Kazakhstan: Reducing Stigma and Pills – Improving Adherence to Treatment

Author: Oksana Maklakova, Russia

In early May, Kazakhstan presented and discussed a new concept of providing antiretroviral treatment (ART) to people living with HIV. The concept will be implemented in 2021–2025. Of Kazakhstan’s 19,384 patients registered in HIV care in 2018, 77% are on ART. This quite high indicator gives Kazakh doctors and civil society activists hope that the UN 90/90/90 targets will be achieved in the country.

One-stop shop approach

“Of course, there is a problem with adherence to treatment in Kazakhstan. Treatment regimens change not only because some patients are resistant to certain drugs and need new combinations, but because sometimes there are interruptions in the supply of certain drugs. Optimized treatment regimens and improved quality of treatment as an objective was included in the new strategy by UNICEF and the Kazakh Scientific Centre of Dermatology and Infectious Diseases. NGOs are also working towards achieving this objective. For example, reduction to just eight universal and effective treatment regimens is planned,” says Lyubov Vorontsova, project coordinator of the Central Asian Association of People Living with HIV.

Since 2017, Kazakhstan has been implementing a “test and treat” strategy. In line with WHO guidelines, antiretroviral treatment is prescribed and provided to patients on the same day they are diagnosed with HIV, without waiting for immune status or viral load indicators. Procurement of antiretroviral drugs (ARVs) is regulated and funded by the government. However, access to ART is still a crucial issue in remote areas of Kazakhstan.

“Last year we monitored adherence to treatment in different cities of Kazakhstan. We wanted to find out, firstly, why people are afraid to start therapy, and secondly, why people drop out after they start ART. The first thing we heard is that people are scared of side effects (though in this regard modern drugs are much better than older ones). People also mentioned treatment fatigue, as ART is a life-long therapy. However, there are also remote areas where people have problems with physically accessing the drugs as they live 300 kilometres away from the AIDS centre and do not always have time and money to go and pick up their medications,” says Vorontsova.

Quitting therapy after the baby is born

People living with HIV (PLWH) in Kazakhstan, as in many other countries of eastern Europe and central Asia, are concerned about the quality of ARVs. Kazakhstan is gradually transitioning to modern regimens which are easier to tolerate, have almost no side effects and, most importantly, are more convenient to take. The biggest challenge for both doctors and civil society activists is stigma, self-stigma and discrimination.

Project coordinator of the Central Asian Association of People Living with HIV Lyubov Vorontsova

“We often hear stories about people who are afraid to take pills at work as someone may see them. There have been cases when colleagues saw a person taking ARVs, then checked the name of the drug on the internet and found out that this person had HIV. As a result, he or she was fired. Of course, such incidents have a negative impact on adherence to treatment,” comments Vorontsova.

There are also problems with the information pregnant women with HIV receive in antenatal clinics. Mothers-to-be agree to start taking ARVs as it is important for their babies. This approach often leads to a situation where the woman stops treatment after delivery. She saves her child, but nobody tells her that first of all she needs the therapy to take care of her own health. To avoid such cases, Kazakhstan would like to introduce peer counselling for pregnant women.

The problem of adherence is crucial in key populations – men who have sex with men, people who use drugs, and sex workers. Due to self-stigma, many do not access health services. It is often much easier for such people to receive support from a civil society organization (CSO) than to go to a government health centre. For this reason, last year many CSOs in Kazakhstan started to actively implement testing and self-testing programmes.

Bargaining for lives

In order to reach as many people living with HIV as possible with quality modern treatment, the Kazakh Ministry of Health decided to procure ARVs through international agencies. It was expected that procuring drugs at minimum prices would allow coverage of patients with new ART regimens to double in the following months, and accelerate transition from older to more modern drugs. However, this spring Almaty residents faced interruptions in the supply of the vital medication dolutegravir.

The Ministry of Health of Kazakhstan and the Pharmacy Committee held negotiations about including Kazakhstan into the voluntary license, which would reduce procurement prices for generic dolutegravir from USD 118 to USD 4.5 This would enable provision of effective therapy to all PLWH in Kazakhstan. However, the patent owner said that only low-income countries can be included in the voluntary license on such terms, and left the old price for Kazakhstan.

“Dolutegravir is really a high-quality medication. It has very few side effects. As there are interruptions in the supply of this drug, patients are transferred to other treatment regimens,” says Vorontsova.

