On December 10, in Istanbul (Turkey), the international HEALTH SUSTAINABILITY FORUM: HIV and COVID-19 in the countries of Eastern Europe and Central Asia (EECA) will be held virtually. Official site of the forum and broadcast: http://forum.aph.org.ua/en/.

“In the context of countries’ transitioning to the national funding, the issue of sustainability of HIV services has been widely discussed in recent years both at the regional and international levels. Countries are reforming their health systems, and many are quite successful, but with the advent of COVID-19, the situation has found a new “player”, says Andriy Klepikov, executive director of the Alliance for Public Health. “We need to use all proven tools to prevent HIV transmission and save the lives of 1.6 million people living with HIV in our region.”

150 experts, including ministers of health, mayors and vice-mayors, representatives of international, national government and non-governmental organizations will meet for an urgent dialogue on the main aspects of the forum:

• Progress of the region in the fight against HIV over the past 3 years. Introduction of new technologies, practices and points of application of efforts.
• Donor and national funding for HIV / AIDS services during COVID-19, incl. in case of crisis situations.
• Budget advocacy strategies: how communities managed to secure an additional over $ 30 million for HIV services in Eastern Europe, Central Asia (EECA) and the Balkans.
• Reducing the price of ART: how countries managed to save $ 119 million by increasing only in 12 focus cities of the #SoS_project, at least 72 thousand people with HIV the chances of life by providing ARV therapy.
• Human rights protection in the EECA region: focus from problem to solution, 6000+ registered cases of human rights violations and their solution. Regional Commission on Drug Policy.
• Building partnerships with governments and the role of political leadership of city mayors in the fight against HIV / AIDS.

“In the countries of our region, we have an explosive mixture with low coverage of COVID-19 vaccines, very low testing rates, but high incidence rates. In the situation with HIV / AIDS, things are not going well: the EECA region is the only region in the world where new HIV cases continue to grow rapidly, and treatment coverage remains at 53%”, Andriy Klepikov emphasizes.

“But there is definitely progress. Thus, over the past three years, an additional $ 35 million has been allocated in the countries of EECA and the Balkans for HIV / AIDS programs, and more than 72,000 people began to receive ARV therapy for the first time. And this is only within the framework of #SoS_project, implemented with partners in 14 countries of the region. Therefore, I believe that with a general, thoughtful approach to solving urgent problems, starting with the authorities at the municipal level and ending with the international one, the achievement of the UN’s 95-95-95 HIV/AIDS Strategic Goals is absolutely real ”.

The forum program includes a press conference “Key to sustainable health system in the cities: HIV, COVID-19 and migrant health”, which will be held live on the website http://forum.aph.org.ua/en/, with the participation of mayors and vice-mayors of EECA cities.

Geography of the forum participants: 21 countries of Central and Eastern Europe and Central Asia (CEECA) and the Balkan Peninsula: Czech Republic, Belarus, Bosnia and Herzegovina, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Macedonia, Moldova, Montenegro, Netherlands, Poland, Romania, Russia, Serbia, Switzerland, Tajikistan, Turkey, Ukraine, Uzbekistan.

Forum is held by: International Charitable Foundation Alliance for Public Health, with financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria and information support from UNAIDS.

The event will be broadcast live in English and Russian on the website http://forum.aph.org.ua/en/ and on the official pages of the Alliance and UNAIDS on Facebook and YouTube.

In 21 years of work, Alliance for Public Health has provided for detection of 70% of new cases of HIV in Ukraine 

Statement on the occasion of the World AIDS Day

Despite the challenges caused by the COVID-19 epidemic for a second year in a row, we still insist that a smart innovative approach to prevention with involvement of traditionally poorly reached populations with a due consideration of specifics of working with them makes achieving United Nations’ ambitious 95-95-95 strategic target for HIV/AIDS¹ totally realistic.

From the very first days of our work in Ukraine, this topic has been the key one for the APH, and it is not without the reason that on the 1^st of December the APH celebrates its 21 years of intensive and very interesting work. We have always been and still remain at the frontline of fighting the epidemics: in 2021, 70% of all newly detected HIV cases in Ukraine were detected by the Alliance, and our contribution to the cascade of treatment was as high as 55%!

We started our work back in those years when virtually all HIV response activities were funded by international donors, and were able to witness how the state was becoming a powerful actor in this area. And now, when some of the services (such as prevention, care and support) are already funded by the government using models created by civil society organizations, we remain a strategic partner in the national response to the epidemic, always willing to give a hand whenever expert support or implementing and piloting innovative models are required. In 2021, the APH has started implementing a new component, “Reaching hard-to-reach key populations” using the peer intervention model, among key population. The goal is to track social connections in key populations and improve their involvement in state-funded basic guaranteed prevention programs. Activities implemented by the APH are complementary to the prevention programs funded by the state, which allows the clients to receive extra services not included in the basic package. A good example is the format of the HCV treatment program for HIV-positive members of key populations implemented in 2021, where the state and the APH act as implementing partners. Under this model, the state procures and supplies medicines, while the APH finds patients and refers them to HCV diagnosing and treatment, providing also for social support and information. Based on this model, in 10 months of 2021, more than two thousand of HIV-positive patients have received a comprehensive service package, including 1.6 thousand who have already completed the treatment.

Thanks to implementation of a number of innovative projects, HIV service cascade for people with drug dependence has improved significantly: from 58-91-73-74 (aware of the status – linked to care – receiving ART – achieved undetectable viral load) in 2017 to 64-94-92-82 according to a bio-behavioural study of 2020.

