HIV Prevention in Armenia during the COVID-19 Pandemic

Problem

Armenia, like many countries of the world, was no exception during to the spread of a new type of coronovirus (COVID-19) and its consequences. Since March 2020, the virus has shown a frightening growth rate, accompanied by deaths. A critical issue was maintaining the sustainability of services for key groups and adapting them to meet emergency challenges.

Solution

The team of the New Generation, realizing the seriousness of the situation, especially for vulnerable groups, switched to new methods of implementing HIV prevention programs, within the framework of which the following services are provided:

• Dissemination of information on COVID-19  along with information on HIV and AIDS
• Information is taken from  WHO, UNAIDS and the Ministry of Health of Armenia
• Delivery of condoms and lubricants to beneficiaries in convenient places, while maintaining conditions of social distance and hygiene rules
• Delivery of HIV tests to beneficiaries for self-testing
• An online platform for ordering tests and registering results has been created
• Provision of medical masks and disinfectants
• Provision of temporary residences (shelters), financial assistance and food packages to beneficiaries who need it
• Assistance in registering and redirecting beneficiaries to participate in state social programs under COVID-19 conditions
• Psychological and legal 24/7 online consultation
• Online HIV counseling by outreach workers
• Translation of UNAIDS documents, which are published in connection with COVID-19, into Armenian

To prevent the spread of infection, the Ministry of Health announced the call for volunteers. The NGO ‘New Generation’ shared this announcement with employees and volunteers. As a result, more than 20 employees of the organization were registered as social workers and translators to make a voluntary contribution to the fight against COVID-19, and many were already actively involved in the work.

To prevent the spread of infection, the Ministry of Health announced the call for volunteers. The NGO ‘New Generation’ shared this announcement with employees and volunteers. As a result, more than 20 employees of the organization were registered as social workers and translators to make a voluntary contribution to the fight against COVID-19, and many were already actively involved in the work.

Taking into account the situation and the appeal of the  government, it is urgent to provide support to those in need who are in their homes and cannot afford to buy enough food and other necessary things.

In early April, the “New Generation”  launched a fundraising campaign in addition to the National Program of Armenia, which aims to meet the needs of risk groups  (people who inject drugs, commercial sex workers, LGBT people, people living HIV, the elderly, refugees and migrants) and help people in need by buying food and other essentials.

Result

All necessary actions have been taken and during the quarantine period more than 200 people have already received assistance and support.

Sustainability in the real world is created by real people

Task

During the coronavirus pandemic, the key task for us was to ensure the continuity of treatment for people living with HIV, both in Armenia and abroad. At the same time, our work should be focused on providing access to free syringes and alcohol wipes for injecting drug users, ensuring the prevention of HIV infection and reducing the risk of coronavirus infection. It was also important to ensure that key populations and people living with HIV were informed of the necessary preventive measures in the context of protection against coronavirus.

These are the tasks faced by the NGO “Real World, Real People” team as an organization implementing programs on “Care and Support for PLHIV” and “HIV Prevention among IDUs” in Armenia.

Solution

Proactive work of social workers. We took control of the situation and took the initiative: our social workers, peer counselors contacted the beneficiaries of services to clarify the supply of ARVs and provide information on the necessary preventive measures to protect against coronavirus.

Hotline is a strategic communication platform. In March-April, more than 850 calls were registered on the organization’s hotline, and our team switched to an every day work schedule, without days off.
The organization’s employees and outreach workers (about 38 people in total) were provided with personal protective equipment.

Provide support to people in OST programs. The employees of ‘Real World, Real People’ decided to help raise and provide funds for two months of methadone therapy to people who became insolvent due to COVID-19 and the state of emergency, but who received methadone replacement therapy for a fee.

Result

In March-April 2020, ARVs were received and delivered to the home for 963 people, of which 798 were in Armenia and 165 outside the country. Citizens residing outside Armenia were sent to regional partner organizations to receive ARVs. About 80 people were provided with food and prevention supplies. During the state of emergency, free syringes and alcohol wipes were available for IDUs throughout Armenia.

None of the organization’s employees or outpatients were infected with the coronavirus. A two-month payment of methadone therapy was provided for individuals who became insolvent due to COVID-19.

Vital services should be provided

Problem

It is estimated that there are 8,100 PLHIV in Azerbaijan, 6,804 of which were registered at the AIDS center at the beginning of 2020. The HIV epidemic in Azerbaijan is concentrated among key population groups, with the most significant epidemic process among IDUs and MSM. But this trend is gradually declining. If we consider the percentage in comparison, it used to be 64%, now is about 50%. In the new realities of the pandemic, the need arose for comprehensive HIV + COVID-19 prevention. One of the most important focuses during the period of the new threat was to provide the necessary protection for the people we help in order to protect them as much as possible from the risk of infection with COVID-19.

Solution

The main task for the Public Union Against AIDS team was to provide and to continue providing services, adapting the format in accordance with the challenges of the COVID-19 pandemic. The focus was on the prevention in the combination of HIV + COVID-19.

During the pandemic, the team of the Public Union Against AIDS went on providing IDU services by complementing basic services with the prevention elements of COVID -19.

In addition to safety counseling, we have expanded the list of organization services with new ones in response to the challenge of a new time:

• First of all, we provided all our team with necessary means of protection and prevention (masks, gloves, sanitizers).
• Arranged the delivery of ARV medication for people living with HIV, who for some reason could not go to get them on their own.
• Special online platform was created in our country where it was possible to issue the permission for employees to move during the quarantine. We did immediately for everyone, so that we don’t have to go there twice, so to say.
• We have optimized harm reduction services: to distribute syringes and other sterile materials to outreach workers, the routes were adjusted according to the place of residence. We began to give clients more syringes and sanitary napkins, for 2 months of the pandemic we have more clients on secondary exchange.
• The syringe exchange point in Baku works without interruptions.
• An important step by the state was to provide financial support to people who lost their jobs during the pandemic. The state began to pay benefits of $115 to people who had no income or lost their job within two months. Our employees helped our clients to get this money.

Result

Our work is still going on and after the pandemic we will definitely leave some improvements and changes in the work of services aiming at preventing not only HIV, TB, HCV, but also COVID-19.
For 2 months of quarantine, we have provided support and vital services for nearly 3,000 clients.

Sustainability of services for the transgender community in an emergency

Problem

It is estimated that there are 8,100 PLHIV in Azerbaijan, 6,804 of which were registered with the HIV service at the beginning of 2020. The HIV epidemic in Azerbaijan is concentrated among key populations, with the most significant epidemic process among IDUs and MSM. The transgender (TG) community is becoming more visible in Azerbaijan. Studies in 2018 showed a high involvement of TG in sex work and increased sexual risks, for example, 74.3% provide sexual services for a fee with an average number of partners of 360 per year. 5.7% of respondents reported HIV-positive status. TG programs are already being implemented under the current grant funded by the Global Fund. By December 2019, 797 TG services were provided in the city of Baku; plan for 2020 is 950. The “regular” package of services includes counseling, distribution of condoms (260 per person per year), lubricants (40 per person / year); IOM available upon request. But during quarantine, the issue of service sustainability was especially acute.

Solution

The NGO ‘Gender and Development’ decided to continue providing services, adapting the format according to the challenges of the coronavirus pandemic. The focus was on HIV + COVID-19 prevention.

Result

During the epidemic, the Gender and Development team continued to provide TG services, focusing on HIV + COVID-19 prevention.

In addition to safety consultations, this is what employees did:

• ARV medications delivery for HIV-positive members of the TG community;
• fundraising for poor beneficiaries to deter them from the risks of sex work;
• distribution of condoms and lubricants for home delivery;
• distribution of condoms and lubricants at limited hours in the NGO office in compliance with all safety measures – masks, gloves, etc .;
• distant consultations of the psychologist by phone.

The work is ongoing and is aimed not only at preventing HIV infection, but also at preventing coronavirus among representatives of the TG community. In particular, in a pandemic, employees recommended TG to suspend sex work because of the risks of coronavirus infection.

For 1.5 months of quarantine, more than 250 TGs received services.

HIV testing and support for homeless people

Problem

Due to the pandemic of the coronavirus infection COVID-19, many of the homeless people lost regular support, and adequate access to medical services, which were difficult to get at the usual time, became practically impossible. The high level of stigma and discrimination in the terms of which they live increases the risk of contracting not only COVID-19, but also tuberculosis, HIV, hepatitis and other diseases.

Solution

The UNAIDS office in Belarus, together with the Street Medicine volunteer initiative, the HIV service organization Positive Movement, and the Ministry of Health launched a project to provide HIV testing and support for the homeless during the COVID-19 pandemic.

Working on the streets, project volunteers not only provide means of prevention, carry out HIV testing, but also provide first aid, do dressings, hand out over-the-counter medication, hygiene products, advise and refer for treatment. Along with testing and distribution of condoms, a survey is being conducted, thanks to which it is planned to identify possible ways of transmission of  HIV infection and to identify basic needs and barriers to get services and treatment.

Result

It is planned to test about 200 people only in Minsk in the first phase of project.

Quarantined HIV

Task

Since March, the Minsk City Hospital for Infectious Diseases on Kropotkin Street began to work with patients who have diagnosed with COVID-19. But it is the only health facility in the city that deals with the issue of dispensation of ART medications. In order to separate the flows, the hospital made various entrances, but it is still psychologically difficult for HIV-positive people to come there. A lot of patients preferred to be self-isolated. The social workers from the organization Positive Movement decided to deliver therapy to people at home so that no one had to interrupt treatment.

Solution

Our group of activists from NGO Positive Movement decided to organize targeted delivery ART people living with HIV in Minsk. In cooperation with the Minsk City Clinical Hospital for Infectious Diseases, we got phone calls collecting applications while maintaining strict confidentiality and the rules for preventing coronavirus infection, started delivering medications.

Using public transport, it is quite difficult to make more than 10 medication deliveries per day. In this matter, colleagues from the UNAIDS Office in the Republic of Belarus came to our aid. Now there is an opportunity to move by car, and our productivity has increased significantly.

Delivery is carried out according to a flexible schedule, during working and non-working hours, including weekends. This is due to the fact that people have different work schedules, and we are adjusting to ensure that everyone is provided with medication on time.

Result

ART delivery is done daily basis for 30-50 locations, helping people get vital medicines. It is under our control to take care of the human security in the terms of the COVID-19 pandemic.

ART: we will not leave you in trouble

Focus: people from Europe and Central Asia

Problem and task

The ITPCru Treatment Preparedness Coalition, together with Life4me +, is helping people living with HIV from the EECA region and other countries of the world who are forced to stay abroad due to interrupted intercountry transport linkages. The problem is that for successful treatment of HIV, these medications must be taken daily. It is not always possible to purchase ARVs in a pharmacy, and even if possible, a doctor’s prescription is needed.

Solution

The point is a simply one: a person contacts ITPCru and / or Life4me +, and the team through their contacts helps to find ARV medication.

Results

According to the latest data, our organizations got about 140 messages (for now their number has increased by about two and a half). Most people received vital medications; for the other, is being worked on.

A united database of startups and innovators from around the world to help with fighting against COVID-19

Task

In a pandemic, timely information is an important aspect of the response to the viral threat. Coronavirus is a problem requiring new and quick solutions, therefore, the timing of communication between thematic startups and users is essential. Accordingly, there was a need to create a single online resource for exchanging information with all interested parties. A special platform containing a complete map of innovation regarding the status of the virus, the fight against it and its consequences.

Solution

StartupBlink in collaboration with the Healthcare Innovation Exchange, a UNAIDS program designed to deliver innovation to the public health service, and the Moscow City Innovation Agency introduced an innovation map for the fight against coronavirus.

The platform is a database of startups and innovators, which allows you to learn about new projects and gives you the opportunity to connect and create solutions in this field. The map contains information on five categories: prevention, diagnosis, treatment, information and adaptation of life and business.

Result

Over 500 innovations and developer contacts have already been presented on the platform in the public domain. The Health Innovation Exchange is planning to publish a report with a list of selected innovations to be presented to partner countries.

Expanding Access to Vital Technologies

Task

Patents and licenses for modern medications for the treatment of various diseases (in particular, such as HIV infection and related opportunistic infections, tuberculosis and others) limit the competition of offers, promote non-transparent pricing and the high cost of treatment. As a result, access to the necessary medicines for a large number of people requiring treatment is difficult, and effective timely counteraction to the spread of diseases is complicated, and it is impossible to reduce mortality and to improve the quality of life of the world’s population.

Solution

UNITAID focused entirely on work in response to the global COVID-19 pandemic. Work was conducted with the Patent Pool of Medicines (MPP) to voluntarily pooling of intellectual property rights in medicines and diagnostics to help the global fight against the disease. The MPP, created by UNITAID ten years ago, has a proven record and is able to start work immediately with the support of WHO.

Result

The MPP Council made a decision to expand temporarily its mandate including any healthcare technology that could contribute to a global response to COVID-19 and where licensing could facilitate innovation and access.

This will allow the MPP to offer its intellectual property and licensing experience to the World Health Organization (WHO) to help the world cope with the COVID-19 pandemic.

The MPP decision came after UNITAID announced the allocation of $ 30 million for innovative products for the treatment and diagnosis of respiratory diseases as part of the global response to the COVID-19 pandemic.

