The National TB and HIV/AIDS Council approved the country proposal to the Global Fund with the total budget of USD 119 million for TB and HIV response in 2018-2020. It was unanimously resolved that three principal recipients of the grant within the proposal will be the Public Health Center of the Ministry of Health of Ukraine, the Alliance for Public Health and the Network of People Living with HIV. For the first time, delegates from the communities of key populations – people who inject drugs, men who have sex with men and sex workers – took part in the meeting of the National Council as its full-fledged members.

The structure of the proposal is based on the gradual growth of the country leadership, with relevant increase in the financing of the Global Fund. Pavlo Rozenko, Chair of the National Council underlined: “The new proposal includes financing activities aimed at overcoming the epidemics of HIV and tuberculosis, improving the quality of services and expanding the opioid substitution treatment. The underlying strategy of the proposal stipulates the mechanism of step-by-step transition of the responsibility for implementation of the program activities from three recipients of the grant to one recipient – government”.

“We appreciate cooperation of the government sector with non-government organizations: together, we will be able to achieve the ambitious goals set forth in the proposal to the Global Fund. We expect that in the course of implementation of the three-year program the share of state funding, in particular aimed at working with the populations most vulnerable to HIV, will be growing”, pointed out Andriy Klepikov, Executive Director of the Alliance for Public Health.

The proposal is to be submitted to the Global Fund on 23 May at the latest, and the final decision of the donor is expected in summer.

For the first time, Alliance for Public Health made an analysis and would like to present data on the real scope of legal and illegal circulation of opioid substitution therapy (OST) drugs in Ukraine.

Alliance has been implementing OST programs since 2005, regularly providing evidence of efficiency and safety of harm reduction approach as opposed to ungrounded accusations on allegedly high volumes of OST drugs leakage.

During 12 years of OST program implementation in Ukraine, almost one and a half tons of OST drugs were delivered to licensed healthcare institutions to cover the needs of the program. The scope of OST drugs leakage recorded in court judgments is less than 0.002% of the total amount of drugs delivered.

Organizers of The First Sex Workers March, held on 3 March in Kyiv, officially sent their draft law to the Chairman of the Supreme Council,  President and Prime Minister of Ukraine calling to immediately abolish the administrative responsibility stipulated in art. 181-1 of the Code of Administrative Offences of Ukraine (for prostitution) on the eve of the Eurovision Song Contest 2017.

In the official letters, which have been sent today to all the three government bodies on behalf of the first national union of sex workers – All-Ukrainian League “Legalife” – and Alliance for Public Health, it is stated that the threat of administrative prosecution is traditionally used by criminal mobs and corrupt law enforcers as a method of psychological pressure on sex workers, which often leads to mental and physical abuse.

Due to artificial criminalization and high level of stigma and discrimination, sex workers (their number in Ukraine being over 80 thousand according to the estimated data) are not able to effectively protect their rights. In this situation, sex workers do not have adequate access to reproductive health services as well as prevention and treatment of HIV and other dangerous diseases.

Authors of the initiative are concerned with the fact that on the eve of the Eurovision Song Contest 2017 which will be held in Kyiv and will be attended by tens of thousands of tourists, in particular from the EU countries, in most of which individual prostitution has been long ago decriminalized, the level of violence and inadequate treatment of sex workers from the side of public authorities and law enforcement agencies will expectedly increase as they will be trying to maximally “clean up” the capital city from “unwanted elements” as it traditionally occurred on the eve of EURO 2012, Eurovison 2005 and other similar events.

Organizers of The First Sex Workers March are confident that cancelling administrative responsibility for individual prostitution on the eve of Eurovision 2017 should become a powerful signal for the European community, which will confirm adherence of our country to the European values, in particular in terms of human rights protection in Ukraine. Such a measured and decisive step towards abolition of vestiges of the totalitarian past will allow bringing out of the circle of marginalization at least 80 thousand Ukrainian citizens, mostly women who earn their living with this hard work!

On 3 March 2017, All-Ukrainian League “Legalife” and the Alliance for Public Health with support of civil society organizations and with participation of human rights activists and mass media held the first Sex Workers March in the history of independent Ukraine along the route: Supreme Council – Cabinet of Ministers – Administration of the President of Ukraine. The main goal of the event was to draw attention of high government officials, general public and mass media to the need to abolish administrative responsibility for prostitution (art. 181-1 of the Code of Administrative Offences). Before the event, initiators for the first time presented their version of the proposed draft law, which today has been sent to relevant legislative bodies with official letters.

