Shrinking Civil Society Space Hinders NGO Activities in EECA

The results of the assessment proved to be the basis for rewarding discussions during AFEW Regional autumn school in Almaty, Kazakhstan last year where the first findings were presented

Author: Aïcha Chaghouani, The Netherlands

Different trends of more restrictive legislation hinder the development of a healthy, independent and diverse civil society in Eastern Europe and Central Asia (EECA). Shrinking civil society space in the EECA countries is making the work of many non-governmental organisations more difficult.

NGOs play a crucial role in the development of effective HIV/AIDS responses. Non-governmental organisations meaningfully involve community key population groups for a better understanding of their needs. The experts are saying that the limited space that NGOs are allowed to maneuver in, is threatening the effectiveness of national and regional policies to contain and stop the growth of the HIV epidemic in the region.

AFEW’s assessment of the situation

Many NGOs in the EECA region, especially those working with key populations and in the field of harm reduction, are currently facing significant challenges. International donors are withdrawing from the region while most local governments are unwilling and/or failing to take over. The withdrawal of funds together with the shrinking civil society space are threatening the investments made and progresses achieved in the last decades in the field of HIV/AIDS.

AFEW International’s experts Janine Wildschut and Magdalena Dabkowska conducted a mixed-methods research to explore the process of shrinking civil society space in the EECA countries, how this affects NGOs and how they are coping with it. With this research, AFEW has gained more insights and learned how NGOs are currently dealing with those challenges. The research is part of AFEW’s regional approach within Bridging the Gaps: health and rights of key populations project.

Coping strategies and regional exchange

The ultimate aim of the research was to assess the coping strategies in a context of shrinking space of civil society in EECA.

“I believe that these coping strategies are vital in the current circumstances and demonstrate the big resilience of the communities and NGOs working with key populations,” says AFEW’s director of programmes Janine Wildschut.

The research was conducted in Kazakhstan, Kyrgyzstan, Poland, Tajikistan, Russia and Uzbekistan.  This mixed-method research consisted of a general primary assessment of the whole region, semi-structured interviews with NGOs and donors, and a survey.

AFEW’s experts believe that by mapping different strategies AFEW is able to facilitate a regional exchange of success and failure stories in which NGOs can learn from each other’s experiences. The identification of different strategies helps organizations to develop more comprehensive coping mechanisms in the current contexts.

“We hope to raise more awareness with donors about the situation of NGOs in the shrinking space of civil society, and will offer coping tools to NGOs,” says Janine Wildschut.

Fight, hide or unite

The outcomes of the research identified three main resilience strategies NGOs adopted in order to overcome the challenges. They are: fight – opposing the authorities, hide – opposing, allying or neutral but out of sight and silent, and unite – allying with the authorities. All interviewed NGOs had different reasons to choose one of these three paths.

AFEW International’s experts Janine Wildschut and Magdalena Dabkowska conducted a mixed-methods research to explore the process of shrinking civil society space in the EECA countries, how this affects NGOs and how they are coping with it

“We want to be more diplomatic. If you are being too much of an activist, you can also just break your organization,” an NGO employee from Tajikistan said.

For some organizations, it was possible to create alliances with the local or national authorities and still continue their work while for others, creating these alliances meant stopping or changing part of their core activities.

“We believe that it is actually ethically wrong to be in alliance with this government. We also do not try to be invisible for them. We do not do anything illegal so we do not hide anything,” a Russian NGO employee said. “There is no law we are violating so there is nothing to hide. If they want to change or stop us we just go to court. We have a lot of strategic activities including cases against the government.”

Further discussion 

Which out of ‘fight, hide or unite’ positions is the most suitable for an NGO, depends on the characteristics of the organization, the context it is operating in and the beliefs of its employees.

“The different paths identified by the assessment could serve as a fruitful basis for further discussion and to build strategic plans on how to deal in such situations. AFEW can facilitate a valuable exchange of best-practices between NGOs. Besides, the discussion can serve as a way to grow awareness and understanding about why a certain NGO takes a specific position, which can prevent undesired conflicts between civil society organisations themselves,” says Janine Wildschut from AFEW International.

The results of the assessment proved to be the basis for rewarding discussions during AFEW Regional autumn school in Almaty, Kazakhstan last year where the first findings were presented. In spring of 2018, the official report will be published and will be available online.

