Eastern Europe and Central Asia is the only region in the world where HIV rates continue to rise rapidly. Between 2011 and 2016, the number of HIV-positive people in Kyrgyzstan more than doubled. Women who use drugs are particularly vulnerable. Yet, they face several barriers to HIV services. Asteria, an organisation by and for women who use drugs in Kyrgyzstan, offers tailor-made support, while also advocating for change.
New HIV infections overtake treatment enrolment
People who use drugs face numerous challenges in Eastern Europe and Central Asia. Initiatives that aim to reduce the harm associated with drug use – that is health, social and economic consequences – are limited. At the same time, HIV treatment coverage in the region is low: only 27 per cent of adults who tested HIV-positive are receiving medication. New HIV infections continue to outpace HIV treatment enrolment here.
Among the most affected by HIV are people who inject drugs
Conservative laws around same-sex relations, drug use and sex work fuels stigmatisation. This obstructs the HIV response in some countries in the region. In Kyrgyzstan, the groups that are most affected by HIV are sex workers (2 per cent), men who have sex with men (6.3 per cent) and people who inject drugs (12.4 per cent). Since 2010, in this country, new HIV infections have increased by 21 per cent.
Gender-specific barriers to HIV services
Women who use drugs face a range of gender-specific barriers to HIV services, and they are a hard-to-reach group in many contexts, even when harm reduction programmes are in place. The stigmatisation and discrimination that they experience is often heightened by gender-based violence and abuse. This increases their risk of contracting HIV and other sexually transmitted infections (STIs). Until now, too little attention has been paid to rectifying inequalities in harm reduction programmes. New approaches are urgently needed to fill this gap as a first step towards improving the safety, health and well-being of women who use drugs.
Kyrgyzstan has no system to support women who use drugs in taking measures to protect themselves against HIV
Health workers lack knowledge
Women who use drugs in Kyrgyzstan are sometimes unable to take care of themselves and their children. But there is no system that supports them in surviving and in taking measures to protect themselves against HIV. Health workers stigmatise and discriminate against them, while health staff also lack necessary knowledge. That’s why HIV-positive women often don’t seek medical care. They fear being mistreated by health workers, denied treatment or, when pregnant, being forced into an abortion. So, pregnant women often don’t get the medical support they need. Moreover, many women who take HIV medicines don’t receive help to adhere to treatment.
Women decided to make change happen themselves
Four female activists were concerned about the absence of gender-sensitive programmes for women who use drugs in Kyrgyzstan and decided to make change happen themselves. They established Asteria, the first social centre in Kyrgyzstan by and for women who use drugs and the first of its kind in Central Asia. Women know best what women need – this is the basis of Asteria’s work. With a peer-to-peer approach, the organisation works to improve the health and well-being of women who use drugs and women who are HIV-positive in Kyrgyzstan. The organisation is also committed to defending their human rights.
Prevention of mother-to-child HIV transmission
In addition to providing direct support to women, Asteria works toward changing laws and rules in Kyrgyzstan. One amazing advocacy achievement was a new agreement approved by the Kyrgyz Ministry of Health that guarantees medical care for women who use drugs and aid for the prevention of mother-to-child HIV transmission. And, thanks to Asteria’s advocacy work, the civil registration rules have been changed. In the past, undocumented women – who were often HIV-infected – could barely access medical care. Now they can utilise health services, including HIV treatment, by showing an NGO certificate.
Development of gender-sensitive services
Asteria has also put the issue of gender-based violence as a major reason for the spread of HIV among women who use drugs on the agenda. Since 2013, Asteria conducts surveys on violence experienced by women who use drugs. The collected data shows that 90 per cent are confronted with gender-based violence. Yet, they don’t have access to services provided in crisis centres. Furthermore, Asteria carried out research into women who use drugs’ access to sexual and reproductive health and rights services, including HIV services. This has resulted in the development of gender-sensitive services.
Gender-based violence is a major reason for the spread of HIV among women who use drugs in Kyrgyzstan
Asteria staff lead training programmes
The Kyrgyz community of people who use drugs is linked to regional and global networks. The International Network of People who Use Drugs (INPUD) and the Eurasian Network of People who Use Drugs (ENPUD) trained them on using the Injecting Drug User Implementation Tool (IDUIT), which contains advice on HIV programming. Asteria staff now lead IDUIT training programmes.
Improved access to HIV services for key populations
Thanks to the efforts of Asteria, women who use drugs and women who are living with HIV now have a voice at the government level in Kyrgyzstan. As a result, access to HIV testing, treatment and care services for key populations has substantially improved. Nowadays, the Kyrgyz government meaningfully involves community-based organisations in the development of HIV programmes and tools. LGBT people, people who use drugs and sex worker groups contributed to the government’s technical working group to develop the national HIV/AIDS programme for 2017-2021.
Organisations’ important role in delivering services
Sustainable financing for HIV programming is ensured in the government programme and in the proposal to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The co-funding share of the Kyrgyz government for HIV prevention and treatment programmes will increase to 50 per cent by 2021. Community-based organisations successfully advocated for this vital funding and continue to play an important role in delivering HIV services.
Asteria Public Foundation
Asteria is a shelter and support centre by and for women who use drugs in Kyrgyzstan. It provides temporary accommodation, food and practical help to women and their children. Asteria also supports women in accessing HIV testing and adhering to treatment. Moreover, the organisation implements advocacy activities.
Asteria’s achievements – striking figures for 2012-2017
- 5,688 people have accessed services, including HIV consultations and harm reduction services.
- 1362 of them were clients of the shelter.
- All HIV-positive clients received medication.
- 328 clients had a consultation with a lawyer.
- 110 persons recovered identity documents (passports and birth certificates).
Text: Anna Maria Doppenberg
Photos: Denis Smirnov