More information about the event can be found in media review of the Sex Workers March. 

Letter to President of Ukraine

Letter to Prime Minister of Ukraine

Chairman of the Supreme Council

Contact details for mass media:

 +38 050 3825178,

 +38 044 4905485, ext. 221

To end the TB epidemic, Ukraine has only one recipe – to implement quality people-centered TB care! This statement was made by Andriy Klepikov, Executive Director of the Alliance for Public Health at the press conference to mark the World Tuberculosis Day.

“Within its pilot projects supported by the Global Fund, Alliance proved that combination of medical, social and psychological support allows increasing MDR-TB cure rate twofold! 80% of patients with MDR-TB were cured! This is a really impressive result, considering that the average treatment success rate for such patients in Ukraine is less than 40%,” – informed the speaker.

Andriy Klepikov also underlined the need to move the function of patient support from donor funding to state and local budgets: “What may seem an additional service, is indeed an essential factor, which makes a significant impact on treatment success.” As a leading civil society organization, co-implementer of the National TB and HIV/AIDS Programs and one of the principal recipients of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Alliance welcomes increased commitments of the state to fund the response to tuberculosis in 2017. But at the same time, our organization points out that the main task today is to guarantee that, as opposed to the previous years, the funds will be spent on the most effective models of care.

At the press conference “People-centered care – the key to ending the epidemic of tuberculosis in Ukraine!”, Olha Bohomolets, MP, Head of the Verkhovna Rada Committee on Public Health and member of the international movement of parliamentarians against TB, Global TB Caucus, told about the strategic plans to end tuberculosis in Ukraine. Thus, she underlined that to have an impact on the epidemic, Ukraine has to reduce TB morbidity by 25%, reduce TB mortality by 35% and increase MDR-TB cure rate at least up to 75%.

But to achieve those goals, the Ministry of Health needs to elaborate a step-by-step action plan and define economic indicators, such as the cost of care per one patient, and others. From her side, Olha Bohomolets told she guaranteed support of the Committee on Public Health in enhancing the response to TB and advocate to the deputies of Ukraine to allocate the required funds from the budget of Ukraine for such response.

Dr. Masoud Dara, Coordinator, Communicable Diseases and Programme Manager, TB, HIV/AIDS and Viral Hepatitis Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe said that coordinated efforts of all stakeholders were essential to overcome the epidemic of TB. He also pointed out that it is critical to scale up access to MDR-TB treatment, in particular ensure: integration of people-centered care into the system of support for TB patients, development and availability of mechanisms of patient support, implementation of innovations in the current treatment models. Besides, Dr. Masoud Dara noted that special attention should be paid to the spread of HIV/TB co-infection and ensured that our country could count on the WHO support in launching effective approaches to ending the TB epidemic.

Patients diagnosed with MDR-TB told about their own experience of receiving people-centered care. “For me personally, people-centered care has a number of advantages. First and foremost, it ensures uninterrupted supply of effective drugs, – told Ihor Svachii, a patient who has been treated within social support program for almost a year. – The second important thing is that I get treatment at home. In a hospital, you feel isolated anyway, and I surely wouldn’t be able to stand it for two years. Emotionally, it is very difficult. At home you are in familiar settings. You’ve got a computer, a TV set, music, books. You can go for a walk. You can feel support of your friends and family, while they would have limited access to hospitals.”

We really hope that patients’ voice will be heard by decision makers and the society in general! People-centered approaches, actively implemented by Alliance, should become an integral part of the future TB care system and should make a decisive impact on the response to the TB epidemic.

Video of the press conference: https://youtu.be/Ssclfb525JM.

Ukraine is known for having a severe TB epidemic. It is one of the TOP 5 countries in the world with the highest burden of multidrug-resistant tuberculosis (MDR-TB): MDR-TB is detected in each fourth patient with newly diagnosed TB and in each second patient with TB relapses. Besides, Ukraine has the worst in Europe TB cure rates – only 71% of new TB cases and 39% of MDR-TB cases are cured. Generally, every year over 30,000 people in Ukraine are diagnosed with TB (four new cases every hour), with every eighth patient dying.

On World TB Day, Alliance for Public Health is presenting solutions that are making a major difference in a challenging TB environment, comprehensively addressing TB detection and treatment.

Diagnostics

Alliance is implementing a project aimed at early TB detection among most-at-risk populations. In 2016, over 160,000 clients were reached with screening survey, and 14,000 of those screened positive were examined for TB at healthcare facilities. Finally, 92% of those diagnosed with TB started proper treatment at healthcare facilities. In particular, addressing HIV/TB co-infection is our special focus.

