HIV/AIDS Surveillance in Europe 2017-2016 Data Released

On 1st of December, we mark World AIDS Day (WAD) to raise awareness about HIV and its impact on individuals and societies around the globe. WAD 2017 in the WHO European Region will focus on the problem of late HIV diagnosis – the high number of people who are diagnosed with HIV at a late stage of infection with consequences for individuals’ health and survival, and for the community where HIV can transmit further.

With this message, we invite you to join us and mark the World Aids Day 2017 in your country.

On 28 November 2017, WHO/Europe and ECDC jointly released the annual report on HIV/AIDS surveillance Europe, containing the latest available surveillance data.

Similar to recent years, the highest proportion of HIV diagnoses (40%) was reported to be in men who have sex with men (MSM). However, for the first time in a number of years, several countries reported a decline in new HIV diagnoses, even after adjusting for reporting delay.

While the data in this year’s report indicate alarming rates and increases in new diagnoses in some parts of eastern and central Europe over the last decade, at the same time there has been a tendency towards stabilising or even decreasing rates in some EU/EEA countries.

Trends by transmission mode, for example, show that the number of HIV diagnoses among MSM in the EU/EEA decreased slightly in 2016 and the number of heterosexually acquired cases has decreased steadily over the last decade.

Moreover, in the EU/EEA, the number of AIDS cases, and the number of AIDS-related deaths, has consistently declined since the mid-1990s.

The report on HIV/AIDS surveillance in Europe 2017 – 2016 data is available here.

TB and HIV – a Plague of Tajikistan Prisons

Prisoners in the yard at a colony in Dushanbe. Photo from the archives. Author – Nozim Kalandarov

Author: Nargis Hamrabaeva, Tajikistan

Around 12,000 million people are held in correctional institutions and pre-trial detention centers in Tajikistan. Approximately 100 of them have tuberculosis, and 220 live with HIV.

“HIV prevalence in prisons in Eastern Europe and Central Asia (EECA) is estimated to be between 2 and 50 times higher than that in the general population. In EECA, Tajikistan has the highest rate of HIV infection among prisoners – 7%, which is about one-fifth of all people infected with HIV in the country. Additionally, according to the estimates, the risk of contracting TB in prison is 60-100 times higher than outside prison walls. Within the prison population, there is an increased rate of tuberculosis-related mortality compared to that in the general population,” states an overview of HIV and TB in Tajikistan prisons as described by AFEW International in 2015. Now, two years later, let us see how this situation has changed.

100 TB patients

“Over the last eight months, 59 new cases of TB in penal institutions were diagnosed. All these patients are registered and receive treatment. In total, there are 100 prisoners infected with TB in Tajikistan, which is less than 1% of the prison population. Compared to the previous years, the situation has improved significantly: TB detection increased, the laboratories are being modernized, there is new equipment and adequate provision of medications,” the Head of the Medical Department of the Main Directorate of the Penal System of the Tajikistan Ministry of Justice Saidkul Sharipov is saying.

According to Mr Sharipov, a real lifesaver for them was the mobile fluorography unit that could be taken from region to region, allowing for step-by-step screening of inmates.

“Such testing is conducted every six months. For example, recently we have examined about three thousand inmates for mycobacterium tuberculosis in all cities and regions, except Dushanbe. We identified 40 suspected cases of TB that will be followed through during the secondary examination,” Mr Sharipov adds.

In total, some 500 prisoners are kept under regular medical supervision, including those who had already received treatment and have fully recovered.

The Deputy Director for Infectious Control of the Republican Center on Social Protection from TB Saydullo Saidaliev also confirms that the situation with tuberculosis is under control and TB prevalence in Tajikistan has decreased.

“In 2005, more than 300 inmates had TB, this year – only 100. The rate of new infections has also been declining: 77 cases in 2016, 59 over the last eight months. Last year, seven prisoners died from mycobacterium tuberculosis, this year we had zero deaths from TB,” Mr Saidaliev says.

Almost all correctional institutions have special TB hospitals for 5–10 beds, as in prison settings one TB carrier could infect tens of people within a year.

HIV “enters’” prisons from outside

Mycobacterium tuberculosis and HIV are often spread in closed institutions.

