Republic of Moldova

Alexander Godin moves through a number of locked doors escorted by a guard to prison 16’s pharmacy. This is part of his daily routine. He comes to get his medicine – a syrup-like dose of methadone. Methadone is an opioid agonist therapy (OAT) to help people overcome withdrawal symptoms, decrease heroin dependence and prevent HIV infection from infected needles.

Since 2000, a few prisons in Moldova offered such harm reduction services.

Now all do.

“I have been on methadone substitution treatment for 10 years,” said Mr Godin. His family urged him to take advantage of such services so he could get healthy again.

“For years I used drugs and opioids and for this, money was needed so problems began among my family,” he said.  Since he has been on the programme, he feels much better.

Any new prisoner to the country’s 17 penitentiaries sees a psychiatrist, a doctor and if needed is offered to join a treatment programme. Comprehensive harm reduction services not only include drug dependence treatment but also needle syringe exchange and HIV testing and treatment. HIV prevalence is 11% among people who inject drugs in Moldova vs 0.36% among the general population.

They are one of the most affected groups in the country. 

For Maria Potrîmba Head of Infectious Diseases at prison 16 (Pruncul) helping prisoners stave off drugs has positive knock-on effects.

“If a patient is on this substitution treatment the person is more aware of consequences and will more likely adhere to their other treatment,” she said.

The prisons also make sure to provide clean syringes with a regular pick-up every two days carried out by volunteer prisoners.

The head of medical unit at prison 13 (Chisinau) believes harm reduction services are important for both inmates and prison employees.

“The volunteers are all prisoners and the vast majority of them are also people who have been treated for communicable diseases like HIV or hepatitis or tuberculosis,” Oleg Costru said.

Moldova has committed more resources to the prison programme over the years. “In the beginning, when these services were developed, they were actually financed from external sources,” said Irina Barbîroș, head of the medical department at the national prison administration. “Over the years, the state assumed its commitment and took over the financing of these services from the state budget.”

UNAIDS, UNODC and WHO have been long-time supporters of expanding these services to all prisons. Currently, according to Harm Reduction International, only 59 countries globally provide OAT in prisons.

This, even though harm reduction has been proven to not increase the number of people with drug dependency but rather provide personal and public health benefits.

Svetlana Plamadeala, UNAIDS Moldova country director, has seen the pilot projects gain traction in the country and is quite proud of the success of the nationwide coverage.

“It is really about putting people in front and people at center as well as taking on a solid public health approach,” she said. For her, to end AIDS, protecting the health and human rights of people who use drugs is key. “It is about equalizing.”

Many of the Ukrainian refugees seeking sanctuary in the Republic of Moldova are from Odesa or the surrounding region, which is one of the regions of Ukraine most affected by HIV. 

Iryna Kvitko (not her real name) fled with her entire family, including her daughter-in-law and young grandson, to the Republic of Moldova. She said that an air-raid siren would sound several times a day, terrifying her grandson. “We thought about whether we should go or not, but it was scary to sit all night in our home—me, my husband, son, daughter-in-law and grandson—and try to explain to the child what the explosions and sounds of shooting were. Plus, to be honest, I was very afraid of the situation regarding my antiretroviral therapy—I was running out of it and it was not clear what would happen next.”

Ms Kvitko has been living with HIV for more than 15 years but keeps her diagnosis a secret. “I work, we live decently. I have a family, children, relatives, friends, colleagues. God forbid that someone would find out—it would all go to dust,” she said.

She described her difficult journey to the Republic of Moldova—there was widespread panic and at the border checkpoints the queues of traffic reached up to 80 kilometres. “Many people just got out of their cars and walked. Our main goal was to take our children and grandson out of Ukraine,” she said.

“My doctor in Odesa gave me information on where people can go to get help with antiretroviral therapy. I called them and after they took my contact number they immediately called me back and explained where to go and what to do and said that they would help me and give me the medicines I need.”

On the very first day of the war, Ihor Plamos (not his real name), together with his wife and child, drove to the Republic of Moldova from Odesa. There were a lot of people at the border, he recalled. “As soon as we got to our destination, I started to drive back to the border, to give a lift to people who had travelled on their own, who had walked seven or eight kilometres.” He took them to an aid distribution centre, from where they travelled on to Georgia or Germany.

