20th International AIDS Conference - Melbourne, Australia


THRE01 No Region and Nobody Left Behind: HIV in Eastern Europe and Central Asia (EECA)
  Regional Session
Venue: Room 203-204
Time: 24.07.2014, 11:00 - 12:30
Co-Chairs: Tatiana Deshko, Ukraine
Chris Beyrer, United States

Eastern Europe and Central Asia is facing quadruple, intersecting epidemics of injecting drug use, HIV, tuberculosis and hepatitis C. According to the UNAIDS 2014 Global Report, 1.3 % of the adult population reports injecting drug use and PWIDs account for 40% of new HIV infections in the region where opioid substitution therapy and needle exchange programmes are severely restricted. Stigmatization and criminalization of men who have sex with men and people who inject drugs contribute to the barriers to comprehensive HIV care and treatment. WHO reports that in the region, only about 35% of the people who need ART are receiving it. Some positive trends and opportunities have emerged, but progress is far from uniform. Following an overview of the situation in the region, a panel of experts will debate key issues and solutions related to poor access to treatment, vulnerability and marginalization, service integration for co-infections and funding.
11:00
THRE0101
Webcast
Introduction
C. Beyrer, United States
T. Deshko, Ukraine

11:07
THRE0102
Key features of the HIV/AIDS epidemic and emerging issues in the region
M. Kazatchkine, UNAIDS

11:17
THRE0103
Webcast
Access to prevention , treatment and care and to harm reduction for people who inject drugs in EECA
D. Ocheret, Lithuania

11:32
THRE0104
Powerpoint
Webcast
An update on the epidemic in Ukraine
A. Klepikov, Ukraine

11:42
THRE0105
The contribution of the civil society and of the community to the response to the epidemic and the challenges civil society faces in the region
R. Stuikyte, Lithuania

11:52
THRE0106
Powerpoint
Webcast
Financial sustainability of the AIDS response in EECA
V. Soltan, Moldova

12:02
THRE0107
Webcast
Panel Discussion
T. Deshko, Ukraine
C. Beyrer, United States

12:23
THRE0108
Webcast
Concluding Remarks
C. Beyrer, United States

Powerpoints presentations
An update on the epidemic in Ukraine - Andriy Klepikov

Financial sustainability of the AIDS response in EECA - Viorel Soltan



Rapporteur report

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 session.

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 interventions.  

Dasha 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.

Andriy 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. 

Dr Viorel 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 government ownership.

Raminta 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 said.

Recommendations:

·       change dialogue on criminalising

·       funding for NGOs beyond the Global Fund

·       garner more support from the EU: they should be helping with funding gap and policies.

·       Support current effective programmes

·       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 back.

 

 

 

 

 




   

    The organizers reserve the right to amend the programme.