Prisoners at a colony in Dushanbe. Photo from the archives. Author – Nozim Kalandarov

“Although we have not analyzed this thoroughly, one could assume that most cases of HIV infection among inmates take place within correctional institutions. Quite some detainees are imprisoned because of drug related crimes, like drug possession. People who inject drugs have a higher risk of living with HIV. Most of them serve a short term, but have the risk to be detained shortly after their release again for another short term. With the window period of detecting HIV, it is difficult to say if and when prisoners have got HIV while detained,”  the Deputy Director of the Republican AIDS Center Dilshod Saiburhanov is saying.

Inmates often learn about their HIV status in prisons, where HIV testing is offered twice a year. Currently we have 220 registered people with HIV, two of them are female, one under age, and 150 receive antiretroviral treatment.

Since 2010, the number of HIV cases among inmates has decreased: 292 were identified in 2010, while over the last nine months only 31 cases were registered – a nine-fold decrease. Screening procedures are improving every year, and 65–70% of prisoners get tested for HIV,” Mr Saiburhanov adds.

Currently, three correctional colonies in Tajikistan have the so-called “friendly offices” that distribute prevention materials – syringes, condoms and information leaflets.

HIV+TB: a particular risk

Experts note that they are especially concerned about HIV and TB co-infection, as people with HIV have a higher risk of getting TB as well.

“That is why there are cases of co-infection in Tajikistan prisons: about 25% of the total number of TB patients,” the Head of the Medical Department of the Main Directorate of the Penal System Saidkul Sharipov says.

Mr Sharipov adds that AFEW-Tajikistan is one of the few international organizations that work in Tajikistan prisons to reduce the burden of infectious diseases, such as HIV and tuberculosis.

“We have been collaborating with AFEW since 2003 to conduct HIV and TB response projects in prisons, as well as information campaigns among inmates to prevent these diseases,” Mr Sharipov says.

One of the main problems is not even the lack of costly treatment and nutrition, because international organizations help with these. It is the lack of healthcare personnel in the penal system.

AFEW Chairman Becomes HCV Change Maker

Board Chair of AFEW International Jeffrey V. Lazarus has recently become one of the 2017 HCV Change Makers from the Economist Intelligence Unit (EIU). The Change Makers programme recognises 18 Hepatitis C Virus (HCV) innovators doing exemplary work in the programme’s three thematic areas: multi-stakeholder approaches; screening; and technology. Their ground-breaking efforts can inspire and guide their peers on the path to HCV elimination. The programme also aims to spark debate and action on HCV policy and access to care.

AFEW‘s Board Chair is awarded for his work in technology. Being the associate researcher at the Barcelona Institute for Global Health, Hospital Clínic, and affiliated professor at the Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Jeffrey Lazarus leads a large-scale digital survey of Hepatitis C patients in Europe. Together with leading stakeholders, Prof Lazarus and his colleagues now plan to repeat the survey on a regular basis, ensuring alignment with the objectives of the WHO Global Health Sector Strategy on Viral Hepatitis.

“The EIU changemaker award is a great recognition of the importance of involving patients in the hepatitis prevention, treatment and care that they need and deserve. My colleagues and I will continue to look for ways to further this agenda,” Jeffrey Lazarus is saying.

Hep-CORE’s 39 questions ask about national coordination, disease monitoring, prevention, testing and treatment. Among them: In your country, are there any HCV testing/screening sites outside of hospitals for the general population? In your country, is there a clear linkage-to-care mechanism so that people who are diagnosed with Hepatitis B and C are referred directly to a physician who can manage their care? Prof Lazarus and his team used Research Electronic Data Capture, an open-access web-based online data collection tool, to design the survey.

Sex Work in Ukraine: Cancelling the Fines and Placing Condomats at Bus Stops Could Halt HIV Spread

Nataliya Isaeva is protesting and advocates for the fast decriminalization of sex work

Author: Yana Kazmirenko, Ukraine

Civil society NGO activists in Ukraine are developing a new legislation on sex work. According to them, eliminating the fines could help increasing access to medical care for women and men involved in sex work – a profession vulnerable to HIV.

“Sex workers try not to have too many condoms with them. If there is a police raid, discovering condoms and recording it in a protocol automatically means detention for sex work,” says Nataliya Isaeva, the head of the All-Ukrainian Charity Organisation “Legalife-Ukraine”, explaining the need to finally decriminalize sex work. Nataliya has been a sex worker since she was 16. Today, after being a sex worker for 15 years, she has HIV-positive status, a family, two healthy children and projects that offer support to her ex-colleagues.

