Alliance for Public Health and the European AIDS Treatment Group are pleased to invite you to online Webinar “U = U = U and I can do more! – An exploration of what we can do more to get the message across”, which will take place on Zoom, 18th February 2022 at 1 p.m.- 2:30 p.m. CET.

In line with EATG’s aim to work on guidelines for healthcare service providers and to address stigma and discrimination, EATG signed on to the 2016 Undetectable=Untransmittable (U=U) consensus statement launched by the Prevention Access Campaign. This states that a person on fully suppressive HIV treatment cannot transmit HIV. However, there remain inconsistencies in the knowledge and understanding of U=U in non-HIV related care. In order to overcome the lack of knowledge and promote awareness and a better understanding of U=U, EATG conducted a mapping initiative that aimed to collect and report on U=U awareness-raising initiatives in HIV care services/ settings in four EECA countries: Belarus, Kazakhstan, the Russian Federation and Ukraine.

This webinar will start with a PechaKucha-style overview of the U=U background, followed by the presentation of the mapping report conducted by EATG on U=U awareness-raising initiatives in HIV and non-HIV care settings from 4 EECA countries. In the second part of the webinar, different actors will be invited to share examples and experiences of good practices from Russia, Ukraine and Italy. A final discussion will be held to reflect upon current trends and focus on what can be done in the future for a better promotion and development of the U=U agenda.

To attend the meeting, please register here.

Questions about the event? Email: marina.cognee@eatg.org

The PLOS portal published a new article “COVID Testing Equity: A Reflection Based on 1.5 Years in the ACT-Accelerator”. The post begins by mentioning the statement “Vaccines alone won’t get us out of this pandemic”, which is aimed at numerous participants in the global response to COVID. The vaccination campaign must certainly continue, but sufficient access to testing for COVID-19 is also important to stabilize and control the situation.

The material itself deals with self-testing for COVID as an important component of protecting yourself, your family and society, and one of the world’s leading partnerships – The Access to COVID-19 Tools (ACT) Accelerator platform. It is a pioneering global collaboration launched in 2020 to accelerate the development, production and equal access to COVID-19 tests, treatments and vaccines.

“Access to self-testing is part of people’s fundamental right to information about their bodies,” the publication notes. The need to expand access is written by reputable media and many experts speak, but the authors of the article focus on the importance of quickly developing clear guidance on rapid antigen tests as part of the “test and treat” strategy. It became especially important with the advent of the first outpatient treatment.

What is the situation with access to rapid tests?

For example, in Canada, the #FreeTheRATs information campaign was launched demanding that the government provide free rapid tests for vulnerable categories of the population. Omicron’s surge led to a high demand for rapid antigen tests (RATs) in December 2021, and companies have responded by working around the clock and investing in automation. Germany, on the other hand, invested in rapid tests long before anyone else, while subsidizing access to self-testing antigen tests sold in pharmacies, via mobile devices called “coronabikes” and via vending machines.

Peter Sands, the Executive Director of the Global Fund wrote that “if you give people unfettered access to these easy-to-use tests giving almost instant results, they will use them to protect themselves, their families and communities”.

According to Nadiya Yanhol, C19RM Coordinator of the #SoS_project 2.0 at the Alliance for Public Health, expanding access to rapid tests for COVID-19, in parallel with vaccination, and especially against the backdrop of the emergence of the first drugs in Eastern Europe and Central Asia, is urgently needed in the region. She shared that back in 2020, the #SoS_project team responded as quickly as possible to the COVID-19 pandemic by starting work in this direction.

“In February 2021 the first tests were delivered to Bosnia and Herzegovina to test key populations and their contacts. Seven other project countries also received tests, namely Kazakhstan, Kyrgyzstan, Uzbekistan, Ukraine, Moldova, Montenegro and North Macedonia”. – says Nadiya. “The first results were not long in coming, as Moldova showed 11% among key groups, during outbreaks and regular waves, testing rates were incredibly high, for example, in November 2021 in Ukraine – 75% among MSM and in October 2021 in Kyrgyzstan – 56 % among KGs.”

