Alliance for Public Health made an analysis and would like to present data on the real scope of legal and illegal circulation of opioid substitution therapy (OST) drugs in Ukraine.
Alliance has been implementing OST programs since 2005, regularly providing evidence of efficiency and safety of harm reduction approach as opposed to ungrounded accusations on allegedly high volumes of OST drugs leakage.
During 14 years of OST program implementation in Ukraine, around 1700 kilograms of OST drugs were purchased at the expense of international donors and of the State budget of Ukraine and delivered to licensed healthcare institutions to cover the needs of the program. The scope of OST drugs leakage recorded in court judgments does not exceed 0.002% of the total amount of OST drugs delivered.
The capital of Ukraine has become a focal point of new record setting and a venue to present an effective package of working interventions, highlight the strength of political will to support decision-making on HIV and TB and the leadership in the countries of Eastern Europe and Central Asia, as well as the Balkan region.
On December 6, 2019 in Kyiv, the International “EECA City Health Leadership Forum” was held, with the participation of top officials of cities – mayors and vice-mayors, representatives of international, national NGOs, invited experts, heads of AIDS and TB centers from 50 cities of the world.
The Forum showcased the results of operational research, practices and innovations with proven efficiency, approaches to HIV detection, testing and treatment, including new technologies and modern methods using network marketing, out-of-the-box decisions of the municipal government for cooperation with NGOs and other partners; the KP movement leaders shared their experience of protecting the rights of communities; moreover, the Forum speakers talked about financing programs and the cost of saving a person’s life, about the regional progress in the context of the fight against epidemics of AIDS and TB.
Andrey Klepikov, CEO of the ICF “Alliance for Public Health”:
“The EECA region in 2020 is already demanding results. And in this context, we are talking about a new dialogue between the state and civil society. Our focus on cities and collaboration with mayors is crucial for addressing HIV/TB. The Alliance team has been working with the regional municipalities teams for the fourth year already, and the cities’ eagerness to cooperate is also increasing. Therefore, the number of partner cities has expanded from 5 to 25 over the past year. As for the methodology, you don’t need to invent the wheel, everything has already been invented and tested. There are working principles on how to reach the level of accelerated response and achieve success. We described our work experience and effective work approaches in cities in a model delivering real results. Cities can make a difference in our countries, and these are not just some imaginary cities, but city leaders, mayors, you and me. For us, this is the way forward. This is #InYourPower, in our power!”
Presentation about the regional progress in combating epidemics, efficient approaches with the overview of the outlook for 2022.
Dialogue about the HIV/AIDS problem in the EECA countries on the highest municipal level
The top officials of the cities discussed good practices, innovations, out-of-the-box solutions of the municipal government and cooperation with non-governmental organizations and other partners.
Within the framework of the forum, a high-level dialogue took place in a panel discussion between the mayors of Kyiv and Odesa (Ukraine), Berne (Switzerland), Chisinau and Balti (Moldova), Svetlogorsk and Soligorsk (Belarus), vice-mayors of Bishkek and Osh (Kyrgyzstan), while Roman Gaylevich (UNAIDS) and Lucica Ditiu (Stop TB Partnership) moderated the discussion.
Vitaliy Klitschko, the Mayor of Kyiv: “HIV is a common problem, and we must join our efforts to stop it”
According to Mr. Klitschko, amid the global epidemics of HIV and TB, the city must create favorable conditions for public organizations fighting epidemics, taking active leverage, and actively engaging in it.
“It is very important that the mayors of many cities around the world would play a leadership role in overcoming diseases. The people’s health should be one of the key priorities of the municipal government, and therefore – a priority in the work of mayors. It is in our power to prevent the spread of HIV and TB, to introduce efficient treatment programs”, said Vitaliy Klitschko.
The Kyiv Mayor is convinced that only joining efforts instead of silencing a common problem can solve it. In Kyiv, this approach is already yielding results.
“Kyiv is showing considerable progress in the fight against AIDS,” said Vitaliy Klitschko. “I am sure that common efforts over the past few years helped us to advance in the fight against this serious challenge for our city and increase the numbers of people who receive medical care and prevention”.
Vitaliy Klitschko signed the Zero TB Cities Declaration on the fight against tuberculosis on behalf of the city. This is the second city in Ukraine after Odesa, which signed the Zero TB Cities.
“Kyiv is taking the lead, and we are ready to extend the positive experience to all regions of Ukraine, the Kyiv Mayor said. – And as for the challenges, we, unfortunately, face a plenty of them”.
Ion Ceban, Chisinau Mayor: “We rely on partnership in combating HIV and TB”
According to the Chisinau City Mayor, Ion Ceban, one of the important tasks for the health care of any city is to ensure that people’s lifespan, in particular of people living with HIV, can be as long as possible. So that they have the opportunity to live to old age, women living with HIV can give birth to healthy children, and the townspeople have access to prevention and testing and undergo it regularly.
“We must consider both treatment and HIV prevention in a comprehensive manner, ranging from vulnerable groups to the general population of cities,” he emphasized.
According to Ion Ceban, special attention should be focused on youth. It is necessary to talk about the transmission methods, the importance of prevention.
A pre-exposure prevention program is already working in Chisinau, and a syringe exchange program is being actively implemented. “This is a very important step for those at risk to keep HIV at bay”, Ion Cebanemphasized. “Next, we have a lot to do about tuberculosis, and we really look forward to a partnership”.
Dmitriy Aleinikov, Svetlogorsk Mayor: “It is easy to achieve 90-90-90 indicators, if we speak up”
In a small Belarusian town Svetlogorsk there is a person who has been living HIV-positive status since 1997. Today his health is quite good and he can live the ordinary life. The reason for this, according to the City Mayor Dmitriy Aleinikov, is that the municipal authorities do not hush up the HIV/AIDS problem, but actively solve it.
“There are only 80 thousand people in Svetlogorsk, but problems such as HIV/AIDS and drug addiction still linger from the Soviet era”, said Dmitriy Aleinikov to the heads of cities of the EECA region at the EECA Cities Forum held in Kyiv on December 6. “And I am grateful that my predecessors did not sweep this problem under the rug”.
Signing of the Paris Declaration posed no additional problems for the city, because, as the Mayor of Svetlogorsk is convinced, achieving the 90-90-90 indicators will be quite easy, if we adhere to the principles of publicity, openness and a strategic approach.
“It will not be difficult, because we speak up, – he stated. – We are tacklingthis problem, it is not new for us, and I am certain that we will solve it”.
Gennadiy Trukhanov, Odesa Mayor: Combating HIV should start from philosophy
Odesa is the first city in Ukraine to commit to the Zero TB Cities initiative and systematically proceeding towards overcoming the TB and HIV epidemic. Today, all forces that used to withstand these challenges alone, became consolidated. Thanks to joint efforts, the effectiveness of treatment has increased from 53% to 72%.
However, as the Odesa Mayor Gennadiy Trukhanov, said at a meeting of mayors as part of the EECA Cities Forum, this was not easy for the city itself. Deputies engaged in heated debate over two sessions. The experience of other cities, in particular the Swiss municipality of Bern, helped to shift the obsolete views.
“We must start with philosophy”, Gennadiy Trukhanov is convinced. – PWID are people with drug addiction. They are dependent. They are not criminals, but people in need of treatment. And only when we socialize them, when they realize that society is not against them, they will look for opportunities for socialization”.
