In countries of Eastern Europe and Central Asia, as well as the Balkan region, the transition from international support to state funding of HIV/AIDS programs, formed in recent years with the support of international donors, is undergoing various stages: somewhere it has just begun, and somewhere there are already results.

Therefore, some of the most pressing issues today are:  how to activate the state to effectively implement priority measures and allocate sufficient funding to overcome the HIV/AIDS epidemic; to prioritize this issue on the public health agenda of each country in the region with more than 2 million people living with HIV?

Alliance for Public Health, Eurasian Coalition on Male Health and the CO “100% Life” shared their expertise and experience in a comprehensive response to challenges and held a regional online seminar (webinar) on “Developing a dialogue between the state and civil society”.

The webinar, which is available in the recording (webinar in russian), presents discussions and presentations on the following topics:

– Inna Gavrylova, coordinator of the information campaign and communications manager of #SoS_project in Alliance for Public Health, spoke about the launch of a new regional initiative – the information campaign #InYourPower, the launch of which is scheduled for October 2. Listen to the presentation.

“We faced the task of creating a motivating public background for a more effective dialogue between civil society and government bodies, to inspire and encourage officials to make appropriate decisions in favor of ensuring the sustainability of HIV services and saving lives of more than 2 million people living with HIV in the region. In the process of the campaign development, we studied the trends, lessons and impact of information campaigns in the region over the past 5 years. We had everything in these six months: heated discussions in the team, we conducted in-depth interviews, discussions with officials, communications with experts and political scientists, representatives of communities from different countries, and in this campaign,  we formed the most simple and understandable communication “it’s in your power to stop the HIV epidemic. We will work to ensure better visibility of successful and efficient work of such cooperation in the EECA countries and the Balkan region, ” said Inna Gavrylova.

Campaign initiators: Alliance for Public Health and CO “100% Life”, with information support from the UNAIDS EECA and financial support from Global Fund to Fight AIDS, Tuberculosis and Malaria, #SoS_project.

– How to work with officials? What is the internal motivation of government officials?

The presentation on the materials of the new ECOM review was presented by Gennady Roshchupkin, coordinator for the development of ECOM community systems, and Natalia Podogova, an expert in building relations with state authorities from EHRA. Listen to the presentation (16:25 min).

“Social accountability is a mechanism of interaction between government bodies and civil society, it is a movement towards each other, which helps the state system to respond in a timely and efficient manner to both problems and challenges, as well as emerging opportunities,” said Natalia Podogova. – “Studying the motivation of government officials and politicians to be open and interact with civil society can help attract them to the category of partners and allies, and existing partnerships can be developed and strengthened. You can read about all this in the review prepared by ECOM, and in the preparation of which I was able to participate”.

– Experience in building cooperation from the position of an official

This topic was presented by Victor Lyashko, an expert in GR and state financial management, who in 2017-2019 held the position of first deputy general director of the public institution Center for Public Health of Ukraine. Listen to the presentation (49 min).

“How to activate the state to effectively implement priority measures to overcome the HIV / AIDS epidemic is a very complex issue. It is especially difficult in the context of parallel reforms, when there is a political struggle for limited resources. And in these conditions, we need not only to ensure a gradual transition from donor funds, mainly from the Global Fund, to financing from state and local budgets, but also to prevent the cessation of such activities or the deterioration in the quality of their implementation,” – noted Victor Lyashko.

We must understand that the results of changes, like any other reforms, will not be visible tomorrow — the epidemic cannot be stopped in a year or two. And even if countries manage to switch to state funding, they need to immediately think and take steps to ensure the stability of this transition. Since after several months of work in the new conditions, there will be populists who will scream at all angles about the inefficiency of using budget money. Therefore, for all of us, the priority should be the issue of optimization and rational use of existing resources that are allocated by the state to overcome the HIV / AIDS epidemic. For example, optimization of treatment regimens, advocacy work with manufacturers to lower prices, rational review of packages of services that will be financed from the state budget. And it is advisable to always discuss answers to questions of rational use of budget funds in extended working groups with the involvement of community representatives. Resources are always scarce, therefore, in such groups, priorities are determined and understanding comes about how state budgets are formed. Another plus of the expanded groups is the involvement of officials at various levels. This, given the short period of political life of officials, will allow us to constantly have partners in the ministries who will be worried about the HIV response. ”

Transition process from donor to national funding for HIV/AIDS programs is currently taking place in the Balkan region countries, as well as the Eastern Europe and Central Asia.

As a result of this transition, people living with HIV and representatives of key groups must be ensured that HIV-services are sustainable at the state level, which means saving lives for thousands of Balkans people. The regional #SoS_project team directed its efforts to achieve this goal with providing expert support at each stage of the transition process and in close cooperation with country partners.