Treatment access

With mobilized resources from the Global Fund and other donors, Alliance dedicated over half of its budget for addressing TB, mainly for procurement of MDR-TB medicines. In 2015-2016 only, we reached USD 34.6 million worth of MDR-TB drugs delivered in all regions of Ukraine.

As of January 1^st 2017, altogether 12,551 patients were enrolled to MDR-TB treatment within the program supported by Alliance with the Global Fund funding, and 5,535 of them continued receiving medications and social care from Alliance.

Treatment success

We proved that patient-centred approach with social support is not an additional element which might be added to standard medical MDR-TB treatment. It is a key cornerstone element of the successful MDR-TB treatment.

Within its pilot projects supported by the Global Fund, Alliance proved that combination of medical, social and psychological support allows increasing MDR-TB cure rate twofold. 80% of patients with MDR-TB were cured. This is a really impressive result, considering that the average treatment success rate for such patients in Ukraine is less than 40%.

Despite the growing challenges, Alliance continues its work on the temporarily occupied territories in the east of Ukraine. Alliance successfully delivered humanitarian aid, including MDR-TB treatment, for over 1,400 patients. We also support our 12 partner civil society organizations in Donetsk and Luhansk oblasts working to ensure early TB detection among most-at-risk populations.

Alliance applauds the governmental leadership and growing commitment to stop the TB epidemic. The result is our joint success based on the partnership with the Ministry of Health, State Centre for Public Health, Ukrainian Red Cross Society, Network of PLWH and numerous civil society organisations, community groups and medical facilities. We are greatly thankful to our international partners: The Global Fund, WHO, TB Europe Coalition, Stop TB Partnership, UN Secretary General Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, United Nations Special Envoy on Tuberculosis, UNAIDS, Zero TB Cities, Global TB Caucus, PAS Center, US Government, PATH and other programs we are coordinating our response with.
Ukraine is currently developing a new proposal to the Global Fund for 2018-2020, with significant funding for TB. It is critically needed to scale up patient centred approach to all in need and eligible MDR-TB patients, to focus on missed TB cases and those lost to follow up. Over the new program, Alliance is planning to gradually transfer the civil society components ensuring patient-centred approach to the MDR patients currently funded by the Global Fund to the domestic funding. The newly approved by the Government 2020 Strategy to fight TB and HIV epidemics sets a good framework for this.

According to UNICEF estimates, in Ukraine there are 21,700 adolescents aged 10-18 years using injecting drugs with detrimental consequences for their health (no data on non-injectors). In the first half of 2015,  159,638 PWIDs accessed harm reduction services in Ukraine. Only 657 (or 0.41%) of clients served within this period were younger than 19 years. Vulnerable and neglected adolescents are most likely to use drugs. These include children whose parents abuse drugs or alcohol, or face other difficult family circumstances (are unemployed, single parents, parents who work long hours). Access to out-of-school activities is limited or very expensive so many adolescents spend considerable amount of their time unsupervised on the streets. Alliance for Public Health started an innovative project “Harm Reduction for Children and Young People Who Use Drugs in Ukraine” supported by Elton John AIDS Foundation.

On 20 March 2017, Practice Centre for HIV, Hepatitis C and Drug Use run by Alliance for Public Health organized a webinar “Harm reduction for adolescents who use drugs in Ukraine: reaching the underserved”. Iryna Zharuk, Project Coordinator presented the experience of Alliance for Public Health in implementing this innovative project. Participants of the webinar learnt about the intervention design, planning steps, networking and partnership, project activities, research component, challenges and how they are addressed. To listen to the webinar, follow the link.

A two-day meeting for Ukrainian experts in implementation of rapid change model for the improvement of addiction treatment (NIATx-RCM) was held on March 1–2 by ICF “Alliance for Public Health” within the research project “Expanding Medication Assisted Therapy (MAT) in Ukraine” within the partnership with the Yale School of Medicine (USA) with financial support of the National Institute on Drug Abuse (USA). Narcologists, nurses and representatives of NGOs who are actively involved in OAT scaling-up in Ukraine attended the meeting. 27 participants from 13 Ukrainian oblasts shared their experiences about progressive strategies of access and retention in OAT, namely: alignment of patients’ routes, peer-to-peer navigation, take-home care, prescriptions, advocacy and process efficiency of OAT drug dispensing. During nominal group techniques the special attention was paid to the barriers for scaling-up OAT services in Ukraine and the ways to overcome these barriers.

