EECAAC 2018: in Search of Optimism

Peter Reiss, Local Co-Chair of the 22nd International AIDS Conference (AIDS 2018), Professor of Medicine at the Academic Medical Centre (AMC) in Amsterdam, the Netherlands

Author: Marina Maximova, Kazakhstan

While the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) was going on in Moscow, Svetlana (the name was changed), a 28-year-old woman living in Karaganda, Kazakhstan became a mother for the first time. It seems that these events are not related at all. However, these two facts were brought together not accidentally. At the international forum, scientists, medical professionals, policy-makers, public officials, international experts and civil society activists argued and discussed how to curb the HIV epidemic and achieve the ambitious 90-90-90 UNAIDS targets. Meanwhile, they were not particularly optimistic. At the same time, a woman living with HIV for eight years gave birth to healthy twins. Maybe it is a sign that we should not give up hope?

Optimists and pessimists together

The question of HIV vaccine has become proverbial. For many years, the best scientific minds of the world have been struggling to invent it. There is no consensus among scientists about the feasibility of a panacea for HIV – the discovery of a vaccine.

Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre honestly says that he is pessimistic about it.

“Personally, I think that it is not possible. There are infectious diseases, to which people naturally become immune after they recover from them. HIV is more like malaria, which does not belong to this category. However, I would be very happy to see such vaccine discovered,” says Dr. Pokrovskiy.

Salim Abdool Karim, Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), vice versa, says that he has never been as optimistic about the HIV vaccine as today.

“A study on the production of HIV antibodies is already in progress. In South Africa, there is a woman, whose antibodies kill about 87% of all known modifications of the virus. We take her antibodies and test their efficiency in HIV prevention,” tells the scientist.

This positive attitude is also shared by Peter Reiss, Local Co-Chair of the 22nd International AIDS Conference (AIDS 2018), Professor of Medicine at the Academic Medical Centre (AMC) in Amsterdam, the Netherlands. He points out that HIV vaccine trials successfully started in Thailand several years ago. Currently, research is going on and the preliminary data are promising. However, this work takes a long time.

Prolonged ART gives a hope for tomorrow

At EECAAC 2018, the leading world scientists shared information about the development of two ARV drugs with prolonged effect

At EECAAC 2018, the leading world scientists shared information about the development of two ARV drugs with prolonged effect. It means that people living with HIV will be able to substitute daily pills with periodic injections. It is much more convenient. Currently, two major research studies of prolonged-action drugs are going on in South Africa.

Stefano Vella, Head of the Department of Therapeutic Research and Medicines Evaluation at the Italian National Institute of Health says that the studies of prolonged-action drugs are currently underway.

“It is not just about injections, but also about implants. For instance, like female contraceptives. It is important that there should be an option to remove them in case of side effects. Every patient should have a choice which medicines to use and the patient’s preferences should be taken into account,” he says.

There is no doubt that the right to choose has an impact on adherence to treatment. For those who have problems with adherence, the ability to take drugs not in the form of pills and without the need of daily administration may be the key to undetectable viral load and better quality of life.

Just a story

Svetlana from Karaganda learned about her positive HIV status when she was 20. The woman did not have a vaccine. For a long time, she could not accept her diagnosis. She even had suicidal thoughts. Svetlana had no idea how to go on living her life. However, she met a man, fell in love with him and they got married. ARV medicine helped her to give birth to healthy children. The happy mother with her babies has already been released from the maternity clinic. The twins have a good appetite; they are quickly gaining weight. This is the main cause of optimism for the woman.

According to the statistics since the 1990s, only in Karaganda region mothers living with HIV gave birth to more than 400 babies. Last year, 36 babies were born. They all remain under follow-up care until they turn 18 months old.

Take part in the Fast Forward Award 2018

Proud winner of the first edition of the Fast Forward Award: Ugandan Network of Young People living with HIV/AIDS (UNYPA)

The Fast Forward Award searches for ‘golden eggs’ – innovative interventions organised by and for the community. The awards aims to link these innovative local solutions with donors in order to increase funding for communities and scale up successful approaches.

Four community-led organisations will be selected to pitch their local innovation on stage at AIDS 2018. A high-level jury of innovation experts and investors will select a winner. The winner receives the Golden Egg, Fast Forward Award, for best community HIV/AIDS solution!