Also, the authors of the publication “COVID Testing Equity” emphasize the importance of ensuring access to testing by governments and manufacturers. And the demand for testing, they believe, will increase significantly only if the general population and communities have access to competent resources on health literacy and the importance of regular or early testing, the benefits of using rapid testing, and the prospects for outpatient treatment. “As the HIV response has shown us, people will flock to tests when there easily deployed treatment are readily available, resulting in huge health benefits for individuals, families, health systems, and the community at large.”

Study shows how to make it easier for NGOs to use COVID-19 rapid tests

In order to expand access to relatively new rapid tests for COVID-19 in the world, it is important to take into account the existing experience, minimizing potential barriers at the “finish line” of their implementation, namely at the point of contact of tests with the target audience.

“As part of the COVID program, we are approached by representatives of NGOs and representatives of key populations with a request to provide a COVID-19 antigen for self-testing. At the community level, timely identification of clients infected with the virus is very important, because there is a risk of stopping the work of vital HIV services, if quarantine is necessary”, – said Nadiya Yanhol. “The use of tests should be as convenient and safe as possible. After all, the patient takes the analysis on his own, without the participation of the medical staff, which does not require additional material costs. This is very convenient and prevents further spread of COVID-19.”

According to her, the #SoS_project team saw certain risks in the fact that the available tests did not have individual packaging, therefore, to confirm the hypothesis, they conducted a survey among end-users of tests about the convenience of using them in non-individual packaging.

“66% of those surveyed used the test for self-testing. 55%* noted that they experienced obvious discomfort during testing, since the tests were not individually packaged. They noted that sterility is not ensured in this way due to the lack of individual packaging, which is a certain barrier”, says Nadiya. “Today, this request still remains unanswered, as it is not possible to purchase tests in individual packages on the Global Fund’s procurement platform. Also, today there are no WHO recommendations and national guidelines in the EECA countries that would recommend the use of Sars-Cov-2 Ag for self-testing. This is also why we fully support COVID Testing Equity initiated by ACT-Accelerator.”

To read the full version of the article, please follow the link.

Additionally:

The ACT-Accelerator platform was launched at the end of April 2020, at an event co-hosted by the Director-General of the World Health Organization, the President of France, the President of the European Commission, and the Bill & Melinda Gates Foundation, the Access to COVID-19 Tools (ACT) Accelerator brings together governments, scientists, businesses, civil society, and philanthropists and global health organizations (the Bill & Melinda Gates Foundation, CEPI, FIND, Gavi, The Global Fund, Unitaid, Wellcome, the WHO, and the World Bank). Following the ACT-Accelerator launch, UNICEF and PAHO became delivery partners for COVAX, the vaccines pillar.

These organizations have joined forces to speed up an end to the pandemic by supporting the development and equitable distribution of the tests, treatments and vaccines the world needs to reduce mortality and severe disease, restoring full societal and economic activity globally in the near term, and facilitating high-level control of COVID-19 disease in the medium term.

Since April 2020, the ACT-Accelerator partnership, launched by WHO and partners, has supported the fastest, most coordinated, and successful global effort in history to develop tools to fight a disease, as well as such an initiative as “COVID Testing Equity”. With significant advances in research and development by academia, private sector and government initiatives, the ACT-Accelerator is on the cusp of securing a way to end the acute phase of the pandemic by deploying the tests, treatments and vaccines the world needs.

*of respondents who used the test from the general packaging for individual testing

As part of the Alliance for Public Health regional project “Sustainability of HIV services for key populations in EECA region” (#SoS_project), a study was conducted in Kazakhstan on the observance of human rights in places of detention.

For three years, local experts have carried out systematic work aimed at strengthening the capacity of civil society organizations and supporting monitoring of the situation with access to services and rights in the penitentiaries of the country, and also prepared a concept for achieving the 90-90-90 goals in the penitentiary system, which ensures unity of the state approach with the approaches used in the public sector. The result of their work was a unique publication of its kind.

