Tuesday, 24 February 2015

The article below still rings true for Africa!

In Uganda and across Africa, HIV continues to prey on women, sex workers and men, who have sex with men.


It is clear that to end the HIV epidemic, we must protect and support these groups. Yet, our country and others enforce bad laws and customs that disempower these groups and make them more likely to be infected with HIV. We cannot hope for an HIV-free generation when we have laws that marginalize and punish those most vulnerable to the disease.

A global commission of legal, human rights and HIV leaders recently released a report that showed punitive laws were standing in the way of effective AIDS responses. Archaic laws and customs make women and girls more vulnerable to HIV. Legally condoned violence and oppression - including genital mutilation, sexual violence, denial of property rights and early marriage - undermine the ability of women to protect themselves.

Laws urgently need to protect women, who are often the ones left to care for the sick, tend to the family and till the fields. In addition, many countries have punitive laws that criminalize sex workers. However, these laws drive sex work underground and put sex workers at greater risk of HIV.

Police violence and the threat of arrest disempower sex workers, making them more vulnerable to abuse and HIV transmission. Many are unable to access prevention and care because of the stigma they face, even from healthcare workers. In contrast, sex workers who are not harassed by the police and who have access to services have lower HIV rates and more economic power.

Laws across the continent also criminalize homosexuality, yet punishing men who have sex with men forces them into secrecy. They are unable to access counseling and testing, making it almost impossible for HIV prevention and treatment interventions to reach them.

In 2008, when the Senegalese government jailed nine gay HIV outreach workers under a law prohibiting "acts against nature," health workers went into hiding, advocacy groups disbanded and HIV treatment sites were shut down.

The time has come for African leaders to take action against bad laws that stifle our HIV response. We must challenge societal values rooted in fear and prejudice and implement laws based on human rights and sound public health. This starts with recognizing the rights of women and decriminalizing homosexuality and voluntary sex work, which is vital to protecting the health and dignity of these groups.

Voluntary sex work should not be confused with human trafficking, which remains an abhorrent human rights violation. Change will not come easy. It will require us to challenge tradition and deeply held personal values. It will mean confronting religious beliefs and antiquated practices that endanger our citizens.

Leaders will face shock, anger and opposition. But change is essential if we hope to slow the spread of HIV. Many leaders have refused to confront this reality. Instead, they opt to hide behind religion and the veneer of morality. But other leaders have demonstrated the courage needed to use laws as a powerful response to HIV.

In May, Malawi President Joyce Banda announced she would make efforts to repeal Malawi's laws that criminalize homosexual acts. "As leaders, especially in this part of the world (Africa), which is the epicentre of the epidemic, we need to harness our efforts in confronting antiquated beliefs based on fear and misinformation that are codified in our laws and engraved in our cultures," said President Banda.

In 2010, Rwanda Secretary of Health Agnès Binagwaho called for human rights-based policies that empower sex workers to negotiate safe sex and protect their health. Botswana enacted a law in 2008 to protect survivors of domestic violence and another in 2004 to establish equality of spouses. In recent years, 8,000 communities across the world, including in 15 African countries, banned genital mutilation.

Leaders in Uganda and across Africa must embrace change and follow these examples. We have a tremendous opportunity to accelerate the end of HIV. We must reverse laws and practices that stand in the way of effective HIV responses and replicate those that protect the human rights and health of our citizens.

Evidence-based, humane HIV responses will not only help shield us from HIV, they will also help build a more prosperous African continent. Africa's leadership must boldly rise to the challenge. Together, we can turn the tide against HIV.

Mr Festus Gontebanye Mogae and Stephen Lewis are members of the Global Commission on HIV and the Law.

Mogae is the former president of Botswana. Lewis is the co-director and co-founder of AIDS-Free World and was formerly the United Nations special envoy for HIV/AIDS in Africa.

Brian Kanyemba| Desmond Tutu HIV Foundation
Research Assistant/AVAC Advocacy Fellow 2011
Men's Research Division
(t) 021 4471025
(e) brian.kanyemba@hiv-research.org.za
skype: brian.kanyemba

As we move towards "HIV undetectable" take note of the message in this abstract!

