Kind regards,

Staff of Public Foundation “Doverie Plus”
Roza Oleynikova, head
Almaty, Kazakhstan”

We would like to thank our partners in Kazakhstan for appreciation of AFEW’s activities in this country. Though left in circumstances, when the funds to continue building innovative HIV prevention programmes like Client management and Harm reduction, and helping the most marginalised populations of Kazakhstan are scarce, we hope to carry on fulfilling our mission – reduce the impact of HIV and AIDS in the region.

As a result of the visit, Ms Ferrier and Mr Irrgang promised to initiate a dialogue with their inter-parliamentary contacts on the Netherlands’ contribution to the international HIV response. They also expressed their readiness to contact the Duma, the lower house of the Russian parliament, in order to highlight the need for increased commitment to harm reduction in Russia.

During this very successful visit, the parliamentarians got to see good examples of harm reduction projects in the Netherlands. They visited three key sites:

•The Mainline Outreach Bus that provides information and support to substance users;
•The User Room at HVO-Querido, where drug users can consume drugs openly in a safe, dealer-free and supervised environment;
•The Amsterdam Health Service, a public clinic that offers specialised welfare and medical services to marginalised clients (including drug users). This ground-breaking centre offers a model for good public healthcare for people affected by or at risk of HIV.

The parliamentarians attended presentations by Els Klinkert (UNAIDS), Daan Gouwe (Trimbos Institute) and Joost van der Meer (AFEW). The speakers highlighted how harm reduction projects across the world are reducing the impact of the HIV epidemic. They also emphasized the need to advocate strongly for harm reduction and rights-based HIV responses in Eastern Europe and Central Asia (EECA).

We remind readers that EECA faces the fastest growing HIV epidemic in the world, an epidemic largely fuelled by drug use and fast becoming generalised in populations. At the same time, there is still minimal political support and funding for programmes that help drug users and people most at risk of HIV. The human rights of people living with HIV remain low on the agenda of healthcare providers, leading to a situation where only 22% of people in need of antiretroviral drugs actually receive them*.

Download the coverage in ‘Het Parool’: Parool 20110201 werkbezoek

Download the presentation by Joost van der Meer: VE presentatie harm reduction veldbezoek TK 2011-01-31

*Report on the Global AIDS Epidemic’, UNAIDS, 2008.

Marina Cherkasova, Project Manager and Communications Officer in Russia, talked to three of the participants to find out why the event was important for them and about life for women living with HIV in Russia.

Anastasia Afanaseva is a Social Worker based in the City of Samara

‘As a social worker, I have worked on projects for sex workers, injecting drug users, conducted outreach work and attended self-help groups for women. At the moment, I’m involved in planning a new project for women living with HIV in Samara.I’m taking part in the school mainly out of personal curiosity. First of all, I really wanted to meet with Sveta Izambaeva, because I want to know more about her personal experiences of being a woman and a mother living with HIV. On the whole, I’m well-informed about HIV, but I wanted to go deeper into issues such as human rights and advocacy.

Discrimination is the main problem facing women with HIV in Russia. A woman living with HIV meets discrimination everywhere she goes: in clinics, at work and within the family. It’s particularly hard to communicate a diagnosis of HIV to medical specialists and close friends and family. Women need psychological support more than anything, so that they are not alone with their problems. In Samara, they can access psychological support through the ‘Time to Live’ project. We help them to make contact with the specialists that they need – psychologists, lawyers and public officials. We also help them to obtain medicines when they need them and milk supplies for their babies.

After the training I had so many ideas for creating new projects and putting new initiatives into action. I was so uplifted by the school and it was good to see how the trainers did such a professional job.There was such a warm and friendly atmosphere here and people were so supportive of one another. Everyone there cared and no-one felt the need to hide anything. All questions were treated as being important and there was always an answer.’