According to Alexander Gatiyatullin, co-author of this material on the national preventive mechanism in the countries of the EECA region based on the experience of Kazakhstan: “This publication has no analogues. Now community representatives have clear algorithms for joining the functions of the NPM: through participation in the work of regional groups and the opportunity to undergo preliminary training in order to understand the essence of the national preventive mechanism. The material focuses the attention of the participants of the NPM of the Republic of Kazakhstan on problems, related to the HIV/AIDS epidemic in penitentiary institutions. Previously, when making preventive visits to places of detention, there was no such close attention to the availability of services for the prevention and treatment of socially dangerous diseases. All this enhances the effectiveness of the NPM, as it allows you to avoid a purely legal approach to the problem through the involvement of specialists in various fields – psychologists, sociologists, social workers, doctors, teachers.”

The publication talks about new vectors of cooperation between key populations and national monitoring mechanisms to achieve the 90-90-90 goals in prison systems.

“We always work with the understanding that preventive work in the context of health in the penitentiary system can only be effective if close cooperation and a good level of mutual understanding of all stakeholders: state bodies, penitentiary institutions and non-governmental organizations are developed. Our activity is aimed at creating a full-fledged opportunity to exercise their right to the highest attainable level of physical and psychological health, guaranteed by the state.During 2019-2021, we managed to carry out a number of strategically important activities regarding HIV prevention and support for PLHIV who are in prison.We want to share our best practices and success, as well as to set an example for other countries in the EECA region so that they can apply our results in practice.” – Lyubov Vorontsova, project coordinator of the Central Asian Association of People Living with HIV and Director of #SoS_project in Kazakhstan.

We invite you to read the publication by the following link (please note, the publication is in Russian for now).

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.

In our #SoS_project Small Talk, we discuss the key focuses of the ongoing efforts to achieve sustainability of HIV services in Eastern Europe, Central Asia and 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. They are true Sustainability Leaders, whose daily work is aimed at creating it.

#SoS_project Interviewer is Ruslan Poverga is the Head of the NGO “Initiativa Pozitiva”, one of the largest and most experienced non-governmental organizations in the field of public health and patient rights in Moldova. Ruslan is a well-known activist not only in his country, but also in the region of Eastern Europe and Central Asia – he has been working in the field of HIV / AIDS for over 20 years and was the first in Moldova to publicly declare his HIV status.

#SoS_project: Ruslan, 2019-2021 brought many challenges, and 2020 generally transformed the world into a completely different reality thanks to COVID. What elements of health sustainability have you been working on in this context?

RP.: Let’s start with the fact that the whole story with COVID, in addition to this terrible burden that has fallen on everyone, both from a humane and from an economic point of view, has revealed all the weaknesses of state systems and, first of all, healthcare. For this reason, we looked at the epidemic from a positive side and decided to build our partnerships at the national level precisely from such a point of view that now, more than ever, we need to be open for quick interaction and prompt response. In order, firstly, to resolve issues related to COVID, and secondly, looking to the future, in the context of the sustainability of the healthcare system, to build long-term processes based on the experience gained. And this is certainly related to both legislation and data collection systems, which should display the whole picture (the number of patients, what has been done, what funds have been poured into the country, how they are used, etc.). That is, everything related to the transparency of information. And of course, we remember about the flexibility of the system – it must respond to any challenges. In this case, in this complex scenery, we managed to force events and decisions that dragged on for several years and did not move forward.

#SoS_project: Can you give specific examples?

RP.: Let’s take the role of civil society in medical and social services. Before COVID, the civil sector was perceived as “care, support, condoms, treatment” etc. That is – work and do not meddle in the rest. During COVID, the situation has forced the healthcare system to look at NGOs as a partner, including in providing access to treatment. In particular, medicines were donated to NGOs to be delivered directly to patients. The step is quite serious.

To a certain extent, this also influenced the fact that PrEP and community PrEP advanced very dynamically in Moldova – the NGO-based partner organization GENDERDOC-M provides pre-exposure prophylaxis and medical counseling.

