ВИЧ и туберкулез: лечение для всех / HIV and Tuberculosis: Treatment for All

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03 ноября 2016

 

Минское заявление министерств здравоохранения стран Восточной Европы и Центральной Азии “ВИЧ и туберкулез: лечение для всех”

Минск, Республика Беларусь

  1. Мы, представители министерств здравоохранения Республики Армения, Азербайджанской Республики, Республики Беларусь, Грузии, Республики Молдова, Республики Казахстан, Кыргызской Республики, Российской Федерации, Республики Таджикистан, Туркменистана, Республики Узбекистан и Украины собрались 3 ноября 2016 года в г. Минск, Республика Беларусь, для обсуждения и координации совместной позиции по расширению доступа к качественным и недорогим антиретровирусным и противотуберкулезным препаратам в странах региона Восточной Европы и Центральной Азии;
  1. Мы понимаем важность и актуальность проблем, в основе которых лежат вопросы эпидемий ВИЧ/СПИДа и туберкулеза, и затрагивающих регион ВЕЦА;
  1. Мы подтверждаем нашу приверженность:
  • Политической декларации по ВИЧ/СПИДу: поиск подходов к ускорению борьбы против ВИЧ/ СПИДа к 2030 г., принятой 8 июня 2016 г. и включающей задачи ЮНЭЙДС 90-90-90 [1];
  • Глобальной стратегии и плану “Global Plan to End TB” 2016 – 2020 [2];
  • План действий по борьбе с туберкулезом для Европейского региона ВОЗ на 2016–2020 гг. [3];
  • План действий сектора здравоохранения по борьбе с ВИЧ-инфекцией в Европейском регионе ВОЗ [4];
  • Повестке дня в области устойчивого развития до 2030 г., включая резолюцию стран-членов ООН, утверждающую намерение покончить с эпидемией СПИДа и туберкулеза к 2030 г. (ЦУР 3: “Обеспечение здорового образа жизни и содействие благополучию для всех в любом возрасте) и в частности индикатор 3.3. [5];
  1. Мы признаем необходимость долгосрочных государственных программ, направленных на укрепление системы здравоохранения и предоставления доступных, качественных и недорогих услуг по профилактике и борьбе с ВИЧ/СПИДом и туберкулезом в странах региона ВЕЦА;
  1. Мы подтверждаем необходимость наиболее полного охвата пациентов и расширения доступа к антиретровирусному и противотуберкулезному лечению и подтверждаем возможность принять рекомендации ВОЗ по назначению антиретровирусного лечения всем людям, живущим с ВИЧ, в соответствии с действующими нормами законодательства стран-участников совещания;
  1. Мы подчеркиваем важную роль доступности современных лекарственных препаратов в реализации права на здоровье и подтверждаем намерение использовать существующие инструменты для снижения цен, чтобы спасти жизнь в странах нашего региона, с учетом действующих норм законодательства стран-участников совещания, в том числе путем:
  • Рассмотрения возможности использования различных механизмов закупок, включая международные механизмы и механизм объединенных закупок
  • Обсуждения цен с поставщиками антиретровирусных и противотуберкулезных препаратов
  • Поддержки производителей из стран ВЕЦА антиретровирусных и противотуберкулезных препаратов;
  1. Поддерживаем гарантии ТАПИС (торговые аспекты прав интеллектуальной собственности) и подтверждаем приверженность работать совместно и соблюдать условия, определенные в соглашении по ТАПИС и инновациям и интеллектуальной собственности, подписанной в Дохе [6] для ускорения доступа к качественным и недорогим антиретровирусным и противотуберкулезным препаратам;
  1. Подтверждаем приверженность работать на укрепление в течение последующих лет регионального сотрудничества по доступу к качественным и недорогим антиретровирусным и противотуберкулезным препаратам в наших странах для поиска наиболее эффективных и экономичных, устойчивых и отвечающих интересам всех сторон решений наших общих проблем в данной области; а также к стремлению укрепить наши совместные усилия, признавая региональную солидарность, общую ответственность и лидерство в политических вопросах, с учетом внутреннего контекста законодательства и юридических обязанностей стран-участниц совещания;
  1. Подчеркиваем важность и призываем к укреплению международного сотрудничества стран региона ВЕЦА по достижению целей и задач, нацеленных на искоренение эпидемий СПИД и туберкулез к 2030 и предоставлению наиболее полного доступа к антиретровирусным и противотуберкулезным услугам.

