Kyrgyzstan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

At the end of January 2021, the Kyrgyzstan Constitutional Court decided to exclude HIV from the list of diseases that prevent people from adopting children or becoming guardians or foster parents. The barrier to parenting for people living with HIV in the country had been in effect for many years.

The change—brought about by a joint effort of activists, lawyers and human rights defenders, but primarily by people who personally suffered from discrimination and fought for their rights—is a victory against stigma and discrimination against people living with HIV in Kyrgyzstan.

Baktygul Israilova, pictured above and who leads the Country Network of Women Living with HIV, is one of those who were affected. Several years ago, she wanted to adopt a child. “At that time, I did not fully understand the depth of the problem. I thought that if I prepared all the necessary documents, submitted them to the right department, they would consider me and make a positive decision,” Ms Israilova said. “I am a mother of two wonderful girls, I have a job, a stable job, so at that time it seemed that everything should be on my side.”

When she found out that she could not adopt a child because of her HIV status, she was shocked. “I’m used to the fact that people living with HIV are constantly discriminated against, but why can’t they become parents and give their love and care to a child from an orphanage?” she said.

At that time, Ms Israilova was starting on her path in HIV activism. “Until that time I was always afraid of something, at first my HIV status. I was worried for my girls, I was worried that I would not find a job, I was afraid that people would not understand me, I was worried that I would not achieve anything in my life. But then I became tired of being afraid. It was a turning point in my life. It was then that I openly declared my HIV status and became the first woman in the country openly living with HIV.”

According to the Kyrgyzstan National Statistical Committee, in 2019 there were more than 2000 children and adolescents under the age of 18 years who were left without parental care, of which 592 were orphans.

In 2018, Ms Israilova met Svetlana Izambayeva, pictured above, an activist from the Russian Federation who is living with HIV and who became one of the first women in the Russian Federation to declare her HIV status openly. Ms Izambayeva had extensive and successful experience in the struggle for the right to adopt in her home country and helped and advised the women in Kyrgyzstan in their battle.

A similar case was being considered by the Kyrgyzstan courts in which the Kyrgyz lawyer Ainura Osmonalieva and lawyers from the Adilet legal clinic were trying to help a woman living with HIV to get custody of her nephew after the death of his mother.

The activists joined forces and resources and studied the entire existing legal framework, international obligations, ratified conventions and the United Nations Political Declaration on Ending AIDS, which the country had committed to implement. The process lasted for two years. Activists from other countries, particularly from the Eurasian Women’s Network on AIDS, helped to collect evidence. The activists highlighted examples of changes in legislation in three eastern European countries—the Republic of Moldova, the Russian Federation and Ukraine. The UNAIDS Country Office in Kyrgyzstan supported the advocacy efforts of the Country Network of Women Living with HIV at all stages and provided technical support to strengthen its organizational and advocacy capacity.

Ms Israilova said that when she had to speak and defend her position before the Constitutional Court judges, she was ready for any developments. “Even if we were given a negative decision, we would not have given up, but tried again and again to achieve a result where every person living with HIV can adopt or become a guardian of a child.”

“When we received a positive decision, I came home and told my girls about what we had achieved. They have long dreamed of a brother and even came up with a name for him. My girls are my light, which illuminates my path. I have managed to achieve a lot in life thanks to the fact that I have them. Now I must prepare all the necessary documents to give happiness to another child,” said Ms Israilova.

Photos: November 2019. Credit: UNAIDS

A new television series for young people in the Kyrgyz language, School Elections, was launched online last week. During six 15–20-minute episodes, a girl, Ayana, who is living with HIV, tells her story of bullying, friendship and the fight for human dignity. The producers of the series hope that Ayana’s example will give hope to young people who face similar challenges.

“We have a simple idea to promote: you may differ from others in your health, appearance or level of wealth. But regardless of this, we all deserve respect, friendship, love and happiness. This series is about kindness and acceptance of others as they are,” said Azim Azimov, Head of Production at the Media Kitchen production studio and the main screenwriter of the series.

Starting on 6 November, new episodes will be aired weekly on YouTube and will also be broadcast on television, Instagram and the teens.kg youth project website. Additionally, each series has one to three interactive episodes—the leading actors invite the viewers to look at the problems raised in the series through the viewers’ eyes, experience each situation for themselves and make their own decisions.

According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), more than 30% of students around the world experience various forms of bullying at the hands of their classmates. Students who are perceived as “different” are often subjected to bullying for reasons of appearance, health status, including HIV status, sexual orientation and gender identity, social status or the economic situation of the family.

“This series tells people about the complex issue in simple and understandable language, to show how strong-willed and honest young people can overcome ignorance, indifference, cruelty and injustice, inspire others and change life for the better,” said Tigran Yepoyan, UNESCO Regional Adviser on HIV, Education and Health.

“This series is a powerful new instrument for reducing stigma in our society, it not only shows the difficulties of living with HIV, discrimination and bullying but also motivates our adolescents not to be afraid to fight for dignity and justice and move forward towards their dreams,” said Meerim Sarybaeva, UNAIDS Country Director for Kyrgyzstan.