Estimating the range of potential epidemiological impact of pre-exposure prophylaxis: run-away success or run-away failure?.
Cremin, Íde; Hallett, Timothy B.
Supplemental Author Material
Published Ahead-of-Print
Collapse Box
Objective: To investigate the influence of potential interactions between key aspects of a pre-exposure prophylaxis (PrEP) intervention on projections of epidemiological impact and cost-effectiveness.
Methods: A mathematical model representing the HIV epidemic and intervention context in Nyanza province in Kenya was developed. We consider a scenario whereby a fixed annual budget is allocated to a PrEP intervention. A standard projection of impact is generated, assuming that the unit cost of PrEP, adherence to PrEP and the ability of the programme to direct PrEP to those at high risk, all stay constant. The influence of dynamic assumptions and possible interactions between PrEP intervention assumptions is then assessed in comparison.
Results: The cumulative impact of a PrEP intervention could be increased approximately two-fold, relative to the standard projection, if positive interactions (between coverage and cost, coverage and adherence, prioritization and time) are assumed, whereas negative interactions between these factors could almost entirely negate the preventive benefit of the PrEP intervention. The corresponding estimates of cost per infection averted span a wide range from $2060 to $36 360.
Conclusions: Multiple potentially interacting factors will determine the impact of PrEP. Model forecasts should reflect that uncertainty and programmes should focus on these factors and measure them, to maximize the impact of programmes.
Copyright (C) 2015 Wolters Kluwer Health, Inc.

new data on oral PrEP and vaginal tenofovir microbicide gel

February 24, 2015

Dear Advocates, 

Today at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, new data on oral PrEP and vaginal tenofovir microbicide gel emerged that have implications for HIV prevention worldwide. We’ve collated the press releases and statements from groups involved in the research, as well as links to relevant webcasts—which become available 24 hours after presentation. Click here to view these resources; read on for a summary of the news.

Three oral PrEP trials presented at CROI provided additional evidence for use of the pill Truvada (TDF/FTC) for prevention. All three trials had very high rates of consistent use and very high rates of protection against HIV infection, specifically:
  • The Partners Demonstration Project among discordant heterosexual couples (where one partner is HIV-positive and one is not) in Kenya and Uganda showed that a program that delivers both PrEP for HIV-negative partners and/or antiretroviral treatment (ART) for HIV-positive partners reduced the risk of HIV infection by 96 percent. These results highlight the potential impact of combining PrEP and ARV treatment to slow the HIV epidemic. 
  • The PROUD Study among high risk men who have sex with men (MSM) in the UK showed that daily oral PrEP reduced the risk of HIV infection by 86 percent when delivered in existing public health clinics.
  • IPERGAY, a French study, was the first to examine the efficacy of “event-driven” PrEP – in this case, a three-day dosing strategy involving four pills around the time of sex – among high risk MSM who reported frequent sex. Overall, PrEP reduced the risk of HIV infection by 86 percent in the trial. Based on reported pill use by men in the trial, the regimen that most participants took amounted to at least four doses a week. Previous studies of daily oral PrEP have shown that this may be enough to be protective. However, it is not clear how well the event-driven regimen would work for men who have less frequent sex than the men in the trial. 
Also at CROI, researchers presented results from a trial of a tenofovir-based vaginal microbicide gel to be used before and after sex among young women in South Africa.
  • FACTS 001 was a trial of a tenofovir-based vaginal microbicide gel to be used before and after sex among young women in South Africa. FACTS 001 found no effect for vaginal tenofovir gel overall in the trial. While it appeared that most of the participants used the product at some point, there was not enough correct and consistent use in the trial to provide significant levels of protection. There was a trend of modest protection among the small proportion of women in the trial who appeared to have used the product consistently. This was similar to trends seen in previous studies of tenofovir gel among women, but not enough to change the overall outcome of the trial. 
AVAC will be working with partners to convene webinars and in-country discussions in a range of locations to talk through the implications of all of these data. We will announce the schedule in the coming weeks; if you have a specific question or would like support in organizing around these data, please contact us. Our recently released AVAC Report: Prevention on the Line provides background and analysis that anticipates and contextualizes these developments.

