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.

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.

Adolescents and young people aged between 16 and 19 years from several countries in eastern Europe and central Asia met in Aghveran, Armenia, from 26 to 29 August for the first Teenergizer strategic planning meeting. They discussed the challenges faced by adolescents living with HIV in their countries, shared the results of the #questHIVtest project and developed the #Teenergizer2020 strategic plan.

Teenergizer is a unique movement of 80 adolescents born to mothers living with HIV and HIV-negative volunteers from Georgia, the Russian Federation and Ukraine. They are united by a set of common values, including support for engagement, tolerance and human rights.  

The issues addressed in the strategic plan include advocating for adolescents’ sexual and reproductive health and rights, the promotion of age-appropriate information on prevention for adolescents and engaging teenagers living with HIV to raise their voices in the HIV response.

In the #questHIVtest project, teams in Tbilisi in Georgia, Kiev and Poltava in Ukraine and Kazan and Saint Petersburg in the Russian Federation promoted easy, safe and youth-friendly HIV testing among adolescents.

Young people visited HIV testing sites and described the barriers to testing they faced. Using this information, they developed a map showing 63 HIV testing locations, accompanied by personal reviews on the HIV test experience, along with fun places nearby for young people to meet. As a result of the #questHIVtest, 1 925 adolescents from 5 cities have tested for HIV.

Max Saani, from Tbilisi, said, “It’s extremely helpful for teenagers to have a map on which adolescents can find youth-friendly testing locations and receive proper help and support.” “This map is very unusual, with fun teen places not even seen in Google Maps,” added Yana Valchuk, from Kiev.

Among the challenges and barriers faced by adolescents during the #questHIVtest were a lack of HIV information, stigma around HIV testing and talking about HIV with friends, the high cost of HIV tests and parental consent. The lack of anonymous HIV tests for young people and the shortage of trained doctors, social workers and psychologists to support adolescents living with HIV were also barriers.

Timur Khayarov, from Kazan, explained that the reasons why many adolescents in the Russian Federation are afraid to take an HIV test include the age limit—14 to take the test with parental consent, 16 without parental consent—and because the test results of minors must be communicated to their parents. “When I was refused an anonymous HIV test because of my age, I showed the personnel a printout of the law. The #questHIVtest helped me to defend my right to services,” he said.

The #questHIVtest project was undertaken with support from UNAIDS and the Viiv Healthcare Foundation.

“I’m convinced that the future is in the hands of adolescents—they are the people who will change and build a new world. By 2020, Teenergizer will be a few steps closer to the world that it seeks,” said Armen Agadjanov, an HIV activist from Yerevan, Armenia.

Armenia has been recognized by the United Nations for its elimination of mother-to-child transmission of HIV programme. The 2017 United Nations Public Service Awards saw Armenia win first prize in the Innovation and Excellence in Delivering Health Services category.

The award was made at the 2017 United Nations Public Service Forum, held in The Hague, Netherlands, on 22 and 23 June to debate how innovative policies can be fostered to implement the 2030 Agenda for Sustainable Development even when resources are scarce, objectives are highly ambitious and interests are disparate.

In 2016, Armenia was one of only four countries to be validated by the World Health Organization for eliminating mother-to-child transmission of HIV.

Quotes

A regional consultation on scaling up access to HIV testing and counselling in eastern Europe and central Asia was held from 20 to 22 May in Yerevan, Armenia.

More than 50 participants from across the region, including community leaders, policy-makers, technical experts and representatives of UNAIDS Cosponsors discussed ways in which HIV testing could be expanded and better linked to treatment. They made legal and policy recommendations in a joint appeal to governments that focused on simplifying and diversifying HIV services.

The participants highlighted that community-based approaches, such as rapid, mobile and home-based HIV testing, provide an opportunity to reach people and places that were not previously covered by services. Community-based models can contribute to the elimination of logistical and social barriers for key populations to access HIV testing and antiretroviral therapy. Moreover, such models allow detection of HIV infection at earlier stages than in health-care facilities. The sooner treatment starts after diagnosis, the better the outcome.

According to UNAIDS estimates, in 2013 there were 1.1 million people living with HIV in eastern Europe and central Asia and 110 000 new HIV infections. The epidemic in the region is still concentrated in higher-risk populations.

Quotes

During a nine day tour of five countries of the Commonwealth of Independent States, a group of HIV advocates met with policy makers and civil society organizations to raise awareness on women and AIDS in this part of the world.

Women against AIDS tour was conceived in the
midst of a growing concern that women are
increasingly at risk of HIV infection in many parts of
Eastern Europe and Central Asia.

Women against AIDS tour was conceived in the midst of a growing concern that women are increasingly at risk of HIV infection in many parts of Eastern Europe and Central Asia. The percentage of adults living with HIV who are women has risen from 11% in 1990 to 28% in 2006.

The tour was sponsored by the AIDS Infoshare organization, UNAIDS, the Global Coalition of Women on AIDS and the United Nations Development Program. Ten AIDS advocates from the region with special guests joining at various points travelled together to learn about the realities of women and AIDS in different parts of the region and also to mobilize local policy makers to act on these issues.

