Quotes and success stories from policy dialogue participants
Ministers of health and senior policy-makers from countries in eastern Europe and central Asia (EECA), together with representatives from international organizations and civil society, gathered in Amsterdam on 23 July 2018 for a policy dialogue on HIV and related comorbidities in EECA.
The dialogue, organized by WHO in cooperation with the Government of the Netherlands and the Joint United Nations Programme on HIV/AIDS (UNAIDS), aimed to revamp political commitment to scale up the HIV response in this part of the WHO European Region. Below are selected quotes from the participants.
“We have the tools and power to lead the way to end AIDS ahead of 2030. We already observe promising trends in several countries of our Region. I am confident that with sustained implementation of evidence-based approaches to prevention, testing, treatment and care, the number of new HIV infections will decrease. In collaboration with partners, WHO is supporting countries to make this a reality.”
– Zsuzsanna Jakab, WHO Regional Director for Europe
“An inclusive rights- and evidence-based HIV response is cost-effective. Let’s use good practices as examples and scale them up.”
– Lambert Grijns, Ambassador for Sexual and Reproductive Health and Rights & HIV/AIDS, the Netherlands
“The strong participation of ministers of health at today’s dialogue shows that the region of eastern Europe and central Asia is determined to reach the 2020 targets [that] countries agreed on at the United Nations General Assembly in 2016. UNAIDS and its cosponsors are supporting Member States to get on the fast track to ending AIDS.”
– Vinay P. Saldanha, Director, UNAIDS Regional Support Team for Eastern Europe and Central Asia
From prevention to elimination of mother-to-child transmission of HIV in Armenia
Control of tuberculosis (TB) and HIV have been public health priorities of the Ministry of Health of Armenia during the last decades. The diagnosis and treatment of both are fully funded by the state and universally accessible for all Armenian citizens, with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria and other partners.
TB/HIV collaborative activities are an integral part of the national AIDS and TB programmes. All aspects of care in these priority areas are regulated by the policy documents approved by the Ministry of Health – the standards of HIV prevention and treatment and of TB control, as well as the national guidelines based on WHO recommendations. They stipulate provider-initiated HIV counselling and testing of all TB patients in all TB clinics countrywide, as well as immediate initiation of antiretroviral therapy (ART) in all diagnosed TB/HIV coinfection cases.
Full coverage with HIV testing among TB patients and ART is achieved through the established laboratory and TB outpatient services network countrywide, a reliable national system of supply-chain management of antiretroviral drugs, test kits and consumables with strong monitoring instruments in place.
Of course, the main secret of success of this achievement is the excellent cooperation established between the National Centre of TB Control and the National Centre of AIDS Prevention, and their concerted actions under the coordination of the Ministry of Health.
– Arsen Torosyan, Minister of Health, Armenia
“Treat all” approach boosts Georgia’s progress towards 90–90–90 HIV targets
Georgia, with support from the Global Fund, took the public health approach to AIDS treatment from the very beginning of the programme’s initiation. Our model of service delivery builds on principles of equity and human rights towards ensuring universal access to high-quality HIV treatment and care for all.
The country had been preparing for its “treat all” policy for several years, inspired by the results of breakthrough treatment and prevention studies conducted in the United States of America, and we didn’t need much time to adopt the WHO “treat all” recommendations.
We started offering lifesaving therapy to all persons living with HIV in Georgia regardless of their CD4 cell count from December 2015. Two years of implementing the “treat all” approach in Georgia show that countries can considerably improve their progress towards achieving the second and third of the 3 UNAIDS 90–90–90 targets.
At the same time, more efforts should be directed towards accelerating HIV diagnosis. Different social support services for people living with HIV will be critical for linking them to care and for improving retention. Mobile ART monitoring teams that provide ART outreach and encourage follow-up among people living with HIV offer a good example of such support.