AVAC’s press release on these developments states:
“Today’s results add to a powerful body of evidence that ARV-based prevention works when it is used correctly and consistently. But they’re also a reminder that with nearly every prevention option available today, from condoms to PrEP to HIV treatment, correct and consistent use is both critically important and a real challenge.

The evidence tells us that we need a two-pronged approach. We should develop ambitious programs to roll out existing, proven options, including daily oral PrEP, around the world to those who can use them.  At the same time, we must continue to develop and test newer methods that others at risk will actually want, demand and use.

There’s growing demand for daily oral PrEP, and the data suggest that there might be other ways to use this strategy that can provide benefit,” Warren said. “For the sake of clarity and impact, providers, advocates and end users need to work together to develop clear, consistent messages that explain what’s known and not known about levels of protection in the context of different types of sex and different patterns of use.

The women in the FACTS 001 trial, the youngest group to date in any ARV-based prevention trial, have contributed so much to our understanding of the challenges and complexities of HIV prevention. The data suggest that these young women truly did want a product they could use to reduce their risk, but that this particular product did not fit into the realities of their daily lives.

Researchers, advocates and donors must keep working with young women at high-risk of HIV to find products that will make sense in their lives. We know that we need a range of safe and effective options for different people at risk. It is clear that no single option can possibly for work all people all of the time.”


Thursday, 19 February 2015

Zimbabwean HIV Positive Feminist Martha Tholanah Wins 2015 David Kato Vision & Voice Award

Renowned Ugandan activist Frank Mugisha will present Martha Tholanah with the award on stage at the prestigious Teddy Awards ceremony in Berlin this Friday.

11 February 2015 [Berlin] – The David Kato Vision & Voice Award (DKVVA) is proud to announce that the 2015 award will go to HIV Positive activist Martha Tholanah from Zimbabwe. Martha risks her life everyday to support lesbian, gay, bisexual, transgender, and intersex (LGBTI) people across the country. Her activism is a powerful example of a straight ally standing in solidarity with LGBTI people despite threats to her own safety and security.

Martha also demonstrates extraordinary leadership on behalf of other marginalized communities, fighting for women’s rights, disability rights and sex worker rights both locally and internationally. She will receive the award on stage this Friday, at the prestigious Teddy Awards ceremony which is part of the Berlin International Film Festival.

“I am incredibly honored to be given this award that to me symbolizes my struggle against injustice in Zimbabwe and across the globe,” said Martha. “By honoring my work we recognize the human dignity and spirit of every person.”

Inspired by the life and work of David Kato, the human rights activist murdered in his home of Kampala, Uganda in January of 2011, the DKVVA recognizes the leadership of individuals who strive to uphold the human rights of sexual minorities worldwide, particularly in challenging circumstances and unsupportive policy environments. The award provides winners with a global media platform and a $10,000 grant to support their efforts.

The DKVVA is supported by a Secretariat based at the Global Forum on MSM & HIV (MSMGF). The MSMGF advocates for equitable access to effective HIV prevention, care, treatment, and support services tailored to the needs of gay men and other MSM, including gay men and MSM living with HIV, while promoting their health and human rights worldwide.

“Community-led efforts play a central role in securing LGBT rights,” said Micah Lubensky, Program Manager of the award and Community Mobilization Manager at MSMGF. “Yet so often these crucial efforts go unrecognized and unfunded. Through the David Kato Vision & Voice Award, we are able to provide activists with a platform to elevate the issues that are affecting their communities, as well as much needed funding to sustain and expand their work.”

As a trained family therapy counselor qualified in medical rehabilitation, Martha has established and headed health programs for Gays and Lesbians of Zimbabwe (GALZ) and the Network of Zimbabwean Positive Women (NZPW+). She currently serves as Chairperson of the Board for GALZ, an organization that has been a long time partner and contributor to MSMGF’s work.

She is currently facing two charges with the Zimbabwe Government linked to her involvement with LGBTI activism. Despite these challenges she remains deeply committed to her efforts and continues to represent GALZ in legally challenging state-sanctioned homophobia and violence.

Martha is also a proud feminist fighting to eliminate sexism in Zimbabwe. She works to make women living with HIV - young women and LBT women more visible in a male-dominated political and social landscape.