Svetlana Izambaeva is an expert in prevention of mother-to-child transmission of HIV and trainer based in Kazan

‘When I first found out that I had HIV, I was so distressed by the thought that ‘Today, it’s me. Tomorrow, it will be someone else’. I realised that I had to do something to combat this epidemic. When you speak to other women about what they have been through, you start to feel more confident about your own powers of endurance. You start to hope that you will live and are even able to talk about your problems openly. This is what I mean by combating the epidemic and the more of us who do this, the bigger are the chances that we will be heard.

I’ve been running a self-help group since 2005. Ever since I took part in the ‘Miss Positive’ contest, I’ve worked actively to advocate for my rights and the rights of other people living with HIV.

The main problems facing women living with HIV are stigma and discrimination, and that includes self-stigmatisation. Medical professionals tell us that they are not taught to be tolerant towards people living with HIV during their time at medical school. They just don’t realise that many different kinds of people get HIV and not just those who take drugs. That’s one reason for the bad attitudes towards us. Another reason, in my view, is the prevailing view of women in our society. People think that women just take care of their families and shouldn’t talk about their rights. But, when a woman is diagnosed with HIV, she has to start fighting for her own rights and those of her children.

And now there are more and more children being born with HIV in Russia. Issues like childcare and provision of milk to infants need to be solved at the legislative level, because it’s very expensive for parents to resolve these issues on their own.

<There is also a lack of non-medical services for women living with HIV and their children. Drug users can go to rehabilitation centres and dispensaries, but there isn’t anything like that for women, even for those who have been subjected to violence because they have HIV. They have nowhere where they can leave their children when they want to attend a self-help group. HIV discordant couples also need additional help, because they are poorly informed and are afraid to look for help.

Many maternity clinics are simply not equipped to deal with women living with HIV. They are put on isolation wards together with drug users and they are not allowed to choose which maternity clinic they go to. Doctors often do not know how to offer consultations to these women or what services they need. I think they need to start incorporating modules about HIV into maternity training.

I’m well-known among journalists in this region and they are ready to work with me. But they do need much more education, because they make mistakes in the way that they write about HIV. For example, they may write that a person ‘is sick with AIDS’. Such language affects the way people relate to us and there needs to be more education for journalists, just as for trainee doctors, so that they are HIV literate. The mass media is important because it forms public opinion. People listen to the media and make decisions on the basis of this information.

There was such an atmosphere of goodwill at this school. All the participants were motivated and keen to obtain information. They were all ready to help one another. If we continue to pull together like this, we will really be able to change things and people will listen to us! Together, we need to strive towards optimism and the good in life.’

Alyona is a peer counsellor and activist based in Samara

‘I took part in AFEW’s school because I plan to work as a peer counsellor for a joint project run by the All-Russian Public Organisation for People Living with HIV and the Red Cross. Through this work, I hope to reach and help other people living with HIV. On a personal level, this school comes just at the right time for me, because I am planning my second child and so the latest information about prevention of HIV transmission from mother to child is very useful. I also just like taking part in these training and educational sessions.

Almost all women living with HIV encounter discrimination at some point: as a public health worker, I’m most upset by the lack of understanding shown by doctors. The lack of information is a huge problem, because people get scared simply by so much being unknown and they don’t know where to turn for help. We just don’t have a system that provides professional assistance to women who face issues like HIV.

Nowadays, you can go to your local AIDS centre and in our town there is a ‘School for Patients’. But, we also need help in resolving psychological issues, legal advice and we need access to a range of medical professionals who will observe regulations and patient confidentiality.

They don’t say ‘knowledge is power’ for nothing. At this school, I’ve found out more about my rights and we’ve all had the chance to talk about our personal experiences. I’ve met so many women here who supported me. I will also help them as much as I can. I’ve also loved spending time in the beautiful countryside and pine forest! All the other participants are so sociable and I’ve met so many new people.’