Hostages and victims of violence

Even administrative charges for sex work that are still in force in Ukraine, make sex workers vulnerable to police violence. According to the Article 181-1, of the Ukraine’s Administrative Code, commercial sex is an administrative offence punishable by the fine of 15 tax-exempt minimum wages (UAH 225 or €7.5) as a maximum penalty.

“Today decriminalization is more important than legalization. Decriminalization would create an environment where sex workers could go to police to complain of violent actions against them,” Nataliya clarifies.

Preparing for the 22nd International AIDS Conference to be held in Amsterdam in 2018, “Legalife” activists have conducted a research on the types of violence against sex workers in Ukraine. They surveyed 175 women and anticipate high levels of “truthful answers”, given that the women were interviewed by activists who had been involved in sex work.

“Preliminary results show high rates of psychological violence against sex workers from police. Many have to deal with unwarranted aggression from their clients: people in passing cars throw bottles at them, and there was one case when they cut a rude word on a woman’s breast,” Nataliya is sharing.

Healthy women work longer

The Ministry of Ukraine’s Center for Public Health estimates the number of sex workers in the country at around 80,000. Some 7.3% of them have been diagnosed with HIV. Administrative liability drives sex workers underground and makes them conceal their occupation, even from doctors.

“Sex workers are usually not the ones to go and have their first HIV test on their own initiative. Decriminalization forms the prerequisite for medical screening and offering help to those in need,” Sergey Kharitonov, the head of HIV prevention and access to treatment projects for sex workers, NGO Convictus Ukraine is saying. Nataliya Isaeva, however, thinks that sex workers do try to take care of their health and contribute much less to the spread of HIV as opposed to what researchers believe.

“Women professionally involved in sex work prefer to use condoms, get tested and make sure they are in good health. The healthier they are, the longer they can work,” Nataliya explains.

Discovering status means banning from pick-up points

Experts from Convictus Ukraine have surveyed sex workers to find out what they do when they learn that they have HIV. Most of them leave work for a while, usually going back home. The story of Polina (34) from Kyiv confirms this. After she discovered her HIV-positive status in 2014, she went home to her parents for the first time in many years. Polina started using injecting drugs when she was 16. After the 9th grade, she travelled to Moscow, hoping to earn good money, and ended up in sex work through the advice from her friend. Amphetamine, heroin, dope – she could just almost write a manual on drugs. In early 2000s, she found out she had Hepatitis C, but she cannot remember when exactly she was diagnosed. After discovering her status, she applied for the opiate substitution therapy.

After learning about her HIV status, Polina switched to opioid substitution therapy

“My body gets ugly from all the injections, but my look is my income. Thus, with a doctor’s paper certifying substance use, I applied for a paid substitution therapy service. It costs UAH 1600 per month. I saved up some money, and I also want to get Hepatitis C therapy,” Polina is saying.

After she was diagnosed with HIV, Polina started to take more care about her health. “I always use a condom, do not go to saunas for groups, etc.,” she says.

According to Polina, only her mother, partner and son know about her status. Her son lives with his grandparents in Russia. Polina hopes that opiate substitution therapy will “wise her up”, help her quit drugs and find her six-year-old daughter whom she abandoned after birth.

Polina’s colleagues find it hard to establish an alternative source of income, and that is why they go back to where they were. Many of them are afraid of undergoing further testing, fearing disapproval from doctors and friends in case “God forbid, someone finds out”.

“Most sex workers suffer from self-stigma which prevents them from accepting their HIV status. If they find out one of them is HIV-positive, the colleagues try to remove this person from the pick-up point by any means,” Sergey Kharitonov says.

New law under development

Activists admit that there is little chance for changing the status of sex work in Ukraine. Back in 2015, decriminalization attempts failed. Andrey Nemirovskiy, the Deputy of the Verkhovna Rada of Ukraine (Samopomich party), submitted and, following a lot of buzz in the media, revoked the legislation regulating sex work in Ukraine. The project failed, not least because of the influence of the Orthodox church, whose vast congregation could have cut off electorate support for the party.

New legislation is developed, but, according to Nataliya Isayeva, it will only be submitted after allies are found. Currently activists are conducting advocacy work among female deputies and developing amendments to other laws.

The project manager at NGO Convictus Ukraine Yulia Tsarevskaya believes that apart from the new law, it is possible to reduce the spread of HIV among sex workers with comprehensive programming. For example, the service of condom and lubricant distribution could be replaced by placing condomats in all cities (at the bus stops and metro stations.)

