Eastern Europe and Central Asia

"I was a drug user for 16 years – I know how society pressures you and puts you in a tight corner… Some people can’t get a passport, some don't have a place to live, some don't take antiretroviral drugs because they continue using drugs... It is impossible to break out of this terrible circle without outside help,” recalls Evgeny Yuldashev, a social worker and HIV peer counsellor in Kyrgyzstan. 

Currently, he provides HIV prevention and care services to vulnerable groups of people, including people who use drugs.

"There are former prisoners living with HIV who lost their rights to housing while they were serving their sentences”, says Mr Yuldashev. “Some are migrant workers living with HIV who were deported and now have no idea where to start again. It is not easy for sex workers who are constantly subjected to illegal detention. They all need HIV services and they all need support in getting their rights back.”

This coercive legal environment and the violence experienced by key populations impacts the HIV epidemic in Kyrgyzstan because fear stops people from seeking and adhering to HIV prevention, treatment, care and support services.

Ainura Osmonalieva is a lawyer and deputy director of Adilet, the largest human rights and legal services organization in Kyrgyzstan. She says that people are not always ready to defend their rights even when they are told it’s possible.

"We have been providing legal services to key populations free of charge for over fifteen years. Still, there are cases when people from communities come to us, we prepare documents to submit to the court, but at some stage, the person disappears or tells us that he is afraid of the consequences and refuses to take further steps. They may experience tremendous pressure if they decide to go to trial. The main reason in my opinion is the high level of stigma and discrimination that exists in society. "

But when all players are ready to fight till the very end, there can be dramatic change.

With the help of Adilet's lawyers, Kyrgyz' activists managed to remove the barrier to parenting for people living with HIV in the country, which had been in effect for many years. As a result, the Country's Constitutional Court excluded HIV from the list of diseases that prevent people from adopting children or becoming guardians or foster parents.

It took lawyers four years and hundreds of hours of analytical work on the conventions, agreements and declarations ratified by Kyrgyzstan for the Constitutional Court to finally decide the issue.

"We collected the evidence base, then a plaintiff came forward and we were able to file a lawsuit on their behalf," says Ms Osmonalieva.

In July 2021, adolescents living with HIV in Kyrgyzstan who were infected in state medical institutions between 2006—2009 filed lawsuits against the state for compensation for moral damage. Families who had battled for justice for more than a decade were given hope when lawyers won a case and a child was awarded $23,000 in compensation.

The Public Foundation "Positive Dialogue" is another non-governmental human rights organization in the south of the country that provides free legal assistance to vulnerable groups.

"We work closely with the Republican AIDS Center and the Osh Regional AIDS Center to monitor the situation regarding patients' rights, including patients who are in prisons, and conduct assessments of the legal environment to understand what legal norms can be applied," says lawyer Arsen Ambaryan.

According to Mr Ambaryan, all players - state bodies, nongovernmental organizations, and human rights defenders must work as a team to eliminate the legal barriers that still exist in the country.

New global targets for 2025 put a special emphasis on creating the enabling environment for ending AIDS, identified in the 10-10-10 targets: that less than 10% of countries have punitive legal and policy conditions that prohibit or restrict access to services; less than 10% of key populations and people living with HIV face discrimination and stigma; and less than 10% of women, girls, people living with HIV and key populations face violence and gender inequality.

“Kyrgyzstan has a lot of work ahead,” says UNAIDS country director, Meerim Sarybaeva. “It will require consistency from all sides and UNAIDS stands ready to provide any support required in this important area."

Video: Evgeny Yuldashev, a social worker and HIV peer counsellor in Kyrgyzstan, answers questions on how we can protect people who inject drugs

“We are demanding that you step up and finally do your part,” said Yana Panfilova, a young female activist from Ukraine who is living with HIV, at the United Nations High-Level Meeting on AIDS in June 2021.

A leader of the regional adolescent-led movement Teenergizer, she emphasized the vulnerability of young people to HIV and the need to provide care and support to adolescents living with HIV and she called on world leaders to keep young people at the forefront of the AIDS response.

