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.

Applications submission closes at 15 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.

The HIV Epidemic in Russia as the Consequence of State Political Ideology

www.poz.com

Author: Ivan Varentsov, employee at Andrey Rylkov Foundation, Russia

“HIV-positive patients keep complaining about the lack of medicines”; “The Archangelsk HIV Centre to be left without its own office building”; “The number of HIV-positive migrants increased 15 times in the last five years”, “The most common deaths among prisoners in Russian Federation are from HIV”, “HIV dissidents are luring the doubters in their communities.” All these Russian media headlines on HIV were published only during the last several weeks. It seems that the issue with HIV situation has been just recently recognized at the highest state level. It was finally decided to create the state strategy on HIV spread prevention in Russia till 2020. Vice-premier Olga Golodets even made a statement that HIV/AIDS subject is one of the most important in Russia. Although, it still feels like all these statements are just mere words. The situation with the spread of HIV, its prevention and treatment in Russia keeps getting worse. It is especially widespread among such vulnerable groups: injecting drug users, sex workers, men having sex with men, and migrants.

Some statistics

A few weeks ago, the Federal AIDS Centre released the information on HIV situation in the Russian Federation as of 31 December 2016. The total number of registered cases of HIV infection among the Russian Federation citizens has reached 1,114,815 people. There were 870,952 HIV-positive Russian citizens as of the end of the year. Herewith, there were 103,438 new cases of HIV infection registered in 2016 among Russian population (morbidity rate of 70.6 per 100k individuals), which is 5.3% higher than in 2015.

A hundred thousand new cases each year! To compare: a little more than 17,000 cases were registered in Ukraine (morbidity rate of 40 per 100k individuals) in the same year. As for the whole epidemic history, since 1987, there were 300,000 registered cases. If you take Montenegro, for example, where Russians like to go for their vacations, there were only 200 registered cases in 30 years. 100k is a population of Tobolsk or Khanty-Mansiysk.

This situation in Russia has been observed for quite a long time now. The constant increase of new cases in the country has been registered since 1998. In 2011-2016, the annual increase on average was 10%. According to the new UNAIDS report, the number of new registered cases of HIV infection from 2010 to 2016 increased by 75% in the Russian Federation. Russia is the “driving force” of the epidemic in the EECA region – in 2016 it accounted 81% of the new HIV cases. It is important to mention that HIV treatment coverage in the country is little more than 30%. According to the global strategy adopted by World Health Organisation, in HIV health sector on 2016-2021 for the cessation of the HIV epidemic, it is necessary to identify about 90% of possible number of HIV-infected population and to provide no less than 90% of the HIV infected patients with antiretroviral therapy.

Profanation of the fight against HIV

Historically, the main HIV epidemic affected group among the Russian Federation population is injecting drug users (IDUs). By some estimates (UNODC, 2009), the prevalence of HIV among IDUs in Russian Federation is more than 37%. It means that there is a concentrated epidemic among this population group. In the period from 1987 to 2008, there were about 79.78% cases of HIV infection connected to the use of injecting drugs. The sexual transmission has been rapidly growing in numbers in the recent years. In 2016, in 48.7% recorded cases the risk factor was heterosexual transmission. Nevertheless, the injecting way of transmission has been consistently enormous – 48.8% in 2016.

Could there be any better signal to authorities to start taking urgent actions in epidemic spread prevention among this risk group? What are they waiting for? There are several effective programs such as “harm reduction” and substitution therapy, which are scientifically proven ways of HIV prevention worldwide. Moreover, they helped reducing the spread of HIV among IDUs in Ukraine. Nevertheless, the above-mentioned programs are not supported by the state HIV prevention strategy in the Russian Federation.

Different level officials, from “specialists” to ministers, keep making statements about no found evidence for effectiveness of these programs. They also tend to say that methadone therapy is a lie invented by the Western pharmacological companies. Following statements would be questioned in any other country, but Russia. Meanwhile, the social establishments dealing with HIV prophylaxis among IDUs and other social groups are listed as foreign agents. Only in 2016, the Ministry of Justice registered seven such organizations.