The official soundtrack of the series, which was supported by the UNESCO Institute for Information Technologies in Education and UNAIDS, was performed by the singer Ayim Ayilchieva.

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.”

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.”

When the son of Kymbat Toktonalieva (not her real name) was finally diagnosed with HIV after numerous visits to the hospital over many months, it was only the beginning of the fight.

Her husband left her, leaving her to look after their child on her own. She fought for her son and his rights, for justice. She went to court, attended rallies, wrote letters, worked with other like-minded people and helped other women in the same situation.

For the past six years, Ms Toktonalieva has channelled that campaigning zeal into working as a peer consultant in a multidisciplinary team in a family medical centre in Osh, Kyrgyzstan, helping people living with HIV to get services, providing support and motivating them to adhere to their HIV treatment. There are 10 multidisciplinary HIV teams in the country, which were formed by UNAIDS in 2013; they all include a specialist in infectious diseases or a family doctor, a nurse and peer consultants.

The peer consultants come from the same environments and backgrounds as the people who they work with and have faced similar problems. They may be people who are living with HIV or people who have been affected by HIV. They have decided to act, helping themselves and others, often serving as a bridge between the medical workers and people living with HIV.

“Working as a peer consultant has given me an opportunity to help people to overcome their problems, many of which I have come across myself in the past,” said Ms Toktonalieva.

The peer consultants work with the medical staff, directing, prompting, helping, talking and listening. They are trained to be non-judgemental and help people who have recently been diagnosed as HIV-positive to accept their status and to learn to live with the virus.

The role of the peer consultants is being expanded by the COVID-19 pandemic. From the very beginning of the pandemic they were in contact with people living with HIV, delivering medicine to people’s homes so they could stay on treatment during the lockdown, distributing food packages and providing psychological support.

Another peer consultant, Kalmurza Asamidinov, who works in Kyzyl-Kiya, said, “My work brings good, but I can’t say that everything works out perfectly. We work with different people. Some need to be persuaded to adhere to their HIV treatment because they don’t believe in the treatment, while others are tired of taking antiretroviral therapy—we have to find a different approach for everyone. People are increasingly in need of simple human communication. Many clients miss mutual help and the support groups, which we cannot provide during the COVID-19 lockdown.”

The peer consultants working in the 10 multidisciplinary teams each have a different story to tell. Mannap Absamov, one of the peers in the multidisciplinary team in Osh, said, “Initially it was difficult. We were not able to understand the medical staff, and they could not understand us. But slowly we found points of contact. The main thing is that almost simultaneously, both on our side and the doctors’ side, there became a clear understanding that we all have one goal. It is important that their patient and our client go to the medical facility and start getting treatment.”

Both during COVID-19 and after, one thing is certain—peer consultants will continue to play a vital role in bringing HIV services to people living with HIV in Kyrgyzstan. 

She is sitting opposite, dressed in a lab coat, and you know that with her you are in safe hands. Her kind eyes convey empathy. Malikakhon Kurbanova, known to all who know her as Malika, has been a nurse at the Kyzyl-Kiya family medical centre in Kyrgyzstan for almost 20 years.

Part of one of 10 pilot multidisciplinary teams specializing in infectious diseases in the country, she has been working with people living with HIV for many years. The multidisciplinary teams were formed by UNAIDS in 2013 and include a specialist in infectious diseases or a family doctor, a nurse and a peer consultant. The teams aim to improve the quality of medical and social services for people living with HIV and their families. During the COVID-19 outbreak they are receiving extra financial help from a Russian technical assistance programme.

Like many health-care workers, Malika has been caught up in the fight against COVID-19. UNAIDS met her recently in her office in the clinic, adjacent to a blossoming apple orchard, and spoke to her about her background and work.

Why did you decide to become a nurse?

When I was a child, I was quite often sick. My mother and I spent a lot of time in hospitals. I always admired the women who wore lab coats and who knew how to inject me painlessly. I knew then that I would become a nurse and help people. When I graduated from school in 1986, I entered the Kyzyl-Kiya medical college and after that, in 1989, I went to work in the health unit in a construction materials plant. That is how my story began. In the beginning of the 2000s the reform of primary health care started and family medical centres were created. I came to work as a nurse and soon joined the infectious diseases unit, where I still work.

You have been working in the COVID-19 response since the very start of the epidemic in the country. Were you frightened?

We do house-to-house visits, helping people with acute respiratory infections. We are human, so of course it was scary—I was afraid about infecting my family.

It is frightening when you are fighting an unknown virus. In the beginning, I did not know what I should tell patients. At the beginning of the pandemic, many people did not believe the truth about COVID-19; some of them accused us of trying to infect them. But over time, people realized that the virus was real, which greatly helped our work.

You work as a nurse in a multidisciplinary team for people living with HIV. How has your work changed since the COVID-19 outbreak started?

To avoid people running out of their medicine and to reduce their possible exposure to people with COVID-19, we are now distributing three-month supplies of antiretroviral therapy, when before we gave out one-month supplies.

