Track E report by Jennifer Butler
Eastern Europe and Central Asia is one of
the two regions with an increasing HIV epidemic. The session was always to be politically important
but the tragedy of MH17, added poignancy and passion. Two of the Co-Chairs, Sergii Dvoriak and
Alexandra Sasha Volgina, both of Ukraine, were unable to attend AIDS 2014 due
to the no-fly zone in Ukraine and the panellist from the Russian Federation, Dr
Vadim Pokrovskiy, declined the invitation to attend AIDS 2014 shortly before
the conference. Professor Chris Beyrer and Tatiana Deschko, Co-Chaired the
The impending reduction of Global Fund
monies to a number of countries in the region was a key concern of the
panellists and the participants. The
overwhelming proportion of funding for programmes from key populations comes
from international donors, especially the Global Fund. Services closed down
when the Global Fund withdrew from Russia.
In Ukraine, there will be a 62%
decrease in funding from Global Fund in 2015, decreasing from $51 million USD
in 2013 to $26 million USD in 2015.
The United Nations Special Envoy on AIDS
for Eastern Europe and Central Asia, Michel
Kazatchkine gave an excellent analysis of the multiple epidemics of HIV,
HVC, TB/MDR-TB in the region. Two thirds of people who use drugs have HCV and
they are two to six times more likely to acquire TB. People in prisons are 23 times more likely to
acquire TB than the general population. Unsafe
injecting drug use continues to drive the epidemic but heterosexual infections
are increasing rapidly; the key populations in this region are people who
inject drugs and their sexual partners, sex workers, incarcerated people and
MSM, and possibly migrants (although the data is not strong). While treatment
access has increased sharply in the last few years it is much slower than the
growth rate of new infections. Using Joe
Amon’s (Human Rights Watch) innovative concept of political epidemiology, and
the importance of addressing the societal, structural, political cultural environment
in the HIV response. The increasing role
of the BRICS, the trend towards regional responses moving away from global
responses, the EU agreement signed by Ukraine, Georgia and Moldova; and the
geopolitical position of the Russian Federation, are important to factors
influencing the HIV response in the region.
He presented compelling modelling data that
providing NSP+OST+ART could reduce by half HIV prevalence/incidence in St Petersburg
over 10 years with only 20% coverage of all three interventions, in comparison
to much higher required coverage rates for only a single or paired set of
Ochieyv, from the Eurasian Harm Reduction Network, reinforced
the importance of having availability of all three components – NSP, OST and
ART – for people who inject drugs. She
stated the importance of ensuring the quality of programmes and ensuring they
reach women who inject drugs as well as men who inject drugs. Importantly she questioned the model of
service delivery for OST and the variation in legal requirements. Georgia has a costly model, requiring three
medical doctors per service, even with low patient numbers, for instance. Similarly there is nor provision for
take-away doses, increasing costs.
The Eurasian Harm Reduction Network has
played a central role in advocating and mobilising for funds and harm reduction
in the region. Dasha Ochieyv stated that “they understand no one will take care
of their health and their rights. We
need to support them morally and financially”. Further the Global Fund and
PEPFAR need to ensure there is community involvement in policy decisions,
keeping governments and health services effective.
Klepikov, International AIDS Alliance, Ukraine,
focused on the successes of the HIV response in Ukraine which has seen a
reduction of new HIV cases and a stabilisation of HIV among the general
population, as well as a reduction in AIDS mortality. One of the key factors in this has been a scale
up of ART treatment and large scale prevention programmes among PWID. Ukraine has been successful in developing an
inexpensive harm reduction programme at $30 per client per year. The challenges are huge too. There is still unmet need for OST. Further, the difficult political environment
is potentially threatening some of these important gains. Funding for programmes for sex workers and
MSM is very limited.
The annexation of Crimea has plunged the
harm reduction programme in Crimea into turmoil: the 800 people who were
receiving OST no longer have access to methadone. There is a call for the Global Fund to have
an emergency project, such as moving OST patients from Crimea.
Soltan, Moldova, stated that a substantial gap exists regarding complex interventions as
treatment and prevention among key populations with only 11% of investments directed
to Key Populations (UNAIDS 2011).
Seventy to ninety percent of funds for key populations comes from
external donors. Dr Soltan called on
Eastern Europe and Central Asia to invest smartly and
prioritise key populations, with budgets reflecting
that; be innovative and patient centred.
Further, TB must be embedded in all programmes. Community based approaches need to be
institutionalised and there needs to be social contracting – services and
programmes; finally, there needs to be social accountability advocating for
Stuikyte, a member of the UNAIDS HIV and Human
Rights Reference Group), reminded the participants that non governmental
organisations are the main deliverers of services for people who inject drugs,
sex workers, MSM, and Transgender people.
She talked of the importance of the NGO
sector to act with unity: harm reduction organisations, for instance, do not
routinely support the issues that are important for sex workers and for gay men
and other men who have sex with men. NGOs
are dependent on external funding but there is very little going to support
advocacy defending the rights of the marginalised.
Law, law enforcement the justice system and
health care providers create stigma and discrimination for key
populations. Lack of treatment access is
another enormous challenge for key populations and only 1% of people who inject
drugs have access to treatment.
A representative of the Russian Harm
Reduction Network made an eloquent appeal from the floor to engage with the
Russian Federation, not create further barriers. He reminded the participants that the
national Russian programme includes NSP
and condoms, although not OST. “Isolation
is easy to achieve but it then becomes difficult to return from isolation “, he
change dialogue on
funding for NGOs beyond the
garner more support from the
EU: they should be helping with funding gap and policies.
Support current effective
Include Central Asia – they are
commonly left out, including here at AIDS 2014
Engage in dialogue with the
Russian Federation: isolation is easy to achieve and very difficult to wind