Eastern Europe and Central Asia

Ten days after the start of the Russian invasion of Ukraine, UNAIDS spoke to Oleksii Kvytkovskyi, the head of the Volna Donbas Resource Center of the All-Ukrainian Association of People with Drug Addiction, a nongovernmental organization working with people who inject drugs in Ukraine.

How are you feeling Oleksii?

I am tired of fear and fleeing. I have decided I will carry on doing what I have been doing for the past 14 years—defending the rights of key communities, notably people who inject drugs and people in need.

This is not your first encounter with war?

Eight years ago, I was there when the Russian Federation attacked the eastern part of Ukraine—as you know, they are now self-proclaimed republics. I have three children and two were born during that conflict, one in 2014 and the other in 2019.

I still work in four cities in the Luhansk oblast (region), which are controlled by the Ukrainian Government, located almost on the front line: Severodonetsk, Lysychansk, Rubizhne and Kreminna.

What are you currently doing in your job?

We at the nongovernmental organization receive and then deliver opioid substitution therapy (OST) and food and water to those who need it. We only have enough OST until the month’s end. That’s about 28 days, and then I don’t know what we will do.

Access to antiretroviral therapy is also problematic in some cities. Basically, we look at who lacks what and if there are risks of interruption.

Have a lot of people left your area?

Very few people can leave because they don’t have enough funds to do so. Until now they have been evacuating women, small children and the elderly as a priority.

Our nongovernmental organization turned to international organizations and we received assistance from the Eurasian Harm Reduction Network, the Eurasian Network of People who Use Drugs and Volna, and that has really helped to provide urgent assistance.

What about you?

I begged my wife to take the children and leave for Lviv. I even found a place for them to live but she said that she wouldn't leave me, and so she stayed.

But I am afraid. I am anxious about my children and my beloved wife.

What keeps you going?

I go to work every day. People ask me if I fear for my life. My answer to this is, “When you solve someone’s problems, you unknowingly forget about fear and war. Then solving the problem of a person from the community becomes the key objective for you, so you set out to help in any way.”

When shelling awoke Valeriia Rachynska in Kyiv on 24 February, the first day of the conflict, she rolled over and tried to get more sleep. As a native of Luhansk, she had already lived through the 2014 conflict.

“I think my brain analysed the noise and realized I was out of harm’s way,” she said by videoconference from a small village in western Ukraine. “But when I saw my kids crying and frightened, I knew I had to relocate yet again.”

The following night she and her two sons stayed in a bomb shelter and then left their home in the capital city with her brother and his family.

As the Director of Human Rights, Gender and Community Development of 100% Life, the largest network of people living with HIV in Ukraine, she stressed that in order to continue helping people, she needed to relocate to a safer place.

“It’s like when you are in an airplane and there is a lack of oxygen,” Ms Rachynska explained. “You put the mask on yourself first then place it on others afterwards.”

The key for her and her organization was being able to have Internet access, a steady mobile phone service, open banks and a relative sense of safety. These days she felt like she was operating a switchboard.

“I respond to all calls and try to redirect them to the right people,” she said. “It has been non-stop and because there are so many attacks and so much unpredictability, I can only advance one step at a time.”

She credits 100% Life’s head, Dmytro Sherembey, for having done advance planning ahead.

“A lot of people told us, “You are crazy to panic,” but at 100% Life we moved our computer servers, documents and anything deemed sensitive to western Ukraine and even Poland and Germany.”

Some of her colleagues stayed in Kyiv saying they would tough it out, but 10 days later many of them left too.

“We are now focusing on evacuations and relocation for people living with HIV and their families as well as marginalized groups by hiring buses for them,” Ms Rachynska said, wrapped up in a blue sweatshirt with a hood. “For those not living in Kyiv, we are sending money via bank transfers for them to buy food and other essentials.”

The country has enough buffer stocks of HIV medications to last until April, but with the help of international partners and UNAIDS’ coordination, 100% Life has urgently planned to have additional life-saving medicines delivered to Poland. The Polish Government has secured a warehouse and agreed to help with logistics, getting antiretroviral therapy to people living with HIV in Ukraine.