In Kyrgyzstan, the New Year Started with Reduced Funding for the HIV Response

Author: Olga Ochneva, Kyrgyzstan

Since January 2018, HIV and tuberculosis programmes in Kyrgyzstan are funded from the new, significantly reduced grant of the Global Fund. There were six months of discussions concerning cost optimization and reduction, taking into account the growing deficit of funds that the country is facing in the nearest three years. The cost-saving mode has already been introduced, first of all affecting the prevention programmes.

Services and coverage are retained

In 2018-2020, Kyrgyzstan will receive 23.4 million US dollars for HIV and tuberculosis response from the Global Fund. For the reference, the previous Global Fund grant stipulated allocation of 20.8 million US dollars for the period twice shorter. The country decided to cut the expenditures gradually. The first six-month cost-saving period started in January 2018. According to Oksana Katkalova, the representative of the UNDP country office, which administers the Global Fund grants in Kyrgyzstan, treatment and diagnostics have been defined as the priorities and prevention interventions have been significantly cut down due to the reduced number of partner organisations.

“The money will be mainly used to purchase anti-tuberculosis and antiretroviral medicines (antiretroviral therapy or ART is a method of HIV treatment) as the number of people who need treatment is growing,” says Oksana Katkalova, HIV Grant Coordinator, UNDP. “We try to retain the services and the coverage, while optimising and reducing the administrative costs.”

Since the beginning of the year, two methadone maintenance treatment (MMT) sites have been closed, with patients referred to the nearest sites. The MMT clients will no longer receive the community support of some non-governmental organisations (NGOs), which used to be financed by the Global Fund. The number of implementing NGOs which receive funding has been diminished. Two NGOs working with people living with HIV (PLWH) in Bishkek and Osh will not be funded, with their services being consolidated and handed over to the organisations, which still get the funding. In smaller towns, services for different key populations have also been consolidated.

“One organisation working with different key populations is quite a good option for smaller regions. It allows saving costs for administrative personnel,” explains Oksana Katkalova. “When in a small town there are two organisations, one working with sex workers and the other one – with people who inject drugs (PWID), each with a coverage of 100-200 people, it makes sense to consolidate those services in one organisation if there is a shortage of resources. Our implementing partners – NGOs – have been selected through tender procedures and now have set coverage indicators, which mostly have been raised. However, they can and should engage outreach workers and peer counsellors for different key populations to reach the required coverage.”

Gender component reduced

The number of needle and syringe exchange points (NSPs) has been reduced from 21 to 15. Two of them used to operate in NGOs as service delivery sites. One of such sites was located in the Asteria residential community centre for women who inject drugs, with the Global Fund grant partly covering rental, personal services (accommodation, laundry, shower, meals, and hygiene packages) as well as the package of basic prevention services and consultations of an STI doctor.

“Unfortunately, the gender component for women who inject drugs has been excluded from the Global Fund project: diagnostics and treatment of sexually transmitted infections, hygiene packages and personal services are no longer available,” tells Irena Yermolayeva, director of the Asteria Charitable Foundation. “The Soros Foundation-Kyrgyzstan and the AIDS Foundation East-West in Kyrgyzstan agreed to cover the rental costs and partly the services for six months. We are doing our best to retain our residential project.”

Two sites in each of the medical and penal systems were closed in 2018

Financial support of the four national networks has also been reduced. Now there will be one network promoting the rights and interests of all the key populations. Medical professionals working with PLWH also feel the shortage of funding. They receive benefits in addition to their salaries from the donor funds. Currently, the strategy of bonus reduction is continued, with shrinking resources, and the amount of the remaining benefits will depend on achieving the performance indicators. It is also planned to reduce payments to the medical personnel engaged in the MMT programme, but it is more complicated as in this case donor funds are the only source of financing. Just to remind that so far, the government has not allocated any money for the methadone maintenance treatment programme.

The programme aimed at the ART adherence improvement has also been cut. Before, all adherent patients used to get monthly motivation payments of 8 US dollars, while since January this year only children receive the allowances of about 14 US dollars, which are to be reduced by 2020.

By 2020, up to 30% of ART costs are to be covered by the state

The country will face even more funding cuts in the following two and a half years of project implementation. It is expected that four more MMT sites will be closed during this period. While in 2017, support within the Global Fund grant was provided to 26 NGOs, it is anticipated that by the end of 2020 only 10 of them will remain.