"I have been on a long journey to accept myself as an HIV positive African woman. I fight for others to overcome the stigma and discrimination in their lives so that they can find self-love and acceptance too,” Said Martha. “This award strengthens my work with organizations such as GALZ and NZPW+. On the day I receive this award, my wish is that the violence and discrimination in Zimbabwe finally stop, and that all people will come together to end discrimination against marginalized communities worldwide.”

Frank Mugisha, Chair of the David Kato Vision & Voice Award and Executive Director of Sexual Minorities Uganda (SMUG), will present Martha with the award on stage at the Teddy Award ceremonythis Saturday in Berlin.

“Martha’s voice and vision inspire hope for a world where injustice toward any and all marginalized communities is no longer tolerated,” said George Ayala, David Kato Vision & Voice Award Advisory Committee Member and Executive Director of MSMGF. “As we celebrate her life and work, we commemorate David Kato’s legacy and recognize the often dangerous efforts of individuals like David and Martha, who demonstrate what human rights and equality really look like.”

Media Contact
Micah Lubensky

Read more about Martha Tholanah’s life and work here.

The David Kato Vision & Voice Award (DKVVA) recognizes and supports the work of leaders who strive to uphold the human rights and dignity of lesbian, gay, bisexual, transgender, and intersex (LGBTI) people around the world. More information about the DKVVA can be found at http://www.visionandvoiceaward.com .

The Teddy Award is an award given at the Berlin International Film Festival, celebrating films and individuals that communicate queer themes and content on a large scale and contribute to more tolerance, acceptance, solidarity and equality in society. Learn more athttp://news.teddyaward.tv/en/ .

No improvements in CD4 count at diagnosis in African patients in last decade

Can be accessed from: Gus Cairns
Published: 04 February 2015

A study by Harvard Medical School has found that the average CD4 count in sub-Saharan African people who are diagnosed with HIV has not risen since 2002. Neither has the average CD4 count on initiation of treatment, which remains well below the AIDS-defining limit of 200 cells/mm3.  The authors call for far more active HIV  testing and facilitated referral programmes, and continued global financial support for HIV testing and treatment.

A second study of a number of different prevalence and incidence surveys conducted by the International AIDS Vaccine Initiative (IAVI) among selected populations in the region shows that annual HIV incidence ranges from zero to 19% according to the population studied, indicating that specific groups should be the subject of testing and referral initiatives. Groups with especially high incidence included the negative partners in sero-different couples, female sex workers (FSWs), men who have sex with men (MSM), young women in certain locations, and specific communities such as fisherfolk on Lake Victoria. Equally, however, surveys of some similar groups in different locations reported low incidence, showing that it may change rapidly and that regular studies should track incidence hotspots.

It was notable that the incidence rate in most populations with high rates fell two- to threefold after the first three months of being included in an incidence survey, showing that clinical referral and monitoring is itself a useful HIV prevention measure.

CD4 count at diagnosis and at start of treatment

The Harvard study looked at CD4 count on diagnosis and at initiation of antiretroviral therapy (ART) in 127 different studies covering over half a million patients between 2002 and 2012. Only six studies looked at CD4 count at both HIV diagnosis and ART initiation in the same patients.

It found that the average CD4 count at HIV diagnosis was 250 cells/mm3 in 2002 and 309 cells/mm3 in 2012. This increase – amounting to a 5.8 cells cells/mm3 increase per year – was not statistically significant.

The average CD4 count at ART initiation actually decreased very slightly, from 152 cells/mm3 in 2002 to 140 cells/mm3 in 2012, well below the AIDS-defining limit of 200 cells/mm3. This decrease was also not significant.  There was no change in CD4 count at initiation after the issue of the World Health Organization’s 2009 treatment guidelines, which changed the recommended CD4 count at which to start ART from 200 to 350 cells/mm3.

There were exceptions to these CD4 figures. When ART was given to pregnant women for the prevention of mother-to-child transmission, the CD4 count at diagnosis and at ART initiation were 395 and 313 cells/mm3 respectively. 