In addition to local, routine problems, the city authorities also have to solve global challenges, in particular, to help health workers in the fight against epidemics. After all, it is in everyone’s interests. “The mayor’s performance is assessed by the city condition: roads, roofs, heating, comfortable public space. That is all true. But we can make cities clean, however with the spread of all dangerous infections in the world, God forbid, the time may come when there will be nobody to walk along these tidy streets”, emphasized the Odesa Mayor.
Inspired by the Bern experience and changing the philosophy of the attitude towards PWID, Odesa promises to take further steps to combat the spread of infections and ensure socialization of PWID. In the near future, the opening of a safe injecting drug use room is planned.
Alec von Graffenried, Bern City Mayor: “Our goal is 100-100-100”
“Bern accumulated solid experience in this area, not because we are better than other cities in any way, but rather because we faced huge problems with drug users. In the 80s, there were hundreds of them right in the center of the city, they wandered around the streets, threw syringes right in the parks and it was terrible”,Alec von Graffenried recalls. “Since then, city mayors had to solve this problem quite effectively, because PWID is one of the most vulnerable groups, and the most problematic in terms of HIV prevention”.
The first step of the city authorities was the free distribution of syringes on the streets. The second step – the authorities went to the places where people sell drugs.
“It turned out to be a lot harder than just distributing syringes. We had to talk to people, and do not arrest them, because drug addiction is a disease. They need to be treated and receive care like patients”, said Alec von Graffenried.
After drug users got used to people who do not blame them, but are willing to help, the city offered them a safe space, free from crime, in the very center of the city. There they could get syringes, take an injection, meet with peers.
Further, the city began to offer PWID medical assistance, social support, so that they could leave the street where everyone could see them.
“We were not telling people, “Come along, we will cure you, you will no longer be addicted”, but simply accepted the fact that they will continue to take drugs. We want to help them so that people could live in normal conditions. – says the Mayor of Bern. – What did we achieve in the end? We have methadone and heroin programs in Switzerland, so that drug users can live a normal life, avoid involvement into crime, to buy drugs. We provided them a possibility to live as an ordinary citizen, and as a result, the number of people with drug addiction decreases, the number of people with HIV decreases even more, tuberculosis is not a problem for Switzerland at all. If we talk about indicators, then Switzerland has come a long and arduous way in 30 years, and now it has reached the goal of 100-100-100”.
Effective HIV strategies that worked well in the cities of the region
The Forum showcased the best municipal practices such as the Harm Reduction Program in Bern, the state-funded Opioid Substitution Treatment Program in Kyiv, new approaches to increase the effectiveness of tuberculosis treatment in Odesa, the promotion of the VCT program in Chisinau, the work on improving the HIV cascade in Almaty and others.
Thus, two years ago, an Almaty citizen had to go to the clinic to get a blood test to get to know their HIV status and wait two days for the result, which again had to be received from the clinic. Obviously, this was far from the best way to identify all people in need of treatment. AFEW Kazakhstan radically changed the approach and improved the situation with HIV detection in the city. In 2018, key innovations were introduced for the first time in Kazakhstan.
First, rapid saliva tests were introduced in the outreach conditions.
This approach is unique, because outreach workers travel to the necessary places to provide testing and counseling. The test itself is very easy to use. It is only necessary to hold a special spatula between the lip and the gum and dip the spatula into the liquid. And after 20 minutes the result is ready.
Secondly, the index testing approach was implemented.
Initially, outreach workers tested those clients whom they knew. Then they asked those of them who had positive HIV status, to refer 3 people from their close circle with whom they practiced risky behavior in the context of HIV to undergo a test. To motivate customers, special coupons were issued with QR codes and outreach worker contacts, which a client could hand out to friends. Everyone who passed the test or attracted another person received 1000 cell phone payment units or a grocery package, upon their choice.
This is a network marketing in action!
Therefore, for a year and a half, 6,000 people were tested. 145 Almaty residents first learned about HIV! For comparison, this is about a third of all identified cases per year in the city!
Third, the efforts of the project team were aimed at increasing treatment coverage.
When the HIV test result turned out to be positive, the client was provided with social support for testing at the AIDS center. If the result was confirmed, the client received assistance to get enrolled for a dispensary registration and immediately start antiretroviral treatment.
At the same time, outreach workers cooperated with healthcare staff to bring back clients who discontinued treatment, the so-called “lost-to-follow-up patients”. Thus, the project team worked with each patient step by step, returning people to treatment and support programs.
As a result of the project 538 people who were diagnosed with HIV now have the right to life! The efforts of outreach workers and a personalized approach helped to provide people with treatment upon learning about their HIV status for the first time or returning to the program.
For comparison: an average of 400 people in Almaty start ARV treatment annually. It turns out that only the efforts of the pilot project team managed to exceed the average annual rate.
Political commitment to ending HIV and TB epidemics and signing of the TB and AIDS Declaration by the six cities at once, a groundbreaking event for the EECA
The groundbreaking ceremony of simultaneous signing the Political Declaration on AIDS and TB: Declaration to Fight against the TB by the six EECA cities: Kyiv (Ukraine), Chisinau (Moldova), Svetlogorsk (Belarus), Bishkek and Osh (Kyrgyzstan), and the Paris Declaration signing by the Balti city (Moldova) was the cornerstone event of the Forum.
Roman Gaylevich, UNAIDS Director in Ukraine: “We welcome and warmly support the personal leadership of the mayors of the cities that have signed the Paris Declaration and the Declaration to Fight against the TB, I would like to put special emphasis on the fact that all these cities have coordinating councils on HIV/AIDS and TB, which include key communities. The joint work of the city authorities and communities, in my opinion, is the core and the driving force behind positive changes”.
We would like to note that the team of the ICF “Alliance for Public Health” and the #SoS_project partners will provide expert, technical and financial support to Svetlogorsk, Osh and Chisinau at all stages of fulfilling their commitments under the Paris Declaration and the Zero TB Declaration.
Key population communities in the focus of attention
Of course, declarations are signed for a reason, and all programs, foundations, public figures and experts are working not just for the statistics, but solely for the sake of saving human life and improving people’s health.
At the beginning of the session, a video presentation of the leaders of the LGBT, PWID, TG, and SW community networks was presented with a perspective on regional problems and challenges that are most relevant in Eastern Europe and Central Asia.
Four leaders of their communities of Almaty, Sofia, Tbilisi and Minsk shared from the Forum stage their experiences and real stories about how they manage to represent the interests and protect the rights of their communities at various levels, be it international or local city platforms. They presented their vision, their strategies and examples of results that can be achieved and how a person’s life can dramatically change in a comfortable social environment.
The emotion was undoubtedly the most intense during this panel with real heroes in their field, people who inspire and adamantly go forward. Kevin Osbourne, Director of the International AIDS Community, moderated the panel.
#InYourPower awards handed to the winners
The Forum culminated in holding the first #InYourPower award ceremony for political leadership in combating HIV/TB in the special nominations and based on the voting results.
Mayors, vice-mayors and representatives of mayors of 13 cities of Eastern Europe and Central Asia received awards: Kyiv, Odesa, Bishkek, Chisinau, Almaty, Tbilisi, Sofia, Osh, Balti, Svetlogorsk, Bar, Bielo Pole, Podgorica.