Another point – it has become proven that, when the system wants, it can change everything very quickly, although until recently “no, it’s impossible, difficult, long.” For example, create a system that will collect data. Previously, it was akin to create spaceships. But in the context of COVID, with the healthcare system, we managed to quickly build a tender health dashboard, which displays all the purchases for the fight against COVID. We did it literally in a month in 2020 – the state has taken measures to decentralize procurement, which made it possible for all medical institutions to conduct them the way they want. Behind it, by the way, a wagon of corruption “flowed”. We foresaw this, and immediately said – yes, we know that there will be problems, but we are proactive and create tender health, where everything will be displayed, which means that it will be difficult for those who want to get carried away with corruption, realizing that everything is in transparent plane. Secondly, the data helps health care providers see from whom the contracting authority has bought more profitably. That is, when circumstances force, everything is resolved quickly.

#SoS_project: And what improvements and changes in the country have occurred in Moldova over the past 3 years with the support of SoS_project?

RP.: Let’s start with PrEP – we have already touched on it. In our country, it has been available since 2018. But the number of patients could be counted on the fingers of one hand. Thanks to the project, we have moved this train dynamically and already about 300 people in Moldova have used the service.

One of the key objectives of the SoS project is the sustainability of funding. And when we speak in this context, we always mention two things: efficient use of existing resources and increased budgets. If we talk about the first aspect, thanks to the common efforts and partnership, thanks to the created, transparent environment, within the framework of the SoS project, we changed the procurement algorithm. When we analyzed the existing one, it became clear that it should look a little different, so that it would be more convenient for the contracting authorities, more time to respond, extend tenders, etc. And by order of the Ministry of Health in 2020, the procurement algorithm was changed. What did it lead to? During the same year, the country managed to save more than 5.5 million lei (about 320 thousand dollars) on the purchase of ARV therapy and other laboratory equipment to fight against HIV/AIDS. It happened because the competitions were extended. It became possible that if, for example, a supplier with a very high price for a treatment (and it differs significantly from the one at which the purchase was planned) came to the announced tender, the state has the right to extend the tender and a generic that is not registered in the country may come to a second stage. Thanks to the change in the contract cycle and the fact that we were involved in this process, NGOs were able to communicate with manufacturers and attract them to the market. In this connection, it also turned out to make more efficient purchases. And more importantly, the team that coordinated the national program was able to rebudget the funds, but in the face of very limited opportunities. Of course, we wanted them to be transferred to harm reduction programs where obligations are not met, but so far, the legislation does not quite allow for this. By the way, we are currently working on a task to have more of these opportunities. However, the national program was able to use the savings to purchase rapid COVID tests, which were in turn donated to NGOs that distributed them free of charge to key populations. Firstly, it is a bonus for clients and their immediate environment. They know that if there are any symptoms, they can immediately come to us and do a prompt test. Secondly, for the staff, it is also important for us not to be constantly quarantined. And in order to work properly (especially when it comes to a team that works in prisons), tests are needed so that we can test ourselves. I will add – during COVID “Initiativa Pozitiva” was the only organization that had access to penitentiary institutions. The availability of tests has made a tangible contribution to the health of both clients and NGO workers, and to the public health system as a whole.

In the context of ARV procurement optimization. We have ensured that community representatives are members of the procurement commission, the body that conducts the centralized procurement of ARV treatment. According to it, as well as a constructive dialogue with all partners, in 2021 we insisted for certain reasons that the competition be stopped, the terms of reference redone, and then announced again. As a result, we saved 500 thousand lei (about 30 thousand dollars). I want to make a point now – you should not think about what is happening in such a way that the contracting authorities are doing their job, and we, like watchdogs, are watching and waiting to catch someone. This is not so, simply because more people are involved in it, we can look from different angles and draw each other’s attention to some shortcomings.