More significantly in terms of general testing and treatment policy, CD4 counts were a lot higher at both diagnosis and ART initiation in so-called ‘active HIV screening’ programmes. This means initiatives such as community-wide screening, community-based combination prevention programmes that include testing, home-testing and home-based testing by visiting health workers.  In active programmes, CD4 counts at diagnosis and initiation were 405 and 268 cells/mm3 respectively. However, only 3.3% of all the people whose CD4 counts were included were involved in studies of such programmes.

South Africa is the one country that had higher CD4 counts on diagnosis in 2012 than 2002: its year-on-year increase in average CD4 count at diagnosis of nearly 40 cells/mm3 a year would appear to be an endorsement of that country’s HIV awareness strategy. However this has not been matched by an increase in CD4 count at ART initiation, which at 123 cells/mm3 averaged over the whole decade is the second-lowest among countries surveyed after Ethiopia.

The researchers comment that there is a relative lack of data post-2010, with only 14% of studies reporting figures from beyond that year: this is because some multi-year studies do not report till the end, so recent improvements in CD4 count at diagnosis and ART initiation could be missed.

HIV prevalence studies

Meanwhile a series of observational studies conducted by IAVI document extremely high HIV prevalence and incidence rates in some populations and surprisingly low ones in others. IAVI runs a project called the African HIV Prevention Partnership that conduct observational studies in different parts of Africa to uncover populations in particular need of prevention intervention. This is work preparatory to creating an African HIV Clinical Research and Prevention Trials Network similar to HPTN in the US.

Their paper looks at three prevalence and ten incidence studies in varied populations in the countries of Uganda, Rwanda, Kenya, Zambia and South Africa.

In the prevalence studies, a variety of populations in Uganda and Kenya were studied including rural communities, clinic attendees, a random whole-area population sample, and in Nairobi female sex workers (FSWs) and their clients.

Groups in which there was particularly high HIV prevalence includes FSWs (20% - in their clients it was 7%), and divorced and widowed people (as opposed to single or married ones), where prevalence was 28% in a Kenyan study, and 22% in a Ugandan one. HIV was also more common in urban versus rural populations: it was 9% urban versus 2% rural people in a Kenyan study, and, in a Ugandan one, 16% versus 10% for people who lived near a highway versus people whose homes were only accessible by foot.

Peak prevalence age was 30-34 in two studies (16.5% in Uganda and 24% in FSWs) and in the non-FSW studies women had higher prevalence than men (in women, 10% and 13% in two studies versus, in men, 5% and 9%).

Condom use, especially irregular use, was actually associated with higher HIV prevalence than not using them at all, but possibly because it was associated with casual sex. In Nairobi FSWs and clients, prevalence was 17.5% in condom users versus 10% in non-users. In Masaka, Uganda prevalence was 10% in people who never used condoms, and also in people who used them more than half the time: but it was 15% in people who used them only occasionally. Prevalence in people with one steady partner was lower (8-11% across studies) than in people who had more than one (14-17%).

Genital ulcer disease (herpes, syphilis and the like - GUD) were associated with 2.5 to four times the prevalence than in people who did not have GUD.

HIV incidence studies – very high rates in some groups

But it was the incidence studies that found continuing high, and in some cases extraordinarily high, rates of ongoing HIV infection in some communities and groups – and low rates in seemingly similar ones.

One of the easiest and most important populations in which to conduct incidence is serodiscordant couples. In most but not all studies of serodiscordant couples annual HIV incidence was higher where the female partner was the initially HIV-negative one. Very high rates were observed in Lusaka, Zambia (9% a year in female partners, 7% in male) and Ndola in the same country (11% in women and 6% in men).

The ‘real-life’ effect of placing the positive partner on ART was documented in one study in Masaka, Uganda where annual HIV incidence in serodiscordant couples was 4% in male partners and 5% in female but only 1% in partners of either gender when the HIV-positive partner was on ART.

In the latter case particularly, much of this continued HIV infection may have come from outside the main relationship: IAVI genotyped all viruses in the HIV positive partners and found that from 20% to 33% of the infections in their studies came from someone other than the main partner, with one exception on Uganda where there were no ‘unlinked’ infections.

Other groups in which very high incidence was found were MSM, with annual incidence rates of 7% and 6% at two places in Kenya and 9.5% at Rustenberg in South Africa;  women in ‘peripheral communities', i.e. irregular housing in Rustenburg (9%) and members of fishing communities in Lake Victoria (10% in women in one Ugandan location and 5% in men).