The event attracted over 70 participants, including senior representatives of the Ukrainian prison service, a representative from the Embassy of the Netherlands to Ukraine, Joost van der Meer, AFEW’s Executive Director, and Elena Voskresenskaya, the organisation’s Regional Director for Ukraine, Belarus and Moldova.

At the conference, Elena Voskresenskaya emphasised the huge progress that the project has made towards tackling infectious diseases in prisons and creating a rights-based approach to prison health in Ukraine. Over the three, years of the project, AFEW assisted in setting up a nationwide HIV policy through the development of training curricula and educational materials for inmates and staff, as well as training teams of peer trainers among staff and prisoners. Read the full article on www.afew.org…

The goal of the study trip was to strengthen communication between Central Asian and German specialists, as well as between the Central Asian delegation members themselves. Delegates represented Kyrgyzstan, Kazakhstan, Tajikistan and Turkmenistan – countries with enormously different HIV and drug-related situations. For instance, in Kyrgyzstan substitution treatment has been successfully launched and approximately 1,000 people are receiving the treatment at the present time. In Kazakhstan, however, only 50 people receive have received this treatment and it is not available in Turkmenistan at all.

The delegation members visited projects sites such as safe injection centres, substitution programmes, social housing projects for people living with HIV who take drugs or are recovering from drug use and services for drug using sex workers. Fixpunkt, one of the organisers of the trip, presented their mobile drug counselling units that offer needle and syringe exchange and counselling for drug users at street level.

Participants were most interested to see for themselves how Germany’s integrated health care system works and how the state is held accountable. Pulod Djamolov, an activist from Tajikistan commented: ‘It was important for us to see that here in Germany it is the state who is primarily responsible for healthcare services and support programmes for drug users and people living with HIV.’

Dirk Schaeffer, Officer for Drug-related Issues at Deutsche AIDS-Hilfe, was especially inspired by the stories of how current and former drug users have been encouraged to participate actively in initiatives and organisations in Central Asia. Deutsche AIDS-Hilfe hosts one of the oldest self-organisation networks worldwide (JES – ‘Drug users, ex-users and people on substitution treatment’) and has been disappointed to see that recent trends in the field in the West have been to exclude current and former drug users from prevention work.

At the end of the trip the delegation members also had a discussion with Dr. Ingo Ilya Michels, Coordinator of the Central Asia Drug Action Programme (CADAP), about finding new ways to cooperate on the fifth round of the project.

Roundtable on East-West Responses to HIV and Drug Use

The Central Asian Study Trip to Berlin culminated in a public discussion on harm reduction in the East and the West. The goals of the event were to broaden insight into HIV and drug use in Central Asia and to identify the opportunities for and obstacles to further international cooperation in the region. Participants of the podium from Central Asia, Pulod Djamolov (SPIN Plus), Ruslan Tokubaev (Narcological Centre of the Ministry of Health) and Bolotkan Sydykanov (GTZ), gave presentations on projects in Kazakhstan and Kyrgyzstan. Joost van der Meer (Executive Director at AIDS Foundation East-West – AFEW) also joined the discussion on lessons learned from international projects in Central Asia in the past. Bolotkan Sydykanov: ‘It’s important to see that we all face the same problems. The difference is in the socio-economic backgrounds to HIV and drug use in each country.’

One of the positive outcomes of the latest exchange between East and West in the eyes of the Central Asian representatives during their trip in Berlin was to see the good governmental and non-governmental cooperation on HIV prevention and drug-related projects. Especially highlighted was the need for better cooperation between the Central Asian countries themselves. Dr. Tachnabat Annamuradova of the Turkmenistan National AIDS Prevention Centre raised the idea of a regional conference on HIV and drug use in Central Asia – an idea that all participating organisations warmly welcomed. Such a conference might help to make the response to HIV and drug use a priority for politicians, whose support is urgently needed in order to ensure the adoption of people-centred, humanitarian approaches to HIV prevention and drug policy.

