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This Week in Global Development
Special edition: What will it take to reverse HIV in Eastern Europe and Central Asia?
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While HIV infections and AIDS-related deaths are declining globally, the Eastern Europe and Central Asia region, or EECA, tells a different story. It is now home to one of the world’s fastest-growing HIV epidemics, with over...
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Foreign.
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Hello, I am Kate Oren, Executive Vice President and Executive Editor at devex. And welcome to this special edition podcast sponsored by Gilead Sciences, where we are going to dive into what is frankly an overlooked and underappreciated challenge in the global fight against hiv. While much of the world has made real progress in reducing HIV infections, Eastern Europe and Central Asia remains one of the few regions where the epidemic is still growing. In fact, it is now one of the fastest growing HIV epidemics globally. To put some numbers behind this, more than 2.1 million people in the region are living with HIV and an estimated 28% do not know their status. And about half of those living with HIV are not on treatment. It is the only region in the world where AIDS related deaths have increased since 2010. There are a number of factors driving these trends that we will get into today. Stigma, restrictive laws, underinvestment in prevention and treatment. But perhaps most notably the disruption caused by the war in Ukraine which has displaced millions and put additional pressure on on already strained health systems. So today we're going to discuss what it will take to reverse this trend. Since 2019, Radian, a partnership between the Elton Johns AIDS foundation and Gilead Sciences, has been working with local organizations across the region who are implementing community led solutions designed to better reach the people who need HIV services most and really offer some models of how the HIV response in the region can evolve. To talk about what this looks like in practice, I'm joined by Dennis Denisenko, Eastern Europe and Central Asia Portfolio lead at the Elton Johns AIDS Foundation. And Dennis works closely with partners across the region through the Radian Partnership. And for him, the issue is also personal. As a Ukrainian, he is witnessing how the war and the HIV epidemic are affecting communities across his own country and the broader region. So, so Dennis, thank you so much for joining us today.
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Thank you for having me.
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So, to start, I want to just kind of help understand the broader picture. You know, when you look at the status of HIV globally, there are a lot of positive trends. Infections and deaths are down, prevention and treatment is up. But when you look at the Eastern Europe and Central Asia region, there is a different story. With HIV infections still rising up. I mentioned some of the contributing factors with the war in Ukraine being one. But can you help us understand, you know, what makes this epidemic different in this region and some of the main factors driving the increase in new infections?
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Yeah, as you mentioned. Correct that while many parts of the world are making the progress in hiv, so Eastern Europe and Central Asia are still facing the Growing crisis. And this is because many people cannot have access to the testing and treatment because of stigma, because of discrimination. Because again when you already, you already mentioned it, the war and a lot of displacement Ukrainians first of all in eco regions. So through the Radiant Partnership we try to support the local community organization to develop practical solution and scale what works.
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And so this Radiant partnership was launched in 2019 again between John AIDS foundation and Gilead Sciences. What is Radian trying to do differently than maybe some more traditional HIV programs?
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That's a good question. I think differently. We trying to orient on community leader organization. So we try to hear the the voice of community, try to understand their needs, not just provide some solutions, but also asking them what's the solution, what they need. And it's build the trust between donors and community led organization and key populations. That's the main difference. The second difference, we try to innovate, we try to support some innovations in our program trying to. To find new ways how we could be more close to the people, how we could reach more people and covered by services. Also it's important to say that we trying to find the model which works and then scale up this model through our funding mechanism.
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So the war in Ukraine has left many particularly vulnerable people displaced. There are many neighboring countries that have welcomed in refugees and are looking to provide services to support them. Can you talk through some of the challenges in being able to provide these services to refugees? When you think about language barriers and just navigating different health care systems and some of the work you're doing to try to address those challenges.
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So yes, as you mentioned already, so the people are faced with many challenges like language, like navigations, disorientations on the new territory and new countries. And they have five projects in Poland, Moldova and Germany which helps people to navigate through their new system and new country again by supporting the community organizations. So they know how to reach the people, they know how to provide testing and treatment. And then we decided to ask them about the solution, what they could do with this situation. And they provide some project for us which will advocate the access to the treatment in this refugee camps. How to reach again, how to provide more tests by peer to peer consulting by reach the people in the clubs in the different areas. Sometimes in some projects they provide some software solution so you could download the apps and quickly orient on your own language in the local healthcare system. So and finally they advocate, they advocate access in these camps to the treatment for our key populations. And it works like this. So we orient it on the Local and community organization. Build the trust and ask them about the solution.
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Hi, I'm Kate Warren, Executive Vice President and Executive Editor at devex. At devex, we don't just cover the biggest moments in global development. We create space to understand who and what are driving the headlines. Alongside gatherings like the World bank and imf, Spring and annual meetings, the World Health assembly, the UN General assembly and beyond, we host DEVEX Impact House where our journalism comes off the page and onto the stage. We bring together a curated group of leaders for live interviews, intimate roundtables, hands on workshops and candid conversations you won't hear in the official meetings. It's where tough questions get asked, the spin gets stripped away and meaningful connections happen. If you'd like to join us or stay in the loop on all of our events online and in person, please visit devex.com events and I hope to see you at a future DEVEX Impact House. So, you know, the war in Ukraine has obviously created a lot of disruption across the region. How have organizations adapted to maintain HIV services during the war, during displacement? You mentioned some of the work in the camps, but you know, when you are working with the partners across the region, what are some of the stories that maybe stand out to you about how the communities are responding to this difficult moment?