The prize was awarded to cities for the following achievements:
– Significant successes in the fight against HIV/TB at the city level,
– The political leadership of mayors and city teams in the fight against HIV/TB, as a symbol of commitment to ending the AIDS epidemic, as well as a sign of support from international partners.
A special award based on the results of voting on the site inyourpower.life was presented to Irina Kutsenko, a deputy of the Odesa City Council.
Dr. Michel Kazatchkine, UNAIDS Special Envoy in Eastern Europe and Central Asia, stated, “We need to change policies to save people, and the ownership of city leaders plays a crucial role!”, greeted the mayors on occasion of awards, significant promotion and commitment to ending the AIDS epidemic and TB.
The participation of the journalist and TV presenter Yanina Sokolova as the host of the event was symbolic; the is the ambassador of the Sustainable Development Goal 3, related to the health and well-being, within the framework of the UN national campaign on promoting the SDGs in Ukraine.
On December 6, 2019, the International Forum on ‘Cities’ Leadership in response to the HIV/AIDS and TB Epidemics’ will take place in Kyiv (Ukraine). It’ll be visited by cities’ mayors, representatives of the international, national organizations from 50 cities of the world. The focus is: innovations, technologies, municipal funding, and political leadership of the cities; mayors.
«We live in the epoch of digital technologies and fast-paced changes, when it’s namely the cities who become leaders in the global health issues. Today more than half of the planet’s population resides in the cities, and in 30 years the municipal population will increase practically up to 70%. Irrespective to the fact that the main problems, which are faced by the population, including infectious diseases, are concentrated on the level of the cities, the infrastructure and resources to stop those are primarily in possession of the cities», – the Forum organizers mention.
The major topic of the Forum is achieving future without AIDS and TB in the fast-growing cities. The main stress of the Forum is made on sharing experience and involvement of the Eastern Europe and Central Asia (EECA) cities in the international movement of mayors to end these epidemics. To get acquainted with the opportunities that are opening for the sustainable development of the cities, representatives of the new potential leader cities are invited to the Forum.
From sharing experience to life hacks: Forum speakers will tell about the funding of the programs and the cost of saving the life of a person, about the progress of the region in the context of combating the AIDS and TB epidemics, will present the approaches in case finding, testing and treatment of these illnesses, which proved to be effective, including new technologies and modern approaches applying network marketing.
Cities’ mayors, executives of international agencies and global initiatives, public opinion leaders, and the best experts of civil society organizations representing more than 25 countries of the world will respond to the main questions: why namely the cities play an important role in the global overcoming the AIDS and TB epidemics and which effective strategies exist to accelerate these measures.
– Panel discussion of the cities’ mayors: Kyiv and Odesa (Ukraine), Bern (Switzerland), Chisinau and Beltsy (Moldova), Svietlahorsk and Soligorsk (Belarus), vice mayors of Bishkek and Osh (Kyrgyzstan);
– Unique for the EECA region synchronic signing of six political declarations on AIDS and TB at the same time by the mayors of Kyiv (Ukraine), Chisinau and Beltsy (Moldova), Svietlahorsk (Belarus), Osh and Bishkek (Kyrgyzstan). Press conference (13:00-13:50);
– Effective practice, innovations, unconventional approach of local authorities related to cooperation with NGOs and other partners, sharing experience of the communities movement leaders;
– the first award ceremony of #вТвоихСилах/#InYourPower campaign for political leadership in combating HIV/TB in the specific nominations and based on the voting results.
Kevin Osborne, International AIDS Society (IAS) Director
Michel Kazatchkine, professor, physician, diplomat and advocate, United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, member of the Global Commission on Drug Policy.
Lucica Ditiu, director of the Stop TB Partnership leading the way to a world without tuberculosis (TB)
Dumitru Laticevschi, Regional Manager of the Global Fund in the Eastern Europe and Central Asia countries
Alec von Graffenried, Bern mayor (capital city of Switzerland)
Ion Ceban, Chisinau mayor (Moldova)
Nicolae Grigorişin, Beltsy vice mayor (Moldova)
Dmitriy Aleynikov, Svietlahorsk mayor (Belarus)
Andrey Zhaylovich, Soligorsk mayor (Belarus)
Tatyana Kuznetsova, Bishkek vice mayor (Kyrgyzstan)
Nurbek Kadyrov, Osh vise mayor (Kyrgyzstan)
The live broadcasting will be ensured in English and Russian. The link to the broadcasting page: Facebook та Youtube.
Quotes
Vitaly Klichko, Kyiv, mayor Киев (Украина):
«It is very important that many mayors of cities in the world today take leadership in overcoming illnesses. The issue of the health cannot be the priority only for the relevant ministries, organizations, or specific municipal institutions or services in charge. Health of the citizens has to become one of the main priorities for municipal authorities, e.g., the priority in the mayors’ work. It is in our power to prevent dissemination of such illnesses as HIV and TB, to introduce effectives programs for treatment thereof. Kyiv signed the Paris Declaration in 2016. We approved the city program and provide funding for it, work primarily with the groups that are most vulnerable to HIV. In response to our effective work the number of new cases of getting HIV infection in Kyiv starts to decrease. But there still are lots of challenges. And we keep on implementation of the best experience in the world, uniting efforts in overcoming HIV and TB with international organizations, with municipal authorities of other cities».
Andriy Klepikov, executive director, International Charitable Fund ‘Alliance for Public Health’ (Ukraine):
‘Alliance for Public Health has been working with the cities in the region during four years already through implementing the Fast-Track strategy in response to the AIDS and TB epidemics. At this Forum, we will present info graphics and tendencies with the major figures and budgets by countries. It is important that the interest of the cities is growing; thus, the number of partnering cities during the last year increased from 5 to 25. Physicians, social workers, nurses, civil society organizations have been continuously doing their job and are still doing it. But one more component is of crucial importance: political leadership. Everyone who is in the chair of the mayor not by a chance of fortune, who has powers to take decisions, has to take these decisions for the sake of people. In the area of combating AIDS and TB epidemics in the cities it means application of innovative approaches and scientifically confirmed international expertise, resource allocations for prevention and treatment, as well as other important steps, which would provide for saving lives. The partnership of the city and of NGOs is a key for success and the future of cities free from AIDS and TB epidemics.
Raman Hailevich, UNAIDS director in Ukraine:
‘According to the last UNAIDS report, which was made publically available before the World AIDS Day, EECA region is the only region in the world where the number of new HIV cases is continuing to grow. That’s why it’s so important to implement these Fast-Track strategies in response to the epidemic namely in this region. The quintessence of this strategy is the initiative to overcome AIDS in the big cities where about 70% of all people living with HIV reside. UNAIDS jointly with IAPAC are coordinators of this initiative at global level. Welcoming and giving warm encouragement to personal leadership of the mayors of the cities who signed the Paris Declaration and ZERO TB Declaration, I want to specifically stress that there are HIV/AIDS and TB Coordination Councils effectively operating in all of these cities, and key populations are their members. Joint efforts of municipal authorities and communities, from my point of view, are the heart and the driving force of the positive changes’.
On December 2, 2019, the unprecedented signing of the Paris Declaration in the Balkans took place.