“So far, the smallest budget has been allocated for 2020 as it is planned that by this time the government will cover up to 30% of expenditures for the ART medicines; besides, we hope to have additional savings,” says Oksana Katkalova. “If during this period the government allocates significantly more funds, they can be used to purchase more ARTs, tests or, for example, to pay bonuses to the medical personnel engaged in HIV prevention, treatment, care and support programmes. Then we will be able to re-distribute part of the donor funds to cover prevention interventions. Every six months, we will adjust the expenditures for interventions and negotiate them in the format of a country dialogue. We hope that there will be a gradual increase in the scope of domestic funding.”

HIV Voluntary Counselling and Rapid Testing Points in Three More Cities in Tajikistan

Voluntary counselling and rapid HIV testing points (VCT) on the premises of public organizations were opened in three more cities of Tajikistan – Dushanbe, Kulob and Khujand – on December 1, 2017. On this day, voluntary counselling and rapid HIV testing services were launched in public organizations Vita, SVON Plus and Amali nek.

“Opening a VCT point on the premises of our organisation will undoubtedly increase the detection of HIV among the key populations. Our clients and AIDS centres are very much interested in this because the timely treatment will help them to save their health and life,” the director of the public organization Amali nek Abduholik Abdurakhmonov is saying.

Creating HIV voluntary counselling and rapid testing points, namely training of medical personnel, making the reparations, purchasing necessary furniture and equipment, became possible because of the project ‘Bridging the Gaps: Health and Rights for Key Populations 2.0’ and due to the regular consultations with AFEW-Tajikistan’s specialists.

“In 2015, AFEW-Tajikistan appealed to the Ministry of Health and Social Protection of the Republic of Tajikistan with a proposal to open a VCT point on the premises of the second office of our organisation in Khatlon region. This initiative was approved by the order of the Ministry and since October 2015, all HIV service organizations of the country had the opportunity to introduce the VCT service. Exactly one year ago, on December 1, 2016, the first point that provides voluntary counselling and rapid HIV testing service started its work in the city of Kurgan-Tube. It operates on the premises of our office in Khatlon region. Now our experience helps other public organizations to create and equip similar offices,” the project manager of AFEW-Tajikistan Dilshod Pulatov is sharing.

In April and September 2017, in Qurghonteppa and Khujand, AFEW-Tajikistan organised a seminar and workshop to share the experience of the organisation on the introduction of VCT services on the premises of a public non-profit organization. The participants also studied the procedures for documenting and planning the costs for maintaining VCT points.

“The seminar-meeting on the introduction of VCT service helped me to understand the main stages of work, what documentation is needed, what requirements for equipping the premises are, how to train staff and what the process of budgeting activities is to introduce VCT service,” the director of the Public Association VITA Eraj Nazarov is saying. “AFEW-Tajikistan helped us to renew the premises according to the necessary requirements, and also trained two of our medical workers for providing pre-test counselling and HIV testing services.”

During the opening ceremony of voluntary counselling and rapid HIV testing points, everyone had an opportunity to be counselled and tested for HIV.

The Train is off but HIV Stays

Author: Anastasia Petrova, Russia

Testing in Kurgan

From 8 July to 20 October 2017, a train carriage went throughout the territory of Russia offering HIV testing services to everyone interested. The campaign was aimed at raising the awareness and increasing the coverage with testing services among the general public.

The strategic train

The train offering HIV testing is a project of the Russian Ministry of Health in cooperation with the Russian Railways. The campaign was initiated within the State Strategy to Combat the Spread of HIV in Russia through 2020. Long-distance passenger trains were equipped with an additional carriage offering free and confidential testing. Project workers conducted pre- and post-test counseling and informed people about HIV and the ways of its transmission. The route lied from Vladivostok to St. Petersburg and included the regions most affected with HIV. Apart from offering HIV testing on the way, mobile laboratories were also functioning on the railway stations. The campaign was aimed at the first component of the global 90/90/90 strategy, which stipulates that 90% of people living with HIV should be aware of their status.

The silent epidemic

The carriage where the testing was conducted

The testing campaign covered 24 regions, with the following cities leading in terms of people tested: Chelyabinsk (2,039 people), Nizhnevartovsk (1,645 people), Irkutsk (1,446 people), Kurgan (1,290 people), and Samara (1,227 people). Moscow was the city with the lowest coverage – only 290 people got tested there. According to the Ministry of Health, within the campaign 25 thousand people were able to get tested and receive professional counseling in the carriage and in railway stations.