ART HELP Hotline

Problem and task

Due to the COVID-19 pandemic and state restrictions, more and more people living with HIV are seeking help outside their native countries in gaining access to life-saving antiretroviral therapy (ART). Failure to cross borders during blockages, overloaded health systems that are poorly adapted to meet the needs of migrants and foreigners, stigma, discrimination, and sometimes, even, criminalization of PLHIV and key populations – all these issues contribute to the risk of ART interruption. We do our best for the person seeking help to prevent treatment interruption.

Solution

A person, who needs ART, contact us and we help him/her to find the necessary medications in the country where he/she is. ‘Stuck in another country without ARV therapy? Email arthelp19@gmail.com, we will help.

Result

Since April 21, during the three weeks of the project, 28 people have contacted us, 24 of which have already received medications, 4 inquiries are still in process. We got messages from Russia, Greece, the USA, Ukraine, Poland, Turkey, Uzbekistan, Latvia, Georgia. Anyway, we do not have such an answer ‘No, we can not help you.’

There is always another way.

No one living with HIV in Estonia should be left without support

Context

On March 12, in connection with the global coronavirus pandemic and its possible wider spread in Estonia, the authorities imposed a state of emergency in the state until May 17, 2020.

Maybe, this is trivial, but, unfortunately, all our organizations and communities had a hard time in these difficult conditions of the COVID 19 pandemic. This is a kind of exam, a litmus test that showed where and at what stage we are. Some previously paid more attention to their career development, the visibility of the organization, the significance of the ‘career’ organization…

But the main thing is that all of us now remain honest, responsive and ready to help others. At the same time, our business requires a lot of time and effort from us, a simple definition of the organization of communities is those who help other people who are at their worst right now … Helping people today, we help ourselves to be realized. Of course, only if our intentions are good. Other organizations and people have to live a long fate in order to find themselves, their calling. Very often the soul hurts for what is happening nearby and around. And there is so much pain and suffering in the world now. The great ones said that suffering exalts, but perhaps they destroy our false ideas about life, make us think. So, the way the world works that something is acquired only at the cost of losing something. I don’t want to make an associative series with our socially significant diseases, and yet, for example, health is the more significant the loss, the greater the internal destruction and the likelihood of breakdown, but there is a greater likelihood of finding the possibility of stronger resistance – to live despite everything. What got a person who went through hardships and destruction – exaltation or humiliation -, he was only aware of this. And here it is so important not to be alone, despite our differences. HIV-positive and HIV-negative, representatives of state structures and non-governmental organizations, cultural and business figures, men and women, sexual and national minorities, emigrants and migrants, disabled and economically active people, religious figures and atheists, advocates of the ‘war on drugs’ and ‘harm reduction’ , national and international unions and networks, etc. and etc. – we will certainly solve, if not all, then many of the challenges and problems, and maybe not only them, maybe it is in our diversity that there is a panacea for our troubles … To be together is then a lot of strength for us and we will be able to get closer to global initiatives on the one hand, and on the other hand, to help those very people who so need our participation, – Lachin Aliyev.

Solution

In response to the coronavirus pandemic, we, taking into account the need to preserve the health and safety of employees and customers, organized the provision of all services online so as to ensure their availability for those who need them.

All personal consultations, including a psychologist, a social worker and counselors, were transferred to the online mode (mobile, Skype, ZOOM, social network messengers).
Due to the emergency situation and the impact of the COVID pandemic, we purchased and distributed among the staff and customers the means for preventing coronavirus (masks, sanitizers, disposable gloves).
Information resources are mobilized as part of the Consortium of Estonian communities of COVID-19 and HIV, which serves as an information center to track the latest news about COVID-19 and transmits accurate information to other groups of civil society.

Since the epidemic began, the Estonian network of PLHIV began to work nonstop in a special mode. No one who needed our help was left unattended, but at the same time, our activities are not able to fully satisfy all the needs of our customers without the help of the state. Therefore, the Estonian Network of PLHIV, on behalf of representatives of communities affected by HIV, addressed an open letter to the Estonian Government, the Social Ministry and municipalities.

The Estonian Network of PLHIV has joined UNAIDS recommendations and appealed to the Estonian Government, paying attention to the following:

• HIV services, including access to condoms, opioid substitution therapy, sterile needles and syringes, harm reduction and HIV testing should be available to people living with HIV and at risk of HIV infection.
• It is necessary to switch to the full implementation of the medication dispensing for the treatment of HIV infection for a longer period – starting from three months or more.
• It is necessary to ensure access to services for representatives of vulnerable groups and remove financial barriers, for example, payment for services – 5 Euros per visit to the doctor.

Result

The Estonian Network of PLHIV has taken over a mission of supporting PLHIV, who have encountered difficulties due to the inability to come back to Estonia, as well as to persons who are in Estonia on working and student visas. Within a month, support was provided for receiving ART to representatives of Ukraine, Moldova, Belarus, Germany, and Israel.

In 2 months of quarantine, more than 300 clients have used the services.

We offer you to join in order to pay our respects to people died of AIDS and COVID-19.

On World Remembrance Day of AIDS Victims, the Estonian Network of PLHIV addresses the people of Estonia to remind them that the human right to health is the basic right of each of us. Join us:

• Light a memorial candle on a terrace, a balcony, in a garden or wherever you want
• Remember and pray for relatives, friends, acquaintances, who have died from AIDS or COVID-19
• Share your memory and photo with us on social networks and do not forget to tag us #ehpv or @EHPV – Eesti HIV-positiivsete võrgustik

Quality psychological services for the trans* people community in the context of the COVID pandemic

Problem: Trans* people are one of the most marginalized groups in Georgia. There are strong transphobic attitudes in the society, as well as in various institutions and the legislation.

Solution: Operational research among Trans* people conducted within the SoS project was extremely important for our community. This was the first study conducted specifically among Trans*People in Georgia providing important recommendations. We believe that this study will be the basis for the introduction of various services and activities to improve the lives of trans people in our country. It is also to some extent the basis for other in-depth studies that will help the governmental and non-governmental sector to properly plan their own activities.

Results: This study identified the need for quality psychological services for the Trans* community and with the support of Sos Project, we have established a free psychological service in the Trans Led community organization “Queer Association – Temida”. The service currently employs two psychologists and online or offline they conduct therapeutic sessions with members of the Trans* community from all over Georgia. Since the beginning of this initiative, overall 250 psycho-therapeutic sessions have been delivered to the beneficiaries. By providing this service, we have helped many community members to overcome psychological problems that were even more important and urgently needed in the context of the COVID pandemic. For the sustainability of this service, we now strive to include it in public health programs, as well as programs funded by the Global Fund.

The study looked at experiences of hate-motivated crimes and other forms of violence or discrimination in Trans* people, which was quite prevalent with 75.8% of participants reporting having been a victim of some type of discrimination over the past 12 months. That is why “Temida” has joined the REAct platform, which today allows us to document and describe various cases of violations among Trans* community, offer legal consultations to beneficiaries, and also develop recommendations for improving legislation and practice.

Cannot meet up? – Go online!

Task

I work in Tanadgoma as a social worker. I also collect cases of human rights violations in the REAct system: if something bad happens, members of my community contact me and we help the victim. Due to the state of emergency and quarantine, I can no longer come and communicate with members of my community.

Solution

I thought: ‘They are all young, so they must be on social networks.’ I started looking for cases of violation of the rights of representatives of key groups on Facebook. I follow communities where LGBT people and sex workers share information and seek help when their rights are violated. In addition, I track hate messages and contact the victim directly to provide psychological support and legal protection if necessary.

Results

Several cases of human rights violations and discrimination have already been found through social networks. We work with a lawyer to resolve them. Community members request online consultations and support during this period.

Smaller teams – more sustainable services

Task

Preventive measures in Georgia were quite strict from the very beginning. We had to find a solution to continue working, as our clients really need us.

Solution

It was decided to restructure the work schedule, optimize working hours and divide employees into several permanent shifts. Thus, in case of infection of one person – only one group (in which this person worked) will go to quarantine, while other groups will continue to work. At the same time, we minimized the number of contacts of each employee, since they worked with the same people. A special guide that outlines work schedules, safety precautions, and operating
rules during the COVID-19 pandemic has been developed and approved. All service areas were provided with safety equipment (including masks, disinfectants, gloves, medical gowns, etc.).

Results

All the employees are happy and healthy ☺

And clients have uninterrupted services.

Features of an operational study on the acceptability of HIV self-testing in a pandemic

Task

As part of the SoS_project, in early 2020, the Georgian Harm Reduction Network launched an operational study to assess the acceptability of HIV self-testing among men who have sex with men and people who inject drugs in Georgia.

The overall objective of the study is to determine the acceptability of HIV self-testing to improve test coverage and communication with medical care by distributing oral fluid and blood test kits among MSM and PWID in Georgia. Due to the outbreak of coronavirus, Georgia declared a state of emergency and imposed some restrictions on movement and assembly throughout the country. Starting from this period, the number of outreach visits, as well as visits to facilities, fell sharply, and the data collection for our study was interrupted. We needed to find a way to continue our work under quarantine, since it was not clear how long it would last, and we did not want to abandon an effective and potentially very useful and important initiative.

Solution

To ensure the uninterrupted provision of services, a special operational guide was developed for sites providing services to the Georgian Harm Reduction Network, which indicates work schedules, safety measures and operating rules during the COVID-19 pandemic. Due to the limited possibilities of using the outreach approach, priority was given to distributing self-testing kits on sites. In addition, with the support of the SoS project, a one-month supply of safety products was purchased (including masks, sanitizers, gloves, medical gowns, etc.), which were delivered to organizations and sites participating in the study, which helped the employees involved necessary protective measures for themselves and ensure the safety of clients during their visits.

In addition, it is planned to launch home delivery of test kits. Social workers will contact the beneficiaries over the phone and through social networks, request consent to participate in the operational research and offer home delivery of the test kit.

Result

Thanks to the measures taken, about 250 test kits were distributed. Despite the quarantine restrictions, it helped 250 representatives of key groups not only to find out their HIV status, but also to improve the quality and increase the life expectancy of their closest associates, their partners, as well as learn about vital and necessary interventions, which will allow them, if necessary, to undergo retesting in the future on their own, without involving social and / or medical workers. And the result of the operational research, of which these people became a part, will help to inform and guide further work with these key groups.

Training for human rights professionals during the COVID pandemic

Problem:

In Kazakhstan, people living with HIV and key populations face serious difficulties in obtaining resource assistance from the state. A number of regulations in the country provide access to healthcare guaranteed by the Constitution of the Republic of Kazakhstan. However, due to the COVID-19 pandemic, it is difficult to hold face-to-face meetings to train future human rights professionals, although the need remains urgent.

Solution:

We created an online course “Human Rights in the Context of HIV”, which provides a basic understanding of human rights protection for people living with HIV. It was developed for PLHIV, NGO employees, it can be useful for human rights defenders, social workers and employees of government agencies, teachers, participants of the National Preventive Mechanism and other interested citizens involved in the protection of human rights.

The aim of the course is to build the capacity of key communities in Kazakhstan in the widespread use of human rights protection instruments. The 3 modules, each with different subtopics, were developed by HIV experts from Kazakhstan and Ukraine. Online training consists of video lectures, assignments, discussions and zoom meetings.

Result:

The total number of people who took part in the online school was 29. The number of people who completed the pilot course was 10. As a result of the training, 1 graduate of the pilot course became a member of the National Preventive Mechanism. Online training we covered: Karaganda region, East Kazakhstan, West Kazakhstan, Kyzyl-Orda, Pavlodar and Akmola regions.

To date, more than 110 people have completed the course “Human Rights in the Context of HIV” on the Stepik online learning platform. It is fully accessible to absolutely everyone! Link to the course – https://stepik.org/course/84152/info

New challenges create new resources for NGOs

Problem

During the state of emergency and quarantine throughout the country, people living with HIV were in a difficult situation. Many lost their jobs and were left without a livelihood. Activists of HIV-service NGOs note the lack of personal protective equipment for employees and volunteers of organizations. Clients of NGOs need food packages, protective equipment (masks, gloves, sanitizers), as well as stable communication with consultants by phone or through the messenger, but due to loss of income they do not have this opportunity. This situation significantly increases the risk in people living with HIV (PLHIV) of COVID-19.

Solution

The Kazakhstan Union of PLHIV, together with the Central Asian Association of People Living with HIV, UNAIDS and NGOs, using the rapid research method, collected information on the needs of NGOs and people living with HIV in Kazakhstan during the pandemic and total quarantine. Activists wrote an application for a grant to the Soros Foundation-Kazakhstan to attract resources for operational assistance to PLHIV in the form of food packages, personal protective equipment against COVID-19, as well as providing technical support to NGOs regarding the prevention of COVID-19 among clients.

Result

Grant application was approved by donor. And now, in five cities of the country – Karaganda, Petropavlovsk, Taldykorgan, Nur-Sultan and Shymkent, active work has begun to provide one thousand PLHIV with food packages and personal protective equipment against COVID-19 through the issuance of special certificates. In addition, the training of five HIV-service NGO employees on how to organize thematic online meetings and webinars began. Active work will continue until the end of August 2020.

