EECAAC 2018: Treatment or Epidemic

The problems of EECA were discussed at the VI Eastern Europe and Central Asia AIDS Conference in Moscow on 8 – 20 April 2018

Author: Anastasia Petrova

Russia accounts for two-thirds of the new HIV cases in Europe and Central Asia. This is what the UNAIDS data show. One of the key factors contributing to the further spread of the epidemic is low treatment coverage: only one-third of people who need treatment get it. This fact, as well as other problems of the region, were discussed at the VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) held in Moscow on 8 – 20 April 2018.

“What should be done to make sure that every HIV positive person has access to high-quality modern treatment from the day he is diagnosed with HIV in any place of our huge country? Maybe we should all – activists, business, government – honestly recognize that the AIDS war is lost, should join our efforts and reconsider where we are and where we go,” said Aleksandr Chebin, the activist of the Patient Control Movement, Yekaterinburg.

Patients demand treatment

“A special program was adopted in Russia to prevent the spread of the virus in the country, which allowed significantly increasing HIV/AIDS patients’ coverage with treatment services,” told Olga Golodets, Deputy Prime Minister of the Russian Federation at the EECAAC 2018 opening ceremony. However, experts say that the measures taken are not enough.

According to Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre, only 35.5% of people living with HIV in Russia receive treatment. Even those who are registered in HIV care are not guaranteed treatment. In early 2018, fifteen regions of the country have reported stock-outs of antiretrovirals (ARVs).

On activists’ of the Patient Control Movement made attempts to voice this message at the opening ceremony T-shirts there was a message STOP, STOCK-OUTS!

Activists of the Patient Control Movement made attempts to voice this message at the opening ceremony. During the speech of Olga Golodets, people present at the ceremony stood up and took their coats off. Red letters on their snow-white T-shirts read STOP, STOCK-OUTS! This silent protest was a way for the patients to express their indignation with access to treatment in the country.

“Fight with HIV is a joint fight, which includes civil society and the volunteers who are now standing in front of us,” said the public official about the protest.

Disease of the system

According to experts from the International Treatment Preparedness Coalition in EECA (ITPCru), stock-outs are a systematic problem in Russia.

“The Ministry of Health announces tenders too late, and then the suppliers fail to supply drugs to the regions in time,” said Natalia Yegorova, Monitoring and Advocacy Officer, ITPCru.

Svetlana Prosvirina representing SIMONA+ project mentioned that according to the survey held by the patients’ community, 50% of patients of the AIDS centres faced problems when receiving their antiretroviral therapy (ART), such as stock-outs and frequent changes of treatment regimens.

“Apart from the stock-outs, we also identified other barriers in access to the health services: location of the AIDS centres, queues, long list of medical examinations to be completed before ART initiation (which is a significant barrier for injecting drug users), long-term before treatment start – 1 to 3 months, and health care system-related problems, such as stock-outs of ARV drugs and diagnostic tools,” told Svetlana.

Tim Martino, Deputy Director of UNAIDS called Russia to adopt the international ‘test and treat’ strategy. This approach stipulates treatment initiation not waiting for the immune status going down. Such strategy proved effective in the African states. However, it is still ignored in Russia.

Vinay P. Saldanha, UNAIDS Regional Director for Eastern Europe & Central Asia explained that to cover all patients with treatment the price of a yearly course per patient should not exceed USD 100

Timofey Nizhegorodtsev, expert of the Russian Federal Antimonopoly Service delivered a speech at the session “Strategies to Enhance Access to ARVT and Drugs to Treat Comorbidities in the EECA in the Light of Current State of Affairs.”

“Currently, a draft law on public health is prepared, which will allow local producers to manufacture the required drugs at affordable prices,” he said

Price reduction is the key

Only a sharp price reduction will make it possible to provide all people in need with treatment in the country, experts say. Vinay P. Saldanha, UNAIDS Regional Director for Eastern Europe & Central Asia explained that to cover all patients with treatment the price of a yearly course per patient should not exceed USD 100.

“Only in this case, the Russian Federation has a chance to achieve the 90-90-90 targets and meet the commitment to end the HIV epidemic by 2030,” pointed out Mr. Saldanha.

The key results of EECAAC 2018, as well as the actions to be taken, are included to the Final Statement of the VI Conference. The document is currently to be adopted by the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor) and will be published before the end of April.

Artificial Respiration: will Russia End Tuberculosis by 2030

In 2016, 1.3 million people worldwide died of tuberculosis. Over the same year, 10.4 million people fell ill with tuberculosis

Author: Anastasia Petrova, Russia

March 24 is World Tuberculosis Day. Tuberculosis (TB) is the ninth leading cause of death worldwide. Russia is one of the top three countries with the highest burden of drug-resistant TB. At the first World Health Organisation Global Ministerial Conference on Ending TB held at the end of the last year in Moscow, the Russian Minister of Health Veronika Skvortsova proclaimed that Russia, supporting the global community goal, aims to end TB by 2030. Experts comment on how feasible this goal is.

Treatment is not cost efficient

Tuberculosis is called a biosocial disease as people from the most socially disadvantaged populations face the highest risk of being infected. People from low- and middle-income countries – India, Indonesia, China, Nigeria, Pakistan, Philippines and South Africa – are affected the most. Such countries cannot procure the required drugs at high prices and, as the treatment access experts point out, it is not cost effective for the pharmaceutical companies to invest in the production of drugs, which will not bring them enough income. It complicates the development and launch of new drugs, while the lack of innovative drugs leads to the development of drug-resistant forms of tuberculosis, aggravating the situation.