Ukraine has the second largest AIDS epidemic in the region. It’s estimated that 250 000 people live with HIV in Ukraine, with more than half on antiretroviral therapy, medication that needs to be taken daily for people living with HIV to stay healthy.

“Our biggest challenge right now is to save lives, provide security and have people stay on treatment,” she said. The 100% Life network has already redesigned key aspects of its programme to get funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria to meet the immediate needs.

Having joined 100% Life in 2011, Ms Rachynska has seen the strides that Ukraine has made to reverse the AIDS epidemic. She is particularly proud of the positive impact that harm reduction programmes, including opioid substitution therapy and needle–syringe exchanges, have had in Ukraine to reduce new HIV infections. HIV in the country continues to disproportionately affect people who inject drugs and the ongoing military offensive may hamper substitution therapy options. She said that 100% Life was actively working to avoid that.

Her other worry involved protecting sex workers, lesbian, gay, bisexual, transgender and intersex people and people who inject drugs. Based on the violence and stigma those groups experienced during the conflict in eastern Ukraine, she fears that key populations will be the targets of violence.

“Our next task will be to start and monitor human rights violations,” she said. “This is very important to me.”

GENEVA, 25 February 2022—Amidst the ongoing military offensive against Ukraine, UNAIDS is calling for the protection of health workers and uninterrupted continuation of HIV and health services for all people, including people living with and affected by HIV. Ukraine has the second largest AIDS epidemic in the region. It is estimated that there are 260 000 people living with HIV in Ukraine, 152 000 of whom are on antiretroviral therapy, medication that needs to be taken daily for people to remain alive and well.

“People living with HIV in Ukraine only have a few weeks of antiretroviral therapy remaining with them, and without continuous access their lives are at risk,” said Winnie Byanyima, UNAIDS Executive Director. “The hundreds of thousands of people living with and affected by HIV in Ukraine must have unbroken access to life-saving HIV services, including HIV prevention, testing and treatment.”

To date, the Government of Ukraine, together with civil society and international organizations, has implemented one of the largest and most effective HIV responses in eastern Europe and central Asia. However, with the ongoing military offensive, the efforts and gains made in responding to HIV are in serious risk of being reversed, putting even more lives in danger.

The right to health and access to HIV services must always be protected, and health workers, representatives of civil society and their clients must never be targets in a conflict. The ongoing military conflict has affected everyone in Ukraine but is likely to be particularly hard for people living with HIV and key populations, including people who use drugs, sex workers, gay men and other men who have sex with men and transgender people. 

As highlighted by the United Nations Secretary-General, the United Nations is committed to support people in Ukraine, who have already suffered from “so much death, destruction and displacement” from the military offensive, in their time of need. 

With the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States President’s Emergency Plan for AIDS Relief and UNAIDS, the Government of Ukraine and civil society partners have delivered HIV prevention and treatment services for people living with HIV and key populations across Ukraine for many years and stand ready to give further support during the ongoing crisis.

UNAIDS staff remain on the ground in Ukraine, working to ensure that people living with HIV and key populations in Ukraine have continued access to life-saving services, with a particular focus on the most vulnerable civilians. UNAIDS will continue to support HIV prevention, testing, treatment, care and support for people across Ukraine affected by the crisis.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Nargis was born in Dushanbe, Tajikistan, into a large family. Life was not easy, and she was sent to a boarding school for low-income families. Her favourite subject at school was physical education, excelling at basketball and swimming. She hoped that after graduating from school in 1991 with a diploma in physical education she would continue her studies at a technical school.

However, because of unrest in the country, she couldn’t carry on with her schooling. “I cried for six months, I really wanted to continue my studies, but instead of going to a technical school, my parents married me off. I was not yet 16 years old then,” said Nargis. When she was 17 years old, she gave birth to a son; five years later, while pregnant with her second child, she learned that her husband was involved in drug trafficking, and he was sent to prison.

