AFEW International Announces Culture Fund for the Students

AFEW International with the support of the Dutch Ministry of Foreign Affairs is announcing a Culture Fund for providing support to all sorts of cultural materials and exhibitions to address stigma and discrimination related to HIV, diversity and other related issues in general, and particularly in the EECA region.

Through the means of arts and culture, the Culture Fund will attract attention of the Dutch people and international community of policy makers, donors, stakeholders, researchers and clinicians who will visit International AIDS Conference in Amsterdam next year, to the issues, challenges and achievement of the EECA region in response to AIDS epidemic.

There are several barriers for the delegates from EECA region to participation in the AIDS conferences: lack of skills on scientific writing and abstract development, costs of participation, language barrier, and quite low interest of the region to the Conference in general.

With our project, we address these barriers, and the Culture Fund will become a specific means to motivate arts and culture communities in the EECA region to attend the conference and thus attract attention of diverse groups of conference visitors including Dutch public to the EECA region and the current state of the AIDS epidemic and response to it.

Meanwhile, we are forming a Think Tank of talented and motivated people who will help us to develop Culture Fund concept; create detailed planning which will identify number of potential recipients of the funds for developing arts and culture pieces; determine criteria for selection of the ideas and initiatives submitted; develop management structure; describe activities and climax event(s); and plan for evaluation; and join coordination group to make it work.

We invite students who are based in the Netherlands to join our Task Force. By the 18th of April we expect to receive a A4 Letter with your vision of the Culture Fund. You can send your suggestions at info@AFEW.nl. More details on what to include in your letter you can find here.

Commentary: the Value of PrEP for People who Inject Drugs

Authors: Rosalind L Coleman and Susie McLean

Corresponding author: Rosalind L Coleman, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.

INTRODUCTION

HIV prevention is currently insufficient for many populations who inject drugs and who continue to bear a disproportionate burden of HIV. Across all regions, the prevalence of HIV for people who inject drugs is up to 50 times the rate of the rest of the adult population and people who inject drugs account for 30% of all new HIV infections outside sub-Saharan Africa. This inadequacy of HIV prevention is most prominently illustrated in Eastern Europe and Central Asia, where new HIV infections are up 57% compared with 2010 and more than half of these new infections are among people who inject drugs.

Pre-exposure prophylaxis (PrEP) can effectively prevent HIV when introduced in an enabling combination HIV prevention programme and chosen by people at high risk of infection. The integration of PrEP into public health programmes has been presented as an opportunity to strengthen HIV prevention for key populations when implemented in a context of linked action for human rights, supportive laws and violence prevention. PrEP is recommended as a choice for people who inject drugs by the American Centres for Disease control and in the recent WHO recommendation, but some critiques of the value and or effectiveness of PrEP for people who inject drugs are emerging, including from consultations with people who inject drugs. These consultations, co-ordinated by the International Network of People who Use Drugs (INPUD), brought together 75 representatives of people who inject drugs from 33 countries, predominantly from Eastern Europe and Central and Eastern Asia to discuss policy and programme considerations of PrEP in their situations. The implementation challenge is to design PrEP strategies that are context specific and differentiated for key populations in all their diversity, including for people who inject drugs.

The risk of HIV transmission for people who inject drugs exists in a context of other adverse health events and the high HIV rates reflect their broader health problems that include hepatitis C (HCV) and other blood-borne diseases, overdose, vein damage and tuberculosis. Much of the health risk associated with injecting drug use is exacerbated by poverty, inequality, criminalization, violence and discrimination.

WHO, UNAIDS and UNODC have defined and endorsed a range of harm reduction interventions to address and prioritize HIV and related health needs of people who inject drugs. Key interventions include needle and syringe programmes (NSP) and opioid substitution therapy (OST) to reduce unsafe injecting and manage drug dependency, as well as the promotion of condom use, facilitated access to testing and treatment for HIV and other sexually transmitted infections, TB, and HCV, and naloxone provision to prevent overdose, supported by appropriate information, education and communication interventions, and “critical enablers,” such as supportive laws, anti-discrimination interventions, interventions to make health services more accessible and acceptable to people who use drugs and anti-violence interventions. This set of interventions represents the formal list of evidence-based “harm reduction” interventions around which significant consensus lies as evidenced by their endorsement by international, regional and national organizations and governments. This harm reduction approach responds to a wide range of adverse health needs, is relatively inexpensive to implement and can have a high impact on HIV and HCV transmission, Despite this, only half of all countries that report injecting drug use provide OST and even fewer offer NSP. Where these interventions are available, they are often provided at an insufficient scale to have a public health impact.

