The HIV epidemic in eastern Europe and central Asia in difficult times: a story of resilience and change DOI Creative Commons
Miłosz Parczewski, Deniz Gökengin

Journal of the International AIDS Society, Год журнала: 2024, Номер 27(S3)

Опубликована: Июль 1, 2024

The eastern European and central Asian (EECA) region is facing the fastest-growing HIV epidemic in world with 160,000 (130,000–180,000) people newly acquiring 2021, an overall 48% increase number of new acquisitions, a 32% rise AIDS-related deaths over past 10 years [1]. World Health Organization East estimated to accommodate 1.4 million living (PWH), majority transmissions reported occur locally be unrelated cross-country migrations [2, 3]. Sadly, according UNAIDS, 2022 only 62% EECA were aware their status 51% PWH received treatment, which resulted viral suppression rate Common (>50%) late diagnoses (with either AIDS-defining condition or CD4+ T cell count <350 cells/µl at presentation) [4] further add epidemiological issues complexity client management [5]. Although key acquisition risk has changed from unsafe injection practices heterosexual transmission, access opioid agonist therapy (OAT) needle syringe programmes often still limited (Kazakhstan) unavailable (Uzbekistan, Turkmenistan), results OAT regional coverage as low 4%, far below UNAIDS target 50%. Furthermore, pre-exposure prophylaxis (PrEP) combination prevention services are availability not formally implemented across multiple countries usually due financial barriers access, such lack state funding for medicines, technical capacity cost service delivery [6]. This substantially larger PrEP gap (the proportion populations "very likely" use if accessible, compared currently using PrEP) located (up 45%) median 17.4% estimate Union [7]. Moreover, there high level stigma countries, especially against gay men other who have sex men. growing suboptimal prevention, testing treatment main reasons that challenge 2030 targets. humanitarian crisis related Russian invasion war Ukraine challenged situation even hindering efforts, forcing both internal displacement (estimated 3.7 million) external migration locals refugees 6.4 million, March 2024) [8]. On top massive casualties, civilian healthcare infrastructures destroyed, seek safety, protection assistance, including continued medical care. home ∼260,000 >130,000 on antiretroviral (ART). significant progress was made response before outbreak resulting 47% reduction incidence 81% AIDS mortality, significantly affected tuberculosis (TB) programmes, diminished capacity, difficulty ART provision [9]. Despite notable hardship, managed maintain full ART, increased rollout by 38% (reaching >27,000 people) doubled PrEP, now available free charge [10]. A large studies published this supplement focus responses given during war, providing good examples resilience strength reflecting personal experiences setting mass trauma. Mass traumas important perspective PWH, these may bring out stress exacerbate mental health issues. Owczarzak et al. analyse bioecological model trauma context among history injecting substance [11]. study 18 interviews four Ukrainian cities autumn 2022. outlines but also confirms deep impact healthcare-related wellbeing participants, necessity respond triggering situations, decrease work opportunities, incremental costs displacement. All factors shown affecting adherence general healthcare. Lazarus analysed non-governmental organization (NGO) described Ukraine, mixed-methods project geographically dispersed (n = 24) governmental 2) organizations representing several regions [12]. Their analysis NGO work, time when aid critical. Following initial shock terror quickly resumed limiting duration cessation services, optimizing reallocating staff. provides strong story support emphasizing NGOs unfortunate "big events" war. topic human rights expanded Lohman presenting assessment TB [13]. consisted series assessments covering period aiming examine scale-up outcomes programmes. paper describes implementation learning evaluation 25 programme implementers, community advocates government officials, 14 organizations. Interview data clearly reflect domains, faced unauthorized disclosure social environment (−19%), verbal abuses/personal threats (−13%) improvement (+33%) perceived confidentiality records. expansion legal advocacy allowing population services. one few numerous where remains challenging. In follow-up oral daily tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) [14] 199 inject drugs (PWID) without text reminders, Morozova longitudinal patterns coupled measurement diphosphate emtricitabine triphosphate dried blood spots participants objective measures [15]. enrolled been longer than 20 (37%) alcohol (67%) >50% moderate severe depression. highly challenging group, >90% cases reporting take more 95% TDF/FTC doses. Alarmingly, spot metabolite revealed reality divergent patient-reported detectable levels. unique confirming divergence between measured PWID, indicating novel telemedicine online interventions can particularly useful marginalized difficult-to-reach populations. Migrants Asia moving disproportionately sexually transmitted infections high-level poor working conditions, lower no system tools groups. Kovtun [16] focused violations sexual orientation, gender identity (SOGI), six Europe, Caucasus (Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan), background rapidly rising epidemic, strict religious norms, discrimination associated minorities HIV, conflict. Using Rights—Evidence—ACTion (REAct) tool, they upon complaints bisexual transgender women. strikingly higher numbers solely based SOGI suggest despite all achievements country last decade terms harm reduction, testing, care, prevails country. effect recent evident police military staff, denials private refusals temporary accommodation denial border crossings. underscore diversity stigma, violations. Mackesy-Amiti define intervention aimed reduce high-risk behaviours Tajik migrants Federation [17]. cluster-randomized controlled trial comparing network-based, peer educator training education training. Male recruited educators trained how deliver knowledge peers. showed baseline percentages binge drinking, condomless sex, equipment sharing considerably high, cleaning behaviour extremely There needle-sharing following intervention, modest behaviour. suggests tailored needs specific groups inclusion peers effective hard reach. Stigma-associated addressed Davis used citizen science approach address HIV-related adolescents young adults Kazakhstan [18]. These called develop digital materials, would assessed rated contest aim promote self-testing. submitted materials judged board contestants, professionals representatives NGOs, submissions awarded. Adolescents interest submissions, members input development study, running media procedures, creating promotional feedback submission system. Inclusion stimulated collaboration adults, importance testing. Lastly, association cognitive disorders presented Mergenova [19]. size increasing acquisitions psychoactive substances. authors performed cross-sectional questionnaire-based 230 stable (>6 months) self-reported addition depression, anxiety, post-traumatic disorder (PTSD) symptoms, memory assessments. Notably, third patients illness, while 25% drug 17% hazardous drinking. mild depression anxiety 20−32%, 6−10%, mood least PTSD symptoms observed 7% cases. Not surprisingly, adherence—missing likely depressive forgetfulness. contrary, better function therapy. emphasizes need precise regular care order tailor provide improving maintaining optimal rates. long neglecting rapid increases transmissions. PWID characteristics each different cultures, beliefs structures long-term efforts epidemic. Europe presents resilience, improve rights, innovative approaches summarizes challenges societal While continuing international support, commitment will vital achieve goals end region. declare competing interests. MP DG jointly drafted revised editorial. read approved final version. We like express our sincere thanks prepared, manuscripts request. grateful research volunteered part supplement. thankful co-Guest Editor, Dr Andriy Klepikov, Executive Director Alliance Public Health, his valuable role conceptualization alone responsible views expressed do necessarily represent views, decisions policies institutions affiliated. Data applicable article datasets generated current study.