The mayors of three cities – Dr Ivan Vuković (Podgorica), G. Dušan Raičević (Bar) and Mr Petar Smolović (Bijelo Polje) simultaneously signed the Paris Declaration on accelerating the measures in cities to end AIDS.
Andriy Klepikov, Executive Director, Alliance for Public Health:
“For the first time the 3 Mayors sign Paris Declaration together showing strong commitment to put an end to the HIV/AIDS epidemic across the country mobilizing resources of the capital city as well as key cities in the south and north of the country. Civil society is the reliable partner to support municipalities in bringing HIV response to new level – becoming fast track cities!
We congratulate our partners from Montenegro – CAZAS and Juventas on the level of organizations as well as Miso, Sanja and Ivana on the level of personalities, whose amazing work resulted in such great political commitment!”
To date, 277 HIV cases have been reported in Montenegro (prevalence of 0.04%), and in 2018, 23 new cases of HIV infection were recorded.
Konstantin Voytsekhovich, UNAIDS EECA advisor:
“The signing of the Paris Declaration by the three biggest cities of Montenegro – Podgorica, Bar and Bijelo Polje firmly puts Montenegro on the fast-track to ending the HIV epidemic by 2030. The commitment and resolve demonstrated today by the three municipalities is even more significant because it is the first such manifestation of leadership on HIV response in the Balkans.
It is also the first time in history of Montenegro when the three different cities have joined forces in taking political and humanitarian action on HIV with strong support from the community-based NGOs #CAZAS, #Juventas and the Alliance for public Health”.
It’s just the beginning of the municipal response to the epidemic, and #SoS_project team is ready to provide the technical assistance and expertise for the cities in order to achieve the targets together!
On 29 November 2019, SkyTest (#SkyTest), a traditional outreach event commemorating the World AIDS Day took place near Kyiv’s highest ferris wheel at Kontraktova square. It is the second year that this event is held by the Alliance for Public Health, Public Health Center of the MoH and partners from civil society.
During the event, everyone interested — media people, students, passers-by — could take free rapid testing for HIV using innovative saliva tests (no blood drops). Every person having taken the test got a ticket for free ride on the ferris wheel. Thus, all who wanted could take not just the innovative rapid test for HIV that did not require even a finger stick, but also receive a professional consultation of the doctor right in a ferris wheel cabin, at the height of 43 metres, while enjoying beautiful views of the winter Kyiv from the bird-view height.
During the Sky Test, a press briefing took place involving representatives of public structures, charitable and civic society organizations, leading infection disease doctors and HIV positive people.
Volodymyr Kurpita, Director General of the Public Health Centre of the MoH of Ukraine:“In the last ten years, technological progress has allowed setting a diagnosis in 15 minutes. However, it is not just about technology, it is also about people — their desires, possibilities and fears.Do not be afraid of testing!Doctors know how to help if the test is positive”.
During the event at Kontraktova square, about 300 people (mostly young students) took rapid tests for HIV in the setting of the special mobile ambulatories. Everyone could receive — without any fee — doctor’s consultations, the main HIV/AIDS protection means (condoms) and informational materials concerning the importance of timely HIV testing.
“Since the beginning of 2019, under our programs of HIV prevention for most-at-risk populations, a total of 407 thousand people took free testing in all regions of Ukraine, which has allowed receiving 9.3 positive results (2.3%).However, more than 80 thousand Ukrainians living with HIV are not even aware of their status.At the same time, testing programs are becoming more accessible.For a long time already, you do not to go to a specialized healthcare facility to get tested.A rapid test can be taken on one’s own, using saliva, without a single drop of blood.For Alliance for Public Health, improving accessibility of testing for HIV is a priority, and we are glad that the state has been paying increasingly more attention to prevention and testing programs; that is a sort of a major test for our Government.Take the test!”, urges Andriy Klepikov, Executive Director of the Alliance for Public Health.
The event was organized by the Alliance for Public Health, Public Health Center of the MoH of Ukraine together with the ACO “Convictus Ukraine”, ICF “Drop-in Center” and CO “ALLIANCE.GLOBAL”.
Ukraine ranks among the top European countries in terms of the number of HIV-positive people.According to expert estimates, 244 thousand HIV-positive people lived in Ukraine as of 2018.One in a hundred of people aged 15 to 49 is infected with HIV, which is among the highest rates in the countries of the region.As of 01.10.2019, 136,849 HIV-positive people were registered at health care facilities in the government-controlled territories of Ukraine (i.e. 326 per 100 thousand people) which means that almost a half of the estimated number of people living with HIV are not aware of their HIV status.That is why testing is just as important component in fighting the spread of HIV and an effective tool for fast-tracking 90-90-90 goals as prevention and treatment.It was assisted testing by the Alliance that has allowed reaching to almost 4 times more people in 2019 (407.3 thousand) compared with 2014 (113.4 thousand).This has resulted in getting 3.3 times more positive results.Among the new clients of prevention project, percentage of positive results of HIV testing is 5 times higher than among the “old” ones, which testifies for efficiency of the implemented activities and highlights new challenges in prevention programs.
Andrii Mykhaylovych Yarovyi, DOB. 06.11.1967, a citizen of Ukraine from the city of Kyiv, since 2009 has been a substitution maintenance/opioid substitution therapy (buprenorphine) patient. He is a member of Eurasian network of people who use drugs (ENPUD), All-Ukrainian Association of People who use drugs (PUD. Ukraine/VOLNA), a human rights champion and a consultant on quality monitoring at ICF “Alliance for Public Health” working on HIV/AIDS prevention programs that since 2004 have been supported by the Global Fund to Fight AIDS, TB and Malaria.
On 25.08.2018, Andrii Yarovyi once again left from Kyiv to the temporarily uncontrolled territory of Luhansk oblast (Eastern Ukraine) as a consultant of the Alliance for Public Health to study the access of most-at-risk populations and HIV-positive people to prevention services and vital treatment.
In 2015-2018, Andrii for this purpose had on numerous occasions visited the uncontrolled territories of Donetsk and Luhansk oblasts where, at that time, programs supported by the Global Fund to Fight AIDS, TB and Malaria.
It was Andrii who, during such a visit in 2015, made unique video-interviews of the last days of the opioid substitution therapy (OST) programme on the temporarily uncontrolled territories in the Eastern Ukraine that formed the basis of the documentary “Live or Die in Donbass?!” In 2014-2016, more than a thousand of OST patients lost access to the vitally important treatment on this territory.
On 26 August 2018, when Andrii was crossing an unauthorized checkpoint in Krasnodon rayon (temporarily uncontrolled territory of Luhansk oblast), he was illegally detained by members of “Luhansk People’s Republic” ( “LNR”), who seized from him 38 pills of «Buprenorphine hydrochloride», a narcotic medication used for OST, with the total weight of 0.152 mg. The day before, Andrii legally obtained a 10-day stock of this drug (a total of 0.16 g) at a healthcare facility in Kyiv for unsupervised administration. The next day, on 27.08.2018, Andrii was brought to the “Ministry of State Security of LNR” and illegally arrested over “large-scale drug-trafficking”, as was stated in the charge Andrii faced several months later. Only in mid-October 2018, Andrii was accessed by a local lawyer hired through the Alliance for Public Health .