New Technologies and Youth Sexuality Education in Georgia

Author: Gvantsa Khizanishvili, Georgia

Improving access to and awareness of health issues among youth using new technologies has become a new way for non-profit sectors around the world to advance issues on their agenda. IntiMate by Bemoni is the first application of such type in Georgia, and it is an excellent example of sexuality education using innovative technologies. It is available for download both by App store and Google play. The app has been developed by Public Union Bemoni as a part of the project “Investing in Sexual and Reproductive Health Promotion and HIV Prevention among Young People in Georgia”.

Non-profit for sex education

Georgia has inadequate policies in the area of sexual and reproductive health and rights. There are strong religious and conservative powers and gender inequality in addition to a fragile civil society that especially influences the lives of adolescents and young people. Much progress has been made in recent years in advocacy to advance youth sexual and reproductive health and rights, for example. In May of 2017, the Georgian Ministry of Education and Science signed a Memorandum of Understanding with the United Nations (UN) Joint Programme for Gender Equality to assist the ongoing revision of the national curriculum and help integrate the issues of human rights, gender equality and healthy living into the educational programme. Additionally, this February, United Nations Population Fund (UNFPA) Georgia initiated an interactive learning module for evidence-based family planning called Virtual Contraception Consultation (ViC), which was introduced at Tbilisi State Medical University.

Despite these advances, there are still many gaps in advancing youth sexual and reproductive health and rights for young people. For example, there are no state supported sex education programs that exist in many countries of Eastern Europe and Central Asia including Georgia. Since there is no state supported sex education programs including information about HIV/AIDS, no information targeted specifically at young people is available, and health service providers are not equipped with the skills to meet young people’s needs for information, counselling and confidentiality of services. Therefore, the non-formal education mostly led by non-profit sector play a significant role in youth sex education.

New ways to raise awareness

The IntiMate app aims to improve knowledge of young people around issues of sexual and reproductive health and rights including HIV/AIDS. With the goal to spark the conversation around the issues, by containing easily comprehensible, fun, attractive content and to encourage participation of young people in prevention of HIV/AIDS. Containing quiz games, video information, definitions, calendar, list of youth friendly services among others, now young people in Georgia will have access reliable information on sexual health and wellbeing at their fingertips. Launched in July 2017, it already has already attracted international media attention.

AFEW Shared Techniques of Relaxation in Kyrgyzstan

The community dialogue platform gathered for the summer school last week in Kyrgyzstan. This summer school was organised within ‘Bridging the Gaps’ programme. The director of programs of AFEW International Janine Wildschut attended the school. After some days of serious work in which the community discussed struggles they face in Kyrgyzstan and how they can come up with a united voice, a training on burnout syndrome and how to prevent it was arranged.

“For many community leaders life is hectic and full of stress. First of all, they do their work with their full heart, which makes them also more sensitive for the stories and troubles of people they help. Secondly, the community members were mostly not trained as managers and leaders of NGOs, and now they are carrying this responsibility with big feeling of commitment. Besides, daily life in Kyrgyzstan for many people consists of a lot of struggle: family responsibilities, economic challenges and little time for relaxation,” Janine Wildschut shares. “This results in feelings of stress, little division of private life and work and little awareness of spending time on hobbies or personal time. Besides, within NGOs there is not much awareness of the need for staff to relax, take holiday time, have some breaks or breathing exercises. Women seem to have more pressure than men, as women are the main caretakers of the household.”

Thіs summer school gave the community members an opportunity to become more aware of stress factors. For one week they were thinking more about themselves, exchanged their worries and learned relaxation techniques.

“As I am not drinking or taking drugs at the moment, I do not know how to relax since that normally was my relaxation,” says one participant of the training who stopped to use drugs. Most of the participants of the summer school also feel that it is very important to be together during such studies since it is the only opportunity for them to gather together outside of official gatherings.

Janine Wildschut shared her experience with stress and burnout. Some of her lessons were taken as eye opener for many.

“When your system stresses up, it “tells” you to run harder, and that is the moment to stop yourself and slow down completely,” Janine said. “To have a boss that understands that this is important and supports you taking a break sometimes is also very important. As the problems around you are a fact of life, you are the only one that can change how you handle this: with stress or by contributing the best you can, but not more than you can.”