“When we arrived, we didn’t know what to do. So, I called my doctor in Ukraine, and she told me where to go,” he said.

The clinic that his doctor referred him to tested his viral load free of charge, and the doctor prescribed antiretroviral therapy for him. He does not want anyone to know that he is living with HIV, noting that the level of stigma around the virus remains very high. “Therefore, I was worried at the beginning about what would happen to my treatment,” he said.

Hanna Brovko (not her real name) travelled to the Republic of Moldova from Odesa with her 11-year-old son, leaving behind her sewing business, clients and friends. She has been living with HIV for more than 12 years, but she does not tell people about her diagnosis. “I don’t need pity, and I don’t want things to be said about me behind my back.”

She received all the necessary medicines upon her arrival in the country but decided to move on to Germany. Berliner Aids-Hilfe helped her to arrange her flight from Chisinau to Berlin, set up her in a family’s house and arranged medical insurance, which is necessary for her to obtain her HIV treatment.

Elena Golovko, an infectious diseases doctor at the Hospital of Dermatology and Infectious Diseases in Chisinau, emphasized that people who come from Ukraine receive all HIV services in the same way that Moldovan people living with HIV do. “Today, we have a person living with HIV hospitalized, there are several HIV-positive women, there are those who have already given birth here and who received syrup to prevent mother-to-child transmission of HIV. There is also a person receiving pre-exposure prophylaxis. We issue a 30-day supply of antiretroviral therapy to refugees. If people stay longer in the country, they can come and receive a refill. We don’t have any problems with ensuring the same level of HIV services,” she said.

However, she added that some people did not know their latest test results or could not remember the name of the medicines they take. “It was important for us to establish communication with colleagues in Ukraine, especially fast communication when a person is directly in the clinic.”

Alina Cojocari, the coordinator of assistance for people living with HIV at the Positive Initiative nongovernmental organization highlighted that it is fully involved in service delivery for refugees in need of HIV services. “We are referring people to health services, supporting them with accommodation in the country and offering them psychosocial and legal support,” she said. “For those travelling from the Republic of Moldova to other countries, we ensure they are linked to HIV services in the next country,” she added.

“This level of HIV services for refugees living with HIV in the Republic of Moldova became possible as these services in the country have long been built around people’s needs,” said Svetlana Plamadeala, the UNAIDS Country Manager for the Republic of Moldova. “This approach is now also being used for refugees. During humanitarian crises, such as the war in Ukraine, everyone is vulnerable and people fear for their loved ones. For people living with HIV, there is also the fear of not receiving timely, life-saving HIV treatment, and in many cases the fear of the disclosure of their status. That is why it is so important to create sustainable, agile, equitable health and social protection systems with people at the centre, which can protect people during a crisis.

At the start of the invasion of Ukraine, the government of the neighbouring Republic of Moldova estimated that there might be around 300 000 people fleeing to the country from Ukraine. That estimate has now increased to 1 million refugees—a huge amount for a country that has a population of only 2.6 million and is one of the poorest countries in Europe.

Soon after the start of the war, a number of humanitarian organizations, United Nations agencies and civil society partners, coordinated by the government, formed response coordination groups and started to address the most acute needs of the people fleeing the war, including shelter, food, health, social protection, the prevention of gender-based violence and mental health support.

“First, we must focus on the basic needs. A lot is yet to be done around coordination with the many humanitarian organizations joining the response. Because this is also the first time ever for Moldovans to face a crisis of this size, we are learning by doing and learning from experience,” said Iurie Climasevschi, the National AIDS Coordinator at the Hospital of Dermatology and Communicable Diseases in the Republic of Moldova.

Svetlana Plamadeala, the UNAIDS Country Manager for the Republic of Moldova, visited several displacement centres near the border of Ukraine and the Republic of Moldova. “People are well-received there, the government is ensuring accommodation and food and trying to ensure that children attend school and kindergarten, as about 75% of the refugees are women and children—there are about 40 000 children under 18 years old in the centres,” she said.