The first step is to determine the necessary amount of national funding needed for key populations programs in countries.

In July-August, in Romania, Bosnia and Herzegovina, we carried out such a calculation of the unit costs of services for key population groups. Kateryna Boiko, financial manager of the Alliance for Public Health, visited several SEE countries. In collaboration with the RAAF (Romania) and the Association Partnerships in Health (Bosnia and Herzegovina) teams and in series of working meetings and consultations, they developed estimates for the unit cost of HIV-services for key groups.

Work meeting with Association “Partnerships in Health” team

“The most optimal approach for determining the necessary funding is to calculate unit cost for all KGs and use them to assess the required budget. We worked with partners in countries that provide such services to key groups, and we were able to make an optimal calculation of the cost of such services, which are currently being finalized,” said Kateryna Boiko.

“We are now in the final stage of the process, – shares in the Romanian Angel Appeal Foundation. – We are discussing with stakeholders the unit costs proposals in order to identify the best solutions sustainable and suitable for the Romanian context. Upon finalization, we will be using these unit costs for Romania Optima calculation. Also, we will be using the information in developing quality standards for services for KP and for the advocacy campaign for the national authorities. This is part of our endeavors of advocating for national allocation for key populations.»

A similar process will take place in Bosnia and Herzegovina.

Aida Kurtovic, Director of the Association Partnerships in Health: “The Global Fund’s funding of HIV programs in Bosnia has been finalized. Now we urgently need to make calculations and include funding in the national and local budgets. We’ve already passed halfway and now we’re clarifying the unit cost calculations.”

The most used approachis developing a unit cost individually for each key group and use it to estimate the needed budget. Unit cost in harm reduction program is an average сost of service provision per one person who receive services and/ or health products during the period (usually year). Unit cost per person has to include services and commodities

Below are examples of unit cost for prevention program among PWIDs in countries (excluding OST), for some GF grants.

“The unit cost in the first place depends on the package of services offered which can be both minimal commodity distribution related, as well as broader inclusive of HBV, HCV, STI testing and treatment. The cost will vary depending on salary levels in the country; as well as economies of scale have strong impact,”– said Kateryna Boiko. – “On average, when there is a transition to state funding, these unit costs are additionally “optimized”, as a rule, states are willing to pay less than international donors.”

Over the past year, a number of publications have appeared in the Tajik media on the topic of recording an increase in the number of criminal cases for knowingly transmitting HIV infection. All of them tell about the application of Article 125 Part 1 of the Criminal Code of Tajikistan and the hypothetical “exposure to the danger of infection”.

And in July, the UN Human Rights Committee published recommendations to Tajikistan, noting the difficult situation of people with HIV and the existence of barriers to access to health care, which cause its rapid spread.

The situation is like this: a single article in the legislation of Tajikistan and the stigmatization of PLHIV prevent the effective fight against the HIV/AIDS epidemic in the country. And what to do? Experts note that the signing of the Paris Declaration will have a positive impact on the current situation, due to the introduction of international experience and evidence-based methods in the epidemic response.

There is political will, but it’s important to properly apply it

“President of Tajikistan Emomali Rahmon speaks of the importance of solving the problems with infectious diseases in the country. There is political will in the country. Health representatives declare their interest in applying science-based modern world practices to reduce HIV and take steps to combat the epidemic, but many patients do not understand the specifics of HIV treatment with ARV therapy, the insufficient of appropriate specialists, lack of peer consultants who can find an approach to each patient, as well as the ambiguous interpretation of existing legislation by representatives of certain authorities may significantly aggravate existing problems”, said Tetiana Deshko, Director of International Programs of the Alliance for Public Health, summarizes a recent visit to Dushanbe.

It’s necessary to that since the beginning of 2019, the number of convictions for HIV infection transmission has increased in Tajikistan, as reported by a number of national media. So, 14 criminal cases were opened in Dushanbe, 39 more – in the Sughd region.

Legal framework for the fight against HIV in Tajikistan

“In September last year, the head of state raised the problems of infectious diseases, including the problems of HIV infection, and we were very grateful because we believed that the government would now pay more attention to this problem. However, it turned out in a little different way, says Tahmina Khaidarova, head of the Tajik Network of Women Living with HIV. – Previously, the Republican Center for AIDS Prevention and Control, specialized NGOs, as well as other competent and informed structures, dealt with HIV/AIDS, now many other specialists who, unfortunately, do not always understand what HIV is, are involved in this issue”.

According to the Tajik law, the crime is not the fact of knowingly becoming infected with the immunodeficiency virus, but a hypothetical “exposure to the risk of infection” Article 125 Part 1 of the Criminal Code of Tajikistan. The consent of the partner is not taken into account, as well as even the use of condoms as a means of safety during sexual intercourse or undetectable viral load.