“If we are going to make real change, these four things must become a reality: comprehensive sexuality education in all schools, in all countries; psychosocial support and peer support for every adolescent with HIV and young key populations; community-led HIV services immediately as the reality, not the exception; and an HIV vaccine and a functional cure,” Ms Panfilova added.

All these recommendations are critical in eastern Europe and central Asia, which is facing the world’s fastest growing HIV epidemic. At end of 2020, there were 60 000 young people aged 15–24 years living with HIV in the region. Many young people remain unaware of their HIV status, and late HIV diagnosis remains a significant challenge in the region.

There are multiple barriers and obstacles in almost all countries in eastern Europe and central Asia for adolescents and young people to access HIV services and care. In many countries there is an absence of adolescent-centred HIV testing and counselling, there are requirements for parental consent for HIV services, there is a lack of access to modern contraceptives and there are confidentiality issues and stigma and discrimination. Harmful norms, taboos related to sexual and reproductive health, inequalities, gender-based violence, COVID-19-related obstacles and mental health problems are further barriers to access to HIV services.

Although significant progress has been achieved over the past 30 years in providing adolescents and young people in eastern Europe and central Asia with access to sexual education and other services, the level of knowledge about HIV prevention among people aged 15–24 years in the region remains low—as low as less than 3% in Tajikistan.

Different approaches have been used by civil society and community-led organizations to reach young people who are vulnerable to HIV. For example, the Dance4life project in Belarus, Kyrgyzstan, Kazakhstan, the Republic of Moldova, the Russian Federation and Ukraine reaches vulnerable young people with the Journey4Life Programme (J4L). J4L helps adolescents aged 14–18 years develop healthy interpersonal relationships that are free from violence and coercion and based on respect for gender equality and teaches them how to maintain their sexual and reproductive health, focusing on the prevention of HIV, unplanned pregnancy and sexually transmitted infections. It aims to reach 1400 young people by the end of 2021 in Kazakhstan and Kyrgyzstan, with support from UNAIDS and the United Nations Educational, Scientific and Cultural Organization.

A recent survey among adolescents run by Teenergizer showed that the availability of HIV treatment for adolescents is not enough to keep them alive. Treatment interruption is a significant reason why adolescents continue to die in the region. According to the survey, HIV-related fears, psychological vulnerability, treatment fatigue and stigma are significant risk factors for treatment interruption among adolescents. The survey noted that they need support from their peers, communities and doctors, and they often need professional psychological help. 

In her United Nations High-Level Meeting on AIDS speech, Yana Panfilova remembered Diana, who recently died of an AIDS-related illness. “This year, I was angry when we lost Diana. She was only 19, born with HIV. But she had pills that were impossible to take, no mental health support and no confidentiality. Like millions of people with HIV, she was killed by inequalities. Millions of people with HIV may have HIV pills, but they live in a world where their families and their societies do not accept them for who they are.”

Svetlana Izambayeva, who organizes It’s simple!  summer camps for children and adolescents living with HIV in the region, explained that adolescents living with HIV are often socially isolated and lonely—they are scared to talk about their diagnosis and fear for their future. The camp’s attendees receive psychological care and support, create networks and support others. 

“We need more political leadership, more data on adolescents and young people, more programmes to address the gaps and more funds for the youth response. But here in the region we already have a growing movement of adolescent and young leaders which we must nurture, fund and further support,” said Lena Kiryushina, the UNAIDS Youth Officer for eastern Europe and central Asia.

GENEVA, 7 July 2021—UNAIDS strongly condemns the attacks on lesbian, gay, bisexual, transgender and intersex (LGBTI) activists and journalists at Tbilisi Pride’s offices and surrounding areas, which have forced the cancellation of Gay Pride events in the city. UNAIDS expresses its solidarity with all LGBTI people in Georgia.

“The shocking violence suffered by LGBTI activists and journalists in Tbilisi is completely unacceptable,” said Winnie Byanyima, Executive Director of UNAIDS. “The authorities must take urgent measures to protect the human rights of the LGBTI community, including their right to freedom of expression and assembly, and to bring those responsible for the attacks to justice.”