Язык: Английский

Control of HIV across the WHO European region: progress and remaining challenges DOI
Miłosz Parczewski, Deniz Gökengin, Ann Sullivan

и другие.

The Lancet Regional Health - Europe, Год журнала: 2025, Номер 52, С. 101243 - 101243

Опубликована: Фев. 20, 2025

Язык: Английский

Процитировано

1
Provision of care for people with HIV migrating from Ukraine: preparing for a long-term response DOI
Miłosz Parczewski, Christoph Boesecke,

Pavel Khaykin

и другие.

AIDS, Год журнала: 2025, Номер 39(6), С. 629 - 638

Опубликована: Апрель 3, 2025

Russia's invasion and war in Ukraine have caused a major humanitarian crisis among Ukrainian citizens, but also specifically affected diagnosis provision of HIV care. As remains the country with second highest (after Russia) incidence Europe, forced migration resulting from has required urgent targeted responses to allow for uninterrupted access medical care antiretroviral drug supply neighboring countries beyond. Response integration people (PWH) been swift across European countries, several challenges remain. Key relate expansion unstigmatized testing tackle late diagnoses, development legal frameworks allowing medication not registered or under patent protection other treatment key comorbidities including tuberculosis (TB) hepatitis C virus (HCV), vaccination programs, continued surveillance resistance changes molecular epidemiology.

Язык: Английский

Процитировано

0
The HIV epidemic in eastern Europe and central Asia in difficult times: a story of resilience and change DOI Creative Commons
Miłosz Parczewski, Deniz Gökengin

Journal of the International AIDS Society, Год журнала: 2024, Номер 27(S3)