“In fact, all discordant couples (in which one of the partners is HIV-positive and the other is negative – author’s comment) may fall under Article 125 Part 1 of the Criminal Code of Tajikistan”, says Khaidarova. – Since this article does not imply actual infection, but the risk of infection. And all people with HIV-positive status who have a sexual partner, according to this interpretation, expose them infection, although this is not the case with ART and suppressed viral load”.

It should be noted that a number of high-profile criminal cases in Tajikistan have recently been initiated exactly under Article 125 Part 1 of the Criminal Code. Accordingly, in this wording, practically all PLHIV who have sexual contacts, may be subject to the article. As a result, PLHIV and representatives of key populations avoid registration and any communication with government agencies. According to the latest data, with an estimated number of 15 thousand PLHIV, 7,800 people are registered, which is just more than a half of the total number.

Over half of HIV cases in the country are of “unknown origin”

Tatyana Deshko shared the latest statistics from the capital’s AIDS center: in the first three months of 2019, 94 new HIV cases were detected in Dushanbe. Of these, the largest category is the so-called “unknown origin,” and this is an obvious fact that people presumably, fearing legislative consequences, do not disclose the source of infection.

“31 cases of sexual transmission were recorded, 19 cases of injection transmission, 4 more – mother-to-child transmission. And 40 cases are recorded as “an unknown way of infection!” – emphasizes Tetiana Deshko. – That is, most cases are of unknown origin. What exactly are these cases, we can only guess”.

In Tajikistan, #SoS_project plans to introduce a system of registration and response to offenses against key populations and PLHIV – ReACT. This will allow us to systematically collect offenses, systematically and urgently provide legal support, analyze violations of rights, recommend and lobby for legislative changes.

The Paris Panacea

Experts believe that one of the effective ways to improve the HIV situation in Tajikistan and, accordingly, to reduce the burden of HIV/AIDS, is that Dushanbe accedes to the Paris Declaration. After all, every fourth HIV-positive Tajik lives in the capital.

Professor Michel Kazatchkine, UNAIDS Special Advisor in the EECA region, recently had an official visit to Tajikistan. As part of the work agenda, he met with Muini Mavsuma Muinzoda, Deputy Chairman of the Executive Body of the Government of Dushanbe (note of the author: mayor of the city), and they discussed the municipal response to HIV/AIDS. Mr. Kazatchkine commented on the outcome of the meeting as follows: “The capital of Tajikistan is currently considering the signing of the Paris Declaration to accelerate the pace of combating HIV and ending the AIDS epidemic”.

It’s necessary to that the Paris Declaration assumes that the city commits itself to achieve 90-90-90 indicators by next year: 90% of all residents should be tested for HIV, 90% of those infected should receive treatment, and 90% of them should have zero viral load. Thus, according to UNAIDS, by 2030 the world will be able to stop the HIV epidemic.

UNAIDS has already sent relevant documents on Dushanbe’s accession to the Paris Declaration to the city municipality. The initiative was supported by the Deputy Minister of Health of Tajikistan.

On September 9, 2019, the official opening of the Fast-Track Cities 2019 conference took place in London. #FTC2019 will run until September 11, 2019. More than 700 participants from more than 300 cities of the world, including mayors of large cities, experts of public activists, representatives of municipal health care structures, regional networks of communities and organizations from around the world, came to the capital of UK to share their experience in implementing effective responses to the HIV/AIDS epidemic on city ​​level.

London Mayor Sadiq Khan speaking at the official opening ceremony Fast-Track Cities 2019 about the problem of health inequalities across the world, as well as the need to end the stigma still associated with HIV. He also reiterated the bold ambition for London to achieve the target of no new HIV infections, deaths, and stigma by 2030. Today, the city’s HIV cascade are “95-98-97”. “But despite our progress, there is still much more to be done as too many people continue to catch the virus. To truly end all new cases of HIV in London, it’s high time the Government made PrEP available via the NHS for all those who need it. No ifs, no buts, and no more pilots – we know it works, it stops the spread of infection and saves money in the long run”, said Sadiq Khan.

The mayor of Odessa, Gennady Trukhanov, and the first deputy mayor of Kiev, Nikolai Pavoroznik, spoke about the achievements of Ukrainian cities at the opening of the conference.

Since the launch of the initiative “Accelerating Action in Big Cities” in 2014, more than 350 cities and municipalities worldwide have signed the Paris Declaration.

Already 10 such cities over the last 5 years from the region of Eastern Europe and Central Asia joined the initiative. Here they are: Bucharest, Romania (2014), Kiev, Ukraine (April 2016), Odessa, Ukraine (February 2017), Almaty, Kazakhstan (July 2017 ), Minsk, Belarus (November 2018), Yekaterinburg, Russia (December 2018), Tbilisi, Georgia (December 2018), Chisinau, Moldova (June 2019), Bishkek, Kyrgyzstan (June 2019), Osh, Kyrgyzstan (August 2019).

