December 21, 2019

Solid results set high standard for transition in 2020

It is just one year left to reach ambitious 2020 targets. The ending year results Alliance for Public Health (APH) is happy to share, made Ukraine and other EECA countries closer to the success, with the scale, innovations, transitioning and sharing effective solutions.

There are 8 highlights from APH perspective (download statement in .pdf):

  1. Nation-wide HIV prevention efforts focusing on Key Populations has brought the epidemic under control. During 2019 APH with its partners was providing HIV prevention and testing services to over 170 000 PWID, 38 000 SWs, 42 000 MSM, thus reaching the highest coverage figured in the entire Eastern Europe and Central Asia. Besides the standard package, 2019 was marked with

  2. Reaching those left behind with effective and innovative interventions.
    • Bringing PeEP: APH-led successful Kyiv pilot scaled up to 22 oblasts with 15 times PrEP coverage increase (from 100 to 1500) just over current year;
    • Self-testing: APH reached out to partners of key populations with HIV oral and blood self-testing; online selftest.org.ua confidentially delivered self-tests to rural and remote areas;
    • Artificial intelligence and Machine learning algorithm worked in APH-led extended risk network testing in community-based outreach to optimize HIV case-finding among key populations in Ukraine, including focus on recent infections;
    • Experimenting with sex and drugs youth: innovatively reached out to users of recreational drugs at night clubs and electronic music festivals, online Free2Ask App and Drugstoreresources;
    • Transgender people are at the highest risk of HIV. During the year over 1000 trans people in Ukraine reached with essential services, promoting rights of trans people at Kyiv Pride in June 2019;
    • Achieving the 2nd 90 – 90% on ARV – in the group of HIV+ clients of Opioid Agonist Treatment run with APH support.
  1. Transitioning the largest KP program in EECA to the governmental funding

At the end of 2019 the largest harm reduction program funded by the Global Fund was transferred to the government funding. APH transitioned its approach to services for key populations which now became the standards approved by the Ministry of Health. The transition is a great result of the joint work with Public Health Center, 100% Life and all implementing NGOs across the country. APH will continue assisting with program oversight, monitoring and technical support and support additional interventions to ensure consistently high quality and maintain coverage.

The successful experience of Ukraine has been used in EECA region. APH-led consortium started 2019-2021 regional GF #SoS_project. This project will ensure sustainability of HIV-services for key populations in 14 countries in EECA region and by 2021 national funding for HIV/AIDS programs will be increased by $10 million from national, regional and municipal budgets and $73.4 millionsavings ensured in the country’s budgets through optimized ARV procurement.

  1. WOW results in TB response

APH adopted Optimized Case Finding methodology for finding missed TB cases. 12 months results show 4.4. times increase in TB detection rate per 1000 contacts in comparison with routine contact tracing. There is a 20% increase of those offered diagnostics in the early detection project (22 536 clients over year). On the treatment side, due to medial and psycho-social support APH managed to increase successful treatment outcomes to 91% and 89% for susceptible and DR-TB patients respectively.

  1. Hepatitis C: getting the best treatment and serving the most in-need patients

Over 2500 patients (PLWH, PWID, prisoners) got through APH comprehensive package of services – starting from HCV diagnostics, followed by treatment, social support, preventive and educational activities and treatment results evaluation. In 2019 Alliance obtained lowest ever in Ukraine price for direct antiviral drugs for HCV  12 weeks treatment  course (US$74.9) and launched HCV diagnostic with GeneXpert in laboratories of health care facilities  in such a way developing  national health system.

  1. Promoting Universal Health Coverage (UHC) agenda

APH is the only Ukrainian organization in the global UHC Civil society Mechanism. In this capacity APH organized a series of consultation prior to the UN High Level Meeting on UHC in September 2019, and is following up with developing multi-stakeholders’ accountability mechanisms. During the year APH expanded its work to supporting vaccination, launching mental health program in 12 regions of Ukraine in partnership with

Ukrainian Institute on Public Health Policy, Yale School of Medicine and U.S. National Institute on Drug Abuse (NIDA).

  1. Leadership of cities in HIV and TB response

APH firmly believes that leadership of cities in HIV/TB response can stop the epidemics. APH completed 3-year regional project “Fast-track TB/HIV responses for key populations in 5 EECA cities” which has significantly improved HIV/TB responses in cities and ensured sustainability achieving a full return of the Global Fund investment of 3.9 Million USD – from cities budget (video). In the new regional project #SoS_project 25 more cities are joining the fast-track initiatives and will sustain response by increasing municipal funding allocations. Just during 2019 political support was provided by mayors of Chisinau (Moldova), Osh (Kyrgyzstan), Svetlogorsk (Belarus) who signed Paris Declaration and ZERO TB Initiative, and Podgorica, Bar, Bijelo Polje (Montenegro) who signed Paris Declaration.

Watch the video: Andriy Klepikov presentation in major event of the year, defining future HIV and TB response in the EECA region.

 

  1. #InYourPower campaign launched

APH with partners launched the information campaign “It’s #InYourPower to end AIDS” – https://inyourpower.life.

“Time is what really matters when it comes to tackling HIV. Therefore, we are looking for leaders. Leaders who can make a difference in their countries. Not the day after tomorrow, not tomorrow, but today”, says Andriy Klepikov, APH Executive Director.

14 awards were provided celebrating distinguished leadership in 2019.

ALLIANCE FOR PUBLIC HEALTH CONTINUES TO STRENGTHEN ITS CONTRIBUTION TO THE DEVELOPMENT OF SUSTAINABILITY OF SERVICES FOR KEY POPULATIONS IN EASTERN EUROPE AND CENTRAL ASIA THROUGH ITS PARTNERSHIP WITH THE GLOBAL FUND, PEPFAR, OTHER DONORS

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December 18, 2019

Broad implementation of self-testing and PrEP will fast-track the EECA region progress in combating AIDS

On December 16-17, 2019 in Istanbul the Regional Consultation for Eastern Europe and Central Asia took place on «Development and adaptation of national HIV guidelines, including self-testing (HIVST) and pre-exposure prophylaxis (PrEP)».

Participants from 21 countries of the region discussed the specific steps and prospective to implement in the EECA countries the most updated WHO recommendations on pre-exposure prophylaxis and self-testing, international practice and cases of Germany, Moldova and Ukraine. The consultation was organized by the Alliance for Public Health team with the technical support of the WHO Regional Office for Europe and with the financial support in the frames of the regional #SoS_project.