The ideology of traditional inaction

It is hard to understand what caused such long-lasting stubbornness of authorities in Russia, and why they refuse to accept effective measures in HIV prevention. Most likely, the reason lies in Russian conservative political outlook. Based on the traditional and social values, politicians do not accept such social groups as drug users and LGBT community. This leads to failures and neglect in observance of consumer rights, including health rights.

The problem is that this attitude is not only perverse and inhumane, but also dangerous to the whole community from the public health perspective. The HIV epidemic is not limited to certain population groups and it is not dying with them, as some may think. It has already surpassed all boundaries. For example, drug user’s sexual partners, on one hand, are very sensitive HIV group, and on the other hand (from the epidemiological point of view), a connecting link between IDUs and the entire population. The number of HIV-positive women is constantly increasing. Therefore, apparently, there will be no changes in the situation with HIV epidemic. Not until we change the ideology.

One in Sixth People Infected with HIV in Tajikistan This Year is a Migrant

Author: Nargis Hamrabayeva, Tajikistan

Approximately five thousand citizens of Tajikistan, which were found to be infected with HIV, tuberculosis and hepatitis during their stay in the territory of the Russian Federation, were declared personae non gratae for lifetime by the government of Russia in June this year. How could this expulsion of infected fellow citizens affect the Republic of Tajikistan?

Generally, after returning from Russia, migrant workers, unaware of their status, may unintentionally put the health of the members of their families at risk by spreading and transmitting infectious diseases including HIV/AIDS, believes Takhmina Khaidarova, the head of the Tajik Network of Women (TNW) Living with HIV/AIDS.

“The consequences of transmitting and spreading of infectious diseases depend solely on the will of the state. Providing that a state fully implements their commitments within the framework of the National Strategy for the Response to HIV/AIDS Epidemic for 2017-2020, it would be possible to avoid drastic consequences. If the government of a state cannot conduct awareness-building work about infectious diseases and their transmission amongst their population on adequate level, despite the fact whether or not infected migrants would be deported, the increase of the epidemic will stay high,” she considers.

According to Takhmina Khaidarova, the main problem is the low level of awareness about infectious diseases, including HIV/AIDS, before the migrants leave the country, during their stay in the host country, as well as on their return to their home country. “Migrant workers have little information and preparation, they are not aware about their status before leaving the country and they do not observe any safety measures during their stay in labour migration. After contracting infectious diseases, they return to their home country and, generally, do not undergo medical examinations; so, unaware of this, they transmit infectious diseases to their sexual partners,” says Takhmina Khaidarova.

She believes that another problem lies in the fear of stigma and discrimination, therefore, migrant workers who have returned do not undergo examination until their health deteriorates considerably.

According to figures provided by the Ministry of Health of the Republic of Tajikistan, there have been noted 384 cases of citizens infected with HIV in the first quarter of 2017, whereby one in sixth is a migrant, who had left in search of work outside the country. Presently, the total number of people living with HIV-positive status in Tajikistan is around nine thousand.

It should also be reminded that Eastern Europe and Central Asia will be a prime focus in the 22nd International HIV/AIDS Conference in 2018, which will take place in Amsterdam in July 2018.

Tatiana Vinogradova: «Only public organizations are able to work with vulnerable groups»

Tatiana Vinogradova

Author: Anastasiya Petrova, Russia

Last year a major event in the field of HIV in Russia became the adoption of the National strategies of counteraction with the spread of HIV-infection in the Russian Federation until 2020. One of the key objectives of the Strategy was the consolidation of efforts of governmental and nonprofit organizations in their fight against the epidemic. Today we discuss the implementation of this interaction in the most progressive city of Russia with the Deputy chief physician of St. Petersburg Center for prevention and control of AIDS and infectious diseases, holder of Doctoral degree in Medicine, third-generation doctor Tatiana Vinogradova.

– Tatiana, do you support the idea of implementation of cross sectoral programs on HIV prevention among vulnerable groups in cooperation with socially oriented non-profit organizations?