In late October 2018, an investigator of “MSS of LNR” charged Andrii with a «violation» of p. 3 of article 282 of the «Criminal Code of “LNR” (large-scale drug/buprenorphine smuggling), and so-called “court of LNR” selected a pre-trial restriction in the form of arrest the term of which was then extended several times; all this time, Andrii was illegally held in inhuman conditions at an underground facility of the “Ministry of State Security of LNR” (at Sovetskya str. 79 in Luhansk).
Based on Andrii’s mother’s claimt on the illegal arrest of her son on the temporarily uncontrolled territory of Luhansk oblast, Svyatoshyn Unit of the National Police n Kyiv City on 22.10.2018 opened a criminal case under article 146 of the Criminal Code of Ukraine (Unified Register of Pre-Trial Investigations no. 12018100080008478). Simultaneously, to organize further exchange, the woman submitted a request and other documents to the Security Service of Ukraine’s United Center for Coordination and Search and Release of Illegally Incarcerated People, Hostages, and Locating Persons who Went Missing in the Area of Anti-Terrorist Operation.
The situation with Andrii’s illegal detainment with the OST drug was included in the Report on the human rights situation in Ukraine of the Office of the United Nations High Commissioner of 16 August to 15 November 2018 (para.52, page 12).
On February 7, 2019, Andrii was transferred for further illegal detainment to the pre-trial Detention center (SIZO) “Luhansk Penitentiary Facility of the Ministry of Interior of LNR” (23rd Line street, 4; Luhansk).
On February 11, based on the appeal of Andrii’s mother, the European Court of Human Rights (ECHR) opened proceedings according to Rule 39 of the Rules of Court of ECHR (interim measures). Considering the importance and urgency of the case, the Court decided to consider it as a priority case under Rule 41 of the Rules of Court and ensure confidentiality of certain information to avoid harm to the complainant (Rule 33.1). ECHR has submitted a corresponding official communication to the responsible public authorities in the Russian Federation and in Ukraine.
On 22 February 2019, so-called “Krasnodon Rayon Court of LNR” illegally sentenced Andrii to a long-term imprisonment and confiscation of property for the «alleged smuggling of drugs» — his OST medications (part 3 of article 282 and part 2 of article 276 of the “Criminal Code of LNR”).
In April 2019, Andriy was transferred from the detention center to Sverdlovsk prison, currently he is located at (94420, Lininskoe village, Sverdlovskiy rayon, 16 Profsojuznaya Str ); the support of APH has ensured he regularly receives food and living essentials; he enjoys limited access to his lawyer; also, he has recently been allowed to see his family once a month.
As far as we know, Andrii has been included in the exchange list, but nothing is known about specific dates. Previously planned exchange events have already been postponed several times.
We would appreciate dissemination of this information among media, international, humanitarian, public or other organizations that may somehow prove helpful in liberation of Andrii Yarovyi and returning him back home.
On November 26, 2019 UNAIDS coordinator in Belarus Vera Ilyenkova and the head of Svietlahorsk district executive committee (city mayor) signed the Paris Declaration to intensify the activities in cities aimed to end HIV/AIDS epidemic.
Svietlahorsk has become the second city in Belarus that signed the Declaration, declaring its active leadership in global combating HIV/AIDS epidemic in the cities all around the world.
The ceremony of signing the document was visited by the representatives of Ministry of Health of the Republic, city government officials, UNAIDS country office in Belarus, Alliance for Public Health as well as many other international and non-governmental organizations.
Andriy Klepikov, Executive Director of the Alliance for Public Health: “I welcome this important strategic initiative of Svietlahorsk. Signing Paris Declaration means readiness to use the best world experience to develop effective city programs for combating HIV/AIDS epidemic, which are supported by the municipal funding and are aimed to improve the health status of the city residents. It’s just the beginning of the accelerated municipal response to the epidemic, and the team of the Alliance for Public health is ready to provide the technical and expert support to the city”.
“By joining Paris Declaration the city of Svietlahorsk takes the responsibility to achieve the 90-90-90 targets, which means that 90% of all people living with HIV should know their status; 90% of patients knowing that they have HIV infection get access to treatment, and 90% of people getting the HIV treatment have undetectable viral load. The city will pay specific attention to the key populations with high risk of getting HIV infection as well as to elimination of stigma and discrimination in regard to people living with HIV. To coordinate these activities, there is a working group established by the district executive committee, which developed the draft city program on combating HIV/AIDS epidemic in 2019-2021 with active involvement of the representatives of key populations.
We understand that reaching the 90-90-90 targets is a challenging task, but it’s necessary to initiate the changes, increase budget allocations from local budget in order to improve the status of health and the quality of life of the Svietlahorsk residents”, – commented the city mayor, Mr. Dmitriy Aleynikov.
It should be noted that in Svietlahorsk, one of the youngest cities in Belarus, there are about 13% of all people living with HIV in the country.
Vera Ilyenkova, UNAIDS coordinator in Belarus: “The ‘Fast-Track Cities’ Program was launched in Paris in 2014, when representatives of 26 cities signed the Paris Declaration. For today there are more than 350 cities and municipalities, which joined the initiative. By signing this document Svietlahorsk undertakes the obligation to achieve the goals of Paris Declaration and put an end to the AIDS epidemic by 2030. UNAIDS is supporting the Svietlahorsk initiative and jointly with the partners, one of which is the Alliance for Public Health, is ready to provide the city with technical assistance and expertise on the issues of accelerating the measures aimed to combat HIV, eliminating of inequality in access to key medical and social services. The key success factor for Svietlahorsk is the perfect coordination and interaction between the government and civil society, including public organizations uniting people living with HIV.”
Representatives of city administration expect that jointly with the partners and with the support of the international organizations the 90-90-90 target will be achieved by 2021, and the end to the epidemic will be put by 2030.
Event participants supported campaigns It’s #InYourPower to end AIDS.
The regional #SoS_project team continues to advocate for the sustainability of HIV services at the regional and national levels in Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Northern Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Tajikistan, Ukraine and Uzbekistan.
In the third quarter of 2019, a lot of work was done to prepare countries for the transition to state financing of HIV / AIDS programs: in Bosnia and Herzegovina, Northern Macedonia, Moldova, Montenegro, Romania the cost of services for key population groups was calculated with the technical support of project experts. A number of key meetings were held in Kyrgyzstan, Kazakhstan, and Copenhagen on improving access to treatment.
In August, the Paris Declaration was signed in the city of Osh (Kyrgyzstan). Joining the Paris Declaration in 2019 is expected in: Dushanbe (Tajikistan), Salihorsk, Svetlogorsk (Belarus), and the signing of the Zero TB declaration is being discussed with the municipal authorities of Kyiv (Ukraine), Chisinau (Moldova), Bishkek (Kyrgyzstan). The Balkans countries have actively approximated joining their cities to the Paris Declaration. There are ongoing negotiations with the city authorities of: Sarajevo, Banja Luka, Mostar (Bosnia and Herzegovina), Podgorica, Bar, Bielo-Pole (Montenegro).
In Moldova, preparations have begun for a national information campaign on pre-exposure HIV prevention (PrEP), and 20 people have already started PrEP.
In the “Gender and HIV 2019” area some activities have started in Georgia, Northern Macedonia, Kyrgyzstan, Russia and Montenegro.
Project partners from Belarus and Uzbekistan successfully completed their studies at the Harm Reduction Academy.
