Eastern Europe and Central Asia

A new community-led public information campaign, It is in Your Power to, aimed at encouraging people living with HIV to start antiretroviral therapy has been launched in the four largest areas of the Russian Federation.

The campaign’s website has 12 “capsules” with inspiring stories told by people living with HIV. By “opening” the capsule, visitors can find out about people’s lives, find facts on antiretroviral therapy, ask questions and get help from peer counsellors on HIV-related issues.

All the stories deliver a message that being diagnosed with HIV does not define a person and that if people living with HIV start treatment they can live a long and productive life.

The campaign covers four major Russian areas—the Novosibirsk, Sverdlovsk and Chelyabinsk regions and the city of Saint Petersburg—where, according to the Federal AIDS Center of the Russian Federation, 200 000 people are living with HIV, about 20% of all registered HIV cases in the country.

“In the Sverdlovsk region, some people do not start treatment because they do not believe that HIV exists, some can’t accept their diagnosis, some are afraid of the side-effects of antiretroviral therapy and some have doubts about the effectiveness of the drugs. But the biggest obstacle is the fear of discrimination, fear of losing their job, fear of isolation. We believe we can address this by telling true stories of people living with HIV on treatment,” said Vera Kovalenko, Head of the New Life civil society organization. 

The campaign was initiated and developed by several community-led civil society organizations, including Humanitarian Action (Saint Petersburg), the Humanitarian Project (Novosibirsk), Light of Hope (Chelyabinsk) and New Life (Sverdlovsk), with the support of a regional SOS_project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria and in close cooperation with other partners in the Russian Federation.

Denis Kamaldinov, Head of the Humanitarian Project, invited people to get help. “If you know you are HIV-positive but are not receiving treatment, please contact us for help. We will help with the registration at the AIDS centre. And the treatment is provided free of charge at the expense of the state,” he said.

“Our mission is to fight for every life, to give hope to everyone,” said Alexei Tananin, Head of Light of Hope.

A chatbot named Eli that can answer questions about growing up, love, relationships and sexual health, including HIV prevention and treatment, has been launched on the VKontakte social network, adding to the resources for health available to young people in eastern Europe and central Asia.

Created by the United Nations Educational, Scientific and Cultural Organization (UNESCO) Institute for Information Technologies in Education (IITE), Eli answers questions on six topics—psychology, physiology, sex, relationships, family and health. The knowledge base was created by an editorial team in collaboration with health workers and psychologists using materials on, for example, sexual and reproductive health, psychological well-being and HIV prevention, testing and treatment from UNESCO, UNAIDS and other United Nations agencies.

A large proportion of Eli’s knowledge base is on HIV prevention, testing and treatment. In a dialogue with a user, Eli explains why young people who have sex may need to be tested for HIV, what kind of tests are available, where and how they can be done and why it is crucial to start antiretroviral therapy immediately if the test results show that the person is HIV-positive. Eli helps to overcome fears and concerns and motivates its users to seek medical help.

“The use of modern innovative information technologies is an indispensable element of successful HIV education and prevention among young people, and UNESCO remains the leader in this area,” said Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

Machine learning technologies were used to create the chatbot. Users can ask Eli a question of their own or choose one of the suggested questions. Artificial intelligence powers the response, taking into account possible connections—for example, when talking about sexually transmitted infections, Eli will give information about symptoms and diagnostic methods and will also tell the user what to do if his or her partner does not want to use protection.

Eli’s language combines expertise and respect for the user and its speech is as gender neutral as possible and free from stigma.

“Eli is an irreplaceable assistant for those who are growing up and discovering new feelings and relationships and who often need truthful information without edification and stereotypes. Eli is another step in implementing UNESCO's global strategy to empower girls and boys to increase their health literacy and to build and maintain healthy, respectful and rewarding relationships,” said Tigran Yepoyan, Head of ICT and Health Education at UNESCO IITE.