From that time on, Nargis had to provide for herself and her family on her own. She got a job in a casino. The earnings were good, but it was there that she started taking drugs. “I was a shy girl, so to make me feel relaxed, I used drugs. From there, I became a drug addict. I didn’t even notice how it happened,” she recalled.

She was eventually fired from her job because of her drug-taking and was forced to look for other ways to survive.

Nargis injected drugs for 14 years, but she started on opioid substitution therapy when it was made available in the country. “While I was on methadone, I was hired as a peer counsellor. I worked with drug users, with people living with HIV. I worked as a consultant in several HIV prevention projects,” said Nargis.

Nargis remained on methadone until May 2021. “Last year, I had to stop methadone because I was sent to prison and there was no methadone in prison. It was very hard, I was in the prison hospital for several months, but as a result I got off methadone and, so far, I am holding on.”

Nargis was imprisoned under Article 125 of the Criminal Code of Tajikistan, under which it is a criminal offence to infect someone with HIV or to put them at risk of HIV infection. Based on this article, law enforcement agencies initiate criminal cases against people living with HIV just on the basis of the potential threat of HIV transmission or simply just based on their HIV-positive status.

“I have been taking antiretroviral therapy since 2013. I have never interrupted it. I have an undetectable viral load. No one wrote a statement against me. I did not infect anyone. The accusation was made on the basis of a note from a man I knew, because we were dating,” Nargis said.

The legislation does not take into account the informed consent of the other sexual partner, regardless of whether there was a risk of HIV infection, or whether the person living with HIV takes precautions against HIV transmission. In addition, the legislation does not define how someone living with HIV should declare their HIV status. In effect, all people living with HIV who have sex can be held criminally liable.

Nargis explained her shame, “Law enforcement agencies called everyone, doctors, my colleagues, relatives, and told them about my HIV diagnosis, asked what kind of relationship we were in, dishonoured me.”

“Article 162 of the Health Code gives doctors the right to disclose the status of HIV-infected patients at the request of the investigating authorities, and does not contain any justification for this. Some criminal cases under part 1 of Article 125 were initiated after the HIV clinic disclosed information about HIV to law enforcement agencies. During the investigation and trial, the defendants’ right to confidentiality regarding their HIV status is not ensured, since investigators, officials, court clerks and judges can request medical information in accordance with the provisions of the Health Code without any specific conditions,” said Larisa Aleksandrova, a lawyer.

Nargis is now free, but she said that she was just lucky. “I was released under an amnesty in connection with the 30th anniversary of the republic.”

She is out of prison, but there are still dozens of other people convicted under Article 125. Now that everyone knows that she is living with HIV, Nargis is ready to fearlessly fight for the right to live, work and love, despite her HIV status.

Nargis continues to work as a volunteer peer consultant on HIV prevention. She has many plans, but the main goal that she is striving for is the revision of articles criminalizing HIV in Tajikistan.

“I always say that there should be more information about HIV, about people living with HIV, so that they don’t fear us the way they do now. Now everything has changed, there is treatment, there is prevention. An HIV diagnosis should not be a guilty verdict—it’s just a diagnosis.”

Most countries in the eastern Europe and central Asia region have criminal penalties and various types of punishment, including imprisonment, for concealing a source of HIV infection, for putting someone at risk of HIV or for transmitting HIV. HIV criminalization disproportionately affects marginalized populations, especially women. Women are more likely to find out their HIV status when accessing health care, such as for pregnancy, and are more likely to be criminalized and punished.

“We know for certain that laws that criminalize HIV are counterproductive, undermining rather than supporting efforts to prevent new HIV infections. We hope that by consolidating the efforts of governments and public organizations it will be possible to revise outdated laws in the near future, taking into account the latest data on HIV, which will allow people living with HIV, or those who are most at risk of infection, to be open in their relationships with medical organizations, to disclose their HIV status and use affordable medical services,” said Eleanora Hvazdziova, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

The ARTiSHOCK Theatre in Almaty, Kazakhstan, recently premiered an extraordinary performance: all its actresses were women living with HIV, ex-prisoners and women who use drugs. They played the role of women who faced stigma, discrimination and violence, an echo of their own life stories.

