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.

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.

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.

Russia is Dancing for Life

Author: Anastasia Petrova, Russia

“Congratulations to “FOCUS-MEDIA” and dance4life for the victory in presidential grants competition!” This was the message Ekaterina Artemenko, the coordinator of projects in Moscow “FOCUS Media” foundation, got from her colleague around midnight on July 31. The happy news spread quickly and all danc4life project members knew about it the next day. The initiative was supported this year by the Presidential Grant Foundation.

Starting from 2006, non-commercial organizations in Russia are supported by the president. This was the first year of the presidential grant competition. For 10-year existence, the system of finance distribution was quite complicated: at first the head of the state approved the list of non-commercial organizations (NCO) – the receivers of grants with his decree, and then the NCOs were included into the finance distribution system. In 2017, the procedure was simplified: grant participants may apply online. There has appeared the unified operator – presidential grant foundation.

Coordination committee summed up the results of the first competition on 31 July, 2017. There were 970 NCOs-winners from 79 regions in the winner list, which is around 15% of all applications. There were 6,623 projects that participated in the competition. Three Russian NCOs, included in the register as “foreign agents,” are among presidential grants recipients. Operator has distributed grants with the total sum of 2.25 billion Russian Rubles within the first competition. The most financed project among the 12 grant departments was “Citizen Health Protection, Promotion of Healthy Lifestyle.”

Recognition of merit

Public Health and Social Development Foundation “FOCUS -MEDIA” celebrated its 20th anniversary last year. “We are happy to have received this grant, but frankly, we are also a bit surprised,” the employees of the foundation are saying.

There is a lot of work ahead even after receiving the grant. Financing will allow to run the project dance4life in 14 Russian cities. It will also include a module on tobacco addiction prophylaxis and anti-tobacco campaigns. Besides, the project will include additional component in the form of helping teenagers and young people with HIV. They will be able to volunteer in the project and take part in all of the activities.

Dancing is a universal language

Dance4life project, which won the grant, is a unique international initiative. The initiative aims at promotion of healthy lifestyle among young people, preservation and promotion of reproductive health, HIV infection prevention and many more socially important diseases. More than two million people from 20 different countries have been a part of the programme over the years of its existence.

The project started in 2005 in Russia. It began after “FOCUS Media” Foundation director Evgenia Alekseeva met the Dutch creator of the project Ilco van der Linde. After this meeting, she decided to take this international initiative to Russia. “FOCUS Media” Foundation existed for seven years by that time, dealt with health protection and, in particular, with AIDS prophylaxis among youth. That is why the aim of the project (which includes the prophylaxis of socially important diseases, addiction formation and strengthening young people) coincided with the foundation’s activity.

Now dance4life is a project with 12-year-old history in Russia, and it runs in more than 14 regions. During the years of its activity, it managed to involve around 220,000 young people, who say that dance4life has changed their lives. The keys to the uniqueness of the project are youth culture, energy and creativity that help spread the information on preserving health and taking responsibility for one’s life. Dancing as a part of the project is a universal language, connecting dance4life participants from all over the world.

The results will be presented on AIDS 2018

There were some guests in the ““FOCUS -MEDIA” Foundation office a week before receiving the news about winning the grant. Yulia Koval-Molodtsova, a former project coordinator in Russia and now an associate in the main dance4life office in the Netherlands, came to Russia to talk about the new working models.

After running the same programme since 2005, the international dance4life team has been working on the analysis and improvement of the project methodology. While the old working model made an accent on youth education, the new programme aims at self-realization of society. Now the programme invites young people on a journey: from relationship with oneself, to the relationships with partners and society in general. The components of HIV and sexually-transmitted infections (STI) prophylaxis, issues of contraception and gender equality are now skillfully connected with such important for young people topics: self-knowledge, establishment of personal boundaries, and control of social stereotypes. The principles of work have not changed: to inspire, teach, involve and celebrate. Due to the “peer to peer” approach, young people become the driving force of the project.

New model of work will be approved during this year. The pilot project is running in two regions. In Nizhny Novgorod, where the project is successfully running from the start, they work in cooperation with local schools. The new contacts will be established from scratch in Kolomna, a city in Moscow region, where dance4life is just starting. The model of the project is universal and can be used for both learning and leisure purposes of young people.

Even though the project will be financed by the Presidential Foundation till the end of 2018, the managers of the project would like to sum up the first results of work by next summer. The results of work and experience in the area of HIV/AIDS among youth will be introduced on the International AIDS Conference in 2018. The focus of this conference will be on Eastern European and Central Asian countries.

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.

Harm Reduction: Redirection of Resources Needed

Why do we need action?

Harm reduction is an evidence-based and cost-effective approach to drug policy and practice that is about keeping people who use drugs, their families and communities safe and healthy.

Harm reduction is about saving lives and it works!

Yet many countries still do not provide harm reduction services. According to UNAIDS, between 2010 and 2014 only 3.3% of HIV prevention funds went to programmes for people who inject drugs.

Why now?

Harm Reduction International’s data shows that since 2014, no new countries have established needle and syringe programmes (NSP) and just three have introduced opioid substitution therapy (OST). Of 158 countries where injecting drug use is reported, over half (78) do not offer OST and more than a third (68) still do not provide NSP. In 2015, a UN target to halve HIV transmission among people who inject drugs by 2015 was missed by more than 80%.

