Supporting community action on AIDS in developing countries NO voice NO programs: V ulnerable communities in the EECA region Developed in collaboration with: ECOM (Eurasian coalition for men’s health), EHRN (Eurasian Harm Reduction Network) Ukrainian association of Substitution treatment advocates, International HIV/AIDS Alliance in Ukraine Shona Schonning, Charles Vitek

Supporting community action on AIDS in developing countries 1. Explosive epidemics among MARPs 2. Political commitments have been made… but 3. Coverage not enough for impact 4. Limited investments and policy space for MARPs 5. Conclusions Presentation outline

Supporting community action on AIDS in developing countries Explosive epidemics among MARPs

Supporting community action on AIDS in developing countries HIV prevalence among IDUs (2006): data from routine serum monitoring (RS) and sentinel surveillance (SS) International AIDS Alliance, Ukraine

Supporting community action on AIDS in developing countries Routes of transmission, reported HIV cases, Russia Source: Russian Federal AIDS Center IDU Hetero- sexual

Majority of women report heterosexual risk but IDU is underreported Hepatitis C is a marker for IDU exposure Substantial minority of HIV+ women deny IDU but are hepatitis C+ Underreporting of IDU status In PMTCT in St. Petersburg, 25% - 40% of ´non IDU´ HIV+ women are hepatitis C+

Supporting community action on AIDS in developing countries Political commitments have been made… PLHA and IDU community representative speaks to UNGASS Delegates

Supporting community action on AIDS in developing countries Political commitments have been made… UNGASS Declaration(2001, 2006) Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia (2004) Vilnius Declaration on Measures to Strengthen Responses to HIV/AIDS in the European Union and in Neighboring Countries (2004) Bremen Declaration Responsibility and Partnership – Together Against HIV/AIDS (2007) A call to regional governments to act now

Supporting community action on AIDS in developing countries Men who have sex with men in Eastern Europe: who are they being reached by? Coverage not enough for impact

Supporting community action on AIDS in developing countries Affected communities are showing the way… Association of substitution treatment advocates in Ukraine (ASTAU) has grown rapidly and built leadership and advocacy skills focused on the protection of rights for medical help for SMT. “Vstrecha” provides HIV prevention services for MSM in Belarus and refers to specifically trained public health services in the 8 largest cities. The information center GenderDoc-M in Moldova is the only organization in the country that deals with protection of rights of sexual minorities. The community center PULSAR-Omsk has done innovative work with MSM and the Russian Federation All Ukrainian PLHA Network Alliance Ukraine

Supporting community action on AIDS in developing countries Limited Data on MSM HIV/STI prevention coverage

Supporting community action on AIDS in developing countries Prevention programs coverage in EECA could not impact There no coordinated data on coverage in the region but clear that very few countries have sufficient (around 60%) coverage of drug users with comprehensive package of services. Where there is, it does ultimately lead to impact on HIV prevalence among younger IDU group.

Supporting community action on AIDS in developing countries Newly detected HIV cases among IDUs and % of young users among IDU cases, Ukraine International AIDS Alliance, Ukraine

Supporting community action on AIDS in developing countries Comprehensive programs for IDUs are needed Comprehensive package of services for IDUs including harm reduction, substitution therapy and access to testing and treatment of HIV need to be introduced in ALL countries.

Supporting community action on AIDS in developing countries Limited investments and policy space for MARPs

Supporting community action on AIDS in developing countries Political commitments are not leading to state support of programs Only in the last 3 years have comprehensive services for MARPS been explicitly included into state strategies and national AIDS programs Stigmatization of vulnerable communities still the main issue which is not addressed. Even where MARPS are included in state programs or strategies, prevention and treatment programs for IDU, FSW, MSM, street children hardly get budget allocations.

Supporting community action on AIDS in developing countries Source: UNAIDS Total HIV spending GR 2010, last year reported - EECA w/o Russia Ukraine 2008 Kazakstan 2009 Belarus 2009 Uzbekistan 2009 Republic of Moldova 2009 Kyrgyzstan 2009 Georgia 2009 Tajikistan 2009 Azerbaijan 2009 Armenia 2009 Millions Last year reported USD Global Fund All other International National budget

Supporting community action on AIDS in developing countries 0% 20% 40% 60% 80% 100% Таджи кистан КыргыстанГрузияАрменияРеспублика Молдова БолгарияУкраинаАзербай Джан БеларусьКазахстанХорватияРоссийская Федерация РумынияЛатвия StateInternational Source: UNAIDS HIV spending by source in EECA: GFATM funds complement national investment but some countries still dependent on donors

Supporting community action on AIDS in developing countries 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PublicInternational 8. Research excluding operations research which is included under 7. Enabling Environment and Community Development 6. Social Protection and Social Services excluding Orphans and Vulnerable Children 5. Incentives for Human Resources 4. Program Management and Administration Strengthening 3. Orphans and Vulnerable Children 2. Care and Treatment 1. Prevention Source: UNAIDS HIV spending categories per financing source: Donors spend more on prevention

Supporting community action on AIDS in developing countries Profile of HIV spending: Only 11% on MARPS though they are the majority of those in need! Source: UNAIDS

Supporting community action on AIDS in developing countries Finance in EECA Key characteristics Big increase in funding since UNGASS (over a billion spent on HIV) GFATM funds stimulate national funds Underinvestment in prevention (especially from national funds) Gross underinvestment in programs targeting most- at-risk populations Money wasted on high pharmaceutical prices Most-at-risk populations and PLHIV may be penalized by GFATM eligibility criteria

Supporting community action on AIDS in developing countries Conclusions Open and participatory approach to program planning and budgeting on national level should be further supported Targeting resources specifically for MARPs in state budgets and donors supported programs. Supporting of community voice in decision making bodies on national and regional level Sustainable programs for communities could be started only if community systems in EECA will be supported