Substitution maintenance treatment during quarantine

Task

Patients of substitution maintanance treatment (PST) in Temirtau, Karaganda region (Kazakhstan) have limited access to the treatment of a chronic disease guaranteed by them by the state. In Kazakhstan, participants in SMT programs are taking the medication at mental health centers under the direct supervision of medical personnel. From mid-March 2020, the building of Temirtau Narcology Clinic was reallocated to the hospital for patients with COVID – 19. Program participants are forced to receive treatment in Karaganda. The quarantine restrictions introduced on March 18, including restrictions on the movement or cancellation of public transport services, make it very difficult to receive daily treatment for SMT patients residing in Temirtau. These restrictions put them at risk of being fined for violation. In turn, patients with SMT cannot fully comply with the recommendations on self-isolation to effectively protect themselves and their loved ones from  COVID – 19.  

Solution

Activists of the Forum of People Who Use Drugs of Kazakhstan published a post on Facebook  calling all the stakeholders to pay attention to the critical situation in Temirtau. After negotiations with the head of the regional narcological clinic, the situation changed. Civil activists were supported by the Eurasian Network of People Who Use Drugs and the Kazakhstan Union of People Living with HIV.

In order to unite efforts, a working group was created with the participation of international organizations – UNAIDS, the United Nations Office on Drugs and Crime in Kazakhstan. Letters calling for urgent action were sent to K. Tokaev, the President of the Republic of Kazakhstan, and E. Birtanov, the Minister of Health of the Republic of Kazakhstan.

Result

People on SMT received special permits issued by the regional health department, which allow them to visit the medical center without fear of being fined. A car has been allocated to patients with SMT for transportation to the site. Program participants can access  inpatient hospitalization in the addiction department for the period of quarantine.

Today, community activists are seeking to restore access to SMT in  Temirtau with the possibility of enrolling new patients, and in the whole country the possibility of handing out take home medicine.

Continuity of patient treatment as a result of well-coordinated work of NGOs

Problem: During an emergency, related to a sharp increase in cases of COVID-19, when it turned out to be a problem to go outside the house, people living with HIV could not simply go to medical centers and get treatment. It was a big question about the continuity of patient care.

Solution: Partnership Network Association immediately organized a number of mobile teams in the regions of the country to deliver and dispense treatment to the patient’s place of residence. Mobile brigades had passes through the city and could carry out this process without hindrance. It made it possible to keep a certain part of HIV-positive people on treatment. According to statistics, 36% were retained on ARV therapy during the pandemic (in 3 out of seven regions: Chui, Jalal – Abad and Osh, the remote areas of these parts of the country).

Result: Thanks to the well-coordinated work of NGOs and medical institutions, there were no cases of refusal from ARV therapy in our country.

If we are united, no pandemic can beat us

Task

Kyrgyzstan is one of many countries affected by COVID-19. Already in mid-March, an emergency situation was announced in the country, and in April – a public emergency regime. Difficulties arose from different angles. We are a young foundation and faced similar situation for the first time. But not only us. In the country as a whole, problems have begun with the provision of medicines for HIV-positive people. Many people lost their jobs, accommodation, and some simply did not have the means to buy food. Difficulties in delivering drugs to HIV patients arose.

The provision of facial masks also caused difficulties, as masks at some point simply disappeared from sale in pharmacies. There were difficulties in obtaining a pass to move around the city, even for volunteer purposes.

We understood that the situation with COVID-19 could drag on for weeks, months, and we need to respond and do something now.

Solution

We, as a newly made foundation, analyzed how to organize our activities in order to make a feasible contribution to helping PLHIV in the context of COVID-19. Delivery of ART was agreed with the doctors of the AIDS center. Our partners were involved in receiving ARVs. Therefore, we have joined the collection of products for those in need. Volunteers worked all days long so that HIV-positive patients had a chance to receive the necessary medications on time, as their lives depend on it. Special volunteer teams were also organized to collect and supply the necessary food kits. Some of the shops and offices of colleagues have become a kind of “hubs” where you can ask for the necessary help, as well as leave a charity package for distribution to those in need. Our volunteers, on bicycles and on foot, took orders – the necessary food and medicine, including antiretroviral drugs – and delivered them to patients. In addition, we tried to provide volunteers with the necessary protective equipment on a regular basis. We also organized the distribution of protective equipment at large grocery stores and supermarkets in the city.

HIV-positive citizens of other countries remained on the territory of our country, they also obtained assistance  thanks to the work of the AIDS Center in Bishkek and such funds as CF ‘Ranar’ and CF ‘Plus Center’.

Result

There is a saying If you helped at least one person, it means that the day will not be spent in vain. This motivation was inspiring to volunteers and workers. For 2 months of the pandemic, we supported at least 70 PLHIV. Our organization, the Central Asian Association of People Living with HIV, and CF ‘Ranar’ worked in Bishkek, and CF ‘Plus Center’ worked in Osh and Jalal-Abad.

The pandemic is not over yet, and it is supposed that we’ll face another outbreak this autumn. We are ready for new challenges and will be ready, if necessary, to help PLHIV, our partners and colleagues.

Can they really hear us?

Problem

Due to the situation with coronavirus in Bishkek, Osh, Jalal-Abad and three districts, the state of emergency has been operating since March 25. Citizens residing in these territories are strictly forbidden to be on the street during curfew hours  from 20:00 to 7:00. In the daytime it is allowed to leave the house only to a store, pharmacy or health  facility. You need to have a passport and a route sheet with you. An emergency mode has been introduced in the rest of the country.

Communities of people living with HIV, like other citizens of the country, faced various problems, among them the loss of daily income and the inability to feed their families.

Solution

Local family medicine centers, together with NGO staff, compiled lists of such families across the country. It was decided to find financing to provide such families with special kits. In addition to basic products, the set also includes coloring books, felt-tip pens and watercolors for children of people living with HIV, which are designed to minimize the mental consequences of quarantine. Such minimal assistance helps maintain adherence to ARV treatment, people will not refuse therapy, since they will have basic food needs for a period of lack of earnings.

Result

The UNAIDS Country Office in Kyrgyzstan, with the support of the Russian program of technical assistance to countries of Eastern Europe and Central Asia in the fight against HIV / AIDS and other infectious diseases, will organize delivery of food packages for 130 PLHIV families most affected by the loss of daily income over the next 3 months.

Advance work has helped ensure the sustainability of treatment

Task

Kyrgyzstan, like most countries in the world, has been affected by the coronavirus pandemic. In the context of this, we had the task of ensuring uninterrupted access to the citizens of Kyrgyzstan, both in the country and forced to stay outside it.

Solution

The ‘Partnership Network’ Association, even before the state of emergency was declared in the country on the 10th of March2020, suggesting future difficulties in providing medicines for PLHIV, patients with tuberculosis and PTM clients, initiated the delivery of drugs for long periods. As a result, the NFC, the AIDS Center issued instructions for the release of ARV medications up to 3 months, and TB medications up to 2 weeks.

In addition, we fully took upon ourselves the coordination of the provision of ARV medications to citizens who are outside the country in migration. Together with our partners from other countries, with the AIDS Center, to date, lists of all PLHIV who are outside the country to whom ARVs are provided have been compiled.

Result

Thanks to the advancing work, there is not a single case of treatment interruption in the country due to the inability to get to the places where medicines were received.

Also today, among the citizens of Kyrgyzstan who are abroad – 24 people have already received and 33 more will receive medicines as soon as their supplies run out.

It is important to note that with this approach it was even possible to return 4 people to the treatment program who interrupted it earlier.

Coordination of efforts of all interested parties and planning of work with consequences of the COVID-19 pandemic

Problem

The COVID-19 pandemic has had a significant impact on the availability of HIV services in Kyrgyzstan. A state of emergency was introduced in the country since March 25, 2020, which was extended until May 10, which limited the free movement of citizens, including in order to receive medical and social services not directly related to a direct threat to life. Despite the fact that PLHIV and people with TB were provided with medicines for a longer period at the beginning of March, the healthcare system was under severe stress. From the current situation, medical workers were afraid of becoming infected with COVID-19 and minimized their contacts with any patients. Some facilities refuse to accept patients, explaining this by the lack of protective equipment and conditions for separation into “clean” and “dirty” zones.
Considering that all coordinating structures have focused their efforts on localizing the epidemic, most other issues have been postponed. For an unlimited period of time, attention has been reduced to the implementation of national strategies and government programs in the branch of health. Obviously, state social procurement programs will not be implemented this year, and the planned increase in funding for HIV and TB projects will be frozen. Meanwhile, due to the COVID-19 pandemic, priorities in financing health care programs, including procurement by medical facilities, are being revised, and PPE procurement is expanding due to a reduction in other procurements, including medicines. Due to the difficult economic situation, the risks of incomplete and untimely financing of health care services increase.

Solution

All of the above will obviously affect the future of HIV programs. Therefore, it is necessary to make attempts to predict the near future and determine an action plan, to form service models that will ensure the effectiveness of measures to achieve goals 90-90-90.

Result

The ‘Partnership Network’ Association, with the support of UNAIDS in the Kyrgyz Republic, has developed a country plan for adapting HIV-related programs to work in the context of the COVID-19 pandemic. This plan has been submitted for consideration and approval to the CCM and the Ministry of Health of the Kyrgyz Republic, and we hope that it will allow us to switch from a mode of randomness in emergency situations and solving urgent tasks to support our key groups to continuing to work systematically to provide services to our groups and achieve goals 90-90-90.
It has already been decided tentatively that the plan will also include measures for tuberculosis and it will become more comprehensive, relying on it, our country can submit an additional application to the Global Fund, revise the current budgets of international projects and approaches to implementing programs.
This is a real achievement of the joint work of diplomats and the public. First of all – the Senate of the Oliy Majlis of Uzbekistan, the Government of the Republic of Uzbekistan, the embassies of Uzbekistan, Tajikistan and Kyrgyzstan, which submitted appeals to the Russian government.

The biggest challenges only begin

Problem

A state of emergency in the country was introduced on March 12. And for people living with HIV, a number of problems immediately arose in Latvia, for which no one was completely ready. The main questions that we had to help answering ourselves and the people we support – how to live if there is no financial cushion, and how to receive vital medical care?

Solutions

So, in our country, changes in the procedure for receiving out-patient services were introduced very quickly, and telemedicine was organized immediately. As early as March, every citizen of Latvia had the opportunity to get remote consultation and an electronic prescription for ARV treatment in any pharmacy. At the same time, it is worth noting a rather low level of people’s knowledge about the principles and possibilities of working with electronic prescriptions (for example, options to expand the powers of proxies, a relative to receive medicines, etc.). This can be done in just a few clicks in the e-health system. And we at AGIHAS quickly prepared information materials (posters, videos, etc.) to inform people living with HIV and our clients from key populations. Materials were distributed in social networks, through the websites of organizations.

Of course, peer-to-peer consultations were held online (telephone, instant messengers, skype, email; face-to-face meetings took place only in exceptional cases).

Inter-urban transportation network almost ceased. As a result, some people found themselves in a difficult situation, because they just could not get to pharmacies in the capital without private transport. In pharmacies in small towns, people generally did not get ART, being afraid of stigmatization. To help, AGIHAS social counselors began supplying door-to-door ARVs for those who needed such support.

Foreign students of Latvian universities who receive therapy in their own countries, for example, India, Pakistan, and Uzbekistan, found themselves in a difficult situation. Due to the closure of borders, they lost the ability to move freely and for at least 2 months and the access to ART was simply closed for them. All Latvian NGOs are concerned about the current situation and are preparing appeals to the Seimas Commission on Social and Labor Issues to resolve this problem. Meantime, treatment access for students is decided privately.

The AGIHAS team actively collaborated with such NGOs as, for example, the service organization Dia Logs, HIV.lv, BaCo (Baltic PLHIV Coalition) and Balthiv (Baltic HIV Association), and also with government agencies – an infectious disease clinic and the University Clinical Hospital to solve all complicated issues during the emergency. As well as Paula Stradins in Riga with regional infectious disease specialists in Daugavpils and Liepaja.

Result

The biggest achievement for us is that not a single person living with HIV has been hospitalized with COVID-19 in Latvia, and no one has interrupted ARV treatment.
Our online consultations have become more popular and in general their total number of requests per month has grown by about 40%.

The world will definitely not be the same, and we understand that all countries will face new challenges after quarantine ends. Thus, most countries reallocated their budgets to fight against coronavirus and now in all countries NGOs need to start advocacy in a timely manner in order to prevent a decrease in the quantity, quality and availability of ARV medication so that treatment regimens for patients remain unchanged. In addition, it is important to prevent the cuts in services funded by the state budget. In particular, we are talking about social mentoring services for HIV patients, mobile testing services and syringe exchange. Indeed, almost no quick tests were conducted until May 12 in Latvia. When the country leaves the self-isolation regime, HIV testing is gradually resuming, and this could lead to a noticeable increase in new HIV cases.

When the vital needs of 600 people are at stake …

Task

In the country, due to the coronavirus pandemic, HIV testing services were reduced, and prevention services have found themselves in unfavorable legal and social conditions. It became a real challenge for both nongovernmental organizations – service providers, and for their recipients – people living with HIV, and representatives of key groups.

Under the new conditions, in order to provide access to prevention services and to continue to help maintain commitment to treatment, we needed to adapt incredibly quickly. We urgently needed to develop new rules for the provision of services and to remote as far as possible into interaction formats and do not forget about compliance with all preventive measures for employees.

Solution

During the pandemic, we managed to turn our entire experience of providing harm reduction services upside down, but we managed.