On 1 December 2018, Tbilisi signed the Paris Declaration to end the AIDS epidemic by 2030, joining more than 300 municipalities in the Fast-Track cities initiative, which was initiated by the Mayor of Paris, UNAIDS, IAPAC and UN-HABITAT in 2014. The initiative commits Tbilisi to work closely with communities, including gay men and other men who have sex with men and transgender people, to foster social equality.

The new UNAIDS Global AIDS Strategy 2021–2026: End Inequalities, End AIDS is also clear that stigma and discrimination against LGBTI people violates human rights, deepens inequalities and acts as a critical barrier to ending AIDS as a public health threat by 2030. A crucial element of the strategy is to address the challenges faced by key populations (gay men and other men who have sex with men, sex workers, transgender people and people who use drugs) so that less than 10% experience stigma, discrimination and violence by 2025. The strategy calls on countries to take immediate action to reduce stigmatizing attitudes and discrimination on the basis of sexual orientation and gender identity as a critical element to ending AIDS by 2030.

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.

On 29 June, one of the largest non-profit organizations based in Saint Petersburg, Russian Federation, is celebrating its twentieth anniversary. Humanitarian Action provides comprehensive medical and social assistance to people who use drugs, including services for the prevention of HIV, viral hepatitis and tuberculosis, following the principle of working with everyone, regardless of their lifestyle.

Humanitarian Action is the successor to Doctors of the World, which worked in the Russian Federation in the 1990s during an economic crisis that saw an increase in drug use and HIV and other infections.

Today, the main mission of Humanitarian Action is to improve the lives and health of people who use drugs, restore their dignity and raise public awareness about drug use. Its vision is, “A world in which people who use drugs do not die from an overdose, HIV, hepatitis, tuberculosis or suicide, have equal rights and opportunities, are not stigmatized and discriminated against and do not experience self-stigma.”

A converted tourist bus, known as the Blue Bus owing to its colour, and a converted minibus, the Little Bus, allow Humanitarian Action to work as close as possible to where people who use drugs live and congregate. A joint project with the Saint Petersburg AIDS centre provides home visits via mobile units to seriously ill people living with HIV, many of whom are former drug users who have been left behind by mainstream services. 

The organization offers personal protective equipment against bloodborne and sexually transmitted infections, including sterile syringes and needles, condoms, etc., and exchanges syringes. In its medical centre—a first of its kind in the Russian Federation, since it provides help through low-threshold programmes—doctors provide anonymous and free medical services in a range of specialities for people who use drugs, sex workers, homeless people and migrants.

People also can also get psychological services from Humanitarian Action. Legal advice on the restoration of documents, guardianship or problems with the law and medical and social support for HIV, hepatitis or tuberculosis diagnosis and treatment are also available.

“Not everyone is ready to change their life immediately. We help people learn to take responsibility for their health and change gradually, moving from one tiny victory to another,” said Alexey Lakhov, the Development Director of Humanitarian Action. “We are a kind of bridge between people who use drugs and various government and nongovernment services. It’s just that with us, it becomes easier to get such help thanks to partnerships with multiple social and medical services.”

The process of helping people who use drugs is based on the principle of taking small steps and is aimed at gradually introducing safer behaviours: do not start using drugs; if you have started, stop; if you use drugs, stop injecting them; if you do inject drugs, always use a sterile syringe; if it is not possible to use a sterile needle every time, at least never use someone else’s; if using someone else’s syringe, always disinfect it.

Some of Humanitarian Action’s employees are themselves former drug users, who share their stories with clients, helping those who wish to quit by referring them to appropriate services.

“We congratulate Humanitarian Action on its twentieth anniversary. We hope that by its thirtieth anniversary we will also be able to celebrate the end of AIDS and the elimination of all forms of stigma and discrimination against people affected by HIV,” said Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

The Republic of Moldova has launched an online platform, ScorecardHIV, to measure progress in the country's HIV response.

The new tool includes indicators and data on epidemiology, funding and procurement, programmes, human rights and community-led services. It will allow governmental institutions, health programme managers, HIV service organizations, communities and other stakeholders to track the progress and assess the effectiveness of HIV programmes in the country. A data filtering system allows the customization of indicators in accordance with the user’s interests and needs.