In the first week after its launch, more than 4000 people subscribed to the Eli VKontakte group and Eli answered more than 150 000 questions from 10 000 users. People also shared their feedback: “Cool and important topic!” “Eli learns and shares it with us! Go for it, Bot!” “This is very cool guys!”  “I would like to thank the creators of this project. You are doing great!”

Eli is available right now and instructions are available for those who have never used such a service.

Eli will serve as a prototype for the creation of similar chatbots in Russian and in the national languages ​​of Kazakhstan and Kyrgyzstan this year and in the languages of other countries in eastern Europe and central Asia in the future.

Lola Makhmudova (not her real name) grew up in a close-knit family, but her parents were afraid to tell her about her HIV-positive status for a long time, even though they both work in the health sector. She found out about it by chance, after hearing nurses talking in the hospital when she was 10 years old.

“Once, a few years later, when I already knew a lot about HIV infection and treatment, I was in the hospital with one boy, he also had HIV,” Ms Makhmudova said. “But his parents refused to give him antiretroviral therapy for religious reasons. I told them about myself, that therapy helps you to remain healthy, that I feel good and live a full life. I am happy that I managed to convince them. We are still friends with this boy.”

Ms Makhmudova is now 18 years old and has been a peer counsellor and volunteer at the Day Center for HIV Affected Families in Tashkent, Uzbekistan, for several years. She communicates with children and adolescents living with HIV, helps them to accept their diagnosis and explains the need for treatment.

Ms Makhmudova has not yet decided precisely what she will become when she is an adult, but she is sure that she wants to help people. She became one of three young people living with HIV to join the new United Nations Youth Advisory Board in Uzbekistan.

She takes her work on the Board for Youth Affairs seriously. “I was scared at first,” she said. “Everyone there is so grown up and smart. But I decided that I would study, I would learn languages ​​so that I could be heard, and I could influence decisions that concern young people.”

The Board for Youth Affairs includes 15 young people from different regions in Uzbekistan, representing various social groups and interests, including the most disadvantaged and marginalized.

“Uzbekistan has agreed to be a fast-track country for implementing the Global United Nations Youth 2030 Strategy. The United Nations Board for Youth Affairs is part of the initiative. Currently, the board works with partners to ensure that the views of young people are taken into account in the development and implementation of United Nations strategies and programmes as well as the State Youth Policy in the country,” said Charos Maksudova, UNAIDS Country Manager for Uzbekistan.

Guzal Akhmedova (not her real name) is a young woman who has been living with HIV for eight years. She is a second-year student at the University of World Economy and Diplomacy and speaks Uzbek, English and Russian and is learning Chinese.

“I have been working as a peer educator for five years, and it is giving me a lot of opportunities. I’m a delegate of the International AIDS Society. In 2018, I was selected to go to the Netherlands to participate in the conference. And this year, I got a scholarship to take part in the virtual AIDS 2020 conference. My life and my story of living with HIV are unique because I love myself, my illness, my body and everything that I have. This all started when I accepted myself as I am. I suggest my simple motto to everyone: positive mind, positive life!”

Shirin Botirova (not her real name) found out that she was living with HIV five years ago, when she was 15 years old. Like many of her peers, she had to go through all the stages of accepting her HIV status. And this, according to her, was not easy. “After a while, I decided to start a new life without self-stigma. And from that day, my activism began. I started going to a self-help group, studying all the information about HIV.”

She also began studying law to know her rights and how to protect people living with HIV.

Since 2015 Ms Botirova has been actively participating in various trainings for peer counsellors.

“Today, I am a national trainer, and I try to share the knowledge and skills that I have. We conduct training throughout the country, and even in other countries, talk about peer self-help groups and consultations, give general concepts about HIV.”

Ms Botirova is doing everything to ensure that the world accepts people living with HIV without stigma. “I want to contribute to creating a world without stigma and discrimination. I set myself the goal of changing the attitude of people towards us, people who are living with HIV, since this is one of the most urgent tasks in our region. I believe that everything depends on ourselves, and I believe that together we can create a world without borders.”