Vinay P. Saldanha, UNAIDS Regional Director for Eastern Europe & Central Asia: “UNAIDS supports the revitalization of cities in EECA in joining the international movement of rapid urban response to the AIDS epidemic. Today there are already 10 such cities, this is very significant, but still not enough to influence the path of the epidemic in the region. We hope that the other cities of our region will join the Paris Declaration in the nearest future, as it provides an additional tool for the city or entity to achieve the goals adopted by all UN member countries in the 2016 Political Declaration on AIDS at the local level.

Tetiana Deshko, Director of the Department of International Programs of the Alliance for Public Health: “While preparing to represent the EECA region in London, we are consolidating our “Paris footprint” as well. We have initiated the accession to the Paris Declaration and the further steps in the response to HIV in 6 out of 10 signatory cities in the Region: Kiev, Odessa, Almaty, Tbilisi, Chisinau and Osh. This is not only a joint work with municipal teams to initiate and prepare the signing of the Paris declarations. This is strategic work to step-by-step coordination of the implementation of the initiative in cities, to develop urban HIV/AIDS programs, to allocate funding, and to provide expert support in building sustainable HIV services in these cities. Much is yet to come, but we are already grateful to our partners for productive cooperation and our joint efforts and achievements. We are currently working on connecting new cities: Dushanbe (Tajikistan), Salihorsk and Svetlogorsk (Belarus), Sarajevo (Bosnia and Herzegovina), Podgorica (Montenegro). As for now we are marking a good milestone when not only one city, but the real EECA urban community operates in their cities and on the international level”.

The London conference is attended by a municipal delegation from the EECA region, consisting of the mayor of Odessa, deputy mayors of Bishkek, Osh, Kiev and Tbilisi, representatives of KP NGO’s, municipal health structures, regional networks and communities organizations.

This year, on December the 6, a regional forum of EECA cities will be held in Kiev, where participants will have a close look at the progress of the HIV/TB response in cities. Over 3 years of work within the framework of regional projects implemented with the support of the Global Fund, cities have managed to achieve significant progress in the municipal response to HIV.

The joint work of the Alliance, the municipality of Odessa, partner NGOs and representatives of key populations led to the development of an HIV/TB program and the allocation of unprecedented funding by the city municipality in the amount of about 2.5 million US dollars for 3 years, and two years of its implementation – to increase by 50% of the number of patients receiving ARV therapy. In Kiev, which is also the city of the Fast Track Cities initiative and adopted the city program with financing, over the same period, progress was 43%, while throughout Ukraine – only 37%.

In Almaty, an urban HIV/TB program was developed with municipal funding for key populations, which is now pending for approval. The city systematically worked to improve the HIV cascade and significantly improved the detection of new HIV cases: in 2018, 354 people were registered with HIV detection, while in 2017 – only 88. Such progress was achieved in many ways thanks to the pilot involving of outreach workers in identifying new HIV cases with quick tests (about 2000 tests per year) in outreach settings; At the moment, at the country level in Kazakhstan, a centralized procurement of rapid tests is being considered, the use of which has already demonstrated its effectiveness.

In Chisinau, the approval of the municipal program with specific and measurable goals, distributed roles with NGOs is expected in the next 2-3 months. Accordingly, a budget of $ 900,000 for 2019-2020 is secured, a third of which consists of municipal money.

Osh was the last city among the signatories of the Paris Declaration on Ending the AIDS Epidemic, and the second city in the country to commit itself to achieving 90–90–90 by the end of 2020. It is one of the oldest cities in Central Asia with a population of almost 300,000. This city was one of the first in Central Asia to suffer from HIV infection in connection with drug trafficking routes passing through the city. From 2005 to 2007, outbreaks of nosocomial HIV infections among infants occurred in the city. According to government statistics, there are more than 1,100 people live with HIV infection in Osh.

A little more than a year remains before sum up and evaluation of the efforts in achieving the 90-90-90 goals. Will any other city join the global movement? We will get to know the answer to this question very soon.

It should be noted that the Paris Declaration offers cities not only tools for combating HIV/AIDS, but also a platform for solving the problems of social integration and public health.

The digest summarized the main activities and achievements of the project for April-June and partially for July.

Announcement of materials of the #SoS_project regional digest  #2

The #SoS_project Regional Team continues to advocate for HIV and AIDS services at the national and regional levels with a new Project Director.

In the second quarter, the Paris Declaration was signed in Chisinau (Moldova). The efforts continue on accession of new cities, namely Dushanbe (Tajikistan), Soligorsk, Svetlogorsk (Belarus), Sarajevo, Banja Luka, Mostar (Bosnia and Herzegovina), Podgorica, Bar, Bielo Pole (Montenegro).