To begin with, we promptly took all necessary actions to increase the stability and safety of the organization’s employees.

• We have developed clear internal guidelines for the provision of services during the coronavirus pandemic.
• To increase sustainability and minimize risk, we divided the team of employees into mini-teams consisting of two specialists – social and medical workers. A new work shift schedule was drawn up for them so that the working hours of the groups did not cross. In this case, even if someone falls ill, other mini-teams that will continue to provide vital services for our customers.
• All our employees were provided with personal protective equipment. We formed new packages of consumables for the participants of the syringe exchange program: the number of all issued instruments was increased, and we also supplemented the packages with personal protective equipment for the prevention of coronavirus infection.
• Consultations for clients on HIV, testing and treatment were hold online: we have begun to use more mobile communications and social networks. Since the very beginning of the epidemic, we have observed a significant increase in the demand for services of this format.
• Separately, we encouraged information and awareness-raising initiative, distributed relevant recommendations online while consulting clients.
  Within the quarantine period, individual customer reception was made only by appointment and in case of emergency.

Results

In 2 months of quarantine restrictions, nearly 600 people have used the services of the harm reduction office of the Demetra Association! And these people just could not pause their vital needs for special harm reduction services and treatment. We managed not only to survive, but also to fully adapt, while maintaining the sustainability of HIV prevention, harm reduction services and expanding our services for the prevention of COVID-19

Equipping prisons with technologies for online activities as well as training and hiring peer-to-peer consultants

Problems:

In March 2020, all penitentiary institutions (PIs) closed their doors to the outside world. And we have ceased to be able to provide our services. Thousands of prisoners were left with their own problems and worries. We returned to the understanding that peer-to-peer counseling services should be integrated into prison services.

PIs were also closed for educational and psychosocial service providers. The most vulnerable in this situation became imprisoned children who had to go to school, and after them other prisoners who were involved in behavior change programs, professional courses, etc.

Solutions:

We started looking for funds for a pilot project to train and hire peer-to-peer consultants. We prepare it, won it and started implementation. Moreover, we turned to all our partners and donors, and also applied for all possible grants for technical support in order to resolve the issue of access to educational services online.

Results:

In July 2021, 46 prisoners completed their studies, 8 of them were recruited. The pilot project will run until December 31, 2021. For a month and a half, the consultants managed to provide assistance to 134 prisoners.

We have equipped 13 penitentiary institutions (out of 17 throughout the country), the Therapeutic Community from PI-9 Pruncul and the central office of the National Penitentiary Administration. Now all prisoners have access to educational courses, informative events. We constantly practice general events for the whole country. In total, the cost of all equipment was more than 30,000 euros.

Ensuring access to treatment and providing prompt assistance to at-risk groups

During the COVID-19 time, we faced a number of aspects in collaboration with key groups, which required a prompt and effective solution on our part:

1. Conducting online activities for the provision of psychosocial services to risk groups

Problem: The pandemic has impacted the drug scene, the substitution of heroin and opium with synthetic drugs due to the difficulties of procurement, transportation and restrictions caused by the state of emergency. And access to synthetic drugs (crystals, spice, salts, speed) has practically not changed: they are easier to get, because there is no direct contact with the supplier, all actions on the Internet are paid for by translations, “bookmarks” are made as well.

The ways of communication through closed messengers (Telegram) and other networks have increased. As a result, the number of new clients involved in harm reduction services has decreased.

Solution: We started looking for funds for staff training and piloting a project to attract new clients through social networks. We wrote a project, got it and started its implementation. Trained employees of the organization to work with social networks and opened our own Telegram channel.

Results:

1. 15 employees of the organization were trained to work in the social networks.
2. We created a telegram channel. At the moment we have 486 subscribers who receive useful information daily.
3. For 9 months through the social network we involved 128 new clients to our services.

2. Providing access to vital information for HIV positive families

Problem: The Coronavirus pandemic has affected many vulnerable groups, in particular families with HIV. Those who live in various regions of the Republic of Moldova found themselves limited in access to medical care, therapy and specialists’ consultations. Due to the lockdown, the ability to travel by transport between cities was limited. Because of the inability of families to come to the hospital not only for therapy, but also for consultations, they found themselves in a more vulnerable situation, not only in the context of HIV infection, but also COVID-19, having no financial opportunity to contact specialists at the right time. In addition, many parents earlier faced problems in raising children as well, and now everything has become aggravated due to the fact that they stay all together at home constantly.

The most vulnerable were HIV-positive children. Schools switched to online studying, but many lacked the technical equipment and access to the Internet.

Solution: We started looking for funds to provide such families with tablets and the Internet.

We organized not only such support, but also the possibility of communication with a social worker and a psychologist. We provided children with stationery and materials for harmonious development. The families were also provided with masks and disinfectants.

Result: 24 families with HIV-positive children received: tablets, Internet access for 17 months, protective masks, disinfectants, and school supplies.

3. Ensuring access to hepatitis treatment during a pandemic

Problem: We faced with a high detection rate of hepatitis during the vulnerable groups testing. Many beneficiaries have problems with access to medical services due to lack of insurance and discrimination on the part of staff of specialized institutions, and the pandemic has exacerbated the situation, including access to treatment for hepatitis C.

The number of beneficiaries with hepatitis increased, and the tools of assistance became smaller.

Solution: We applied for 30 medical policies procurement for people who use psychoactive substances and live with hepatitis, but do not have the opportunity to buy it. For those beneficiaries who had it, we organized assistance and support at all stages of treatment.

Results:

1. 30 people received policies.
2. 485 consultations on hepatitis were conducted.
3. There were 247 tests for Hepatitis C.
4. 45 people received treatment.

In the process, we identified violations of patients’ rights and provided high-quality and effective medical care to people from vulnerable groups. And also, it was possible to find other ways of providing with policies as well.

Ensuring ART continuity in Moldova

Problem and task

During a pandemic, one of the main recommendations is not to leave home. But there are people who need to regularly take medications that are available only in health facilities to survive. Such people find themselves in a conflict situation: on the one hand, you need to get to the clinics, and getting into public transport, which runs less and less, is a threat to health in the current circumstances. Staying at home and interrupting treatment for PLHIV is a direct threat to life.

Solution

For patients with HIV (we are talking about 800 people in this case), until May 2020, under emergency conditions, free delivery of drugs at the place of residence is offered. The team of  social workers ofrom NGOs, together with employees of regional AIDS centers, according to the stated needs and developed routes, will ensure timely delivery of medicines.

Result

The whole process of technical support has been provided for the implementation of the delivery of ARV drugs to the regions of the Republic of Moldova. Since March 17, after the authorities declared a state of emergency in response to the COVID-19 pandemic, 777 people living with HIV in the Republic of Moldova have used the free home delivery of antiretroviral drugs. Courier delivery of antiretroviral drugs was delivered to patients from settlements affiliated to ART centers from IMSP SDMC, IMSP SR Cahul and IMPS SM Balti, who were not able to personally contact ART centers. Also delivered through the Regional Social Centers of the municipalities. Chisinau, Balti and Comrat or through NGOs supporting people living with HIV (in Social Centers / NGOs). Also, 68 people living with HIV, who are citizens  of the Republic of Moldova and are currently abroad, received access to antiretroviral therapy at their place of residence, i.e. in 14 other countries. All of them received information and technical support on access to vital medications.

Ensuring uninterrupted work of the therapeutic community in the penitentiary system and contact with relatives in COVID-19

Problem and task

During the pandemic, all penitentiary facilities almost stopped any contact with the outside world. Visits are prohibited, all educational activities provided by external organizations are also prohibited. The state of emergency increased the anxiety of the rehabilitation program participants because they were worried about those who stayed at home – parents, wives, children, brothers, sisters who are in danger. The level of vulnerability has grown because prisoners do not know whether the family is  well, whether relatives are able to care about themselves, or whether they are coping. The Executive Code prohibits prisoners from accessing the Internet, and this complicates the process of communication between prisoners and relatives in quarantine.

At the same time, from June 30, 2018 at the Prunkul penitentiary facility with the support of the Positive Initiative and the facility authorities, the rehabilitation program for people who use drugs is working on the basis of the Therapeutic comminity. One of the most important aspects of such a program is its continuity, which has become difficult to ensure due to quarantine restrictions arising from the COVID-19 pandemic.

Solution

After negotiations with the PU-9 administration and a common understanding of the importance of this approach, as well as considering the importance of preventive measures in COVID-19, a consensus was found. The Positive Initiative was the only organization that continued to visit the penitentiary during the pandemic.

Result

The prisoners who are in the Therapeutic community by the penitentiary institution were able to continue the rehabilitation program.

Also, in the penitentiary system, prisoners were allowed to use the Internet during quarantine. They were given the opportunity to call and arrange Skype meetings with relatives more often.

Creation of transparency in the use of resources in the conditions of COVID-19 in Moldova

Problem and task

During a pandemic, one of the main tasks is to ensure the availability of medicines and preventive drugs in medical institutions and pharmacies. The measures taken by the authorities to ensure the urgency of procurements, in addition to the positive effect, can have an impact on reducing transparency and inefficiency risks using budget funds. Moldova faced the vital task of mobilizing all the resources available in the country and ensuring the most efficient use of funds allocated to combat the COVID-19 pandemic.

Solution

Partners were mobilized and an informal Coalition of public organizations was created for observing the principles of transparency and efficiency in the use of public money in a pandemic and the projected consequences of COVID-19 in the Republic of Moldova.

Open applications were sent to the following state structures: the Government of the Republic of Moldova, the Commission for Emergency Situations of the Republic of Moldova, the Ministry of Health, Labor and Social Protection, the Ministry of Finance, the National Medical Insurance Company, the State Procurement Agency, the Center for State Central Procurement in Healthcare, the National Agency of Dispute Resolution.

On March 31, 2020, an Open Appeal of public organizations was published on compliance with the principles of transparency and efficiency in the use of public money in a pandemic and the projected consequences of COVID-19, on April 23, 2020, an Appeal was published due to a critical deterioration in procurement transparency, and on April 29 2020 – Civil society statement on the response of the Ministry of Finance on transparency and efficiency in medical procurement. The documents called on the authorities to ensure the transparency of medical procurement, in particular, there were requirements to publish detailed lists, technical specifications, the number of planned purchases and contracts for the purchase of medicines, medical devices and medical equipment with specifications, quantities and prices, data on supplies, as well as urgently finalize the necessary functionality of the electronic procurement system.

Result

A coalition of NGOs for observing the principles of transparency and efficiency in the use of public money, together with the Ministry of Health, with the support of the Open Contracting Partnership, developed the tender.health online platform. This is a site where you can find information on procurement of medical facilities for the fight against coronavirus. The tender.health website will update information on which products all medical institutions purchase, in what quantity, for what amount and with which supplier they work with. Each website visitor will be able to see what they spend budget money on. Moreover, now, before purchasing, hospital representatives will be able to quickly check and select a supplier, compare prices. The Ministry of Health, in turn, will be able to analyze data on procurement of hospitals.

Expansion and modification of HIV prevention services in Montenegro

Problem and task

COVID-19 has influenced harm reduction programs at so many levels and has led to a new design of these programs in line with the new challenges, needs and barriers that key populations vulnerable to HIV have begun to face. Despite the fact that key populations have higher health risks, COVID-19 preventive measures have pushed them even closer to the brink, their economic circumstances have become more complex, and a large number of PWIDs have lost their homes and jobs. In addition, access to OST was limited for some patients who lived in remote areas or were isolated. Access to testing was also limited, since in Montenegro testing is provided only in health facilities.

Solution

CAZAS has expanded the range of services provided – to address issues related to access to treatment, care and support (in particular, with regard to OST), work has begun to protect the rights of patients. 

• Collaboration was established with the clinical center to deliver buprenorphine to clients from remote areas and/or in isolation (Roma clients)
• A fund was created to distribute consumables to customers, which also included hygiene products and supplies; kits are distributed among clients in need
• Mental health services launched
• Newsletters on the needs and challenges faced by key groups related to COVID-19 have been sent to all facilites involved in HIV services and authorities.
• Collaboration with the media was organized to advocate for the protection of patients’ rights, to draw attention to the need to ensure access to treatment, as well as to maintain confidentiality and prevent stigma

Result

Despite the COVID-19 pandemic, harm reduction services in Montenegro continue to be provided to all clients who need them. The standard package of services has been expanded with activities to protect the rights of patients, the distribution of food packages and hygiene products. Since the introduction of preventive measures in connection with COVID-19 in Montenegro, more than 250 clients have been provided with such services. Buprenorphine daily delivery continues to be provided to six clients who are in isolation or quarantined.

Modified and comprehensive access to sex worker services in a COVID pandemic

With the begining of the global crisis caused by the СOVID-19 virus, a number of consequences were created that required an integrated approach to address them. HOPS – Healthy Options Project Skopje, successfully dealt with all the challenges brought by this global pandemic. In order to protect our clients, sex workers and people who use drugs, HOPS has adjusted the working conditions and the implementation of services, both in the Day Centers and in the out-reach activities, respecting the protection measures from СOVID-19 recommended by the Government of RSM.

We applied to all ad-hoc grants available in our country, as well as strengthened the cooperation with our partner donors. In this way we managed to maintain the quality of our services, not to allow the increase of the low HIV prevalence among sex workers and enabled the availability of all services that were conducted before the pandemic (regular HIV testing and access to social, legal and psychological services). We showed the care for the health and rights of sex workers during the pandemic.