Are you a community-led organisation? Do you implement an activity, approach, or project, which fits this description? Apply or nominate others to take part in the Fast Forward Award 2018!

The deadline is the 7th of May 2018. Download the full call for proposals and/or the application form.

Source: aidsfonds.org

Metropolis 2020: on the Way to 90-90-90

Author: Anastasia Petrova

Dynamics of the HIV epidemics in big cities is a pressing issue all over the world. According to the United Nations, by 2050 most people will live in big cities. This is most relevant for the developing countries with low incomes and growing HIV epidemics. Considering that the key populations are concentrated in metropolises, experts point out that there is obviously a need to implement HIV prevention and treatment programs at the municipal level. The decision to end the AIDS epidemic in big cities by 2020 is embedded in the Paris Declaration signed on 1 December 2014 with support of the UNAIDS.

This topic is the basis of the Fast-Track TB/HIV Responses for Key Populations in EECA Cities Project implemented by AFEW International in collaboration with Alliance for Public Health and presented within the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) held in Moscow, Russia. Together with the municipalities of five big EECA cities, civil society representatives developed measures in response to the spread of HIV/TB in key populations.

On 20 April, Anke van Dam, Executive Director, AFEW International moderated a session called “Fast-Track HIV/TB Responses in Healthy Cities” at EECAAC 2018. The session was co-chaired by Svetlana Plămădeală, Country Manager, Coordinator, UNAIDS, Moldova; Alla Yatsko, President, Public Association ‘Youth for the Right to Live’, Moldova; and Erika Tserkasina, Program Officer, Eurasian Coalition on Male Health, Coordinator, MSM Programmes in Almaty, Beltsi, Odesa and Sofia, Estonia.

“We cooperate with five metropolises in the region: Odesa (Ukraine), Tbilisi (Georgia), Beltsi (Moldova), Almaty (Kazakhstan) and Sofia (Bulgaria). The key criteria in selecting the cities were HIV prevalence and readiness of the local authorities for cooperation. Through organizing a network of community representatives, we established cooperation with the municipalities,” said Anke van Dam, Executive Director, AFEW International.

The goal of the Fast-Track TB/HIV Responses for Key Populations in EECA Cities Project is to contribute to achieving 90-90-90 targets, including reduced mortality and increased funding for HIV/TB treatment. One of the main tools is strengthening partnership between the authorities and civil society. To achieve this objective, the project includes research studies, workshops, and meetings with decision-makers. It is planned that the preliminary results of the project will be presented at the International City Health Conference ‘Developing healthy responses in a time of change’ to be held in Odesa on 13-14 September 2018.

A Survey on Collaborative TB/HIV Activities in Countries of the WHO European Region

Tuberculosis (TB) and HIV cause significant suffering in Europe. It is estimated that 27,000 patients have both diseases. The distribution of co-infected patients is heterogeneous in Europe. Collaborative activities are needed to take the best care of those with TB/HIV co-infection. This is the background information of the survey on collaborative TB/HIV activities in countries of the WHO European Region created by the Wolfheze working group on collaborative TB/HIV activities.

The Wolfheze group documents and promotes the best models and identifies research priorities of integrated TB/HIV care in the European region. Members of the group also identify barriers in TB/HIV services and collaboration. AFEW’s executive director Anke van Dam is the chair of Wolfheze Working Group on TB/HIV collaborative activities.

What this survey adds:

• All countries have guidelines for management of TB/HIV co-infection.

• Models of care for TB/HIV co-infection differ between countries.

• Collaborative TB/HIV activities as recommended by WHO are not universally implemented.

The full version of the survey is available here.

 

 

PLWH Network Launches New Concept Clinics in Ukraine

Author: Yana Kazmirenko, Ukraine

All-Ukrainian Network of People Living with HIV (PLWH) plans to open five 100 Percent Life all-patients-friendly clinics this year. The ultimate plan is to cover the entire Eastern Europe and Central Asia (EECA) region.

The Project to create the 100 Percent Life network of clinics is a challenge for the Charitable Organisation All-Ukrainian Network of People Living with HIV/AIDS. It is considered to be the largest patient organization throughout the former Soviet Union. During the past several years, modern medical centres accessible for all patients have been opened in each region of Ukraine. Medical centres will provide treatment and social support to those frequently dealing with discrimination at regular hospitals: people living with HIV, representatives of key risk groups. HIV-positive patients will receive services free of charge, clients, in general, will receive them at below-market prices.