The APH remains at the frontline of supporting patients of substitution maintenance therapy: of 16478 persons receiving the treatment, 5.6 thousand (33%) receive psychosocial support, which has led to reaching a high figure of 95.6% of HIV+ SMT patients on ART. We also advance pre-exposure prophylaxis services: thanks to the social support services, in the first 10 months of 2021, almost 3000 persons have started PrEP, which is an important step for preventing HIV. 130 thousand young people have received information and counselling on harm reduction and sexual health on Drugstore, an innovative digital platform.

25 mobile ambulatories of the APH successfully provide HIV/STD prevention services to members of key populations in remote towns and villages, in the night, and during the lockdown, moving the services closer to clients.

For a second year in a row, we have been working during the pandemic, yet it does not restrict our activities; instead, it makes us develop new ways and model of work. Adjusted working hours, moving activities outdoors, appointments, queue management, providing medical masks and disinfectants to staff and clients, remote counselling — those were the methods to ensure uninterrupted provision of HIV prevention services in 2021. Thanks to advocacy activities of the APH and thorough work with public and non-government partners, almost 90% of SMT patients started receiving takeaway drugs during strict lockdown, which allows reducing the risk of treatment interruption when epidemic response measures are levelled up. Some new activities are introduced: transporting clients to healthcare facilities, delivery of PrEP drugs by post, providing support and home nursing to clients with disabilities, supporting key population members receiving outpatient treatment of COVID-19 and being on self-isolation.

The APH has made a significant contribution to HIV response on the international level as well! Under Fast Track Cities initiative, in January-June 2021, in 12 cities/regions in Eastern Europe and Central Asia, the number of diagnosed PLHIV has increased by 14%, and the number of PLHIV on ART has grown by 12%. Despite competition for resources with other fields of healthcare, national funding of HIV/AIDS programs has been increased: for the first time ever, Tajikistan has provided funding for social contracting of support for ART patients ($11.5 thousand), and in North Macedonia, advocacy helped achieving a 42.5% increase of funding of the AIDS program in 2022 (from EUR 1.42 million to 2.02 million).

On the World AIDS Day, the APH reaffirms its commitment to fighting the epidemic and its willingness to continue being an active partner to the state and the international partners in producing effective ways to implementing comprehensive HIV prevention programs and ensuring maximum state funding for them!

¹ According to the Fast-Track strategy of the UNAIDS, by 2030, 95% of HIV-positive people are to be aware of their status, 95% are to have started antiretroviral therapy, and 95% of those receiving the treatment are to have achieved maximum viral suppression (when the viral load is undetectable).

Belgrade (Serbia) – today, on the eve of World AIDS Day at the National Conference “Inequality. AIDS. Pandemic. – LET’S PUT A FULL STOP” seven Serbian cities at once joined the Fast-Tack Cities international initiative and signed the Paris Declaration.

Earlier, three cities of Serbia have already supported the international initiative to improve the health of citizens Fast-Track Cities: Sombor, Kragujevac, Zvezdara. Today they are joined by Subotica, Novi Sad, Sabac, Stari Grad, Zajecar, Novi Pazar and Nis, making Serbia the leader of the Balkan states and the second country in the world by the number of partner cities of the Paris Declaration!

Konstantin Voytsekhovich, UNAIDS EECA advisor, “It is my great honor to address you on this occasion. After today Serbia will become the 2d biggest country in Europe with the biggest number of cities and municipalities who have joined the Paris Declaration. Serbia is a leader in Eastern Europe in terms of concentrating fast-track response of HIV, actions in the cities and I would like to thank Mayors and municipalities who have decided to take a bold step to join Initiative and to sign the Paris Declaration today. It means, that access and treatment for people, living with HIV will be improved, but their concerns will be honored and addressed by the authorities. People will be able to live healthy and productive lives, being included in the society and communities. On behalf of UNAIDS Regional Ofiice I want to add only one more thing – welcome to the family!”

Andriy Klepikov, Executive Director of Alliance for Public Health: “I want to congratulate cities, but first of all – people, living in it for this big step forward. Signing Paris Declaration is very important and very timely, because it is the end of the year, we plan budgets for the next one, because we expect that signing Declaration will be turning into action. And usually city approves HIV/AIDS program, then approves the budget and then funding goes to the most need – key and vulnerable populations through civil society organizations. We welcome the Serbian municipal leadership. Serbia has significantly strengthened its commitment and response to AIDS since 10 cities signed the Paris Declaration!»

The signing ceremony was attended by over 70 guests, including representatives of the Serbian Ministry of Health, the Ministry of Labor, Employment, Veterans and Social Affairs, the Ministry of Human Rights and Social Dialogue, the World Health Organization, the Joint United Nations Program on HIV / AIDS (UNAIDS), as well as The Serbian Institute of Public Health, the Alliance for Public Health and leading NGOs from the country and region of Southeast Europe.

Also, Andriy Klepikov presented the #InYourPower regional award to representatives of the new Fast-Track Cities partner cities.

***

Conference “Inequality. AIDS. Pandemic. – LET’S PUT A FULL STOP ”is organized by Timok Youth Center in the framework of the project “Sustainability of services for key populations in Southeast Europe and Central Asia” (#SoS_project), with the support of the Alliance for Public Health.