«More and more countries adopt the policy supporting HIV PrEP. There are many researches, which prove the effectiveness of several PrEP regimens for different populations. This gives the grounds to presume flexibility, choice and accessibility for people who might benefit from PrEP. As of today, there are no hesitations regarding the need to ensure access to PrEP as a part of the standard HIV prevention service package», – says Olga Denisyuk, project manager of the Alliance for Public Health.

Discussions of the specific steps to implement these interventions gain pace during the events of different levels and involve wide range of stakeholder audience. The apparent significance and importance of the issue for the countries and readiness to develop healthcare systems to introduce these services gathered international experts and representatives of national teams of regional healthcare systems representing Azerbaijan, Armenia, Belarus, Bosnia and Herzegovina, Germany, Georgia, Denmark, Kazakhstan, Kyrgyzstan, Lithuania, Moldova, Romania, North Macedonia, Serbia, Russia, Tajikistan, Ukraine, Uzbekistan, Montenegro and Switzerland.

Sergey Filippovych, #SoS_project director: «It’s important even today to more rapidly move from pilots, which proved their relevance, to immediate implementation of the effectively functioning strategies of HIV prevention, testing and treatment. Broad implementation of self-testing and PrEP in the countries of our region will significantly fast-track the EECA regional progress in combating HIV/AIDS. I’ll stress that in the countries of our region strategic implementation of these interventions is supported not purely at the level of operational researches; there’ll be also broad spectrum of technical support provided in the frames of the regional project «Sustainability of Services for Key Populations in Eastern Europe and Central Asia» (#SoS_project).

As regards to application of operational researches, Olga Denisyuk mentioned that the important task remaining for EECA region is in rapid introduction of PrEP maximally adapted to the local context. This is possible to achieve at local level just through initial organization of operational research. «These researches can help develop and evaluate the models of low-threshold access to PrEP in a short time and further serve as basis to scale up the program for the whole country». However, it goes without saying that, based on the results of researches, the NGOs should be involved in order to rapidly implement the important steps to improve health and not to lose the time and the expertise developed in the bureaucratic routine.

We will mention that the primary drug for PrEP is TDF, which is used in different PrEP combinations and regimen.

It is interesting that, according to the report on Assessment of accessibility and major barriers in introduction and scale-up of PrEP in the EECA region held by ЕСОМ in 2018, the major conclusion mentioned that «there were no impassable barriers identified which would make PrEP implementation impossible in any of the countries. When the needed support is available … it seems realistic to resolve the issues of PrEP introduction and scale-up in the EECA region in the immediate future».

EECA region needs a kick: WHO recommendations on HIVST/PrEP

It’s worth mentioning that during recent years the evidence base on reasonability of self-testing introduction and PrEP effectiveness in or region significantly increased.

In 2019 WHO updated its PrEP recommendations as well as HIV self-testing (HIVST) as the effective approach to improve detection of new HIV cases. In the updated HIVST guidelines there were new recommendations outlined regarding optimization of self-testing implementation, including effective service delivery models and linkage to care and support tools.

As the newest recommendations are publicized, their rapid implementation at local level in the countries is very important. Moreover, the evidence base for this is available; also, the negative trends of the region should be considered and controlled by the countries.

Elena Vovc, Technical Officer, TB, HIV & Viral Hepatitis program within the Division of Health Emergencies and Communicable Diseases of the WHO Regional Office for Europe, told that, irrespective to all efforts, WHO European region is not achieving the targets by 2020. Let’s mention that the action plan for healthcare in response to HIV epidemic on the WHO European region adopted by all the countries of the region in 2016 set up the specific goals and target to fast track the response before 2020 in all countries of the WHO European region, including EECA countries.

Surely, it’s consolidated work in the countries in order to:

– achieve decrease in number of new infections by 75% in comparison with 2010,

– mortality resulting from AIDS was less than 30 000 cases (for information: the global target on AIDS mortality is less than 500 000),

– mortality resulting from TB among the people living with HIV was decreased by 75%,

– HIV service cascade achieved the level of 90-90-90.

«HIV self-testing is effective, and in order to introduce it, support is needed as well as relevant policies in the countries. Strategic implementation of this step requires participation of many stakeholders, and I’m glad that currently we’re discussing this issue in such extended format with participation of teams from countries. And we’re not simply talking about scaling-up opportunities of HIV detection; this will help cover more people with the treatment needed at early stages. This is that necessary kick, which can be done by the region right today», – says Elena Vovc, WHO Regional Office for Europe. – «As regards to PrEP, its introduction could potentially save the costs for the HIV combating programs. Thus, with a view to the new data and WHO recommendations, countries already can offer in their national recommendations day-to-day PrEP for all facing the higher risk of getting HIV-infected as well as PrEP intake when needed. It has to make our efforts in the area of STI prevention, including HIV, more efficacious ».

To make this important kick, it’s necessary to introduce pivotal actions at all stages including prevention, detection, and treatment.

Global experience and barriers that might be prevented

In the frames of the Regional Consultation in Istanbul global experience in implementation of PrEP and self-testing was reviewed as well as experience of the countries of the region – Ukraine, Germany, Moldova and Russia.

Olga Denisyuk, program manager of the Alliance for Public Health, shared the experience of Ukraine on PrEP implementation. She stressed the key points, which should be taken into consideration by all countries before introduction of PrEP, in particular, availability of national guidelines and/or relevant instructions on PrEP. Also she stressed that the barrier for this intervention may lay in absence of the indications to use for PrEP in the instructions of some manufacturers of TDF/FTC or other drugs recommended for PrEP! It is important to understand that the potential participants of the program are not always interested in visiting healthcare facilities, that is why it is important to maximally involve community-based organizations to cooperation in this area.

«In order to successfully introduce PrEP in any country of our region I’d recommend to envisage and/or analyze availability of the regulations to implement PrEP at national level. It’s necessary to ensure development of strict mechanism on how to implement PrEP at local level; also the needs have to be considered, since this intervention is not that much known in our countries. I mean development and launch of national information campaign on PrEP promotion among MSM and other key populations. Also pay attention to PrEP inclusion to HIV prevention service package and its accessibility at the community level», Olga Denisyuk told.

Such PrEP pilots already are operating in the frames of the #SoS_project in Moldova; their launch is planned in Belarus, North Macedonia, Bosnia and Herzegovina; as regards to self-testing – in Georgia and North Macedonia.

Executive Director of the “Fenix Plus” NGO Yevgeniy Pisemskiy shared the experience of work in Russia: «We think that self-testing has good prospective not only among key populations. We hope that in nearest future the self-testing kit might be bought in any supermarket, like it is now in Switzerland».