In autumn of 2016, a pilot clinic was opened in Poltava, and this year medical centres in Kyiv, Zaporizhia, Lviv, Chernihiv and Zhytomyr will receive their first patients. The capacity of the clinic in the capital will be 900 patients per month.

The Network is preparing to present the Clinic Network Project at the 22nd International AIDS Conference AIDS 2018 in Amsterdam. They are convinced that such format will be highly sought in all countries of the EECA region.

“The first centre of this kind abroad will be opened in Moldvova – they have liberal legislation. Georgia and Kazakhstan are also expressing interest,” says Dmitriy Sherembey, the Chairman of the Coordination Board of Charitable Organisation All-Ukrainian Network of PLWH.

The philosophy and services of these clinics will be a drastic difference from the reality of Ukrainian AIDS centres. Below is the outline of the main differences.

Donors become investors

The Clinics Project changes the roles of donors and non-profit organisations. Under the PLWH Network, model donor organisations become investors, and non-governmental organisations (NGOs) become entrepreneurs.

“At the present time, donors award grants, and in the end, they receive a report on “why it did not work and how flawed the world is.” We are knocking this system down: each hryvnya spent on the clinic by donors continues to work after grant completion. All profit from clinics will be invested into the development of new services. The donor acts as an investor and receives profit not in monetary equivalent but in humanitarian terms,” says Mr. Sherembey.

According to calculations of the Network Head, 50 thousand dollars invested in a clinic will turn into a million within 20 years. At the same time, money spent by a patient at the clinic will turn into a service to a person who wants to live, as opposed to being just owner’s profit.

Medical staff of Poltava clinic praised for thoughtful treatment. Photo by PLWH Network

The clinic in Poltava has become profitable just six months after opening. This gives a chance to NGOs to say good-bye to the role of petitioners and enter the market of medical services, which is rated at 100 billion US dollars a year in Ukraine.

“The network of clinics will allow maintaining programmes and staff in case the Global Fund leaves Ukraine. We have been observing the negative experience of closing up programmes and discharging specialists in the Eastern European countries that have joined the European Union,” adds Yaroslav Blyakharskiy, Manager of Social Entrepreneurship Section of PLWH Network.

Medical centre is put together like Lego

Each clinic will have a different set of services, depending on the diseases in the region, what is offered by competitors and the paying capacity of the population. Three specialists will form the basis: a family doctor, an infectious disease specialist and a drug treatment specialist.

Poltava was not a random choice for the pilot project – it is a typical medium-size Ukrainian city. If the project proved to be sought after in this city, it is bound for success in other regions.

“The pilot clinic provides help in the following fields: neurology, allergology, nosology, narcology, pain and withdrawal syndrome relief. Narcology has proven to be in the highest demand,” says Mr. Blyakharskiy.

In Kyiv centre this list will be supplemented with gynecology, urology and dermatology.

Progressive standards of care

Progressive European treatment protocols will be used at 100 Percent Life medical centres. The Clinics Project is integrated into the medical reform, which is currently dismantling the Soviet-times model. Under the reform, each citizen of Ukraine will have to select a family doctor; and the Government will transfer money to the doctor for treatment of this patient. The family doctor will be able to prescribe antiretroviral therapy, which is currently received by 90 thousand patients in Ukraine.

A mobile application as your health manager

100 Percent Life medical centre will make all communications between patients and medical staff automated as much as possible. Clients will be able to install an application on their mobile phones enabling on-line arrangement of appointments, medical tests, receipt of prescriptions and seeing the entire treatment regimen. Patient’s medical record will also be available electronically. The application will allow covering 60% of all communications between the patient and the clinic.

Medical centre accommodates the patient

Poltava clinic is open until 10 p.m. seven days a week. For the PLWH Network it is vital that all categories of patients get equal access to proper quality services and treatment and do not face rejection and discrimination.

According to the research conducted by the PLWH Network, around 19% of surveyed HIV-positive patients in Ukraine have faced refusal of medical examinations that did not involve contact with blood (the research is titled Evaluation of multiple stigma faced by high risk group representatives with regards to HIV infection – editor’s note). Around 80% of patients were refused by the consulting physician.