In 2016, 1.3 million people worldwide died of tuberculosis. Over the same year, 10.4 million people fell ill with tuberculosis.

Sustainable threat

TB morbidity rate in Russia is 58.44 cases per 100,000 people. On one hand, there has been a steady declining trend in TB mortality in the country since 2005 (except for the vulnerable populations). According to the WHO, in 2016 the mortality rate was 8.2 cases per 100,000 people a year (as compared to 16 cases in 2011). On the other hand, WHO experts observe two crucial problems in the Russian Federation: growth in TB morbidity among people living with HIV and widespread of the drug-resistant forms of TB – extensively drug-resistant tuberculosis (XDR-TB), multidrug-resistant tuberculosis (MDR-TB), and rifampicin-resistant tuberculosis (RR-TB).

According to the WHO, Russia is one of the top three countries with the highest burden of extensively and totally drug-resistant tuberculosis, with higher rates in India and China only. In 2016, the share of XDR-TB in the new TB cases in Russia was 27%, and in recurrent TB cases – 65%. It means that now there is no effective treatment for many people. Only 31% of people recover from XDR-TB. The cause of drug-resistant TB is first of all associated with treatment interruptions. The main reason of patients “dropping out” is the lack of social support.

“Patients should not only be treated but should also be provided with comprehensive social support. The treatment is long and hard, it takes over a year. It leads to many people losing their jobs. If people have no means of subsistence, they have to stop their treatment and go to work. The situation is even more complicated for people who have small children,” says Svetlana Prosvirina, member of TBpeople, the Eastern European and Central Asian network of people with experience of TB. “Such drop-outs are extremely dangerous as the bacteria which survive after the treatment interruption adjusts to the medications, which contributes to TB evolution to MDR-TB and XDR-TB.”

Coverage of people living with HIV with treatment is low

Experts agree that to curb the epidemic of tuberculosis by 2030, the government should make efforts to fight drug-resistant forms of TB and create conditions for the patients not to interrupt treatment

Tuberculosis is the main AIDS-defining disease and the leading cause of death among people living with human immunodeficiency virus. The risk of co-infection is related to the low immune function of people living with HIV, who need to receive antiretroviral therapy (ART) constantly to stabilize their immune responses. However, in Russia treatment coverage of people living with HIV remains extremely low. According to the Federal AIDS Research Centre of the Rospotrebnadzor Central Research Institute of Epidemiology, in 2017 the coverage rate was only 35.5%.

People who use drugs are also in a difficult situation. TB activists point out that TB treatment clinics often do not have a drug counsellor and sometimes do not even have a license to provide help to people who suffer from the abstinence syndrome (group of symptoms with varying combinations and severity, which develop when a person terminates using psychoactive substances or reduces the dose taken after their recurrent use, usually during a long-term and/or in high doses – editor’s note). Those symptoms make the patients refuse from further treatment, which not only leads to drug resistance but also creates pre-conditions for further transmission of the disease.

Ending TB by 2030

Experts agree that to curb the epidemic of tuberculosis by 2030, the government should make efforts to fight drug-resistant forms of TB and create conditions for the patients not to interrupt treatment.

“Comprehensive support of vulnerable populations, including the patients, is required to prevent the spread of tubercle bacillus,” says Kseniya Shenina, activist, member of the TBpeople Coordination Council.

Based on the conclusions of the Russian Public Mechanism for Monitoring of Drug Policy Reform, an important pre-condition to overcome the problem is the revision of the Russian drug policy in compliance with the “Support Don’t Punish” approach. Experts believe that the country urgently needs to approve recommendations of the numerous UN bodies on drugs and HIV, including recommendations of the Committee on Economic and Social Rights. Only compliance with these conditions will make the goal of ending tuberculosis by 2030 more feasible.

About Us with Us Only: Russian Specialists to Attend AIDS 2018

Author: Anastasiya Petrova, Russia

February 5th 2018 was the deadline for submission of abstracts for the 22nd International AIDS Conference (AIDS 2018). One of the key issues during AIDS 2018 will be the discussion of the response to the HIV epidemic in Eastern Europe and Central Asia (EECA) countries. Below you can see the expectations from experts and representatives from Russian NGOs who have submitted their applications for the Conference.

Yevgeniy Pisemsky

Yevgeniy Pisemsky, HIV and LGBT activist, Head of Organisation PHOENIX PLUS, Person of the Year according to Winq magazine

About the organisation

Our organisation has been active for 11 years now. The main area of activity of Phoenix Plus is support, care and prevention for MSM in relation to HIV. We also support expanding of service centres and fulfillment of human rights.

What the AIDS Conference means for me

In general, I have a positive history with AIDS Conferences. I have visited four. When I came to my first conference in Thailand, I saw a tremendous community of professionals, however, I did not feel myself part of their camp. At that time, the AIDS Conference stimulated my ambitions and I made a resolution to move forward and get something done. So we did – the conference in Mexico City was opened by the fellows from my organisation. This was such an honour! I sat there, in the middle of the conference hall, and cried remembering how it all started.

At the conference in Vienna, I met Elton John AIDS Foundation representative for the first time. Seven years passed and we are still working together. They are our main partners. This is also a result of such conferences. A conference for me is most importantly a possibility to start new acquaintances, form joint plans, and only then acquire knowledge about new technologies and innovations.