Besides, on her trip in Kyrgyzstan, AFEW’s director of programs conducted a focus group about community advocacy to see if change in this area is occurring, what is required to have a greater involvement of the community, and how the dialogue platform contributes to that. Janine also interviewed community NGOs on the situation of shrinking space for CSOs in Eastern Europe and Central Asia. The situation in Kyrgyzstan nowadays is stable. Wider coalitions are initiated and hard work is done with the government to show the invaluable work that NGOs are doing.

PrEP: effective and empowering

Author: Marieke Bak

Pre-exposure prophylaxis (PrEP) is a new HIV prevention method that consists of a daily pill taken by HIV-negative people to reduce their risk of becoming infected with HIV. PrEP is highly effective in preventing HIV transmission, as scientific research shows. A large international study among gay men and transgender women, the so-called iPrEx trial suggested that PrEP can reduce the risk of HIV infection by at least 92% when the pills are taken consistently. PrEP is also effective when used by heterosexual men and women, as well as by people who inject drugs.

Although PrEP is more expensive than other HIV prevention methods, it can be a cost-effective tool, especially when delivered to people at high risk of HIV. By preventing the costs of lifetime HIV treatment, PrEP may even lead to healthcare savings, especially when the drug patents expire and the cost drops.

Moreover, PrEP is the first method of HIV prevention that is directly under the control of the at-risk individual. This is in contrast with treatment as prevention (TasP), which is dependent upon partners’ HIV treatment adherence to ensure suppressed viral load. Besides, because PrEP separates the act of prevention from the sexual encounter, it can be used without sexual partners knowing and provides additional protection when condoms are not used consistently.

The World Health Organization now recommends that PrEP should be offered as a choice to key populations affected by HIV as well as to anyone else at substantial risk of HIV infection.

TRANSFORMING HIV INFECTION

PrEP is a pill consisting of anti-retroviral drugs that needs to be taken every day in order to be effective. Currently, the only drug approved for use as PrEP is sold by Gilead Sciences and is called Truvada, which consists of a combination of tenofovir and emtricitabine (TDF/FTC). Truvada was first approved for prevention in 2012 in the United States of America.

In contrast to PEP, or post-exposure prophylaxis, PrEP is taken before exposure to HIV to prevent any possible transmission. PrEP works by blocking an enzyme called HIV reverse transcriptase, thereby preventing HIV from establishing itself in the body. While PEP can be thought of as a “morning-after pill” for HIV prevention, PrEP can be compared to the contraceptive pill that is taken every day. Similarly, PrEP may transform HIV infection just like the pill transformed family planning.

The most common side effects of Truvada for PrEP are nausea, vomiting, dizziness, headache and fatigue, although these symptoms usually resolve within a few weeks. Some people in trials also experienced small changes in kidney function or a decrease in bone mineral density. An updated version of Truvada was created that contains a new form of tenofovir, which is thought to be safer for bones and kidneys. At the moment, the so-called “Discover study”, is being set up in North America and Europe to investigate the new PrEP medicine called Descovy.

By the way, PrEP does not protect from sexually transmitted diseases (STDs). Fears that PrEP might be used as a “party drug” exist. However, in the iPrEx study as well as in a meta-analysis by the World Health Organisation, it was shown that PrEP does not lead to an increase in the number of STDs and has no effect on condom use. Rather, PrEP reduces the fear and anxiety that often comes with sexual activity for those at high risk of HIV.

However, because PrEP is not 100% effective and because it does not protect from STDs, it should not be used as a standalone prevention method. According to WHO guidance, PrEP should be offered as part of so-called “combination prevention” which includes the use of condoms as well as regular follow-ups and HIV testing.

PREP IN EASTERN EUROPE AND CENTRAL ASIA

Despite the recommendation to offer PrEP to people at high risk of HIV infection, the global availability of PrEP remains limited. The PrEP target set by UNAIDS in their strategy on ending the HIV pandemic is to get three million people on PrEP by 2020. However, only 2% of this target had been reached in June 2016.

At the moment, Truvada for PrEP has been approved in the United States, Canada, Australia, Peru, South Africa, Kenya, Zimbabwe, Israel, and the European Union. Approval is pending in Brazil and Thailand. In the European Union, PrEP has been approved by the European Medicines Agency (EMA) although the implementation of PrEP programmes is the responsibility of each member state separately. To date, only France and Norway have made PrEP available as part of their healthcare system. Scotland recently announced that it will do the same.