Yevgeniy told about implementation of large-scale research project in Russia on the issue of HIV self-testing among MSM and transgender people. 26 thousand people got the “SAFE BOX” self-testing kit and reported on its result using the web-site gaytest.info. The research team representing Higher School of Economy measured, to which extent this method of HIV testing is applicable for MSM.

«Per our calculations, we detected more than 2000 HIV cases, and the approach by itself proved to be first-best applicable for MSM and transgender people. We developed the report, which describes in details how people got the self-test kit and their reaction on its usage», – Yevgeniy Pisemskiy tells. – «We see that there are projects currently being developed in Kazakhstan, Kyrgyzstan, Russia and Ukraine, which will really help to countries to achieve first 90% while testing key populations. Since self-testing allows to have HIV test in comfortable conditions and by oneself, without facing stigma and discrimination».

Also he mentioned that national Ministry of health methodological guidelines on work with key populations the self-testing method was envisaged, and currently the work on inclusion of these recommendations to national strategy is ongoing.

What about EECA countries?

Low level of PrEP and HIVST accessibility is still observed in the EECA region.

Aibar Sultangaziev, head of the “Partnership Network” Association, took part in the Regional Consultation on Self-Testing and PrEP in EECA countries, which took place on December 16-17 in Istanbul. We asked him whether the country is ready to introduce these interventions at national level and if there are any barriers for the moment, and he replied as following:

“The opportunities of self-testing and PrEP are included in our new national HIV treatment guidelines, which are currently under discussion and approval in the Ministry of Health. If compared with the acting guidelines, these issues were described rather frivolously; the new guidelines are fully in line with the latest WHO recommendations dated December 2019. The company manufacturing saliva tests is currently starting the process of their registration, and we will support them. After the registration is complete, we will promote introduction of mechanisms to make the tests available in the pharmacies”, – says Aibar Sultangaziev. – “PrEP is already available in the country, and currently about 30 people (according to the Republican AIDS Center) already get it, but Truvada (TDF+ emtricitabine) is currently procured for the Global Fund costs. Our goal is to make it accessible for the national budget costs. Actually, Truvada is already being procured for the national budget costs during this year, but the reporting mechanism on distribution of the drugs for people has to be improved.

Yes, as of now, or physicians and governmental officials can hardly understand that the person is not currently ill, but already has to take drugs. But it’s about timing. When one understands economic reasons and economy, which PrEP can ensure, no more questions arise”.

In North Macedonia the situation is a bit different.

Andrej Senih representing the Association to support people living with HIV “Stronger Together”:

“The roll-out of PrEP and self-testing in North Macedonia has been very delayed. We are now working intensively within SoS project, and with WHO support, on national PrEP guidelines and a protocol for а PrEP program, while at the same time making plans for introducing several self-testing options. We are ambitious in our objectives, but it is realistic to expect that we will achieve access to PrEP and self-testing for key affected populations already in the first half of 2020”.

In Moldova, the national information campaign on PrEP is under development. Currently more than 70 people started PrEP already.

Vyacheslav Mulyar, LGBT Community Health Program coordinator within the Information Center “GENDERDOC-M”: “As of today, in the Republic of Moldova everyone who needs PrEP can have it. During next year we plan to advocate for changes to the National PrEP clinical guidelines, namely, by supplementing it with the mechanism of the Community PrEP and case scheme (2 + 1 + 1) recommended by WHO as alternative to the existing scheme. We are also open for exchanges of experiences, which proved to be fruitful, with the partner organizations and governmental structures, and we think this experience has to be considered in the changes, which will be brought at national and international level. We are also grateful for the National HIV Program, Hospital of Dermatology and Infectious Diseases, А.О. «Positive Initiative» and others for cooperation”.

Yevgeniy Goloschapov, Director of the Advocacy department of the public association Initiativa Pozitiva: “When we were developing the PrEP campaign, we requested the potential participants in order to attentively consider the most effective mechanisms of informing about #PrEP, counseling of those interested in PrEP and distribution of drugs. The pilot envisages that about 100 male and female will take PrEP”.

Participants of the PrEP campaign also get social support and counseling of NGOs’ consultants. After the campaign is held, its results will be analyzed, which would become a basis for recommendations on relevance of further PrEP introduction in the country.

It should be noted that the #SoS_project is aimed to ensure sustainability of services for key populations in 14 countries of Eastern Europe and Central Asia. To achieve this ambiguous goal, the regional project team consolidates and distributes the best global experience among stakeholders in the countries of the region, as well as directly supports implementation of effective interventions like HIVST, PrEP and others.

Implementation of the #SoS_project is coordinated by the Alliance for Public Health in consortium with the 100%Life (All-Ukrainian Network of PLH), Central Asia Association of People Living with HIV and Eurasian Key Populations Health Network with participation of 14 national, governmental and non-governmental organizations as well as regional networks representing key populations, international agencies and organizations, and technical partners. Funding of the regional project is supported by the Global Fund to Fight AIDS, Tuberculosis and malaria.

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December 10, 2019

Scope of OST drugs in legal and illegal circulation in Ukraine

Alliance for Public Health made an analysis and would like to present data on the real scope of legal and illegal circulation of opioid substitution therapy (OST) drugs in Ukraine.

Alliance has been implementing OST programs since 2005, regularly providing evidence of efficiency and safety of harm reduction approach as opposed to ungrounded accusations on allegedly high volumes of OST drugs leakage.

During 14 years of OST program implementation in Ukraine, around 1700 kilograms of OST drugs were purchased at the expense of international donors and of the State budget of Ukraine and  delivered  to licensed healthcare institutions to cover the needs of the program. The scope of OST drugs leakage recorded in court judgments does not exceed 0.002% of the total amount of OST drugs delivered.

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December 05, 2019

Press Release: EECA City Health Leadership Forum in ending AIDS and TB will take place in Kyiv

 

On December 6, 2019, the International Forum on ‘Cities’ Leadership in response to the HIV/AIDS and TB Epidemics’ will take place in Kyiv (Ukraine). It’ll be visited by cities’ mayors, representatives of the international, national organizations from 50 cities of the world. The focus is: innovations, technologies, municipal funding, and political leadership of the cities; mayors.

«We live in the epoch of digital technologies and fast-paced changes, when it’s namely the cities who become leaders in the global health issues. Today more than half of the planet’s population resides in the cities, and in 30 years the municipal population will increase practically up to 70%. Irrespective to the fact that the main problems, which are faced by the population, including infectious diseases, are concentrated on the level of the cities, the infrastructure and resources to stop those are primarily in possession of the cities», – the Forum organizers mention.