My expectations from AIDS 2018

It is very important that at the conference in Amsterdam an attempt to focus attention on EECA region, where HIV situation is worse than in Africa will be made. I would like to share success stories about what we did in Russia on self-testing and learn something new from others. I have prepared an abstract and hope to deliver an oral presentation. We will try to communicate that there are achievements in Russia as well.

Aleksey Mikhailov

Aleksey Mikhailov, Monitoring Division Manager at the International Treatment Preparedness Coalition in Eastern Europe and Central Asia, Patient Control Movement activist

About the organisation

Since 2010, we have been conducting monitoring of state procurement of ARV medications. At that time interruptions in the supply of HIV treatment medications began, and we tried to understand why that was happening. Following analysis of state procurement, we realized where interruptions come from and undertook attempts to change the situation.

What the AIDS Conference means for me

I have never been to AIDS Conferences before, this one will be my first. Since the situation with AIDS in the EECA region is currently one of the most challenging epidemiological situations in the world, the AIDS Conference is a great opportunity to put problems of the region into focus. At the same time, it is also an opportunity to discover world trends and implement them in the Russian Federation. This is probably more related to prevention, as our country has its own way of optimizing treatment.

My expectations from AIDS 2018

It is my hope that the organisers will place greater emphasis on what is going on in Russia, Ukraine and other EECA countries. Today we stand at the threshold of a revolution in treatment. Soon we will have prolonged-release medication forms. Development of enhanced dolutegravir, which can be taken once a month, is in progress. It would be vital to learn about similar research, which is for sure to be presented at the AIDS Conference.

Irina Maslova

Irina Maslova, Leader of Silver Rose – Sex Workers’ Rights Movement, CEO of Astra Charitable Women’s Foundation

About the organisation

My official position is Chief Executive Officer of Astra Foundation, where we deal with HIV prevention among women and access to HIV related services. From this position, I am able to communicate with the government from the public healthcare perspective. At the same time, I lead Silver Rose – the movement of sex workers and their supporters, which is not registered but is fighting violence and HIV spread within this vulnerable group. In the past three years, we have done a lot to reverse article 6.11 that criminalizes sex work and to improve the situation for sex workers in our country.

What the AIDS Conference means for me

AIDS Conference for me is a possibility to meet new people. It is vital for experienced specialists to be able to pass their best practices on to those who follow. We have submitted two abstracts to this Conference. The first one is based on the research conducted jointly with Trans-regional NGO Positive Dialogue and AFEW International and related to violence as an obstacle to access to prevention programmes. The second one is on analysis of a project within the framework of co-funding to the main programme of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The uniqueness of this project is that we have managed to reach the 90/90/90 goal. It would be great to share that experience.

My expectations from AIDS 2018

Today we need to talk about bringing the main donors back to Russia. The Global Fund is shutting down its operation in the country, and the government does not finance work with key groups and will not do so while sex work remains to be criminalized. Until the government starts working with this target group, sexual transmission rate will keep growing. In order for the projects for key groups to be effective, we need continuity and that is impossible without funding.

Maria Yakovleva

Maria Yakovleva, HIV activist, Director of Candle Charitable Foundation

About the organisation

We are a self-organization of people living with HIV established in 2004. We provide direct services to vulnerable groups, however currently this activity is being carried out outside projects. We provide equal counselling, social support, as well as first-aid kit and a hotline. The Foundation also provides technical assistance for the Global Fund Coordination Board Secretariat.

What the AIDS Conference means for me

I attended the previous AIDS Conference in South Africa and that was my first International Conference. I was lost at first and only towards the end gained an understanding of how all the resources could be utilized. During the first several days I just walked around open-mouthed at the amount of communication, new information and acquaintances with representatives from organisations around the world. During the previous conference I got acquainted with professionals in AIDS services – representatives of influential organisations in our domain. I really want to go to AIDS2018. The possibility of sharing the information about what is going on in Russia is also very vital. I believe that speaking about your position is also a way of impacting the situation in the country.

My expectations from AIDS 2018

The focus of the upcoming AIDS Conference is EECA region, so the problems to be addressed there will be much closer to us. I hope there will be donors interested in projects in our region. We are also eager to find ground for dialogue with decision-makers.

Blind Response: Experts Offer Different HIV Estimates in Russia

National campaign: HIV testing in a train carriage, 2017

Author: Anastasia Petrova, Russia

According to the UNAIDS, Russia ranks third based on the rate of the new HIV cases in the world after South Africa and Nigeria. However, there are inconsistencies in the data on HIV incidence dynamics in the country provided by different offices.

Mixed opinions

In May 2017, it became clear that there are some discrepancies in the data on the growth rate of new HIV cases in Russia presented by different government offices. Comparing statistics for the previous years, Veronika Skvortsova, Russian Minister of Health announced that in 2016 HIV incidence dropped down twofold.

“We had the total of 86.8 thousand new cases of HIV, while a year ago, in 2015, there were over 100 thousand. Thus, the number of HIV cases fell down by 15%,” said Veronika Skvortsova.

However, Vadim Pokrovskiy, Head of the Russian Federal AIDS Centre presented different data, which, vice versa, demonstrate a growing number of HIV cases in the country. The scientist told about the growth of HIV incidence by 5.3%. According to the recent data of the Russian Federal AIDS Centre presented shortly before the World AIDS Day, in the first 10 months of 2017 regional AIDS centres reported 79,075 new cases of HIV. This is 2.9% more than during the same period of 2016. This data shows the continuing growing trend in HIV incidence.