The performance, the script for which was written by female activists, was the idea of the Revanche Center for Comprehensive Care (also known as the Revanche Foundation), supported by the UNAIDS Country Office for Kazakhstan and the Eurasian Network of Women Living with HIV.

“The idea of ​​a social theatre was a dream that has finally become a reality,” said Anna Kozlova, a social worker for the Revanche Foundation. “We decided to talk about the experience of violence. After all, it is not only physical or sexual. To be rejected by society and discriminated against is also violence, but psychological.”

Nadezhda Plyaskina, the play’s director, said that it was not easy to work with the aspiring actresses. “I was afraid: these women have such considerable life experience; what can I teach them? In addition, it was necessary to teach acting in a way that did not hurt: they are all vulnerable. Each rehearsal revealed them to me as real, amazing, wonderful people. I told them: “Play with your heart.””

And they played with their hearts, telling their stories of imprisonment, abuse, stigma, loneliness and hope. The performance was a great success and was widely covered by Kazakh media.

Ms Kozlova began using drugs when she was 17 years old, which landed her in prison for 17 years. “All women who come out of prison are already victims. They are broken, vulnerable, don’t know how to live, where to go. They need help to become strong.” Four years ago, she went to the Revanche Foundation for help, and there she found a job, a family and a purpose. “I know from my experience that things can change,” she said.

Zulfiya Saparova has been living with HIV for 15 years; she is on antiretroviral therapy and works as a peer consultant for Equal to Equal Plus. She faced abused and violence and tells her story from the stage. “My heroine in the performance comes on stage holding a frying pan. This story is imprinted in my memory: my neighbour constantly walked around with black eyes. She was beaten by a drunken husband. Once her daughter came to visit her, and a black eye appeared on the husband’s face—she had protected her mother by beating him with a frying pan.”

Natalya Kovaleva, a social worker for the Revanche Foundation, spent eight years in prison. Her last term was three years and compulsory treatment for drug addiction. Currently, she works with young people who use drugs on HIV prevention. “If it wasn’t for the Revanche Foundation, I would either be behind bars or dead,” she said. “I have a mission here.”

The heroine she plays faces physical and psychological violence, total control, prohibitions and beatings. “I don't want to arouse pity, so I played a strong, independent woman who refuses to endure bullying. All this was in my own life,” said Ms Kovaleva.

The Revanche Foundation helps women in difficult situations, including women living with HIV, women who use drugs, children who lived in orphanages and former prisoners.

Elena Bilokon, the director of the Revanche Foundation, says that her work is focused on the most vulnerable and socially unprotected women, as there are no state support programmes for them. “Yes, the state provides patients with HIV drugs, but there is no psychosocial and social support. This year alone, 285 women living with HIV applied for our help,” she added.

“There is a clear link between violence against women and HIV. Studies show that women living with HIV are more likely to have experienced violence, and women who have experienced violence are more likely to be living with HIV,” said Gabriela Ionescu, the UNAIDS Country Director for Kazakhstan. “For this reason, UNAIDS highlights the need to address violence against women as a key human rights issue and the need to provide support to the most vulnerable women, including social and psychological help.”

The next performance will take place on 1 March, Zero Discrimination Day. The activists also plan to perform the play in several prisons in Kazakhstan. 

Participants from 21 countries in central and eastern Europe and central Asia and the Balkans met in December 2021 in Istanbul, Turkey, for the International Health Sustainability Forum: HIV and COVID-19 in Eastern Europe and Central Asia.

The participants discussed the most efficient means to ensure the sustainability of AIDS programmes and the role of community organizations in providing uninterrupted HIV services during the COVID-19 pandemic in the region.

The results of a three-year project implemented by the Alliance for Public Health in a consortium with 100% Life (formerly the All-Ukrainian Network of People Living with HIV), the Central Asian Association of People Living with HIV and the Eurasian Key Populations Coalition, with the participation of a wide range of partners, were also presented and reviewed. The project was funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and was supported by UNAIDS.