Also one of the most important benefits was that during a pandemic we prevent HIV epidemic among sex workers.

Problems:

During this extremely difficult period, caused by the COVID-19 pandemic, sex workers faced a number of challenges. Due to strict legal restrictions, especially the curfews  and closure of restaurants, sex workers faced drastic reductions in work and income, which for some were the only means of subsistence. Due to the nature of sex work, these measures also reduced the number of clients using the services of sex workers. During this period, the Government of RSM adopted a series of economic measures for the citizens, but because sex work is not recognized in our country, sex workers can not use these measures. Only some sex workers took advantage of government measures aimed at citizens who are part of the informal economy. Also sex workers were at high risk of domestic violence.

Solution:

To make it easier to overcome the effects of the СOVID-19 crisis, especially on sex workers who have been directly affected, HOPS has implemented several governmental and non-governmental projects, providing material assistance to sex workers (food, hygiene kits, immunostimulants, funds for disinfection and protective masks as prevention by СOVID-19). They were constantly and timely informed about the new measures adopted by the Government of the RSM, especially those for curfews, in order to protect sex workers from criminal charges. Information materials were continuously distributed on how to protect themselves from СOVID-19, to recognize the symptoms in time and where to go if they notice a certain symptom in them or a member of their family. Since the beginning of the pandemic, we have been working on protection of the mental health and and socio-economic rights of sex workers, through constant free psychological support, as one of the mechanisms for dealing with anxiety in this group of people.

Results:

The comprehensive access to services provided by HOPS during the СOVID-19 crisis has resulted in a small number of sex workers being infected with this virus. By providing material assistance, we managed to improve the socio-economic situation of sex workers, to improve their mental health through continuous psychological support, to have access to all services despite the modified way of working and thus not enough to increase human rights violations by sex workers. HOPS will continue to advocate for the promotion of the rights of sex workers and will contribute to a better status in the society of sex workers.

Harm reduction programs for PWUD community in pandemic situation

Problem:

With the begining of the COVID-19 pandemic, the harm reduction program had to adapt to the new conditions of the overall functioning of the community. Namely, the drop-in centers could not work due to preventive measures for protection against COVID-19 virus, which measures prohibited the grouping of people indoors and outdoors. Also, police curfew and quarantines were in force, which enormously restricted the movement of people.

Solution:

In order to meet the daily needs of the clients of the program, very soon after the declaration of the pandemic, the activities were shifted to out-reach work, online counseling and information sharing through social media. During last year, with our out-reach teams we managed to rich almost 80% of our regular clients, but also, with our visibility on-line, we riched to new clients as well.

Protective equipment (СOVID protective suits, protective gloves, visors and medical masks) was procured for the members of the field teams in order to safely conduct contacts with the clients. Additionally, medical masks and disinfectants were distributed to our clients because some of them couldn’t afford protective material against COVID-19.

Results:

Injection equipment was constantly available to customers, distributed by the our-reach teams, as well as social service services available 24/7. Additionally, the clients were offered online services from the legal and psychological service, as well as educational information for protection against COVID-19.

The social work centers were closed for clients and access to the social services offered by state social protection system was restricted. Government measures to protect vulnerable categories of citizens were also unavailable to our clients because they did not meet the necessary conditions / criteria. Due to that, HOPS -Healthy Options Project Skopje distributed food packages and hygienic materials to everyone who needed them the most, especially to the Roma population. Totally HOPS distributed more then 400 humanitarian packages, of whitch at least 150 were distributed among Roma PWUD.

A positive example was that the Daily Hospitals for the prevention and treatment of addictive diseases during the pandemic were open every day and there was no interruption in the substitution treatment with methadone and buprenorphine. The situation with the pandemic and especially the measures that restricted movement were the reason for buprenorphine supstitution therapy to be widely distributed throughout the country, unlike before when patients from all over the country had to come to the only buprenorphine center in Skopje. This is a great positive benefit for patients from other cities who are being treated for opiate addiction.

All of this has contributed to HIV prevalence remaining low and we have had almost no covidue-positive clients.

«Let’s not forget the other epidemics too!»

Problem:

Despite the fact COVID-19 has preoccupied our lives for the past 2 years, we must not forget to live within, and outside of this bubble! This may mean continuing to live our lives, while having access to all possible safety options. Given the lack of any formal PrEP service in North Macedonia, the initiation of a PrEP pilot in our country was long overdue, with initial planning dating back to 2018. Although we were hoping for a much earlier start, Covid-19 happened and everything got delayed, especially since professional human resources and key partner institutions, such as the Clinic for Infectious Diseases were forced to shif their focus towards the new pandemic. Nevertheless, we gave it a try and gave it a push. And we can now proudly say that, while many will remember 2021 for the COVID-19 pandemic, we in the North Macedonia communities of gay and bi men, trans people and others, will also remember it for the introduction of the PrEP.

Solution:

Stronger Together, our community-based organization of people living with HIV, in partnership with the University Clinic for Infectious Diseases and Febrile conditions in Skopje, initiated a PrEP pilot in January 2021, using a window of opportunity when COVID-19 numbers had decreased substantially, as well as the enthusiasm of our committed partners from the Clinic’s side. In our pilot clients are offered a range of new services free of charge, as part of a comprehensive sexual health package. It contains HIV testing, STI testing, PrEP provision, medical follow-up, counselling and prevention resources – condoms and lube. To address the issue related to accessibility, care and support we have developed a strong network of supporters of the PrEP program, becoming a well-known entity among the community. We also organized a mobile PrEP service and managed to reach out to people in need outside of Skopje, the capital. The PrEP and sexual health service was designed and is being led almost exclusively by community members.

Results:

Despite the COVID-19 pandemic, the HIV prevention package in North Macedonia was finally supplemented by a PrEP service. The program is quite successful and well accepted within the community. Since the introduction of the pilot in the country, more than 70 clients have been provided with a complete sexual health follow-up – a tailored package of services which had not been readily available and accessible prior to the pilot and has now been introduced within the HIV Centre at the Clinic for Infectious Diseases. Moreover, it has helped us tackle other aspects of sexual health, such as for example an outbreak of syphilis within the community of gay and bisexual men and other MSM.

Online support for PLHIV community

During the COVID-pandemic we faced few serious points that we responded through actions and initiatives:

Problem:

the fear of the PLHIV to go to hospitals to take their treatment as at that point, all infectious disease hospitals in Romania were mainly for COVID patients.

Also, because of the pandemic situation, the patients faced problems in accessing their ARV treatment or their treatment scheme have been changed without their approval. All these problems were out there but we didn t know how many problems there were or at which hospitals.

Solution:

We have developed www.tratamentARV.ro which is the first and only transparent and public monitoring mechanism of the level of access of the patients to ARV treatment. Basically, the patients are reporting the hospitals where these problems are, we try to find out what is going on by talking to other patients in the aria or doctors active in those hospitals, we put the problems on the map and in this way every patient and the public authorities can see how many problems there are in real time/in 6 months/in 12 months. Also, each hospital has it s own track record with all the situations in which patients did not have access to their treatment.

Also, we started an online support group which included sessions every Monday for several months.

Result:

On our online support group, we are now at sezon 4 and we had a lot of guests from different arias – doctors, psychologists, nutrition specialists, actors, HR managers etc. Now we have 64 registered persons living with HIV for the group and the moderator is also living with HIV.

During the first 6 months of the pandemic, with help from ViiV UK, we distributed 400 free protection KITs to 400 persons living with HIV from Romania. 1 kit contained: 4 reusable masks, 2 KN95 masks, 40 one use medical gloves, 1 medical face visor, 1 sanitizer for hands containing 70% alcohol, 1 glycerine hand cream as treatment for the constant use of the hand sanitizer, 1 educational material regarding the strategies a person living with HIV should follow to protect oneself against COVID-19 and the life with HIV in the pandemic caused by COVID-19, 1 paper personalized bag and 3 DUREX condoms.

Maintaining continuous access to ARV therapy in the context of the COVID epidemic

Problem: In the context of the COVID epidemic, the allocation of people living with HIV into a separate group is of high social importance. It is related to the fact that in order to keep their health, such patients need to take specialized treatment, access to which may be limited due to the state restrictions. It is vital for an HIV patient to maintain a high level of treatment adherence by taking medications regularly and to undergo the necessary medical check-ups. In the case of retirement age or disability, these difficulties only increase for a patient with HIV infection.

Solution: To solve the problem, the consultants of the IPOP “Positive Region” began to provide a consulting service remotely, by phone or using online messengers and video. Also, due to the introduced measures to restrict movement during the pandemic, the demand of ART home delivery has increased as well.

Result: In spite of the increased workload, risks, as well as realizing the complexity of the situation the employees of the “Positive Region” organization continue to provide the necessary assistance (including the purchase of personal protective equipment at their own expense). But alas, the existing resources of the organization are not enough to reach everyone in need.

Providing Assistance to Families in Need During the COVID-19 Pandemic

Problem: During self-isolation due to the COVID-19 pandemic, many families, who raise children with HIV found themselves in difficult life situations. Especially families with guardianship of the child by the grandmother, single mothers and large families. They need products, funds to buy clothes, opportunities for organizing distance learning. Also, due to self-isolation in many families, relations “parents-child” got worse.

With the self-isolation regime, we began to conduct groups and individual consultations online. The implementation of this format seemed simple, but as a result, after 2 weeks of active online communication by computers, all employees felt pain (eyes began to hurt). Many (including our beneficiaries) got a depressed mood due to self-isolation and the inability to support each other personally.

Solution: Realizing this, we tried to make the meetings as joyful and inspiring as possible. Providing individual consultations with a psychologist, holding a club for parents, meetings of support groups for adolescents – all these issues continued as well. Also, I want to emphasize that the implementation of the Tramplin mentoring project: training in Moscow, St. Petersburg and Novosibirsk took place online as well.

Result: The organization provides material assistance to families in need in the Moscow region, St. Petersburg, Samara – more than 50 families have already received such support. About 48 consultations of a psychologist were carried out. There were three parent club meetings and six support group meetings for teens.

Providing basic necessities for women living with HIV and raising infants

Problem: Due to the global COVID-19 pandemic, Russia has developed a number of restrictive measures on access to treatment and prevention of vertical transmission of HIV infection for women living with HIV and raising infants (our key group). For example, difficulties in movement, inability to obtain basic necessities and breast milk substitute.

Also, caused by job cuts and massive layoffs of employees, part of the key group is forced to take unpaid leave. As a result, there is a significant increase in the financial burden – more than 80% of the funds from the benefits offered by the state in connection with COVID-19 were spent by the key group in the 1st month of quarantine.

Right now, women living with HIV and raising infants in the Nizhny Novgorod region are literally in colossal danger: according to the latest report from the state budgetary healthcare institution “Nizhny Novgorod Regional AIDS Center” for the first quarter of 2020, women living with HIV gave birth to 75 children. But adherence to ARV therapy is reduced, the risk of breastfeeding and vertical transmission is allowed, because of lack of funds on breast milk substitutes purchases. The situation is urgent.

Solution: The STEP Charitable Foundation gave a prompt response to the challenge posed by the global pandemic. We took measures for the urgent purchase of humanitarian kits, which included essential items (diapers, bottles, etc.), as well as kits of breast milk substitutes. A hotline for psychological support and peer counseling for women living with HIV was organized by phone, as well as a support group was organized in Skype. It is noteworthy that upon learning about our problem, the breast milk supplier company went forward, reducing the price and adding sets of breast milk substitutes for free. It allowed us to stay within the allocated budget for the project.

Result: In just the first month of the project on the provision of humanitarian aid and breast milk substitutes to women living with HIV, we managed to reach 46 women raising infants from 0 to 12 months in the Nizhny Novgorod region. Our initiative continues its work. You can get humanitarian aid for women living with HIV at the office of the STEP charitable foundation in Nizhny Novgorod.

Timely and effective support for partner organizations in the context of the COVID-19 pandemic

Task

The whole world was not ready to confront the coronavirus pandemic, being “face to face” with it, and the countries of Eastern Europe and Central Asia (EECA) were no exception. The health systems of entire countries found themselves in a situation of total lack of resources and knowledge about the treatment of a new virus.

Solution

As part of the Russian HIV/AIDS Technical Assistance Program, assistance was provided to countries in the EECA region in COVID-19 coronavirus counteraction by the ministries of health, medical and public organizations of four countries: Armenia, Kyrgyzstan, Tajikistan and Uzbekistan.

Results

Armenia: The Republican AIDS Center of Armenia received 1,500 rapid tests for antibodies to coronavirus. Using these tests, rapid testing was organized at border crossing points on the basis of a mobile clinic previously donated to the Ministry of Health. In addition, personal protective equipment was purchased for medical personnel, as well as sanitizers.

In Kyrgyzstan, within the framework of the Program, work with people living with HIV has been strengthened, in particular, algorithms for the delivery of antiretroviral drugs to patients for 3 months have been developed and implemented. 170 families of PLWH who are in quarantine and have lost sources of income were delivered food packages within 3 months (March-May), which also include some goods for children.

In cooperation with the Association of Dentists of Kyrgyzstan and the Kyrgyz State Medical Institute for Retraining and Further Training, a training course on “Infectious Safety in Dentistry with COVID-19” was introduced.

