Country level activities

Country level support to adoption and implementation of HTS guidelines: (a) National working groups technical assistance support; (b) Revision of functional responsibilities regarding HTS of HIV specialized settings, relevant testing points and lab(s), and other level institutions including primary care entities; (c) Training of new entities/people engaged in testing procedures; (d) Training for lab professionals to engage more in monitoring and improving the quality of testing procedures; (e) Conduct comparative cost analysis of RDT-based vs current diagnostic algorithm in two countries – to support investment case at policy level; (f) TA for HIV testing algorithm verification activities in 2 selected countries

Costing Methodology for HIV infection testing costs based on current HIV testing strategies and RDT-based testing costs and data collection tool are developed, data on Kazakhstan and Georgia are collected, the reports are under finalization.

PAS in collaboration with WHO Euro and WHO CO, on September 19-21, 2023, in Ankara, Turkey, organized the study tour and training: Laboratory aspects of transition to new HIV testing algorithms. The main scope of the events was to discuss the ways to improve HIV testing services in line with WHO recommendations and to enable countries to exchange their best experiences of the revision of national HIV testing strategies. The event was attended by: representatives of the National HIV Programs responsible for HIV testing strategies and laboratory specialists responsible for laboratory diagnostics of HIV, monitoring and testing quality at the national level from Turkiye, Ukraine, Moldova, Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan and Azerbaijan; WHO EURO office, PAS Center, APH.

A two days training for laboratory specialists in HIV testing in Kazakhstan on November 30 – December 01, 2023. During the training, the participants discussed what will be the role of the reference laboratory, the role of laboratories in the regions, the changed responsibilities of laboratory specialists, the ensuring of the quality of the testing, the monitoring and evaluation of the testing etc.

A two days training for laboratory specialists in HIV testing in Georgia on December 07-08, 2023. The training was dedicated to the discussion and planning of the verification study of the HIV testing algorithm using rapid tests.

Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines

Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.

WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.

National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.

Decentralization of HIV testing services through integration to primary healthcare

Synthesis Report on assessment of readiness of health systems to decentralize HIV testing services in 5 countries of the EECA region is developed and can be found at the link.

The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.

Technical support in implementation of simplified registration for ARVs

Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.

The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.

Advocacy efforts were aimed at optimizing the ARV procurement process, expanding the involvement of the patient community and representatives of key vulnerable groups in advocating for access to drug supply and diagnostic and monitoring. Legal justifications were prepared for key regulatory acts that regulate the process of conducting and organizing the procurement of medicines and medical devices. These documents were presented to the national stakeholders (representatives of SK-Pharmacy, National Institute of Intellectual Property, National Center for Drug Expertise, Kazakh Scientific Center of Dermatology and Infectious Diseases, UNICEF) within the framework of the working meeting on “Cancellation of re-examination and registration of medicines and medical devices on the territory of the Republic of Kazakhstan”.

Technical support in optimization of medicine procurement cycles

Priorities for improvements of PSM systems in Armenia, Georgia and Kazakhstan were discussed and agreed for further activities in 2023-2024. In Kazakhstan, MOH provided a list of its activities aimed to preserve state registration procedure and expressed the need to develop relevant legislation. In Georgia, access to the Global Fund procurement mechanism is of the highest priority. In Armenia, long-term agreements for ARVs and streamlining procurement practices from bottom to the top level in terms of centralization/decentralization and improvement of medicines registration procedure are of importance.

Georgia developed legally binding draft Drug Agency letter with supporting technical analysis allowing to significantly simplify receiving waivers for medicines import for Georgia.

Kazakhstan developed draft MoH order to mitigate some risks for medicines tendering procedures for Kazakhstan.

Armenia developed draft Law and draft Governmental decree enabling launching a medicines reimbursement reform for Armenia.

Advocacy for engagement of patient community experts into national working groups to develop and adopt medicine procurement lists and technical procurement documentation

Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.

The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.

Online training/webinar “Building understanding of ARV procurement process” was held and online training/webinar “Building skills in advocacy, effective communication, legislative issues, right to adequate drug supply, monitoring, and transparency skills”. Based on the results of the online training/webinars, the prepared materials were compiled into a training manual, which were sent to the training participants.