And yet, at the same time, some groups with very high prevalence did not have a high rate of ongoing HIV infection. Even though HIV prevalence in Nairobi FSWs was high (see above), annual incidence was very low: in rural communities in Masaka where HIV prevalence was 10%, ongoing HIV incidence was so low in the general population that the team shifted their incidence survey to serodiscordant couples and fishing communities. And in one study in Kenya there were no infections observed within discordant couples at all (this study is unpublished so there is as yet no explanation for this).

One striking and near-universal finding was that enrolment into an HIV incidence study brought down incidence in itself. There were astoundingly high HIV incidence rates among some people in the first three months of their involvement in incidence studies: 15% and 19% in HIV-negative women in Zambian serodiscordant couples, 16% in Kenyan MSM, 12% among women with casual partners in South Africa. In all cases, although incidence remained high, it fell 1.5 to 4-fold after the first three months of being in the survey. This phenomenon has been seen in HIV prevention studies before and may be due to regular monitoring and the attention and counselling of healthcare workers.

HIV prevalence in sub-Saharan Africa has been in decline throughout the period of these studies and access to ART has expanded hugely. However what these two studies show is that the HIV epidemic is still very much an ongoing one in some groups in Africa.

The IAVI writers comment that their findings "provide valuable data for prevention trial design and conduct, prevention planning, and service delivery," especially in key affected populations where  there is high HIV incidence "despite regular HIV testing and counselling."


Siedner MJ et al. Trends in CD4 count at presentation to care and treatment initiation in sub-Saharan Africa, 2002-2013: a meta-analysis. Clinical Infectious Diseases, e-pub ahead of print: pii: ciu1137. 2014.

Kamali A et al. Creating an African clinical research and prevention trials network: HIV prevalence, incidence and transmission. PLoS One, Doi:10.1371/journal.pone.0116100. 2015.

Paul Semugoma MD. (MSM Technical Expert - Health4Men | Anova Health Institute | semugoma@anovahealth.co.za | Tel +27214472844 | Fax +27214472887 | Mobile +27765705942)
Ivan Tom's Center for Men's Health, Victoria Walk, Woodstock, Cape Town 7925
Web http://anovahealth.co.za/  http://www.health4men.co.za/| Twitter @AnovaHealthSA ; @H4Mtop2btm  | Facebook Anova Health Institute : Health4men

The Future of ARV-Based Prevention, CROI Feb 2015

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White House Releases FY16 Budget Request
Kaiser Family Foundation

The White House's FY2016 budget request includes the majority of funding for U.S. global health programs. The administration has flat-lined PEPFAR funding and cut tuberculosis funding for USAID Global Health Programs by 19.1 percent. Furthermore, while the pledge to provide $1 to the Global Fund for every $2 pledged by other donors has been met, the overall U.S. contribution to the Global Fund was reduced by 18 percent.

ResourcesNew Resources: Models, Tools, and Research 

US Guidelines on Prevention with People Living with HIV Now Emphasise Engagement with Care, HIV Treatment and Social Factors

A recent article for aidsmap summarizes new recommendations from the Centers for Disease Control and Prevention on HIV prevention interventions. Since 2003, when guidelines were last issued, there has been greater focus on antiretrovirals and the social and structural factors behind transmission. The new guidelines also stress the importance of rigorous data collection to identify and more effectively treat underserved individuals and groups. 

The Effectiveness and Efficiency of the HIV Response in Africa: Views and Recommendations of Grassroots Caregivers and Other Stakeholders
International AIDS Society

This brief, produced with support from the USAID- and PEPFAR-funded Health Policy Project, describes efforts by the International AIDS Society to survey its members and consult with a variety of HIV and AIDS community stakeholders to improve the effectiveness and efficiency of HIV service planning and delivery. Responses highlight the importance of inclusiveness, health systems strengthening, and cooperation between government agencies and other donors. 