In a month, on December 6, Kyiv will host municipal delegations from more than 30 cities of the world at the regional EECA City Health Leadership Forum, coordinated by the Alliance for Public Health in cooperation with the Kyiv City State Administration and UNAIDS. The forum will present and discuss the progress and most relevant interventions for the cities of the last 5 years in countering the epidemic of HIV, tuberculosis and viral hepatitis. The conference will be broadcast online on the Alliance for Public Health Facebook page.
In anticipation of the event, we studied the world experience of one of such interventions using the example of the Ukrainian city of Sumy in innovative approaches to harm reduction programs for the Eastern Europe and Central Asia countries. Thus, a harm reduction room was opened in the city with the support of municipal authorities for the first time in the EECA region. By the end of the year, it is planned to open a second one, and, moreover, this experience can be implemented in other cities of the region in the near future.
Such a unique experiment for the region attracts the attention of representatives of municipal authorities, NGOs, and other cities. So, this year, the municipal delegations of Poltava, Odessa, Kyiv, Chernigov (Ukraine), Balti, Chisinau (Moldova), Kazakhstan visited the facility to study the experience, a series of meetings were held to discuss the prospects of opening similar rooms in other cities. Therefore, we wonder, in which EECA city the next harm reduction room will be opened in cooperation between the municipal authorities of the city and NGOs?
Background, or why we need harm reduction rooms
For the first time, a community center allowing controlled drug use was launched in the Netherlands in the early 70s. The center provided booklets with basic information about health and drug use, offered food and clothes, distributed clean syringes and also allowed to use them on the spot. The local administration and the police supported the project, but the center achieved official status only in 1996.
The first harm reduction facility for controlled drug use, officially approved by the municipal authorities and supported by health professionals, was opened in Bern in 1986 and continues to work.
Today, more than one hundred injection rooms are officially operating in the world: in Switzerland, Germany, France, Canada, Australia, Spain, Luxembourg, Norway, the Netherlands and now in Ukraine, such facilities also appeared in the USA several years ago.
Such centers address overdose cases with almost 100% efficiency, which is confirmed, for example, by the estimates. And some reports point out to the economic efficiency for national and municipal budgets, since ambulance is called much less often, and the likelihood of HIV, TB and hepatitis spread in the society is significantly reduced. Other repeatedly proven positive aspects of such an experience are: reducing crime, improving the overall health and quality of life, reducing the number of “relapses”, improving the socialization of patients (a regular job, place of residence, restored family ties).
Assessment of benefits of the harm reduction room in Sumy
Global experience shows where harm reduction rooms are introduced on the basis of state facilities in societies with a high level of discrimination and criminalization of people who use drugs, it’s difficult for them to gain the target group trust. In Sumy, this problem was successfully addressed through the involvement of social workers from a non-governmental organization.
“The approaches to harm reduction in Ukraine have not changed dramatically for 20 years, so the most challenging task now is to gain trust of people who use drugs so that they are not hesitant to use in this municipal space. Everything here is built on trust, – said a public activist and the facility launch initiator, Oleksiy Zagrebelnyi. – The result of our activity at the moment is that there are more and more visitors, we began to receive feedback from them, which means that the room is in demand. It means that our efforts are not in vain. The services we provide are unique, they are in demand, and it is a success, because the social side of this project has significant benefits for the public”.
A significant example of the harm reduction room benefits is a considerable improvement in the security atmosphere in society and a decrease in the number of complaints to the Sumy authorities regarding the negative consequences of drug use, in particular: littering with used syringes and other means in the territories of hospital facilities, house entrances, playgrounds and just on the streets; use in public places, etc. According to Maksym Galitskyi, the deputy mayor of Sumy on health and safety, such appeals have become scarce once the room was opened. “Previously, there were several appeals every week, now we receive one complaint per month. This is an obvious success”, he said.
According to the chief doctors of the Sumy Regional Narcological Dispensary Taras Zlydennyi, about 50-70 people visit the harm reduction room every day, the total number of patients who are actively using substitution treatment in the city is more than 300 people, and the number of registered patients at the drug dispensary is up to 600 people. The room provides preventive counseling services to reduce the drug use harm in general and provides information on the consequences of street drugs, tests for HIV and hepatitis, counseling for relatives and members of PWUD families, exchange of syringes, as well as protection and preventive measures.
Political will and the municipal authorities’ consensus are a prerequisite of success
The Sumy approach to harm reduction is unique, because the city managed to dispel the stereotypes regarding the methods of combating drug addiction, and instead of stigmatizing and persecuting PWUD, the representatives of the city authorities, law enforcement agencies, the medical sector and NGOs united their efforts and provided the conditions for controlled drug use. Moreover, the harm reduction room is funded exclusively from the city budget, and financial assistance from international organizations, the ICF “Alliance of Public Health” and the International Renaissance Foundation, was needed only at the start of the project to repair the premises.
“There are 2 options to fight against any problem – this is either tough prosecution and looking for ways to eradicate, which are often too expensive and do not achieve effective results. The other way is the policy in which we try to reduce harm, thinking about the safety of our citizens”, said Maksim Galitskyi. – “In Ukraine, various officials, often having different mindsets, are responsible for protecting health and safety. This is a national scale problem throughout the country, since there is no single policy-maker in the field of counteracting drug trafficking, and the Ministry of Health has no influence on the SSU. In Sumy, I am an official responsible for safety and health, and this we managed to create a communication platform on which NGOs, together with authorities, reached a certain consensus on this issue”.
The importance of having political will and consensus among different branches of government is also recognized by the regional administration.
“Sumy region was lucky to have officials who are able to understand, realize, support such an initiative”, said the ex-head of the staff of the Sumy Oblast State Administration, and the current first deputy Minister of Development of Communities and Territories of Ukraine Dmytro Zhivitskyi. – We had political will, and the Head of the oblast administration supported us. Non-governmental organizations took up the function of awareness raising, expert examination and providing international experience for the administration, for the deputies, whose support we managed to gain”. According to him, the work in the harm reduction area provided an effective tool for the implementation of out-of-the-box solutions in the field of public health, which will work in the future. “Taking off in this direction, we realized that we have a well-developed mechanism for making and implementing joint out-of-the-box decisions, which was lacking before this”, he said. – “Back in 2017, we created the oblast Public Health Center, the first full-fledged regional facility. Now we have created a working group, and in mid-July we will adopt the oblast public health program, which will take into account the experience with drug users. That is, our task today is to implement a philosophy of prevention and addressing the causes rather than eliminating the consequences”.
Where in the EECA region the next harm reduction room is about to open
“The first harm reduction cabinet in the world was opened in the Swiss city of Bern 33 years ago. Since this time, the city has become healthier and safer, access to HIV treatment today is unconditional, and a comparison of the situation on the streets of 1986 and today clearly demonstrates the dynamics of improvement. We will talk about this in detail at the regional EECA City Health Leadership Forum on December 6, which will be held in Kyiv. We would like the cities of the EECA region to follow the path of improving the health and quality of life of citizens, using effective evidence-based methods to counter dangerous epidemics such as HIV, TB and viral hepatitis,” said Ievgen Kushnir, program manager of the Alliance for Public Health.