The major topic of the Forum is achieving future without AIDS and TB in the fast-growing cities. The main stress of the Forum is made on sharing experience and involvement of the Eastern Europe and Central Asia (EECA) cities in the international movement of mayors to end these epidemics. To get acquainted with the opportunities that are opening for the sustainable development of the cities, representatives of the new potential leader cities are invited to the Forum.

From sharing experience to life hacks: Forum speakers will tell about the funding of the programs and the cost of saving the life of a person, about the progress of the region in the context of combating the AIDS and TB epidemics, will present the approaches in case finding, testing and treatment of these illnesses, which proved to be effective, including new technologies and modern approaches applying network marketing.

Cities’ mayors, executives of international agencies and global initiatives, public opinion leaders, and the best experts of civil society organizations representing more than 25 countries of the world will respond to the main questions: why namely the cities play an important role in the global overcoming the AIDS and TB epidemics and which effective strategies exist to accelerate these measures.

Forum organizers: Alliance for Public Health with the direct support of the Kyiv mayor Vitaly Klichko and the team of KCSA, in partnership with UNAIDS, as well as with the financial support of the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

Accreditation for journalists at the link: https://bit.ly/385rfkP

Contact: Inna Gavrylova (+38096)753-8160

The Program includes:

– Panel discussion of the cities’ mayors: Kyiv and Odesa (Ukraine), Bern (Switzerland), Chisinau and Beltsy (Moldova), Svietlahorsk and Soligorsk (Belarus), vice mayors of Bishkek and Osh (Kyrgyzstan);

– Unique for the EECA region synchronic signing of six political declarations on AIDS and TB at the same time by the mayors of Kyiv (Ukraine), Chisinau and Beltsy (Moldova), Svietlahorsk (Belarus), Osh and Bishkek (Kyrgyzstan). Press conference (13:00-13:50);

– Effective practice, innovations, unconventional approach of local authorities related to cooperation with NGOs and other partners, sharing experience of the communities movement leaders;

– the first award ceremony of #вТвоихСилах/#InYourPower campaign for political leadership in combating HIV/TB in the specific nominations and based on the voting results.

Key speakers of the Forum:

  • Vitaly Klichko, Kyiv mayor (Ukraine)
  • Andriy Klepikov, Executive director, ICF ‘Alliance for Public Health’, member of the Global Fund Board on behalf of the Developing Country NGO Delegation
  • Raman Hailevich, UNAIDS director in Ukraine
  • Gennadiy Trukhanov, Odesa mayor (Ukraine)
  • Kevin Osborne, International AIDS Society (IAS) Director
  • Michel Kazatchkine, professor, physician, diplomat and advocate, United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, member of the Global Commission on Drug Policy.
  • Lucica Ditiu, director of the Stop TB Partnership leading the way to a world without tuberculosis (TB)
  • Dumitru Laticevschi, Regional Manager of the Global Fund in the Eastern Europe and Central Asia countries
  • Alec von Graffenried, Bern mayor (capital city of Switzerland)
  • Ion Ceban, Chisinau mayor (Moldova)
  • Nicolae Grigorişin, Beltsy vice mayor (Moldova)
  • Dmitriy Aleynikov, Svietlahorsk mayor (Belarus)
  • Andrey Zhaylovich, Soligorsk mayor (Belarus)
  • Tatyana Kuznetsova, Bishkek vice mayor (Kyrgyzstan)
  • Nurbek Kadyrov, Osh vise mayor (Kyrgyzstan)

The live broadcasting will be ensured in English and Russian. The link to the broadcasting page: Facebook та Youtube.

Quotes

Vitaly Klichko, Kyiv,  mayor Киев (Украина):

«It is very important that many mayors of cities in the world today take leadership in overcoming illnesses. The issue of the health cannot be the priority only for the relevant ministries, organizations, or specific municipal institutions or services in charge. Health of the citizens has to become one of the main priorities for municipal authorities, e.g., the priority in the mayors’ work. It is in our power to prevent dissemination of such illnesses as HIV and TB, to introduce effectives programs for treatment thereof. Kyiv signed the Paris Declaration in 2016. We approved the city program and provide funding for it, work primarily with the groups that are most vulnerable to HIV. In response to our effective work the number of new cases of getting HIV infection in Kyiv starts to decrease. But there still are lots of challenges. And we keep on implementation of the best experience in the world, uniting efforts in overcoming HIV and TB with international organizations, with municipal authorities of other cities».

Andriy Klepikov, executive director, International Charitable Fund ‘Alliance for Public Health’ (Ukraine):

‘Alliance for Public Health has been working with the cities in the region during four years already through implementing the Fast-Track strategy in response to the AIDS and TB epidemics. At this Forum, we will present info graphics and tendencies with the major figures and budgets by countries. It is important that the interest of the cities is growing; thus, the number of partnering cities during the last year increased from 5 to 25. Physicians, social workers, nurses, civil society organizations have been continuously doing their job and are still doing it. But one more component is of crucial importance: political leadership. Everyone who is in the chair of the mayor not by a chance of fortune, who has powers to take decisions, has to take these decisions for the sake of people. In the area of combating AIDS and TB epidemics in the cities it means application of innovative approaches and scientifically confirmed international expertise, resource allocations for prevention and treatment, as well as other important steps, which would provide for saving lives. The partnership of the city and of NGOs is a key for success and the future of cities free from AIDS and TB epidemics.

Raman Hailevich, UNAIDS director in Ukraine:

‘According to the last UNAIDS report, which was made publically available before the World AIDS Day, EECA region is the only region in the world where the number of new HIV cases is continuing to grow. That’s why it’s so important to implement these Fast-Track strategies in response to the epidemic namely in this region. The quintessence of this strategy is the initiative to overcome AIDS in the big cities where about 70% of all people living with HIV reside. UNAIDS jointly with IAPAC are coordinators of this initiative at global level. Welcoming and giving warm encouragement to personal leadership of the mayors of the cities who signed the Paris Declaration and ZERO TB Declaration, I want to specifically stress that there are HIV/AIDS and TB Coordination Councils effectively operating in all of these cities, and key populations are their members. Joint efforts of municipal authorities and communities, from my point of view, are the heart and the driving force of the positive changes’.

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December 02, 2019

Balkans set up the record: 3 cities of Montenegro signed the Paris Declaration to end AIDS

On December 2, 2019, the unprecedented signing of the Paris Declaration in the Balkans took place.

The mayors of three cities – Dr Ivan Vuković (Podgorica), G. Dušan Raičević (Bar) and Mr Petar Smolović (Bijelo Polje) simultaneously signed the Paris Declaration on accelerating the measures in cities to end AIDS.

