Situation report on the status of HIV/TB/HCV/OST programs in Donetsk and Luhansk oblasts (as of )

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1 International HIV/AIDS Alliance in 5 Dymytrova St., building 10-A, 9-th floor, 03680, Kyiv, Tel.: ( ) Fax: ( ) Е-mail: office@aidsalliance.org.ua Situation report on the status of HIV/TB/HCV/OST programs in Donetsk and Luhansk oblasts (as of ) Background The situation on ensuring the implementation of comprehensive HIV, TB and viral hepatitis prevention and treatment activities in the Eastern affected by the warfare is still complicated and further aggravates every new week. Despite half-destroyed system of transport routes between the settlements and critical humanitarian situation, ICF "International HIV/AIDS Alliance in " (Alliance-) continues to support the operations of HIV prevention projects on the basis of 13 regional NGOs: 11 of them are located in the Donetsk oblast, including 5 ones in the area uncontrolled by ; 2 ones in the Luhansk oblast, including 1 on the uncontrolled territory. The work is carried out in 13 cities and 33 small towns of both oblasts, allowing to cover almost 32,500 people who inject drugs (PWID) and 2,300 of sex workers (SWs). According to the data by Ukrainian Center for Socially Dangerous Diseases Control of the Ministry of Health of as of the moment only on the territory uncontrolled by the Government of there are about 16,500 of PLWH, among them 7,700 are being on the antiretroviral therapy (ART), about 2,300 people have active TB, including about 500 people with MDR-TB. Opioid substitution therapy (OST) The most critical situation in the warfare area is related to the opioid substitution therapy (OST). Due to extremely complicated situation and legislative restrictions implemented by the Government of in the ATO area since December 2014 the delivery of narcotic drugs to Donetsk and Luhansk is impossible. As of today the impossibility of supplying the medicines in the key reason for gradual winding-up of the OST on the temporarily uncontrolled territory. During the last few months more than 400 patients in these oblasts were compelled to stop the therapy. The stock of buprenorphine on the temporarily uncontrolled territory was fully depleted back in the beginning of January. 150 drug dependent people, OST patients in Luhansk oblast narcologic dispensary, may be deprived of treatment due to exhaustion of the methadone stock next week! Another more than 300 patients receiving methadone OST may become cut off this life saving treatment as the stock of medicines would suffice only till the end of February. Alliance regularly organizes the supply of OST medicines to the government-controlled territories of Donetsk and Luhansk oblasts where OST provision is continued in full. However, it is now impossible to deliver the medicines due to the above limitations.

2 Information on OST in Donetsk and Luhansk oblasts (as of ) Donetsk oblast Planned number (as of there were 620 patients) Actual number of patients as of on the territory controlled by on the territory not controlled by Number of sites: on the territory controlled by on the territory not controlled by Number of sites where OST was discontinued Luhansk oblast Total Difference compared to the previous information as of (25 Luhansk oblast, Stakhanov); 4-Donetsk oblast (>400 patients) 0 Humanitarian project of the Alliance on the support of OST patients relocated from the Crimea and the Eastern From the beginning of May 2014 within the framework of a special humanitarian project supported by the International Renaissance Foundation, Open Society Foundation and Elton John AIDS Foundation 9 cities of hosted 205 OST patients who were compelled to relocate from the occupied Crimea and uncontrolled territories of Donetsk and Luhansk oblasts. Project funding will expire in January As of relocated patients were receiving appropriate services in 7 cities of, among them 8 patients from the Crimea, 34 from Donetsk oblast and 53 from Luhansk oblast. As a result of vigorous negotiations with potential donors the Alliance recently managed to obtain separate funding from the Pompidou Group and the Council of Europe via the Kingdom of Norway, which would allow to continue supporting 75 relocated patients for the period up to 2 months. Moreover, the Alliance recently applied to the Global Fund to obtain consent for the use of available resources and saved funds in the amount of USD 900,000 to provide support for relocated OST patients and HIV prevention programs for street children in the ATO area.

3 HIV prevention Coverage of the vulnerable groups representatives Coverage of PWID Coverage of SWs Planned Actual % Planned Actual % Donetsk % % Luhansk % % TOTAL PWID people who inject drugs SWs- sex workers Provision of commodities. As of today almost all the projects are adequately stocked with commodities for January-February There is the shortage of HIV tests. Stock levels of alcohol swabs (enough for 4-5 months) and tests for HepB and syphilis (enough for up to 6 months) are sufficient. Alliance takes necessary actions to ensure the supply of rapid tests and other materials to meet the needs of partner organizations in Donetsk and Luhansk oblasts as soon as possible. TB prevention and treatment On the territory of Donetsk oblast controlled by rapid TB diagnostics is provided via GeneXpert systems installed in Kramatorsk and Mariupol cities (procured by the Foundation for Development of ). Consumables (cartridges) for will be procured and supplied by Alliance- at the expense of the Global Fund. The GeneXpert system procured and supplied by the Alliance at the expense of the Global Fund remained in Donetsk. It is not possible to supply consumables for this system now. The situation in Luhansk oblast is even more severe. The only GeneXpert system procured and supplied by Alliance at the expense of the Global Fund remained in Luhansk, and we have no information as to whether it operates or not. To prevent interruption of treatment of the patients with MDR-TB who were treated at the expense of the state budget, Alliance made an emergency procurement of the second line TB drugs funded from the Global Fund grant; some of them will be forwarded to Donetsk and Luhansk oblasts. The medicines should be sufficient to treat about 550 patients with MDR-TB. First supplies to Mariupol, Kramatorsk and Lysychansk will be made already this week. Viral hepatitis C (HCV) treatment In connection with the problems of Luhansk oblast AIDS Center operation, including prolonged power blackout, the temperature regimen of PEG-interferon storage was disrupted, causing the spoiling of medicines, thus 5 patients with HIV/HCV co-infection were deprived of treatment. In Donetsk oblast AIDS Center PEG-interferon treatment is continued for all 5 HCV patients. Actual and potential risks In connection with the state of emergency announced by the Government of in Luhansk and Donetsk oblasts on January 26, new difficulties with commodities supply are possible, which may have adverse effect on the established supply schemes.