A new project aimed at helping countries to incorporate recency testing into national HIV reporting systems has been launched by UNAIDS in seven countries of eastern Europe and central Asia.  

A recency test is a laboratory-based test that detects whether an HIV infection is recent (less than six months) or not. The incorporation of HIV recency testing in national HIV case reporting systems will help to assess how HIV is being transmitted, describe behaviours that are facilitating HIV transmission and optimize HIV-related data collection and information on risk factors.

Many countries in eastern Europe and central Asia report that despite significant progress in the epidemiological surveillance, prevention and treatment of HIV, a substantial number of new HIV diagnoses are made late. In Armenia, for example, according to national data, almost 66% of all new diagnoses of HIV infection in 2019 were made at the stage when the CD4 count was less than 350 cells/mm³ (in Kyrgyzstan, the percentage was 53%, while in Tajikistan it was 56%).

“The average time from infection to the moment a person enters the health-care system in the region varies from five to seven years,” said Lev Zohrabyan, a UNAIDS Regional Strategic Information Adviser. “All those few years, a person could be putting at risk his or her own health and the health of a partner. Moreover, prevention measures are often based on old data on transmission.”

By determining recent infections among people newly diagnosed as living with HIV, countries can identify the geographic areas and subpopulations where HIV transmission is happening. They can then effectively interrupt HIV transmission by building evidence-informed policies, guiding resources to the right place and measuring the impact of HIV prevention programmes.

“We often understand the situation as it was—what happened five years ago. This test allows us to identify and characterize cases that occurred a maximum of six months ago. Thanks to this system, we may better understand where the latest cases of HIV infection occurred,” said Meerim Sarybaeva, UNAIDS Country Manager for Kyrgyzstan.

After a multicountry study, the testing has been thoroughly evaluated and discussed with national partners with the aim of developing the most effective way of incorporating HIV recency testing into national HIV case reporting systems. The innovative technology has been transferred to national experts through extensive training programmes provided by UNAIDS for epidemiologists and laboratory experts.

This innovative approach is being integrated into routine HIV surveillance in several countries in eastern Europe and central Asia in the framework of the UNAIDS Regional Cooperation Programme (RCP) for Technical Assistance on HIV and Other Infectious Diseases, funded by the Government of the Russian Federation. The RCP aims to strengthen health systems, ensure better epidemiological surveillance of HIV and promote the scale up of HIV prevention programmes among key populations at higher risk in Armenia, Belarus, Kyrgyzstan, Tajikistan and Uzbekistan.

Ishenim Nuru, which means “Ray of faith” in Kyrgyz, is a community organization that has been operating in the Chui region of Kyrgyzstan for many years. It started as a group of people living with HIV, their relatives and volunteers and then established itself as a nongovernmental organization that continues to work to fulfil its mission of improving the quality of life of people living with HIV.

Today, Ishenim Nuru provides the only shelter in the area for people in key populations. “With the COVID-19 epidemic, the situation has worsened for many people, but it has become extremely difficult for people released from prison who are living with HIV, people with tuberculosis and representatives of key populations—many of whom were left without a roof over their head and without help. Therefore, we decided to open a shelter,” said Elmira Asanovna Dzhorbaeva, the head of Ishenim Nuru.

The shelter is a place where people can come and receive basic services, where they can sleep, eat and wash clothes, explained Ms Asanovna. “In our shelter, people living with HIV and their family members can get, in addition to basic services, referral to medical institutions. We work closely with city and regional AIDS centres, send clients for viral load tests, provide adherence counselling, engage lawyers, restore documents, provide psychological assistance, and even help with employment,” she added.

Currently, the shelter can accommodate only 10 people at a time, but according to Yuri Malyshev, the shelter’s social worker, when the situation becomes bad sometimes up to 30 people live in the shelter. “We put in additional beds, try to find a way out. People with different destinies live here, some have no documents, some cannot apply for a pension, some have recently been released from prison, and everyone should have a chance. Our main condition is for a person to have a desire to change and adherence to antiretroviral therapy.”