Andriy Klepikov, Executive Director, Alliance for Public Health:
“For the first time the 3 Mayors sign Paris Declaration together showing strong commitment to put an end to the HIV/AIDS epidemic across the country mobilizing resources of the capital city as well as key cities in the south and north of the country. Civil society is the reliable partner to support municipalities in bringing HIV response to new level – becoming fast track cities!
We congratulate our partners from Montenegro – CAZAS and Juventas on the level of organizations as well as Miso, Sanja and Ivana on the level of personalities, whose amazing work resulted in such great political commitment!”

To date, 277 HIV cases have been reported in Montenegro (prevalence of 0.04%), and in 2018, 23 new cases of HIV infection were recorded.

Konstantin Voytsekhovich, UNAIDS EECA advisor:
“The signing of the Paris Declaration by the three biggest cities of Montenegro – Podgorica, Bar and Bijelo Polje firmly puts Montenegro on the fast-track to ending the HIV epidemic by 2030. The commitment and resolve demonstrated today by the three municipalities is even more significant because it is the first such manifestation of leadership on HIV response in the Balkans.
It is also the first time in history of Montenegro when the three different cities have joined forces in taking political and humanitarian action on HIV with strong support from the community-based NGOs #CAZAS, #Juventas and the Alliance for public Health”.

It’s just the beginning of the municipal response to the epidemic, and #SoS_project team is ready to provide the technical assistance and expertise for the cities in order to achieve the targets together!

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November 29, 2019

PRESS RELEASE Dedicated to the World AIDS Day “Test under the Clouds” (#SkyTest)

On 29 November 2019, SkyTest (#SkyTest), a traditional outreach event commemorating the World AIDS Day took place near Kyiv’s highest ferris wheel at Kontraktova square. It is the second year that this event is held by the Alliance for Public Health, Public Health Center of the MoH and partners from civil society.

During the event, everyone interested — media people, students, passers-by — could take free rapid testing for HIV using innovative saliva tests (no blood drops). Every person having taken the test got a ticket for free ride on the ferris wheel. Thus, all who wanted could take not just the innovative rapid test for HIV that did not require even a finger stick, but also receive a professional consultation of the doctor right in a ferris wheel cabin, at the height of 43 metres, while enjoying beautiful views of the winter Kyiv from the bird-view height.

During the Sky Test, a press briefing took place involving representatives of public structures, charitable and civic society organizations, leading infection disease doctors and HIV positive people.

Volodymyr Kurpita, Director General of the Public Health Centre of the MoH of Ukraine: “In the last ten years, technological progress has allowed setting a diagnosis in 15 minutes.  However, it is not just about technology, it is also about people — their desires, possibilities and fears. Do not be afraid of testing! Doctors know how to help if the test is positive”.

During the event at Kontraktova square, about 300 people (mostly young students) took rapid tests for HIV in the setting of the special mobile ambulatories. Everyone could receive — without any fee — doctor’s consultations, the main HIV/AIDS protection means (condoms) and informational materials concerning the importance of timely HIV testing.

“Since the beginning of 2019, under our programs of HIV prevention for most-at-risk populations, a total of 407 thousand people took free testing in all regions of Ukraine, which has allowed receiving 9.3 positive results (2.3%). However, more than 80 thousand Ukrainians living with HIV are not even aware of their status. At the same time, testing programs are becoming more accessible. For a long time already, you do not to go to a specialized healthcare facility to get tested. A rapid test can be taken on one’s own, using saliva, without a single drop of blood. For Alliance for Public Health, improving accessibility of testing for HIV is a priority, and we are glad that the state has been paying increasingly more attention to prevention and testing programs; that is a sort of a major test for our Government. Take the test!”, urges Andriy Klepikov, Executive Director of the Alliance for Public Health.

The event was organized by the Alliance for Public Health, Public Health Center of the MoH of Ukraine together with the ACO “Convictus Ukraine”, ICF “Drop-in Center” and CO “ALLIANCE.GLOBAL”.


Ukraine ranks among the top European countries in terms of the number of HIV-positive people. According to expert estimates, 244 thousand HIV-positive people lived in Ukraine as of 2018. One in a hundred of people aged 15 to 49 is infected with HIV, which is among the highest rates in the countries of the region. As of 01.10.2019, 136,849 HIV-positive people were registered at health care facilities in the government-controlled territories of Ukraine (i.e. 326 per 100 thousand people) which means that almost a half of the estimated number of people living with HIV are not aware of their HIV status. That is why testing is just as important component in fighting the spread of HIV and an effective tool for fast-tracking 90-90-90 goals as prevention and treatment. It was assisted testing by the Alliance that has allowed reaching to almost 4 times more people in 2019 (407.3 thousand) compared with 2014 (113.4 thousand). This has resulted in getting 3.3 times more positive results. Among the new clients of prevention project, percentage of positive results of HIV testing is 5 times higher than among the “old” ones, which testifies for efficiency of the implemented activities and highlights new challenges in prevention programs.


https://phc.org.ua/    https://selftest.org.ua/


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November 28, 2019

Information about illegally convicted Andrii Yarovyi

Andrii Mykhaylovych Yarovyi, DOB. 06.11.1967, a citizen of Ukraine from the city of Kyiv, since 2009 has been a substitution maintenance/opioid substitution therapy (buprenorphine) patient. He is a member of Eurasian network of people who use drugs (ENPUD), All-Ukrainian Association of People who use drugs (PUD. Ukraine/VOLNA), a human rights champion and a consultant on quality monitoring at ICF “Alliance for Public Health” working on HIV/AIDS prevention programs that since 2004 have been supported by the Global Fund to Fight AIDS, TB and Malaria.
On 25.08.2018, Andrii Yarovyi once again left from Kyiv to the temporarily uncontrolled territory of Luhansk oblast (Eastern Ukraine) as a consultant of the Alliance for Public Health to study the access of most-at-risk populations and HIV-positive people to prevention services and vital treatment.

In 2015-2018, Andrii for this purpose had on numerous occasions visited the uncontrolled territories of Donetsk and Luhansk oblasts where, at that time, programs supported by the Global Fund to Fight AIDS, TB and Malaria.
It was Andrii who, during such a visit in 2015, made unique video-interviews of the last days of the opioid substitution therapy (OST) programme on the temporarily uncontrolled territories in the Eastern Ukraine that formed the basis of the documentary “Live or Die in Donbass?!” In 2014-2016, more than a thousand of OST patients lost access to the vitally important  treatment on this territory.