Another important step towards accelerating measures to overcome the HIV epidemic at the municipal (and, therefore, global) level: on November 25, 2021, Kryvyi Rih (Ukraine) signed the Paris Declaration and joined the FastTrackCities – Ending the AIDS epidemic program.

The ceremony was attended by members of the mayor’s office of Kryvyi Rih, representatives of the Alliance for Public Health, ICF “100% of Life”, the Joint United Nations Programme on HIV/AIDS (UNAIDS).

“The Alliance for Public Health has supported HIV prevention programs for years with funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US Centers for Disease Control and Prevention (CDC). This is a rather extensive program on a national scale, probably one of the five largest city programs. Since the HIV epidemic in Kryvyi Rih is large enough, many need treatment. And there is still a large part of the city’s citizens that do not know about their status, that they are infected. Our program helps to test undiagnosed cases and start treatment as soon as possible. HIV is not such a terrible disease as it was 20 years ago, but there is still a stigma of this disease among the population. Therefore, our task is also to make people not afraid, understand that you can get effective treatment and be healthy for many years, even with HIV status,” – says Pavlo Smyrnov, Deputy Executive Director of the Alliance for Public Health ICF. “We welcome the signing of the Paris Declaration by Kryvyi Rih, because with all the funding that will come from international organizations, from the state budget, the most important thing is leadership on municipal level. This is the most important ingredient for success, because programs become effective only with a strong city government that directs and coordinates these efforts and uses their leadership potential to achieve such results.”

The Alliance for Public Health made a significant contribution to the development of the city of Kryvyi Rih in the fight against HIV / AIDS. Based on the key results of project implementation in 2021:

• more than 15 million hryvnias were allocated for the operation of projects in the city of Kryvyi Rih;
• purchased and supplied medical equipment, personal protective equipment against COVID-19 in the amount of about 5 million hryvnia;
• with the support of the Alliance in Kryvyi Rih, a mobile outpatient clinic is operating, implementing the OCF CITI / CIRI (MCF) project;
• separate funding has been allocated for a program to detect tuberculosis among representatives of vulnerable groups (homeless people, ex-prisoners, people who inject drugs and contact persons) and equipping the OST site.
• as well, in recent years in Kryvyi Rih, 450 patients – representatives of key groups of the city’s residents – were discovered and redirected for diagnosis and treatment of viral hepatitis C. In 2021, the Public Health Foundation, in terms of the number of detected and treated cases of viral hepatitis C among PLHIV, is the undisputed leader among NGOs in all regions of Ukraine. It is the only NGO that in 2020 ensured 100% adherence of patients to treatment and 100% effectiveness of HCV treatment among PLHIV.

On behalf of the city, the document was signed by Yuri Vilkul, Secretary of the City Council, acting Mayor of Kryvyi Rih: “I believe that this is really significant support for our city and an assessment of the work of all our departments, public organizations in the prevention and treatment of HIV/AIDS. There are no trifles in such a question – this is the life of people. No one in the world is immune to get infected with HIV. And the task of the mayor is to make prevention and treatment possible. And the city undertakes not only to sign the declaration, but also to fulfill what it says.” He was supported by the co-signer of the declaration – Roman Gailevich, UNAIDS Director in Ukraine: “Kryvyi Rih has become the fourth city in Ukraine to join this important global initiative. I hope your city will become the first city in Ukraine to achieve fast track goals.”

The city’s initiative in the fight against HIV was also recognized with a special regional award #InYourPower – it was presented to Yuri Vilkul by Pavl0 Smyrnov.

In 2022, the Alliance for Public Health plans to support the work of many areas in Kryvyi Rih worth more than UAH 13 million aimed at improving the detection and treatment of HIV, TB, supporting the operation of a mobile outpatient clinic, ensuring the continuity of services in conditions of quarantine measures and outpatient treatment through COVID-19.

***

The Fast-Track Cities initiative is a global partnership between cities and municipalities around the world and four core partners – the International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Human Settlements Programme (UN-Habitat), and the City of Paris

Thursday November 18, 2021, (Warsaw, Poland)— A group of distinguished personalities from the Eastern European and Central Asian region led by the Former President of Poland Aleksander Kwaśniewski,  today launched the  Eastern and Central European and Central Asian Commission on Drug Policy (ECECACD), a new independent regional body  set up to bring  evidence -based scientific data to the table  to initiate honest conversations with decision-makers in the countries of the region.

The region is home to an estimated 3 000 000 people who use drugs— one quarter of all people who inject drugs worldwide and is also one of two regions in the world where HIV infections continue to increase.

“As a member of the Global Commission on Drug policy, I am proud to see how political mobilization and commitment can, and have, changed drug policies to be more evidence-based and human rights oriented,” said President Aleksander Kwaśniewski who will also chair the new body. “That is why I am inspired to initiate a Regional Commission on Drug Policy—one that will focus on the specific epidemiology of the region.

“My fellow Commissioners and I are all joining the ECECACD to learn some more with the aim of initiating an open, evidence-based dialogue that helps to promote a more balanced and human rights approach to drug policy in the region.”