To date, the shelter’s activities are supported by a United Nations Development Programme project, with financial support from UNAIDS. According to Ms Asanovna, the organization is actively discussing the sustainability of the shelter in the face of reduced donor funding amid COVID-19. “We are looking for sponsors, writing projects, we are planning to build our own greenhouse, build a carpentry shop and our own bakery, so that clients have work. Of course, we dream that one day the shelter will have its own property, since we are renting a small house. I really hope that all our dreams will come true.”

Meerim Sarybaeva, UNAIDS Country Manager for Kyrgyzstan, said, “People who need critical  support should get it. In the absence of shelters run by the state, this deficiency is being filled by nongovernmental organizations that are mobilizing resources and providing the needed assistance to people during the coronavirus pandemic.”

In Yerevan, the capital of Armenia, all polyclinics are now providing free, anonymous, and fast testing for HIV, Syphilis, Hepatitis B and C as part of the “Do not guess, get tested” campaign launched by the Ministry of Health and the Yerevan Municipality on World Hepatitis Day.

“It is an important signal to the population that we keep providing all necessary HIV services to people and that the COVID-19 pandemic has not stopped our prevention and testing work,” said Alexander Bazarchyan, Director of the National Institute of Health.

In preparation for this initiative, the Ministry of Health together with the National Institute of Health and the Municipality of Yerevan, conducted training sessions for medical staff in 20 polyclinics in Yerevan. More than 300 health workers—family doctors, infectious disease specialists, general practitioners, laboratory specialists, etc—received theoretical and practical information on “Management skills of Tuberculosis, Hepatitis B and C” and “HIV testing and counselling services in primary healthcare facilities”. 

The activities continued during the COVID-19 epidemic through an educational website developed with support from UNAIDS. The site is a platform where specialists can post accredited online courses so that health professionals can continue their education for free.

In addition, rapid tests for HIV, Syphilis, Hepatitis B and C were purchased within the framework of the UNAIDS Regional Cooperation Programme (RCP) for Technical Assistance on HIV and other Infectious Diseases funded by the Government of the Russian Federation. The RCP aims to strengthen health systems, ensure better epidemiological surveillance of HIV, and promote the scale up of HIV prevention programmes among key populations at higher risk in Armenia, Belarus, Kyrgyzstan, Tajikistan, and Uzbekistan.

“We welcome such timely support as this initiative can facilitate access to testing for people through primary healthcare services and make another step towards achieving Armenia’s commitments to increase access to early diagnosis and treatment,” said Roza Babayan, UNAIDS Representative in Armenia.

As the Global Fund to fight AIDS, Tuberculosis and Malaria—one of the main donors for the HIV response in the last 20 years in Eastern Europe and Central Asia (EECA)—is moving away from funding the HIV response in EECA, the region is looking for ways to invest their available domestic resources in a much more cost-effective way.

“There are purely epidemiologic and economic arguments behind this transition,” said Dumitru Laticevschi, Regional Manager Eastern Europe and Central Asia Team, The Global Fund. “The economies here are considerably better for the same level of disease burden than the average in the world, that’s why it is expected that the region increasingly takes care of the epidemic by itself.”

The key challenge for the Global Fund, UNAIDS and other partners is to strengthen national responses and “to squeeze the problem to a size that is manageable for the governments to take over,” added Mr Laticevschi.

A series of HIV allocative efficiency studies conducted in 2014 in the region with support from the World Bank, UNAIDS Secretariat and some cosponsors, the Global Fund, USAID/PEPFAR and other partners, recommended countries to prioritize investment in the most cost-effective interventions to maximize health outcomes, including updating HIV testing and treatment protocols, reducing treatment costs, and optimizing service delivery. The studies were based on the Optima HIV mathematical modelling approach which has been applied in over 60 countries globally to help support HIV-related investment choices.