“The fact that those 24 regions were covered is important. Here in Russia, 10 out of 85 regions have 50% of new HIV cases, and as for the 24 regions covered, they have over 70% of such cases. That is why I think that this campaign has a concrete result as it is focused on the most affected regions,” the chief independent expert in HIV diagnostics and treatment at the Russian Ministry of Health, Yevgeny Voronin is saying.

Awareness-raising materials in the format of railway tickets

It is interesting that no official statistics was announced on the total number of HIV cases detected. However, according to the Minister of Health, Veronika Skvortsova, as of the date when the train was passing Moscow the number of HIV positive cases detected was 248. Thus, the total number of such cases is more than 250 or 1% of the people tested. Considering the fact that testing was conducted in the general population, this number shows the severe epidemiological situation in the country and proves the tendency of HIV epidemic going beyond the key populations.

The train is off

Such campaign is an unprecedented intervention aimed at raising the awareness of people in the area of HIV/AIDS. Apart from testing passengers, the campaign was an important newsmaker. Reports in federal and regional mass media allowed millions of people in Russia to learn about the importance of this problem and about the necessity of regular testing. A positive outcome is that after the train left mobile sites to continue testing remained at some railway stations.

Closing ceremony in St. Petersburg

Alongside with that, if the data about one percent of the HIV cases detected in the general population is confirmed, it will mean that the situation has got out of control. In this case, the measures taken by the Ministry of Health are to be scaled up a hundred times and are to be aimed not only at awareness raising and detection of new cases but also at treatment. Testing as it is is not a measure of response to the epidemic. Every patient should receive therapy in order to achieve minimal viral load not to transmit the virus to other people. However, in Russia less than a half of people living with HIV get the necessary medications.


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.

The First AFEW Regional Autumn School Was Conducted in Kazakhstan

Author: Marina Maximova, Kazakhstan

Representatives of 10 countries took part in the first regional autumn school organized by AFEW, which was held from 30 October to 5 November in the Oy-Karagay gorge, not far from Almaty, Kazakhstan. The school was conducted with the support of the Dutch Ministry of Foreign Affairs.

High mountains, hot sun, picturesque autumn landscapes, atmosphere of the national yurt instead of the traditional training hall – combined with the team spirit and expectations of positive changes – contributed to the creative atmosphere of the event. The school participants included representatives of the AFEW network from Kazakhstan, Kyrgyzstan, the Netherlands, Tajikistan, Ukraine, sub-grantees of the project ‘Bridging the Gaps: Health and Rights for Key Populations,’ and partner organizations. Such allies and friends are the biggest guarantee of success.

Learning to bridge the gaps

“The autumn school helps to find the answers to a range of questions and get acquainted with the new innovative practices in working with key populations,” says Dilshod Pulatov, Project Manager, ‘Bridging the Gaps’ programme, AFEW-Tajikistan.

He presented the results of the social study to assess the level of labour migration among people who use drugs. It was conducted for 18 months in Tajikistan and Kyrgyzstan. The study, which covered 600 respondents, demonstrated regional trends and showed interesting results. The main of them is that the labour migrants who use drugs do not know where they can get help and who can offer such help. In both countries, the respondents pointed out that as labour migrants they experienced problems with access to health and social services.

The results of this research study will help AFEW to scale up the access of drug users to quality HIV prevention, treatment, care, and support services and find new partners. Partnerships were created right at the discussion platform. This study proved to be interesting not only to the participants, but also to the guests invited to take part in the autumn school, including representatives of the Project HOPE in Kazakhstan.

Platform for discussion and activism

Today, ‘Bridging the Gaps’ programme is implemented by the organizations from four countries of the region. The autumn school became a platform to discuss strategies, barriers, innovations, and opportunities for cooperation.

“In our country, the biggest gap is an access of underage people who use drugs (PUD) to services. Many services are offered to adult PUD, in particular with support of the international donors. It allows them getting qualified help. At the same time, people often forget that the first experience of drug use happens under the age of 18,” tells Anastasia Shebardina, Project Manager, AFEW-Ukraine.

The project made an important contribution for radically changing the situation: it opened the only rehab centre for drug dependent adolescents in Chernivtsi and supported four civil society organizations.

In each country, there are success stories, which became possible thanks to the project implementation. So far, these are just tiny steps forward in the big scope of the existing problems. Every such step became possible thanks to project staff and activists working hard for a long time, but such victories, even if they are small, enhance personal motivation of people and allow them to set bigger goals.