The ECECACD will feature the following Commissioners:

• Aleksander Kwaśniewski, Former President of Poland (Chair)
• Michel Kazatchkine, Former Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland
• Pavel Bém, Ex-Mayor of Prague, Czechia
• Vytenis Andriukaitis, WHO Special Envoy for Europe, Lithuania
• Elvira Surabaldiyeva, former Deputy Prime Minister Kyrgyzstan, Kyrgyzstan
• Andris Piebalgs, Adviser to the President of Latvia and former European Commissioner for Energy (Barroso I) and former European Commissioner for Development (Barroso II), Latvia
• Elena Pinchuk, Founder, Elena Pinchuk AIDS Foundation, Ukraine

In recent years, independent Regional Commissions have been set up in Latin America, under the leadership of Fernando Henrique Cardoso (Brazil), and in West Africa – West Africa Commission on Drugs, under the leadership of Kofi Annan.

ADDITIONAL INFORMATION

The first analytical reports of the Commission:

• Drug laws and policies in four regions of Eurasia
• Perception of drugs in Central and Eastern Europe and Central Asia: overhaul needed
• Production, trafficking and consumption of illicit drugs in EECA region

Drug Policy and health in the ECECA region

Central and Eastern European countries and Central Asian countries face prevailing problems associated with the trafficking and transit of illicit drugs from Asia and Latin America, mostly to EU member states, as well as with drug use of locally produced synthetic opioids and new psychoactive substances.

Approximately half of all new HIV infections occur among people injecting drugs (PWID). One in seven PWID is living with HIV and one in three is infected with hepatitis C.

The region is home to 3 000 000 people who use drugs — that is one quarter of all people who inject drugs worldwide.  And 66% of whom are living in Russia and 77% in Russia and Ukraine together. Unfortunately, access to harm reduction and health services remains limited. In some countries harm reduction services do not sufficiently cover the number of people who use drugs. A number of countries in the region still have no harm reduction services at all.

The Central and Eastern European countries and Central Asian countries face prevailing problems associated with traffic and transit of illicit drugs from Asia and Latin America mostly to EU member states, as well as with the use of locally produced synthetic opioids and new psychoactive substances.

Across the region, drug policy is primarily focused on the reduction of drug supply and demand, through law enforcement programs that aim to end illicit drug markets and stop consumption. Repressive and punitive polices are applied to people who use drugs, imposing severe criminal sanctions.

This imbalance between repression and care is reflected in the region’s legislation, and has led to a range of negative consequences: growing HIV, hepatitis and tuberculosis epidemics, widespread corruption in law enforcement agencies, economic waste, etc.

The region is one of two in the world where HIV infections continue to increase. Approximately half of all new HIV infections occur in people injecting drugs (PWID). One in seven PWID is living with HIV and one in three is infected with hepatitis C.

The criminalization of drugs and drug use is the main cause for an increase in prison populations in EECA countries. Arresting and putting people who inject drugs (PWID) in prison is both expensive and associated with an increase in HIV infections.

A simple shift in resources from criminalization to harm reduction approaches, would ensure economic savings and more HIV infections averted. Accordingly, to the recent research by The Economist – over a 20 year period (2020-2040) the cost savings accrued from decriminalizing can buy antiretroviral therapy (ART) and opioid agonist treatment (OAT) to control the current HIV epidemics in people who inject drugs (PWID) in Belarus, Kazakhstan, Kyrgyzstan and Russia.

Reinvesting saved costs (that is €773m over 20 years) into scaling up antiretroviral therapy (ART) to 81% coverage and opioid agonist treatment (OAT) up to 40% coverage as per UNAIDS/WHO guidelines—would ensure a decrease in HIV incidence in PWID by 79.4-92.9% over 20 years.

That is something governments cannot ignore!

According to the data, collected through the REAct (instrument for the community-led monitoring of most marginalized groups’ human rights violations), one out of every three cases of such violations registered in EECA region involves police and law enforcement agencies severely violating fundamental human rights such as the right to life, freedom, and bodily integrity.

Moreover, every third detained drug user experiences torture or other cruel, inhuman or degrading treatment during arrest or detention. In order to make detainee collaborate in the investigation or to obtain confessions, police officers impede access to opioid-substitution therapy, causing unbearable suffering and abstinence syndrome to detained drug user.

In contrast to what we see in the region, many countries around the world have moved, or are moving away from  the “war on drugs” approach in  one  form or the other: Jamaica, Switzerland, Germany, Portugal, Uruguay, Canada, and Mexico are good examples.. These countries have acknowledged the failures of prohibition and therefore adopted new approaches to address the drugs issue through policies that protect human rights and address the drug-related harms more efficiently.

Within the ECECA region, Czechia, for instance, has one of the lowest rates of HIV infection among PWID (<1%), of overdoses (20 cases per year), and  low hepatitis infection rates. They have one of the smallest heroin markets in Europe, and people who use drugs are in contact with services.

Further Information: Inna Gavrylova, Alliance for Public Health, E-mail: gavrylova@aph.org.ua

The European Harm Reduction Conference has been held since 2011 and is one of the largest events in this area for representatives of civil society, communities of key groups, the medical staff, politicians, researchers and the media.

Marseille (2011), Basel and Amsterdam (2014), Bucharest (2018) have hosted the conference in the past. This year, the 5th European Harm Reduction Conference (#EHRC2021) by Correlation European Harm Reduction Network in close cooperation with the Eurasian Harm Reduction Association and the Czech organization SANANIM in Prague.

The Conference serves as a certain hub with the purpose to exchange experiences and different points of view on harm reduction, social inclusion and related topics, and is a platform for interaction at both the national and regional levels. From November 10 to 12, participants were presented with the latest research and development in the field of harm reduction, best innovative practices and achievements of global drug policy, as well as its impact on people who use drugs and other marginalized groups such as sex workers and people living with HIV.

