Maksut Karimovitch Kulzhanov, the head of Kazakhstan’s Public Health Institute and representative for Eastern Europe on the Board of The Global Fund, shares his views on Kazakhstan’s progress
towards MDG 6.
Maksut Karimovitch Kulzhanov, the head of Kazakhstan’s Public Health Institute.
UNAIDS: What would you consider Kazakhstan’s biggest achievement in its HIV response?
Mr. Kulzhanov: I would mention several successes. First, the epidemic in our country is being contained at the concentrated stage and roughly at the same level. Second, public funding of the AIDS response is steadily increasing, and even though these resources are still inadequate, we can consider it as an achievement, seeing ten years ago we didn’t have them at all. In my opinion, an important development is the enhanced work with vulnerable populations and the growing support provided by the government to NGOs. The new law adopted to promote the activities of NGOs is facilitating involvement of civil society in outreach work, which is one of top priorities for Kazakhstan.
UNAIDS: What are the main obstacles for achieving MDG 6 in Kazakhstan?
Mr. Kulzhanov: The main obstacles are probably similar to those found in other countries, such as the complexity of working with vulnerable populations and making the various governmental bodies and authorities understand certain aspects of the epidemic. There are also problems with access to treatment. Today, Kazakhstan doesn’t have the capacity on its own to provide antiretroviral treatment to all who are in need. This is where assistance provided by The Global Fund is crucial, as it helps to maintain treatment coverage at an acceptable level.
UNAIDS: Do you believe that investments in Kazakhstan’s AIDS response contribute to achieving the other MDGs?
Mr. Kulzhanov: Investments into the AIDS response in Kazakhstan is targeted to activities in this specific area. As to other MDGs, in particular decreasing child mortality and maternal health, the government is making serious efforts in this area and some progress has been made. These goals are also a priority for Kazakhstan, which adopted three years ago the WHO criteria, as well as their methodology and approaches. This is already yielding good results.
UNAIDS: What can be done to change the course of Kazakhstan’s HIV epidemic?
Mr. Kulzhanov: A very important aspect is the funding and planning of the response. Unfortunately, in our region – and in Kazakhstan specifically – the governments do not yet have the capacity to ensure funding of the response, and not infrequently they also lack the relevant know-how in this field. That is why we attach great importance to working with The Global Fund, which is virtually the only agency that can make a real impact in terms of funding the response. On the other hand, it is important to work with other international organizations, such as UNAIDS, which provide crucial technical and consultative support.
As a representative of our region on Board of The Global Fund the number one task today is to change the criteria that were adopted by The Global Fund a few years ago and that are now severely restricting our countries in their eligibility for grants. The categories of countries as defined by the World Bank based on their income do not always reflect the reality in all its complexity.
In our region, where the gap between the rich and the poor is very wide, and the overall situation in terms of well-being is rather good, certain populations live in deep poverty. It is exactly within these population groups that the epidemic is spreading especially fast. This is what is overlooked in The Global Fund criteria. We must do everything to change these criteria, so that The Global Fund works for all countries. This is particularly important for our region, which is just a step away from a generalized epidemic.
UNAIDS: What is being done in your country to prioritize HIV prevention?
Mr. Kulzhanov: Our official programmes list HIV prevention among the five programmatic priorities but a lot remains to be done, for example in the area of HIV prevention among migrants. Migration in the region is on the rise. There are legal migrants and illegal migrants, with the latter often being in the majority. They are completely isolated from all services – no access to medical services, education and information. When we conducted a pilot survey at one of the large markets in Almaty, it revealed that among the migrants, mostly represented by sexually active young people, many simply do not know about condoms or other means of protection. So a lot needs to be done in this area. Overall, we lack coordination and better multi-sectoral interaction. We must join efforts at all levels.
