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.

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.

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

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

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

Background, or why we need harm reduction rooms

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

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

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

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

Assessment of benefits of the harm reduction room in Sumy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where to start: expert advice

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

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

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

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

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

Text: Inna Gavrylova

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.

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

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

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

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

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

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

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

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

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

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

– Experience in building cooperation from the position of an official

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

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

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

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

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

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

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

Work meeting with Association “Partnerships in Health” team

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

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

A similar process will take place in Bosnia and Herzegovina.

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

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

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

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

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

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

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

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

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

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

Legal framework for the fight against HIV in Tajikistan

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

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

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

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

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

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

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

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

The Paris Panacea

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Announcement of materials of the #SoS_project regional digest  #2

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

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

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

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

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

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

Thanks for your attention and enjoy reading the digest.

Read full digest on web browser

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

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

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

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