Inclusion of PrEP into nationally approved service packages for MSM and/or other key populations

ECOM in partnership with WHO regional office for Europe analyzed five national PrEP protocols (Armenia, Kazakhstan, Kyrgyzstan, Georgia and Ukraine) and provided Report with recommendations on the steps needed to include PrEP into nationally approved standard package of servises. The report is under design and will be published by the end of February.

Much work was done in 2023 to present recommendations based on analyzes of PrEP Protocols in 5 countries. Online and offline meetings with stakeholders, monitoring visits (Kazakhstan, Kyrgyzstan) were held, the results were presented at various meetings, conferences, and technical consultations. Based on the analysis of PrEP Protocols and updated WHO recommendations, policy briefs were developed and sent to countries, the purpose of which was to show and not miss the importance of new interventions that can improve PrEP services in countries.

Community groups conduct community-led assessment of national quality standards in accordance to IDUIT and organize dialogue with service providers and MOH/local authorities

Moldova

PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers. Next steps and recommendations for CCM were elaborated.

GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. The aim is to leverage the platform to advocate for a comprehensive revision of the National Clinical Protocol on Pre-Exposure Prophylaxis (PrEP) in the first quarter of 2024. This strategic move aligns with the commitment to fostering meaningful changes in the national approach to PrEP in response to the insights gained through the CLM survey.

Kazakhstan

Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared. Meeting with CCM is planned to be organized in January 2024.

Georgia

Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.

Kyrgyzstan

Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.

Tajikistan

Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.

Armenia

“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. In addition, results are in active use in the National dialogue now.

Integration of community-led monitoring (CLM) into the health care systems of countries in the EECA region to assure the quality of services for key populations (KPs)

Practical handbook on community-led monitoring tools was developed in English and Russian languages. The checklist with EHRA and other partners for CLM was discussed and agreed upon.

On 2-8 December 2022, specialists from the Eurasian Harm Reduction Association (EHRA) conducted regional online training “Community-Led Monitoring Methods” for the representatives of community organizations in the CEECA region. The training was attended by 38 representatives of organizations from different vulnerable communities in the CEECA region. The aim of the training consisting of three online sessions was to train leaders of self-organizations from different key communities in the CEECA region to understand, which role CLM can play in their advocacy work, how to formulate the proper problem and research question for CLM, and which of the different methodologies can most effectively provide the data needed for advocacy. Video recordings of the training, as well as presentations can be found at the link.

Following the CLM Handbook, developed in 2022, integration of CLM into the healthcare system can be ensured through productive and sustainable participation of community representatives in the decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services.

CLM has been conducted in all planned countries. Results were presented in 5 countries and protocols were received (Moldova, Georgia, Tajikistan, Kazakhstan and Kyrgyzstan). In Armenia, the results of the CLM are in active use in the National dialogue now. The focus group with broad number of experts and MSM community members (including representatives from CCM) was conducted, and based on the results PrEP was identified as a key priority and included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. “

Provision of HIV prevention services with precautions against COVID-19

Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.

National Contingency Planning

Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.

Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.

Technical support in implementation of long-term contracts for ARV procurement

Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.

The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.

Advocacy efforts were aimed at optimizing the ARV procurement process, expanding the involvement of the patient community and representatives of key vulnerable groups in advocating for access to drug supply and diagnostic and monitoring. Legal justifications were prepared for key regulatory acts that regulate the process of conducting and organizing the procurement of medicines and medical devices. These documents were presented to the national stakeholders (representatives of SK-Pharmacy, National Institute of Intellectual Property, National Center for Drug Expertise, Kazakh Scientific Center of Dermatology and Infectious Diseases, UNICEF) within the framework of the working meeting on “Cancellation of re-examination and registration of medicines and medical devices on the territory of the Republic of Kazakhstan”.

Introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations, including with TA provided by the WHO Regional Office, Europe

Costing Methodology for HIV infection testing costs based on current HIV testing strategies and RDT-based testing costs and data collection tool are developed, data on Kazakhstan and Georgia are collected, the reports are under finalization.