Lack of scale of these evidence-based interventions results from a number of factors: lack of funding and prioritization, the design and delivery of services that are not targeted to reach key populations and structural barriers that prevent people who use drugs from accessing services. These factors shape the wider risk environments of people who inject drugs and constitute a form of structural violence, when associated with repeated incarceration; compulsory registration on official lists as drug users; and high rates of violence, police harassment, homelessness and poverty.

People who inject drugs will need to know about, believe in and value PrEP, alongside other interventions such as clean needles and OST. Without consideration of the sometimes violent and hostile environment in which these harm reduction services are delivered, people who inject drugs may not embrace PrEP and instead view it as a reductionist and potentially destabilizing intervention that could divert attention away from existing harm reduction services.

DISCUSSION

Concerns expressed about PrEP by people who use drugs underline the importance of identifying particular policy environments, geographies and sub-populations of people who inject drugs and their sexual partners for whom PrEP may be of value.

PREP AND HARM REDUCTION SERVICES

The people who inject drugs who were involved in the consultations agreed that, in a context where other key harm reduction services were in place, PrEP would be a desirable option for some people who inject drugs. It was felt, however, that in countries with the highest injection-drug-associated HIV burden, the reality was far from being realized. Respondents expressed opposition to any introduction of PrEP that was not part of an effort to strengthen broader harm reduction and social justice programmes.

Any new intervention, including PrEP, should strengthen broader health promotion and combination HIV prevention approaches, bolster any existent effective interventions and respond to the diverse needs of the population. A comprehensive combination HIV prevention programme includes condom and lubricant provision, immediate initiation of antiretroviral therapy and the offer of PrEP and also supports related interventions such as harm reduction programmes for people who inject drugs and voluntary medical male circumcision (VMMC) for men in eastern and southern Africa.

HIV prevention spending for key populations such as people who inject drugs in low- and middle-income countries is heavily dependent on international financing which is flattening while domestic funding for key populations is low. A change in donor priorities could destabilize existing harm reduction programmes if they compete for limited funding. This threat is intensified by weak policy and financial support by many governments who have permitted harm reduction programmes that are funded by external sources but who show no or limited commitment to funding harm reduction from national budgets when donors retreat. In contexts where harm reduction programmes are politically unpopular, PrEP could present a convenient and “magic bullet” intervention that allows governments to claim that they are addressing HIV prevention, whilst reducing funding and policy support for other evidence-based harm reduction interventions that people who inject drugs need and prioritize. The ethics of providing PrEP when HIV treatment access for people who use drugs is so poor was also questioned at the consultations.

In any situation, PrEP can only be economically and clinically effective when it is funded as part of an accessible and comprehensive HIV prevention and treatment programme.

PREP, DRUG USE AND SEXUAL TRANSMISSION OF HIV

People who inject drugs account for a disproportionate share of HIV burden whether attributable to injection drug use or in combination with sexual transmission. There is a complex and fluid interaction between the injection or other use of drugs and increased sexual HIV transmission risk. People who inject drugs report low levels of condom use. In Eastern Europe and Central Asia, where half of new infections are among people who inject drugs, 6% of new infections are among sex workers and one-third of new infections are among clients of sex workers and other sexual partners of key populations. Therefore, PrEP has possible value in the social and sexual networks of people who inject drugs where the incidence of HIV is high. These people might include the sexual partners of people who inject drugs, non-opioid drug users who also inject but for whom there is no established substitution treatment and others within the wider drug-using community who are unable to negotiate safe sex, including both women and men who inject drugs and who have sex with men, people who inject drugs and sell sex, transgender people and those who are vulnerable to sexual violence or exploitation. Given what we know of the overlap and double HIV burden of sex work and injection drug use, there is a need for synergy and a broad approach to harm reduction programming. This could include the offer of PrEP to address both sexual and injection-related health risks. The one trial of PrEP that was specific to people who inject drugs was not able to differentiate between the prevention of sexual- and injecting-related HIV transmission.