AIDS 2018 March in Amsterdam

AFEW International received the invitation to join AIDS 2018 march in Amsterdam, and we are sharing this message with you. Please fill in the form below in case you are planning to join the march:

Hello everybody,

In a couple of months the International AIDS Conference 2018 will be held in Amsterdam. We are excited and are looking forward to work together with activists all over the world and make this event one to be remembered.

As you might know from previous conferences, traditionally there will be a march or demonstration of HIV and AIDS activists. This year the march will take place just before the official opening of the conference at the RAI Amsterdam Convention Centre in the afternoon of Monday, 23rd of July 2018. With this email we would like to introduce us to you and ask you to join us in the march/demonstration to raise our voices for and with people living with HIV.

We are aware that we might be a little ahead of time. But it gives us together with you more time to activate more people and to organise a good march in cooperation with the local authorities. Please forward this email to more organisations, people, living with HIV or relatives and friends you know and who might like to become part or support the march. 

For some organisational matters we kindly ask you to let us know if you and your organization are interested in updates or possibly want to get  involved. You can do so by filling out an online form: https://goo.gl/forms/ahKbXV9xO2gRSmnd2

You will soon hear from us again (if you want).

Kind regards,
Alexander P. &
Hans V.  &
Alexander S.

Source: www.aidsactioneurope.org

Do we Treat or Harm: how Ukraine is Fighting against Tuberculosis

Olga Klimenko in the children’s ward of the tuberculosis dispensary. Photos from the personal archive

Author: Yana Kazmyrenko, Ukraine

At the entrance to any public polyclinic in Ukraine, an announcement is greeting a patient: visit a doctor is possible after a fluorography only. The obligatory lungs X-ray maintains a semblance of the fight against tuberculosis. In Ukraine, most of the patients get to know their status very late. The country has not been able to take the tuberculosis epidemic under control for more than twenty years. Ukraine has the world record of multidrug-resistant forms of tuberculosis and is still treating patients, sending them to prolonged isolation in overcrowded dispensaries.

Olga Klimenko – an activist of TBpeople – Eurasian Network of People who have had tuberculosis – was diagnosed with this desease in 2015. By the time of hospitalization, she was sick for at least six months. In 2016, Olga published a book The world inside me. Confession of the tubercular woman in which she described her life experience with the disease.

Now Olga is trying to help patients with this diagnose. On the webpage of her community in Facebook The world inside me, requests appear every day: to transfer money for the purchase of inaccessible drugs, which for the most part are not licensed in Ukraine, to purchase washing machines for tuberculosis dispensaries or diapers for recumbent patients. Last month, Olga was “coaching” 34 patients.

“I do not know when and where I contracted tuberculosis. No one knows. Everyone remembers the last long-lasting flu after which he or she felt weakened and broken down. Ukrainians usually do not go to the doctor, we go to the drug store and buy a full set of antiviral drugs. We remove symptoms, but do not cure diseases,” says Olga.

During the treatment, Olga had good and bad times. The most difficult was the separation from her daughter: the girl was sent to a special boarding school for children who were in contact with infected people, where her homegrown girl spent six months with children from dysfunctional families. Olga still did not forgive doctors who did not tell her that after two weeks from the start of the treatment she was not contagious anymore.

Ukraine is breaking records

Olga’s story is typical for Ukraine where the epidemic of tuberculosis is spreading for several years. More than 30 thousand of Ukrainians are diagnosed with a not active tuberculosis and more than 10 thousand – with an active form. Every day 90 people get their status. These figures are underestimated: according to the World Health Organization (WHO), every fourth patient in the country stays undiagnosed.

Back in 1995, WHO announced that Ukraine has exceeded the epidemic threshold – 50 cases per 100,000 people. Since then, the situation has only worsened – the conflict in the East of the country forced 1.5 million residents of Lugansk and Donetsk regions to resettle. In these regions, there were 15% of Ukrainians who were diagnosed with tuberculosis. Every fifth TB patient is HIV-positive.