In 2022, the project conducted an assessment on policies, regulations, and practice of HIV Rapid Testing/Self-testing in 4 SEE countries and developed a report on findings and recommendations. The assessment was conducted in North Macedonia, Albania, Montenegro, and Serbia. The purpose of this assessment was to evaluate country-specific policies, regulations, and practical factors that are currently facilitating or affecting community-level access to rapid diagnostic tests, including self-testing of HIV. Some of the key recomendations which are suggested: to update National Guidelines/Protocols for HIV testing, outlining clear HIV testing algorithm in line with WHO recommendation including community based testing and HIV self-testing; update the existing internal protocol on HIVST; develop policy and advocacy recommendations for reducing HIV-related stigma and discrimination; integrate HIV self-testing into existing HIV service delivery models including OST programs. The report can be found at the link.

In Georgia new HTS guideliness was approved, in Kazakhstan was submitted for approval. The new testing strategies include the use of rapid tests for HIV testing, the decentralization of testing (the involvement of PHC, NGOs, specialized medical institutions), the exclusion of the use of the western blot test for confirmation.

Decentralization of HIV testing services through integration to primary healthcare

Synthesis Report on assessment of readiness of health systems to decentralize HIV testing services in 5 countries of the EECA region is developed and can be found at the link.

The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.

In Kazakhstan, a roadmap for HIV decentralization was elaborated, and national discussions were initiated. During this process, a partnership was developed between the involved national consultant and different local stakeholders and partners, including UNICEF, which is playing a significant role in terms of access to HIV diagnostics and medicines.

In November 2023, was organized a study visit by the GF for colleagues from the AIDS Center and other state agencies from Kazakhstan to Georgia to learn about the Georgian experience. Based on the visit, the normative and legal amendments to National protocols regarding decentralization were discussed, but development and approval were postponed until 2024.

The main reason for the postponement is the validation of test systems produced by local manufacturers in Kazakhstan that are not prequalified by the WHO.

Decentralization of HIV treatment through integration to primary healthcare

Synthesis Report on assessment of health systems to decentralize HIV treatment services in 5 countries of the EECA is developed and can be found at the link.

The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.

In Kazakhstan, a roadmap for HIV decentralization was elaborated, and national discussions were initiated. During this process, a partnership was developed between the involved national consultant and different local stakeholders and partners, including UNICEF, which is playing a significant role in terms of access to HIV diagnostics and medicines.

In November 2023, was organized a study visit by the GF for colleagues from the AIDS Center and other state agencies from Kazakhstan to Georgia to learn about the Georgian experience. Based on the visit, the normative and legal amendments to National protocols regarding decentralization were discussed, but development and approval were postponed until 2024.

The main reason for the postponement is the validation of test systems produced by local manufacturers in Kazakhstan that are not prequalified by the WHO.

Legal environment and situation analysis as well as mapping of civil society partners in the area of access by migrants to HIV and TB services

On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.

On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.

On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.

Also, in Q4 REG has launched a study is Kyrgyzstan.

On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.

Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan and Kyrgyzstan were held and are available at the links: Tajikistan, Kyrgyzstan.

In addition, the report “Ukrainian Refugees in European Countries: Barriers, Solutions and Best Practices. Access to HIV and Tuberculosis Care” was developed and is available at the link.

Ensure a monitoring system for the implementation of the human right to health in prisons through national preventive mechanisms

An analysis of the current situation regarding the development and implementation of tools to ensure access to harm reduction services with a focus on OST was conducted by FreeZone in Georgia and in Kyrgyzstan.

An analysis of the current functioning of NPMs was carried out by FreeZone in Moldova and Kazakhstan.

For Moldova and Kazakhstan, Information on key indicators of the incidence of socially dangerous diseases in penitentiary institutions was collected, namely data on the total number of convicts held in penitentiary institutions; detailed information on the number of people living with HIV infection; the number of detected cases of tuberculosis; the number of convicts who were provided with treatment for viral hepatitis. The results can be found at the links: Moldova,  Kazakhstan.

In Georgia, the Overdose prevention training module was developed for prison staff. The Module is aimed at training the prison employees involved in the release preparation programs. The training module contains both theoretical material, as well as practical exercises. The Module details overdose prevention mechanisms and interventions that are necessary in case to prevent death.