Such discrepancies became visible to the public, so the Ministry of Health offered relevant explanations on its official website. In the article dated 17 May 2017, it is written that “in his report, Dr. Pokrovskiy presents the results of scientific epidemiological monitoring of the Institute of Epidemiology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) based on the positive laboratory tests for HIV and not the statistical data on HIV incidence for the previous year. The incidence, however, shows the number of people with the confirmed diagnosis (not the number of laboratory tests).”

Thus, according to the Ministry of Health, the calculation method used by Rospotrebnadzor is less accurate considering that one person tested for HIV several times is calculated as several new cases. Some experts, however, say that both statistical approaches may be used as there is a growth of the HIV incidence in the country, but the rate of such growth is decreasing.

“Positive” statistics

Veronika Skvortsova, the Russian Minister of Health

The data on the total number of people living with HIV in Russia is also not quite clear. The Rospotrebnadzor report mentioned above states that as of 1 November 2017 there were 924,608 Russian citizens living with HIV. As for the Ministry of Health data, we have not received any reply to our official request on the number of people living with HIV as of the date of this article. The Ministry fails to submit such data to the UNAIDS to prepare annual reports on the HIV epidemic in the region.

However, some data suggest that the number of people living with HIV in Russia is much higher. Thus, 25,000 Russian citizens were tested in the course of the famous free anonymous testing campaign run by the Ministry of Health in a train carriage, which was held from 7 July to 28 October 2017. Out of them, 375 results were positive. If such statistics is extended to the general population, up to 1.5% of people in Russia may be diagnosed with HIV.

Creating a register

Experts say that the country needs an accurate estimate of the number of people living with HIV.

“The first and the most important goal is to understand the situation and have full information on the number of people living with HIV, the treatment regimens they use and the need in medicines,” says Sergey Krayevoy, Deputy Minister of Health.

It is planned to introduce a Federal Register of People Living with HIV in Russia to analyse the scope of medicines needed and to systematize the statistics. Such database will be administered by the Ministry of Health. Apart from the diagnosis, records will also be made on the health state of the patients, medicines prescribed to them and other data allowing to see the full picture of their health. Thanks to such register, a person relocating within the country will be able to get help in any region.

Vinay Saldanha: Treatment should be Provided to all HIV-positive People

Author: Anastasia Petrova, Russia

This year, the issue of treatment coverage for people living with HIV has been broadly discussed in Russia on World AIDS Day. We are talking on this topic with Vinay Patrick Saldanha, Director, Regional Support Team for Eastern Europe and Central Asia (EECA), UNAIDS.

– Mister Saldanha, today at the press conference, organised by the movement Patient Control, we heard that in Russia only up to one third of all people living with HIV receive treatment. What measures are to be taken to reverse the situation?

– A hard and fast decision is to be taken on adopting the ‘test and treat’ strategy. In line with the World Health Organization (WHO) guidelines, which have already been used for several years, all people with the HIV status should get uninterrupted and high-quality treatment. At the same time, treatment guidelines issued by the Russian Ministry of Health state that priority in treatment should be given to the patients with the immune status below 500 СD4 cells. Thus, with the limited access to drugs, doctors have to prescribe therapy to those who have the weakest immunity and open the so-called waiting lists. In many regions, the situation is critical.

Now in Russia there are mass HIV testing campaigns. However, to motivate people to get tested the second part of the strategy – the ‘treat’ component – should also be offered. If a person is concerned as he had some questionable contacts or he knows that his sexual partner is HIV positive, it means a direct risk of infection. It would be very good for such person to check his HIV status. However, if he knows in advance that he would not get treatment and that the AIDS centres have the “waiting lists,” he will not be highly motivated to get tested. To remove those questions from the agenda, all national governments should adopt the ‘test and treat’ policy. I am happy to say that in Eastern Europe and Central Asia there are quite a few countries, which have already announced following this policy: Armenia, Ukraine, and Kazakhstan. They treat all patients who test positive: the patient can seek and get help. If Russia wants to achieve the 90/90/90 target by the end of 2020, the decision to ‘test and treat’ is to be taken in 2018.

– A year ago, Russia adopted the State Strategy to Combat the Spread of HIV through 2020. How do you assess its effectiveness?

– The very fact that there is such a strategy is a great achievement. For many years, the epidemiological situation remained complicated due to the lack of a strategy. For the first time, the government issued an important state document calling to urgently accelerate the measures to combat HIV. It is very good that such measures are to be taken not only by the government, but also by the society, mass media, private sector and trade unions.

However, it would be good if people who prepared the Strategy would define clear and measurable targets for each year: what should be the reduction in the new HIV cases, how many patients are to be enrolled to treatment. The five-year goals are defined but how is it possible to split them and follow up on the achievement of interim targets each year?

– Vadim Pokrovsky said that the Strategy does not have a strong financial background…

– It is a question of state priorities. I think that Russia, having the resources and knowing how to distribute them in the best way, is able to find the sufficient funding to combat HIV. This is not just about the budget increase. There are high-quality drugs, which are less expensive than those procured in Russia. Thus, apart from allocating two or three times more money from the state budget, the cost of drugs may also be reduced. In the last two years, thanks to the pro-active approach of the Ministry of Health, an unprecedented reduction in the cost of HIV treatment in Russia was observed. Such price reduction strategy shall be continued until all patients have access to drugs. My estimate is that in the EECA region the cost of treatment should not exceed 200 US dollars per patient.

– Speaking about price reduction, do you mean compulsory licensing?