The project is implemented in strong collaboration with Ukrainian Institute on Public Health Policy and Public Health Center of the Ministry of Health of Ukraine.

On the International Sex Workers Rights Day marked on 3 March 2017, for the first time in Ukraine a group of civil society activists and sex workers with support of human rights advocates held a Sex Workers March, demanding to cancel administrative responsibility for prostitution   (article 181-1 of the Code of Administrative Offences of Ukraine). This day was announced as the national day of mourning for miners who died as a result of the tragic accident on March 2, so organizers (All-Ukrainian League “Legalife” and Alliance for Public Health) after a minute’s silence called on participants to proceed with the event in the format of a “silent procession”.

To draw the attention of public officials to the problem of violation of sex workers’ rights,  their stigmatization and violence towards them, marchers with improvised posters “My work is my choice!”, “Sex work is also work!”, “Taxes, not penalties!”, “armed” with red umbrellas and hard hats, masks, “certificates of sex workers” as well as some elements of their professional “workwear”, led their silent peaceful procession along the government quarter, heading their way from the building of the Supreme Council, past the Cabinet of Ministers, to the Administration of the President of Ukraine, which was the final point of the march.

“Currently article 181-1 of the Administrative Code is still used as a repressive instrument of corruption, extortion, intimidation and violence”, – said Yulia Dorokhova, leader of the movement for the rights of sex workers, lawyer of the All-Ukrainian League “Legalife”.

Threats to issue an administrative offence report for prostitution are traditionally used by corrupt members of law enforcement bodies as a means of psychological pressure on sex workers, which often leads to mental and physical violence as the legislation of Ukraine works against them, depriving them of their rights to human dignity and protection.

“In Ukraine, the laws are used to commit unlawful acts! I had to do “volunteer work” in police [provide sex services to policemen for free] for them not to issue an administrative offence protocol.  If I said no, they could have beaten me”, – confesses Olena, a sex worker from Zhytomyr region.

“Administrative responsibility for prostitution is one of the essential factors contributing to the spread of HIV epidemic in Ukraine. According to the joint estimates, today in Ukraine there are about 80 thousand of sex workers. Only in the capital city, there are almost 11 thousand of them. In the east of Ukraine, over 25 thousand people provide sex services to earn their living. The Supreme Council of Ukraine with billions of dollars in cash recorded in electronic declarations of people’s deputies, cannot continue to shamelessly ignore and marginalize a rather big group of Ukrainian citizens”, – said co-organizer of the event, Pavlo Skala, Director: Policy and Partnership at Alliance for Public Health.

Participants of the march brought to the Parliament, Government and President’s office a draft law developed by them on canceling the administrative responsibility for prostitution, calling people’s deputies to sign this legal document and submit it for consideration to the Supreme Council, rather than engage in “political prostitution” behind the scenes. Though this week the premises of Parliament was empty and quiet as the deputies are currently away “working with their voters”.

Recognized human rights organizations also supported the main demand of the marchers:

“People who provide sex services are one of the most socially unprotected populations in the world. They are very vulnerable to discrimination, violence and abuse of power. We advocate for complete decriminalization of all aspects of voluntary provision of sex services and call for comprehensive legal protection of sex workers from exploitation, trafficking and violence,”- told Oksana Pokalchuk, director of Amnesty International in Ukraine.

Media Coverage of Event

On February 28, 2017, the mayor of Odesa Gennadiy Trukhanov signed Paris Declaration of commitment to Ending AIDS and has therefore joined the global cities movement initiated by the Mayor of Paris and UNAIDS in 2014. The city takes the commitment to significantly increase HIV testing and treatment coverage of Odesa residents with the aim to end AIDS in 2030 and to focus on programs for key populations.

Currently in Odesa, like on average in Ukraine, one in two HIV-positive persons knows his/her diagnosis while access to ART is lower than across the country. The leadership the city is demonstrating today can make a critical difference in responding to AIDS and sustaining the response.

The ceremony gathered representatives of Centre of Public Health, UN Secretary General special envoy on HIV/AIDS in EECA Michel Kazatchkine, representatives of UN family in Ukraine, including UNAIDS, UNICEF, representatives of the Embassy of France, representatives of the Network of People Living with HIV, Alliance for Public Health and other civil society organizations, Olena Pinchuk Anti-AIDS Foundation, partners of the city AIDS response programs.

Michel Kazatchkine extended warm greetings from the mayor of Paris, Anne Hidalgo, who was one of the initiators of the Paris Declaration in 2014.