According to Ms Plamadeala, almost half of the refugees are being accommodated by families in their homes. “We see the extraordinary mobilization of ordinary people, who are providing remarkable support to people who are fleeing from the war,” she said.  

The government’s policy is that Ukrainian refugees will receive the same services as Moldovans, including HIV-related services. “If any of the refugees ask for antiretroviral therapy, we provide it to anyone. We will not refuse anyone if we can help them,” said Mr Climasevschi.

“UNAIDS was part of the planning process right from the very beginning of the crisis to ensure that refugees have access to all HIV-related services that Moldovan people have, including antiretroviral therapy, opioid substitution therapy and HIV and tuberculosis testing,” said Ms Plamadeala. “Stigma and discrimination towards people living with HIV is still high. Perhaps not all people living with HIV have been able to access the services, so we are engaging with our civil society partners to proactively provide information to people so they know where to go for support.”

Ruslan Poverga, from the Initiativa Pozitiva nongovernmental organization, said that the organization is already identifying refugees in need of antiretroviral therapy and is referring them to support. “We’ve started proactively informing people, and, if required, providing an integrated package of HIV prevention services, including HIV, tuberculosis and hepatitis testing and screening, and the provision of harm reduction and condoms. We will understand the need for such services more clearly in the near future.”

The UNAIDS Country Office for the Republic of Moldova has reallocated funds for urgent humanitarian response needs. This will increase the capacity of the National AIDS Programme to provide antiretroviral therapy to a much larger number of refugees living with HIV. Viral load testing is available to check viral loads if a change of treatment regime is necessary.

“The situation is evolving. We monitor the situation very carefully to understand when and how to look for more support. The Global Fund to Fight AIDS, Tuberculosis and Malaria is ready to make reallocations if they are needed, and the Republic of Moldova is able to access resources from the Global Fund’s emergency fund. In the event that the National AIDS Programme would be not able to cover the needs, we will look for more support from the Global Fund, UNAIDS, the United Nations Children’s Fund and the World Health Organization,” added Ms Plamadeala.

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.”

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.

Nadezhda Kilar’s battles with her health service providers began several years ago. “I did not agree with how obstetrics services for women living with HIV are provided in our city,” said Ms Kilar. “From admission to discharge, there was a constant violation of rights.”

Ms Kilar, who lives in Tiraspol, in the Republic of Moldova, has been living with HIV for several years. Her antiretroviral therapy has suppressed her viral load to undetectable levels, but during pregnancy and childbirth she was isolated. She was kept in an isolation ward, gave birth in a separate delivery room and after giving birth was placed in a special room for women living with HIV—a room with bars on the window.

“All the other women leave through the front door, where relatives meet them with flowers and a photographer. But I was let out through the back exit, where there are garbage cans,” she said.

And the discrimination did not stop with her. “Although my son does not have HIV, in the maternity hospital he was alone in a separate special room, under a sign with “HIV contact” written on. Why should a child feel this stigma?” Ms Kilar said.

“I want to give birth to my next child in a normal maternity hospital. And I do not doubt that it will be so. For something to change, a lot still needs to be done, but the main thing is I must defend my rights,” she said.

Ms Kilar’s relationship with her husband started to break down after he became violent towards her. For a long time, she didn’t do anything about it, as she thought that violence was the norm. “My father often beat my mother; I myself was twice in hospital after his beatings.” Not knowing what to do, she sank deeper and deeper into depression. “I didn’t want to live,” she said.

But change slowly came about. When she realized that she could not cope with her financial problems, the violence and her depression, on the advice of a peer consultant at the HIV clinic she attends in Tiraspol she joined the Women’s Mentoring Programme, along with 20 other women living with HIV from different communities in the area. The Women’s Mentoring Programme, a joint project of UN Women and UNAIDS and supported by the Government of Sweden, works through peer consultants and mentors to help women living with HIV to understand and identify their problems, learn about their rights and get support in the fight against violence and discrimination.

“I understood that it would not be the same as before. I realized that I would not tolerate the beatings,” Ms Kilar said.