– This as well. When compulsory licenses were discussed for the first time, the Russian government represented by the Ministry of Health was concerned that the foreign pharmaceutical companies may leave our country, stop the clinical trials and Russia would be excluded from the innovations. I know over 15 countries in the world, which issued compulsory licences for HIV drugs. In none of those cases, none of the pharmaceutical companies ceased their activities in such countries. Vice versa, such policy led to sharper price declines and scaled up access to treatment. That is why I strongly welcome the discussion of this question at all levels.

One option is to issue a license to produce drugs in the country and another is to facilitate the procurement of quality drugs from abroad at lower prices. Thus, Brazil, for example, for 20 years was famous for producing most “first line” drugs for its citizens. However, three years ago, even before the WHO guidelines were issued, it was the first country to make a decision to treat all people living with HIV. After all the costs were calculated, it became clear that such coverage could not be reached if only locally produced medicines are used. Then the country started purchasing generic medicine from Indian brand producers for 400 US dollars per patient a year. It is a very interesting example of how access to high-quality medicine may be ensured without violating the patent rights.

– Surely, you will take part in the XXII International AIDS Conference in Amsterdam next year. What are your plans for this event?

– We have a joint plan for two very important conferences: VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) and the XXII International AIDS Conference (AIDS 2018) in Amsterdam next year. As UNAIDS, we are co-organizers of the ЕССААС 2018 and members of the AIDS 2018 Committee. We encourage specialists and mass media representatives to not only take an active part but also to build kind of a strategic bridge between those conferences. We would like the international participants to intensively share their experience at ECCAAC 2018 and representatives of the EECA region to broadly present their developments at AIDS 2018.

Deadline Extended: Stipends for Dutch Based Delegates to Visit EECAAC 2018

VI Eastern Europe and Central Asia AIDS Conference (EECAAC 2018)

“Mobilizing resources: experience, investments, innovations”

18-20 April 2018, Moscow, Russian Federation

The organizers of the VI International Eastern Europe and Central Asia AIDS Conference (EECAAC 2018) provide 10 stipends for Netherlands-based organizations to participate in the Conference. The forum will be held three months before the XXII International AIDS Conference (AIDS 2018), which will be hosted by Amsterdam on 23-27 July 2018.

The Dutch Ministry of Foreign Affairs acts as the observer in the EECAAC 2018 Organising Committee to enable clear links and continuity of discussions at both conferences. Why is it important? One of the five 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. EECAAC 2018 is a platform for scientific exchange in the EECA region and will open the dialogue on partnerships and joint effort coordination in HIV response which will be continued at AIDS 2018.

The main goal of EECAAC 2018 is to focus on measures for eliminating the HIV epidemic and other public health concerns in Eastern Europe and Central Asia, present high-performance programs and provide experience exchange opportunities for scientists, experts, policy makers, healthcare professionals, activists and public figures in relation to the best HIV response strategies.

VI International Eastern Europe and Central Asia AIDS Conference is expected to convene up to 3000 participants and will feature:

  • Presentation of innovative approaches to the prevention and treatment of HIV/AIDS, opportunistic and concomitant infections.
  • Strengthening the link between science and practice.
  • Development of regional healthcare systems.
  • Exploring ideas around the new “AIDS/HIV-free generation”.
  • Expanding the role of sport in HIV response.
  • Discussing HIV and migration.
  • Expanding the role of partnerships and joint effort coordination in HIV response.
  • Examining economic aspects of HIV response.

 Conference organizers:

  • Joint United Nations Programme on HIV/AIDS (UNAIDS)
  • Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)

Why stipends for Dutch organizations?

The stipends will be provided to 10 representatives of Netherlands-based organizations in order to stimulate greater presence of these organizations at EECAAC 2018 as well as facilitate cooperation between the Netherlands and the EECA countries in HIV/AIDS response and related areas. The XXII International AIDS Conference will be specifically featured at EECAAC 2018.

Representatives of the Dutch NGOs and scientific institutes, activists working in the field of HIV/AIDS, SRHR, HIV and co-infections are invited to apply for a stipend to visit EECAAC 2018 and support the Dutch delegation at the Conference. Representatives will also be encouraged to occasionally represent the Netherlands at the Dutch Booth and/or to promote their NGO at the Community Village.

What do the stipends cover?

  1. Return economy class flight.
  2. Airport – hotel – airport transfer.
  3. Hotel – Conference – hotel transfers.
  4. Accommodation in the hotel (3-4 stars).
  5. Meals (breakfasts, lunches or dinners) for all days of the Conference.
  6. Per diems will not be provided.
  7. Support in obtaining visa if required.

Who can apply?

Individuals complying with all of the following criteria may apply:

  1. The applicant is 18 years of age by the time of the Conference and a staff member of an NGO, community-based organisation, scientific institution, network, association, or non-registered entity, located in the Netherlands
  2. An organisation, represented by the applicant, works in one of the following areas:
    1. HIV/AIDS prevention or service provision.
    2. HIV/AIDS and co-infection with TB and/or viral Hepatitis prevention or service provision.
    3. HIV/AIDS related non-medical research.
    4. HIV/AIDS and co-infection with TB and/or viral Hepatitis research.
    5. Support and service provision to the most vulnerable population including people using drugs, sex workers, LGBTQ, MSM.
    6. HIV/AIDS prevention and/or sexual health education for young people.
  3. An organisation, represented by the applicant is non-profit.
  4. An organisation, represented by the applicant, is working in the EECA region or has a demonstrable interest in this region.
  5. The applicant commits to actively participate in the whole duration of the Conference.
  6. The applicant is eager to contribute to the preparation for AIDS 2018 after the return from EECAAC by sharing knowledge and experiences at the events, which will be eventually organised in the run of the AIDS 2018 in the Netherlands.