Addressing the forum, Peter Sands, the Executive Director of the Global Fund, highlighted the key elements of successful AIDS programmes in the region, among them “systems, not project-based interventions,” the meaningful engagement of communities and their ownership of the HIV response and removing human rights barriers.

“Increasing public funding of HIV services through social contracting mechanisms, which was a rare case a few years ago, has now become an important component of a systemic response to the HIV epidemic in many countries of the region,” said Andriy Klepikov, the Executive Director of the Alliance for Public Health. He noted that over the past three years public funding of HIV services through social contracting mechanisms in the region amounted to more than US$ 30 million. “This is one of the most important achievements of the joint efforts of community organizations and governments in the region.”

However, as the participants noted, to sustain this success an appropriate legal framework, the support of governments and the strengthening of initiatives made by communities are needed.

Several cities across the region have produced impressive results due to the leadership of local governments that have not only taken responsibility for developing and funding municipal AIDS programmes, including services for key populations, but also through the involvement of community organizations in their implementation.

Thus, systematic work by the city government in close cooperation with community organizations saw Odesa, Ukraine, achieve the 90–90–90 targets. “Odesa has managed to change the strategy for HIV testing and treatment. Our experience has already received recognition from the international community. And we are ready to share our best practices and successes,” said Gennadiy Trukhanov, the Mayor of the city.

The experience of the Republic of Moldova was presented by Fadei Nagachevsk, the Vice-Mayor of Chisinau, and Ruslan Poverga, from Initiative Positiva, who demonstrated the importance of close interactions between city governments and community organizations to ensure the accessibility of services for key populations. Mr Poverga also noted that the integration of peer consultants and social workers in public institutions helps to ensure the sustainability of services.

The best practices of municipal responses to the HIV and COVID-19 epidemics of Kyiv, Ukraine, Osh, Kyrgyzstan, Podgorica, Montenegro, Kragujevac, Serbia, Bern, Switzerland, Prague, Czechia, and Istanbul, Turkey, were also presented.

According to Sergiy Dmitriev, an international expert on public health, civil society organizations have also played a leading role in reducing the prices of antiretroviral medicines by monitoring the procurement cycle and budget and attracting generic suppliers. The price of an annual course of first-line antiretroviral therapy has decreased to US$ 131—the average cost of first-line antiretroviral therapy in nine countries in the region was US$ 192 in 2017. Most of the savings on purchases, about US$ 119 million, remained within AIDS programmes.

Another critical area where community organizations have been playing an increasingly important role in the region is community-led monitoring of human rights violations. The results of work on the REAct system (a human rights violation monitoring system) were presented: during 2020 and 2021, more than 6000 cases of human rights violations and cases of stigma and discrimination were registered in seven countries.

Among the most frequent offences in the region are violence by law enforcement officials, denial of access to medical services, disclosure of medical data and stigma in health-care settings, as well as physical violence against women by their partners and relatives. Based on an analysis of all cases, civil society organizations, together with lawyers and governmental partners, developed recommendations for countries that will form the basis for further advocacy.

“Community-led organizations have become leaders in providing people-centred, human rights-based HIV services in the majority of countries in eastern Europe and central Asia,” said Alexander Goliusov, Director, a.i., UNAIDS Regional Support Team for Eastern Europe and Central Asia. “Their meaningful engagement in decision-making processes and financial sustainability provided by government funding are the key for an effective response to HIV and COVID-19 and for future pandemics.”

The forum video is available: in Russian and English

https://www.youtube.com/watch?v=gCVqVUKAJmo

https://www.facebook.com/AlliancePublicHealth/videos/4581620981957116

On the eve of World AIDS Day, the Russian language social media network OK.RU hosted a live broadcast, Telling the Truth, as part of an education project that has been run by UNAIDS and the United Nations Educational, Scientific and Cultural Organization since 2015. The show was organized in collaboration with a popular magazine, Domashniy Ochag, and was devoted to the use of condoms and the link to the HIV epidemic in eastern Europe and central Asia. 

