The Elton John AIDS Foundation announced on 10 October a new funding initiative for key populations in eastern Europe and central Asia.

The Key Populations Fund for Eastern Europe and Central Asia will focus on prevention and treatment of both HIV and hepatitis C for the people in the region most vulnerable to HIV—people who inject drugs, gay men and other men who have sex with men and sex workers. Over the next three years, the fund will aim to reach 20 000 people in the region with prevention, testing and treatment services.

People who inject drugs, gay men and other men who have sex with men and sex workers remain disproportionately affected by HIV in eastern Europe and central Asia as they are beyond the reach of many prevention and treatment services. They make up the majority of people living with HIV in the region.

Eastern Europe and central Asia is the only region of the world where both new HIV infections and AIDS-related deaths are rising. New HIV infections have increased by 60% and AIDS-related deaths by 38% since 2010. Only 27% of people living with HIV in the region had access to life-saving antiretroviral therapy in 2016.

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As for everyone, food security is vital for people living with HIV. Access to food improves adherence to HIV treatment and lack of sufficient food can increase the risk of HIV infection through increased transactional, survival and intergenerational sex. And malnourishment affects how well HIV treatment works—people living with HIV who are malnourished are two to six times more likely to die in the first six months of treatment than those who are not.

For people living with HIV in eastern Ukraine, the conflict has had a significant impact on their food security, with most people living with HIV severely food insecure and living in extreme poverty. The conflict has displaced many people—especially women and children—HIV services have had to be relocated and the quality of services in many facilities is poor.

To prevent the collapse of HIV services and to increase food security for people living with HIV, civil society organizations and the United Nations have stepped in. In the parts of eastern Ukraine not controlled by the government, the United Nations and a few humanitarian organizations are the only entities making antiretroviral therapy and other medicines available.

The World Food Programme (WFP), a UNAIDS Cosponsor, is assisting thousands of people living with HIV in the conflict-affected areas with food support through a programme with the All Ukrainian Network of People Living with HIV, a nongovernmental partner of WFP. In the government controlled areas of Donetsk and Luhansk, 6500 people living with HIV are in a cash-based transfer programme to provide money for essential food. The assistance, which includes regular medical appointments and the monitoring of adherence to HIV treatment, has led to a fourfold decrease in treatment interruptions. In areas of eastern Ukraine not controlled by the government, in-kind food assistance has helped thousands to meet their basic needs.

The need for food support among people living with HIV in eastern Ukraine is, however, far outstripped by the resources available to support them. Although 6500 people living with HIV in Donetsk and Luhansk are accessing cash-based transfers, thousands more are not being assisted, and the need is even greater in the areas beyond government control. There are fears that even this limited help may have to end, since WFP has yet to receive funds to continue the programme in 2018.

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The Republic of Moldova’s National Health Insurance Fund has announced that it will finance HIV prevention services provided by nongovernmental organizations for two projects for key populations. The services will cover sex workers, gay men and other men who have sex with men and people who inject drugs in Chișinău and Bălți. Approximately US$ 120 000 will be provided to cover an initial one-year period.

The nongovernmental organizations Youth for the Right to Live, which is based in Bălți, and Initiativa Pozitiva, which is based in Chișinău, will implement the projects, which aim to reach around 1000 people who use drugs in Bălți and about 700 people from key populations in Chișinău.

In 2018, four projects will be supported by the National Health Insurance Fund, with a target of 60% of needs to be covered from domestic resources by 2020.

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During a two-day visit on 25 and 26 September to Belarus, UNAIDS Deputy Executive Director Luiz Loures and the Ambassador for Sexual and Reproductive Health and Rights & HIV/AIDS of the Netherlands, Lambert Grijns, met with civil society organizations and communities of people who inject drugs, women living with HIV, men who have sex with men and sex workers to hear their perspectives on the current needs and challenges of the AIDS response in the country.

Mr Loures and Mr Grijns also met with the Minister of Health of Belarus, Valery Malashko, and the First Deputy Minister of Health, Dmitry Pinevich, to discuss the HIV epidemic in the region and exchange best practices on the AIDS response in western and eastern Europe, particularly around prevention policy and programme implementation. Potential collaboration between the Netherlands and Belarus was also discussed.

During the meeting, Mr Loures acknowledged the efforts of Belarus in scaling up its AIDS response using domestic resources. The country is on track to achieving the 90–90–90 targets by 2020 and is committed to expanding HIV prevention programmes, including programmes for key populations.

Mr Grijns noted the achievements of Belarus in harm reduction, reducing the cost of antiretroviral treatment and eliminating mother-to-child transmission of HIV. He also commended the close collaboration with civil society and that domestic funds would be provided to nongovernmental organizations, ensuring continuity of community outreach and service delivery.

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The Russian AIDS Center Foundation was founded a year ago by journalist and television presenter Anton Krasovsky to support people living with HIV and share information about the AIDS epidemic.