Опубликована: Июль 1, 2024

The eastern European and central Asian (EECA) region is facing the fastest-growing HIV epidemic in world with 160,000 (130,000–180,000) people newly acquiring 2021, an overall 48% increase number of new acquisitions, a 32% rise AIDS-related deaths over past 10 years [1]. World Health Organization East estimated to accommodate 1.4 million living (PWH), majority transmissions reported occur locally be unrelated cross-country migrations [2, 3]. Sadly, according UNAIDS, 2022 only 62% EECA were aware their status 51% PWH received treatment, which resulted viral suppression rate Common (>50%) late diagnoses (with either AIDS-defining condition or CD4+ T cell count <350 cells/µl at presentation) [4] further add epidemiological issues complexity client management [5]. Although key acquisition risk has changed from unsafe injection practices heterosexual transmission, access opioid agonist therapy (OAT) needle syringe programmes often still limited (Kazakhstan) unavailable (Uzbekistan, Turkmenistan), results OAT regional coverage as low 4%, far below UNAIDS target 50%. Furthermore, pre-exposure prophylaxis (PrEP) combination prevention services are availability not formally implemented across multiple countries usually due financial barriers access, such lack state funding for medicines, technical capacity cost service delivery [6]. This substantially larger PrEP gap (the proportion populations "very likely" use if accessible, compared currently using PrEP) located (up 45%) median 17.4% estimate Union [7]. Moreover, there high level stigma countries, especially against gay men other who have sex men. growing suboptimal prevention, testing treatment main reasons that challenge 2030 targets. humanitarian crisis related Russian invasion war Ukraine challenged situation even hindering efforts, forcing both internal displacement (estimated 3.7 million) external migration locals refugees 6.4 million, March 2024) [8]. On top massive casualties, civilian healthcare infrastructures destroyed, seek safety, protection assistance, including continued medical care. home ∼260,000 >130,000 on antiretroviral (ART). significant progress was made response before outbreak resulting 47% reduction incidence 81% AIDS mortality, significantly affected tuberculosis (TB) programmes, diminished capacity, difficulty ART provision [9]. Despite notable hardship, managed maintain full ART, increased rollout by 38% (reaching >27,000 people) doubled PrEP, now available free charge [10]. A large studies published this supplement focus responses given during war, providing good examples resilience strength reflecting personal experiences setting mass trauma. Mass traumas important perspective PWH, these may bring out stress exacerbate mental health issues. Owczarzak et al. analyse bioecological model trauma context among history injecting substance [11]. study 18 interviews four Ukrainian cities autumn 2022. outlines but also confirms deep impact healthcare-related wellbeing participants, necessity respond triggering situations, decrease work opportunities, incremental costs displacement. All factors shown affecting adherence general healthcare. Lazarus analysed non-governmental organization (NGO) described Ukraine, mixed-methods project geographically dispersed (n = 24) governmental 2) organizations representing several regions [12]. Their analysis NGO work, time when aid critical. Following initial shock terror quickly resumed limiting duration cessation services, optimizing reallocating staff. provides strong story support emphasizing NGOs unfortunate "big events" war. topic human rights expanded Lohman presenting assessment TB [13]. consisted series assessments covering period aiming examine scale-up outcomes programmes. paper describes implementation learning evaluation 25 programme implementers, community advocates government officials, 14 organizations. Interview data clearly reflect domains, faced unauthorized disclosure social environment (−19%), verbal abuses/personal threats (−13%) improvement (+33%) perceived confidentiality records. expansion legal advocacy allowing population services. one few numerous where remains challenging. In follow-up oral daily tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) [14] 199 inject drugs (PWID) without text reminders, Morozova longitudinal patterns coupled measurement diphosphate emtricitabine triphosphate dried blood spots participants objective measures [15]. enrolled been longer than 20 (37%) alcohol (67%) >50% moderate severe depression. highly challenging group, >90% cases reporting take more 95% TDF/FTC doses. Alarmingly, spot metabolite revealed reality divergent patient-reported detectable levels. unique confirming divergence between measured PWID, indicating novel telemedicine online interventions can particularly useful marginalized difficult-to-reach populations. Migrants Asia moving disproportionately sexually transmitted infections high-level poor working conditions, lower no system tools groups. Kovtun [16] focused violations sexual orientation, gender identity (SOGI), six Europe, Caucasus (Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan), background rapidly rising epidemic, strict religious norms, discrimination associated minorities HIV, conflict. Using Rights—Evidence—ACTion (REAct) tool, they upon complaints bisexual transgender women. strikingly higher numbers solely based SOGI suggest despite all achievements country last decade terms harm reduction, testing, care, prevails country. effect recent evident police military staff, denials private refusals temporary accommodation denial border crossings. underscore diversity stigma, violations. Mackesy-Amiti define intervention aimed reduce high-risk behaviours Tajik migrants Federation [17]. cluster-randomized controlled trial comparing network-based, peer educator training education training. Male recruited educators trained how deliver knowledge peers. showed baseline percentages binge drinking, condomless sex, equipment sharing considerably high, cleaning behaviour extremely There needle-sharing following intervention, modest behaviour. suggests tailored needs specific groups inclusion peers effective hard reach. Stigma-associated addressed Davis used citizen science approach address HIV-related adolescents young adults Kazakhstan [18]. These called develop digital materials, would assessed rated contest aim promote self-testing. submitted materials judged board contestants, professionals representatives NGOs, submissions awarded. Adolescents interest submissions, members input development study, running media procedures, creating promotional feedback submission system. Inclusion stimulated collaboration adults, importance testing. Lastly, association cognitive disorders presented Mergenova [19]. size increasing acquisitions psychoactive substances. authors performed cross-sectional questionnaire-based 230 stable (>6 months) self-reported addition depression, anxiety, post-traumatic disorder (PTSD) symptoms, memory assessments. Notably, third patients illness, while 25% drug 17% hazardous drinking. mild depression anxiety 20−32%, 6−10%, mood least PTSD symptoms observed 7% cases. Not surprisingly, adherence—missing likely depressive forgetfulness. contrary, better function therapy. emphasizes need precise regular care order tailor provide improving maintaining optimal rates. long neglecting rapid increases transmissions. PWID characteristics each different cultures, beliefs structures long-term efforts epidemic. Europe presents resilience, improve rights, innovative approaches summarizes challenges societal While continuing international support, commitment will vital achieve goals end region. declare competing interests. MP DG jointly drafted revised editorial. read approved final version. We like express our sincere thanks prepared, manuscripts request. grateful research volunteered part supplement. thankful co-Guest Editor, Dr Andriy Klepikov, Executive Director Alliance Public Health, his valuable role conceptualization alone responsible views expressed do necessarily represent views, decisions policies institutions affiliated. Data applicable article datasets generated current study.

Язык: Английский

Процитировано

1