“One of our achievements is developing the standards of services for PUD serving sentences in the Georgian prisons. We educate prison staff and have drafted a special training module for this purpose. In some organizations, support groups for PUD are already functioning. Rehab centre Help has opened its doors to clients. Now 12 people can stay there and get qualified help. We plan to cover all correctional facilities in the country with our activities,” shares his plans Vazha Kasrelishvili, Project Coordinator of the NGO Tanadgoma.

From knowledge sharing to new rehabilitation models

Sharing knowledge and best practices is one of the goals of the autumn school. Together, it is easier to elaborate strategies and innovative approaches, considering that the tendencies in development of the situation in the region are similar. Today, the search to fund vital projects also requires joint efforts, taking into account the reduction of the funding received from the Global Fund to Fight AIDS, Tuberculosis and Malaria and other donors in the region. So far, national governments are not ready to take over this financial burden in full scope. Despite their broad fundraising efforts, civil society organizations do not have enough grant funds aimed at scaling up access to services for key populations.

“With the support of the Ministry of Health of the Kyrgyz Republic, within our project we developed two clinical guidelines: on managing pregnancy, delivery and postnatal period of female PUD and on mental health and behaviour disorders in children and adolescents caused by the use of new psychoactive substances. We were able to open a social office for women with HIV, which offers counselling of psychologists and peer consultants. In the country, there are two rehab centres for women with HIV and drug dependence, which cooperate with friendly clinics,” tells Natalya Shumskaya, the head of the AIDS Foundation East-West in the Kyrgyz Republic.

Today, there is a need to use new, more effective rehabilitation models. This idea has been supported by all participants of the autumn school. Such models should be aimed at developing inner strength – empowerment – of each of the members of key populations.

“Maybe now it is time to change and expand our understanding of the rehabilitation concept. It is not only detox and psychology. There should be equal opportunities, in particular based on harm reduction, to accept yourself,” points out Anna Sarang, President of Andrey Rylkov Foundation, Russia.

Preparations to AIDS 2018

Participants of the autumn school also discussed preparations to the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, the Netherlands – the main event of the next year for activists of the AIDS organizations. All countries of the Eastern Europe and Central Asia are already actively preparing for the conference. How can decision makers be involved into this crucial event? What channels are most effective in communicating information about the conference? How to make this event significant? Every day, participants of the autumn school discussed these and other questions. Besides, they learned how to write abstracts for the conference and choose catchy titles for them.

It is very important that the participants developed some new ideas, concepts and thoughts, because starting from 1 December 2017 registration for AIDS 2018 will be open. It will be a new and diverse platform for discussions making decisions significant for all countries and communities.

AIDS 2018: Preparing for Registration and Submitting Abstracts

Author: Anna Tokar, Ukraine

The registration for the 22nd International AIDS Conference (AIDS 2018) will symbolically start on December 1 – the World AIDS Day. The conference will gather scientists, political leaders, and people living with HIV from all around the world. One of the key objectives of AIDS 2018 is to spotlight the state of the epidemic and the HIV response in Eastern Europe and Central Asia with a focus on investments, structural determinants and services.

You can already start preparing for the registration for the Conference. Below you can find some important tips:

  • You will be asked to create your personal account – a webpage at the conference website – where you will need to put your key personal information (name, date of birth, education, etc.) Through this account you will submit your thesis or register for the Conference.
  • Registration can be individual or group (only applicable to the registration of five people or more.) The company or organization requesting a group registration must nominate one group representative who will administer the group communication with the Conference committee.
  • Usually, when applying for a scholarship, one should submit a cover letter with clear reasoning of why this scholarship is needed. Your personal details and passport data will be requested.

Scientific tracks

AIDS 2018 Conference will welcome submission of abstracts for original contribution to the field in the following scientific tracks:

Track A: Basic and Translational Research.

Track B: Clinical Research.

Track C: Epidemiology and Prevention Research.

Track D: Social and Political Research, Law, Policy and Human Rights.

Track E: Implementation Research, Economics, Systems and Synergies with other Health and Development Sectors.

Tips for writing a strong abstract

Even though there are no abstract guidelines yet available, you may consider developing a draft anyhow.