At the same time, one mobile clinic in April-May 2020 was used as a testing point at a checkpoint at the entrance to Issyk-Kul Oblast. In the clinic around the clock, replacing each other, worked two teams of medical workers, consisting of an immunologist, laboratory assistants and a paramedic. Testing of people entering the region was carried out using express tests for COVID-19. Upon receipt of a positive result, smears were taken for PCR analysis. Persons who received a positive result were sent for observation. The mobile clinic tested more than 3,300 people. Testing is voluntary, but not anonymous.

In Tajikistan, there are no restrictions on conducting preventive examinations through the operation of mobile testing sites for HIV, hepatitis and syphilis. Strengthened protection measures for patients and health workers.

During the pandemic, 8 types of infectious safety information materials (brochures, leaflets and posters) in Tajik were quickly developed, printed and distributed to the general population, representatives of vulnerable groups and labor migrants.

Also, as part of the Program, face masks, disinfectants sterile for delivery to 21 maternity hospitals in Andijan region of Uzbekistan were procured.

Couriers in cars rush to the rescue

Task

The coronavirus pandemic has led to the fact that many people who need regular visits to health visits, were simply locked up, on self-isolation. This directly affects the needs of people living with HIV, and disruptions in antiretroviral therapy schedules jeopardize their health and even life.

Solution

Representatives of the Novosibirsk NGOs ‘Ostrov’ and ‘Humanitarian Project’, with the support of the AIDS Center, organized the delivery of ARV drugs for those people living with HIV who are not able to pick up drugs on their own at the health facility.

In order to maintain the anonymity of patients and not disclose their HIV status, they apply for delivery of therapy to the AIDS Center of Novosibirsk. Applications are accepted confidentially by the operator at the AIDS Center. After clarifying the patient’s data, his attending physician prescribes the necessary medicines and passes them by proxy to a volunteer or representative of one of the NGOs involved in the project.

Result

The risk of coronavirus infection in people living with HIV has decreased in Novosibirsk. In addition, the Humanitarian Project has begun delivering HIV tests and prevention packages to those most vulnerable to HIV. To get a kit for an HIV test, you just need to fill out an online application.

Home delivery of life

Task

During the aggravation of the situation with COVID-19 and the regime of self-isolation in the Chelyabinsk region, the issue of providing vital medicines to HIV patients became acute. The health and life of a person living with HIV directly depends on the daily use of ART, as well as a lean attitude to their health. The necessary medicines can only be obtained at a medical facility. During the pandemic, a new challenge arose for people living with HIV – the risk of exposure to coronavirus infection on the way to the hospital. But interruption of treatment is out of the question. Interrupting treatment is almost tantamount to health complications. and, which is extremely critical, weakening of the immune system, which can lead to more serious consequences.

Solution

Together with the AIDS Center, NGOs in the Chelyabinsk region decided to form mobile teams for the delivery of vital medicines for treating HIV patients at home. A convenient algorithm for responding to a crisis situation was urgently developed, which included 3 stages. We divided the tasks and quickly started to work.

So, the first stage is the preparation of ART, as well as calling patients to inform and identify needs. The were cases when someone who needed help didn’t ask for it. Therefore, many perceived our call as salvation.

The second step was the development of routes. There were days when it was necessary for mobile teams to cover more than 90 addresses! Accordingly, in order to be in time, such routes had to be carefully planned.

And the third stage is the delivery of vital ART to homes of people.

Result

From March 30, 2020 to this day, 7–10 teams continue to deliver ARV drugs for people living with HIV on demand. Even at the stage of dialing, we conducted an individual approach and assess the risk situation in which the person is potentially located. So, first of all, we covered more than 1,000 people who are especially in need of ART delivery – these are people with limited mobility, elderly, pregnant women and children. Next, we worked on the coverage of the second category of PLHIV with CD-4 below 350 cells.

By combining the efforts and resources of the AIDS Center of the Chelyabinsk Region and patient organizations, we managed to help more than 2500 PLHIV by delivering ‘Life to Home’, but this is not the end. We continue to deliver ARVs until the self-isolation mode is over and it is safer to move around the city.

ART delivery in Yekaterinburg

Task

Like all citizens, during the COVID-19 pandemic, people living with HIV are recommended a self-isolation regime. More than 50,000 PLHIV and more than 30,000 PLHIV who receive ART are constantly living in Yekaterinburg. The main tasks faced by medical and public organizations in relation to the provision of HIV services: how to reduce risks for program participants, how to rebuild existing services, how to receive ARVT in a timely manner, and what else needs to be supported in the new realities.

Solution

Since March 30, 2020, the AIDS Center has announced new rules for admitting patients and receiving ART. In Russia, with the participation of NGOs and volunteers, ART delivery to patients was organized. On average, 200 people receive medications on daily basis. Organized "hot" telephone lines. NGOs, when switching to remote work, intensified online counseling of participants. There was a need to organize work to accompany complex cases (tuberculosis, trauma, palliative care, etc.), support for food packages, and NGO staff actively joined the initiative of the medical community in connection with the delivery of ART, while observing all the necessary precautions.

Result

On a daily basis, NGO staff provides psychological support to people living with HIV. It was possible to organize case management, online counseling during the self-test, return to care and treatment for those who interrupted treatment, registration of disability in absentia – all this activities NGO employees have been doing remotely for a month. Every day in Yekaterinburg, 14 mobile teams consisting of drivers, medical staff of the AIDS center, NGO staff and volunteers deliver ARVs to patients who confirm that they are ready to receive the drugs at an agreed address. The mechanism for receiving therapy by NGO employees by proxy from patients is clearly tuned. In April, 3,300 people received drugs while staying at home, significantly reducing the risk of COVID-19 infection.

#Remembrance wall – it is not necessary for the dead, it is for the living

Problem

From the beginning of the epidemic, it was clear that the first who came across it were doctors, infectious disease doctors. Those doctors who have always been our friends and our colleagues. These were the doctors, who treated our HIV-positive people. And it became clear that the country is not ready for an epidemic. Then at the end of March, most did not understand the scale of the disaster.

The first bell was the appeal of doctors of the St. Petersburg city Pokrovskaya hospital, in which they reported a lack of protective equipment. Just a couple of days later, WHO was informed that in a number of countries mass infection of medical workers began to occur. This alarming trend reached 10%!

In the hospitals of our city there were no corny protective suits. I know that in the same Botkin hospital for a long time doctors used ordinary medical masks.

By May 14, in St. Petersburg and the Leningrad Region, 69 people died due to coronavirus, 21 of them are medical staff.

Solution

Despite the fact that our state system is quite conservative and not very operational, after the widely publicized this problem, remedies began to come to the city’s hospitals, including as humanitarian aid from business. But the doctors still continued to die.

In late April, doctors began to create a remembrance list by themselves. The list, which included the names of their colleagues, doctors, nurses, who got infected with coronavirus at work and died.

We created the Wall of Remembrance. We wrote a post on Facebook, which turned out to be resonant. More than 120 empathetic people shared it. And that was just the beginning. Federal and international journalists became interested in the issue and helped to attract the general public to this problem.

And we managed to reach the authorities. The Wall of Remembrance to this day remains in place. The issue of protecting physicians is on the highest level of agenda.

This is probably the most important thing that happened in these few days.

But the fight against coronavirus continues for St. Petersburg and the Leningrad region. If we started the wall of Remembrance with 9 photos, today there are already 17 names in this list of dead physicians.

Result

Our struggle continues. Doctors still need protective and preventive measures. The state must recognize their death in the workplace. However, I can say many thanks to the infectious disease specialists of our Botkin hospital. This is one of the safest places for people with coronavirus. Many thanks to that that there is not one dead physician in this hospital. Thanks to them for the fact that when this madhouse against COVID-19 ends, we will have a chance and our HIV-positives will have a chance to continue treatment, continue to live.

Somehow it will not just go away by itself or small steps towards it

Problem

The most important problems faced by people living with HIV, especially those who decided to make money in the regime of so-called ‘days off’ in Russia, were the threat of medication interruptions and lack of means of existence.

Solution

Thank God, many organizations in our country have been involved in such assistance. We have also joined and are still engaged in medication delivery for HIV-positive patients of the AIDS center. There are 3 people in our team: a social worker, a volunteer driver and I.

It so happened that the people we help are mostly the elderly. We started helping with medicines and products, but at a certain point we realized that they were among the most vulnerable to coronavirus. People over 65 are not allowed to leave the house. This is one of the quarantine rules. One of the restrictive measures. Our wonderful ‘grandparents’, 65 and 70 years old, 72, 85, and one is already 91 years old. They do not go out, they practically do not go out for almost two months! They do not use a computer. They have the simplest phones. And in addition to support with medicines and products, they just need communication, psychological support, which we also began to provide, subject to all preventive safety measures. I call each of them every week by myself, some of them even more often, to talk, to listen, to cheer up …

Result

In 1,5 months of the pandemic, we, with our small team, supported 49 people with food packages. And we will continue doing this.

We try as much as possible to include all older people in the social protection system … or we find different ways to provide this assistance with the help of our friends from various NGOs in the city. Together, coping with trouble is easier.

* “Pi-5” – Low-threshold site of prevention, assistance, support and adoption in St. Petersburg

Prevention among sex workers will be!

Problem

The introduction of restrictive measures, reducing the flow of clients, closing jobs, lack of work – all of this has greatly affected the lives of sex workers.

Despite the epidemic and the bans, we made this decision for ourselves when we began to understand that most sex workers were leaving, stop working due to restrictive measures, but this does not mean that clients stop walking. This does not mean that we should stop the prevention of sexual transmission of HIV.

Solution

The new measure, which we foresaw to include in the motivation package not only condoms and lubricants, the ability to do an HIV test, but also masks, gloves, and antiseptics. It is important to maintain stability: you can come to our office, we go to the outreach ourselves. Many sex workers lost their jobs (women with children, transgender people, migrant workers), so supporting food sets is a vital necessity, people just need to eat and give food to their children.

Result

The flow of appeals fell by 80%, but over the past 2 months, only 289 people received a minimum package of services, 87 sex workers were tested for HIV, and out of 29 people of sex workers clients were tested for HIV.

The newly detected HIV-cases – three new SRs … They are all migrants. Now we will try to resolve the issue with diagnostics and ART initiation therapy (most likely, it will be not free). Over 95 food packages delivered to those who are in need …

HIV prevention cannot be stopped. Sooner or later ‘COVID’ will leave, and our ‘beloved’ HIV will remain …

In 20 years of work we are ready for any challenge

Tasks

The main task for our foundation has always been and will be protecting society from the spread of HIV and its consequences, helping to maintain health on the basis of respect for every human life. Within the emergency caused by the coronavirus pandemic, it was crucial for us to maintain the sustainability of the vital support services for our clients.

Solution

During the period of the epidemic of a new coronavirus infection, the St. Petersburg Charitable Foundation ‘Humanitarian Action’ has organized delivery of ART therapy to patients registered in AIDS centers in the city of St. Petersburg and the Leningrad Region since March 30, 2020. The therapy delivery is done by the case managers of the fund and the courier service to the patients’ home addresses in the city of St. Petersburg, the Leningrad Region and other Russian territories, where patients currently registered in the city and regional AIDS centers are. At the same time, the delivery of ART to patients was also organized in medical institutions, where people living with HIV were on long-term treatment.

Delivery of medication is carried out within 2-5 days after the attending physician, social services staff, employees of rehabilitation centers, etc. call the ‘hotline’ to the coordinator of the medical and social support service of the foundation. Additionally, protection kits from COVID-19 are put with ART kits such as medical gloves, alcohol wipes, and tablets for the convenience of receiving ART. Also, the delivery of ART to the home is carried out by the employees of the project “Medical and social assistance to people with limited mobility living with HIV”, where blood sampling is carried out; an infectious disease specialist, a psychologist and a social worker consult patients.

During the period of self-isolation, case managers of the fund continue counseling individually, covering all the clients of the fund:

– Support on social networks (Vkontakte, Telegram) and by phone. Counselling topics: HIV prevention and treatment, viral hepatitis, enrollment in care at AIDS centers, receiving ART, drug addiction treatment, document recovery.
– Advising a lawyer and case managers on legal issues related to alternative criminal sanctions for drug offenses.
– To inform on the adherence to treatment and retention of all clients who are accompanied by therapy; additionally, the client’s location, admission schedule and ARVT reserve are specified by time.

All fund services also are available for people who apply for the first time.

Collaboration goes on with 54 institutions in the city and the region assisting drug-related medical and social services.

Case managers of the fund talk about the importance of maintaining adherence to ART to PLHIV who received it, and provide them with long-term support.

Result

From March 30 to May 10, 2020, 181 people were receiving antiretroviral therapy, including those in medical institutions for long-term treatment.

By May 10, 2020, the services of the medical and social support service reached 1542 people living with HIV.

We are still at the forefront!

Problem

The period of self-isolation affected everyone. But most of all, people living with HIV and the limitations of vulnerable groups, including migrants, felt the limitations. The main problem is the inability to receive the necessary medical, social, legal assistance. Examples include problems with receiving ART for HIV-positive citizens and the difficulty of visiting AIDS centers, difficulties in getting counseling / testing for HIV, viral hepatitis and STIs for representatives of a group of key groups (MSM, SWs, migrants, etc.). Most HIV-positive migrants are forced to stop taking antiretroviral drugs because of the inability to go home to get them, or to buy, as most of them lost their jobs and became hostages of the situation. Sometimes migrants do not even have money to buy food, pay for housing.