The first regional “Advocacy and HIV” Advocathon-2019 was held with the participation of 8 country teams, which developed specific step-by-step plans to build the sustainability of HIV services for people living with HIV.

Round 7 of the Harm Reduction Academy has successfully started with the participation of the project team from Belarus and Uzbekistan.

A baseline assessment has been carried out in 14 EECA countries, work on operational monitoring of drug availability is ongoing, #SoS_project partners represent the project at new sites and events.

Moreover, #SoS_project now has visual branding that considerably contributes to improving project visibility.

Thanks for your attention and enjoy reading the digest.

Read full digest on web browser

On December 6th, under leadership of Mayor of Kyiv Vitaliy Klitchko, EECA City Leadership Forum will take place in Kyiv. The Forum presents a unique opportunity to share successful HIV and Tuberculosis city response models and facilitate movement to ending these diseases in EECA cities. It will gather some 150 participants from 20 countries to speak about cities leadership in responding to HIV and Tuberculosis, challenges and successful solutions that have proven efficient. Several Mayors from Western European and EECA cities as well as representatives of city administrations, NGOs, national and international organizations and agencies, and academia are expected to participate in the Forum.

The Forum will be conducted in the historic heart of the city in Podil theater and will last from 9.30 to 17.00, followed by networking reception until 20.00. Agenda will include mayors’ high level panel discussion, presentation of successful city responses and innovation to fast-track city to 90-90-90, will feature inclusion of key populations in the city response. Detailed agenda with logistics note will be circulated at a later stage. The forum will have two working languages: English and Russian, simultaneous translation provided.

The meeting will give the broadest space for communication on city HIV and TB responses in EECA and will provide an opportunity for panel and unofficial communication and networking.

We would be honored to have the pleasure of your participation in the Forum.
For more information please contact Ievgen Kushnir

There is a replenishment in the global community of cities that have adopted the strategy to accelerate the fight against the HIV/AIDS epidemic (#FastTrackCities): on August 21, the authorities of Kyrgyz city Osh signed the Paris Declaration. Thus, a new important milestone has been achieved for the #SoS_project team. That is one more step for the Eastern Europe and Central Asia countries to approach a salvation of more than 280 thousand people living with HIV by sustainable HIV services provided.

Representatives of the Ministry of Health of the Republic, city authorities, UNAIDS subregional office for Central Asia, Alliance for Public Health, as well as other international and non-governmental organizations attended the signing ceremony.

The Deputy Mayor of Osh, Nurbek Kadyrov, on behalf of the city authorities expressed his readiness to assume all obligations and actively cooperate with partners. The city hall has already approved a social order program for 2019-2020, where one of the main goals is to fight against HIV/AIDS, tuberculosis and hepatitis. Representatives of the city authorities expect that, together with partners and with the support of international organizations, by 2021 they will achieve 90-90-90 goals, and by 2030 the city will end the epidemic.

Currently, 1215 PLHIV are registered in Osh (more than 21.5% of the total number in the country), and 373 of them receive treatment. “This is very small number. We have something to work with,”Nurbek Kadyrov emphasized. – Therefore, we are ready to move in this direction. We don`t want the Paris Declaration to become a simple declarative statement, so we will work with partners on the municipal program with specific goals and with an appropriate roles distribution.”

As of August 1, 2019, about 9.3 thousand cases of HIV were officially identified and registered in Kyrgyzstan, more than 2 thousand people died, almost 80% of PLHIV know their status, 62% of them receive therapy.

Aybar Sultangaziev, Association “Partnership Network” Director, also shares the optimism of the city government representative: “At the very beginning, when we were starting to raise the issue about the Paris Declaration signing – we didn’t have a clear idea what it actually was, – he recalls. – And although local authorities were involved in the processes, so far, we didn’t have close interaction with the public sector. I hope that now we will work closely together. What normally has to be done in 5 years, we will do in 3.”

Andriy Klepikov, Alliance for Public Health Executive Director, noted that Kyrgyzstan has set a clear example for other countries and the highest level of commitment to the fight against AIDS in Central Asia. Indeed, this is the only country in the region where the two main cities – Bishkek and now Osh, have confirmed their strategic intention to stop HIV/AIDS.

“The signing of the Paris Declaration does not imply shifting all responsibility for the response in the fight against HIV / AIDS to the city only. On the contrary, it is a mechanism for attracting additional resources and international expertise that will accelerate the municipal response of the epidemic, he said. “For our part, the regional team #SoS_project, for our part, guarantees support for this process and its further steps.”

According to Mr. Klepikov, it is very important to treat the signing of the declaration, which is a political document, not as a goal, but as a tool to achieve victory over the epidemic. And without the active efforts of all parties, achieving this will not be easy.