Recently, a new wave of the allocative studies was concluded in 11 countries of the region (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Romania, Tajikistan, Ukraine, and Uzbekistan). Individual reports with a set of recommendations for each country, as well as a regional report with aggregated results from the eleven-country analysis are available here.

“We provided the technical support for these analyses,” said Sherrie Kelly, Team Lead HIV, TB, and Malaria Applications, Burnet Institute who supported the 2014 and 2019 studies in EECA. “We have the models in place and work with the national teams. The countries are the owners of the projects, data, and results. We are just the mathematical modelers.”

The modeling is informed by demographic, epidemiological, behavioural and other data, as well as expenditure estimates provided by national teams and available in the literature. The epidemic model is overlaid with a programmatic costing component and a resource optimization algorithm. Results are intensively discussed and validated by national teams and key stakeholders from respective countries. The UNAIDS Secretariat facilitated the entire process to ensure the capacity of national partners to facilitate optimized health spending was strengthened.

“We hope that the recommendations from the study will help our national partners to adjust National Strategic Plans and to focus on the most efficient, cost-saving interventions with maximum health outcomes and will not only save money, but will save people’s lives,” said Alexander Goliusov, UNAIDS Regional Director in EECA a.i..

Inspiring stories of solidarity during the COVID-19 outbreak in eastern Europe and central Asia have been shared by community leaders, businesspeople, celebrities and others. Under the umbrella of #TogetherWeWin, a series of Instagram and Facebook Live talks have shown how people are supporting each other in this difficult time. 

“The COVID-19 pandemic has become not only a challenge to health care and economies, it has also become a test for social solidarity. We have seen some amazing examples of solidarity and unity in supporting people who are left behind,” said Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

Arusik Mkrtchyan, from Armenia, a long-time friend of UNAIDS, spoke with Narine Manukyan, chair of the AI MAYER (Armenian Mother) charity, which helped more than 300 families who lost their livelihoods during the lockdown with food and medicine. “I have always believed that charity should support people in a sustainable and long-term way, create opportunities for people to solve their problems by themselves. But in this situation, families with children with disabilities whose parents lost their jobs faced the problem of not having food to eat,” said Ms Manukyan. Ms Mkrtchyan also spoke with Hamlet Khnkoyan, who started the Let’s Help Families in Need movement, which initially helped several families in his neighbourhood with food supplies but snowballed into supporting more than 600 families.

Olya Tira, the UNAIDS Goodwill Ambassador for the Republic of Moldova, spoke with the blogger Lilu Ogovan, a founder of Together for You, Anna Racu, and Ruslan Poverga, from the Positive Initiative.

Ms Racu spoke about Together for You, which supported medical personnel by providing personal protective equipment and disinfectant, as well as purchasing other medical equipment. Aid was initially provided to ambulance stations, but, over time, hospitals that were looking after patients with COVID-19 were also helped. Mr Poverga said that the Positive Initiative, together with partners, delivered antiretroviral therapy to more than 850 people living with HIV, including 65 Moldovans who were trapped abroad during the lockdown. “The crisis forces people to be creative. People stopped thinking in terms of “possible” and “impossible”, we just know that it is necessary to do this and that’s it, and the question is only how exactly we will achieve what we want. And I am very glad that, thanks to our partners as well, we have succeeded,” Mr Poverga said.

In Belarus, there was a live broadcast by Yuri Tkachuk, a singer, television presenter and member of the country’s UNAIDS Red Ribbon Team. UNAIDS Goodwill Ambassador Svetlana Borovskaya, along with television journalist and producer Irina Rombalskaya, as well as representatives of the People Plus community organization, Tatyana Zhuravskaya and Anatoly Leshenok, and Julia Stoke from the Positive Movement, discussed the theory of small actions.

“I believe in this theory. Even when it looks like you do not have a lot of time and financial resources, you can still help substantially. For myself, I chose the path of one good deed a day,” said Ms Rombalskaya, who is buying food and medicine for older people during the lockdown. Ms Zhuravskaya and Mr Leshenok organized the delivery of antiretroviral therapy and helped Belarusians who were outside the country when the border was closed to obtain antiretroviral therapy.