Tuberculosis for export

The resettlers are at risk of tuberculosis in Ukraine. Photo by UNIAN

Compared to the other post-Soviet countries, indicators of Ukraine look particularly depressing. If in Ukraine the incidence rate according to the data for 2016 was 67.6 per 100 thousand people, in Belarus it was at the level of 39.9, in Kazakhstan – 52.2, in Poland – 17. The European average is 12 people per 100,000 population.

In the top 20 countries of the world, tuberculosis has already become an exotic disease. The epidemic in Ukraine frightens the neighbors – about 5 million Ukrainians work in the EU countries and Polish media write that a visa-free regime with the EU will allow tuberculosis to migrate to Europe. Warsaw is even discussing the possibility of medical control on the border with Ukraine.

Resistant mycobacteria

Director of the Public Health Center of the Ministry of Health of Ukraine Vladimir Kurpita says that the prevalence of multidrug-resistant tuberculosis (MDR-TB) is the main feature of the Ukrainian epidemic.

Many patients refuse to continue treatment the moment they start feeling better. They do not want to spend at least six months in the dispensary and to be unemployed, staying on the verge of poverty. Due to discontinued treatment the health situation worsens – mycobacteria becomes resistant to drugs. To treat this form, more toxic drugs should be used, the duration of treatment gets longer and it becomes several times more expensive. Now in Ukraine, 85% of the funds allocated for tuberculosis are spent for treatment of multidrug-resistant tuberculosis.

According to Kurpita, treatment of regular tuberculosis lasts six months and costs the state about 30 euros, compared to the treatment of a complicated form of infection, which takes up to 20 months, and the price for that reaches 400 thousand euros. Currently, there are 1.2 thousand cases of such highly resistant bacteria diagnosed in Ukraine. In this sad rating, only India overtakes Ukraine.

Family doctors will start to treat tuberculosis

Experts agree that it is possible to defeat tuberculosis if compulsory hospitalization will be replaced by outpatient treatment. This step may reduce the chance for reinfection in the hospital. Now patients at different stages of recovery are getting treatment in hospital rooms for 5-7 people for years, and they have the risk of catching a nosocomial infection at any time.

A health reform that is currently ongoing in Ukraine, involves the transfer of patients with non-active tuberculosis under the responsibility of family doctors. The last ones are supposed to get extra paid for each of the cured patients.

“The main idea is that doctors will be in closer contact with patients, will know their health history. Responsible people will receive their pills and will lead a familiar lifestyle,” explains Olga Klimenko.

She dreams for three Ukraine-wide days off not because of some celebration but because of a mass medical examination for the all Ukrainians so that people could find out that they have some dangerous disease before it gets to the last stage.

Post-Soviet Countries Need a Single Document on HIV in the Field of Migration

Presidium of the seminar

Author: Marina Maximova, Kazakhstan

In the post-Soviet countries, there is no single document that would regulate the issues of HIV prevention, diagnosis, and treatment for migrants as well as their legal status. Migrant workers do not get the adequate services in the countries where they work which inevitably leads to the decline of their health status and to the growth of the HIV epidemic in the region. This message was the main one in the discussion at the sub-regional technical seminar in Astana, Kazakhstan on February 19-20, 2018. The event was organized by the United Nations Population Fund (UNFPA) in cooperation with the Joint United Nations Program on HIV/AIDS (UNAIDS) with the support of the Ministry of Foreign Affairs of the Kingdom of the Netherlands.

HIV rates continue to grow in EECA only

The seminar became a platform for a dialogue between representatives of governments, international and non-governmental public organizations from Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Russia, Uzbekistan and interested regional partners.

Extraordinary and Plenipotentiary Ambassador of the Kingdom of the Netherlands to the Republic of Kazakhstan, the Kyrgyz Republic and the Republic of Tajikistan Dirk Jan Kop

“The incidence of HIV is predominantly stabilizing around the world. Even if the indicators are very high, they do not grow. However, in Central Asia and Eastern Europe (EECA), HIV incidence is increasing. HIV is not a problem of marginalized groups only. HIV is closer than you think. It must and can be stopped, also it must be stopped in Central Asia,” says Extraordinary and Plenipotentiary Ambassador of the Kingdom of the Netherlands in the Republic of Kazakhstan, the Kyrgyz Republic and the Republic of Tajikistan Dirk Jan Kop.

This concern was supported by all the participants after considering the situation, strategies used in different countries, best practices, main priorities for the effective response to the HIV epidemic among labor migrants.