At #EHRC2021, the Ukrainian delegation included representatives of Alliance for Public Health, the #SoS_project, other civil society organizations, as well as members of the government and the community of people who use drugs from several cities, making it the largest after the Czech one. Ahead of the Conference, the team took part in a workshop on HIV prevention, treatment and care among people who use stimulant drugs, organized by the United Nations Office on Drugs and Crime (UNODC), which aimed to increase the knowledge and capacity of participants, as well as developing effective strategies to ensure that people who use stimulant drugs have access to HIV services. Maria Malakhova, Alliance for Public Health: “Participation in this workshop was very useful. We managed to agree with the leading Czech organization in the field of harm reduction SANANIM on further cooperation and a study tour of stakeholders from Ukraine to the Czech Republic to learn more about the experience of this country and use it for a pilot project on substitution therapy for stimulants users in our country, which is planned under the next regional grant for 2022-2024 “.

The first day of the Conference was held in the context of establishing cooperation between Fast Track Cities partners and the UNITE Global Parliamentarians Network to End Infectious Diseases, which brings together current and former government officials, incl. Senates and Congresses, the European Parliament and other regional and international legislatures and operates in 75 countries around the world. The meeting was attended by Ricardo Baptista Leite, founder and president of the Global Network, MP of Portugal, Mariam Jashi, former MP of Georgia, representatives of UNODC, WHO, Alliance of Public Health, deputies of the Odessa City Council, Kyiv City Council, Vice-Mayor of Chisinau and Deputy Minister health care of Bosnia and Herzegovina. Discussions included potential collaboration between the participants, improving urban performance, and sharing best practices of municipalities in promoting harm reduction and drug policy change, with the aim of maintaining global health as a priority. “Alliance has been implementing Fast Track Cities approach since 2017. As per now, we’ve been fast tracking municipal responses in 30 cities in the EECA region by helping cities to develop municipal HIV programs aiming 95-95-95, to advocate for municipal funding allocation for KPs and to implement innovative and successful interventions.” – shared Ievgen Kushnir, Alliance for Public Health.

The role of cities and local governments in addressing public health, safety and social cohesion was highlighted in the plenary session “Fast track cities on harm reduction – local interventions make the difference” during the Conference, supported by the Alliance for Public Health.

As noted by Pavel Bem, ex-mayor of Prague and member of the Global Commission on Drug Policy: “Local authorities have a crucial role in addressing public health, urban security and social cohesion. They are at the forefront of reducing harm and implementing inclusive measures to tackle the unintended consequences of drug use for the individual and the public. At the same time, cities operate in the legal and social framework of national policies and facing contextual challenges such as economic downfalls, migration or the struggles with a global pandemics like HIV and COVID. Our goal is to discuss experiences, problems and solutions with leading experts and local authorities for mutual learning and exchange.” He was also supported by Tetiana Deshko in her video message to the session participants: “Role of cities in epidemics is absolutely clear: to give an example from my home country – 5 cities are home for 70% of people, living with HIV in Ukraine. The EECA region is going through a broad decentralization reform, which means that more and more resources and make-decision powers are available for mayors of the cities. And the choices that they make in response of HIV and drug-use is critically important.

As for today 26 cities in EECA region have already signed Paris Declaration and they have a willingness to respond HIV among key populations as well as they make concrete steps to make a relevant and strong response. What a bright example is Odesa. In 2017 the city developed a program to respond HIV and TB and allocated over $ 2 million for the 2-years period for OST therapy and syringe exchange through pharmacy. Other example – Belts (Moldova) developed a program and allocated municipal resources, as well as the city of Chisinau, the Osh city (Kyrgyzstan) is another bright example.

The investment into HIV and drug use responses have really proven to be a sustainable investment in favor of broader public health challenges the cities faced. Ten more cities joined Zero TB initiative and now jointly working on improving TB programs. They have become active on Hepatitis and when we were heat by COVID-19 epidemic they developed COVID-response programs for key populations. As an example: 3 cities in Ukraine (Kyiv, Odesa and Dnipro) received rapid reagent tests and immediately started testing key population groups, even before vaccine arrived. Likewise, Bosnia and Herzegovina cities became real allies of response for key populations while no one else where there.”

Tetiana Deshko, Alliance for Public Health Video message to the participants of “Fast track cities on harm reduction – local interventions make the difference” Panel Session on the #EHRC2021

Thursday, November 11, 2021, (Geneva, Switzerland; Warsaw, Poland)— A group of distinguished personalities from the Eastern European and Central Asian region will launch the  Eastern and Central European and Central Asian Commission on Drug Policy(ECECACD), a new regional commission set up to  inspire better drug policy in the region inspired by the Global Commission on Drug Policy.

The Regional Commission is an independent body chaired by Aleksander Kwaśniewski, former President of Poland and member of the Global Commission on Drug Policy.

The ECECACD will feature the following Commissioners:

• Aleksander Kwaśniewski, Former President of Poland (Chair)
• Michel Kazatchkine, Former Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland
• Pavel Bém, Ex-Mayor of Prague, Czechia
• Vytenis Andriukaitis, WHO Special Envoy for Europe, Lithuania
• Elvira Surabaldiyeva, former Deputy Prime Minister Kyrgyzstan, Kyrgyzstan
• Andris Piebalgs, Adviser to the President of Latvia and former European Commissioner for Energy (Barroso I) and former European Commissioner for Development (Barroso II), Latvia
• Elena Pinchuk, Founder, Elena Pinchuk AIDS Foundation, Ukraine

In recent years, independent Regional Commissions have been set up in Latin America, under the leadership of Fernando Henrique Cardoso (Brazil), and in West Africa – West Africa Commission on Drugs, under the leadership of Kofi Annan.