In Kazakhstan, a Facebook Live stream was hosted by Adele Smith, a television presenter and head of the Charity Warehouse project. She talked to Aruzhan Sain, the Commissioner for Children’s Rights in Kazakhstan and founder of the Volunteer Charity Foundation, which helped children with serious illnesses during the COVID-19 outbreak when, due to the closure of the border, there was a significant shortage of medicines and medical supplies. Volunteers found and purchased medical equipment and medicines and delivered them to children’s hospitals, with the foundation later expanding its work to other medical institutions.

Konstantin Avershin, a businessman and leader of the I’m Alma-Ata movement in Kazakhstan, initiated the Who If Not Me challenge, aimed at helping people in need. Assistance was provided in various areas, from the supply of personal protective equipment to doctors to legal support for victims of domestic violence. The challenge brought together 14 cities in Kazakhstan, many volunteer networks operating in the country and the government.

Elena Bilokon, the founder of the Community of Women Living with HIV in Kazakhstan, also joined the broadcast and spoke about her story of supporting people from key populations and about living with HIV in a crisis.

Erkin Ryskulbekov, a UNAIDS Goodwill Ambassador for Kyrgyzstan and television presenter, invited a human rights activist, Gulgaaki Mamasalieva, and Kyrgyzstan’s triathlon champion, Aivaz Omorkanov, to his Instagram Live feed.

Ms Mamasalieva shared her experience in creating an online forum that brings together most of the country’s volunteer organizations and makes it possible to make a direct request for assistance and receive an immediate response. The forum is based on the Telegram platform and facilitates volunteers communicating with each other during an emergency. “We have 10 years of experience in civil monitoring. We know all the standards and requirements for providing such assistance, including how these processes should be organized during emergencies,” said Ms Mamasalieva.

Mr Omorkanov spoke about how he managed to complete his triathlon training programme while staying at home under lockdown as well as starting an online fundraising initiative, inviting world sports starts to join him and raise funds to provide personal protective equipment for doctors at the infectious diseases hospital. In total, US$ 6500 was raised. “My message was that we can help our country even while staying at home,” said Mr Omorkanov. In addition to raising funds, the action had another goal—to encourage people to do sports and maintain a healthy lifestyle, even while under lockdown.

Mr Ryskulbekov ended the discussion by saying, “When I do charity work and help people, I understand that although my actions are needed by others, I’m actually the one who needs it the most; it’s me who becomes happier by doing good things.”

Arpi Hakobyan (not her real name), a former sex worker, lost her income after the COVID-19 pandemic hit Armenia. And then her parents threw her out of their home and took her passport. She had no place to go and no one to ask for help, until a friend advised her to contact the New Generation nongovernmental organization.

Opened by the New Generation in June 2020 in the centre of Yerevan, the capital of Armenia, the Safe Space occupies a three-storey building that gives people living with HIV, members of key populations and women who have suffered from domestic violence a safe refuge.

“When the COVID-19 pandemic began, we started receiving calls from people who, because of their belonging to key populations or because they were HIV-positive, were discriminated against, found themselves without work, without support, sometimes without a home,” said Sergey Gabrielian, the head of the organization. “It is widely believed in our society that it is these groups that spread not only HIV but also COVID-19, which is why they are expelled from work or from society. These people have nowhere to get help from—they are not on any lists of recipients of government social assistance programmes.”

The Safe Space gave Ms Hakobyan a place in the shelter. The New Generation’s lawyer and psychologist reached out to her, helped to replace her documents and found her a job.

Referrals are made to the shelter by HIV service and human rights organizations across the country. Administrators, lawyers, psychologists and volunteers are on duty 24 hours a day. For the first three days, psychologists and lawyers work with the clients to find out their circumstances, help with documentation and understand how to proceed further. The average stay in the shelter is 15 days, with the maximum being a month.

