The regional meeting “Strengthening coordination and advocacy of regional unions and networks of key populations in order to achieve the “90-90-90” target in Eastern Europe and Central Asia” was organized by the Eastern Europe & Central Asia Union of people living with HIV (PLWH) in Yerevan at the end of May 2015. The meeting participants represented various regional networks and vulnerable groups: PLWH, people who use drugs, sex workers, MSM, youth and women living with HIV. In the view of the rapidly changing situation the meeting participants decided to create an advocacy and coordination road map for the next two years. The UNAIDS and UNFPA offered their support to this planning process.

The 90-90-90 UNAIDS target aims are:
•By 2020, 90% of all people living with HIV will know their HIV status;
•By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy;
•By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression;

It was generally agreed that 90-90-90 is a good overarching goal for the regional networks, present at the meeting. However some of the meeting participants were in doubt regarding the feasibility of achieving the 90-90-90 target, because of an increase in mortality, the worsening of the situation of the vulnerable groups, lack of prevention measures, and the reduction in funding for civil society organization (CSOs) and the community in the Eastern Europe & Central Asia (EECA). For instance, at Minsk (UNAIDS) regional conference the question of migration policy was discussed in relation to health services alongside community-based HIV testing, the need to reduce treatment costs and the problem of criminalization of vulnerable groups. It was noted that the criminalization is increasing in the recent years. Thus, how exactly the 90-90-90 targets are going to be achieved in EECA remains to be seen.

The TB community faces comparable problems and it is not surprising that the response, which will be detailed in the Global Plan to Stop TB (2016-2020) will aim for a similar 90-90-90:
Finding at least 90% of all people with TB in the population that require treatment and placing them on appropriate therapy. As a part of the effort to reach at least 90% of all people with TB, making a special effort to reach at least 90% of the key population groups – the most vulnerable, underserved, at risk populations in countries. Reaching at least 90% treatment success through affordable treatment services, promoting adherence and social support.

Some of the TB-related barriers, identified by the ECUO meeting participants included the price of second-line drugs for treating drug-resistant TB and their quality; there were mentioned the incidents when TB generic drugs are more expensive than quality assured brand drugs. Lack of TB/HIV integration in the health systems and also in the implementation of programs by CSOs was mentioned as one of the barriers. Another barrier was a lack of patient-centered approach in TB/HIV. In relation to declining funding, it was voiced that e.g. in Kazakhstan the social procurement is not available to CSOs and the social services to PLWH are contracted to a state structure, which is not functioning well. Similarly, in the Russian Federation and in Azerbaijan the mechanisms for social procurement exist and CSOs can, in principle, receive the money from the government. However, as some of the participants shared, the government usually has other priorities.

As part of the solutions to the many challenges, which we face together, TB Europe Coalition could use the experience of the HIV Key Affected Populations and introduce the human rights element (access to diagnosis and treatment) in the capacity building / advocacy trainings by TBEC to TB key affected populations. In addition the TB and the HIV networks will benefit from more intensive exchange of information about the TB/HIV issues they encounter, and having joint advocacy activities in the region. Finally the regional networks agreed to step up cooperation by exchanging agendas and work plans, joint trainings on advocacy, negotiations and working with politicians. At the national level mobilization of community through exchange of information, coordination meetings and the use the Regional Platform (planned to be funded by the Global Fund) was discussed. It was preliminary agreed that all networks will once a year prepare a joint position paper about the situation in the region – to coordinate the work and have unified messages. It would be important for TB Europe Coalition to participate in this and other activities of the regional networks.

The first join action was the support of the TB Europe Coalition to the HIV networks’ appeal to the WHO office for the European region. As a result we hope that a representative from the EECA region, delegated by the communities, will partake in the Guideline Development Group updating the WHO guidelines on the antiretroviral therapy.

Source: This blog was prepared by Nonna Turusbekova,  TBEC Steering Committee member who attended the meeting in May 2015 in Yerevan.

 

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