The way HIV affects labor migration

Labor migration and HIV prevalence are increasing. This already became a stable trend of the region. There are numerous examples where migrant workers with HIV have no access to antiretroviral therapy in the places of temporary residence. Legislation of some countries provides for the deportation of foreign citizens with HIV. Migrant workers often experience stigma and discrimination.

UNFPA Regional Director for EECA countries Alanna Armitage

“Recent epidemiological surveillance data in Uzbekistan and Tajikistan have shown that the prevalence of HIV among people returning from labor migration is 2-4 times higher than among the general population. Migrant workers from Central Asian countries face serious challenges in access to the full information and adequate HIV prevention, care and treatment services,” said UNFPA Regional Director for EECA countries Alanna Armitage.

Experts unanimously admit that better access to HIV prevention and treatment in Central Asian countries is the key to elimination of the HIV epidemic.

Aid for migrants with HIV started in Kazakhstan

In 2018, HIV-positive migrants in Kazakhstan begin to receive aid with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Treatment and laboratory testing will be provided to 150 people.

“Kazakhstan is a country with a low HIV prevalence. Last year, more than 16,000 foreigners were tested for HIV. 0.2% HIV cases were found. If we take the vulnerable groups only, this figure among foreigners will reach nine percent,” says the vice-minister of health of the Republic of Kazakhstan Lyazzat Aktayeva.

In a country where migrants with HIV do not have to be deported, 61 thousand people were tested. This is a heavy burden on the national budget. So far, migrant workers have no legal status and opportunities to receive even a minimal medical service are very limited. Therefore, we need new strategies for working with this category of the population and not only within a single country.

First shot in the battle

The participants called the seminar the first shot in the battle for an overall strategy for the prevention, diagnosis, and treatment of migrants in the post-Soviet space. The creation of a special structure located in Russia as the biggest receiving country of migrant workers was approved to regulate this process.

Recommendations of the seminar will be presented for discussions at the forthcoming international conferences on HIV/AIDS, which will take place this year: The VI International AIDS Conference for Eastern Europe and Central Asia (April, Moscow) and 22nd International AIDS Conference AIDS 2018 (July, Amsterdam).

Happy with HIV in Tajikistan

Tajik wedding. Source: wikimedia.org

Author: Nargis Hamrabaeva, Tajikistan

A Tadjik girl Nozanin was diagnosed with HIV after her husband-migrant returned home a few years ago. As the man has found it out, he walked out on her… Now the 40-year-old woman is happily married again.

Everything was like a fairy tale

“It happened unexpectedly, like in a fairy tale. Once I was taking care of the household, when my friend, who liked me, called. He said that he would come with a mullah (a clergyman conducting the wedding ceremony according to the Muslim canons – editor’s note) and some of our colleagues. They really came. After the religious wedding ceremony, we went to his parents,” Nozanin is saying.

This friend turned out to be a client of the Republican Network of Women Living with HIV, where Nozanin has been working. He was also HIV positive. He wanted to marry a woman with the same status and Nozanin somehow even tried to find him a suitable candidate. It turned out that the man was already in love with her…

“I never thought that I could ever get married again, especially having HIV status,” she says.

Today Nozanin considers herself to be a happy woman. Together with her husband they have a lot of plans and ideas, and they also want to give birth to a healthy child. Many couples living with HIV have the same desire.

A marriage contract is not needed

700 people in Tajikistan receive support from the Republican Network of Women Living with HIV. For the most part, these are young people who want to start a happy family.

Tahmina Haydarova, the head of the network, says that young men between the ages of 18 and 35 come to them searching for a soulmate with the same HIV status. Often these are labor migrants, former drug users or prisoners who have never been married before. Brides are usually those who have already been married. These women contracted the virus from a migrant husband or partner who used drugs.

Such brides do not ask to sign a marriage contract; they do not ask for an apartment or dacha. The most important thing for them is the timely use of antiretroviral therapy by their future spouse and a healthy life.

HIV is not a barrier

Each year the Republican Network of Women Living with HIV helps at least 5-6 young HIV positive people to find their spouses. Takhmina Haydarova is telling about 10 couples who decided to start a family with the fact that one of the spouses is HIV positive.