Consultations with these linked populations could identify additional situations where PrEP might be valuable. Some parallels may be drawn from the views of sex workers who also experience stigma and discrimination that prevents them from engaging with health services. A comprehensive literature search found an “enthusiasm” to use PrEP among sex workers in China, Peru, sub-Saharan Africa and the United States if it were to be distributed through user-friendly services and promoted with non-stigmatizing information and adherence support. This view is tempered with the caution that PrEP introduction should benefit sex workers and their immediate community and not be introduced only for the public health impact in the general population. For some, debate on PrEP promotion provides an opportunity to engage with policy makers on human rights.

This reaction found an echo from a North American INPUD consultation participant and emphasizes the notion that PrEP services should be in step with the varying needs and desires of the priority population for whom it is intended.

It is important to remember that people who inject drugs have the same sexual rights and sexual health needs as those in the general population and that in contexts where HIV transmission is at least partly driven by unsafe injecting in combination with risky sex, HIV prevention impact achieved for people who inject drugs can influence HIV transmission dynamics in the wider population.

PROVISION AND UPTAKE OF PREP

For all criminalized and highly marginalized (key) populations, an enabling environment where their voices can be heard, supported by legislation and zero tolerance for violence, is vital to meet HIV prevention targets and ameliorate many other adverse health events. Where these conditions are still lacking, their absence is a huge constraint to achieving better health and quality of life. Without them, improved services can remain under-utilized and inefficient since key populations will often remain underground for fear of arrest or violence. A person’s request for PrEP can require the disclosure of sometimes illegal and risky practices, along with repeated contact with sometimes hostile health services. In conditions such as these, people who are at substantial risk of HIV exposure and who could benefit from PrEP are unlikely to seek it for fear of discrimination, breaches of privacy, criminal sanctions or other threats.

The history of rights-based health interventions, including for people who inject drugs, has advanced through a series of small victories. The requirement to attend to the context, practices and priorities of key populations applies to all HIV programme implementation, and the emergence of interest in PrEP presents an opportunity to examine these factors more deeply. Current focus and debate on PrEP implementation provides an opportunity for people who inject drugs who are interested to shape the development and design of PrEP services. Health planners and decision-makers will need to engage with people who inject drugs and their sexual partners in order to understand their interest in PrEP, and how any such interest can be integrated with broader prevention services and, for example, the need for drug dependency treatment, overdose treatment, HCV and HIV treatment and the need for protection from human rights violations.

CONCLUSUIONS

PrEP is best understood as an additional potential HIV prevention option for some people who inject drugs and their sexual partners in specific circumstances. The challenge is to ensure that the potential of PrEP is not undermined by narrow and overly biomedical understandings of its value, removed from the real lives of those most at risk of HIV exposure. Harm reduction programmes are intended to address a range of interests and needs, and it is likely that harm reduction programmes could be an effective implementation platform for PrEP for people who inject drugs. (From data and experience of using the medicines in HIV treatment, no interaction is expected between PrEP containing tenofovir/emtricitabine or tenofovir/lamivudine and heroin, methadone or methamphetamine).

PrEP can be an opportunity to harness a specific intervention for longer term public health and human rights outcomes. PrEP will realize its HIV prevention potential if it is introduced in a way that complements and strengthens existing harm reduction and health promotion activities, if it contributes to reducing discrimination and empowers key populations at risk of HIV infection. Creating opportunities to hear from and engage with people who use drugs about their interests, needs, values and preferences regarding HIV prevention, alongside wider health and other needs, is a priority for health programmers and decision-makers. These are some of the factors that will ensure the potential of PrEP for people who inject drugs is realized in a variety of real-world settings.

Full abstract & sources: www.jiasociety.org

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.

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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.