– In addition to the scientific-organizational work in the AIDS Center, I am responsible for the interaction with public organizations in the context of HIV-infection in Saint-Petersburg. I think, this is very important. HIV is a socially sensitive disease, and groups of HIV vulnerable people – people who inject drugs, men who have sex with men, sex workers – usually are not easy to approach. I am deeply convinced that only nonprofit organizations, organizations that deal with this issue and have experience in the field, are able to work with the key groups. Even if we have an opportunity to send “a man in a white coat” to interact with these key groups, there is no guarantee that this health worker will be accepted and will be able to perform all the necessary tasks. Nonprofit organizations have access to these closed groups, they are able to work on the principle “peer to peer.” Representatives of vulnerable groups perceive them appropriately and they are able to provide medical assistance as well. This is the most important! We can find a lot of new HIV-cases by testing a large number of people, but when we test the general population or key populations, our work is not limited with testing and identifying, we also should provide medical support. Peer consultants and employees of nonprofit organizations are the best in this field.

– How does the Center for prevention and control of AIDS and infectious diseases cooperate with NGOs? Is there any model or mechanisms?

– AIDS Center in St. Petersburg works with community organizations from the very first day of its existence. In the beginning, there was no AIDS Center in its modern sense, but there was an office based in Botkin hospital, which started this interaction. The first nonprofit organization was registered by Nikolay Panchenko. Therefore, we can say, that here in St.-Petersburg we already have thirty years of cooperation experience between public institutions and community organizations. We work together since the early 90’s.

Committee on health care through the Center for prevention and control of AIDS and infectious diseases provides financial support for the HIV prevention offices, which work in the city. Nowadays there are four such offices based on public medical institutions. These offices work in close cooperation with community organizations that employ peer consultants. Together with nonprofit organizations we conduct events, various events like testing days, for instance. Nonprofit organizations also hold round tables, press conferences, which our doctors always attend.

Nonprofit organizations also participate in the Coordinating Council affiliated to the government of St. Petersburg. This Council consists of the leaders of the organizations representing each of the key groups: those who work with people who inject drugs, or who work with LGBT community, or with women, or who provide legal support. In our city, the Health Committee as well as the Committee on social policy work in cooperation with NGOs in the context of HIV infection. I do not think there is another similar model in other regions. NGOs in Saint-Petersburg receive grants and funding not only from health but also from social policy institutions. There are many offices across the city, where peer consultants officially and legally work with the vulnerable groups, provide them support and accompany them to the AIDS Center.

– It seems to me, that we have adopted a western model of interaction, is it true?

– Yes. Basically HIV-infection appeared in Russia later than in Western Europe and the United States. Why to reinvent the wheel, if there is already some experience that can be used? I remember in the late 90s – early 2000s, when the first wave of HIV-infection started, and it spreaded very quickly among people who inject drugs. In one year 10,000 cases were found. At that time, it was something terrible. People were dying. At that time, it was a fatal diagnosis. Then the first bus appeared on the basis of the AIDS Centre, and our head nurse Marina Petrova was sitting in that bus nearby the metro station Gostiny Dvor, taking blood. Back at the time there were no rapid tests, and no one could predict that they will once appear. We used test tubes. This work was done in cooperation with public organizations.

– Are there any effectiveness indicators of such an interaction and what are they?

– Our AIDS center is one of the largest AIDS centers in Russia. 35,000 patients are registered, and a lot of them come from mobile laboratories of local public organizations. There are several organizations in our city that are doing rapid testing and providing counselling about HIV infection. 80% of people, who get their diagnosis during the testing in these organizations, then go and get registered in the AIDS Center. This is very important, because it is not enough just to identify a new case. A person needs some health survey to decide if the therapy is necessary. We must provide some psychological support to help him or her deal with the stress, which is unavoidable when the person learns the diagnosis. We must motivate him or her to be followed up by a doctor. After all, if she or he will be followed up by a doctor, she or he will stay alive. This is the most important thing. If a person receives antiretroviral therapy, he or she does not transmit the virus further. A person lives, and a virus is not spreading.

– The 22nd AIDS conference – AIDS 2018 – will be held in Amsterdam, and the organizers would like to see a wide representation of people from Eastern Europe and Central Asia there. Have you participated in previous conferences and do you plan to attend the next one?