“The ministry will take the lead and provide political support to make sure further implementation of the tool is as effective, systematic and sustainable as possible,” said Denis Chernelya, the Secretary of State at the Ministry of Health, Labour and Social Protection. “It will be an extremely useful tool for internal monitoring as well as for understanding the main factors that contribute or impede the achievement of the set targets.”

The scorecard aims to ensure open, transparent and collective state and community-led monitoring of the HIV response. It will contribute to real-time data analysis and a rapid evidence-informed HIV response. The platform was developed by the UNAIDS Country Office for the Republic of Moldova together with the Positive Initiative nongovernmental organization and other local civil society organizations under the auspices of the Ministry of Health, Labour and Social Protection and the National Programme for the Prevention and Control of HIV/AIDS and Sexually Transmitted Infections.

The indicator map of the scorecard, which was discussed and agreed upon by all stakeholders, is sourced from the national HIV programme, ministries and government agencies and civil society organizations and is updated regularly, depending on the selected indicator—once a month, quarterly or half yearly. The platform allows data to be aggregated from different applications and sources and visualizes progress and failures in HIV programme implementation almost in real time. A task force consisting of several community organizations will update the scorecard and periodically review it.

The scorecard demonstrates how real-time data, technology and innovation can be of service for evidence-informed decisions and can strengthen cooperation between the government and communities.

“If we need to make decisions today, then we need the most recent data today. All our efforts were aimed at digitizing all possible processes, creating an infrastructure and finding IT solutions where everything can be accumulated, and then creating an analytics tool that will show us the main indicators,” said Ruslan Poverga, the Director of the Positive Initiative.

“We welcome such an important development in the Republic of Moldova,” said Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.  “The scorecard was developed in line with the core principles of the new global AIDS strategy, including significant and measurable participation of civil society, a national response based on the available scientific evidence and technical knowledge, and respect for human rights and gender equality. I believe that the ability to track progress in real time, identify priority areas for rapid measures and political will and buy-in by the county’s national authorities will enable the Republic of Moldova to significantly accelerate progress towards the goal of ending AIDS by 2030.”

Sevara Khalimova (not her real name) moved from Uzbekistan to the Russian Federation to earn money to pay for her children’s education. After living in the country for many years, living with a relative and working in a shop with her, her relative discovered that Ms Khalimova was living with HIV. She was thrown out of her home, leaving her not only homeless but also without work and support.

Ms Khalimova was one of many migrants living with HIV in the Russian Federation who participated in a series of studies conducted by the Regional Expert Group on Migrant Health (REG).

“Migrants, especially migrants living with HIV, are among the most vulnerable and marginalized groups. Health issues are not a priority for migrant associations,” said Daniel Kashnitsky, Academic Relations Coordinator. “The stigma and discrimination that accompanies HIV is a serious barrier to their access to health services and their ability to defend their rights. The study was the first attempt to give a voice to migrants. We hope that the results of the study will not only equip us with a better understanding of the barriers to health services for migrants but will also contribute to a change in legislation.”

According to the Ministry of Internal Affairs, more than 5 million foreign citizens migrate to the Russian Federation annually, although with undocumented migrants the number is likely much higher. However, the Russian Federation remains one of the few countries in the world that deports migrants who are living with HIV, so they face a stark choice: go home and lose their income or stay in the country illegally, risking deportation, and without HIV treatment. Foreign citizens living with HIV cannot legally buy or be given antiretroviral therapy in the Russian Federation.

The study found that migrant women are at a higher risk of HIV infection—they often have less access to HIV-related information, are often dependent on their spouse, are at a higher risk of forced sex work and are more stigmatized. Pregnant migrant women living with HIV in the Russian Federation who have a residence permit have the right to receive antiretroviral therapy, but that treatment is stopped immediately after childbirth. Undocumented migrants have no right to treatment.

According to the REG study, lack of information, legal uncertainty, language barriers, stigma and discrimination, gender inequality and inability to return to their country of origin prevent migrants in the Russian Federation from accessing HIV prevention and testing services and information on HIV.