In Kyrgyzstan, meetings were held with the Ministry of Justice, the Ministry of Finance, etc. on the expanding health services, including HIV services in the penitentiary institutions; extended discussions were initiated at the Country Coordination Committee meetings and round tables on issues related to expanding government funding for penitentiary institutions.

In Moldova, temporary accreditation of the training program for the profession of “peer-to-peer consultant” in penal institutions of Moldova was obtained, and activities related to advocating for the inclusion of the position of “peer-to-peer consultant” in the list of positions in penitentiary institutions were provided.

In Kazakhstan, on November 30, 2023, a meeting was organized to discuss the current issues of compulsory social health insurance, the guaranteed volume of free medical care services for representatives of the PWUD community, drug provision, and diagnosis of diseases among prisoners. To intensify community participation in the mechanisms to ensure the implementation of state policy on combating TB and HIV/AIDS, the prisoners and ex-prisoners community member was included in the CLM Working Group during the Country Coordination Committee meeting on November 3rd, 2023.

In Ukraine, communication was ensured with the relevant government bodies (Center for Health Protection of the Ministry of Health of Ukraine, the Health Center of the State Criminal-Executive Service of Ukraine, and others) to advocate for the updated SOP standard. Discussions were initiated for the preliminary approval of the SOP “Diagnostics, treatment and support of PLHIV (and suspected HIV) in medical points of the Health Center of the State Criminal-Executive Service of Ukraine”. An updated SOP was presented and discussed within the Working Group on ensuring the continuity of services in the penitentiary institutions. An order of the Health Center of the State Criminal-Executive Service of Ukraine on the approval of SOP has been prepared, signed, and published.

Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people

Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:

• “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
• “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
• “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
• “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).

• The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
• The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
• The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
• The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
  

Evidence-based advocacy interventions with the aim of removing legal barriers to, and improve the rights of, migrant access to HIV and TB care in sending and receiving countries of in EECA region: national and regional (EECA) meeting and roundtables with participation of civil society, migrant organizations, healthcare officials and parliamentarians

On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.

On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.

On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.

On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.

REGMH held a number of online and offline seminars and rioundtables to present and discuss the results of their studies in Azerbaijan, Tajikistan and Kyrgyzstan. A number of discussions was also held to scale up remote registration of migrants with HIV to get access to HIV services. For now, remote registration is functional in Tajikistan, and the preparatory work is implemented in Armenia, Azerbaijan and Kazakhstan.
In particular, on June, 6 in Dushanbe REGMH held a Round Table on protecting health of Tajik migrants. The purpose of the meeting that gathered together the staff of the AIDS Center, the patients’ community, specialists from NGOs in the region and host countries was to discuss the maintaining of the algorithm for remote registration of citizens of Tajikistan with HIV living abroad, and to formulate further steps to improve access of migrants to HIV services. Deputy Director of the Republican AIDS Center made a proposal to develop and sign a Memorandum for Mutual Recognition of Medical Tests at the level of Republican AIDS Centers in the Central Asian region.

On December 4, REGMH held a Round Table in Yerevan, Armenia. The key focus of the meeting was the provision of HIV services for Armenian citizens living abroad.

On December, 25 REGMH participated in online meeting to discuss current issues of implementation/piloting of “Remote registration of migrants with HIV in Uzbekistan”, organized by a consortium of organizations in Uzbekistan to promote the protocol, including IOM, CCM, AFEW, and REGMH. During the meeting, representative of CCM informed that the protocol was accepted and signed by the Center for State Sanitary and Epidemiological Surveillance of the Republic of Uzbekistan. What is very important, the final version includes recommendations suggested by REGMH making it easier to register a migrant than it was in an initial version of the document.

On June 15, REGMH held its quarterly Working group meeting on remote registration of PLWH living abroad. As a result of the Round Table held earlier in Uzbekistan, the group managed to attract specialists from the Republican AIDS Center and the CCM of Uzbekistan. During the meeting, the Group discussed the issue of accepting medical documentation (certificates, test results) issued by country of migrant’s destination, which are necessary for remote registration; also, the standard for the minimum set of documents for remote registration of citizens in migration (based on WHO’s recommendations) were presented to participants on order to foster the development of remote registration in the EECA countries.