Altogether, the evening yielded much lively discussion, memorable exchanges and some inspiring ideas for future cooperation! For more information please contact carolin.vierneisel@dah.aidshilfe.de or visit www.aidshilfe.de

Last Friday, during the closing ceremony of the Global Village, Ilona van de Braak, Director of Communications, AIDS Foundation East-West (AFEW) updated delegates on the huge response to the Vienna Express campaign and the future of the wishes: ‘We have handed bags full of messages to four of the most important decision-makers in the global HIV response – Michel Sidibe (Executive Director of UNAIDS), Miche Kazatchkine Executive Director of the Global Fund to Fight AIDS, Christian Kroll (Global Coordinator for HIV/AIDS at UNODC) and Mats Ahnlund (Acting Director of the International AIDS Society). We are keeping our promise – every single wish will be delivered. In the coming weeks, we will continue to use our blog on www.viennaexpress.org to post events news from continuing Vienna Express activities and to publicise the core message of the AIDS2010 conference as encapsulated in the Vienna declaration. ’

AFEW’s presence at AIDS2010

Aside from the East-West Wish Tree, which formed a popular focal point of the Global Village and attracted wide press coverage, AFEW also ran a photo booth at the conference. Here, visitors had their pictures taken and chatted to AFEW staff informally about the Vienna Express campaign and the HIV situation in Eastern Europe and Central Asia.

Altogether, 20 AFEW staff members and 10 representatives of local partner organisations came to Vienna as part of the AFEW delegation. To read their presentations and find out more about the sessions they ran, see www.afew.org

The Messages

We will provide feedback from the message recipients over the coming period here on the blog. In the meantime, here are just some of the wishes that were collected from participants of the Vienna Express campaign:

‘Tell 10 boys and 10 girls about HIV and they will tell their friends. Maybe, each one will tell all his or her friends. Then, maybe we can stop HIV!’  Natalya (14 years old), Bishkek, Kyrgyzstan.

‘I wish that there were more campaigns like the Vienna Express, so that young people took the issue of HIV seriously, protected themselves and accessed services in AIDS centres if they need them.’  Oksana, Taldykorgan, Kazakhstan.

‘The main thing is not to be afraid and not to listen to the voice of prejudice. Various illnesses can appear and some can be cured, but your thoughts and attitudes should not be prisoners of them.’  Sergey, Kyiv, Ukraine.

‘I call upon the people of the world to take HIV and AIDS more seriously. Health for all and health is most important of all.’  Olga, Odessa, Ukraine.

‘We must develop the potential of NGOs in the Russian regions and motivate them to act together.’ Ilya, Moscow, Russian Federation.

‘I wish that there was more participation of people living with HIV in the response to HIV in Uzbekistan and that they had more opportunities.’  Sergey, Tashkent, Uzbekistan.

‘I wish that the government would pay more attention to HIV and AIDS. We need to give young people more information.’  Irina, Kirovograd, Ukraine.

‘Life is beautiful! Protect your own life and the lives of others!’  Nino, Tbilisi, Georgia.

‘Find out more about HIV and distribute more information. It should be accessed in the schools and we need more volunteers to carry out this work!’  Olga, Taldykorgan, Kazakhstan.

‘People living with HIV – do not be afraid to live!’  Yuliya, Tallinn, Estonia.

‘We need people from across the world to join our efforts to improve the response to HIV and AIDS in Belarus.’ Natalya, Minsk, Belarus.

‘Equal rights and equal access will make us stronger!’ Kiromidrin, Dushanbe, Tajikistan.

‘More lectures about HIV and AIDS are needed in prisons, because here we have very little access to information.’ Victor, Penal colony No.47, Kyrgyzstan.