As for the second option related to financing, it concerns an increase in the budget. And here we have the most striking example is Chisinau, which signed the Paris Declaration, approved the municipal program on HIV/AIDS for 2020-2021 and allocates resources for its implementation. Now we are waiting for the approval of the national program until 2025. That is a good practice that did not exist a priori before. More precisely, only at the national level, and at the municipal level, and it was not discussed. And now we have very good, close cooperation, and this is also the result of the SoS project.

Another point related to funding is that in Moldova, the health insurance fund allocates resources for prevention among risk groups. But she does not fulfill her obligations in terms of money (how much is promised and how much is actually given). The algorithm and mechanism for the procurement of services is also not very effective, for example, just now we have signed a contract for 2021. There is no time at all for its implementation, you can no longer do anything effectively. But we have a public, state institution that plays the role of the main recipient, and for many years of cooperation with the Global Fund, they already have a well-established mechanism for purchasing services from NGOs. Therefore, now we have initiated the synchronization of these two algorithms in order for the country to have one good, working mechanism for the purchase of services. It gives hope that already in 2022, the purchase of services, tender announcements, etc. will not be at the end of 2022, but at the beginning of the year. And for 2023 – in November 2022.

I also want to note that the country has developed a tender health dashboard with all the digitized indicators and processes in the country, including the work of NGOs: who the services have reached, what kind of people they are, the number of services provided, etc. It is updated every day. So in a real time, we see the overall picture of the service.

#SoS_project: How does this relate to the sustainability of services?

RP.: Absolutely directly: data that shows the situation with resources and what has been done at their expense facilitate any kind of activity that is aimed at building its sustainability. Because when you operate with relevant facts and figures, it is much easier to talk about funding. Moreover, the dashboard digitizes the processes associated with changing legislation, approving the national program, etc. Previously, no one understood where the start was, what the intermediate results should be and when the end. At what stages the work “sags” was also not clear – everyone “woke up” only at the end of the deadlines. Now everything is different, the processes are completely digitized, and if there is a delay at some stage, we immediately fix it.

Another component that I cannot fail to mention is REAct, a mechanism  for monitoring and responding to human rights violations. In addition to the fact that it was launched and implemented effectively, within the framework of this component at the country level, we managed to synchronize this activity with another regional project (RADIAN), it is reflected in the application for the Global Fund and will be supported in the new year. Also, the issue of recording cases of such violations is included in the national program, i.e. it is already institutionalized and we have the prospect of sustainability on this issue. Moreover, over the past year and a half, we have managed to solve several strategic cases that influenced the change in regulatory documents. For example, until last year, HIV-positive or discordant couples could not adopt a child/children, obtain guardianship, or use artificial insemination services. We removed this barrier as part of the SoS project. Another case, as a fact, of human rights violations that was recorded and resolved: over the years, about 30 patients from the city of Arheev (40 km from Chisinau) had to travel to the capital to receive substitution therapy (ST). Daily. For people, it was a real hard labor. Our REActors recorded everything, followed by an appeal to the Council for Equality. And as a result, the issue was resolved! In the Council, we made a reconciliation of the parties, and in Argeev, the ST site was opened.

#SoS_project: What are your goals for the coming years?

RP.: There are two areas that we are actively working on – first, it is the decriminalization of HIV transmission and increasing the permissible minimum doses for the storage of substances.

***

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)

For 2020-2021, more than 6,000 cases of violation of rights, stigma and discrimination were documented in 7 countries of the Eastern Europe and Central Asia region.

On December 10, Human Rights Day, the Alliance for Public Health is launching a regional information campaign “Declaration or Decoration of Human Rights?” in order to draw public attention to the glaring number and variety of violations in the EECA region, in particular – in relation to the most marginalized groups of society vulnerable to HIV and tuberculosis.

“Continuing human rights violations, the HIV epidemic will not be stopped. We have collected evidence of loud human rights violations that limit access to essential health services, prevention and treatment of HIV, tuberculosis and other diseases.” – states Andriy Klepikov, executive director of the Alliance for Public Health ICF. “According to REAct data, the main violators of rights in the EECA region are representatives of state institutions – medical workers, police, courts. Although it was the states that proclaimed their commitment to respect, protect and promote human rights and freedoms by signing the Declaration of Human Rights. It is the state, through its institutions and structures, that must protect and guarantee human rights, and not vice versa – violate them.”