The next delivery of dolutegravir is expected in June. The Ministry of Health will then prepare documents to submit for compulsory licensing, under which generic drugs can be procured at a lower price.

AIDS 2018: Prevention Focused on Key Populations

Source: www.aids2018.org

Author: Marina Maximova, Kazakhstan

Just before the 22nd International AIDS Conference in Amsterdam AIDS 2018, a new Global AIDS Update prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) was presented in Paris. The report shows that the HIV epidemic is still growing in the countries of Eastern Europe and Central Asia (EECA). In the recent year, the number of new HIV cases in the region has doubled.

Participants of AIDS 2018 debated a lot on the reasons of this trend. Experts explained it, in particular, with a lack of prevention programmes, especially among people who inject drugs (PWID). Today, they account for over half of the new HIV cases. That is why implementation of the innovative multilevel interventions aimed at HIV prevention in key populations is to be continued.

For several years already, the Global Health Research Center of Central Asia (GHRCCA) and the Social Intervention Group (SIG) of Columbia University have been implementing projects and evidence-based interventions aimed at HIV prevention among key populations in the region, in particular in Kazakhstan. The results and achievements of three of such projects were presented at a special session of AIDS 2018.

Good News from NOVA

Assel Terlikbayeva

Assel Terlikbayeva, GHRCCA Regional Director:

NOVA Project is the first intervention combining harm reduction services and microfinance for women in difficult life circumstances. In two years, about 500 women from vulnerable populations – sex workers and people who use drugs – developed their skills to reduce the risks of contracting HIV and other sexually transmitted infections. Women received professional training in sewing and hairdressing. The most active participants received micro loans to start their own businesses. About 82% of project participants were able to open savings accounts, and many of them did it in the NOVA Project. About 70% of project participants were qualified for non-repayable allowances to start their own businesses, while 36% of women were able to use this opportunity.

Renaissance is possible

Louisa Gilbert

Louisa Gilbert, PhD, GHRCCA Co-Director:

The Renaissance Project is an innovative HIV prevention intervention aimed at PWID couples. Project results are inspiring first of all for its participants. Here is some of the optimistic statistics: unsafe sexual behaviours among project participants and their sexual partners were reduced by 42%, hepatitis C incidence decreased by 69% and HIV incidence – by over a half in the harm reduction group as compared to the control group.

Throughout the project, there were 89 instances when Naloxone was successfully used to reverse overdoses: in 15 cases, the medication was used to deliver first aid and saved lives of the Renaissance Project participants and in 74 cases – of PWID partners and their immediate circle.

PWID choose trust

Nabila El-Bassel

Nabila El-Bassel, PhD, Executive Director of GHRCCA and SIG, Professor of Columbia University:

In the recent year, the number of PWID visiting pilot confidential counselling sites and going through HIV rapid testing has more than doubled. It is very important that the number of new HIV cases detected at such pilot sites has grown. Implementing evidence-based strategies in routine activities allowed scaling up PWID coverage with harm reduction and HIV testing services. It became possible through the Bridge Project.

Besides, the project enhanced the role of outreach workers in finding and recruiting new clients as well as the role of nurses in working with HIV-positive people. Implementing electronic data collection helps to improve tracking and monitoring of the services and referrals provided.

Awareness and Acceptability of PrEP Among Men Who Have Sex with Men in Kazakhstan

Oral pre-exposure prophylaxis (PrEP) is an antiretroviral method of HIV prevention recommended to men who have sex with men (MSM) at high risk of infection. In Kazakhstan, which has one of the fastest growing HIV epidemics globally, PrEP is not currently available. The aim of this study is to explore the possibilities for PrEP initiatives in Kazakhstan by investigating awareness and acceptability of this prevention method among MSM. This mixedmethods study employs an online survey and qualitative interviews to describe PrEP awareness and acceptability. Less than half (39.8%) of survey participants had heard of PrEP.

However, a majority (85.2%) of MSM would possibly or defi nitely use PrEP if it was available. Awareness of PrEP was positively associated with willingness to use PrEP. The main reason to be interested in PrEP was an increased feeling of protection, whereas barriers were related to the idea of taking daily medication and the potential for side effects. PrEP is an essential component of HIV combination prevention. Our findings suggest potential for PrEP programmes among MSM in Kazakhstan and possibly in other Central Asian nations, when taking into account burdens of taking PrEP as well as more structural health policy issues.