During the broadcast, which was watched by more than 1 million people, experts and celebrities discussed the most common myths, misconceptions, difficulties and fears connected to condom use.

Before the broadcast, an online survey of 1050 people aged 18 to 60 years was conducted on what Russian Internet users think about protection against sexually transmitted infections and what they consider to be safer sex. The study found that 87% of respondents had had sex without a condom, with older respondents reporting higher rates of sex without a condom.

“HIV has already reached the general population in this region. Almost 70% of all new HIV infections have been linked to heterosexual sex in recent years. At-risk people include single women aged more than 35 years and men and women who no longer worry about contraception and therefore do not use a condom,” said Natalya Ladnaya, Senior Researcher at the Central Research Institute of Epidemiology, Rospotrebnadzor. 

Among the reasons for unprotected sex, the respondents most often named “awkwardness of discussing it with a partner”, which was reported by 41% of the respondents. In addition, “trust in a partner” (35%), “discomfort during intercourse” (20%), “fear of spoiling romance” (31%) and “fear of being misunderstood by a partner” (19%) were listed among the reasons for not using a condom.

Appearing on the broadcast was Masha Godlevskaya, who has been living with HIV for 22 years. She works as a peer consultant for the EVA Association, which provides HIV services. She explained that many women who go to the EVA Association for a consultation are embarrassed to carry condoms because of the stereotype that having a condom available means that they are available and ready for sex.

“Both women and men are victims of this story,” said Ms Godlevskaya. “If a man insists on having sex without a condom, the woman should be ready to say: “I don’t want to. I don’t want to offend you, but no sex without a condom.””

“We help women believe in themselves, work with a psychologist, fight back against their abusers, build new relationships where they can discuss everything frankly. I want our women to be able to defend their bodies, their rights, and be able to take their lives into their own hands,” she added.

Vera Brezhneva, UNAIDS Goodwill Ambassador for Eastern Europe and Central Asia, noted that many women vulnerable to HIV were born in the time of the Soviet Union, when there was no promotion of safer sex. “I didn’t know about HIV at all. Most of us at that time were afraid of pregnancy only. We believed in love as if love protects you from everything. We were not told that a condom is not protection against men or women but protection against infections.”

Ms Godlevskaya shared her story of becoming infected with HIV. “I was 16 years old. He was my first love, and, as it seemed to me then, the last one. It was a serious relationship, there was trust and we knew nothing about the need to use a condom.”

Marina Travkova, a family psychologist and sex therapist, noted that adolescents are vulnerable to HIV and other sexually transmitted infections. “They need help. There is nowhere to get reliable information. I am in favour of compulsory sex education in high school and for condoms to be available in school toilets. I always remind my sons before they go out: wallet, phone, brain, condom,” she said.

For a significant part of the population, especially young people, the cost of condoms is too high, noted Ms Ladnaya. “We are discussing these issues with partners, and we hope that there will be government programmes to support the production of condoms. There are nongovernmental organizations that provide condoms for free, but I believe that they should be available at every step,” she said.

Discussing the perception that sex with a condom is worse than sex without one, the reason that people often do not use condoms, the panellists noted that comfort might be related to the quality and size of a condom, as well as insufficient knowledge of how to use a condom and lubricant correctly.

Grisha Tumanov, a journalist and blogger and author of the Man, Where Are You Going? podcast, commented on a viewer’s question: “Is a condom needed if it’s love, which presupposes mutual trust.” He noted that, “We don't have a culture of speaking on sensitive topics, what you expect from relationships, including sexual relationships. And love does not absolve one of responsibility. This does not happen in adulthood. You are responsible for each other.”

Representatives of ministries of health of the Commonwealth of Independent States (CIS) countries, health-care experts and representatives of UNAIDS and the World Health Organization (WHO) convened to discuss the priorities of CIS countries in addressing new pandemic challenges and other health-care issues in Minsk, Belarus, at the 34th meeting of the Council for Health Cooperation of the CIS. 