The ECECA region continues to have a mixed record on drug policy. More moderate public health approaches in countries like Czechia and Estonia contrast with a more oppressive policy in countries such as Russia and Belarus. HIV incidence continues to increase in Eastern Europe  accompanied by high rates of drug resistant tuberculosis (TB).

ENDS

What: Launch  the  Eastern and Central European and Central Asian Commission on Drug Policy (ECECACD)

When: 10:00-11:00 CET, (GMT +1)Thursday, November 18, 2021

Where: This media launch will  be a live Zoom event. Media can register here:

Who:

• Aleksander Kwaśniewski, Former President of Poland (Chair)
• Michel Kazatchkine, Former Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland
• Pavel Bém, Ex-Mayor of Prague, Czech Republic
• Vytenis Andriukaitis, WHO Special Envoy for Europe, Lithuania
• Elvira Surabaldiyeva, former Deputy Prime Minister Kyrgyzstan, Kyrgyzstan
• Andris Piebalgs, Adviser to the President of Latvia and former European Commissioner for Energy (Barroso I) and former European Commissioner for Development (Barroso II), Latvia

Further Information:

Michael Kessler

Michael Kessler Media

Mob: +34 655 792 699

Email:michael.kessler@intoon-media.com

The need for building sustainability in the context of the transition to national funding has been widely discussed over the past few years. Countries are reforming their health systems, but with the advent of COVID-19, other threats, such as HIV, have not disappeared, and in a number of countries the situation with detection and initiation of ARV treatment has become even worse.

We decided to find out how the region has progressed over the past 3 years and launch a new #SoS_project Small Talk, in which we want to discuss the key focuses of the ongoing efforts to achieve sustainability of HIV services in Eastern Europe, Central Asia, Southeast Europe with leaders of nongovernmental organizations. With those who are at the forefront of the fight against the HIV epidemic, and now COVID-19. They work closely with government agencies to ensure that 2 million people living with HIV in EECA and SEE countries have access to quality ARV treatment and key social services for HIV in a format that is convenient and safe in the context of the COVID epidemic.

The heroes of our SmallTalk set of interviews are international partners of #SoS_project, the largest regional Global Fund project in the EECA region. They are true Sustainability Leaders, whose daily work is aimed at creating it.

#SoS_project Interviewer is Aibar Sultangaziev, public figure, expert on public health reform, expert on access to HIV/TB treatment, chairman of the Partnership Network Association (Kyrgyzstan). Aibar’s experience in the field – over 15 years.

#SoS_project: Aibar, we can name you as one of the leaders in building the sustainability of national health systems in the EECA region. After all, you are included in all planning and reforming of health care processes in Kyrgyzstan in the context of HIV, tuberculosis and COVID-19. Even more – in many projects you are the Lead. 2019-2021 brought many challenges: a transition period from donor funding to the national one, COVID-19, restarting the human rights system in the country, etc. 2020 has transformed the world into a completely different reality. A lot has changed. And in this context, let’s talk about health sustainability. So, what is it?

AS: Nowadays a lot of people are talking about sustainability. What is it? – It is a state of a certain balance, a sense of confidence, security, predictability, or in simple words, a normal state, which is simply necessary for everyone to live a normal life, and the healthcare system is no exception. This balance is needed in order to fight effectively against the epidemic, create favorable conditions for people, save and extend the lives of citizens, providing both treatment and the necessary social services. Basically, health care balance is a matter of national security in any country. Its components are constantly changing and it is very important to track key parameters and influence them in a timely manner.

#SoS_project: And in the context of fight against epidemics, how is the sustainability of services in the fight against HIV/AIDS created? What specific improvements have occurred over the past 3 years in Kyrgyzstan, due to this fact? Please, give some examples.

AS: Improvement in sustainability is created by influencing on key points. For example, speaking of the major improvements that have come about through collaboration and our partnership on the Global Fund #SoS_project platform, I can highlight the following points.

Firstly, there has been an improvement in access to quality treatment for people living with HIV and optimization of direct costs to the country at the same time. So, according to a number of strategic steps with the support of the project, we managed to reduce the cost of the most common HIV treatment regimen – TLD, which is received by more than 80% of all people living with HIV (PLHIV – SoS_project note). The price has been reduced for the country to $ 5.55 for a month course! It is $ 66.6 per year in United Nations Development Program purchases and up to $ 7.8 for a monthly course ($ 93.6 per year) in public procurement. It saves a significant portion of HIV program funds. There is nowhere below. And the list of names of ARV therapy on the Kyrgyz market has been significantly expanded, which makes it possible to effectively compete and reduce prices.

Secondly, development and construction of national system for HIV social services contracting, which are strategically important for the country and provided by specialized and experienced nongovernmental organizations. Also, for 3 years of work in the SoS_project partnership, national funding for HIV programs has increased 3 times, reaching 63 million soms ($ 745,562) annually. In 2019, the implementation of the state social contracts began and in 2021 the Republican AIDS Center allocated 5 million soms for state social procurement. And I would like to emphasize the important contribution to the achievement of such results of our partners from the Republican AIDS Center, NGO 100% Life, ItpcRu, the Institute for Analytics and Advocacy, the Alliance for Public Health, etc.