Read more of the study here.

Stigma Affects the Motivation for HIV Testing

Author: Marina Maximova, Kazakhstan

As estimated by UNAIDS, 35 million people globally died of AIDS-associated diseases since the onset of the epidemic. People living with HIV die of tuberculosis, cancers, hepatitis… Meanwhile, there is no data on how many lives are lost to stigma. Today stigma is the strongest barrier for testing among those who are not aware of their status and for receiving services among people living with HIV (PLWH).

Migrant with HIV double stigma

Salavat Kabjalelov is an outreach worker and a peer consultant in the Zabota (‘Care’) Charitable Foundation. He helps labour migrants: offers consultations on HIV, tells about the need to get tested, navigates clients for diagnostics to the AIDS Centre and to the tuberculosis clinic. Salavat can find the right words for every client. He had no citizenship or registration, no access to antiretroviral treatment (ART) and he wanted to hide not only from his problems but also from hostile stares and rough remarks of people around him.

Salavat Kabjalelov

He and his wife lived a quiet life, not seeking medical care. For migrants, the main thing is their job, not their health. Then, three years ago something tragic happened. Salavat lost his wife. The young woman died of cancer.

“I tried to arrange hospice care for my wife. I was even ready to pay for it, but it was not possible. They refused me. She was living with HIV. It appeared that it was more important to be a citizen. If you had a severe disease, it was not an argument. The good news is that now the situation in Kazakhstan is improving and migrants with HIV will be provided with ART. However, it will not bring my wife back,” complains Salavat.

Everyone goes through self-stigma

Lyubov Chubukova

Lyubov Chubukova works in the Kazakhstan Union of People Living with HIV. She is a delicate woman of strong character, who can convince people both from the tribunes of international forums and in one-on-one arguments. Twelve years of living with HIV made her a leader. She experienced stigma in a private health centre where she came when she got pregnant – young and confused. An older woman gave her an advice – to seek health services only in the AIDS Centre. However, Lyubov says that her self-stigma was even stronger. Every person who learns about having HIV faces this problem.

“I no longer consider myself a victim as it makes it impossible for me to live and grow. Good support in fighting self-stigma is trusting people and knowing your rights. You have to live on, not restricting yourself, and overcome your fears. Otherwise, you may reach the worst point,” says Lyubov.

Lyubov does not hide her status. Vice versa, she often takes part in TV shows and open discussions as an expert. She is convinced that stigma affects the motivation for HIV testing. People are afraid to get tested for HIV as they are worried that their test may come back positive. At the same time, if a person living with HIV starts the therapy too late, the probability of treatment success is much lower and it can even lead to death of the patient.

Every tenth person living with HIV has suicidal thoughts

Three years ago, the Central Asian Association of People Living with HIV within the Leader of People Living with HIV Project funded by USAID for the first time in the region carried out a survey to assess the index of stigma in three Central Asian countries – Kazakhstan, Kyrgyzstan and Tajikistan.

Results of the study in Kazakhstan showed that every tenth person living with HIV had suicidal thoughts. PLWH aged 30 and above suffer most from self-stigma as well as people with small (one to nine years) history of living with HIV. Self-discrimination mainly leads to the decision not to have any more children. Every third person living with HIV in the country makes such a decision.

The study demonstrated that the experience of injecting drug use as well as the experience of imprisonment were the drivers of stigma towards people living with HIV. Most often, PLWH faced discrimination from the side of health workers (first of all, refusal to provide health care) and public officials, while discrimination from the side of their immediate social environment was far less common. Moreover, the cases of discrimination were accumulated in the first ten years of a person living with HIV.

No silence about stigma

Baurzhan Bayserkin

The first step in overcoming stigma is to break the wall of silence. Approval of regulations at the country level is a real victory. In the beginning of the year, the National Plan to Fight Stigma and Discrimination against People Living with HIV was approved in Kazakhstan.

“Stigma and discrimination related to HIV status are the major barriers for PLWH to access prevention, care and support services. To end the spread of HIV, a focus should be made on the complete eradication of discrimination, first of all in health institutions. It will allow achieving a significant reduction in the growth of HIV epidemic,” says Baurzhan Bayserkin, General Director of the Republican AIDS Centre.

Kazakhstani are going to continue this discussion at the 22nd International AIDS Conference in Amsterdam AIDS 2018.