“Analyzing the REAct cases, we saw that there is no area of ​​life in which representatives of communities would not face stigma, discrimination or infringement of their rights. Not only human rights are violated constantly and often, and moreover – everywhere. The info campaign just illustrates this. It was not difficult for us to find examples of violations from real life under each of the thirty articles of the Declaration. And under the “hottest” articles like the right to freedom from cruel and inhuman treatment and torture, the right to freedom from arbitrary detention, we had to tearfully choose the loudest cases among hundreds of others. ”- says Victoria Kalyniuk, coordinator of the REACT system in EECA and author of the campaign idea.

Based on evidence collected through REAct and 30 articles of the Universal Declaration of Human Rights, the information campaign “Declaration or Decoration of Human Rights?” was created not only to draw public attention to the main trends and nature of offenses, but also to make specific recommendations to improve the situation in each country.

All analytical reports and detailed information can be found on the campaign page – https://declaration.react-aph.org.

***

On December 10, 1948, The UN General Assembly adopted the Universal Declaration of Human Rights, a milestone document proclaiming the fundamental human rights each individual is entitled for, without any discrimination.

The governments declared their commitment to respect, protect and promote human rights and freedoms and reinforced it in further documents.

However, 73 years later, the rights and freedoms proclaimed in the Declaration and further documents, are routinely and often violated, especially with regard to the most marginalized populations, vulnerable to HIV and TB.

Friday, December 10, 2021 (Istanbul, Turkey, and virtually at https://forum.aph.org.ua/en/) – mayors,

vice-mayors, heads of municipal health departments of Kyiv and Odesa (Ukraine) , Chisinau (Moldova), Osh (Kyrgyzstan), Kragujevac (Serbia), Prague (Czech Republic), as well as the leaders of the international charitable foundation, ITPCru and the newly created Commission on Drug Policy ECECACD, will talk about the components of sustainable health care in countries and cities, violation of human rights in the context of HIV and health issues of migrants during the period of COVID-19, as well as answer journalists’ questions live.

The press conference will take place as part of the HEALTH SUSTAINABILITY FORUM: HIV and COVID-19 in the EECA region.

Press conference speakers:

• Andriy Klepikov, Alliance for Public Health (Ukraine)
• Denis Godlevskiy, ITPCru (the Russian Federation)
• Pavel Bém, ECECA Commission on Drug Policy, Ex-Mayor of Prague (Czech Republic)
• Fadei Nagacevschi, Deputy Mayor of Chisinau (Moldova)
• Hanna Starostenko, Deputy Mayor of Kyiv (Ukraine)
• Venera Ryskulova, Deputy Mayor of Osh (Kyrgyzstan)
• Nikola Ribaric, Head of local administration, City of Kragujevac (Serbia)
• Iryna Kutsenko, Deputy of the Odessa City Council (Ukraine)

LIVE

When: 1 p.m. – 1:30 p.m. CET, (GMT+3), Friday, December 10, 2021

Where: The press conference will be held in Istanbul, Turkey, at the Hilton Bomonti Hotel, and virtually at https://forum.aph.org.ua/en/.

Translation into Russian and English will be provided.

The broadcast of the press conference will be open to everyone on the website https://forum.aph.org.ua/en/.

Accreditation for journalists for online and offline participation at the link: https://cutt.ly/KYzd4mx.Through the accreditation form on the forum, you can send your questions to the speakers of the press conference in advance. In this case, the questions will be raised by the host on behalf of the editorial office and your media will get an exclusive comment. The time of the press conference is limited, so not all questions of the live broadcast can be asked to the speakers.