How to apply?

In order to apply, please follow these simple steps:

  1. Follow this link in order to register for the Conference.
  2. Fill in the required fields at STEP 4 of the registration process.3. Wait for the decision of the Selection Commission regarding your application.

Deadline extended: applications submission closes at 24 January 2018.

Stipend awardees announcement: 31 January 2018.

The Selection Commission

The Selection Commission will consist of representatives of the AFEW International, the Dutch Ministry of Foreign Affairs, GNP+, and independent consultants. The selection of the candidates will be based on criteria listed above and the following considerations:

  1. Even representation of the different areas and target groups.
  2. Strong commitment for active participation in EECAAC 2018.
  3. Strong commitment to share knowledge and experiences after returning to the Netherlands.
  4. Preference will be given to those candidates who otherwise wouldn’t be able to visit EECAAC 2018.
  5. A maximum of one representative per organization.

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.

 

Tuberculosis is Finally Getting on the Agenda of the Heads of State

22 November 2017, Geneva, Switzerland – Last week, 75 ministers agreed to take urgent action to end TB by 2030 at the conclusion of the WHO Global Ministerial Conference on ‘Ending TB in the Sustainable Development Era: A Multisectoral Response’ in Moscow, Russia. President Vladimir Putin of the Russian Federation gave the keynote speech on the first day of the Conference on 16 November. The first high-level plenary started with the welcome address of Amina J Mohammed, UN Deputy Secretary. The Conference was opened by Veronika Skvortsova, Minister of Health, Russian Federation, Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Zsuzanna Jakab, WHO Regional Director for Europe, Dr Aaron Motsoaledi, Minister of Health of South Africa and Chair of the Stop TB Partnership, and Timpiyan Leseni, TB survivor from Kenya. The meeting was attended by ministers and country delegations, as well as representatives of civil society and international organizations, scientists, and researchers. More than 1000 participants took part in the two-day conference which resulted in collective commitment to ramp up action to end TB.

“In order to achieve a radical change in the fight against this disease, new approaches are needed, both at the national and international level, as well as the joint work of governmental agencies, public and professional organizations. Only coordinated and consistent actions will help us achieve a final victory over TB. We expect these steps to be supported at the highest level – by the General Assembly of the United Nations, whose meeting next year will focus on the problems of TB,” said the President of Russia Vladimir Putin.

“The UN HLM on TB is the moment we have all been waiting for, and we will we seize the moment. No more calls for action, we need commitment. Together I know we can do it, it will not be easy but we must believe it is possible. This house is full, the attendance of so many ministers shows the commitment but we need to prepare for real commitment,” said Dr Tedros, WHO Director-General.

Speaking at the opening of the Global Ministerial Conference on TB, Minister of Health of South Africa and Chair of Stop TB Partnership, Dr Aaron Motsoaledi emphasized the need to elevate the discussions and engagement to end TB at the level of heads of state and government and UN leaders. “Tuberculosis kills more than 4500 people every day and it is time to be seriously addressed with the support and engagement of the heads of governments. We need to ensure that going towards the UNHLM in New York in September 2018, we have a very strong participation, a very strong Political Declaration and a very strong accountability framework.  If we want this, we need  to have good quality data on TB and for it to be user friendly that heads of state, ministers of finance and even ministers of health can rapidly see the status of their epidemic and targets,” said Dr Motsoaledi.

On this occasion, the Minister launched the Stop TB Partnership interactive country dashboards site that presents country-based TB essential information in a manner that is simple and user friendly in easy-to-use graphs – including TB burden, TB care and service delivery, finances and selected determinants/comorbidity.

No new data is collected, rather that data is derived from the Global Fund, Institute of Health Metrics and Evaluation, the Stop TB Partnership, WHO and the World Bank – as indicated in the dashboards.*

Petition signed by more than 35,000 people from 120 countries presented to  Dr. Tedros, head of WHO and Ministers of Health.

In Moscow, the Stop TB Partnership and MSF released the report ‘Out of Step in Eastern Europe and Central Asia’ (EECA), presenting the results of an eight-country survey of national TB policies and practices. Among the countries surveyed, 75% have adopted the policy to use rapid molecular testing instead of older, slower testing methods, yet only half of those countries are actually using the test widely.

“In TB, we fight not only with mycobacterium tuberculosis, but also with the time. When we look at policies and guidelines and if country programmes need to update them, this is not an easy task, and it will take a lot of time to make it happen. If you add the time to have it approved and start the roll out, we are speaking here of years, not months. This is why it is important to keep up with the new recommendations and be able to adjust and adapt to the country context rapidly,” said Dr Lucica Ditiu, Executive Director of the Stop TB Partnership.

At the Global Ministerial Conference, Mariam Avanesova, who was treated for MDR-TB in Armenia in 2010-2012 and represents TBpeople, the Eurasian network of people with TB experience, handed over a petition to WHO’s Director-General, Dr. Tedros Ghebreyesus. The #StepUpforTB petition is an urgent call for health ministers in key TB-affected countries to get their TB policies and practices in line with international standards, as defined by WHO, including testing and treatment of TB and its drug-resistant forms. Initiated by MSF and the Stop TB Partnership, the petition has been signed by more than 35,000 people from 120 countries united with people affected by TB.