– The first AIDS conference I attended was held in Geneva in 1998. Now I plan to attend the conference in Amsterdam. I already have two ideas for the conference abstracts. During the conference, I would like to get new information about the interaction with public organizations.

Beyond Resistance: Drugs, HIV and the Civil Society in Russia

The speech given by Anya Sarang, the President of the Andrey Rylkov Foundation, at the side event Reducing the harms of drug control in Eastern Europe and Central Asia which took place during the 60th annual meeting of the Commission on Narcotic Drugs on 17 March 2017 in Vienna. 

In 2016 the UNAIDS reported that the HIV epidemic has been taken under control in most countries of the world. The countries of Eastern and Southern Africa have reached a 4% decline in new adult HIV infections, the rates of which were also relatively static in Latin America and the Caribbean, Western and Central Europe, North America and the Middle East and North Africa. At the same time, the annual numbers of new HIV infections in Eastern Europe and Central Asia increased by 57% with Russia responsible for 80% of the new cases. There are only a few countries in the world where HIV keeps rising, and Russia has the fastest rate. According to the Federal AIDS Centre, around 300 people get infected, and 60 people die of AIDS every day. As of August 2016, the number of registered HIV cases was 1,060,000 while the estimates go beyond 3 million. And according to the Ministry of Health, only 28% of patients in need receive antiretroviral therapy.

The main group affected by the HIV in the country is people who inject drugs (PWID). From 1987 to 2008 about 80% of HIV infections were related to unsterile injections and still in 2015 almost 55% of the new cases are among drug users.  Since the beginning of the epidemic, over 200,000 people with HIV have died, the primary cause of death being co-infection with tuberculosis. According to WHO, Russia is among top countries with the highest burden of TB including its multidrug-resistant forms.  Another deadly co-infection is hepatitis C: its prevalence among people who use drugs reaches 90% in some cities. And drug users are entirely excluded from any treatment programs.

The reason for such a dramatic dynamic in public health is the Russian government’s failure to address the HIV epidemic, especially among the people most affected. The Russian government is notoriously negligent to the issue of HIV, vigorously adherent to the most repressive and senseless drug policies and openly resistant to evidence-based internationally recommended harm reduction programs and opioid substitution treatment with methadone and buprenorphine. The government not only fails to provide the financial support to these programs, it explicitly opposes them in the State strategies, such as the National drug strategy. At the same time in the past several years, the international support to HIV prevention has also dramatically shrunk. Due to the aggressive line of the Russian government towards the international aid and unkept promises to allocate own resources towards the epidemic, most international donors have left the country. That resulted in 90% decrease in the coverage of needle and syringe programs. Back in 2009, we had 75 harm reduction projects reaching out to 135.000 clients, and in 2016 there are only 16 projects to reach out to 13.800 individuals which is less that half percent of the estimated number of people who inject drugs. These few remaining projects are supported by the Global Fund to Fight AIDS, tuberculosis, and malaria, but even this symbolic support expires by the end of this year, and there are no new sources on the horizon.

To make the situation even more tragically absurd, in 2016 the Russian government started to attack non-governmental organizations that provide prevention services to people who use drugs and to LGBT. In one year alone, eight AIDS organizations were registered as “Foreign Agents” based on the fact that they receive funding from the Global Fund. Inclusion into the list means four times more reporting, expenses for administrative work and increased risks of fines and administrative charges. It also means that the organizations will not be able to receive any money that comes from the governmental sources.

All of the above has created the situation when the AIDS Service NGOs are blocked from the potential governmental funding while at the same time, most international donors have terminated their support to the Russian NGOs. Some donors, including USAID and several UN agencies, had to cease their operations in Russia due to the government pressure, a supporter of advocacy and human rights initiatives in the area of public health, the Open Society Foundations have been blacklisted by the authorities. But many potential donors also believe that a) situation in Russia is hopeless, and there is no way to improve and b) that their support may exacerbate the risks for the NGOs. Our organization believes that its necessary to provide more truthful information to the international partners about the situation in Russia and possibilities to express support and solidarity.