The study calculated the cost of treating people living with HIV, based on the prices charged by private medical centres and laboratories in the Russian Federation. The researchers estimated that the cost of outpatient consultations and the provision of antiretroviral therapy is about US$ 1200 per year, which at present is not covered by the state and is not allowed to be paid for by individuals or the health-care schemes of foreign governments. They also calculated the cost of treating an opportunistic HIV-related infection as a result of someone living with HIV not accessing antiretroviral therapy. Inpatient treatment for 21 days would cost US$ 3200, which would be paid for by the government. The researchers did not estimate the significant non-medical costs associated with the deportation of migrants living with HIV, which are borne by the state.

The study shows that migrants living with HIV should be able to access antiretroviral therapy and not be subject to deportation from the Russian Federation. Such a change in legislation would help to reduce new HIV infections and would reduce expenditure on medical care and non-medical expenses.

In the past two decades, many countries, including Armenia, Bulgaria, the Republic of Korea and the United States of America, have removed legal provisions that discriminate against migrants living with HIV. Reducing barriers to migrants accessing antiretroviral therapy brings about significant results for public health.

“Lifting restrictions on the long-term stay of people living with HIV and removing barriers to people seeking health and social care will improve overall public health outcomes, support the most vulnerable and create a more robust, effective and equitable response to the HIV epidemic,” said Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia. 

The Union for HIV Prevention and Harm Reduction is a nongovernmental organization located in Balti, in the Republic of Moldova. It provides integrated services to people who use drugs and other affected populations throughout the north of the country.

Each year, more than 3000 people benefit from its services, which including mobile testing for HIV, sexually transmitted infections and hepatitis, harm reduction services, including a needle–syringe programme, the distribution of condoms and psychological and social support. The organization’s outreach and medical workers work closely with state clinics and hospital departments that offer opioid substitution therapy to people who use drugs.

However, the organization has faced a long-time logistical problem with regard to the collection of used needles and syringes generated by the harm reduction programme. Medical waste disposal in the Republic of Moldova, especially in the north of the country, is problematic. Ala Iatco, the nongovernmental organization’s head, explained that destruction of used equipment was only possible by contracting medical institutions to do the work and that the union had to send boxes with contaminated waste to Chisinau, the capital of the country.

“For the approximately 20 years of the harm reduction programme in the country, this problem was always present and solved through burning needles and syringes or other non-environmentally-friendly ways. We had to find a solution to increase the effectiveness of the comprehensive package of services and enhance the safety and security of personnel and volunteers while operating the needle–syringe programme,” said Svetlana Plamadela, UNAIDS Country Manager for the Republic of Moldova.

The UNAIDS Country Office for the Republic of Moldova, together with the United Nations Office on Drugs and Crime and the union, came together and suggested a solution. In July 2017, specialized modern medical waste management equipment was procured from the Russian Federation and installed within a Union for HIV Prevention and Harm Reduction facility. The total cost of US$ 23 000 was funded with resources from the One UN Joint Action to Strengthen Human Rights in the Transnistrian Region of the Republic of Moldova project, financed with the support of the Swedish Embassy and co-funded by the Center for Health Policies and Studies (PAS Center), which is a Principal Recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“The availability of the one-stop disposal system provided by the needle smelters and syringe cutters significantly reduces the risk of accidental exposure and contamination with bloodborne diseases by the volunteers and medical personnel,” added Ms Plamadela.

So far, three organizations—the Union for HIV Prevention and Harm Reduction, Young Women Cernoleuca and Adolescent!—have benefited from the needle–syringe destruction equipment. Partner organizations usually make monthly shipments of needles and syringes for destruction, which are collected by field workers in eco-boxes.

According to Ms Iatco, the equipment is easy to use and maintain. “The machine transforms the contaminated syringes and needles into biologically safe waste. We save almost 50% of the cost of destruction. And, most importantly, we face much fewer risks as we avoid transportation, storage and transfer of hazardous material. For our organization, located in a remote area where no such equipment is available in medical institutions, it’s a cost-effective and less risky solution,” she said.

The needle–syringe programme in the Republic of Moldova started in 1999. Its main goal is to prevent the transmission of HIV and other infections among people who inject drugs by avoiding the sharing of injecting equipment and ensuring enhanced access to health-care services and psychosocial support. The programme also aims to curb the sexual transmission of HIV among people who inject drugs and their sexual partners by promoting the use of condoms and raising awareness about the link between drug use and risky sexual behaviours.