#SoS_project: So it means, sustainability in the context of HIV/AIDS is a work at the national level, with ministries and departments?

AS: Not only. The contribution in sustainability building is also very important at the municipal level. And it is logical, because large cities are home to the largest population, so they are both drivers of epidemics and the best partners for solving problems on a global scale. So, I can note that the mayor’s office of one of the largest cities in the country – Osh, has taken a number of important strategic steps over these 3 years: the Paris Declaration was signed, the city program to overcome the HIV and tuberculosis epidemic was approved and is being implemented. In 2021, in the amount of 300 thousand soms ($ 3,550), funds were allocated for the state social contract for the key groups testing component and support for the PLHIV Сenter. And we, along with partners from Center Plus, the Alliance for Public Health, UNAIDS, provided technical and expert support at all stages.

#SoS_project: So sustainability is mainly about financing treatment and support?

AS: Not exactly. The human rights field related to fight against stigma and discrimination of people living with HIV, as well as the criminalization of HIV, is also very important for sustainability. And we have made good progress in this direction, thanks to cooperation with SoS_project and national partners, including UNDP and The Soros Foundation-Kyrgyzstan. During these three years, we managed to introduce the REAct electronic system for documenting offenses, which is included also in the draft of the new National HIV program, as the main tool for monitoring violations of the rights of PLHIV and key groups.

We have built partnerships with the Soros Foundation street lawyers project and registered cases receive a solution in the form of legal and social consultations, legal support. To date, 1147 calls have been registered and 60% of them have already been successfully resolved, and work continues with the rest. By the way, it is very important that the continuation of the work of the base is supported within the framework of the Global Fund national grant until 2023.

#SoS_project: has COVID-19 added work, made it more difficult, or made it easier?

AS: COVID-19 made it more complicated, but we adapted very quickly and for example switched to online, like the whole world. In April 2020, at the very beginning of the COVID epidemic, we promptly developed a national action plan, which we are using up to these days. With the support of the special program of the Global Fund on COVID-19 in cooperation with the Alliance for Public Health, we officially brought to Kyrgyzstan 10,500 rapid tests with high sensitivity – STANDARD Q COVID-19 Ag (SD Biosensor, South Korea). The tests were delivered to the Republican AIDS Center and then distributed to healthcare organizations, AIDS and tuberculosis centers, nongovernmental organizations working with key populations and PLHIV. It will improve the detection of COVID-19 and prevent its widespread spread among vulnerable populations to HIV. We were the first in the EECA region to get access to additional GF funding for COVID and received $ 6.6 million instead of $ 4. Their active implementation is already underway, more than 30 X-ray machines, a tomograph, tests and much more are being purchased. However, even this is an incomplete list of what has been achieved during the #SoS_project funding in Kyrgyzstan.

***

The #InYourPower info campaign was launched with the financial support and initiative of the team of the regional project “Sustainability of services for key populations in Eastern Europe and Central Asia region” (aka #SoS_project)

The annual Fast-Track Cities 2021 Conference is hosted October 20-22, 2021, in Lisbon by the International Association of Providers of AIDS Care (IAPAC), in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Fast-Track Cities Institute, and other partners.

Key themes of Fast-Track Cities 2021:

• Best practices and policy recommendations to ensure access to holistic HIV care, which supports long-term treatment success and quality of life for all People living with or at risk of HIV.
• Set out targets and programmes for health-related quality of life that governments with HIV community must put in place.
• Health equity, to ensure access to innovative care and better HIV health outcomes for all communities.

The delegation from the Eastern Europe and Central Asia region is also taking part in the Conference this year and represented by the UNODC Programme Office in Eastern Europe, the Joint United Nations Programme on HIV/AIDS, the Alliance for Public Health, NGO 100% Life, officials of the Kyiv City State Administration.

On behalf of Vitali Klitschko and the Kyiv Mayor’s Office, Anna Starostenko, Deputy Mayor of the Kyiv City State Administration spoke at High-Level Panel on the first day: “We have made every effort to ensure that HIV / AIDS prevention and treatment programs do not stop, as well to adapt it in COVID-19 reality. Thanks to close and well-coordinated cooperation between the municipality and the state, we managed to ensure the implementation of the preventive component of the HIV response. Our prevention programs, such as mobile teams, outpatient clinics, syringe exchange points, have reached 90 percent of risk groups … All these actions did not slow down the Fast-Track goals, but also improved the achievement of certain results. According to the first 90 indicator – 77% are aware of their HIV status. According to the second 90 component – 83.4% know about the status and receive treatment. The third indicator is that we have even exceeded our expectations: 95% of them are receiving ART. Kyiv willingly shares its best practices, cases, positive experience in fight against HIV with cities in the Eastern Europe and Central Asia region. In particular, a year ago, our municipality, together with partners from the Alliance for Public Health, hosted delegations from more than 20 cities in our region to discuss modern and effective approaches to fight against HIV and TB. And today, more than 20 cities have already joined the Fast-Track family in the region and are implementing the ambitious 95-95-95 plans.”