How Can People Living with HIV and Key Populations Access Justice in Ghana?
Health Policy Project

This blog post, written by members of the Ghana Commission for Human Rights and Justice (CHRAJ) and the Health Policy Project, discusses CHRAJ's new online reporting system for cases of discrimination against people living with HIV and key populations. Although some cases have been resolved under the system, there is a need for continuous civil society engagement to ensure that all known cases of discrimination are reported to the proper authorities and investigated. 


15 HIV Advocates to Watch in 2015
Mark S. King

Mark S. King, an award-winning blogger, author, and HIV and AIDS advocate, profiles 15 HIV advocates from around the world who significantly (and positively) impact the delivery of HIV programs to ensure that the highest-need populations are reached and treated effectively. 

InterviewInterview with Dmytro Sherembey

HIV Policy and Advocacy Monitor: What drove you to become involved in advocacy?

I have advocated on behalf of a variety of health- and governance-related causes for more than 20 years and view myself as a product of others' advocacy work, especially that of the ACT UP movement in the United States during the early years of the global HIV epidemic. When I contracted HIV 15 years ago, there was no treatment available in Ukraine. To be treated, you had to either travel abroad or do what I did, along with several other activists: stay and fight for the right to treatment. ACT UP fought for access to combination therapy treatment and demanded that it be made available to everyone around the world. Between their advocacy and our own, Ukrainians like me are on therapy, alive, and thriving.

HIV Policy and Advocacy Monitor: Can you provide examples of successful Patients of Ukraine advocacy campaigns?

In 2011, it was unclear whether the government would continue to provide antiretroviral therapy (ART) to those already receiving the treatment. In collaboration with the Ukrainian Network of People Living with HIV, Patients of Ukraine collected 500 postcards signed by children living with or affected by HIV and delivered them to the president at a press conference. Each card included the campaign's request to the president's administration: "Let us live." After the conference, the prime minister signed an order to finance treatment for PLHIV and, in January 2012, the minister of health announced that the state would pay for treatment for an additional 42,000 Ukrainians living with HIV.

Now, with the currency devaluation and the war, there are once again concerns about whether the government will be able to continue financing treatment. Patients of Ukraine has proposed a tax on alcohol and tobacco to help fund the health sector. Advocacy helps us find solutions to health problems and promote change in the broader health system. It is the key to our success because, from an investment perspective, it provides a significant return by impacting many people's lives.

HIV Policy and Advocacy Monitor: How have the ongoing conflict with Russia and Ukraine's internal strife compromised health services in Crimea and in the east and southeast of Ukraine?

Services have been most compromised in areas not controlled by Ukraine. Volunteer organizations have tried to deliver ART to conflict zones but it is not possible to systematically control the delivery process. This leaves people exposed to possible treatment discontinuation, worsening health, and increased risk of transmission. After the war, rebuilding the most conflict-affected regions and ensuring access to HIV care and treatment for residents of these places will be very difficult.

HIV Policy and Advocacy Monitor: How has your organization's work changed or refocused since the 2014 change in government?

Patients of Ukraine is currently engaged in a healthcare sector reform initiative. We have presented ideas and proposals to the government and will continue advocating for healthcare reform in 2015. We will begin by targeting the pharmaceutical sector to make medicines on the market less expensive by allowing, for example, direct procurement of medical supplies. We are also working to liberalize domestic markets by breaking down barriers to creating and developing high-quality medicines in Ukraine. Reducing the money spent on medicines will free resources for Ukrainian hospitals to more effectively meet the needs of their patients. As a result of direct procurement and a more liberal marketplace, the country would recoup over a billion dollars from black market sales.

These efforts will be followed by a service availability assessment to monitor the health sector and produce valuable data for use in a range of advocacy efforts. Saving lives has to be the state's top priority; it is a crime for a government to withhold life-saving treatment from its citizens. Patients of Ukraine works to remind the state of this priority, particularly in the context of its 2015 budget.

HIV Policy and Advocacy Monitor: How does Patients of Ukraine keep up-to-date and knowledgeable about relevant issues to present decisionmakers with appropriate solutions?

We never expect someone to solve anything for us; change is something you have to achieve on your own. Our organization tries to build its expertise around advocacy topics by seeking knowledge from various stakeholders and experts, and collaborating with people who share our views and beliefs. By collecting this knowledge and experience, we use it to affect positive change.