A memorandum on deepening cooperation between the Council for Health Cooperation of the CIS and the WHO European Office was signed during the meeting. “We are stronger when we are united. A global problem such as the COVID-19 pandemic cannot be solved by national measures only,” said Hans Kluge, the WHO Regional Director for Europe.

Igor Petrishenko, the Deputy Prime Minister of Belarus, noted the importance of joint operational decision-making, “so that there is consistency in the CIS on eliminating and counteracting the spread of COVID-19, as well as continuing vaccination and implementation of the Travelling without COVID-19 app within the CIS.”

The Minister of Health of the Russian Federation, Mikhail Murashko, noted that countering infectious diseases requires ensuring that health systems are stress-resistant. “They must quickly adapt to new challenges,” he stressed.

Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia, presented the new priorities for the HIV response in the region outlined in the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS and the new United Nations Political Declaration on AIDS, taking into account the COVID-19 pandemic.

He outlined the directions in the new strategy, on which there is consensus among all the CIS countries, among them: achieving the 95–95–95 targets by 2025, ending inequalities in access to HIV services and health technologies, the active engagement of civil society and community organizations and ensuring the financial sustainability of the HIV response.

Mr Goliusov thanked the Russian Federation, which since 2013 has been providing financial assistance in strengthening health systems and counteracting HIV and other infectious diseases in five countries of the region, Armenia, Belarus, Kyrgyzstan, Tajikistan and Uzbekistan, having allocated more than US$ 49.5 million in financial assistance.

The participants decided to prepare and send to the Government of the Russian Federation a letter recognizing the efforts made under the framework of the regional programme of technical assistance in combating infectious diseases, including HIV, hepatitis and sexually transmitted infections, as highly effective, noting that they had directly reduced the HIV burden in the region, and requesting the Government of the Russian Federation to consider the continuation of the programme in 2022–2025.

UNAIDS also supported proposals from representatives of the Russian delegation on research on mental health and HIV and on oncological pathology among people living with HIV on antiretroviral therapy.

The CIS is a regional intergovernmental organization that was formed following the dissolution of the Soviet Union in 1991. It encourages cooperation in economic, political and military affairs and has certain powers relating to the coordination of trade, finance, law-making and security. The Council for Health Cooperation of the CIS consists of ministers of health and chief state sanitary doctors of the CIS member states. The council maintains relations with WHO, UNAIDS, the World Health Assembly and the United Nations Children’s Fund.

“I am 18 years old, and I am already thinking about getting married. In our area, girls get married early. I’m afraid that with my positive HIV status I won't be able to find a boyfriend, which means I won’t have a family,” said Sayora Akmatova (not her real name), a participant of a training on sexuality education for adolescents living with HIV, held in Osh, Kyrgyzstan.

More than 60 young people living with HIV and their parents from different regions of Kyrgyzstan recently participated in a series of trainings for adolescents and young people living with HIV on sexuality education, reproductive health and prevention of violence conducted by Araket Plus and the Reproductive Health Alliance Kyrgyzstan.

“Adolescents and young people living with HIV are exposed to various types of violence, so there is a need to integrate HIV prevention and treatment programmes with programmes on sexuality education, reproductive health and gender equality. Through such courses we wanted to ensure that teenagers living with HIV received a comprehensive training package, including leadership skills, how to identify and address violence and how to overcome self-stigma,” said Meerim Sarybaeva, the UNAIDS Country Director for Kyrgyzstan.

During the parallel training for parents of adolescents living with HIV, issues such as psychological challenges and personal boundaries, the importance of interpersonal communication and the need to communicate difficult and sensitive topics with children, such as contraception, condom use and sexually transmitted infections, were discussed.

Uluk Batyrgaliev, a sexual and reproductive health trainer at the Reproductive Health Alliance Kyrgyzstan worked with a group of parents and talked about how the fears of parents of children living with HIV are most often associated with their future.

“I was surprised to hear those parents of HIV-positive children agree in advance between themselves to marry their children to each other, so not to infect the “clean”,” said Mr Batyrgaliev. “The word “clean” is used by the parents to describe people who are HIV-negative. This is incredibly self-stigmatizing.” 