“It is important to fill the obligations of the city authorities with joint efforts so that they work for the global goal that all countries of the world have signed up to achieve global goals 90-90-90,” he said. “We would like to emphasize the importance of interaction between the public sector, non-governmental organizations and international structures.”

The Joint United Nations Program on HIV/AIDS representatives also expressed their support  to Osh city. UNAIDS Country Director Meerim Sarybaeva, who became the second signatory to the declaration, emphasized that Osh has always been in a good position, often ahead of other major cities in the country and in the region.

“Given the epidemiological situation, we see that a lot is being done,– she said. – I hope that the signing of the Paris Declaration will make treatment and prevention even more accessible, more people will be tested for HIV, thereby creating a favorable environment in the city. The City Hall initiative will help to all prevention programs move forward, thereby creating an environment without stigma and discrimination, involving all vulnerable segments of society, all possible parties that should be participants in this process. Respecting human rights, we will achieve all our goals.”

The Republican government, in turn, at the legislative level supports the initiatives of local authorities to combat the HIV/AIDS epidemic, adopting the necessary documents and following the World Health Organization (WHO) protocol recommendations. The country approved the government program “Human Health – A Prosperous Country” until 2030, in whichHIV control occupies a leading position. In addition, state programs on HIV are adopted every 5 years. All important events are planned, and the 90-90-90 strategy is adopted in the latest program for 2017-2021. This was explained by Sharipa Suvanalieva,a leading specialist of the Ministry of Health.

“The peculiarity of the program is that the executor is not only the Ministry of Health of the Kyrgyz Republic and health authorities, but also other ministries and departments. Moreover, municipal authorities are of great importance,– said Ms. Suvanalieva. – Testing coverage is carried out for all population groups, mainly pregnant women and their sexual partners. For the first time, the country allocated funding in the amount of 3 million soms (about $ 43,000) for non-governmental organizations that conduct prevention programs. And the curtailment of laboratories amount, from 48 to 11, helped to increase their effectiveness. In order to increase coverage, 17 clinical protocols will be reviewed in accordance with the WHO recommendations. A list of vital drugs is regularly updated. Well and, besides everything else, we are working towards commitment – we have developed a plan to attract people who refuse treatment.”

To recall, in July Bishkek also joined Paris Declaration. Thus, Kyrgyzstan became the first country in Central Asia, where two cities at the political level declared their intention to defeat HIV and achieve 90-90-90 goals.

The Paris Declaration assumes that the city commits itself to do everything to achieve 90-90-90 by 2020. This means that 90% of all residents should be tested for HIV, 90% of infected should receive treatment, and 90% of them should have zero viral load (the virus must be completely suppressed). According to the World Health Organization, by 2030 the world will be able to stop the HIV epidemic.

#SoS_project introduces a new online system – REAct (Rights + Evidence + ACTion) in 4 countries of Eastern Europe and Central Asia. It is supposed to increase the effectiveness of efforts in the key groups and people living with HIV (PLHIV) rights protection.

The online tool REAct  is being launched by the Alliance for Public Health within the regional project “Sustainability of Services for Key Groups in the EECA Region” (aka #SoS_project) to document and promptly respond to human rights violations. In August – September training events will be held in Kyrgyzstan, Tajikistan, Georgia and Moldova.

Frontline AIDS (UK) is the REACT system’s developer and technical partner #SoS_project team to implement tool in EECA Region.

“We hope that REAct, as an innovative, easy-to-use and secure tool for documenting cases of violation of key groups and PLHIV rights, will help to collect, register and resolve even more cases, to provide legal support systematically and urgently, to analyze violations of rights, to recommend and lobby for legislative changes. As a result, we will be able to help more people. We are confident that our collaboration with the country and regional partners will be productive and beneficial for all stakeholders and the most important – for all clients,”  said Victoria Kalyniuk, REAct Regional Coordinator within #SoS_project, Alliance for Public Health.

The first country in the EECA region to start working with the system is the Kyrgyz Republic. Participants of the training, which is to be held on August 12-15 in Kyrgyzstan, will discover the opportunities and develop practical skills in using the databases, monitoring and reporting, as well as softskills to improve interviewing of victims.

“The event is attended by representatives of NGOs, the state and donor organizations that work in the field of human rights in our country. One of the important tasks that we all need to solve at this stage is how the proposed system can be effectively integrated into ongoing activities in the country, how it can increase the effectiveness of ongoing work to uphold the rights of those who need it,”  says Aybar Sultangaziev , Executive Director of the Partnership Network Association.

According to Mr. Sultangaziev, in Kyrgyzstan it is planned to implement a REAct system in cooperation with the Street Lawyers Project. For more than 3 years, almost all NGOs working in the country in the field of HIV / TB have been using an institution of public defenders. It involved 23 public human rights defenders from key population groups that work in all regions of Kyrgyzstan, recording more than 1000 cases annually.