In each of the capital cities of Armenia, Moldova, Kazakhstan, Russia, and Ukraine—the tour group joined with civil society organizations and groups of People Living with HIV (PLHIV) to talk about some of the most difficult issues such as stigma and discrimination and their consequences including losing children’s custody, being thrown out of the home and losing jobs.

“These are real issues,” said Deborah Landey, Deputy Executive Director of UNAIDS who joined the last part of the tour. “We have a collective responsibility to make a difference for women ,” she added.

The predominant mode of HIV transmission in the region remains through the use of non-sterile injecting drug equipment. However an increasing proportion of HIV infections — 37% of reported cases in 2005 — are estimated to occur during unprotected sexual intercourse. In Ukraine, the proportion of people infected with HIV through heterosexual transmission increased from 14% of new cases between 1999 and 2003 to over 35% of new cases in the first six months of 2006.

“We must look at every AIDS plan and strategy and ask whether it works for women,” emphasized Ms Landey. “This is our chance to curb the epidemic in this region,” she added.

The Women Against AIDS also produced a set of
issues to be considered and recommendations when
developing national AIDS strategies in the region.

The tour ended where it started, with women. Sergei Golovach a renowned photographer and a guest on the tour took photos of his fellow advocates for an exhibit to be held called Love, Live and Dream. Through portraits h e wanted to emphasize that it does not matter who is HIV-positive.

“Just look at this photo,” said Ms Landey, remarking on one of the portraits of a mother and her daughter that has been turned into an advocacy poster. “It is all about a mother’s love—which has nothing to do with one’s HIV status.”

Moved by these portraits and what she learned from the tour participants, Elena Vasilieva, Editor in Chief of the Russian Cosmopolitan magazine promised to publish an article about the Women Against AIDS tour in the November edition. To help break down stereotypes she said “a glossy magazine is the right place to raise socially important topics.”

The Women Against AIDS also produced a set of issues to be considered and recommendations when developing national AIDS strategies in the region. Highlighting the critical importance of translating these recommendations into actions, Anna Dubrovskaya, from 'Golos anti-SPID' in Russia said “our wonderful recommendations will not work if there is nobody to demand from policy makers that they keep their promises. The most important thing is to not let this initiative die.”

All photo credit: UNAIDS/Serge Golovach

Links:

View photo gallery
Listen to interview with UNAIDS Deputy Executive Director Deborah Landey
Visit the Global coalition on women and AIDS' web site
Visit UNDP's web site
Visit AIDS Info Share's web site

Women against AIDS tour was conceived in the midst of a growing concern that women are increasingly at risk of HIV infection in many parts of Eastern Europe and Central Asia. The percentage of adults living with HIV who are women has risen from 11% in 1990 to 28% in 2006.

The tour was sponsored by the AIDS Infoshare organization, UNAIDS, the Global Coalition of Women on AIDS and the United Nations Development Program. Ten AIDS advocates from the region with special guests joining at various points travelled together to learn about the realities of women and AIDS in different parts of the region and also to mobilize local policy makers to act on these issues.

Moscow, 27 May - The team is at Sheremetievo Airport. Could not wait to look at the posters and unpacked them right before flying to Almaty (Kazakhstan).

Kazakhstan, 27-28 May - Elnara Kurmangalieva (State Centre for Healthy Life Style) informing about HIV prevention programmes among youth.

Kazakhstan, 27-28 May - Group photograph.

Armenia, 29-30 May - Oganes Madoyan (Real World - real People) opens the discussions. None of the HIV positive women from Armenia was ready to talk openly and express the needs of the community.

Moldova, 30 May-1 June - Aleksander Shishkin (actor and DJ) first on the right side, joined the round table discussions to support implementation of gender specific programmes in Moldova. He also reiterated the need to carry out information campaigns on HIV prevention for young people.

Moldova, 30 May-1 June - Igor Kilchevski (Credinta) offers to discuss the recommendations of the project participants. High stigma and discrimination is perceived by women living with HIV in Moldova.

Ukraine, 2-5 June - Welcoming remarks by Anna Grekova (All-Ukrainian Network of PLHIV) at a press event.

Ukraine, 2-5 June - A cameraman filming for the national TV channel. The media can play a critical role in reducing stigma and discrimination towards women living with HIV.

Moscow, 6 June - UNAIDS Deputy Executive Director Debbie Landey plays a key role in addressing gender dimension to the response to HIV. She actively participated in the Tour.

Moscow, 6 June - Round table participants: (from left) Natalia Ladnaya (Federal AIDS Centre), Sergei Golovach (Photographer), Anna Dubrovskaya ('Golos Anti-SPID' NGO, Ufa, Russia), Elena Tamazova (UNAIDS, Russia), Anna Grekova (All-Ukrainian Network of PLHIV), Debbie Landey (DExD, UNAIDS), Vladimir Pozner (President of the Russian TV Academy), Lyudmila Untura ('Childhood for All' NGO, Moldova), Maria Ivannikova (AIDS Infoshare, Russia), Tatiana Stupak ('Victoria' NGO, Kazakhstan), Larisa Dementieva (Federal Service for Protection of Consumer Rights and Human Wellbeing)

All photo credit: UNAIDS/Serge Golovach