We Fight, We Hide or We Unite

We Fight, We Hide or We Unite: coping strategies amongst resilient harm reduction organisations and community networks in the context of shrinking space for civil society in Eastern Europe and Central Asia

The title of this report, ‘We Fight, We Hide or We Unite’, reflects the survival strategies we identified amongst resilient harm reduction non-governmental organisations and community networks of people who use drugs (PWUD) in Eastern Europe and Central Asia (EECA). This assessment forms a part of the regional approach of the AFEW Network within the ‘Bridging the Gaps: health and rights of key populations’ programme, financed by the Ministry of Foreign Affairs of The Netherlands. This report presents the primary findings from the assessment, ‘Shrinking Space for Civil Society Organisations in Eastern Europe and Central Asia’, conducted between June and September 2017 at the international level by AFEW International and at the regional level.

We provide a detailed description of the overall study purpose, methodology, background and context regarding the shrinking civil society space and the coping strategies of HIV and PWUD CSOs working under these circumstances. The results of this assessment will be used to develop ideas and strategies on how to cope with the local contexts of the shrinking civil society space. In this way, it will contribute to the survival of CSOs and improving the current situation. This assessment represents the first step in the development of this focus within the AFEW Network’s regional approach within the ‘Bridging the Gaps’ programme. It will be followed by an analysis of existing gaps in the support necessary for specific interventions and initiatives to support specific coping strategies; the development of pilot projects on advocacy, service delivery or capacity building; and the continuous monitoring of results.

The full version of the report is available here.

Integrated Care Centre in Almaty – a Home for Everybody

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices

Author: Marina Maximova, Kazakhstan

A month ago, the first Integrated Care Centre for people in difficult life circumstances, called Revenge, was opened in Almaty, Kazakhstan. The centre was established at the initiative of the community of people living with HIV.

Invisible People

People living with HIV (PLWH), people who use drugs (PUD), those who are released from places of confinement… Those people are often left behind and ignored. They are invisible, pinned to the wall of despair, with a trail of problems that remain unresolved for years, not believing that there is a light at the end of the tunnel. Now they know where they can find help. Where they will be understood and will not be neglected. Now the address 14A Omarov Street, Almaty is well known to many people. They pass it on to each other, realizing that for someone it might be the last hope.

“The centre was opened by the community, which is one of the factors attracting the potential clients. Here people can stay overnight or even live for a while until they are able to resolve their most pressing problems. The main thing is that here they are able to get a temporary registration, which is the main barrier in re-issuing the documents, getting “registered” with a healthcare facility, etc. The centre is a unique initiative and its launch was very well timed,” tells Roman Dudnik, Executive Director of AFEW Kazakhstan.

AFEW Kazakhstan supported the idea of opening the Revenge Centre within the Project “Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia.” Among other initiators – activists of the Kazakhstan Network of Women Living with HIV and the Revenge Social Support Fund.

I reached the lowest point of my life

Director of the newly established centre Yelena Bilokon knows about the lives of people who practice risky behaviours not by hearsay. She was using drugs, lived in the street and has been living with HIV for 22 years. Rehabilitation centres inspired her to start a new free life. She got acquainted with the rehab clients within her community activities. When she saw the premises, the joint work, the support people provided to each other and their enlightened faces, she felt that she wanted to open her own centre.

Timurtau centre was her first success. It is a crisis centre for families called My Home, which provides assistance to many women and their children who are in trouble. The Almaty project is more large-scale.

“We have clients who have not been able to access antiretroviral treatment (ART) and, thus, to reduce their viral load and even go through medical examinations for three years or more. What can we say about migrants if even our citizens cannot receive these services? The same story is with tuberculosis patients who are left without social benefits, which they are entitled to. People are not even able to find jobs. As for children, when they get into crisis situations with their parents, they also need help, sometimes even more than adults,” says Yelena Bilokon, Director of the Kazakhstan Network of Women Living with HIV.

Up to 40 calls a day

In the centre, telephones are ringing all day long. Many people need help. The centre, in fact, is also in need of help. Kitchenware, clothes, bed linen, furniture, food… All these things are brought by good people. There was a call for help in social networks – and a lot of people responded.

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices. 25 people were tested for HIV with rapid tests, 17 found jobs, 11 were examined for hepatitis and tuberculosis. It is not just statistics. Every number symbolises the struggle for someone’s health and life. Every day.