“As a result, we will be able to respond more quickly to violations and to receive expertise from around the world to develop the experience of our human rights defenders,” says Aybar Sultangaziev.

Aibek Bekbolotov, deputy director of the Republican AIDS Center, takes part in the training. In his opinion, the REAct system is of significant interest for the country in the context of improving the situation with human rights. At the same time, Mr. Aybek notes that for the effective implementation of this tool in countries, the #SoS_project team needs to engage the state by increasing the interaction and showing the need for and advantages of this system, as well as to promote the exchange of reports to validate cases and to gain more support at the state level.

Elmira Djorbaeva, Ishenim Nuru Public Foundation (Tokmok) reflects about the training: “I like that there will be less paper work. As a leader of the organization, I am glad that through this program I will be able to monitor my social workers. In my opinion, REAct – is not only about documentation, but also about the effective organization of the working process and management. ”

It is important to say that due to the online format, high level of data protection, easy-to-use format and variety of opportunities, the introduction of the REAct system will let us to reduce significantly existing legal barriers and to guarantee the most important human rights for access to HIV prevention services, and also to improve care and support services.

“I am convinced that the training itself and the subsequent implementation of the electronic system, in addition to the activities that are already being carried out in Kyrgyzstan, will allow us to institutionalize the existing active work.

In addition, the government of the country and the Ministry of Health actively support even at this early stage all key processes in order to introduce innovations related to electronic tracking. Representatives of the Ministry of Health even suggested us to consider in the future the possibility of integrating these bases with the base of the Ombudsman, law enforcement agencies, so that the response to violations of rights will be prompt, “Aybar said.

Sharipa Suvanalieva, a leading specialist of the Public Health Department of the Ministry of Health of the Kyrgyz Republic, noted that there is currently a great demand for digital databases in Kyrgyzstan and online monitoring using functional IT developments, and the Ministry of Health is interested in implementing modern online systems in its work. She said that she will monitor the implementation of REAct by national NGOs and in the future it will be possible to consider the institutionalization of these processes at the state level.

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The event in Kyrgyzstan is held by the Partnership Network Association with the support of the Alliance for Public Health, as part of the regional project “Sustainability of services for key groups in the EECA region” (aka #SoS_project).

SoS project implementation team: Alliance for Public Health, Association Partnership Network, (Kyrgyzstan),  SPIN plus (Tajikistan),  Georgian Harm Reduction Network (Georgia), Initiativa Pozitiva (Moldova), regional community networks Eurasian Harm Reduction Association and Eurasian Coalition on Male Health  with technical support Frontline AIDS.

On the 26th of July 2019, Alliance for Public Health in partnership with local organizations in over twenty cities of Ukraine held an all-Ukrainian awareness raising event dedicated to the World Hepatitis Day observed on July 28 every year. 

During the event, anyone willing had the opportunity to take a free rapid test for hepatitis C virus at mobile ambulatories, get a qualified consultation from doctors and social workers, read information on transmission paths, specifics of the testing, prevention and treatment of viral hepatitis.

In the nearest time, it is planned to test about 3 thousand people for HCV as a part of the all-Ukrainian event. That number includes 500 people to be tested during the central event in Kyiv near the Peoples’ Friendship Arch, close to the newly opened Bicycle-Pedestrian Glass Bridge.  For this purpose, 4 mobile ambulatories staffed with respective medical personnel were working there today. Results of the anonymous rapid testing were available in 10-15 minutes.

According to preliminary results, 18 of 196 tests (9%) proved positive, including 11 persons (6%) who learnt about their problem for the first time! (the information is updated)

Experts estimate that over 300 million people around the world suffer from viral hepatitis, incl. 71 million people with hepatitis C virus (HCV). Every year, more than one million people around the globe die from viral hepatitis. 

Ukraine is among the “leaders” in terms of incidence of hepatitis B and C in Europe.  According to WHO and national experts, 3% to 5% of Ukrainian population (more than 2 million people) are infected with hepatitis C.  90% of the infected are not aware about their condition, as hepatitis virus can live in human body for years, ruining human’s health.

However, in case of timely diagnosing and beginning of treatment, hepatitis C is not a deadly disease. Modern medications allow successful treatment of most patients.

This is why organizers of the event tried to emphasize the importance of spreading reliable information about viral hepatitis (Know!); draw people’s attention to basic prevention measures (Prevent!); and stress the importance of testing for viral hepatitis, as this is vitally important to prevent late stage disease manifestations (Get tested!). The times when treating HCV was extremely expensive and ineffective have passed — new, effective medications are available now (Get treated!).