Our team works since 2009 providing daily health services on the streets of Moscow to people who use drugs. We do outreach work to sites where drug users get together, where we give our HIV prevention materials: sterile needles and syringes, condoms, rapid tests for HIV and Hep C, peer counseling, and support as well as referral to various health institutions. We see from 10 to 30 people daily, and last year alone almost three thousand people contacted our small service. We carried out more than 300 consultations on HIV and hepatitis, and in the last three years, we received reports of 735 lives saved with Naloxone we provide to the clients to prevent deaths from overdoses. We also run a street lawyers project, helping drug users to stand for their rights and dignity, providing them with legal skills and empowerment to represent their interests in courts and state institutions. We have a team of 4 lawyers and around 20 social workers and volunteers. We also provide secretarial support to the Forum of people who use drugs in Russia and facilitate documentation and submission of reports on human rights abuse to the state parties as well as the international human rights bodies. Several strategic litigation cases that came out of the Forum’s work aim to improve the legal context in Russia with regards to access to health and justice, including a case currently under review by the European Court of Human Rights on lifting the ban on opioid substitution therapy in Russia and in Crimea.

In 2016 our organization has been registered as a Foreign Agent, and we were subjected to a fine for not volunteering ourselves into the registry. There was some skepticism concerning our ability to continue the work with this status, but we didn’t want to lose our services because of the bureaucratic inadequacy of the Ministry of Justice. We have challenged their decision in court which surprisingly supported us by finding the Ministry’s decision illegal and lifting the fine. We are still listed as a Foreign Agent, but we also fight this decision by the legal means including, if necessary in the European Court of Human Rights. With the help of our partners and supporters, we have generated a fiscal security fund to sustain our work in case of financial sanctions on behalf of the Ministry. We have also received a lot of support for our cause from the mass media and the general public, including the recently started parliamentary debates on the inadequacy of application of the Foreign Agents law to the AIDS prevention NGOs.

Our experience and the experience of like-minded organizations demonstrate that it is still possible to provide AIDS and drug services in Russia, even in the context of political suppression of the NGO work. The only and the most important condition is the commitment to the protection of rights and health of our community. We are learning by doing and hope to develop creative approaches and a practical model of operations for organizations or groups who find themselves in similar politically restricted circumstances not only in Russia but other countries of our region.

We believe that the western NGOs and governmental organizations should not ‘give up on Russia.’ In fact, now more than ever we need the support and solidarity to continue our work and keep saving lives, health, and dignity, despite the political oppression.

EU-Russia Civil Society Forum Invites Young Professionals to Poland

The EU-Russia Civil Society Forum invites young professionals aged between 25 and 35 from the EU, Russia, and other European states to apply for the Annual “Europe Lab” Forum.

Forum for Young Professionals “Europe Lab” is a unique communication and exchange platform for change makers from all over Europe working in public administration, business, NGOs, universities, think tanks, and other fields of professional engagement.

Main goals of “Europe Lab” are to enable cross-sector cooperation and promote exchange of ideas, develop partner and professional networks, and encourage common cross-border projects and initiatives all over Europe.

The working language of the Forum is English.

“Europe Lab” will take place on 27–30 July 2017 at the European Solidarity Centre in Gdańsk, Poland.

The programme of “Europe Lab” 2017 includes:

Workshops:

  • Freedom and Captivity – Solidarity in the Present and in the Past
  • Climate Change – Where Are You Going?

Innovative Formats:

  • Gdańsk in the Spot – City Development Hackathon
  • 360° Story – Multimedia Telling

Each format will be curated by a coordinator.

The best common projects, whose ideas were elaborated during the Forum, will be granted. The results will be presented at the 8th General Assembly of the EU-Russia Civil Society Forum in 2018.

Finally, “Europe Lab” alumni are invited to join the young professionals’ platform at the EU-Russia Civil Society Forum, to lead and play a role in a number of future initiatives.

Costs for workshops, accommodation, and meals are covered by organisers. Travel costs are borne by participants themselves.

Please submit your application until 1 May 2017 here.

Should you have any questions, don’t hesitate to contact us via e-mail.

Forum for Young Professionals “Europe Lab” is organised by the EU-Russia Civil Society Forum in cooperation with the European Solidarity Centre as well as supported by the European Commission and the Oak Foundation.