Articles and interviews about the Vienna Express were published in the local media across the 14 countries of the campaign (for example, see ‘Samara Today’ in Russia, ‘ATN Kharkiv TV’ in Ukraine), in the national press (‘The Independent’ in the UK, ‘Komsomolskaya Pravda’ in Moldova, ‘Hindustan Times’ in India, ‘China Daily’, ‘France 24’, ‘Die Presse’ in Austria), in the specialist press (Russia’s noaids.ru, healthdev.net) on partner websites (AIDS Action Europe, Society Association HIV in Latvia, World AIDS Campaign), news engines run by international agencies (UNAIDS, UNICEF), on popular blogs (see Mark E. King’s blog, the AIDS2010 blog, International HIV/AIDS Alliance) and on discussion fora (Poltava Forum).

Highlights of the session included the speech by Shona Shonning of the Eurasian Harm Reduction Network in which she analysed the spending patterns on HIV-related programmes in EECA. She noted that while spending has increased in recent years, there is still very little money spent on HIV prevention among the most at-risk groups. In Russia, for example, almost nothing is spent on HIV prevention programmes for injecting drug users and other at-risk people.

Ani Shakarishvili of UNAIDS gave an overview of trends in the epidemic among each vulnerable group. She pointed out that there is a severe lack of data on trends among men who have sex with men (MSM). AFEW’s Director for the Central Asian Republics, Roman Dudnik, took up this theme in his speech.

‘I wish to thank Ani for her speech here today where she touched on the issue of men who have sex with men. This is not just an ‘issue’, this is a question of recognising that they even exist. This discussion today is VITAL, because unfortunately in our region, Eastern Europe and Central Asia, men who have sex with men are completely ignored. Basically, over the 25 years that we have had this HIV epidemic, our region has ignored the very group among whom the epidemic was first recognised.

Yesterday, I received the news that a young man in Tajikistan, a 22-year old gay activist, was brutally murdered simply for being who he was and for having sex with men. The investigation into his death has not yet finished, but our current information is that his sexuality was the motivation behind the murder.

Now I want to put some very simple questions to you, Russian-speaking people from Eastern Europe and Central Asia: what are we going to do in order to make sure that this never happens again? How long are we going to pretend that nothing is happening? How long will we keep on making presentations and saying that MSM is an ‘unknown’ group for us? It is a known group! These people exist, but they are afraid to stand up and identify themselves, because they are killed for who they are and because they do not practice sex in the ‘normal’ way.

How long will we MSM, gays (or whatever other title you give us), working in various organisations, continue to do anything rather than solve our own problems? And how long will we just work on the latest ‘sexy’ topic from our donors? How long will our governments just close their eyes to inconvenient questions? We say that HIV prevention is a human right. If that’s true then we should not forget that we, with our various preferences and priorities – including in the field of sex – have the right to life and to health. It shouldn’t matter where we live, what we do or with whom we have sex.’

‘I truly hope that the world will give everyone a voice in the fight against HIV. No more discrimination!’
Laura, Canada.

‘The governments of the world should be targeting their funding towards HIV prevention measures. The populations should be enlightened openly on true prevention.’
Francis, Kenya.

‘La lutte contre le HIV/Sida doit tenir compte du niveau de developpement des pays pauvres, notamment africains.’
Kabore, Burkina Faso.

‘The world is very small. Give us universal access. Free female condoms for young people, clean needles, ARV and proper information. Don’t cut funding for HIV!’
Dian, Indonesia.

‘Global leaders stand up and live up to their country’s pledges and correct the wrongs by providing the rights.’
Carl, Netherlands Antilles.

Michel Sidibe’s Wish

The Director of UNAIDS visited the East-West Wish Tree yesterday in order to read the messages, chat to AFEW’s Executive Director Joost van der Meer about the campaign and add his own wish to the tree. Mr. Sidibe said that he had never encountered such an original and colourful campaign. He thanked the organisers for their work to highlight HIV in Eastern Europe and Central Asia and hung his special message to the EECA region on the tree:

«Ноль новых случаев ВИЧ-инфицирования. Ноль случаев дискриминации. Ноль связанных со СПИДом смертей».