“Opening of such centre offering integrated services for vulnerable populations is an important event for our city. All the crisis centres, which existed before, had their own profiles and worked only with certain populations. People who need help cannot always find a centre offering the necessary services quickly. The Revenge Centre helps everybody,” says Alfia Denebayeva, Deputy Chief Physician of the Almaty AIDS Centre.

Workshops on case management, outreach work, stigma and discrimination delivered by medical professionals and civil society leaders help the centre clients to become volunteers. Recently a youth and adolescent club was opened in the centre, with many guests coming for the opening ceremony. In fact, they are not called guests here – those are our friends and allies, and their number is growing day by day.

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).

AFEW Builds Models for the Future with Improved TB/HIV Care

AFEW, Hivos and PharmAccess and KNCV representatives after the presentation on the Dutch congress ‘Soa.Hiv.Seks’

Author: Olesya Kravchuk, AFEW International

The ‘Improved TB/HIV Prevention & Care – Building Models for the Future’ project was presented during the Dutch National Congress ‘Soa.Hiv.Seks’ on 1 December 2017 in Amsterdam, the Netherlands. Three working models from Kazakhstan, the Philippines, and Nigeria implemented by AFEW, Hivos and PharmAccess with KNCV Tuberculosis Foundation as the lead agency were shown to the Congress audience.

HIV and TB are two of the biggest public health threats in the world. Mounting challenges associated with these mutually reinforcing diseases are both medical and socio-political. In the efforts to address many of the common challenges, AFEW, HIVOS, PharmAccess and KNCV, with support from the Dutch Ministry of Foreign Affairs, collaborate in different parts of the world via the ‘Improved TB/HIV prevention and care-building models for the future’ alliance to jointly design and pilot innovative models of cooperation between the public, private and community sectors involved in the fight against HIV and TB, to find new ways of ensuring and expanding affordable, patient-centred and high quality access to care for key affected populations.

“After the project has started in Almaty, Kazakhstan, we can observe positive changes. A patient has information about good quality care, knows where to go for treatment and support, and has a choice in seeking care in the public sector, private sector and civil society,” the executive director of AFEW International Anke van Dam is saying. “Self-support groups and client management for TB patients are being organized and the HIV and TB working group is supported by the head of the Almaty City Health Department.”

Private clinics in Kazakhstan are now engaged in the public healthcare sector. They are integrated into the national monitoring and evaluation system for public/non-public TB/HIV care provision in Almaty city.

In Kazakhstan Students Debated on HIV

Author: Marina Maksimova, Kazakhstan

Opening ceremony of the first international debate tournament in Almaty “SpeakUp: AIDS”

Over 400 students from universities of the CIS countries took part in the first international debate tournament on HIV “SpeakUp: AIDS” in Almaty, Kazakhstan.

“Almaty is the city of students and active young people, who are interested in gaining knowledge, in particular in the area of healthy lifestyle and HIV prevention. Out of 5 000 people living with HIV in Almaty one-third is young people. Our city has a tradition to conduct spectacular campaigns dedicated to the World AIDS Day. This year, it was the first time we held debates on this topic among young people,” said Murat Daribayev, deputy akim (akim  is the head of a local government in Kazakhstan and Kyrgyzstan – note of editor) of Almaty.

Among the debate participants, there was the best 2017 speaker in the world representing the international debate movement, the main judge Raffy Marshall (Oxford), students from the major higher educational institutions of the country as well as from the UK, Kyrgyzstan, Russia, Tajikistan, and Sweden. The international panel selected 120 teams to take part in debates on this critical social issue. The tournament was held in line with the British parliament model.

The right to argue

Aleksandr Semenov, a student of the law department at the Kazakh National University is not a newbie in the debate movement. For the seventh year in a row, he wins his right to take part in the debates. He got through to the final round ten times, won five tournaments and even trained other debaters.

“The debates are a separate culture. It is sort of a recharger for your brain to always keep you thinking and analyzing to be able to assess a problem from various points of view. Additionally, you have to do it as fast as possible. The topics are always different: politics, culture, religion, sports… It was the first time when we had our debates on HIV. Therefore, the first conclusion is that we cannot keep silent, we should talk about it and ruin the stereotypes. Young people may be the opinion leaders,” says Aleksandr.

There are two people on his team: he and Altynay Dzhumasheva, a student of the American University of Central Asia from Kyrgyzstan. For debaters, it is not important which country or university the team members represent, the main thing is the efficiency of their joint efforts, mutual support, ability to swiftly catch the idea voiced by the partner and develop it in an emotional and convincing manner.