On 26 August 2018, when Andrii was crossing an unauthorized checkpoint in Krasnodon rayon (temporarily uncontrolled territory of Luhansk oblast), he was illegally detained by members of “Luhansk People’s Republic” ( “LNR”), who seized from him 38 pills of «Buprenorphine hydrochloride», a narcotic medication used for OST, with the total weight of 0.152 mg. The day before, Andrii legally obtained a 10-day stock of this drug (a total of 0.16 g) at a healthcare facility in Kyiv for unsupervised administration. The next day, on 27.08.2018, Andrii was brought to the “Ministry of State Security of LNR” and illegally arrested over “large-scale drug-trafficking”, as was stated in the charge Andrii faced several months later. Only in mid-October 2018, Andrii was accessed by a local lawyer hired through the Alliance for Public Health .

In late October 2018, an investigator of “MSS of LNR” charged Andrii with a «violation» of p. 3 of article 282 of the «Criminal Code of “LNR” (large-scale drug/buprenorphine smuggling), and so-called “court of LNR” selected a pre-trial restriction in the form of arrest the term of which was then extended several times; all this time, Andrii was illegally held in inhuman conditions at an underground facility of the “Ministry of State Security of LNR” (at Sovetskya str. 79 in Luhansk).

Based on Andrii’s mother’s claimt on the illegal arrest of her son on the temporarily uncontrolled territory of Luhansk oblast, Svyatoshyn Unit of the National Police  n Kyiv City on 22.10.2018 opened a criminal case under article 146 of the Criminal Code of Ukraine (Unified Register of Pre-Trial Investigations no. 12018100080008478). Simultaneously, to organize further exchange, the woman submitted a request and other documents to the Security Service of Ukraine’s United Center for Coordination and Search and Release of Illegally Incarcerated People, Hostages, and Locating Persons who Went Missing in the Area of Anti-Terrorist Operation.

The situation with Andrii’s illegal detainment with the OST drug was included in the Report on the human rights situation in Ukraine of the Office of the United Nations High Commissioner of 16 August to 15 November 2018 (para.52, page 12).

On February 7, 2019, Andrii was transferred for further illegal detainment to the pre-trial Detention center  (SIZO) “Luhansk Penitentiary Facility of the Ministry of Interior of LNR” (23rd Line street, 4; Luhansk).

On February 11, based on the appeal of Andrii’s mother, the European Court of Human Rights (ECHR) opened proceedings according to Rule 39 of the Rules of Court of ECHR (interim measures). Considering the importance and urgency of the case, the Court decided to consider it as a priority case under Rule 41 of the Rules of Court and ensure confidentiality of certain information to avoid harm to the complainant (Rule 33.1). ECHR has submitted a corresponding official communication to the responsible public authorities in the Russian Federation and in Ukraine.

On 22 February 2019, so-called “Krasnodon Rayon Court of LNR” illegally sentenced Andrii to a long-term imprisonment and confiscation of property for the «alleged smuggling of drugs» — his OST medications (part 3 of article 282 and part 2 of article 276 of the “Criminal Code of LNR”).

In April 2019, Andriy was transferred from the detention center to Sverdlovsk prison, currently he is located at (94420, Lininskoe village, Sverdlovskiy rayon, 16 Profsojuznaya Str ); the support of APH has ensured he regularly receives food and living essentials; he enjoys limited access to his lawyer; also, he has recently been allowed to see his family once a month.

As far as we know, Andrii has been included in the exchange list, but nothing is known about specific dates. Previously planned exchange events have already been postponed several times.

We would appreciate dissemination of this information among media, international, humanitarian, public or other organizations that may somehow prove helpful in liberation of Andrii Yarovyi and returning him back home.

On April 28, 2019 during the opening ceremony  of the 26th Harm Reduction International Conference  Porto ( Portugal) Andrii Yarovyi  was awarded with the Carol and Travis Jenkins Award as a victim of a deliberate violation of human rights involving illegal imprisonment for storing legally obtained OST drugs. This award has been presented each year since 2005 to a person who either used to, or currently uses drugs, and who has made an outstanding contribution to reducing drug-related harm.


Free Andrii Yarovyi


Andrey Yarovoi receives the 2019 Carol and Travis Jenkins Award


Focal point at ICF “Alliance for Public Health” — Pavlo Skala (mobile. +380-503825178, skala@aph.org.ua).

Information about Andrii Yarovyi, who was illegally detained and convicted on the temporary uncontrolled territory of Ukraine

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November 26, 2019

The second city in Belarus joined the Paris Declaration to end AIDS epidemic

On November 26, 2019 UNAIDS coordinator in Belarus Vera Ilyenkova and the head of Svietlahorsk district executive committee (city mayor) signed the Paris Declaration to intensify the activities in cities aimed to end HIV/AIDS epidemic.

Svietlahorsk has become the second city in Belarus that signed the Declaration, declaring its active leadership in global combating HIV/AIDS epidemic in the cities all around the world.

The ceremony of signing the document was visited by the representatives of Ministry of Health of the Republic, city government officials, UNAIDS country office in Belarus, Alliance for Public Health as well as many other international and non-governmental organizations.

Andriy Klepikov, Executive Director of the Alliance for Public Health: “I welcome this important strategic initiative of Svietlahorsk. Signing Paris Declaration means readiness to use the best world experience to develop effective city programs for combating HIV/AIDS epidemic, which are supported by the municipal funding and are aimed to improve the health status of the city residents. It’s just the beginning of the accelerated municipal response to the epidemic, and the team of the Alliance for Public health is ready to provide the technical and expert support to the city”.

“By joining Paris Declaration the city of Svietlahorsk takes the responsibility to achieve the 90-90-90 targets, which means that 90% of all people living with HIV should know their status; 90% of patients knowing that they have HIV infection get access to treatment, and 90% of people getting the HIV treatment have undetectable viral load. The city will pay specific attention to the key populations with high risk of getting HIV infection as well as to elimination of stigma and discrimination in regard to people living with HIV. To coordinate these activities, there is a working group established by the district executive committee, which developed the draft city program on combating HIV/AIDS epidemic in 2019-2021 with active involvement of the representatives of key populations.
We understand that reaching the 90-90-90 targets is a challenging task, but it’s necessary to initiate the changes, increase budget allocations from local budget in order to improve the status of health and the quality of life of the Svietlahorsk residents”, – commented the city mayor, Mr. Dmitriy Aleynikov.

It should be noted that in Svietlahorsk, one of the youngest cities in Belarus, there are about 13% of all people living with HIV in the country.

