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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
Ensuring uninterrupted work of the therapeutic community in the penitentiary system and contact with relatives in COVID-19
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.
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.
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.
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.
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.
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.
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.
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.
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.
A united database of startups and innovators from around the world to help with fighting against COVID-19
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.
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 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.
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.
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.
Substitution Maintenance Therapy “on hands” up to 14 days
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.
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.
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?
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.
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.
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.
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.
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.
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.
OST Hotline is the most important communication platform for OST patients under COVID-19 quarantine restrictions
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.
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.
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.
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.
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.
Coordination of efforts of all interested parties and planning of work with consequences of the COVID-19 pandemic
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.
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.
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.
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.
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.
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.)
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.