Stronger arguments

At the tournament, the debaters could use any of the three languages: English, Kazakh or Russian. The organizers selected several key topics. They included digitalization of the health care, drug use problems, sexual education, HIV and children, stigma and discrimination of people living with HIV. The participants were to be competent in all the topics.

“One of the rounds addressed the topic of drug addiction. What should change in the countries and in minds to give information about drugs and for drug users to have a choice of treatment and rehabilitation options? Our “opposition” team had to resist a storm of arguments from the “government.” Finally, the victory was ours! Our arguments on the need to adopt an efficient state drug policy and open state rehabilitation centres appeared to be stronger,” tells Altynay Dzhumasheva.

Counting on the young people

Debates among young people in Kazakhstan are a new instrument in response to AIDS. Organizers of the debates included the local Almaty administration, the Ministry of Health of the Republic of Kazakhstan, the Republican AIDS Center, the Health Department of Almaty, UNAIDS, and UNICEF.

Search for the new formats of HIV prevention among young people is an important topic to be discussed at the International AIDS Conference (AIDS 2018) in Amsterdam.

“Kazakhstan has already started its preparations to declare the elimination of mother-to-child transmission of HIV. We hope that information about HIV will continue to be accessible and accurate. The progress we have achieved has been to a great extent made possible thanks to people not being silent and youth being actively engaged,” HIV/AIDS Specialist from UNICEF Ruslan Malyuta is saying.

The winner of the English league of the first international debate tournament on HIV was a team from the People’s Friendship University of Russia. The best team in the Kazakh league was from the Taraz State University (Kazakhstan), and in the Russian league – from the Eurasian National University (Astana).

With Tuberculosis, it is Important to Take Medicine and Believe in Yourself

Sultanmurat from Kazakhstan wanted to get cured of tuberculosis no matter what but the treatment was difficult

Sanat Alemi is one of the civil society organizations (CSOs) supported by the Improved TB/HIV prevention & care – Building models for the future project which gives support to TB patients and their relatives. Founded in 2016 in Almaty, Kazakhstan by a group of ex multidrug-resistant or extensively drug-resistant TB patients, they quickly showed successes through their established self-support groups as well as one-to-one TB patient support. Sanat Alemi is also implementing several community-based activities such as social mobilization, advocacy, and communication to improve TB literacy among people affected by TB, TB/HIV, AIDS and other socially significant diseases (drug abuse, alcoholism, etc), aiming at reducing stigma, discrimination.

Success is possible with trust and professionals

“The social support for TB patients plays a key role in increasing adherence to the treatment. The success in treatment is possible with the combination of trust, human relationships and the support of professionals, such as a psychologist and social worker,” the current director of Sanat Alemi Roza Idrisova is saying.

A TB patient and client of Sanat Alemi Sultanmurat did not know anything about tuberculosis, except that it was a dangerous disease.

“I was horrified when I heard I had TB. I could not even imagine how I got it. I started coughing blood which was so scary, but I did not suspect that it could be TB,” he says. “I thought that the pain was caused by my liver or another internal organ. I told about this to my mother, as she is my closest relative. The other relatives reacted with understanding and this helped me a lot.”

What does not kill us makes us stronger

Sultanmurat wanted to get cured no matter what but the treatment was difficult. In the beginning, he could not tolerate the drugs, and he developed allergies.

“I struggled and tried not to miss a single day of medications and injections. I heard about Sanat Alemi from other patients and started to attend their self-support groups. Receiving support from other patients and social workers during treatment is of great help and being able to join trainings and meetings with different specialists is very useful and gives a lot of interesting information. I had the opportunity to ask questions that I had for a long time. I believe that in the future Sanat Alemi will keep the same spirit and will support many other TB patients,” Sultanmurat says. “TB completely changed my life. I started to appreciate life and learned to tolerate the sickness. I started to appreciate and love my relatives even more as they proved once again that they are there for me and that they would never give up on me during difficult times.”

Sultanmurat would like to say to other TB patients that this disease is curable like many other diseases. The most important thing is to follow the treatment, take pills without interruption, eat well and do sports. It is also important to be friendly, always and everywhere provide support and assistance to other people with TB. The most important thing is to believe in the best, in your recovery and do not forget that what does not kill us makes us stronger.