Language and grammar

The official language of the conference is English. Thus, all abstracts should be developed and presented only in the English language. The abstracts that are written well have higher chances to be selected by the Conference committee, regardless of their content. Grammar mistakes and typos will distract the reviewers from the actual study content. The reviewers might also wonder if the author is able to communicate study findings in the English language at all. For a non-native speaker, it might be quite difficult to spot all the mistakes or weird phrases. That is why we highly recommend asking for some assistance, for example from your English-speaking colleagues or friends. We also suggest to use the examples of previous conference abstracts and peer reviewed scientific papers. Studying them will help you to understand how to be succinct and informative at the same time. Besides, you might be able to see some useful linguistic construction and techniques.

Brevity is the soul of wit

The abstract should be short, yet informative. That is why you would need to have sufficient time to “pack” all the information into 300 words. If you plan to write an abstract in the last moment, you would not have time to think it through, and thus, most probably you would start “cutting.” As a result, you can end up with the text full of abbreviations, with one line of introduction and super reduced methods section, which will look like a broken puzzle.  Good abstract should be well-balanced, and all its sections should be connected and should smoothly tell the story to your reader. The reviewers would not appreciate any quizzes in your abstract, they would not guess what you mean or what you intend to say. Therefore, the text should be easy to follow, it should be reader-friendly and logically built. In other case, the reviewers might decide that the information provided in the abstract is not enough and simply reject your abstract.

Results will come later

The common problem of many people is to write the abstract without having data or analysis done. It is better not to write an abstract at all, if there are no results available. You also might consider using some previous data. Just try to have some new research questions in your abstract, or try to use a new analytical approach.

Prioritizing the key message

The abstract should be written in such a way, that a key message can be easily grasped. This key idea should be stated in the introduction as the study goal. It should also be presented in the methods, proved by the results, and finally, it should “crystalize” in the conclusion. Think it over for this type of task requires slow thinking and digesting.

Abbreviations and professional terms

Even though the reviewers should be familiar with commonly used abbreviations and professional terms, it is seen as a bad manner to use these concepts without full spelling or clear description. Therefore, when using abbreviation and professional terms, try to follow the norms of scientific writing. Firstly, all abbreviation should be spelled out, when used for the first time in the text. Secondly, the professional language should be avoided or used upon clear definition. Besides, no discriminating or stigmatizing language is acceptable.


If in the Post-Soviet countries, the phrases like “we recommend conducting an additional study” or “more research is needed” are well-accepted, in the Western world such phrases can be perceived as a bad tone, since there is no such field of science where no additional research is needed. Yet, using the precious words for providing these kind of statements is a waste, especially when talking about the conference abstracts. In the conclusion of the abstract, the reviewer is waiting for your final word, the answer to your research question, not for an empty phrase. Another typical mistake is to make ambitious loud claims which are not supported by the results, for instance, that the sample size was not representative, but the conclusions are made based on the whole country population. The best advice is to support the conclusions by data, not by the ambitions of the author. One should also remember that conclusion is like saying goodbye to your readers. Therefore, you should think about leaving them with the feeling of the firm handshake and with a polite smile on your face. This is what you reader will remember.

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 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.

Drug Treatment Systems in Prisons in Eastern Europe Discussed by AFEW Board Member

Council of Europe Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs published a new publication “Drug Treatment Systems in Prisons in Eastern and Southeastern Europe”. The publication sheds light into the situation of drug users among criminal justice populations and corresponding health care responses in ten countries in Eastern and Southeastern Europe: Albania, Bosnia-Herzegovina, Georgia, Kosovo, Macedonia, Moldova, Montenegro, Russia, Serbia, and Ukraine. AFEW‘s board member Vladimir Mendelevich is one of the contributors of the publication. 

The research project on drug-treatment systems in prisons in Eastern and South-East Europe looks in detail into the situation of drug users among criminal justice populations and the corresponding health-care responses in nine countries in Eastern and South-East Europe – Albania, Bosnia-Herzegovina, Georgia, Moldova, Montenegro, Russia, Serbia, “the former Yugoslav Republic of Macedonia” and Ukraine – and Kosovo. It was conducted between 2013 and 2016, and is a first attempt to collect relevant data on drug use among prison populations and the related responses in the nine countries and Kosovo.

Although the places chosen are quite heterogeneous in size, structure, legislation, economy, culture and language, they are all in a process of economic, social and cultural transition. This has triggered reforms of some of their prison systems and policies but it has also led to financial and political instability and lack of leadership due to frequent changes in the prison systems’ top management.

The full publication can be downloaded here.

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.