Ievgen Kushnir, Manager of international programs, Alliance for Public Health notes: “Despite the “hybrid” format of the event – online and offline, the most interesting and deep program is ahead. At this Conference, it is very interesting for me to get acquainted in detail with the achievements and successful interventions in the context of the COVID-19 epidemic: what worked and what did not, in order to determine the next steps and opportunities for the cities of EECA. Our task also at Fast-Track Cities 2021 is to share tangible results of cooperation with the mayor’s offices of our region – today we are cooperating with 25 cities, 17 of which have signed the Paris Declaration and are moving towards the goal of 95-95-95 step by step. I am glad that already on the first day of the Conference, Carlos Moedas, the new Mayor of Lisbon, shared his interest and support to the Regional Initiative of the Alliance #InYourPower to defeat the HIV epidemic. It confirms once again that the effect of the global, well-coordinated work of cities in the fight against HIV will not keep you waiting long.”

The purpose of the Conference in 2021 is to analyze the success and progress of participants in the Fast-Track Cities movement, to discuss common problems for all parties involved, and also provide an opportunity to share best practices in overcoming HIV, TB, HBV and HCV in cities. In addition, the conference organizers included the COVID-19 epidemic among the issues discussed. As José M. Zuniga, President, IAPAC and the Fast-Track Cities Institute, highlighted at the Conferene Welcome: “In the midst of the COVID-19 pandemic, Fast-Track Cities are at the forefront of advancing global public health goals. City multilateralism is critical for cities to serve as engines of innovation to achieve Sustainable Development Goal 3.3.” Winnie Byanyima, Executive Director, UNAIDS supported him as well: “Cities and municipalities will play a central role in ending AIDS. Through bold public health leadership, they can end the inequalities and social exclusion that preventing the most marginalized from exercising their right to health.”

During his welcome speech, the contribution of Fast-Track Cities was also noted by Marcelo Rebelo de Sousa, President of Portugal: “This congress is crucial to remind us of the fundamental role of cities on the health of communities. Apart from the progress made, we still have a long way to reach the sustainability goals we have set.”

Since UNAIDS engaged high-level global stakeholders in dialogue in December 2013 to develop a roadmap to expand access to HIV testing and treatment, there has been an increase in accountability and commitment between governments, NGOs and community leaders by 2030 to eliminate AIDS as a public health threat. At the same time, recognizing that the active political engagement of mayors and other municipal leaders will be critical to the fight against HIV in cities (and therefore at regional and country levels), 26 cities and municipalities signed the Paris Declaration of Fast Track in 2014 to eradicate the HIV epidemic (Fast-Track Cities). To date, the initiative has a map of more than 350 cities and municipalities around the world, many of which have made great strides in achieving and exceeding UNAIDS targets of 90-90-90. In addition, Fast-Track Cities’ work also aims to eliminate stigma and achieve the Sustainable Development Goals for key populations: people living with HIV (PLHIV), tuberculosis (TB) and viral hepatitis, as it remains clear that the fight must go the same way against all these public health threats at the same time.

Alliance for Public Health has launched a second regional COVID-19 program funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria as a part of the COVID-19 Response Mechanism (C19RM). The budget is US $ 1,545,780. The implementation of the activity is for 6 months of work – from October 1, 2021 to March 30, 2022.

The coordination of the COVID-19 program at the regional level will be carried out by the #SoS_project team in 14 countries of Eastern Europe and Central Asia.

“Within the framework of the first support program of the Global Fund, in 9 months we implemented catalytic measures to prevent, identify, study the impact and develop an action plan for responding to the health system in the case of unforeseen pandemics like COVID-19, in three sub-regions at once – Eastern Europe, Central Asia and Southeast Europe”, – says Sergii Filippovych, Director of #SoS_project, Alliance for Public Health. “So, 8 countries received 76.7 thousand rapid tests for COVID-19 as humanitarian aid. For example, in Moldova during 1.5 months out of 223 express tests, 26 (i.e. more than 11.6%), were positive, which indicates the urgent need for testing with rapid tests for early detection of coronavirus, reducing the risk of infection transmission and, accordingly, increasing timely access to treatment. The second support program, through the Global Fund’s regional grant mechanism, will also focus on supporting sustainability and critical interventions in the response to co-epidemics. ”

The focus of the second program is aimed at:

• support for key groups and communities,
• study the impact of COVID-19 on the social determinants of health and the quality of services provided to key groups,
• support for digital technologies,
• pprocurement of rapid antigen and PCR tests,
• pprocurement of special vending machines (condoms/syringes),
• other activities that will significantly support the achievement of HIV/TB programs in the context of COVID-19.

The second regional COVID-19 program expanded its geography to support country programs aimed at helping key populations. The program also includes interventions aimed at human rights, community involvement and attention to gender issues, community-based monitoring, and ensuring sustainable access to services. Our partners in the implementation of the program are – EHRA, ECOM, ENPUD, CAAPL.

Government funding for HIV prevention and treatment services for key populations and people living with HIV was extremely insufficient in the EECA region at the end of 2020. With the outbreak of COVID-19, which shook the whole world, all countries were forced to revise their budgets, setting the priority area of ​​budget spending on measures against COVID-19. It has endangered many years of work to build the sustainability of HIV services in the countries of the region.

It should be noted, that #SoS_project quite naturally became the main platform for the implementation of activities on COVID-19 as a part of the new program to support the region by the Global Fund. Existing partnerships with national partners, knowledge of the region and problems, understanding of financial gaps and opportunities, as well as the work of the #SoS_project team on budget advocacy at the national and municipal levels will help strengthen the program and provide its immediate launch and rapid implementation within 6 months. It is assumed that the services and terms of their provision will continue in the future.

C19RM Сoordinator – Nadiya Yanhol yanhol@aph.org.ua