“If a person loves and accepts you for who you are, then HIV is not an obstacle to start a family. Today antiretroviral drugs that block the HIV are available. A person living with HIV with a suppressed viral load can start a family, give birth to a healthy child, live a full and happy life the way our clients do,” she says.

According to the Republican AIDS Center, the total number of HIV positive citizens in Tajikistan has reached 10 thousand people, one third of them are women. Since 2004, women with HIV have given birth to 1,000 children, 600 of these children have no HIV.

HIV Risks Grow in Kazakhstan

The number of new HIV cases in Kazakhstan is still growing

Author: Marina Maximova, Kazakhstan

In Kazakhstan, the key alarming trend of the recent years is the growing sexual transmission of HIV. Before, most people in Kazakhstan contracted HIV when sharing injecting equipment, but now most infections are transmitted through sexual contacts.

A commonplace story

Zhaniya (the name is changed) learned about her positive HIV status when she got pregnant and went to the maternity clinic for the medical check-up. She got tested and could not believe her eyes when she saw the test result as she never used drugs and her husband was her first and only man. Repeated testing confirmed the positive result. The woman was afraid to tell her husband and family about her status, feeling scared, ashamed, hurt and confused. She could not remain silent either as any news are spread quickly in her village, let alone bad news. The conversation with her husband made it all clear.

“He confessed that he used to inject drugs. It was long ago, when he was still very young. Now he is sorry about that and wants to have a family and children. My husband also got tested for HIV and his result was positive too. He did not know about his disease and did not want to infect me. Now the main thing is for our baby to be born healthy. Doctors say that it is possible,” says Zhaniya.

In Kazakhstan, 99% of pregnant women living with HIV give birth to healthy children. These women often give birth to two or even three children. In the recent decade, the rate of mother-to-child transmission of HIV dropped four times.

Taking into the account the achievements of the national AIDS service, the stories of Zhaniya and other women living with HIV sound commonplace. The face of the epidemic is becoming more and more female. If earlier mostly men got infected with HIV, now the gender proportion looks more equal. The statistics is illustrated by the following trend: most men rarely go to clinics or make appointments with doctors. Women take more care of their health in general, while pregnant women twice get tested for HIV free of charge.

No sexual education in schools

Natalia Rudokvas, Director of the Answer Charitable Foundation

Another problem contributing to the increased risks of HIV is lack of relevant educational programs in schools and colleges. High school and college students have no access to the information about the routes of HIV transmission and ways to protect themselves at special classes or lectures. There are no guidelines or instructions for educators on this topic. In families, where the topic of sex is a taboo due to the peculiarities of local mentality, children fail to get any information or advice from their parents.

“When our activists make attempts to offer school lectures on the safer sex – we are told we cannot do it. For some reason, promotion of condoms and other contraceptives is considered equal to… debauchery. People blame us, saying that this is what our presentations cause,” tells Natalia Rudokvas, Director of the Answer Charitable Foundation from Ust-Kamenogorsk. She is puzzled with such attitude and hopes that this crucial topic will be discussed at the upcoming 22nd International AIDS Conference AIDS 2018.

Lack of any systematic sexuality education in past years loudly echoes today. Natalia says that people over 30 years of age more and more often seek counselling at their charitable foundation. While young people injecting drugs regularly get tested for HIV and fall under control of the health professionals, older people with “forgotten” histories of drug use stay in the shadow.

The epidemic is growing older

Baurzhan Bayserkin, General Director of the Republican AIDS Centre at the Ministry of Health of Kazakhstan

Several years ago, mostly young people aged 20-29 got infected with HIV in Kazakhstan. Now the age threshold went up to 30-39 years old. Most people got infected twelve or more months ago, and only 10% of the patients were infected within the recent nine months.

“The data received became the ground to carry out an additional epidemiological survey to determine the network of contacts and expand the list of potential risks of infection. High proportion of people who got infected long time ago demonstrates that people have low concerns about contracting HIV. The new approach shows the real picture of the morbidity and allows evaluating the efficiency of prevention measures,” sums up Baurzhan Bayserkin, General Director of the Republican AIDS Centre at the Ministry of Health of Kazakhstan.

The number of new HIV cases in Kazakhstan is still growing. As of today, there are about 29,000 of Kazakhstani and about 2,000 of foreign citizens living with HIV in Kazakhstan.