HIV: A Turning Point
There are, unfortunately, barriers that prevent reduction in the number of new HIV infections in the world. What is the reason behind this? According to experts, this is facilitated by inadequate political support and, as a result, lack of investment, as well as reluctance to address delicate problems related to the rights and needs of young people with regard to sexual and reproductive health.
The year 2018 has become important in Uzbekistan in terms of combating HIV infection. This June, the President of the Republic of Uzbekistan signed a decree aimed at counteracting the contamination of diseases caused by the human immunodeficiency virus and preventing nosocomial infections.
Monitoring and evaluation in the field of HIV prevention, treatment and care services in Uzbekistan is carried out by the Interagency Expert Council (IEC) on Ensuring Interaction with International and Foreign Organizations in the Sphere of Counteracting the Spread of HIV, Tuberculosis and Malaria and Involvement of Donor Funds for Activities, of which the United Nations Office on Drugs and Crime (UNODC) is also a member.
The guest of our editorial office today is deputy chief physician on epidemiological issues at the Republican Center for State Sanitary and Epidemiological Supervision of the Ministry of Health of the Republic of Uzbekistan, Botirjon Kurbanov, who has agreed to share his observations with our readers
- Please tell us about the novel measures outlined in the presidential resolution.
- The document describes comprehensive measures in six chapters - a total of 24 steps. The resolution notes that the achievement of the set goals will directly depend on financial support. A distinctive feature of this document is that each event is accompanied by information on financial costs. I think this approach will ensure complete and timely fulfillment of tasks. In total, more than 103 billion soums and 35 million US dollars will be allocated for 24 measures.
In the resolution, the situation of vulnerable groups of the population and provision of services in Confidence Rooms and Friendly Offices is separately examined.
- Explain, please, the role and value of Friendly Offices.
- Friendly Offices are a relatively new practice for national AIDS centers. Starting from this year, more attention has been paid to the activities of Friendly Offices that provide services to vulnerable groups of the population. It is extremely important to ensure the uninterrupted operation of the rooms, timely providing them with the necessary funds for the implementation of preventive measures.
The resolution provides that over the years financing and management of the Friendly Offices and Confidence Rooms, one of the key elements in HIV prevention and control activities, will be implemented by the government.
Also, the resolution reflects the prevention of nosocomial infections. A separate section emphasizes the prevention of HIV infection through parenteral transmission, as well as the improvement of the material and technical base of AIDS control centers and other treatment and prevention facilities.
I would like to highlight that the resolution presupposes the improvement of normative acts in the field of HIV prevention. It should be noted here that proposals to perfect the legislative and regulatory documentation have been developed jointly with a number of international organizations. When developing this resolution and amending legislative and regulatory documents, recommendations and best practices presented by international organizations are taken into account.
- Why do you think it is time to gain momentum when the state decided on this important step?
- I think it is quite logical, considering the transformations taking place in Uzbekistan in all sectors. The healthcare system in this case is no exception.
Healthcare reform, as well as the need for comprehensive measures led to the fact that we today have this resolution. The document went through a long process of preparation and development and is a thoroughly thought-out plan for implementing complex measures. I consider it very relevant and timely.
- For many years you have been chairman of the monitoring and evaluation working group under the Interagency Expert Council and are directly involved in monitoring throughout the country. What are your impressions from your last trips?
- I have since 2014 been the chairman of the working group on monitoring and evaluation at the IEC. All these years we monitor, verify and study the activities and the role of Confidence Rooms throughout the country.
Every year, the logistics of Confidence Rooms are improved thanks to a grant from the Global Fund for the HIV component that we visit with partner and technical support from the UNODC and the IEC Secretariat. When I first started working as a chairperson of the working group, the number of registered HIV cases in Confidence Rooms among vulnerable groups, in particular among people who inject drugs, was several times higher than it is today.
The main goal of Confidence Rooms is to reduce the incidence of HIV infection among susceptible groups of the population, that is, among those who inject drugs.
- What work helps achieve this?
- It is promoted thanks to the right approach, the training of assistants to Confidence Rooms, the work of volunteers who themselves carry out preventive work and train their patients. Preventive measures give their results: the number of HIV infected among vulnerable groups of the population has been decreasing every year, that is, the main goal of Confidence Rooms is achieved.
- The situation in cities is more or less clear, but how are things going on in remote places?
- The level of accessibility of services of Confidence Rooms is improving both in cities and in remote areas. It is important to recall that in the Confidence Room all services are free. Moreover, they conduct consultations and screening tests. Fifteen years ago, injecting drug users did not have access to the trust offices, could not get the services and advice of specialists. Today, all this is available, even in remote areas. Until recently, people who inject drugs could not get disposable syringes and other services for the prevention of infections. On the one hand, they feared to go anywhere, on the other, there was no access to consulting services. To date, there are no prohibitions or obstacles that could prevent injecting drug users from receiving the necessary medical advice.
- What other favorable changes will the new resolution bring about?
- The new resolution envisages extensive works to raise public awareness through the media.
A separate event involves the creation and dissemination of social videos, innovative projects and their distribution in social networks. The population will receive useful information about HIV prevention and treatment. This process will involve all interested ministries and departments, as well as international organizations.
- By the way, since we already touched on interagency work, what is the role of improving the intersectoral approach actively discussed today?
- Combating the spread of HIV requires a comprehensive approach. To make tangible changes, it is necessary to interact with the public sector and civil society, and international organizations. A special role is assigned to the non-state sector, civil society organizations that, on a peer-to-peer basis, provide services to vulnerable groups of the population on a par with Confidence Rooms. It is necessary to recognize that the state needs the help of non-governmental non-profit organizations in the process of providing services to exposed groups of population in the form of consultations, training of the population and conducting screening tests. Thus, to achieve results in this area, intersectoral approach and comprehensive preventive measures are needed. Alone, the healthcare system or AIDS centers, or the same center of the State Sanitary and Epidemiological Surveillance, will not be able to achieve their goals.
- How can we revitalize the intersectoral approach?
- If each participant in this process asks questions like “What can I give? What other approach or solution exists that other partners have not thought about? What can be done to make a contribution to the fight against AIDS and HIV prevention and influence the situation?” I think the process will really be stepping up.
The 22 June resolution of President of the Republic of Uzbekistan on additional measures to counteract the contamination of diseases caused by the human immunodeficiency virus and preventing nosocomial infections, envisages that starting from the year 2022, means for the prevention of the spread of HIV virus among the vulnerable groups of population are to be assigned from the national budget. In 2017, the prevalence of HIV infection among those who inject drugs was 5.1% (for comparison: among the general population, this figure was 0.1%, according to the Republican Center for AIDS Control). The level of awareness of those who inject drugs about the transmission routes of infection is improving – it is 82.6% (in 2007 it was 76.9%). Coverage of preventive measures, including information and educational materials, increased almost threefold and amounted to 68% (in 2013 it was 24%).