We also focus on psychosocial support for people living with HIV. People need mutual support. Our peer consultant calls patients every day and holds online self-help groups via WhatsApp. Thanks to the financial support given to the project, the transport costs of visiting clients and monitoring their adherence to antiretroviral therapy is covered. The most vulnerable people living with HIV have been receiving food packages since April.

What is the hardest part of your work?

We’ve always had difficulties and they are likely to continue, that is the nature of our work! Sometimes I feel like leaving it at behind, but then I realize that this is my life—I am a nurse. It gives me strength when I see that my actions for my patients bring results and people get better.

Like most other countries, COVID-19 has not bypassed Kyrgyzstan—cases have been seen in the capital, Bishkek, and in almost all other major cities and provinces in the country.

In order to respond to the pandemic, a state of emergency was introduced on 25 March in Bishkek, Osh, Jalal-Abad and three districts, which restricts people to their home from 20:00 to 07:00 and allows people to leave their residence during the day only for a few specified reasons.

Like everyone else, people living with HIV in the country—UNAIDS estimates that there are 8500 people living with HIV in Kyrgyzstan—have faced a variety of challenges, including loss of earnings and difficulties in feeding their families.

In the small town of Karabalta, in the north of Kyrgyzstan, the HIV community organizations Believe in Yourself and the Country Network of Women Living with HIV work to promote the rights of people living with HIV. In the time of COVID-19, however, their services are even more in need.

Umid Shukurov, the Director of Believe in Yourself, explained that since the lockdown in Kyrgyzstan was announced, people living with HIV have got in contact with the organization in greater numbers. Access to food is a major concern for many. “Many people call us in despair, women cry and ask for help. Of course, we help in every way possible, but our resources are limited. When we, together with the Country Network of Women Living with HIV, compiled a list, we realized that 12 women living in our small town are in a distressed situation. Some of them have recently become mothers or are raising their children alone. Yesterday, we distributed food packages and some women could not believe that someone had reached them and brought them some food. The asked me, “Is it real that someone has heard us?”’’

Baktygul Shukurova, the Director of the Country Network of Women Living with HIV, knew that the network would face various problems after it was set up, but never thought that the problems would be of this magnitude. “Our task is to keep people on antiretroviral therapy. I have been through difficult situations in life myself and I know how difficult it can be when you simply have nothing to feed your children with. Only a person who has been through all this can understand the needs of communities. When you and your children have nothing to eat, you don’t care about the medication.”

Access to antiretroviral therapy is being ensured in the country by the provision of mulitimonth dispensing of medicines. During the COVID-19 pandemic, the national AIDS centre in Kyrgyzstan will be providing three-month supplies of antiretroviral therapy to all people living with HIV who are on treatment.

The UNAIDS Country Office in Kyrgyzstan, with the support of a Russian technical assistance programme, is organizing the delivery of food packages, which will supplement other social assistance available for people living with HIV, to 130 families of people living with HIV who have been the most affected by their loss of earnings. Apart from the food, the packages also contain colouring books, marker pens and watercolour sets for the children of people living with HIV, to help them get through the lockdown.

“We hope that this small help will go some way to enabling people living with HIV to remain on treatment,” said Meerim Sarybaeva, the UNAIDS Country Manager for Kyrgyzstan.

Osh, Kyrgyzstan, has become the latest city to sign the Paris Declaration to end the AIDS epidemic in cities, becoming the second city in the country to commit to reaching the 90–90–90 targets by the end of 2020.

“We sign this declaration because we realize that large cities are the engine of HIV,” said Kadyrov Nurbek Suyunbaevich, Deputy Mayor of Osh. “Thanks to effective HIV testing and treatment, we can control the epidemic and people can live a healthy and fulfilling life. The city of Osh is taking steps to end AIDS and we are already allocating funds for HIV prevention.”

“UNAIDS is pleased that Osh has become a Fast-Track city. By signing the Paris Declaration, Osh will also strengthen health systems in the city,” said Meerim Sarybaeva, the UNAIDS Country Manager in Kyrgyzstan.

Osh is one of the oldest cities in central Asia, with a population of almost 300 000 people. It was one of the first places in central Asia to be affected by HIV, owing to the drug trafficking routes that passed through the city. From 2005 to 2007, there was a severe outbreak of nosocomial HIV infections among children in the city. According to government statistics, there are more than 1100 people living with HIV in Osh.

Osh implemented some of the first HIV prevention programs in Kyrgyzstan. The city has expanded its HIV rapid testing programme for people at higher risk of HIV, launched a treatment adherence programme for people living with HIV based on mobile technology and is scaling-up the coverage of opioid substitution therapy. 

“This is an important political step, which requires that we mobilize the necessary resources, both human and financial, to ensure effective HIV prevention programmes for all key populations,” said Aybar Sultangaziev, Director of the Partnership Network Association

Since the launch of the Fast-Track cities initiative on 1 December 2014, more than 350 cities and municipalities around the world have signed the Paris Declaration. The declaration offers cities not only tools to end AIDS but also a platform to address social inclusion and public health.