Galina Chirkina, the Executive Director of the Reproductive Health Alliance Kyrgyzstan, emphasized that the relationship between sexual and reproductive health problems and HIV is evident to professionals but is not always apparent to others or adolescents living with HIV.

“We teach young people living with HIV to have a common understanding of how they can have a successful sexual life, and how they can plan their future and family. Realizing the right to reproductive health and the future starts with sexual education.”

The education system in Kyrgyzstan doesn’t include sexuality education courses for young people in schools. However, as optional courses, teachers can choose healthy lifestyle courses that include special sexuality education lessons for high school students. A healthy lifestyle curriculum was developed in 2014 with United Nations system support in Kyrgyzstan and was recommended for all schools in the country.

The trainings were organized within the regional cooperation programme on infectious diseases, implemented by the UNAIDS Country Office for Kyrgyzstan and funded by the Government of the Russian Federation.

Larisa Aleksandrova is a legal expert at the Center for Human Rights and has been protecting the rights of women living with HIV in Tajikistan since 2011.

For the past few months, she has been helping a lawyer to open a criminal case against a man who attacked his wife, Amina Khaidyrova (not her real name), and repeatedly threatened to rape her daughter from her first marriage. The prosecutor's office has so far refused to open the case, considering it a private family matter. According to the prosecutor’s office, if there are only minor injuries, the victim must seek to open a criminal case against the attacker by filing an application to the court by herself. The man is now in hiding and the prosecutor's office continues to refuse to open the case, now claiming that he cannot be found.

Ms Khaidyrova, who is living with HIV, will stop at nothing to get justice. She says that she has nothing to lose and fears for her life and the life of her daughter.

Ms Aleksandrova says that women who have been victims of violence often either do not report the assault to the police or withdraw the allegation, fearing the consequences. She says that women don’t report violence for a variety of reasons—some want to keep their family together, no matter what, others do not want publicity, but the majority are afraid of finding themselves without economic support, since women in Tajikistan are often economically dependent on their husbands.

“In general, women are ready to endure. And women living with HIV are even more willing to endure,” said Ms Aleksandrova.

She emphasized that there were rare cases when women living with HIV have sought help, but fear of disclosure of HIV status, stigma and discrimination, lack of support from family and friends, the vulnerability of people living with HIV because of the criminalization of HIV transmission, legal illiteracy and insecurity prevent women from asserting their rights in court.

Speaking at a training jointly organized by UNAIDS, the United Nations Development Programme and the United Nations Office on Drugs and Crime for 35 representatives of nongovernmental organizations working on human rights and gender-based violence prevention, Ms Aleksandrova presented the legal norms governing the legal status of people living with HIV. She also discussed the criminal legislation of the country on HIV, international and national standards for the protection of women’s rights and sexual and gender-based violence and mechanisms for the protection of women living with HIV who are victims of violence.

The participants analysed cases related to sexual and gender-based violence against women, reviewed and worked out strategies for prosecuting such cases and gave practical advice on strategies for dealing with gender-based violence. According to the participants, such training for nongovernmental organizations in Tajikistan is crucial if they are to reach more women, particularly women living with HIV.

“Community-based monitoring of violations of the rights of people living with HIV and their ability to access confidential HIV services is an important component of community empowerment to speak up and raise questions about the root causes that drive the spread of various forms of violence. These problems can only be resolved if communities are literate in the field of civil and international human rights and are ready to stand up for their rights and seek the proper implementation of the law against domestic violence,” said Nisso Kasymova, the UNAIDS Country Manager for Tajikistan.

Ms Aleksandrova believes that legal literacy is critical, but it is insufficient to solve the problem. She said that if a woman is economically dependent, she will not use her legal knowledge. “I always say that women need to be given confidence in the future, the confidence that they will not be thrown out into the street, that they will be able to protect themselves, they will be supported and they will be able to live on and realize themselves in life.” But you need to start small, she added, “Do not be silent, talk about the problem, demand and defend your right to life, health and economic independence.”