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Well, it was quite difficult in the first couple of years when the world begins in 2022. The People was disoriented, the organization was disoriented. Lots of IRV under retrovirus therapy spots was shelling and damaged and lots of displacement, internal displacement people were there. But because lots of efforts was put in previous years again with radiant support. So we have a strong network of organization who, who react on this situation, even unpredictable situation like a war. And they flexible change the approach. They provide mobile clinic, mobile testing, they provide a lots of shelters for the people. They try to, to be close to the patients and to the people.
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Yeah. And when you talk about needing to reach the challenges of reaching people, particularly in a conflict environment and Radian has been successful of reaching hundreds of thousands of people. What approaches have proven effective so far? You mentioned mobile clinics and then we think about lessons that maybe could work and apply to other regions. Unfortunately we are seeing rise in conflict and crisis around the world. And so as we think about some of the lessons from this partnership and the work you're doing that maybe could apply to other scenarios, you know, what are some of those lessons learned or approaches that you think are very effective?
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Well, the first lessons I think it's about the trust. So we really need to rely on community lead organization. That's actually the difference with other donors that we try to hear the voice of community and build this trust. And the second one is we need to be more close to our patients, not orient on some stationary clinics. But if we hear that the people doesn't understand the language of the doctors of the clinics, like we do with some German organization by creating some software which helps to translate the doctor's speech the doctor receives, which helps to mapping all services to orient to navigate them. So the second lesson is to hear the voice of communities. And of course it's important to partnership with other donors with different networks of organization, because all what we try to do, we're doing through our partners.
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So Dennis, you mentioned some of the innovation that Radian is funding. Can you expand on that more about what that looks like and how you're taking some of those lessons learned from the innovations and helping to scale those across the region. And then also I'd love to hear a bit more about the different funding pillars Radian is leading on.
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So I'll begin from the, from the last one. We have three pillars, three funding mechanism. In Radian, it's Innovation Fund, where we are trying to find the new solutions of the problem, of the roots of the problem. Then Success Replication Fund, when we have some stable sustainable model and we try to replicate this model to the different countries, like we have examples with Almaty City, when we have a good index testing model and we reach a lot of people by testing and decrease the timing between when the person receives of results and start the treatment. And this model we already replicated in Romania, which has of course some difference, but the model works. So the second one is Success Replication Fund and the third one is Equity Challenge Fund, which where we focus on structural barriers, on the legislations, on the barriers which face to the people, when people faced with some local barriers. We're trying to define some interesting and innovative idea. Like I provide examples like in Kazakhstan we support the project which using artificial intelligence, for instance. And this application helps doctors and social workers make a strong connection between their patients. Like you download some applications like patients and by video, by artificial assistance, the system could check your emotional status and prevent you from interrupting the treatment. So if the system has such kind of signals, they pass this information to social workers and the social workers could immediately go to the patients and in this way to prevent interruptions of treatment. So such kind like these innovations. And then if it will be successful, of course we will replicate it to other countries.
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Can you know, the this epidemic is one that many in the global health community don't fully appreciate within the region. And what message would you share with global health leaders, policymakers, other international donors about why they need to be paying attention to this region, why they need to invest in it and what role they should be playing in reversing this trend? And some of the successful models that you all have shown that could play a role in reversing. What would you like to see those global leaders do to help accelerate all the great work that you are doing?
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Well, I think that donors and international partners have a critical role to play by investing in community lead innovations and leadership. They can help to remove the barriers that prevent people from accessing live setting, HIV prevention, testing, care. And it's important to remember that we cannot end the global HIV epidemic while leaving Eastern Europe and Central Asia behind. So closing that gaps will require long term commitments, long term solutions, stronger partnership with the communities, and the investment in solutions that comes from within the region.
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Well, before we wrap up, you know, obviously there's a lot of challenges that remain. But what gives you hope about the future of the HIV response in the region?
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We have a strong community led organization on the ground. And what gives their hopes, it's their resilience. So they have so many challenges like finance crisis, the war crisis again, the, the stigma and discrimination because it's always exists. But our community is so resilient, they so resist all these challenges. And it gives me a hope each times when I visited our partners. It gives me a lot of hope.
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Well, that is great to hear and I know there's been many challenges in the region and this only exacerbates it. So Dennis, thank you so much for sharing your insights with us today and thank you to Gilead Sciences for helping us bring this really important issue to light to our audience. Again, I think it is underappreciated within the global health space, the real challenges that persist in this region and growing in many ways. But thank you for your time and to our listeners. Thank you for tuning in.
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Thank you for having me. Yeah, thank you.