REGMH has launched a series of Webinars “Health of Refugee and Migrants from the EECA countries”, designed both for those who flee and seek help in the host country and for those who organize help in receiving countries. Also, webinars could be of interest to those who research and solve systemic problems.

The first webinar took place on August 09 and was devoted to revision of problems that Ukrainian refugees who use drugs face: “People Who Use Drugs from Ukraine: Challenges and Solutions”.

Migration and Health Summer School was hekd on 21-22 Aug 2023 in Yerevan, Armenia. where participants discussed best practices and solutions for providing medical care to migrants and refugees from the EECA region. Country representatives of REGMH from the EECA region, representatives of health authorities from the EECA countries, experts from regional and international organizations, WHO, UNAIDS, UNDP, and MSF attended the event, totally, 40 participants from 12 countries.

On November 24, 2023 REGMH held a Round table in Bishkek, Kyrgyzstan to discuss current issues of migrant health in the context of HIV. The event brought together experts from relevant ministries and departments, non-governmental and civil sectors, as well as representatives of international organizations. A key part of the round table was the presentation of study’s results conducted by REG in 2023 “Situational and economic analysis in the field of migration and the provision of medical services related to HIV in the Kyrgyz Republic” to identify legal and institutional barriers related to HIV faced by citizens of Kyrgyzstan returning from migration.

REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.

Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).

The following publications are available:

• Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
• Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
• Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
• REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
  Situational Report by APH: Drug policy in Georgia and Challenges.
• Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.

REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.

Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.

Through the use of the Stigma Index 2.0 , measure HIV-related stigma and discrimination experienced by PLHIV in countries of the EECA region by delivering training for interviewers and researchers to familiarize them with the methodology and survey instrument, and in conducting interviews and entering data into the RedСap database system, as well as to develop and disseminate the survey report

Protocols for Stigma Index Research are developed in Armenia and Georgia. The filed phase will start in 2023.

In all three countries the Protocols are approved. Moreover, the Stigma Index Researches are fully completed in Armenia and Georgia.

The reports has been approved by the Global Partnership and presented to all stakeholders. In Kazakhstan, the protocol is approved and the field stage of the research is successfully completed with a final sample of over 1430 surveyed respondents. Currently, within the project, the Research Team has commenced the analysis of the collected data and is preparing the initial draft of the Research Report.

Legal environment assessment on MSM and trans people in 4 countries

The goal of this comparative analysis of legislative barriers preventing LGBT people from fully realizing their rights in 12 CEECA countries is to show progress or, on the contrary, regression in terms of the development of legislation and law enforcement practice, enabling or preventing LGBT people from realizing their human rights.

An updated analysis of activities from the end of 2021 to the beginning of 2023 shows the main changes and provides a list of key advocacy recommendations on where the attention of national teams and international organizations is needed to improve the human rights situation in 12 countries of the region.

Decriminalization of HIV and unintended HIV transmission

100% Life conducted an analysis of the legal environment in Georgia, Kyrgyz Republic and the Republic of Uzbekistan in order to identify regulatory legal acts that need to be amended to reduce the criminalization of people living with HIV.

During 2023, draft legislative amendments to the regulations in the context of the legal and legislative acts that contribute to the criminalization of HIV in Georgia, Kyrgyzstan, Kazakhstan, and Uzbekistan were developed. These amendments concern both general and specialized norms.

• Draft Law “On amendments and additions to the Criminal Code of the Republic of Kazakhstan on liability for infection with the human immunodeficiency virus (HIV)”
• Legal justification for excluding HIV/AIDS from the Order of the Deputy Prime Minister – Minister of Labor and Social Protection of the Population of the Republic of Kazakhstan dated June 22, 2023 No. 230 “On Approval of the Rules for the Activities of Organizations Providing Special Social Services”
• Legal justification for amending the requirements to the health of citizens (military personnel) for military service according to the columns in the Order of the Minister of Defense of the Republic of Kazakhstan dated December 22, 2020 No. 722 “On approval of the requirements to the health of persons for service in the Armed Forces, other troops and military formations of the Republic of Kazakhstan”.

Legal framework for financing HIV services from domestic funds – development and approval

Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.

Increasing domestic financing of countries for services to key groups

Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.

Regulation of service packages for key groups

In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.

Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.