100% Life, formerly known as the All-Ukrainian Network of People Living with HIV, the largest organization for people living with HIV in eastern Europe and central Asia, is marking its 20th anniversary on 5 May. Those 20 years have seen it work on the most challenging issues of the HIV response in Ukraine, on health-care reform and overcoming stigma and discrimination and barriers to accessing health services.

The organization works to provide 100% access to treatment to 100% of Ukrainian people living with HIV. It strives to improve the quality of life for people living with HIV and promotes the rights and freedoms of people living with HIV, tuberculosis and hepatitis C, including the right to self-determination and the right to make decisions that directly influence their lives.

Beginning with seven members in 2001, today it has grown to 474 members and 15 000 associate members. The first office was opened in Kyiv and now the organization unites 24 regional offices across the country.

In 2004, the organization, together with partners, prevented interruptions of antiretroviral therapy for 137 patients. At the end of 2019, 100% Life was purchasing HIV medicine for 113 000 people.

“Over the years of work, we have purchased 7 230 000 packs of antiretroviral therapy,” said Dmitry Sherembey, head of the 100% Life Coordinating Council. Think about these figures! Behind each of them is a saved life. We are grateful to all our partners who believed in us and continue to believe.”

In 2016, the first 100% Life medical centre was opened in Kyiv. Five years later, three more centres have been opened in Ukraine, in Poltava, Rivne and Chernihiv. These centres are the first clinics created by patients for patients, where services are provided free from stigma and discrimination.

“I have great respect for the struggle that the organization has waged against stigma and discrimination against people living with HIV and other vulnerable people. It is thanks to 100% Life that the first opioid substitution therapy programmes for people who use drugs in Ukraine started, sex workers began to speak openly about their rights and people living with HIV had hope for a normal life, medical care and help from the state,” said Raman Hailevich, the UNAIDS Country Director for Ukraine.

In 2016, the organization received the United States President’s Emergency Plan for AIDS Relief (PEPFAR) award for the best partnership among the 40 countries in which PEPFAR operates.

The same year, there was a breakthrough in state funding of the HIV response, which was increased by 2.3 times. The success of the 20/50/80 transition plan is partly because of the efforts of 100% Life, which worked with the government and advocated for increases in the HIV budget, access to treatment and the optimization of health-care systems.

The struggle of 100% Life won’t stop. New problems come along that need to be addressed.

“We are now facing a new challenge—the COVID-19 pandemic,” added Mr Sherembey. “Our experience gained over the years of interaction with government agencies, partners and donors allows us to contribute to the common cause of the struggle. With the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria and USAID, almost a million pieces of personal protective equipment have been purchased for Ukrainian doctors and social workers, 200 000 tests for COVID-19 have been bought, equipment for oxygen stations at hospitals has been procured, information campaigns on vaccination against COVID-19 have been conducted, and much more is being done.”

The Epidemiological Well-Being international conference, which will draw attention to the need for stronger health systems and preparedness against epidemics in the light of the colliding COVID-19 and HIV pandemics, opened today in Moscow, Russian Federation. The aims of the conference include discussions on the progress made against infectious diseases globally, highlighting interim results for reaching the goal of ending AIDS by 2030 and coming up with recommendations for sustainable approaches to combating infectious diseases.

The conference was opened by Anna Popova, Head of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), who emphasized the importance of effective international cooperation. “In a critical situation of the rapid spread of the new coronavirus, countries around the world rallied for one goal—to defeat a common enemy, the COVID-19 pandemic. We realized how important it is to maintain a constant dialogue and prompt exchange of information on outbreaks of infectious diseases, to conduct scientific research and confirm laboratory data for the diagnosis of infections,” she said.

The President of the Russian Federation, Vladimir Putin, and the Deputy Prime Minister of the Russian Federation, Tatyana Golikova, sent welcoming words to the participants and organizers.

Winnie Byanyima, the UNAIDS Executive Director, welcomed the decision of the Russian Government to convene the conference in a video statement, saying, “I am grateful for the Russian Federation’s engagement as a United Nations Member State on the UNAIDS Programme Coordinating Board, your strong commitment to ending AIDS and your support to UNAIDS’ efforts of ending AIDS in eastern Europe and central Asia.”