Since 2019, Ms Kilar has been working in a sales job and has been studying at the university to become a teacher. “It’s not easy for me. I do not sleep much at night, but I have gained confidence that I can solve problems on my own,” she said.

Iren Goryachaya, the Programme Coordinator for the Women’s Mentoring Programme, explained that the programme provides a range of services. “We not only deal with the issues of discrimination in a health-care institution or the fight against violence—we see a woman as a person from different perspectives. First, it is important to help women accept their HIV status and overcome self-stigma. Without this, it is impossible to achieve a different attitude towards herself either from doctors or men.”

“Often, women in the Republic of Moldova have insufficient access to reliable information about HIV. They still cannot defend their right to safe sex. Various forms of violence, including sexual violence, the widespread violation of women’s rights and the controlling behaviour of men further aggravate the situation. All this deprives women of the opportunity to defend their right to health,” said Svetlana Plamadeala, the UNAIDS Representative for the Republic of Moldova.

Ms Kilar looks to the future with confidence. “I see myself as a free woman. I do what I want. My children are growing up in a safe environment. I don't worry about my HIV diagnosis. If I decide to have another child, I will give birth in a normal hospital.”

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.”

Mihai Ceban (not his real name) has been locked down at home since 17 March, when a state of emergency was declared in the Republic of Moldova in response to COVID-19. He is an information technology specialist, so working from home has not disrupted his daily routine too much. His was worried, however, by his inability to go out to get his supply of HIV pre-exposure prophylaxis (PrEP). He has been taking PrEP to prevent becoming infected with HIV since September 2019. Although he has a partner, he says taking PrEP makes him feel safer. “You can’t fully trust your partner,” he said.

During the state of emergency, restrictions imposed by the authorities and the fear of becoming infected with COVID-19 limited his social contacts to a maximum of two or three people. However, his partner continued to lead an active social life, which increased his risk of HIV infection. 

"The fear of COVID-19 was enhanced by the fear of getting infected with HIV. That's why, when I saw I was running out of my pills, I started worrying. I wondered what I would do if no one was working? How do I protect myself? The response came from the GENDERDOC-M Information Center, which delivered my PrEP at home. And the fact that it was delivered to me during the pandemic means that my right to health was respected. It’s my right to have an active protected sex life during the pandemic. And the delivery of PrEP services at home has brought psychological relief and reduced the anxiety of becoming infected with HIV,” Mr Ceban said.

Mr Ceban is not the only beneficiary of the PrEP deliveries. Alexandru Goja, a health programme consultant at the GENDERDOC-M Information Center, said that during the pandemic more than 90 people received PrEP deliveries at home. 

“At the beginning of the pandemic, everyone went into a kind of panic. Some people on PrEP discontinued taking it, but most wanted to continue. For them, we went out, into the parks, in front of their apartments blocks, where we tested them for HIV and delivered their medicine. During quarantine, people from key populations avoided going to medical institutions to pick up their medicines, trying to prevent the risk of becoming infected with COVID-19. The support provided by nongovernmental organizations helps them to exercise their right to health,” said Mr Goja. 

Angela Nagît, an infectious disease specialist at the Hospital of Dermatology and Communicable Diseases, agrees with him. During the pandemic, she carried out consultations and prescribed PrEP remotely. It is very important that once enrolled on PrEP, the person should stick to it, she said. 

“In the Republic of Moldova, HIV infection continues to be a major public health problem with a great medical, social and economic impact. Around half of the people who are estimated to be living with HIV don’t know their status. Unprotected sexual contact is one of the risk factors for HIV transmission. PrEP is a way to prevent infection, thus ensuring the right to health, especially for those from the key affected groups,” she said.

From 17 March, following the government’s declaration of a state of emergency in response to the COVID-19 pandemic, around 800 people living with HIV in the Republic of Moldova have been receiving antiretroviral therapy at home for free.

A team of social workers and people from the four regional centres for people living with HIV are ensuring the timely delivery of the medicines and are giving information on protection against COVID-19. The social workers, trained by the World Health Organization, explain how to prevent the transmission of the coronavirus, identify its symptoms and take the necessary action in the event that people contract COVID-19. 