Today, at the foundation’s office, weekly support groups are held at which people living with HIV and their relatives have access to professional support. Other activities at its office include seminars on legal support, lectures on various aspects of HIV, film premieres and discussions on legislation. A hotline on HIV issues is available for calls from all over the country. Every day, the foundation’s staff address specific requests from people who have been denied treatment, trying to assist everyone who asks for help.

All the work done by the foundation is, one way or another, aimed at responding to stigma and discrimination against people living with HIV in the Russian Federation. “We are fighting discrimination and the fact that people living with HIV are considered “dirty” and contagious. We do this under an umbrella of “Don’t be afraid”—all our work is built around this slogan,” said Mr Krasovsky.

The AIDS Center Foundation exists exclusively thanks to donations by individuals and companies—there are no state or faith-based organizations among the donors. There are only a few members of staff.

“Several people have recently joined our team, who will be responsible for group programmes, lectures and community work. Shortly, a group developing a self-testing programme will join us,” said Mr Krasovsky.

“Independence is important to us. We do not agree with the attitude of government bodies towards people living with HIV, to people who use drugs. We are strong opponents of discrimination against lesbian, gay, bisexual, transgender and intersex people,” he added.

In recognition of the first anniversary of the foundation, Mr Krasovsky said, “All we achieved is due to our supporters. All my colleagues and myself, all the people who turned to us for help, appreciate and cherish your help. We want you to stay with us in the future, which, despite everything, we still have.”

Adolescents and young people aged between 16 and 19 years from several countries in eastern Europe and central Asia met in Aghveran, Armenia, from 26 to 29 August for the first Teenergizer strategic planning meeting. They discussed the challenges faced by adolescents living with HIV in their countries, shared the results of the #questHIVtest project and developed the #Teenergizer2020 strategic plan.

Teenergizer is a unique movement of 80 adolescents born to mothers living with HIV and HIV-negative volunteers from Georgia, the Russian Federation and Ukraine. They are united by a set of common values, including support for engagement, tolerance and human rights.  

The issues addressed in the strategic plan include advocating for adolescents’ sexual and reproductive health and rights, the promotion of age-appropriate information on prevention for adolescents and engaging teenagers living with HIV to raise their voices in the HIV response.

In the #questHIVtest project, teams in Tbilisi in Georgia, Kiev and Poltava in Ukraine and Kazan and Saint Petersburg in the Russian Federation promoted easy, safe and youth-friendly HIV testing among adolescents.

Young people visited HIV testing sites and described the barriers to testing they faced. Using this information, they developed a map showing 63 HIV testing locations, accompanied by personal reviews on the HIV test experience, along with fun places nearby for young people to meet. As a result of the #questHIVtest, 1 925 adolescents from 5 cities have tested for HIV.

Max Saani, from Tbilisi, said, “It’s extremely helpful for teenagers to have a map on which adolescents can find youth-friendly testing locations and receive proper help and support.” “This map is very unusual, with fun teen places not even seen in Google Maps,” added Yana Valchuk, from Kiev.

Among the challenges and barriers faced by adolescents during the #questHIVtest were a lack of HIV information, stigma around HIV testing and talking about HIV with friends, the high cost of HIV tests and parental consent. The lack of anonymous HIV tests for young people and the shortage of trained doctors, social workers and psychologists to support adolescents living with HIV were also barriers.

Timur Khayarov, from Kazan, explained that the reasons why many adolescents in the Russian Federation are afraid to take an HIV test include the age limit—14 to take the test with parental consent, 16 without parental consent—and because the test results of minors must be communicated to their parents. “When I was refused an anonymous HIV test because of my age, I showed the personnel a printout of the law. The #questHIVtest helped me to defend my right to services,” he said.

The #questHIVtest project was undertaken with support from UNAIDS and the Viiv Healthcare Foundation.

“I’m convinced that the future is in the hands of adolescents—they are the people who will change and build a new world. By 2020, Teenergizer will be a few steps closer to the world that it seeks,” said Armen Agadjanov, an HIV activist from Yerevan, Armenia.

The 2030 Agenda for Sustainable Development takes ​to scale ​what the AIDS response has been working towards for 30 years—a multisectoral, rights-based, people-centred approach that addresses the determinants of health and well-being. The individual stories in this series highlight the linkages between HIV and related Sustainable Development Goals (SDGs), each told from the personal perspective of people affected by HIV. The series paints a picture of how interconnected HIV is with the SDGs and how interdependent the SDGs are with each other. Most importantly, the stories show us the progress we have achieved with the AIDS response and how far we have left to go with the SDGs. 

After nearly 15 years of injecting drugs, Sergey gave up hope. He had tried a number of times to kick his addiction, but he had failed miserably.

In 2009, in a last ditch effort, he enrolled in the Belarus Opioid Substitution Therapy Programme.

“My relatives did not believe this programme would help me and thought of it as just another hopeless attempt to quit drug use,” Sergey said.

His biggest challenge, he explained, was to prove to doctors and his relatives that he really wanted to stop injecting drugs and that this would help him cope with his drug addiction.

He comes every day to the government opioid substitution therapy (OST) centre in Minsk to receive a medical dose of methadone, which helps to alleviate his dependence on opioids.