Media contacts:

Inna Gavrilova, Public Health Alliance,

Mob .: +380 96 753 81 60 (Telegram, WhatsApp, Viber)

E-mail: gavrylova@aph.com.ua

Additional Information for the countries of Eastern Europe, Central Asia (EECA) and the Balkan region:

1. Regional information campaign “Declaoration of Human Rights?”

The COVID-19 pandemic has worsened the human rights situation in 7 EECA countries: for 2020-2021 the REAct system has registered 6,000+ cases of rights violations, stigma and discrimination. The collected evidences point to legal barriers, harassment and criminalization of HIV-vulnerable populations. It makes it difficult or even impossible for them to access health services, prevention and treatment of HIV, tuberculosis and other diseases.

The awareness campaign, based on evidence collected through REAct as well as the 30 articles of the Universal Declaration of Human Rights, illustrates that the rights of marginalized populations most vulnerable to HIV and tuberculosis continue to be violated in practice. Analytical reports have been published on the website https://react-aph.org/en/, which reflect the main trends and nature of offenses, as well as offer specific recommendations to improve the situation in each country.

According to REAct data, the main violators of rights in 7 countries are representatives of state institutions – medical workers, police. The most common offenses are discrimination, misconduct, violence by law enforcement agencies, denial of access to health services, disclosure of health data and stigma by health workers, physical violence against women by sex partners as well as relatives and police officers.

2. Situation with HIV / AIDS

The EECA region is the only region in the world where the number of new HIV infections continues to rise among all age groups. According to UNAIDS, there are 1.6 million people, living with HIV in the countries of the region, only 53% of whom are receiving ARV therapy.

Since the beginning of the epidemic, 79.3 million people worldwide have been infected with HIV and 36.3 million have died from AIDS-related illnesses. Today in the world about 37.7 million people, living with HIV, and almost 6 million of them do not know that they are infected. About 28.2 million people, living with HIV are receiving antiretroviral therapy. In case of insufficient action, UNAIDS has warned of the risk of 7.7 million AIDS-related deaths over the next 10 years.

3. COVID-19 and vaccination

The total number of cases in the world exceeded 266.5 million people, active cases at the moment – 21.2 million.

4. Health of migrants

Within the global AIDS response, migrants are often identified as a “key population” for HIV prevention activities. Although migration does not equal HIV vulnerability, they face increased risk of HIV infection during after migration due to multiple legal, social, and economic barriers they face on the route and in the receiving countries.

HIV positive migrants often persist in a state of legal uncertainty. Many seek and some obtain medical care, but the arrangements are often not stable. As a result, migrants living with HIV often remain silent and submissive, and socially excluded; they face multiple barriers to attaining health services, especially in the countries of Central and specifically Eastern Europe.

Efforts must be made to reduce barriers to health services, for the benefit of migrants and their communities, and cities being the magnets of migration play a crucial role in addressing the health needs of mobile populations.

5. Drug policy and health

The Central and Eastern Europe and Central Asia (CEECA) countries face widespread problems related to the illicit trafficking and transit of illicit drugs from Asia and Latin America, mainly to EU Member States, as well as the consumption of locally produced synthetic opioids and new psychoactive substances.

People who inject drugs (PWID) in the region account for about half of all new HIV infections. Every seventh one lives with HIV, and every third is infected with hepatitis C.

The region is home to 3,000,000 people who use drugs, accounting for a quarter of all people who inject drugs worldwide. 66% of them live in Russia. Unfortunately, access to harm reduction and health care services remains limited. In some countries, harm reduction services provide insufficient coverage of people who use drugs. A number of countries in the region still have no harm reduction services at all.

A simple transition from criminalization to resource-based harm reduction approaches will generate cost savings and prevent more HIV infections. Over a 20-year period (2020-2040), according to a recent study by The Economist, savings from decriminalization could afford buying antiretroviral therapy (ART) and opioid agonist therapy (OAT) to control the current HIV epidemic among PWID in Belarus, Kazakhstan, Kyrgyzstan and Russia.

Reinvesting cost savings (i.e. € 773 million over 20 years) in expanding ART coverage to 81% and OATto 40% according UNAIDS / WHO guidelines – will decrease HIV incidence among PWID by 79.4-92.9% over 20 years.

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.

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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.

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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