In Eastern Europe and Central Asia (EECA), PrEP is not available yet. However, demonstration projects are currently being set up in Georgia, Ukraine and Azerbaijan. These pilot studies consist of several phases. In Georgia, the first stage of PrEP implementation included a training session for those involved in the pilot, as well as the conducting of a needs assessment among Georgian men who have sex with men (MSM) and capacity building for local NGOs, before the actual start of the pilot in 2017. In Central Asian countries, there seems to be less interest in PrEP, although the Ministry of Health of Kyrgyzstan is planning to start an evaluation on the possibilities of introducing PrEP in the country.

Challenges of introducing PrEP in EECA may include the cost of PrEP, but also the high levels of stigma and discrimination in some countries. However, with HIV incidence in EECA rising by 57% between 2010 and 2015, treatment alone will not stop the epidemic. Given its proven effectiveness, providing PrEP to key populations can be a significant step in controlling the explosive growth of the HIV epidemic in this region.

Communities will be Educated how to Analyse Data and how to Act

Two new modules for the program community-based participant research CBPR [e] Education that is supporting and strengthening the research capacity of organizations acting on behalf of and representing the interests of communities in Eastern Europe and Central Asia (EECA) are released online today.

The program consists of the number of activities, including training for community-based participatory research, small grants program, workshop on dissemination and abstract writing and workshop on presenting research findings on AIDS2018 Conference.

AFEW International gives program participants the opportunity to take part in online e-learning modules for further development of their research skills. The modules are also available for others who are interested in community-based participatory research. Course that costs 75 euros, includes 7 modules on the preparation and conduct of community-based participatory research.

The first module announced today is Data Analysis. Analyzing data is necessary to make sense of the outcomes of the study and to answer the research questions. Analyzing data will help working towards a way of representing the data to a larger public.

The second module is called Bringing about social change: translating knowledge into action. After the data is collected and analyzed, the participant is ready to write the reports and to disseminate the results to others. It is the time now to determine how the participant can bring social change that will benefit the community. The evaluation of the research will be also discussed in this module.

Later on, everyone will be able to participate in the webinar on data analysis, which will be held in late spring or summer of 2017.

Natalya Shumskaya: “We Want to Improve Country Health System Coordinating Mechanisms”

shumskayaPublic Foundation “AIDS Foundation East-West in the Kyrgyz Republic” makes a significant contribution to public health of the country in reducing the growth rate of socially significant infections in Kyrgyzstan. The head of AFEW-Kyrgyzstan Natalya Shumskaya is telling what we should expect from the organisation in 2017, and outlines the achievements of the previous year.

 – How was the year of 2016 for AFEW-Kyrgyzstan? What do you think were your greatest successes?

– 2016 was a successful and fruitful for our organization. We managed to keep our activities on HIV prevention in the prison system, including law enforcement, prevention of HIV among women who use drugs. During the last year, 1013 women received an access to health and social services. One of the achievements was that in 2016 our organization supported the Ministry of Health of the Kyrgyz Republic in the development of the clinical protocol “Pregnancy, childbirth and the postnatal period for women who use drugs.” In December of the last year this protocol was adopted. Later, we started a very difficult project with the aim to return the patients with multidrug-resistant tuberculosis (MDR-TB) to the treatment. Since August 2016, AFEW-Kyrgyzstan together with the City Centre for Tuberculosis Control in Bishkek started a project “Joint control of tuberculosis and HIV in Kyrgyz Republic.” During five months of 2016, 17 MDR-TB patients returned for the treatment; three patients co-infected with HIV were connected to antiretroviral treatment, five patients with tuberculosis and extensively drug resistant TB (XDR-TB) had the necessary tests, and their results were given to the council for inclusion in a treatment program under the new scheme. There was organized controlled treatment at home for 28 patients. The delivery of products is done 6 days a week, except Sundays. Additionally, project case managers conduct information sessions with patients with MDR-TB and their inner social circle, monitor the side effects of anti-TB drugs, and, if necessary, deliver drugs to relieve the side effects. They also maintain regular contact with doctors. In January of 2017 we increased project staff. It was done for the full coverage of all MDR-TB patients who need to receive treatment at home and assisting them to diagnosis and friendly services. Two case managers and a social worker were hired.

– How is the work of the research department of your organization that you created two years ago?