A friend who lived in Germany told him about harm reduction and substitution therapy, but he never believed that one day it would be available in Belarus.

Sergey is one of nearly 900 people enrolled in the OST programme, which started in 2007 with a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. It includes the provision of methadone under strict medical supervision, regular medical check-ups, psychological support and social work services. In addition, OST helps people living with HIV who used to inject drugs to maintain adherence to their daily regimen of antiretroviral therapy.

Today there are 19 government OST sites across Belarus, but these still cover less than 5% of people who inject drugs in the country. Belarus wants to increase coverage to at least 40% of people who inject drugs in order to lower the number of new HIV infections among people who inject drugs.

In Sergey’s case, the programme helped him turn his life around. Not only did he get a job and keep it, but he suddenly had plans for himself.

SDG 3: Ensure healthy lives and promote well-being for all at all ages

Good health is a prerequisite for progress on ending AIDS. Ensuring healthy lives and promoting well-being for all at all ages, including people living with or at risk of HIV, is essential to sustainable development. For example, successfully ending the AIDS epidemic will require enormous health service scale-up, with a focus on community services, targeted testing strategies, ensuring treatment is offered to people following diagnosis (including regimes appropriate for babies, children and adolescents), and regularly support and monitoring for people on antiretroviral medicines. Eliminating mother-to-child transmission of HIV depends on providing immediate treatment to pregnant women living with HIV, integrating HIV and sexual and reproductive health services, and engaging male partners in prevention and treatment services.

Increasing service integration in a way that responds to individuals’ needs—whether that be combining tuberculosis (TB) and HIV services or providing youth-friendly HIV, sexual and reproductive health services—leads the way in reshaping efficient, accessible and equitable health services for HIV and beyond. HIV can be ended only by promoting the right of all people to access high-quality HIV and health services without discrimination.

The following stories explore how inextricably linked SDG 3—ensure healthy lives and promote well-being for all at all ages—and ending AIDS are. For every individual, protecting and maintaining good health underpins the capacity to fulfil their multiple roles within family, community, society and the economy. Mona’s story recounts her struggles with HIV and TB, discrimination, and the right to be treated fairly and with dignity. Lidia works with partners in the health services, community health system and private sector to ensure female seasonal coffee pickers are given the information and services they need to prevent mother-to-child transmission of HIV. Sergey describes his experience of how a harm reduction programme helped him overcome his addiction while adhering to antiretroviral therapy. Christine tells her story of how, as a community health worker, she reaches out to women where and when they need her to prevent mother-to-child transmission.

A public–private partnership between the Elena Pinchuk ANTIAIDS Foundation and the city of Kyiv has enabled 1300 people living with HIV in Kyiv, Ukraine, to access antiretroviral therapy.

The partnership, a part of the Kyiv Fast-Track city programme, allows Kyiv to double antiretroviral therapy coverage of people living with HIV at no extra cost. The public–private partnership enables antiretroviral therapy to be procured for less than half the previous average cost of the medicines in Ukraine. Before the signing of the partnership, the antiretroviral therapy programme in Ukraine was financed by the national budget and by resources from international donors.

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Armenia has been recognized by the United Nations for its elimination of mother-to-child transmission of HIV programme. The 2017 United Nations Public Service Awards saw Armenia win first prize in the Innovation and Excellence in Delivering Health Services category.

The award was made at the 2017 United Nations Public Service Forum, held in The Hague, Netherlands, on 22 and 23 June to debate how innovative policies can be fostered to implement the 2030 Agenda for Sustainable Development even when resources are scarce, objectives are highly ambitious and interests are disparate.

In 2016, Armenia was one of only four countries to be validated by the World Health Organization for eliminating mother-to-child transmission of HIV.

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Free and anonymous HIV testing and counselling were available from the Test to Win pavilion in Kazan, Russian Federation, during the Fédération Internationale de Football Association (FIFA) Confederations Cup, held between 17 June and 2 July.

The pavilion also included an exhibition on HIV and sports and was the scene for workshops, training and appearances by sports celebrities, during which visitors could learn more about HIV. Fatma Samoura, the FIFA General Secretary, visited the pavilion, as did 2018 FIFA World Cup Ambassador Alexey Smertin, Miss Russia 2017, Polina Popova, and the photographer Serge Golovach.

During the two weeks of the competition, more than 3500 people visited the pavilion and received counselling on health issues—more than 1000 of whom were tested for HIV.

The campaign was led by the nongovernmental organization New Century, in partnership with Svetlana Medvedeva’s Foundation for Social and Cultural Initiatives and with support from the Ministry of Health of the Russian Federation, the Republican Center for Prevention and Control of AIDS, the Ministry of Health of Tatarstan and UNAIDS.

On 26 and 28 June, Kazan hosted FIFA’s Forum 'Football for Hope' to promote and develop the use of football as a tool for social development in the Russian Federation and abroad. The forum brought together representatives of nongovernmental organization supported by FIFA’s Football for Hope from all over the globe to share their experiences and successes working in social development in football. The programme included panel discussions with the participation of UNAIDS and others on how football can help to achieve the Sustainable Development Goals.

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