Solution

During the period of forced self-isolation, the staff of the Steps Foundation continue to work to support HIV-positive people. Thanks to the established contacts and a wide network of trusted doctors, personal meetings and consultations are held, and communication via videostreaming is also possible. The network of friendly psychologists and addiction doctors was significantly expanded, due to a sharp increase in requests for these professionals.

Oddly enough, but during the period of self-isolation, the Fund increased its work in HIV/STI prevention among key groups. Due to a decrease in work, for example, among sex workers and, as a result, earnings, many representatives of this key group began to provide services without the use of contraception, therefore, counseling and testing became one of the fundamental factors for them. During March-April 2020, the number of detected cases of HIV and STIs increased sharply. Also, testing and counseling for HIV and STIs is carried out for representatives of MSM and TG.

The operating hours of the low threshold center of the Fund are expanded, and there are practically no days off. Employees conduct testing 6 days a week (by appointment) so that queues are not created and visitors minimally contact.

Migrants receive HIV and STI care, but since many are in Russia illegally, employees help them get tested without the threat of being discovered by the authorities. If a migrant is referred to the Fund, he is always in contact with a consultant who, in the event of a meeting between a migrant and a police officer, advises on the rules for communicating with the police with observance of the rights of citizens. If necessary, we accompany the migrant to the AIDS center or other medical facilities, to friendly doctors. If it is necessary to receive ART, employees help to find the necessary drugs, which in the conditions of restrictions on movement, as well as the termination of work of most organizations, is very difficult.

Result

In April 2020, in the context of restrictive measures in connection with the COVID-19 epidemic, 340 people received help and support, 160 people were tested for HIV infection, of whom 100 received also n STI diagnostics. If diseases were detected, consultations and referrals were made to the necessary doctor for further treatment. More than 500 sex workers received personal protective equipment. Also 50 people receives services from a psychologist, 30 – from an addiction doctor, 25  – from a sexologist, 47 – from a lawyer, and 80 – from an infectious disease doctor. In most cases, they were accompanied by an employee or volunteer of the Steps Foundation.

The social low-threshold Center for the period of self-isolation is divided into several zones to prevent the risk of infection. Thus, several additional waiting rooms are created, in consultation offices the disinfection is carried out every hour.

Citizens of Russia were assisted in finding ART through reserve medical kits and Foundation volunteers. Migrants were mainly helped to enroll in care and undergo necessary diagnotics for ART initiation.

The Fund employees worked to the limit of their capabilities, due to the fact that in most cases they worked as volunteers and obtained no remuneration. 

The use of digital technologies during the COVID-19 pandemic

Problem:

During the closure of many institutions, the introduction of restrictions and number of changes in the usual life, it is extremely important for representatives of key groups to receive information concerning them quickly and easily.

Solution:

For the first time, within the framework of a communication campaign, a mobile application “Salomat Bosch!” was represented in Tajikistan. It can be used in a broad risk assessment of behavior and was developed with the participation of #SoS_project, UN WOMEN Tajikistan and the Central Asian Association of PLHIV, Kazakhstan. The content of the application was formed with the participation of the community representatives, after conducting focus groups, which discussed the content, design and usability.

Result:

“Salomat Bosch!” includes information about HIV and targeted care. And while maintaining confidentiality, you can assess your behavioral risks and make a decision about getting an HIV test. Also, as part of #SOS_project, we regularly published success stories, all events were highlighted on the organization’s social pages, because such communication is an obligatory part of an advocacy project, which helps to form public opinion without distorting information.

REAct program implementation

Problem:

Previously, there was no systematic program for recording cases of violation of rights in Tajikistan, and, accordingly, no evidence base that would allow formulating adequate measures to eliminate violations of rights for key populations.

Solution:

The implementation of the REAct program became extremely relevant during the COVID-19 pandemic. Organizational program in Tajikistan: Coordinator – professional lawyer, four reactors / paralegals from partner civil society organizations working with representatives of key populations. Initially, the following pilot regions were covered: Dushanbe, PO “SPIN Plus”, GBAO, Khorog, PO “VOLUNTER”, Sughd region, city of Khojent, PO “DINA”, Khatlon region / Kulyab zone, city of Kulyab, PO “Chovidon”. Since September 2020, the REAct program has been expanded to 9 regions – there have been added: Districts of Republican Subordination, Vakhdat, PO “MARVORID”, Gissar / Tursun Zade, PO “Tajikistan Network of Women Living with HIV” and an additional reactor in Dushanbe, PO “Equal possibilities”. The program works with representatives of all key groups and demonstrates an example of mutual cooperation between the population and professional lawyers.

Result:

In 2020, 165 cases were recorded. As part of the program, regular trainings were held for street lawyers, they improved their educational level in providing primary legal and targeted assistance, a system of legal referrals, learned how to prepare statements, appeals. For the entire period of the program, legal assistance was provided to 250 beneficiaries.

The work of the program will be supported and expanded in Tajikistan, and its results will be used to form messages to medical workers, in dialogue with representatives of law enforcement agencies, the penitentiary system, within the framework of thematic working groups under the National Coordinating Committee on AIDS, Tuberculosis and Malaria. It is necessary to bring all services for key populations as close as possible, to provide assistance in an accessible form and in an understandable language.

Sustainable and long-term support for programs and projects to fight against HIV/AIDS

Problem:

Reducing funding from international donors is a major challenge faced by many NGOs in Eastern Europe and Central Asia. Over the past years, the NGO sector has accumulated a huge potential for the effective implementation of HIV prevention and care services for different key groups involved in the HIV/AIDS epidemic. In the long term, it is necessary to ensure the sustainable implementation of programs/projects and the possibility of allocating funding directly to NGOs, through the mechanism of state social contracting.

Solution:

Work on the implementation of the state social contract system was started in Tajikistan in 2016. In 2018, a working group under the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan developed a document “Specification and standards for categories of social services. Social services for people living with the human immunodeficiency virus and their environment.” This document was approved by order of the Ministry of Health and Social Protection of the Republic of Tajikistan No. 141, March 7, 2019. In 2019-2020, social services were defined taking into account the type, specification and standards of categories of social services for PLHIV. The timing of the time spent on social services and the timing of the social case have been determined. Regular working events were held with representatives of the Ministry of Health and Social Protection of the Republic of Tajikistan, with representatives of the Agency for Social Protection of the Population. There were consultations with representatives of the Alliance for Public Health on monitoring the results of ongoing activities. Technical assistance and support were provided by representatives of the Institute for Analytics and Advocacy.

Result:

All conducted budget advocacy activities contributed to the formation of a mechanism of state social contracting to provide assistance to people living with HIV who have found themselves in a difficult life situation in Tajikistan. In 2020, NGO “SPIN Plus” participated in the tender of the state social contracting and received the project “School of PLHIV Patients” for implementation. In 2021, the “Guide to the School of PLHIV Patients” was developed, approved for use and work in state social contracting, for the provision of social services in work with PLHIV. The guide is universal and applies to key populations in the penitentiary system and in public health. Within the framework of this project, 120 people living with HIV were covered by social services.

Further, the prospective expansion of the state social contracting is planned, as well as the participation of several organizations working in the field of providing services related to HIV/AIDS in a tender for receiving funding from the government. Expanding the sustainability of services is a strategic initiative for the effective use of public organizations resources (human one, work experience etc.).

Pandemic Lessons or What Reality Taught Us

Task

The first reported cases of COVID-19 became known on April 30 in Tajikistan. Indeed, to a certain extent, we had a head start of 1 month. Within this time, we studied the experience of neighboring countries, negotiated with doctors and planned our work in emergency mode.

Current issues are such in our country the demand for access to symptomatic therapy, means of protection and food packages has grown. The ability and need for movement are limited, incomes have fallen, and customers need the bare essentials.

We understood that there is a necessity to create new types of information and educational materials in the format of mobile applications with listing / mapping of places where you can get help with HIV and related problems. Up-to-date information was also needed for those who did not have access to the Internet and / or to do it by telephone.

Solution

So, we coordinated the work of the SPIN Plus team, taking into consideration the needs of community representatives and in constant interaction with the Republican and city centers for HIV prevention.

Firstly, we provided our staff with all the necessary means of protection and prevention in accordance with the recommendations of the World Health Organization (mask regimen, maintaining distance, constant sanitation, etc.).

Secondly, we collected data and prepared basic information materials (leaflets and booklets), which will not lose their relevance, for distribution to customers. The recommendations regarding telephone counseling have also been updated. In addition, we coordinated work with the Republican Hotline to process requests on our profile and provide promptly support to people who will need our help.

The main focus of the work is to maintain adherence to ART: home delivery of ART, counseling on taking medications and the use of symptomatic therapy. Delivery of ART is agreed with AIDS Center doctors. If it is necessary, we connect clients with doctors by phone, Skype or other convenient online method. We took over all the main communication and support organization in this format – SPIN Plus employees are on call 24/7. In the first 10 days of quarantine, we saw that current service was quite demanding in Tajikistan.

Outreach work focuses on transferring at issuing station or delivering disposable tools for PWID. Each communication with customers, our employees talk about the basics of providing assistance in connection with the pandemic, where to go, when you have changes in the health condition and what to do first.

Result

In May, we have already assisted more than 100 people. People who can rely on our help for 100%.

Advocacy of migrant rights in Russia during the COVID-19 pandemic

Problem and Tasks

Labor migration is an integral part of the modern history of the Republic of Tajikistan. According to various estimates, the number of migrant workers from Tajikistan ranges from 500,000 to 1 million people (almost 10% of the country’s population). According to Russian law, the HIV-positive status of foreign citizens is an obstacle to entry into the Russian Federation (process to obtain a visa) and obtaining a work permit, as well as an occasion to receive notification of the undesirability of staying in the Russian Federation.

According to official figures, the proportion of migrants among new HIV cases registered in Tajikistan increased from 10.1 percent in 2014 to 18.8 percent in 2018. Labor migrants practice risky sexual behavior, which also contributes to the growth of sexually transmitted infections (STIs).

Since 2005, IOM has been implementing projects on the health of migrants and, together with partners, is trying to provide comprehensive services in synergy with legal, social support, and access to HIV and TB services, including among key individuals. The Ministry of Labor, Migration and Employment of the Republic of Tatarstan, as well as the Ministry of Health and Social Welfare of the Republic of Tatarstan and public organizations are actively involved in the implementation of projects.

The coronavirus pandemic created new challenges where labor migrants were in the most vulnerable position. It is necessary to take operational decisions in order to avoid interruption of treatment and the potential deterioration in the health of migrants residing in the Russian Federation.

Closing borders has aggravated the situation of migrants living with HIV, as lack of access to ARV treatment affects their immune status and makes them even more vulnerable to COVID19 infection.

Decisions and actions:

Considering the COVID-19 pandemic, the Republican Center for AIDS Prevention and Control in Tajikistan provided people living with HIV ART with medications in advance for several months to reduce the need to go to the AIDS Centers for medications.

At the same time, migrants living with HIV and located in the Russian Federation receive ART using informal networks, some managed to get it in advance from the Republican AIDS Center of Tajikistan, which transmitted ART to their migrants through relatives. During this difficult time, diaspora organizations in the Russian Federation played a significant role in supporting migrants by providing information and social assistance. For example, the Tajik diaspora of the NGO “NUR” provides food assistance to vulnerable migrants, mobilized volunteer doctors from among the diaspora to consult and assist in the hospitalization of migrant workers. The hotline telephone is working around the clock.

The ITPCru Treatment Preparedness Coalition, together with Life4me.plus, is helping people living with HIV who find themselves in a country with limited travel restrictions receiving antiretroviral medications.

One of the main challenges was the difficulties associated with the need to pay for patents to extend the documented staying of migrants in the Russian Federation. With the temporary closure of private and other enterprises and the forced reduction of workers or sending on unpaid leave, many migrants were unable to pay for patents. This fact made thousands of migrants violators of the migration law, according to which entry into Russia for migrants could be closed for several years. To help migrants, embassies, international and public organizations united, who turned to the Government of the Russian Federation with concrete proposals that could improve the situation of migrants.

Result

At the end of April, the long-awaited news came – the Russian president signed the Decree “On temporary measures to resolve the legal status of foreign citizens and stateless people in the Russian Federation in connection with the threat of the further spread of a new coronavirus infection (COVID-19),” which provides for the following: employment of a foreign citizen is NOT determined by a work permission, nor by a patent, or even the purpose of entry into a migration card, but only by observing the rules of self-isolation by the employer; the stay of foreigners in Russia until June 15 is not due to migration registration, visa, terms of the temporary residence permit, residence permit, patent, etc .; payment of patents is suspended from March 15 to June 15; it is forbidden to make decisions on expulsion, deportation, readmission, undesirability of stay, a ban on entry, and a reduction in the length of stay.’

SAFE BOX home delivery

Task

Due to quarantine and public transport, the flow of people wishing to be tested for HIV has sharply decreased. Previously, prevention and testing services for men who have sex with men (MSM) were provided on the basis of community centers of organizations.