She also expressed hope that the targets in the new Global AIDS Strategy 2021–2026 will be reflected in the Russian Federation’s state strategy against HIV. Ms Byanyima also called on the governments participating in the conference, “To engage in the negotiations in New York on a bold, new, ambitious political declaration that does not lower the bar and will advance the momentum to end AIDS by 2030.”

Shannon Hader, the UNAIDS Deputy Executive Director for Programme, addressed the participants of the conference. “While COVID-19 has increased and exacerbated many of the inequalities that were already perpetuating new HIV infections and AIDS-related deaths, it has also shown the critical importance of lessons from the HIV response—science, community leadership, the importance of public health advocacy and the critical importance of an all-of-government, all-of-society approach to end pandemics.”

The conference includes more than 20 sessions on critical aspects of combating epidemics and is hosted by Rospotrebnadzor with the support of the Ministry of Foreign Affairs and the Ministry of Finance of the Russian Federation and in cooperation with UNAIDS.

The recent regional launch of the global AIDS report 2020, Prevailing against pandemics by putting people at the centre, in eastern Europe and central Asia provided a platform for the proposal of a joint revision of social and legal enablers in the region to achieve the proposed 2025 targets. UNAIDS Cosponsors, governments and civil society partners presented their views on the issue and the joint action to be taken. 

Based on the regional data, the 90–90–90 treatment cascade in the region is far off the targets, having reached only 70–44–41. Lev Zohrabyan, the UNAIDS Strategic Information Adviser for Eastern Europe and Central Asia, noted that one of the reasons for this is late diagnosis: in 2019, 53% of all new HIV cases in the region were registered in the later stages. In his opinion, it shows that testing strategies need revision and require enabling societal conditions.

Societal and service enablers have been given prominence in the proposed 2025 targets; in particular, it is outlined in the 10–10–10 targets that:

• Less than 10% of countries have punitive legal and policy environments that deny access to justice.
• Less than 10% of people living with HIV and key populations experience stigma and discrimination.
• Less than 10% of women, girls, people living with HIV and key populations experience gender inequality and violence.

Achieving these goals includes having enabling laws, policies and public education campaigns that dispel the stigma and discrimination that still surrounds HIV, empower women and girls to claim their sexual and reproductive health and rights and end the marginalization of people at higher risk of HIV infection.

“Interventions in these areas create conditions for people to be more active in HIV testing, seek help and start antiretroviral therapy immediately upon diagnosis, adhere to a treatment regimen or proactively seek HIV prevention services, including pre-exposure prophylaxis,” said Mr Zohrabyan.   

Rosemary Kumwenda, the Regional HIV/Health Team Leader at the United Nations Development Programme Istanbul Regional Hub, presented an analysis of the legislation in the eastern Europe and central Asia region on the criminalization of HIV and key populations, noting that the situation in the region remains unfavourable for an effective HIV response. The criminal codes have changed in many countries, but discriminatory laws are changing very slowly. Although many countries revisited their legislation regarding HIV exposure, HIV transmission is criminalized in virtually every country in the region. The Russian Federation and Belarus remain “leaders” in the criminalization of HIV and key populations. Criminal penalties for sex between adult men remain in Uzbekistan and Turkmenistan. The biggest challenge for the region, where more than 48% of new HIV cases are among people who inject drugs, is the criminalization of drug use and possession.

In the presentation An Inventory of Existing Tools for Creating a Favourable Social and Legal Environment in the Eastern Europe and Central Asia Region, given by Tatiana Deshko, the Director of the Department of International Programs, ICF Alliance for Public Health, Ukraine, the ReACT mechanism, which comprehensively works for the rights of key populations, was presented. ReACT (Rights, Evidence, Actions) is the programme’s principle for monitoring violations of rights and is being implemented in 37 cities in seven countries of the region with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Cases of rights violation are registered in a mobile application and then lawyers work with specific cases at the individual level or at the system level of revising legislation. Last year, about 2000 cases were registered. The analysis shows that law enforcement agencies are the primary violators of the rights of key populations in almost all countries, using threats, intimidation, illegal detention and abuse of authority. The health-care system, with denials of medical services, discrimination based on HIV status or disclosure of HIV status, is ranked after law enforcement. “Strategic analysis of cases based on the ReACT-collected data allows not only help for specific people to protect their rights but also formulating recommendations for revising legislation in countries,” said Ms Deshko.