– The Department continues to work successfully. Over the past year, the researchers conducted a qualitative study among the inmates of correctional facilities that are getting ready to be released. It was called “Prisons, injecting drugs and the environment of risk of HIV infection.” This is a continuation of the positive experience of effective cooperation of AFEW-Kyrgyzstan with medical school researchers from Yale University and the State Penitentiary Service of the Kyrgyz Republic. This study aims to describe and research the quality of the program of methadone substitution treatment in the penitentiary system of Kyrgyzstan and civil society. The recommendations based on those results will be offered to the country to optimize harm reduction programs.

– One of the main directions of your work is cooperation with the police and the prison systems. Please tell us, how is this cooperation going? What is the role of AFEW in it?

– AFEW cooperates with the Ministry of Internal Affairs for 10 years already. In 2016 our organization has provided technical support to the Ministry in carrying out monitoring visits to all the regions of the country. The aim of the visits was to control how the law enforcement officers perform the instruction on HIV prevention. In addition, we organized and conducted four trainings for the staff responsible for the official trainings and for non-governmental organizations on the reform of law enforcement agencies. It is important that the civil sector supports current reforms, and it is important that law enforcement officers assist the execution of the State Programme on HIV.

AFEW is also working with the penitentiary system of the country for more than 10 years. We work together in three areas: technical assistance and coordination, increasing the capacity of staff and providing direct services to prisoners. In 2016 we worked first in six and then in four institutions to promote the goal 90-90-90. We provided services for people who inject drugs (PIDs), told them about HIV and the ways of transmission, motivated them to pass the test for HIV. We actively worked with people living with HIV at the stages of realising of the diagnosis, preparation for therapy, start of therapy, development of adherence to treatment. One of the achievements, of course, is to extend the work on the colony-settlements. Before, prisoners there fell of HIV prevention services, as there are no medical units there, and they usually have no documents for getting help from the civilian health organizations.

– In October AFEW-Kyrgyzstan helped to sign a memorandum of cooperation of four key groups. Please, tell us what these groups are and why their teamwork is so important? How is this cooperation going now?

– Unfortunately, there is mutual stigma within the key groups. Cooperation can help to overcome barriers and build partnerships. The leaders of key groups started to work closer. They discuss new joint projects, research abstracts for AIDS2018 conference in Amsterdam. Together they will carry out activities to reduce stigma and discrimination in relation to other key groups through the mini-session, for example, PIDs for LGBT and sex workers’ organizations. Since last year, we have been inviting all the participants of memorandum for the event and, of course, they also invite us for their events.

– In February, you will host a training for the members of the Country Coordinating Committee on HIV/AIDS (CCC) project BACK UP-Health. Tell us more about it. What are other areas of your work with the CCC?

– Starting from July 2016, AFEW-Kyrgyzstan will implement the project “Harmonization and consolidation of resources to fight HIV infection and tuberculosis in Kyrgyzstan.” It will be done with the financial support of GIZ, program Back Up-Health. With this project we want to improve the coordination mechanisms in the country’s health care system. We want to involve civil society in the discussion on the reform of CCC, and we also want to increase the capacity of the Committee. In February of 2017 AFEW-Kyrgyzstan plans to host a seminar for members of the CCC to prepare the Country Request for continued funding in the state funding for 2018-2020. The following groups will take part in the seminar: members of the Committee for the preparation of applications for resource mobilization and harmonization of CCC; CCC board; members of the Advisory Working Group, which were included by the Kyrgyz Ministry of Health; national experts who work on the preparation of the request for continued funding who will directly collect information and write application; international consultant; head of the expert working group on writing requests for funding, and also key partners from the public and international sectors which may influence decisions and who expressed their readiness to provide technical assistance in the preparation of high-quality country request to the state financing from Kyrgyzstan. During the workshop, participants will act as experts and will share their knowledge and experience with each another. They will also learn how to fill the forms for the requests, will learn the new priority areas of TB and HIV, which are included in national policies and programs, will discuss and analyse the share of public funding, make mapping of the services, clients and funding. Actually, the main purpose of this seminar is to assist the CCC, experts and other stakeholders in the preparation of high-quality application. We want everyone to have one vision and one structure of the request, so that the process of approval of the CCC members is efficient and fast.

– What are AFEW-Kyrgyzstan plans for the year of 2017?

– AFEW-Kyrgyzstan spent its first three years as a local non-governmental organization. The most important achievement is that we were able to successfully implement its first strategic plan and to develop partnerships with international and donor organizations. In 2017 we will review the strategic plan of the organization. Of course, the priority for the board of the organization has been and continues to be ensuring of the stability of the organization.

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.