Mayor of Odesa Gennaidy Trukhanov said: ‘The city is well prepared to take this commitment. We have a good level of collaboration with the municipal services, strong AIDS service, partner NGOs to make this commitment possible’.

Andriy Klepikov from Alliance for Public Health acknowledged the leadership role of Odesa civil society in responding to HIV epidemic: ‘Currently the Global Fund program implemented by Odesa partner NGOs is annually reaching to over 24 thousand (or 65% of the estimate) of representatives of key populations groups. Thanks to a large extent to the prevention programs new HIV cases are going down in Odesa in last years’.

Odesa is the first city to sign Paris declaration within the Global Fund supported EECA regional cities program implemented by Alliance for Public Health (Ukraine) together with AFEW International (The Netherlands), Contact Netz/Licit (Switzerland) and under technical guidance of Stop TB Partnership and UNAIDS EECA office.

‘Odesa signing Paris declaration within our regional city project on HIV and TB in EECA is setting an example for other cities of the project from the 5 countries – Bulgaria, Georgia, Kazakhstan, Moldova and Ukraine,’ said Tsovinar Sakanyan, the Global Fund portfolio manager.

Vinay Saldanha, Regional Director for Eastern Europe & Central Asia, UNAIDS, comments: ‘As new HIV cases continue to increase in Eastern Europe and Central Asia (EECA), the epidemic is focused in major cities. Concentrated among key populations and their sexual partners, particularly people who inject drugs, this can be reversed if cities get on the ‘Fast-Track’ to end AIDS. The leadership of the city of Odesa is the kind of immediate and decisive leadership needed to fast-track its AIDS response by 2020’.

Representative of SWAN who attended the ceremony expressed her expectation that key populations groups will be supported and prepared to  actively engage in planning and implementation of the follow up steps in Odesa to make 90-90-90-90 a reality for those most vulnerable to the epidemics.

Tuberculosis should become a priority in the general trend towards health system reform as currently we have all leverages to change the situation with the epidemic in Ukraine for the better!

This statement was voiced by Andriy Klepikov during the press conference at UNIAN news agency held on 24 February 2017, which was aimed at discussing patient-oriented models of TB care. The executive director of Alliance also mentioned that there is a vital need to support transition to the outpatient models of TB care delivery and increase treatment efficiency. Unfortunately, today only about 40% of patients with multidrug-resistant tuberculosis are successfully cured. This indicator may be increased up to 80% and more thanks to the social support of patients so that they do not stay alone with their disease and life problems. Within its pilot projects, Alliance for Public Health proved that the combination of medical, social and psychological support allows doubling treatment success rate for patients with multidrug-resistant tuberculosis.

To sum it up, Andriy Klepikiv said that he welcomes scaling up government commitments to finance the response to tuberculosis in 2017: only budget to procure drugs will amount to half a billion hryvnias! At the same time, the most important task today is to guarantee that as compared to the previous years money will be spent for the most effective TB treatment models. From its side, Alliance as one of the key partners of the TB-REP regional project, contributes to the cooperation with all stakeholders in terms of implementation of patient-oriented approaches in response to the crisis situation with TB in Ukraine.

On behalf of the government, representative of the Ministry of Health of Ukraine, acting Head of Public Health Department, Natalia Piven thanked civil society organizations for their active involvement into the response to the TB epidemic in the country and underlined that currently efforts are underway to re-focus on evidence-based medicine and outpatient models of TB care. Piloting of those models is stipulated within the TB-REP project and is included to the concept of the National TB Program 2017-2021.

Head of TB Prevention and Treatment Unit of the Public Health Center of the Ministry of Health of Ukraine, Iana Terleieva informed that 8 thousand cases of MDR-TB are detected in Ukraine annually – in every fifth case of newly diagnosed patients and in every second case in patients with recurrent conditions. Besides, a focus was made on the main advantages of patient-oriented approaches: better treatment success rates as compared to those patients who are treated in in-patient healthcare facilities and cost efficiency due to re-allocation of funds to cover patients’ needs. Iana Terleieva underlined that it is very important to unite the efforts of governmental and non-governmental organizations!

The press-conference with participation of governmental institutions and civil society organizations was organized by Ukrainians against TB NGO within the TB-REP regional project (TB in Eastern Europe and Central Asia Project on Strengthening Health Systems for Effective TB and DR-TB Control). The Project is aimed at reforming TB care system as part of general health system reforms and provides technical support to TB projects of civil society organizations in 11 countries of Eastern Europe and Central Asia (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan). The Project is implemented with financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the principal recipient of the Project is Center for Health Policies and Studies (PAS Center).