Vera Ilyenkova, UNAIDS coordinator in Belarus: “The ‘Fast-Track Cities’ Program was launched in Paris in 2014, when representatives of 26 cities signed the Paris Declaration.  For today there are more than 350 cities and municipalities, which joined the initiative. By signing this document Svietlahorsk undertakes the obligation to achieve the goals of Paris Declaration and put an end to the AIDS epidemic by 2030. UNAIDS is supporting the Svietlahorsk initiative and jointly with the partners, one of which is the Alliance for Public Health, is ready to provide the city with technical assistance and expertise on the issues of accelerating the measures aimed to combat HIV, eliminating of inequality in access to key medical and social services. The key success factor for Svietlahorsk is the perfect coordination and interaction between the government and civil society, including public organizations uniting people living with HIV.”

Representatives of city administration expect that jointly with the partners and with the support of the international organizations the 90-90-90 target will be achieved by 2021, and the end to the epidemic will be put by 2030.

Event participants supported campaigns  It’s #InYourPower to end AIDS.

 

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November 08, 2019

#SoS_project team releases the third regional overview digest

The regional #SoS_project team continues to advocate for the sustainability of HIV services at the regional and national levels in Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Northern Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Tajikistan, Ukraine and Uzbekistan.

In the third quarter of 2019, a lot of work was done to prepare countries for the transition to state financing of HIV / AIDS programs: in Bosnia and Herzegovina, Northern Macedonia, Moldova, Montenegro, Romania the cost of services for key population groups was calculated with the technical support of project experts. A number of key meetings were held in Kyrgyzstan, Kazakhstan, and Copenhagen on improving access to treatment.

In August, the Paris Declaration was signed in the city of Osh (Kyrgyzstan). Joining the Paris Declaration in 2019 is expected in: Dushanbe (Tajikistan), Salihorsk, Svetlogorsk (Belarus), and the signing of the Zero TB declaration is being discussed with the municipal authorities of Kyiv (Ukraine), Chisinau (Moldova), Bishkek (Kyrgyzstan). The Balkans countries have actively approximated joining their cities to the Paris Declaration. There are ongoing negotiations with the city authorities of: Sarajevo, Banja Luka, Mostar (Bosnia and Herzegovina), Podgorica, Bar, Bielo-Pole (Montenegro).

In Moldova, preparations have begun for a national information campaign on pre-exposure HIV prevention (PrEP), and 20 people have already started PrEP.

In the “Gender and HIV 2019” area some activities have started in Georgia, Northern Macedonia, Kyrgyzstan, Russia and Montenegro.

Project partners from Belarus and Uzbekistan successfully completed their studies at the Harm Reduction Academy.

Thank you for your attention and enjoy the reading of the full version of the digest in the browser

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November 04, 2019

Harm reduction сabinet in Sumy: evaluation of one year of work by local authorities

In a month, on December 6, Kyiv will host municipal delegations from more than 30 cities of the world at the regional EECA City Health Leadership Forum, coordinated by the Alliance for Public Health in cooperation with the Kyiv City State Administration and UNAIDS. The forum will present and discuss the progress and most relevant interventions for the cities of the last 5 years in countering the epidemic of HIV, tuberculosis and viral hepatitis. The conference will be broadcast online on the Alliance for Public Health Facebook page.

In anticipation of the event, we studied the world experience of one of such interventions using the example of the Ukrainian city of Sumy in innovative approaches to harm reduction programs for the Eastern Europe and Central Asia countries. Thus, a harm reduction room was opened in the city with the support of municipal authorities for the first time in the EECA region. By the end of the year, it is planned to open a second one, and, moreover, this experience can be implemented in other cities of the region in the near future.

Such a unique experiment for the region attracts the attention of representatives of municipal authorities, NGOs, and other cities. So, this year, the municipal delegations of Poltava, Odessa, Kyiv, Chernigov (Ukraine), Balti, Chisinau (Moldova), Kazakhstan visited the facility to study the experience, a series of meetings were held to discuss the prospects of opening similar rooms in other cities. Therefore, we wonder, in which EECA city the next harm reduction room will be opened in cooperation between the municipal authorities of the city and NGOs?

Background, or why we need harm reduction rooms

For the first time, a community center allowing controlled drug use was launched in the Netherlands in the early 70s. The center provided booklets with basic information about health and drug use, offered food and clothes, distributed clean syringes and also allowed to use them on the spot. The local administration and the police supported the project, but the center achieved official status only in 1996.

The first harm reduction facility for controlled drug use, officially approved by the municipal authorities and supported by health professionals, was opened in Bern in 1986 and continues to work.

Today, more than one hundred injection rooms are officially operating in the world: in Switzerland, Germany, France, Canada, Australia, Spain, Luxembourg, Norway, the Netherlands and now in Ukraine, such facilities also appeared in the USA several years ago.

Such centers address overdose cases with almost 100% efficiency, which is confirmed, for example, by the estimates. And some reports point out to the economic efficiency for national and municipal budgets, since ambulance is called much less often, and the likelihood of HIV, TB and hepatitis spread in the society is significantly reduced. Other repeatedly proven positive aspects of such an experience are: reducing crime, improving the overall health and quality of life, reducing the number of “relapses”, improving the socialization of patients (a regular job, place of residence, restored family ties).

Assessment of benefits of the harm reduction room in Sumy

Global experience shows where harm reduction rooms are introduced on the basis of state facilities in societies with a high level of discrimination and criminalization of people who use drugs, it’s difficult for them to gain the target group trust. In Sumy, this problem was successfully addressed through the involvement of social workers from a non-governmental organization.

“The approaches to harm reduction in Ukraine have not changed dramatically for 20 years, so the most challenging task now is to gain trust of people who use drugs so that they are not hesitant to use in this municipal space. Everything here is built on trust, – said a public activist and the facility launch initiator, Oleksiy Zagrebelnyi. – The result of our activity at the moment is that there are more and more visitors, we began to receive feedback from them, which means that the room is in demand. It means that our efforts are not in vain. The services we provide are unique, they are in demand, and it is a success, because the social side of this project has significant benefits for the public”.

A significant example of the harm reduction room benefits is a considerable improvement in the security atmosphere in society and a decrease in the number of complaints to the Sumy authorities regarding the negative consequences of drug use, in particular: littering with used syringes and other means in the territories of hospital facilities, house entrances, playgrounds and just on the streets; use in public places, etc. According to Maksym Galitskyi, the deputy mayor of Sumy on health and safety, such appeals have become scarce once the room was opened. “Previously, there were several appeals every week, now we receive one complaint per month. This is an obvious success”, he said.

According to the chief doctors of the Sumy Regional Narcological Dispensary Taras Zlydennyi, about 50-70 people visit the harm reduction room every day, the total number of patients who are actively using substitution treatment in the city is more than 300 people, and the number of registered patients at the drug dispensary is up to 600 people. The room provides preventive counseling services to reduce the drug use harm in general and provides information on the consequences of street drugs, tests for HIV and hepatitis, counseling for relatives and members of PWUD families, exchange of syringes, as well as protection and preventive measures.