Olena Kucheruk, program manager at the International Renaissance Foundation: “As a person who has been developing harm reduction in Ukraine for 20 years, I remember how the first harm reduction services started. How innovative it was then, and how many barriers then had to be overcome. Then we could not even think that sometimes safe use rooms would be our reality. I am very happy to see that this is becoming possible today. 20 years is a long period of time, but everything is changing: people, doctors, local authorities and the police are now having a completely different understanding of the issue and expertise. It is very pleasing and inspiring. We would like to continue supporting and developing such rooms in other cities of Ukraine”.
Note that the Sumy harm reduction room was opened at the regional drug dispensary. Local authorities and international organizations (the ICF “Alliance of Public Health” and the International Renaissance Foundation) provided the startup support for the facility. According to the results of the year, this experience, according to representatives of the city’s authorities and non-governmental organizations, has proved its efficiency and expediency.
Public activists from the Moldavian city of Balti showed interest in opening such a room in their city. Moreover, the mayor said earlier that it would be much easier to implement such programs in Balti, because for this you would only need to “copy” Bern’s experience initiated 33 years ago. Now the experience of the Ukrainian city of Sumy will become a best practice.
Moreover, the mayor of Odessa Gennadiy Trukhanovnoted earlier, that “We need to change the mentality and attitude of our people. Of course, we use our experience and the changes that have occurred in the field of drug policy and the fight against HIV over the past 30 years to improve the situation in Odessa. Unfortunately, we treat people who use drugs as criminals, while we should treat them as sick and dependent people”. Inspired by Bern’s experience in drug policy as part of the #FastTrackSities study visit, Mr. Trukhanov promised to open a safe drug use room in Odessa in the EECA region.
According to Oleksiy Zagrebelnyi, repair work in the second safe use room is currently underway in Sumy, and by the end of the year it is planned to open another harm reduction room at the opposite end of the city. For this, there is already the first successful experience, and all the necessary procedures that have been developed in the course of the current safe use room equipping. However, other cities will have to make some efforts to implement such a project.
Where to start: expert advice
Experts emphasize that opening a harm reduction room in the city will involve two important aspects, the regulatory and the economic issues.
First, it is necessary to analyze the adoption of programs involving work with drug users, people living with HIV, people with hepatitis, TB and concomitant infections and calculate the costs of treating those who have been infected by chance.
“As a rule, local program packages already exist in many cities”, said Yelena Koval, consultant for the International Renaissance Foundation on the availability of pain management medications and drug policy. – “Among local programs, we need to look for those that have a harm reduction component, analyze at which healthcare facilities such programs work, who is involved there. And then – just imagine that an infected syringe can be dropped at the building entrance, on the playground, and calculate how much post-exposure prevention will cost for a person who is accidentally exposed to the infection. How much resources will be needed in order to deliver medications, how much a treatment regimen will cost. Then it becomes clear that the cost of a harm reduction room launch is comparable to the expenses which will be incurred even in a single such case”.
In order to open such a facility, it is necessary to assess the needs of the city/oblast/region, create a program that will include further steps, identify sources of funding and conclude an agreement with a health facility.
In recent years, cities have demonstrated leadership in improving people’s health and effectively combating HIV, TB, and hepatitis. And this trend is crucial at the global level, because today, 55% of the world’s population lives in cities, and it is expected that by 2050, two-thirds of the world’s population will be urban dwellers. The cities can benefit from decentralization of programs and resources, an expert community input and world experience, they only need to have political will of local authorities and the safety and health issues will be addressed. City mayors have powers to save over 2 million lives in Eastern Europe and Central Asia today.
On October 2, the team of the regional project “Sustainability of Services for Key Communities in the Eastern Europe and Central Asia Region” (# SoS_project) announced the launch of the “It’s in Your Power to Stop HIV” information campaign that started with flash mob in social media marked with hashtags #InYourPower and #вТвоихСилах.
“Doctors, social workers, nurses, community organizations have done and are doing their job. But another component is important: state leadership. Everyone who is not accidentally in the office of an official who has the authority to make decisions should take them in favor of the people. And in the area of HIV/AIDS, this means progressive legislation, allocation of funds for prevention and treatment, public procurement at competitive market prices, and other things that can save lives,” says Andriy Klepikov, executive director of the Alliance for Public Health. – Time is what really matters when it comes to tackling HIV epidemic. Therefore, we are looking for leaders. Leaders who can make a difference in their countries. Not the day after tomorrow, not tomorrow, but today.”
Campaign is initiated by Alliance for Public Health and CO “100% Life” and is implemented with information support from the UNAIDS EECA regional team and financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria within the framework of #SoS_project. The campaign will last until December 2021.
“#SoS_project is a working strategy to save lives, and our campaign is a simple and clear action guide that will explain that in order to stop the epidemic you don’t need to be a magician,” comments Dmitry Sherembey, head of the Coordinating Council of the CO ” 100% Life. “The dialogue between patients and officials, the optimization of procurements, tolerance and, most importantly, the ability to listen and hear each other – these are simple steps that are necessary to stop the epidemic.”
According to campaign coordinators, they were faced with the task of developing a communication strategy that would form a motivating public background and contribute to increasing the effectiveness of the dialogue between civil society and government officials. Thus, the main task was to offer them a scenario of interaction understandable to both sides. This is necessary in order to form a new generation of leaders who will be able to see and understand the social demand to accelerate the fight against HIV/AIDS. They will have the arguments and make important decisions in favor of sustainability of HIV services in order to save at least 2 million people living with HIV in Eastern Europe and Central Asia, as well as the Balkan region.
Tetiana Deshko, director of international programs at the Alliance for Public Health, shared her experience of working with municipal teams, which showed that cities have the resources and infrastructure to stop the HIV/AIDS epidemic. “I appeal to the mayors of cities in Eastern Europe and Central Asia, the only one of the two regions where the HIV epidemic continues to grow: it’s in your power to stop the HIV epidemic! As mayor, you can sign the Paris Declaration; to develop a city program with goals for the prevention, identification and immediate start of treatment; allocate respective city funds.”
Vinay P. Saldanha, UNAIDS Regional Director for Eastern Europe & Central Asia:
“It is extremely important today to reach a new level of dialogue and interaction between civil society and state partners. I hope that within the framework of SOS_project and InYourPower initiative the conditions for such interactions will be created and we will be able to reverse the trajectory of the HIV epidemic in the region and then finally end the AIDS epidemic once and for all. “
The campaign has already been openly supported by Peter Sands, Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria, Michel Kazatchkine, UNAIDS Special Advisor on HIV, TB and Hepatitis, Gennady Trukhanov, mayor of Odessa (Ukraine), Kostas Bakoyannis, mayor of Athens (Greece), Nurbek Kadyrov, Deputy Mayor of Osh (Kyrgyzstan), representatives of the municipal government of Sofia (Bulgaria), as well as #SoS_project project partners from the countries of the region. The list of supporters is growing.
“In the process of developing the campaign, we studied the trends, lessons and impacts of information campaigns implemented in the region over the past 5 years. During the six months of preparation, we went through everything: heated team discussions, radical changes in the concept, in-depth interviews and discussions with officials, consultations with communication experts and political scientists, representatives of communities from different countries! – note the initiators of the campaign. – As a result, we formed the message that was positive, simple and most understandable to all parties: it’s #InYourPower to end HIV! And we will make the best examples in the EECA region known to everyone.”