Source: Stop TB Partnership

HIV Prevention in Key Populations: an Overview of Service-Delivery Projects in Russia

The Blue Bus mobile prevention unit, the bus of hope

Author: Anastasia Petrova, Russia

According to the World Health Organization, about half of new HIV cases occur in key populations: injecting drug users, men having sex with men and sex workers. Social stigma, violation of human rights, lack of access to the necessary services create barriers to protection of health for millions of Russian citizens. That being said, providing care to people with an HIV-positive status and those who are at risk of infection is an essential measure to safeguard health of the whole nation. By implementing service-delivery projects for key groups, non-governmental organizations play an important role in preventing the spread of the HIV epidemic both in the communities and among the general population.

The bus of hope

The Blue Bus mobile prevention unit, engaging clients in service provision

The Blue Bus of the Humanitarian Action Foundation is the first mobile prevention unit for drug users. In 2017, the project celebrates its anniversary: 20 years ago, the Blue Bus started its first journey in St. Petersburg.

Throughout these 20 years, Humanitarian Action has been true to its principles of helping those most vulnerable to the HIV epidemic. Many clients have double or even triple diagnosis: HIV, tuberculosis, hepatitis B and C, and addiction to psychoactive substances.

People are referred to service-provision programs through street outreach, mobile units and stationary needle exchange centers. Peer counsellors provide motivational counselling, assist with hospitalization to specialized medical institutions and follow-up their clients to increase retention in treatment programs.

The Blue Bus mobile prevention unit, distribution of materials, motivational counselling

Bus workers distribute sterile syringes, needles, water for injections, alcohol swabs, cotton balls, bandages, vitamins, vein ointment, naloxone, etc. People who use services are not always ready to change their behavior just like that. Talking to the project staff, they get important information on how to reduce infection risks and protect their health.

For most clients, the Blue Bus is the only safe place where they are treated with respect and understanding, and the only possibility to take a rapid test, receive primary medical counselling, get access to HIV and TB testing and treatment, be referred to public institutions and learn how to protect human rights. The team of the Blue Bus proudly values these trustful relationships between project staff and clients that have been built over the years of program implementation.

Dialogue between equals

Outreach work in the Cabaret bar

NGO Positive Dialogue is one of the oldest HIV-service organizations in St. Petersburg. Since its establishment in 1996, Positive Dialogue has gained substantial experience in working with key populations. In July 2015, the organization launched HIV prevention projects for closed population groups: men having sex with men (the Positive Dialogue project) and sex workers (the Silver Rose project). Both projects are community-driven, with the main goals to promote safer sex practices among MSM and SWs, increase access to services, including HIV/STI testing, uphold human rights, strengthen communities and counteract stigma.

The outreach team of the Positive Dialogue project conducts weekly field work in the night clubs visited by MSM and the LGBT community. The clients talk to peer counsellors and ask questions about HIV and other STIs, learn about pre- and post-exposure prophylaxis, receive condoms and lubricants.

Outreach work in the Priscilla club

The Silver Rose staff members provide counselling for sex workers in their office and conduct outreach work in the local saloons and street sex work areas. The project helps the girls preserve their health and human rights, protect themselves against violence, receive contraceptives, get tested for HIV and get referrals to trusted doctors. Peer counsellors also provide psychological support and involve sex workers in client management programs.

Training on how to use a female condom

Legal components make up an important aspect of the project’s work – the so-called “street lawyers” trained by the project provide legal aid and support in cases of violations of MSM/LGBT and SWs rights. Project clients take part in educational trainings and seminars.

Particular attention is devoted to community development and mobilization, to encourage community-driven HIV responses. Project activists organize campaigns and round table discussions aimed at overcoming societal stigma.

Women plus

Social support center for women, pre-test counselling

HIV-positive women are the focus of one of the projects run by EVA Association. In October 2017, a social support center for women affected by HIV will be launched by EVA – a low-threshold service offering comprehensive individual assistance to HIV-positive women in crisis situations.

The project team unites specialists with various experiences: peer counsellors, client management officers, lawyers, psychologists. Clients will be offered counselling, rapid HIV testing with pre- and post-test counselling, and individual management of each case. Women will be able to obtain contraceptives (condoms) here and take part in self-help group sessions for women living with HIV and their family members.

Social support center for women, rapid testing for HIV

Experienced specialists working in EVA will do their best to make the center as client-friendly and as responsive to clients’ needs as possible – for example, by allowing clients to bring their children, organizing distribution of clothes for women and kids, giving out hygiene kits. EVA collaborates with the municipal public services and socially oriented NGOs, which will improve activities aimed at informing women about the existing support services, providing access to various specialists and representing women in these institutions.

The center will give special attention to the prevention of violence and dependent and co-dependent behaviours. It is pilot project, unique for the region, with a focus of preventing negative social consequences of HIV among women.

Social support center for women

Prevention projects for vulnerable groups in Russia were launched 20 years ago by our western colleagues. However, international funding for these and other social projects has been significantly reduced. Unique low-threshold HIV prevention programs are becoming as vulnerable as their clients. Some organizations manage to secure financial support from the government. Others try to change their structure. We would like to believe that projects that help thousands of people representing very closed populations to protect their health will not become extinct in Russia.

Cry for Access to Treatment for People Living with HIV in Russia

The event dedicated to the Day of Remembrance of People who Died from AIDS, Moscow, May 2015

Author: Anastasia Petrova, Russia

“Medicines for the treatment of HIV, hepatitis C, and tuberculosis are provided free of charge to all needy patients in Russia.” This phrase is the first thing we see on Pereboi.ru main page – the resource where people living with HIV in Russia can tell their stories about how they were refused treatment.