Solution

Within the framework of the project ‘Accelerating efforts to fight against HIV / AIDS in Ukraine’ (HealthLink), which is implemented by the Alliance for Public Health in partnership with the All-Ukrainian Network of PLHIV with financial support from the United States Agency for International Development (USAID), the website was launched https://oraltest.org.ua/en/. On this web-page, MSM can order home safe boxes for themselves and partners, using the video instructions on the site to self-test, as well as getting advice from a social worker. The safe box includes: an oral HIV test, condoms, a lubricant, health information materials, a social worker’s card, a bag for disposing of the test and pleasant little things – stickers, magnets, bracelets with motivations.

Result

During the period from April 11 to May 8, 2020, with the help of the largest courier delivery service, 202 safe boxes were sent to the following regions of Ukraine: Dnipropetrovsk, Odessa, Zaporizhia, Nikolaev and Kherson regions.

Harm reduction room and saving lives

Task

Before the coronavirus pandemic, the Sumy harm reduction room was operating in usual regime. It was the first room of such kind in the region of Eastern Europe and Central Asia. Services such as counseling, testing, distribution of preventive kits, self-help groups, information sessions, and a preventive service for using the room for safe use and safe disposal of used tools were provided. Due to the COVID-19 pandemic and the need to comply with WHO preventive measures, adjustments were needed to the harm reduction room. We faced with 2 equally important tasks: to maintain the sustainability of services, while it was also necessary to provide employees and patients with means of protection and prevention of coronavirus infection.

Solution

We continued to provide services as usual, also from Monday to Friday, using the ‘through the window’ service format: clients continue to receive counseling, syringes, condoms, lubricants, etc. In exceptional cases, if you need a consultation of a social worker, testing or space for consumption, then, in compliance with all safety measures, the client receives these services directly in the office. Clients and social workers are in the office exclusively in a mask and gloves. According to the requirements for maintaining a safe distance, only 1 patient can now stay in the room during consultation, testing or use. After consultation, appropriate disinfection is carried out in the room.

Result

Thanks to the taken measures, the entire functionality of the harm reduction room services remained available to patients in full and the sustainability of the provision of preventive services was ensured.
Every day from 10 to 40 people use the services of the harm reduction room. Vital services continue to work in the new environment, in a safe space created for the community of people who use drugs. Preservation of such a unique service allows people to have free access to a wide range of vital services for them, located in a place where they feel trust, receive the necessary support and, as a result, effective prevention of the spread of HIV and other dangerous infectious diseases are being provided in Sumy.

Substitution Maintenance Therapy “on hands” up to 14 days

Task

Quarantine restrictions, namely the impossibility of free travels and the inability to use public transport, the risks of infection due to crowds in the OST sites and low immune status, created obstacles for patients of substitution maintenance therapy programs to receive medication and, therefore, to continue treatment. This could lead to interruption of treatment, the loss of patients from the program and, thus, the efforts of many participants could be made over in the process in vain, from local initiative groups and non-governmental organizations to large international donors of financial resources, to implement these programs and return to a high number of people who use drugs and, consequently, the potential worsening of the situation with the AIDS epidemic in Ukraine.

Solution

After the announcement of quarantine and the outbreak of the coronavirus epidemic, SMT began to be provided on take-home basis in some countries of the EECA region for a period from 5 to 14 days, in Ukraine this period is up to 14 days, in most cases 10 days.

Within the framework of the project with the support of the Global Fund, the International Technical Assistance Project ‘Improving the Quality and Sustainability of Sunstitution Maintainance Treatment in Ukraine’, which is being implemented with financial support from the US Centers for Disease Control and Prevention (CDC), it has become possible to provide patients with take-home OST for up to 14 days. Within the framework of the project, one of the most important conditions for the rapid transition of OST patients to a 10-day form of medication delivery was provided – more than 50,000 quick tests for determining psychoactive substances (surfactants) were delivered. This initiative was also accompanied by a request to law enforcement agencies regarding the prevention of violations of the rights of patients with OST who are transferred to the self-taking of narcotic drugs OST for a quarantine period of up to 10 days.

In addition to issuing medication for a longer period for taking them at home, the quarantine SMT program also supports its patients with online counseling by phone using Skype, Viber, Telegram services, escorting clients to health care facilities as necessary, optimizing the work schedule SMT sites for convenient distribution of customer flows and additional counseling regarding the prevention of COVID-19.

Result

Currently, almost 90% of patients in substitution maintenance therapy in Ukraine receive take-home medications for a period of 10 days.

Mobile clinics at the forefront of the pandemic

Task

Due to the newly imposed restrictions during the COVID-19 pandemic, there was a risk of interruption of ART for HIV-positive people who are unable to get to health facilities to receive medication. This problem arose not only among clients of the KPIF project, but also among other patients living in remote areas of the regions of Ukraine who work as part of projects financed by PEPFAR funds. Patients on ART often do not own car, the means to organize their travel in accordance with existing restrictions and new rules, or they are not able to get to the AIDS center due to their health conditions.

Solution

The main advantage and tool for solving this problem for the KPIF project team was the principle of the project itself – the use of mobile clinics that work in certain locations of a particular region.

Based on the problem, the following decisions were made:

1) To arrange delivery of antiretroviral therapy medication for clients residing on routes approved by the project. The regional teams of the KPIF project were able to provide assistance in the delivery of medication not only for the clients of their project, but also for all clients who need therapy.

2) To provide assistance to medical workers in dispatching medication for project clients through the Nova Pochta postal service: box packaging, registering, delivery and shipping.

3) Ensure targeted delivery of medication to patients’ homes.

4) To deliver medication to certain trust offices which are located in the area.

Result

Thanks to the modification of services under this project, 439 people living with HIV were able to receive antiretroviral therapy during quarantine in 4 regions of Ukraine – Kherson, Odessa, Dnepropetrovsk and Donetsk regions.

Project: ‘Improving HIV case detection and treatment access for people who inject drugs in Ukraine’ at the initiative of the Key Population Investment Fund (KPIF), which is being implemented with financial support from the US Centers for Disease Control and Prevention ( CDC)

OST Hotline is the most important communication platform for OST patients under COVID-19 quarantine restrictions

Task

During the COVID-19 pandemic, in connection with quarantine, the corresponding restrictions and changes in the usual treatment for OST patients, there was a need for particularly active technical support, advocacy and information for existing and potential patients on all issues related to the specific treatment during quarantine. The possibility of visiting the OST site, for those who do not live within walking distance from it, is almost impossible. People are not recommended to leave home, except in cases of special need; therefore, if you want to consult and get information, you need to look for alternative ways to get in touch with relevant specialists.

Solution

The National Hotline on Drug Dependence Issues and OST is a very effective and sought-after resource among patients in projects implementing opiod substitution therapy and people who want to learn more about the possibility of receiving this service, taking more than 4000 calls per year. The hotline operates in an intensive mode during quarantine and provides legal advice, coverage of the medical aspects of medication, informing about the work of OST during quarantine, advocating the patient transfers to on their own medication and raising awareness of overdoses. A key factor contributing to the effectiveness and the key to success is that the mechanism work is ensured by the self-organization of the community of people who use drugs, and the operators are former or current OST patients who have undergone special training.

Result

The demand on this resource in providing advice and advocacy in connection with quarantine has increased significantly. Only in the first 2 weeks of quarantine, the number of calls to the hotline increased by almost 50%. The most common appeals in the first 2 weeks of quarantine was related to questions how to join the OST program and / or how to get a take-home dosage. 

In addition, on a regular basis, online legal advice is provided on the hotline and, in general, you can consult on any issues related to OST. Thanks to the work of the Hotline, travel passes for public transport were issued for OST patients in in Kryvyi Rih and Dnipro.

Coordination of the hotline work: Hope and Trust Foundation, supported by ICF Alliance for Public Health, funded by the Global Fund to AIDS, Tuberculosis and Malaria. https://www.facebook.com/osthotline/

ART delivery to HIV-positive people

Task

Under quarantine, a large number of people with HIV-positive status find themselves in a situation where they do not have access to the vitally important antiretroviral therapy. It is an integral part of providing complex care for people living with HIV. Everyone who takes ART understands that because of this, their immunity retains their functions, their quality of life is maintained and improved, and treatment should not be interrupted in any case. Due to restrictions in the work of transport during quarantine measures for HIV-positive people, especially those living in remote settlements, it became impossible to visit health facilities to receive the necessary dose of the medications and, in fact, there was a threat of treatment interruption for an unlimited period.

Solution

Within the framework of the HealthLink project ‘Accelerating efforts to resist HIV/AIDS in Ukraine’, which is implemented by the Alliance for Public Health  in partnership with the All-Ukrainian Network of PLHIV, with the financial support of the United States Agency for International Development (USAID), with project team of GO ‘Return to life’(Kirovograd region) and GO ‘Synergy of souls’ (Dnipropetrovsk region) arranged delivery of medications for HIV-positive people using mail services, company and private cars of organizations and project employees. Vital medications are given to HIV-positive residents of Kropyvnytsky, Znamenka, Alexandria (Kirovograd region) and Dnipro.

Result

Despite quarantine, thanks to the efforts of the large and friendly team of the HealthLink project, HIV-positive patients continue to receive medications on time and do not interrupt treatment. Social workers regularly keep in touch with doctors and patients to provide comprehensive care.

GO ‘Return to Life’ and GO ‘Synergy of Souls’ with the support of ICF “Alliance for Public Health”

Supervision as prevention of “burnout” and the support basis for doctors and social workers

Task

The coronavirus epidemic set completely new targets and challenges for professional working in the healthcare, harm reduction, social and psychological assistance to representatives of risk groups and HIV-positive people. It became necessary to reformatting activities ‘in the fields’, quick training of specialists  in the new changed conditions, as well as their constant support in the implementation of new directions.

Solution

Based on the requests of social workers and doctors, during the quarantine, new topics of consultations were added, which are carried out online by https://supervision.org.ua/ supervisors by psychologists, infectious disease doctors, and managers. Such new topics of online consultations appeared: changing the format for providing services to clients of projects in the regions, new communication channels with clients, project work in connection with changes in the activities of health facilities, distant support of clients and possible forms of monitoring compliance with ART, OST, etc. Supervisors provide their supervisors with up-to-date information about COVID-19, using modern sources of reliable information, helping to adapt the activities and forms of work with clients in the region, taking into consideration the quarantine changes and the specifics of the work of health facilities, and also give recommendations on the prevention of professional burnout.

Result

307 online supervisions were held for social and medical workers from 13 regions of Ukraine and the Crimea during the quarantine period. Most supervisants participated in more than one supervision and left positive feedback about the supervisor.

Innovation at the peak of fight against the epidemic

Task

In recommendations for overcoming the COVID-19 pandemic, CDC and WHO emphasized the need to
establish an online schedule for patient visits in specialized health facilities in order to escape long
waiting in queues and crowds in the halls of health facilities.

Solution

Within the framework of the ACCESS Pro project we support the implementation of Medical Information
System ‘HIV infection in Ukraine’ (MIS HIV), we were able to launch an online schedule of patients’ visits
in health facilities specializing in the treatment of HIV infection.
For this purpose, the special module ‘Registry’ was urgently updated in MIS HIV, which allows patients
to make an appointment directly from the ‘100% LIFE’ application in their smartphones. This application
was also developed by ‘100% LIFE’ specifically for HIV patients, and is integrated into the Medical
Information System ‘HIV Infection in Ukraine’.

Result

The interface of the module has become more convenient for medical staff; the video instructions for
connecting facilities and making an appointment are posted in the system itself. In addition, project
specialists actively support health facilities in connecting to the Registry module. 50 establishments
already support online appointments, and their number is growing daily.
Thus, appointments were organized, and their number in the waiting zones of medical establishments
significantly decreased. What is more, the ‘100% LIFE’ mobile application is used as a communication
channel for the exchanging of relevant information about COVID-19 and tips for people living with HIV.

Proactive work in COVID-19 counteraction

Task

Uzbekistan is taking a rigorous approach to tackling the coronavirus pandemic. The closure of cities, the ban on travelling in cars and public transport, rigid self-isolation. Such measures could endanger those who need ongoing support, such as people on ART. You can’t buy it in pharmacies of Uzbekistan. The main task was: how not to lose the lives of people with HIV, saving them from COVID-19?

Solution

As soon as it became known that COVID-19 came to the country, all AIDS centers began to provide ART medication for two months. After the introduction of car stickers, the Ishonch va Khaet organization compiled lists of people who applied to the organization for the need for ARV therapy, for any reason. For example, a person is stuck in another city, registration does not correspond to the place of residence, there is no way and means to get to the center or clinic.

The program ‘Positive motherhood’ was implemented with the support of AFEW for pregnant women and women in labor living with HIV. Peer counselors provided social support delivering ART, infant formula, providing escort to health facilities and PCR testing for infant diagnosis.

On the part of the AIDS service, measures were also taken to decentralize ART to the bases of district clinics in the offices of infectious diseases.

And already in these clinics, patients received medications in infectious disease offices.

The Republican Commission included people living with HIV in the list of cases for which a special permit for driving vehicles was not required. The centers began issuing certificates, which then had to be shown at the checkpoint and explained that a person was traveling to Tashkent for vital medicines.

Result

With the help of operational collaboration between the Ishonch va Khaet NGO and the Tashkent AIDS center, it was possible to provide PLHIV with ART, infant formula, provide access to secondary medical care, and also minimize the risk of their infection with COVID-19 without violating the quarantine regime.