The emergency measures put in place by the government will initially last until 15 May and include limitations on people leaving their homes except for going to work, buying medicines and food and walking their pets.

AIDS activists agree that the decision will help to avoid the risks encountered by people living with HIV associated with travelling by public transport and going to health centres to get their medication. Most importantly, it will help to avoid interruption of HIV treatment.

“We had to find the most effective solution to this problem, and we are proud that the representatives of the national AIDS programme found a solution,” said Ruslan Poverga, General Director of the Positive Initiative. “The medical sector, social services and nongovernmental organizations are doing everything possible to provide people living with HIV with access to treatment and reduce their risk of coronavirus disease.”

In the Republic of Moldova, more than 6000 people living with HIV are receiving HIV treatment, which they usually get from eight treatment facilities around the country, including prisons. In order to provide the medicines in people’s homes, the National HIV Programme Management Unit developed an algorithm to assess the risk of people living with HIV not being able to access their medicines, taking into account distance from the treatment facilities.

Identifying an efficient solution and obtaining all necessary political support and approval, as well as designing the algorithm and starting the implementation of the programme within one week of work, was made possible owing to the leadership of the Ministry of Health, Labour and Social Protection, the National HIV Programme Management Unit and the Positive Initiative. UNAIDS and the World Health Organization bureau in the Republic of Moldova provided guidance and technical and financial support to ensure the efficient implementation of the initiative.

“The delivery of antiretroviral medicines to people living with HIV in remote, rural and other areas of the Republic of Moldova, where there are no HIV treatment centres, through the involvement of nongovernmental organizations and regional centres for people living with HIV, is an amazing solidarity and mobilization effort by all partners,” said Svetlana Plamadeala, UNAIDS Country Manager for the Republic of Moldova.

Ruslan Codrenu, the Acting Mayor of Chisinau, Republic of Moldova, signed the Paris Declaration to end the AIDS epidemic in cities on 31 May. He committed the city to achieving the 90–90–90 targets by 2020, whereby 90% of all people living with HIV know their HIV status, 90% of people who know their HIV-positive status are on treatment and 90% of people on treatment have suppressed viral loads. The city will specifically focus on marginalized and vulnerable people and on ending stigma and discrimination.

“Achieving 90–90–90 will be difficult, but it is never too late to start making the necessary changes to improve people’s lives and health. Today, the city authorities commit to significantly increasing the coverage of the residents of Chisinau with HIV prevention, testing and treatment services, with the aim of ending the AIDS epidemic and concentrating efforts on programmes for key populations,” said Mr Codrenu.

Mr Codrenu said he expects that a new municipal HIV control programme for 2019–2020 will soon be adopted by the city council. The programme will focus on additional HIV testing and treatment for approximately 750 people living with HIV and the provision of HIV prevention services for key populations.

“Chisinau must move quickly, not only to reach 90–90–90, but also to eliminate discrimination against people living with HIV and key populations, which remains a significant barrier. In this struggle, our city is not alone. Chisinau is supported by a team of regional and national leaders who are willing to share their expertise,” said Svetlana Plamadeala, UNAIDS Country Manager for the Republic of Moldova.

Chisinau already supports a range of HIV prevention programmes for key populations, including harm reduction and opioid substitution therapy programmes for people who inject drugs, rapid HIV testing and condom distribution for sex workers and their clients and condom distribution among gay men and other men who have sex with men. However, it is planned that with the adoption of the new municipal HIV control programme, the quality, coverage and impact of the programmes will be significantly enhanced.

Chisinau is the seventh city in eastern Europe and central Asia to sign the Paris Declaration, which since 2014 has been signed by more than 300 cities worldwide.

The signing of the Paris Declaration in Chisinau is the most recent result of a long history of effective cooperation between national, state and nongovernmental organizations, regional networks representing key populations and international organizations

According to government estimates, there are about 3200 people living with HIV in Chisinau.

“Today, we witness what can be achieved through political will. It is of paramount importance to us that the Paris Declaration is not another declarative statement, but is followed by the adoption of the municipal HIV programme, with specific and measurable goals and roles and a budget,” said Ruslan Poverga, General Director of the Positive Initiative.