HIV-positive citizens of Kyrgyzstan getting ART while abroad

Aybar Sultangaziev, Director of the “Partner Network” Association, discusses helping HIV-positive migrants from Kyrgyzstan.

During the COVID-19 pandemic, the role of the civil society sector and its donators in Kyrgyzstan became clearly seen both in the attempts to control coronavirus and related limitations. The government also says that it supports civil society and freedom of speech in the country.

The association has been working since 2004. Antiretroviral therapy became available for people with HIV in Kyrgyzstan in 2005. What role did the civil society play in these changes?

Since the beginning of 2000s, considering the economic situation in Kyrgyzstan, HIV prevention was mostly carried on by civil society organizations, with the support from international organizations. In 2004, the Partner Network Association was created. It is an association of 48 civil society harm reduction programs. We did not specialize on migrants living with HIV. We represented a service organization providing diverse preventive services to key groups.

In 2009-2010, our organization was re-registered, widening the programs of advocacy and rights protection for vulnerable groups. Now it covers 26 NGOs focused on decreasing the harms, and preventing HIV/AIDS, tuberculosis, and viral hepatitis C infection. To receive targeted help, a person can contact us on social media.

What are Partner Network services for Kyrgyzstan citizens who stay abroad?

The COVID-19 pandemic led to the closure of borders. Many Kyrgyzstan citizens found themselves out of their home country. These include some people living with HIV who had low supply of medications, potentially resulting in noncompliance of treatment. The situation was even more complicated because some countries do not permit HIV-positive people to stay at their territories. We neither encourage nor dissuade out clients from migration; we focus on protecting their health. Thus, Partner Network together with AIDS centers, with financial support from UNAIDS Kyrgyzstan, UNDP grants, partners from ITPCru, has organized the process of ART provision for our citizens out of the country. We received requests from migrants in Russia and Kazakhstan who asked us to send them at least 3-months-worth quantity of treatment. Based on these requests, we built a list of HIV-positive migrants in need of therapy.

Between March and May 2020, ART delivery for migrants was financed by UNAIDS Kyrgyzstan. We purchased ART in several ways. We either searched for medications in Kyrgyzstan or transferred money to partner NGOs in Russia which then bought drugs and distributed them to migrants.

For three months, 90 Kyrgyzstan citizens living with HIV received therapy abroad.

In June, when flights resumed, we developed an algorithm of ART delivery, signing an agreement between a commercial courier service and our association. We paid for the drug delivery with a postal service. Authorized representatives of people living with HIV (social workers, outreach workers, family members, friends) received medications in AIDS centers and initiated shipments. Since that moment and until the end of the year, Partner Network sent medications to migrants with the financial support of UNDP grants.

Up to late 2020, ART for 3-6 months of treatment was sent directly from Kyrgyzstan to 70 more people abroad. About a half of request were recurrent, the rest involved new cases.

It is worth mentioning the coordinated work among the regional AIDS services in Kyrgyzstan. They established contacts with people living with HIV abroad, obtained their consent to receive treatment from Russian partners, and thus provided continuous treatment for HIV-positive people during the pandemic.

Earlier, the Government claimed that 80% of total ART financing would be provided from the state budget. That was before 2021. What is the current situation?

Before 2018, all ART costs in Kyrgyzstan were covered by the Global Fund. Our Association is one of the key partners of the Ministry of Health and the Republican AIDS Center regarding HIV, tuberculosis, and viral hepatitis in Kyrgyzstan. In recent years, due to our initiative, a roadmap of shifting HIV-related programs financing towards the state has been approved and started.

According to this roadmap, the source of funds to purchase the ART was from the government budget (20% of total needs in 2019, 30% in 2020) and the Global Fund. In 2019, the government’s funds reached 63 million Som (900 thousand USD). A part of this amount was directed to ART purchase, which provided the treatment for the whole year 2020 for 50% Kyrgyzstan citizens living with HIV. The rest of needs were covered by the Global Fund.

What is the role of Partner Network in HIV prevention and treatment in recent years? Are there any changes for people living with HIV in Kyrgyzstan?

Due to the increase in the government’s financial support, more pharmaceutical companies want to ship their products to Kyrgyzstan. The has led to the competition in the market of vital medications. Therefore, costs of vital medications decrease. In 2019, six ART medications were approved in Kyrgyzstan, as well as five drugs for the treatment of the viral hepatitis C (HCV) which is often a comorbidity among people living with HIV.

The Partner Network conducted several meetings with pharmaceutical companies to discuss the issues of drug approval and price lowering. As a result, the price of TLD (tenofovir, lamivudine, and dolutegravir, a fixed combination for the treatment of HIV infection — a translator’s note) decreased from 23 to 15.5 USD. The price of velpatasvir (sofosbuvir) for the treatment of HCV infection decreased from 800 to 450 USD.

In the beginning of 2020, understanding COVID-related challenges, our Association had initiated the development of guidelines which were later approved by the Ministry of Health. These guidelines permitted the provision of patients with enough ART for one to three months. Thus, many people with HIV were able to receive medications before the enforcement of the state of emergency. Due to existing plan of development at the country level, in the last 3 years we were able to increase the treatment coverage among HIV-positive people by 20%. The viral suppression* was reached in 86% patients on treatment. This is our collaborative work and success.

What are main changes due to new conditions such as the pandemic and lockdown? What issues stay unsolved, and what are new challenges?

Unfortunately, COVID-19 has not led to any positive shifts for HIV-infected migrants. The main issue is still the same, and it has even become worse — I am talking about the access to treatment. Due to financial hardships, some migrants cannot come home for a medical assessment, viral load testing, and the receipt of ART. Migrants refer to increased costs of the air travel and are also afraid to lose jobs in case the borders close again. At the same time, few of them can afford a medical examination in Russia; it is too expensive.

For these reasons, the civil society and international organizations are the only unconditional support and help providers for migrants from Kyrgyzstan.

In the previous year, there was a discussion of amendments to a Law on NGO which would oblige the latter to provide detailed reports on their work to the government. If such a report is not provided or is not satisfactory for the tax office, the organization might be forcefully closed via the courts. At the same time, NGOs in Kyrgyzstan are being financed by international structures and provide several reports to the tax office, Social Fund, and National Statistics Committee. Although the amendments were criticized, and civic activists, advocates, representatives of international institutions asked for their cancellation. This summer the amendments were approved in the first and second readings. In autumn, a revolution happened in the country. Currently, the issue of the updated Law on NGOs application remains unsolved.

*Viral suppression is a decrease of HIV-infected cells in blood to undetectable or very low level because of stable antiretroviral treatment.

Nadezhda Rogozina

The article was prepared with support of Oxfam representative office in Russia