{"id":41448,"date":"2018-02-20T11:13:29","date_gmt":"2018-02-20T10:13:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=41448"},"modified":"2018-02-23T12:49:34","modified_gmt":"2018-02-23T11:49:34","slug":"michel-kazatchkine-winds-of-hope-on-hiv-aids-in-eastern-europe-and-central-asia","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/02\/20\/michel-kazatchkine-winds-of-hope-on-hiv-aids-in-eastern-europe-and-central-asia\/","title":{"rendered":"Michel Kazatchkine: Winds of hope on HIV\/AIDS in Eastern Europe and Central Asia?"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/2013\/11\/05\/michel-kazatchkine-aids-huge-progress-but-time-for-a-rethink-on-how-to-end-the-epidemic-for-those-most-affected\/michel_kazatchkine\/\" rel=\"attachment wp-att-29874\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-29874\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2013\/11\/michel_kazatchkine.jpg\" alt=\"michel_kazatchkine\" width=\"160\" height=\"130\" \/><\/a><span style=\"font-weight: 400\"><a href=\"http:\/\/www.unaids.org\/en\/resources\/presscentre\/pressreleaseandstatementarchive\/2017\/november\/20171121_righttohealth_report\">The announcement by UNAIDS<\/a> that some 21 million people living with HIV are now on treatment uncovers an extraordinary achievement and one of the great global health milestones of this century.<\/span><\/p>\n<p><span style=\"font-weight: 400\">It gives us hope that the other 15 million or so people living with HIV can also soon access anti-retroviral treatment, and hope that we can begin to turn around the spiralling rates of HIV infection occurring in Eastern Europe and Central Asia (EECA). Much of the media coverage focused on the intransigence of the government of the Russian Federation to changing its prevention policies around HIV\/AIDS, namely via the supply of clean needles and opioid substitution therapy (OST) such as methadone. And with <a href=\"http:\/\/journals.plos.org\/plosmedicine\/article?id=10.1371\/journal.pmed.1002462\">the number of people living with HIV in Russia now officially exceeding 900,000<\/a> compared to 250,000 a decade ago, and people using drugs still representing over 40% of newly diagnosed cases, that criticism is fair.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">However this focus also obscures the fact that i<\/span><span style=\"font-weight: 400\">n<\/span><i><span style=\"font-weight: 400\"> Eastern Europe and Central Asia <\/span><\/i><span style=\"font-weight: 400\">which has been much maligned over the past decade for its slowness in responding to the HIV\/AIDS epidemic, we are now beginning to see strong hints that public health initiatives based on scientific evidence are taking on a legitimacy across the region.<\/span><\/p>\n<p><span style=\"font-weight: 400\">On a political level we are seeing increased awareness and leadership, for example the Russian Federation government for the first time adopted a state HIV\/AIDS strategy followed by <a href=\"http:\/\/static.government.ru\/media\/files\/QKTjakw8C8wsZkBBSL7cW3qNFYJv8Son.pdf\">an action plan 2017-2020<\/a>.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">There is growing national dialogue across sectors in Kazakhstan, Kyrgyzstan, and Moldova on the back of national multi-partner AIDS conferences held in both countries in 2016 and 2017. Very significantly, Kazakhstan has now successfully transitioned from external financing from the Global Fund to Fight AIDS, TB and malaria to cover the majority of costs for their AIDS response from domestic sources. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Truly encouraging too has been the decision by the Ukrainian cities of Kiev, Odessa, and Balsi in Moldova and Almaty in Kazakhstan to associate themselves as <a href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/07\/07\/urban-public-health-strategies-will-be-key-to-ending-aids\/\">Fast-Track Cities committed to reaching the 90-90-90 treatment target by 2020<\/a>, the aim of which is to ensure that, by 2020, at least 90% of people living with HIV know their status, 90% of all people diagnosed with HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Finally, and hugely important, we are now seeing significant health system reforms in countries like Ukraine and Kazakhstan that are vital to responding to the AIDS and TB epidemics more effectively and efficiently.<\/span><\/p>\n<p><span style=\"font-weight: 400\">This groundswell of change in the region has been building up for some time now and we are seeing the fruits of it beginning to emerge.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Quite remarkably, nine of the 12 EECA countries now implement national programmes around OST, with Uzbekistan currently considering its uptake. Russia and Turkmenistan are certainly isolated on this front, by not implementing a similar strategy.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Armenia and Belarus have now officially been declared by the WHO as having eliminated the transmission of HIV from mother to child. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Equally encouraging is the increase by 13% in antiretroviral treatment coverage across the region in the last two years. Armenia, Belarus, Kazakhstan, Georgia and Ukraine have already adopted a \u201cTest and Treat\u201d strategy and several more countries in EECA are currently pending approval.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Lastly and perhaps a strong indicator of commitment to respond to the epidemic across the region is the significant headway being made across the region to reduce the high prices of anti-retroviral drugs (ARV). The positive steps being made in the region on HIV\/AIDS provides genuine hope. We will need to build on these growing expectations if we are to successfully overcome the barriers that have come to define the epidemic in the EECA. Despite the progress, new cases and AIDS-related mortality continue to increase as a result of previous neglect and inadequate policies over the past fifteen years. Some 400 000 people do not know their HIV positive status, anti-retroviral therapy (ART) coverage is still the lowest among any region of the world, and prevention programmes are poorly funded and fail to reach the majority of those vulnerable groups at high risk of contracting HIV, and who also continue to be stigmatizsed, criminalised, and often denied access to services. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The growing signs that we may be seeing perceptible changes in HIV\/AIDS responses from governments across the EECA region is cause for hope for those at risk of and living with the disease. Those changes will definitely need to be predicated on respect for the human rights of all people to have access to health care if we are truly to change the trajectory of the HIV epidemic in EECA.<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Michel Kazatchkine<\/strong> is Special Advisor to the Joint United Nations Program on AIDS for Eastern Europe and Central Asia.<\/span><\/i><\/p>\n<p><em><strong>Competing interests:<\/strong> None declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The announcement by UNAIDS that some 21 million people living with HIV are now on treatment uncovers an extraordinary achievement and one of the great global health milestones of this [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/02\/20\/michel-kazatchkine-winds-of-hope-on-hiv-aids-in-eastern-europe-and-central-asia\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":39600,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-41448","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Michel Kazatchkine: Winds of hope on HIV\/AIDS in Eastern Europe and Central Asia? 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