As part of the discussion of the second 10, Alexandra Volgina, the Manager of the Global Partnership for Action to Eliminate All Forms of HIV-Related Stigma and Discrimination, Global Network of People Living with HIV, spoke about the People Living with HIV Stigma Index 2.0 study and the role of the Global Partnership for Action to Eliminate All Forms of HIV-Related Stigma and Discrimination.

Four countries of the region, Kazakhstan, Kyrgyzstan, the Republic of Moldova and Ukraine, have entered the Global Partnership for Action to Eliminate All Forms of HIV-Related Stigma and Discrimination. “If we compile the ReACT system, the Stigma Index and other instruments you’ll get a clear picture of what exactly needs to be done to make a difference. We need to address this issue jointly, all partners together. If we change the situation in the area of ​​stigma and discrimination, we will be able to stop the epidemic,” said Ms Volgina.

An example of such an integrated approach, from data to policies and action, was shared by Evghenii A. Golosceapov, a member of the Equality Council in the Republic of Moldova, the first state institution in the post-Soviet countries dealing with discrimination against various groups.

As part of the Equality Council’s work, studies on the People Living with HIV Stigma Index were carried out, where, through public opinion polls and in-depth interviews, categories of people who are marginalized by society were determined. People living with HIV ranked the second among those categories, after lesbian, gay, bisexual, transgender and intersex people. The Equality Council also uses data from the People Living with HIV Stigma Index, the ReACT registration system and research on the legal environment on HIV.

On this comprehensive basis, more than 70 recommendations on practical steps in the field of legislative changes were developed. These data were used to develop a new national HIV programme and a country proposal to the Global Fund. In addition, the Equality Council considers specific cases of discrimination and complaints (e.g. dismissal due to HIV status) and supports civil society organizations in defending the rights in court. In recent years, the restriction on artificial insemination for people living with HIV has been lifted in the Republic of Moldova, as well as the ban on adoption and guardianship.

All the data collected shape the Roadmap for the Elimination of Discrimination, a government programme in which people living with HIV play a critical role. In the Republic of Moldova, the ScorCard system has also been launched, which allows real-time tracking of the implementation of recommendations and progress towards the adopted targets in reducing stigma and discrimination.

Regional gender gaps in the context of the HIV response were presented by Enkhtsetseg Miyegombo, a Programme Specialist at the UN Women Europe and Central Asia Regional Office.

According to her, the COVID-19 pandemic has largely erased progress in this area and exacerbated existing inequalities: lockdowns disproportionately affected the workload of women who do unpaid domestic work, reduced women’s economic opportunities due to job losses, limited their mobility and increased documented violence against women. These new circumstances were superimposed on existing problems—a lack of awareness about HIV, barriers to discussing safer sex with a partner, revival of patriarchal stereotypes, religious restrictions—as a result of which, women find themselves under growing pressure. Ms Miyegombo highlighted that investment in gender equality programmes is critical to the effectiveness of the regional HIV response.

A study conducted by the Eurasian Women’s Network on AIDS helped to identify the key characteristics of violence and the specifics of organizing assistance to victims of violence in 12 countries of the eastern Europe and central Asia region. The results of the study supplemented the available international data on violence and equipped national civil society organizations with real facts for political advocacy. Elena Rastokina, a specialist in advocacy and community mobilization from the Almaty Model of HIV Epidemic Control project in Kazakhstan, presented successful practices of community-based monitoring in the eastern Europe and central Asia region, concluding that this approach is important as it allows communities to know their rights and barriers and to have systematic data to advocate for systematic change.

Alexander Goliusov, the Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia, stressed that the new 10–10–10 targets are addressing the inequalities that are fuelling the spread of HIV, COVID-19 and other pandemics. “Testing and treatment remain our priorities; however, now our fast track to them lies in combatting inequalities,” he said.

The recording of the launch in Russian and English, along with all presentations and materials, can be found here.