Political will and the municipal authorities’ consensus are a prerequisite of success

The Sumy approach to harm reduction is unique, because the city managed to dispel the stereotypes regarding the methods of combating drug addiction, and instead of stigmatizing and persecuting PWUD, the representatives of the city authorities, law enforcement agencies, the medical sector and NGOs united their efforts and provided the conditions for controlled drug use. Moreover, the harm reduction room is funded exclusively from the city budget, and financial assistance from international organizations, the ICF “Alliance of Public Health” and the International Renaissance Foundation, was needed only at the start of the project to repair the premises.

“There are 2 options to fight against any problem – this is either tough prosecution and looking for ways to eradicate, which are often too expensive and do not achieve effective results. The other way is the policy in which we try to reduce harm, thinking about the safety of our citizens”, said Maksim Galitskyi. – “In Ukraine, various officials, often having different mindsets, are responsible for protecting health and safety. This is a national scale problem throughout the country, since there is no single policy-maker in the field of counteracting drug trafficking, and the Ministry of Health has no influence on the SSU. In Sumy, I am an official responsible for safety and health, and this we managed to create a communication platform on which NGOs, together with authorities, reached a certain consensus on this issue”.

The importance of having political will and consensus among different branches of government is also recognized by the regional administration.

“Sumy region was lucky to have officials who are able to understand, realize, support such an initiative”, said the ex-head of the staff of the Sumy Oblast State Administration, and the current first deputy Minister of Development of Communities and Territories of Ukraine Dmytro Zhivitskyi. – We had political will, and the Head of the oblast administration supported us. Non-governmental organizations took up the function of awareness raising, expert examination and providing international experience for the administration, for the deputies, whose support we managed to gain”. According to him, the work in the harm reduction area provided an effective tool for the implementation of out-of-the-box solutions in the field of public health, which will work in the future. “Taking off in this direction, we realized that we have a well-developed mechanism for making and implementing joint out-of-the-box decisions, which was lacking before this”, he said. – “Back in 2017, we created the oblast Public Health Center, the first full-fledged regional facility. Now we have created a working group, and in mid-July we will adopt the oblast public health program, which will take into account the experience with drug users. That is, our task today is to implement a philosophy of prevention and addressing the causes rather than eliminating the consequences”.

Where in the EECA region the next harm reduction room is about to open

“The first harm reduction cabinet in the world was opened in the Swiss city of Bern 33 years ago. Since this time, the city has become healthier and safer, access to HIV treatment today is unconditional, and a comparison of the situation on the streets of 1986 and today clearly demonstrates the dynamics of improvement. We will talk about this in detail at the regional EECA City Health Leadership Forum on December 6, which will be held in Kyiv. We would like the cities of the EECA region to follow the path of improving the health and quality of life of citizens, using effective evidence-based methods to counter dangerous epidemics such as HIV, TB and viral hepatitis,” said Ievgen Kushnir, program manager of the Alliance for Public Health.

 

Olena Kucheruk, program manager at the International Renaissance Foundation: “As a person who has been developing harm reduction in Ukraine for 20 years, I remember how the first harm reduction services started. How innovative it was then, and how many barriers then had to be overcome. Then we could not even think that sometimes safe use rooms would be our reality. I am very happy to see that this is becoming possible today. 20 years is a long period of time, but everything is changing: people, doctors, local authorities and the police are now having a completely different understanding of the issue and expertise. It is very pleasing and inspiring. We would like to continue supporting and developing such rooms in other cities of Ukraine”.

Note that the Sumy harm reduction room was opened at the regional drug dispensary. Local authorities and international organizations (the ICF “Alliance of Public Health” and the International Renaissance Foundation) provided the startup support for the facility. According to the results of the year, this experience, according to representatives of the city’s authorities and non-governmental organizations, has proved its efficiency and expediency.

Public activists from the Moldavian city of Balti showed interest in opening such a room in their city. Moreover, the mayor said earlier that it would be much easier to implement such programs in Balti, because for this you would only need to “copy” Bern’s experience initiated 33 years ago. Now the experience of the Ukrainian city of Sumy will become a best practice.

Moreover, the mayor of Odessa Gennadiy Trukhanov noted earlier, that “We need to change the mentality and attitude of our people. Of course, we use our experience and the changes that have occurred in the field of drug policy and the fight against HIV over the past 30 years to improve the situation in Odessa. Unfortunately, we treat people who use drugs as criminals, while we should treat them as sick and dependent people”. Inspired by Bern’s experience in drug policy as part of the #FastTrackSities study visit, Mr. Trukhanov promised to open a safe drug use room in Odessa in the EECA region.

According to Oleksiy Zagrebelnyi, repair work in the second safe use room is currently underway in Sumy, and by the end of the year it is planned to open another harm reduction room at the opposite end of the city. For this, there is already the first successful experience, and all the necessary procedures that have been developed in the course of the current safe use room equipping. However, other cities will have to make some efforts to implement such a project.

Where to start: expert advice

Experts emphasize that opening a harm reduction room in the city will involve two important aspects, the regulatory and the economic issues.

First, it is necessary to analyze the adoption of programs involving work with drug users, people living with HIV, people with hepatitis, TB and concomitant infections and calculate the costs of treating those who have been infected by chance.

“As a rule, local program packages already exist in many cities”, said Yelena Koval, consultant for the International Renaissance Foundation on the availability of pain management medications and drug policy. – “Among local programs, we need to look for those that have a harm reduction component, analyze at which healthcare facilities such programs work, who is involved there. And then – just imagine that an infected syringe can be dropped at the building entrance, on the playground, and calculate how much post-exposure prevention will cost for a person who is accidentally exposed to the infection. How much resources will be needed in order to deliver medications, how much a treatment regimen will cost. Then it becomes clear that the cost of a harm reduction room launch is comparable to the expenses which will be incurred even in a single such case”.

In order to open such a facility, it is necessary to assess the needs of the city/oblast/region, create a program that will include further steps, identify sources of funding and conclude an agreement with a health facility.

In recent years, cities have demonstrated leadership in improving people’s health and effectively combating HIV, TB, and hepatitis. And this trend is crucial at the global level, because today, 55% of the world’s population lives in cities, and it is expected that by 2050, two-thirds of the world’s population will be urban dwellers. The cities can benefit from decentralization of programs and resources, an expert community input and world experience, they only need to have political will of local authorities and the safety and health issues will be addressed. City mayors have powers to save over 2 million lives in Eastern Europe and Central Asia today.

Text: Inna Gavrylova

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