These figures are a call to action.

By contrast, each year governments spend over $100 billion on drug control strategies that have little effect on demand for drugs or on those who profit from the drug trade. At the UN General Assembly Special Session on Drugs in 2016, governments showed a new willingness to rethink these approaches. But now they must rebalance their spending.

What are we calling for?

We are calling on governments to redirect 10% of the resources currently spent on ineffective punitive responses to drugs and invest it in harm reduction by 2020.

What we will this achieve?

Even this small redirection of funding could achieve big results.

A 10% redirection of funding from drug control to harm reduction by 2020 would:

  • End AIDS among people who inject drugs by 2030.
  • Cover annual hepatitis C prevention need for people who inject drugs. Globally. Twice over.
  • Pay for enough naloxone to save thousands upon thousands of lives every year from opiate overdose.
  • Ensure effective advice, healthcare and emergency responses in the face of newly emerging challenges.
  • Strengthen networks of people who use drugs to provide peer services and campaign for their rights.
What will happen if we don’t act now?

If the adoption of harm reduction in new countries continues at the current pace, it will be 2026 before every country in need has even one or two harm reduction programmes. In the meantime, thousands, if not millions, of lives will be lost.

Source: Harm Reduction International

‘Building a Healthy Future Together’ – AFEW Releases its 2016 Annual Report

AFEW International releases its 2016 Annual Report ‘Building a Healthy Future Together.’ The report highlights AFEW Network’s key activities in the region of Eastern Europe and Central Asia (EECA).

“Now more than ever, key at-risk populations need increased access to health services to combat the three epidemics of HIV, TB and viral hepatitis, something that was highlighted last year in the new World Health Organisation global health sector strategies on HIV and on viral hepatitis,” said Anke van Dam, executive director of AFEW. “Eastern Europe and Central Asia is the only region in the world where new infections of HIV are still on the rise, and where multi-drug resistant TB and viral hepatitis cases, also as co-infection with HIV are so highly prevalent.”

On the road to the 2018 International AIDS Conference that will be held in Amsterdam, last year AFEW International started to engage representatives at all levels to ensure that the relevant issues, successes and challenges from EECA are addressed at AIDS2018.

“With AIDS2018 and through all of our projects detailed in this report, AFEW International continues to contribute to a healthy future for the people of EECA,” says Anke van Dam.

The English version of our Annual Report is available here (download PDF.) The Russian version of the Report can be read here (download PDF.)

The Photo Exhibition ‘Life in the Shadow’ was Shown in the Netherlands

Last week the photo exhibition ‘Life in the Shadow’ was brought to the Netherlands by public Foundation ‘AIDS Foundation East-West in Kazakhstan.’ It was possible to see the images of people affected by HIV and tuberculosis during Wolfheze workshops in the Hague on 31 May – 2 June.

The main goal of the exhibition is to reduce stigma and discrimination against people with HIV and tuberculosis.

“We were very lucky with the opportunity to bring the exhibition to the Netherlands and show it to the bigger number of people,” the project manager of AFEW Kazakhstan Kristina Zhorayeva is saying. “Our models were very brave to show their faces and share their personal stories. They wanted to tell people that they are not different and they also have dreams and hopes.”

At the end of March the photo exhibition ‘Life in the Shadow’ was shown in Almaty, Kazakhstan. Some people from Kazakhstan saw the images for the first time in the Netherlands though.

“I have heard about this exhibition from AFEW, and today I saw it in the Netherlands even though it was displayed in my native Almaty,” the head doctor of one of the private clinics of Almaty Galiya Tulebayeva is smiling. “I look at these pictures of the patients with pleasure. It is great to see that there are smiles on their faces and they are in positive mood.”

As of February 2017, in Kazakhstan there were registered 29,568 HIV cases. According to the official data, in 2016 there were 14,345 tuberculosis patients registered in the country.

Visitors reviews of the photo exhibition ‘Life in the Shadow’

Jamshid Gadoev, WHO Country Office for Combating Tuberculosis, Hepatitis and HIV-AIDS in Uzbekistan:

– Only brave people can show themselves in such a way. They got sick and went through the processes that other people are going through now and do not hesitate to show all of this. On each photo I see a smile. Probably, they are happy with their treatment and are glad that they were rescued. They seem to be happy with their lives.

We also published a book and made a video about what tuberculosis patients feel before, during and after their treatment. We asked our patients to associate tuberculosis with some color, and children were asked to associate it with color and with the animal. Many people said that the disease for them is associated with red, yellow or black. Children usually said that their illness is a red teddy bear. Adults told that for them tuberculosis is black and is associated with the sound of a trumpet. After treatment, these associations often change and colors become brighter.

Alexei Bobrik, WHO technical specialist on HIV, tuberculosis and hepatitis, WHO Country Office, Ukraine:

– To overcome the burden of these diseases, it is necessary to talk about this problem so that the population knows about it, and the negative attitude towards the diseases decreases with time. It is necessary to communicate information, so that there is no stigma and discrimination. We must know that normal people are vulnerable to these serious diseases as well.