“Of course, we are not a hotel, this small programme is not designed to support people for several months—there only 37 people who can be simultaneously in the shelter. And the demand for it is enormous,” said Mr Gabrielian.

A key feature of the shelter is a special HIV services room in which people can take an HIV test and get counselling and a referral to an HIV clinic. People who use drugs and need harm reduction services are referred to a nearby organization where such services can be obtained.

Mr Gabrielian said that when it became obvious that the fight against COVID-19 could hit the HIV epidemic hard, the New Generation’s employees decided to switch to a new way of providing HIV services—online consultations, the provision of tests and prevention materials by mail and the use of outreach workers.

“We insisted that programmes for key populations should not be stopped because of the coronavirus, otherwise, with the end of one pandemic, we will see an outbreak of the AIDS pandemic,” he said.

Today, the Safe Space project is supported by the Elton John Foundation, with support also from the Swedish Government. Negotiations are under way with the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNAIDS on the future of the service.

“The coronavirus made us understand what new ideas could be included in the HIV service programme. It was these special circumstances that made us move on and look for new ways to support people in times of crisis,” said Mr Gabrielian.

Shakhnoz Amirova (not her real name) lives in Tashkent, Uzbekistan. She has been taking antiretroviral therapy regularly since 2017, when she discovered that she was living with HIV. She continued the treatment while pregnant with her child, so she did not have to worry about her baby’s health, which was born HIV-free. But the COVID-19 pandemic has changed everything, and the lockdown restrictions severely limited access to medical services.

The immediate anxiety about the possible disruption to her HIV treatment and that of her husband, who is also living with HIV, was allayed by the health-care facility that she attends, the Republican AIDS Center, dispensing a two-month supply of antiretroviral therapy for everyone who needs it.

However, Ms Amirova was pregnant again and worried about the impact that COVID-19 may have on her and her unborn child, since information on how COVID-19 may affect people living with HIV was scarce. She was even unsure whether the coronavirus outbreak would stop her being able to have her baby at the maternity hospital.

“Women living with HIV feel especially vulnerable during pregnancy and childbirth, as fear of virus transmission, stigma and discrimination are added to the fears for the well-being of their baby. Of course, the situation with coronavirus is an additional stress factor. At such a difficult moment, women really need help and support, and we are trying to provide this help to them,” said Evgenia Korotkova, a representative of Ishonch va Khaet, an organization that helps people living with HIV.

The Positive Maternity programme run by Ishonch va Khaet helps women living with HIV who are pregnant or have recently given birth with social support, delivering antiretroviral therapy and baby food and providing medical care. During the COVID-19 outbreak, Ishonch va Khaet and similar organizations are working doubly hard so that people who need help get it as quickly as possible.

Yuldashev Kahramon Haldarovich, the Director of the Republican AIDS Center, noted the special role of nongovernmental organizations during a pandemic. “Community involvement in HIV prevention and support for people living with the virus are very important, especially at such tense moments, when the efforts of all health professionals and doctors are concentrated on fighting another pandemic. We cannot leave people who need HIV services behind; they also need help, and they need it today. The work of volunteers from social organizations is priceless.”

Since keeping patients and medical personnel in maternity hospitals safe from COVID-19 is such a priority, UNAIDS and the United Nations Population Fund have made a donation of a range of personal protective equipment, including masks and gloves, and disinfectant to 21 maternity hospitals in Uzbekistan.

“Protecting medical personnel in maternity hospitals from infection is as important as protecting pregnant women. The country is currently on the way to eliminating mother-to-child transmission of HIV. Preventive measures against COVID-19 are important for supporting the progress made,” said Charos Maksudova, the representative of UNAIDS in Uzbekistan.

Ms Amirova safely gave birth in the maternity hospital, happy that both her and her baby avoided becoming infected by the new coronavirus and that her baby was born HIV-free. “But fear for my children, especially for a newborn, does not leave me for a minute,” said Ms Amirova.

Now back at home, she is receiving help from peer counsellors from the Positive Maternity programme.