– David Sergeenko, Minister of Labour, Health and Social Affairs, Georgia
Republic of Moldova’s approach to sustainable financing of HIV prevention services
Sustainable financing of HIV prevention services for key populations is a major challenge, especially for countries that are beneficiaries of international support, such as the Republic of Moldova. To facilitate a shift to domestic funding for the HIV response, the Ministry of Health created a platform in 2016 with the Union for HIV Prevention and Risk Reduction (a consortium of national NGOs), and with national and international stakeholders, including the Global Fund, UNAIDS, WHO, the National Health Insurance Company and the National AIDS Programme Coordination Unit. The involvement of the National Health Insurance Company was crucial for a better understanding of challenges and possible options for mobilization of financial resources.
This dialogue produced a revision of the legal framework for the financing of harm reduction services and identification of domestic finance sources. The revised framework regulates financing options for project-based HIV prophylactics and risk prevention measures submitted by NGOs. Through resource mobilization options, the National health Insurance Company can procure the services provided by NGOs.
This engagement is expected to increase key populations’ access to prevention measures and their coverage through harm reduction programmes. We believe that this combined action will in turn decrease new HIV infections among key populations.
-Rodica Scutelnic, Secretary of State, Ministry of Health, Labour and Social Protection, Republic of Moldova
Collaboration between civil society and national institutions key for sustainable HIV response
If the history of the HIV epidemic has taught us one thing, this would be that a sustainable HIV response is only possible with concerted efforts of nongovernmental organizations (NGOs) and communities from one side, and national governmental systems from the other. Communities and community-based organizations of gay men and other men who have sex with men (MSM) have vast experience with piloting successful interventions; however, rolling them out at a wider scale is only possible with legislative and financial support from governments.
Recent examples of this cooperation in the WHO European Region include the nationwide introduction of preventive measures such as pre-exposure prophylaxis (PrEP) in France, Norway and Belgium, which has been advocated for by gay communities and is now funded by national health systems. In Ukraine, representatives of gay and MSM communities are equal partners in the National HIV Coordinating Council, which sets up strategies and directions for the national HIV response. In Georgia, the National Centre for Disease Control (NCDC) works hand in hand with community-based lesbian, gay, bisexual and transgender (LGBT) organizations, including Equal Movement and Tanadgoma, to tackle the alarming 22% HIV prevalence among MSM in the country. While NGOs work directly with communities to raise awareness and to mobilize and provide prevention and referral services, the NCDC ensures medical interventions including antiretroviral drugs for treatment and PrEP.
We need these good examples to be replicated throughout the whole Region to defeat HIV by 2020.
– Vitaly Djuma, Executive Director, Eurasian Coalition on Male Health
Civil society relies on public funding and cooperation to provide sustainable and effective harm reduction services
Harm reduction is not just about distributing syringes and needles or implementing other HIV prevention activities. It is about civil society peers becoming the most effective vehicle between people using drugs and health and social services. In order for harm-reduction services provided by civil society to be sustainable and effective, it is crucial to secure domestic funding and to have the cooperation of local authorities. This applies to testing and treating of HIV, TB and hepatitis, as well as to supporting employment and social integration of people who inject drugs.
Good examples from the European Region include Czechia and Estonia, which support a full package of services for people using drugs, and cities such as Riga (Latvia) and Porto (Portugal), which provide drug users with effective referral systems. In Portugal, for example, instead of imprisonment and punishment, the provision of comprehensive social support for people leads to HIV prevention and treatment as well as to reintegration in social life. This mix of non-repressive drug policy and effective health care saves costs for local communities. The Eurasian Harm Reduction Association (EHRA) is now trying to transfer the Portugal and Czech approaches to other countries in eastern Europe.
From 29 countries of central and eastern Europe and central Asia, members of EHRA are ready to collaborate with national and local authorities to make services available and protect rights. However, with the ongoing changes in the nature of the drug scene and the increasing use of new psychoactive substances, we also need to learn new ways for health and social services to meet the new needs of drug users and provide universal health coverage.
We are learning, for example, how to provide harm-reduction counselling online, how to build cooperation with ambulance and mental health specialists, and how to procure new distribution materials and drug tests to reduce health risks from using new drugs. From health and social authorities in countries we expect flexibility and understanding of people’s needs. We are willing to make everything possible to save lives.
– Ganna Dovbakh, Executive Director, EHRA