Political, governance, partnership gaps: lack of political will to address health issues in key populations and promote human rights and access to services by these key groups.
  • Financial gaps: sustainability of the HIV/TB responses is a major threat to programs for key populations in EECA.

Aims and objectives of the Cities TB/HIV Regional project

The goal of the project is to develop models of sustainable city responses to HIV and TB in key populations in EECA that significantly contribute to achieving 90-90-90 HIV/TB targets for key populations. The goal is supported by the following four objectives:

  1. Development and implementation of a model for key populations for the ’90-90-90’ targets of the HIV and TB response in selected cities of the EECA region.
  2. Establishing effective partnerships between municipalities and NGOs/CSOs in selected EECA cities.
  3. Ensuring sustainable allocations of municipal funding for key population programs in project cities.
  4. To increase knowledge management and popularize city responses on HIV and TB in cities of the EECA region and globally.

Project will be implemented in 5 cities in 5 countries: Almaty (Kazakhstan), Beltsi (Moldova), Odesa (Ukraine), Sofia (Bulgaria) and Tbilisi (Georgia).

The project is implemented by the Alliance for Public Health (APH) as lead agency, together with AFEW International and Licit.

One of the planned activities is:

Situation Assessment tool development and training on its use

At the beginning of the project, a needs or situation assessment will be carried out in 5 project cities aiming at identifying particular HIV/TB key populations needs, services, data gaps, barriers to access and sustainability of services resourcing.

Terms of Reference:

Job Location:

  • In Europe, Eastern Europe and Central-Asia

Period and duration:

  • Starting date 13 March 2017
  • A first outline of the tool should be ready by 30 March 2017
  • Provide an update of data every 1 week
  • The final version of the tool should be ready by mid-April 2017
  • A training in how to use the assessment tool in the second part of April 2017
  • A workload of 20 working days is expected

Overall Job Objective:

The development of instruments for the assessment with broad consultations with the project partnership and a training provided to implementers on how to use it. Specifically, the assessment addresses improvements in city data systems, availability of population size estimates and their mapping, improvements in city cascade information, HIV, TB, prevention, treatment, health and social integration, human rights of key populations, legal issues, city and country drug policy, accessibility to existing services, existing coordinating bodies and city governance, role and practice of law enforcement, attitudes of media, programs and their resourcing and potential areas for cost optimization.

Description of core responsibilities and tasks:

– collect information and results from assessments done by ECUO’s regional EECA project looking at challenges in transitioning from one stage of cascade to the other
– collect information and results from the situation assessment methodologies on the combinations of services available and the level of funding for interventions within the EHRN regional project
– identify relevant sources for HIV and TB data at national and city level
– consult with the project partners about the relevant topics, the sources and how to do the assessment
–  identify software to be used for mapping the data
– write a comprehensive tool to conduct the assessment
– train contact persons on how to use the assessment tool

Requirements

– Epidemiology and/or research background at university level
– Knowledge about HIV and TB in Eastern Europe and Central-Asia
– Familiar with the governmental and non-governmental landscape in EECA
– Speaking and writing in English and Russian

Contacts/Key Relationships:

–            Project partners
–            AFEW International for reporting and updating

Please, send your application to Anke van Dam’s email: anke_van_dam@AFEW.nl. The deadline is 15 March.

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.

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.

Reversing the HIV Epidemic

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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 

Reasons for Drug Policy Reform

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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.

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.

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!

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