Professional patients

Pereboi.ru is one of the projects of the Patient Control – a public movement whose members are people living with HIV and other socially significant diseases, as well as their supporters. The movement has existed for seven years in Russia. The initiative group, not being an organization or legal entity, has grown into a professional community of patients who have risen to defend their rights.

In addition to direct actions, activists of the Patient Control monitor government procurement of antiretroviral therapy (ART), write complaints and make appeals to public authorities. Representatives of the community also work with pharmaceutical companies: one of the main obstacles to treatment is inflated prices for medicines.

Founded in autumn 2010, the movement’s goal is to ensure effective control of the provision of high-grade medical care and the improvement of quality of life for HIV positive people. Activists say that any person sharing their views can join them. The main concern on which activists are working is the disruptions in medical supplies for people living with HIV, hepatitis and tuberculosis in Russia.

Fighting with supply disruptions

“For more than six years there have been interruptions in medical supplies for the treatment of HIV/AIDS in Russia. Life-saving medicines, that have to be taken strictly by the clock and in a certain order are partially or completely lacking in AIDS centres,” activists are saying.

This situation is interconnected with repeated changes in the system of procurement of medicines for people living with HIV. The latest change is the transition to a centralized system in 2017. Before that, the medicines in regions were bought according to special schedules, and now the Ministry of Health of the Russian Federation is the responsible party. These changes have led to the slippages in the procurement schedule and serious supply disruptions this year.

The event by the Ministry of Health of the Russian Federation, Moscow, July 2013

At the moment, supply disruptions of medicines happen almost everywhere throughout the country. People living in different regions of Russia such as Nizhny Novgorod, Norilsk, Tomsk, Kostroma write messages to pereboi.ru almost every day. Only in 2016, the activists counted appeals from more than 30 cities. These cities are also situated in such prosperous areas as Moscow, the Leningrad and Moscow regions.

Last summer the activists of Patient Control facilitated the situation with interruptions in treatment of children and pregnant women in the AIDS centre near Moscow. 30 patients signed the petition after which the Federal Service for Surveillance in Healthcare conducted an unscheduled inspection at the AIDS centre near Moscow and in the regional Ministry of Health office.

In order to avoid the following situations, activists get updated on the formation of purchases for 2018 by raising the issue at a high authority level. On August 14, 2016 there was a meeting of patients with representatives of the Federal Service for Surveillance in Health Care and the Ministry of Health of the Russian Federation. The government informed activists about the expected additional financing in the amount of 4 billion rubles this year and the planned annual increase by 1.5 billion rubles in the budget for the purchase of medicines. However, according to the representatives of the movement this is not enough to solve the problem completely.

Improving quality

Side effects from the low-quality medicines is another issue patients are talking about. Due to the strong health issues that arise in response to therapy, people often abandon the existing treatment. A short list of the issues they face includes rash, kidney problems, lipodystrophy. It is difficult to get treatment replacement afterwards if the therapy scheme was changed according to medical or pseudo medical indications, because formally the therapy is still being provided.

Day prior to the meeting of the Commission on Vital and Essential Drugs (VED) on September 4, 2017 in Moscow Patient Control representatives addressed the Minister of Health of the Russian Federation. The request was to include VED in the list of contemporary drugs in 2018 for the treatment of HIV-infection and chronic hepatitis C. Following the meeting, the Commission made a decision to add six medications, four of them were also in the activists’ list. The Commission included two medicines for HIV infection treatment: dolutegravir, raltegravir for children and two for hepatitis C: dasabuvir/ombitasvir/paritaprevir/ritonavir and daclatasvir.

Activists are also working on the ways to achieve patient feedback in cases when ART was proven ineffective or had side effects. Patients along with the physicians will now be able to fill out an online form on the Federal Service for Surveillance in Health Care. This will help to improve the quality of medication control.

Treatment as prevention

The internationally recognized principle of treatment as prevention is one of the most effective and yet most underestimated ways to prevent the spread of HIV infection in Russia. The number of HIV infections in our country keeps growing and thus patients’ collaboration is extremely important.

At the Red Ribbon Award 2012 during AIDS 2012 in Washington, USA

The Patient Control movement is one of the communities in the Eastern European and Central Asian (EECA) countries dealing at a highly professional level with access to therapy of people living with HIV. SIMONA+ project is one of Patient Control initiatives aimed at systemic problem solving. This project studies access to medical and non-medical services for people living with HIV, as well as reacts to violations of patients’ rights by direct actions, press conferences and round-table discussions. Nowadays, SIMONA+ covers more than 13 entities of the Russian Federation. Its main goal is to improve the quality of HIV treatment and diagnostics, as well as to increase adherence among the representatives of key groups. Apart from serving patients’ interests, the project tries to minimize HIV spread among the general population.

The Patient Control projects are a community response to the epidemic. These projects consider the needs of people living with HIV and facilitate cooperation between specialists working in the AIDS control field. These merits have already been recognized once: at the 19th International AIDS Conference in Washington in 2012, the Patient Control initiative group was awarded the Red Ribbon Award for outstanding work concerning the AIDS epidemic. Promotion of such initiatives is declared as one of the leading goals for the 22nd International AIDS Conference, which will take place in Amsterdam next July. Representatives of the Patient Control movement plan to submit the report on their work in 2016-2018 to AIDS 2018.