HIV: A Turn­ing Point

Uzbekistan Today (English) - - HEALTH -

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

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- 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%).

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