4 As the shelling of residential districts in the warfare area became much more frequent last week, it is now impossible to adhere to clearly determined schedules of outreach routes operation because of the frequent shelling of residential areas. Consequently, the role of permanent service delivery points became more important. Migration of clients outside of cities/oblasts affected by the conflict requires re-allocation of the target groups coverage, as the highest inflow of PWID and SWs is registered in Slovyansk and Krasny Lyman cities, where the increase of the number of clients in harm reduction projects was recorded. It's worth to ensure re-allocation of clients between different NGOs in the future. On the territory of Horlivka and Slovyansk there is a large number of street children and most-atrisk-adolescents, homeless or deprived of care. Since scheduled funding of GFsupported prevention projects among most-at-risk-adolescents has expired. Social needs of this group are becoming more acute, there is a threat of socially dangerous diseases spread. In connection with this Alliance- is planning to continue the support of prevention projects targeted to children and adolescents with risk behavior in these cities. Taking into account the experience obtained by the projects, we are considering the possibility to modify minimum prevention packages for the principal HIV/AIDS risk groups, as well as options of more flexible organizational arrangements for harm reduction projects work in these settlements during the conflict. Other matters During the last two weeks after the issue of the first situation report regarding the East of a number of topical publications were published in the foreign and domestic media upon the initiative or upon direct informational support of the Alliance (The Guardian, BBC, AFP, Al Jazeera, British Medical Journal, Der Tagesspiegel etc.) regarding the crisis situation with ensuring OST therapy in the East of and adverse effects of the OST interruption in the occupied Crimea since May Key publications on this matter are separately posted in the Alliance's Facebook page. State response to the crisis Unfortunately, despite wide international repercussions, in the last few weeks the Government of did not provide proper response to the crisis situation in order to ensure uninterrupted treatment on the uncontrolled territories of two oblasts. The draft Resolution of the Cabinet of Ministers "On Certain Issues of Introducing the Interim Procedure of Assistance Provision to the Population on Temporarily Uncontrolled Territories of Donetsk and Luhansk oblasts" developed by the working group of principal recipients of the Global Fund grants and authorized state bodies, and aimed mostly at preventing further interruption of HIV/TB prevention and treatment programs on temporarily uncontrolled territories of the Eastern was not approved at the Government session of as a priority draft to be adopted under a brief procedure. According to the available information, the draft Resolution under the standard procedure was forwarded for approval to the respective central governmental bodies which, in its turn, may result in delaying the adoption of the interim procedure of assistance and supply of the life-saving medicines for another several weeks or even months.

5 Thus, the major part of responsibility for the lives of hundreds of patients on the uncontrolled territory who can become deprived of treatment very soon because of medicines stock depletion rests on the Government of, which is procrastinating with urgent adoption of the necessary legislative document. The draft CMU Resolution developed and approved by the interested NGOs and international organizations entails engaging the reputable international humanitarian organizations in the practical implementation of supplies. The legislative fundamentals of the new procedure include the Law of "On Implementation of the Programs of the Global Fund to Fight AIDS, Tuberculosis and Malaria in " and the Geneva Convention relative to the protection of civilian persons in time of war. Recommendations Alliance considers that further neglect by the Government of of the treatment access crisis and OST interruption threat on the uncontrolled territories of Donetsk and Luhansk oblasts is unacceptable, and calls on all national and international stakeholders, as well as leading media, to pay special attention to the abovementioned problem, as the result of which hundreds of patients are deprived of the life-saving treatment, and even more of them will be cut off it in the shortest time because of omission of the responsible state officials who have to promptly solve similar crisis situations. Only immediate endorsement of the respective Resolution of the Government on the interim procedure of assistance provision to the people on temporarily uncontrolled territories of the East of and practical implementation of the necessary medicines supply by via international humanitarian organizations according to the approved mechanisms would prevent fatal consequences and retain lives of thousands of chronically ill people of who actually became the hostages of this situation! ICF "International HIV/AIDS Alliance in " National HIV/AIDS Hotline: OST Hotline: Contact person: Myroslava Andrushchenko е-mail: Phone , ext. 229