It should be noted that more than 30 years of experience in combating the HIV/AIDS epidemic have demonstrated episodes of both tough confrontation and successful interaction between government agencies and civil society. Today in the region there are examples of bold decisions and selfless work of both sides. For the most part, productive dialogue and examples of effective cooperation in a number of countries are the key to stop the epidemic.
The #InYourPower campaign is designed to talk about such decisions and people, showing that everyone can stop HIV. The main thing is to learn and acknowledge the contribution of partners and work together to provide the necessary assistance to those who really need it.
The organizers of the info campaign do not limit the geography of its action; therefore they present all the promotional materials in Russian and English. At the same time, the organizing team will focus its efforts on 14 countries of EECA and the Balkan regions: Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Tajikistan, Ukraine, Uzbekistan.
The main feature of the campaign will be the “regional like” or the #InYourPower award. This prize will be awarded to leaders in the fight against the HIV/AIDS epidemic – officials, experts and politicians who, according to representatives of civil society, have made the greatest contribution to the fight against the epidemic in their country. You can nominate such leaders by filling out the application form on the web site https://inyourpower.life/. The nomination will be put to the vote by “likes”, and the nominees who have collected a sufficient number of likes will be submitted for consideration to special committee of trust to make a final decision on the award. The information component will be a special series of publications on people and solutions that save lives in the EECA region and the Balkans.
More info about the campaign with detailed guide on how to join and support it ,can be found on official web site https://inyourpower.life/ and campaign’s pages on Facebook and Twitter. All materials are available in Russian and English.
According to Mr. Klitschko, amid the global epidemics of HIV and TB, the city must create favorable conditions for public organizations fighting epidemics, taking active leverage, and actively engaging in it.
Ion Ceban, Chisinau Mayor: “We rely on partnership in combating HIV and TB”
Dmitriy Aleinikov, Svetlogorsk Mayor: “It is easy to achieve 90-90-90 indicators, if we speak up”
Odesa is the first city in Ukraine to commit to the Zero TB Cities initiative and systematically proceeding towards overcoming the TB and HIV epidemic. Today, all forces that used to withstand these challenges alone, became consolidated. Thanks to joint efforts, the effectiveness of treatment has increased from 53% to 72%.
“Bern accumulated solid experience in this area, not because we are better than other cities in any way, but rather because we faced huge problems with drug users. In the 80s, there were hundreds of them right in the center of the city, they wandered around the streets, threw syringes right in the parks and it was terrible”, Alec von Graffenried recalls. “Since then, city mayors had to solve this problem quite effectively, because PWID is one of the most vulnerable groups, and the most problematic in terms of HIV prevention”.
Such a unique experiment for the region attracts the attention of representatives of municipal authorities, NGOs, and other cities. So, this year, the municipal delegations of Poltava, Odessa, Kyiv, Chernigov (Ukraine), Balti, Chisinau (Moldova), Kazakhstan visited the facility to study the experience, a series of meetings were held to discuss the prospects of opening similar rooms in other cities. Therefore, we wonder, in which EECA city the next harm reduction room will be opened in cooperation between the municipal authorities of the city and NGOs?
“The approaches to harm reduction in Ukraine have not changed dramatically for 20 years, so the most challenging task now is to gain trust of people who use drugs so that they are not hesitant to use in this municipal space. Everything here is built on trust, – said a public activist and the facility launch initiator, Oleksiy Zagrebelnyi. – The result of our activity at the moment is that there are more and more visitors, we began to receive feedback from them, which means that the room is in demand. It means that our efforts are not in vain. The services we provide are unique, they are in demand, and it is a success, because the social side of this project has significant benefits for the public”.
A significant example of the harm reduction room benefits is a considerable improvement in the security atmosphere in society and a decrease in the number of complaints to the Sumy authorities regarding the negative consequences of drug use, in particular: littering with used syringes and other means in the territories of hospital facilities, house entrances, playgrounds and just on the streets; use in public places, etc. According to Maksym Galitskyi, the deputy mayor of Sumy on health and safety, such appeals have become scarce once the room was opened. “Previously, there were several appeals every week, now we receive one complaint per month. This is an obvious success”, he said.
According to the chief doctors of the Sumy Regional Narcological Dispensary Taras Zlydennyi, about 50-70 people visit the harm reduction room every day, the total number of patients who are actively using substitution treatment in the city is more than 300 people, and the number of registered patients at the drug dispensary is up to 600 people. The room provides preventive counseling services to reduce the drug use harm in general and provides information on the consequences of street drugs, tests for HIV and hepatitis, counseling for relatives and members of PWUD families, exchange of syringes, as well as protection and preventive measures.
“Sumy region was lucky to have officials who are able to understand, realize, support such an initiative”, said the ex-head of the staff of the Sumy Oblast State Administration, and the current first deputy Minister of Development of Communities and Territories of Ukraine Dmytro Zhivitskyi. – We had political will, and the Head of the oblast administration supported us. Non-governmental organizations took up the function of awareness raising, expert examination and providing international experience for the administration, for the deputies, whose support we managed to gain”. According to him, the work in the harm reduction area provided an effective tool for the implementation of out-of-the-box solutions in the field of public health, which will work in the future. “Taking off in this direction, we realized that we have a well-developed mechanism for making and implementing joint out-of-the-box decisions, which was lacking before this”, he said. – “Back in 2017, we created the oblast Public Health Center, the first full-fledged regional facility. Now we have created a working group, and in mid-July we will adopt the oblast public health program, which will take into account the experience with drug users. That is, our task today is to implement a philosophy of prevention and addressing the causes rather than eliminating the consequences”.
“The first harm reduction cabinet in the world was opened in the Swiss city of Bern 33 years ago. Since this time, the city has become healthier and safer, access to HIV treatment today is unconditional, and a comparison of the situation on the streets of 1986 and today clearly demonstrates the dynamics of improvement. We will talk about this in detail at the regional EECA City Health Leadership Forum on December 6, which will be held in Kyiv. We would like the cities of the EECA region to follow the path of improving the health and quality of life of citizens, using effective evidence-based methods to counter dangerous epidemics such as HIV, TB and viral hepatitis,” said Ievgen Kushnir, program manager of the Alliance for Public Health.
Olena Kucheruk, program manager at the International Renaissance Foundation: “As a person who has been developing harm reduction in Ukraine for 20 years, I remember how the first harm reduction services started. How innovative it was then, and how many barriers then had to be overcome. Then we could not even think that sometimes safe use rooms would be our reality. I am very happy to see that this is becoming possible today. 20 years is a long period of time, but everything is changing: people, doctors, local authorities and the police are now having a completely different understanding of the issue and expertise. It is very pleasing and inspiring. We would like to continue supporting and developing such rooms in other cities of Ukraine”.
“As a rule, local program packages already exist in many cities”, said Yelena Koval, consultant for the International Renaissance Foundation on the availability of pain management medications and drug policy. – “Among local programs, we need to look for those that have a harm reduction component, analyze at which healthcare facilities such programs work, who is involved there. And then – just imagine that an infected syringe can be dropped at the building entrance, on the playground, and calculate how much post-exposure prevention will cost for a person who is accidentally exposed to the infection. How much resources will be needed in order to deliver medications, how much a treatment regimen will cost. Then it becomes clear that the cost of a harm reduction room launch is comparable to the expenses which will be incurred even in a single such case”.