Several years ago, Alliance for Public Health implemented a program of highly effective HCV treatment with modern direct-acting antivirals. At the time, they were largely unknown in Ukraine.  Their advantage is in being well-tolerated by patients, causing almost no adverse effects and providing very high effect through a three-month treatment course!

“In the last 4 years, under an innovative pilot project of the Alliance, almost 2.2 thousand people from among the most vulnerable populations in 19 oblasts of Ukraine have received services of diagnostics and free treatment of viral hepatitis C with modern drugs. Thanks to that, 98% of patients have completed the full course of treatment and 95% have been cured. Recently, we have provided HCV testing for 1000 inmates of Ukrainian prisons and further diagnostics and treatment for 50 inmates, of whom 49 have also been cured. Unfortunately, it has been three years since Ukraine had a special state program to fight viral hepatitis, but the resources available for the state now allow completely solving the problem”, said Pavlo Skala, Policy and Partnership Director of ICF Alliance for Public Health.

Continuous work to reduce the prices has now made modern medications affordable for Ukrainians.  The Ministry of Health procures drugs at world’s lowest prices. According to the MoH, the largest batch of HCV drugs in the recent years has been procured and is already being distributed to the regions.  In the nearest future, over 7 thousand patients will be able to receive free innovative treatment involving taking pills daily for three months.

Taking a rapid test for viral hepatitis takes 10 minutes and can be done even at home — for that you need to buy a usual rapid test at a pharmacy. Just keep in mind that a positive result of a rapid test for HCV is not the final diagnosis. You need to see a doctor immediately!

“Know! Prevent! Get tested! Get treated!”

National hotline on viral hepatitis: 0-800-50-33-10 

(all calls are toll-free within the borders of Ukraine)

According to expert estimates, more than 2 million Ukrainians are infected with hepatitis C and over 600 thousand – with hepatitis B.             According to official data of the MoH of Ukraine as of 01.01.2019, there are 82 564 persons in Ukraine with HCV and 23 687 with HBV, which is 5.2% and 3.4% of the estimated numbers respectively. This means that the other infected people are unaware of their diagnosis, as in 80% of cases the disease is asymptomatic.

One of priority activities of ICF Alliance for Public Health is fighting the spread of the epidemic of hepatitis C virus in Ukraine and providing diagnostics and treatment of HCV for vulnerable populations.  Since 2015, it has been the support from the Alliance that allowed hundreds of HCV patients to receive modern treatment free of charge, after which the MoH of Ukraine started procuring similar medications with public budget funds.

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On July 15-17, Tbilisi hosts the regional #Advocathon 2019  “Advocacy and HIV”, the first event of this format to be held in Eastern Europe and Central Asia. Eight country teams representing  #SoS_project from Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan and Uzbekistan will get together to develop advocacy plans to ensure the sustainability of HIV services in the EECA region.

The non-standard format of the event will allow to unite the unique experience of representatives of NGOs, governments, the expert community and PLHIV to create innovative solutions to problems in the field of public health financing and HIV-prevention projects in the EECA region.

Sergey Filippovich, Director of the regional  #SoS_project at the Alliance for Public Health: “This is one of the key activities of #SoS_project in the context of budget advocacy building the understanding of the problems we are facing and supporting the public sector to mobilize national resources. To support advocacy efforts of countries we will direct all available resources, including regional information campaign to be launched in autumn. The main goal of the information campaign is to change the format of communication and build a new history of dialogue between the state and the civil sector.”

It should be noted that the teams will consist of representatives of NGOs, associations of HIV-positive people, community-led organizations, key groups representing participating countries, as well as representatives of the public sector.

Dmitry Sherembey, Head of the Coordination Council of the CO “100% Life”: “Here we gathered the leading experts in the field of HIV / AIDS from the EECA region, who do very important work every day. Our work has a human dimension and  very concrete result – the saved lives of patients. The goal of our meeting here is to unite all parties concerned to write a victory plan, a plan that will help us stop the epidemic. And we will not look for patterned and simple solutions, because we are realize clearly for whom we work and the scale of the problems we are facing. And those problems require innovative approaches and  thinking outside the box.”

As the result of their work the teams will present specific budget advocacy projects in the field of HIV financing aimed at strengthening the capacity of the communities and achieving the sustainability of HIV response programs in the countries of the EECA region.

Advocathon is an interdisciplinary workshop event, during which participants specializing in various issues will work in mixed teams to solve problems related to the topic of the event with the direct mentoring and support of leading experts of the region.

The event was organized in the framework of the project “Sustainability of Services for Key Populations in the Eastern Europe and Central Asia Region” (aka #SoS_project), implemented by a consortium of organizations from countries of the EECA region under the leadership of the Alliance for Public Health  in partnership with the charitable organization “100% of Life”, Central Asian Association of People Living with HIV and the Eurasian Key Populations Health Network.