03 November 2016

 

Minsk Statement of the Ministries of Health of Eastern Europe and Central Asia “HIV and Tuberculosis: Treatment for All”

Minsk, the Republic of Belarus

  1. We, Representatives of the ministries of health the Republic of Armenia, the Republic of Azerbaijan, the Republic of Belarus, Georgia, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, the Russian Federation, the Republic of Tajikistan, Turkmenistan, Ukraine and the Republic of Uzbekistan met on 03 November 2016 in Minsk, Belarus to discuss and coordinate positions on common interest in expanding access to affordable and quality assured Antiretroviral (ARV) and Antituberculosis (anti-TB) medicines in countries of the Eastern Europe and Central Asia (EECA) region;
  1. We recognize the gravity of the problems resulted from HIV/AIDS and tuberculosis epidemics affecting countries of the EECA region;
  1. We reaffirm our commitment to:
  • the Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030 adopted on 08 June 2016, including the UNAIDS 90-90-90 treatment target [1];
  • Global Plan to End TB 2016 – 2020 [2];
  • Tuberculosis Action Plan for the WHO European Region 2016–2020 [3];
  • Action plan for the health sector response to HIV in the WHO European Region [4];
  • 2030 Agenda for Sustainable Development, including the resolution of Member States to end the AIDS and TB epidemics by 2030 (SDG3 Ensure healthy lives and promote well-being for all at all ages) and SDG 3.3 [5];
  1. We acknowledge the need for long term state programs that are aimed at strengthening healthcare systems and providing accessible, affordable and high-quality HIV and TB services in countries of the EECA region;
  1. We reaffirm the urgent need for full coverage of patients and expanding access to HIV and TB treatment and confirm the possibility to adopt the 2015 World Health Organization Guidelines recommending that antiretroviral therapy be initiated for everyone living with HIV in accordance with the legislation of the countries participating in the Regional Consultation;
  1. We underline the importance of accessibility to modern medicines in the realization of the right to health and commit to utilizing all available tools to reduce the prices in order to save lives in the countries of our regions in accordance with the legislation of the countries participating in the Consultation through:
  • Considering the possibility to use different procurement arrangements, including international and pooled procurement;
  • Negotiating prices with ARV and TB suppliers;
  • Supporting manufacturers of ARV and anti-TB medicines from EECA states;
  1. We support the Trade-Related Aspects of Intellectual Property Rights (TRIPS) safeguards and are committed to work together to implement the provisions contained in the Doha Declaration on TRIPS and Innovation and Intellectual Property [6] to facilitate access to affordable and quality-assured ARV and anti-TB medicines;
  1. We commit to strengthen the regional cooperation over the next years in order to advance access to affordable and quality assured ARV and anti-TB medicines in our own countries to deliver more cost-effective, equitable and sustainable solutions for common challenges; and that our efforts are intensified through regional solidarity, shared responsibility and political leadership with consideration of internal legislative context and legal obligations of the countries participating in the Regional Consultation;
  1. We highlight the importance of and call for strengthened international cooperation countries to support the efforts to achieve the target on ending the AIDS and TB epidemic by 2030 and implement universal access to HIV and TB services.

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“HIV: yesterday, today and tomorrow” in Kazakhstan

Speech given at the opening of the National Conference on “HIV: yesterday, today and tomorrow” in Almaty, October 12,  2016

Honorable Minister,

Distinguished colleagues,

I thank you for the invitation to this conference. I am truly pleased to be back in Kazakhstan on this occasion.

I wish to congratulate the Ministry of Healthcare and Social Development of Kazakhstan and colleagues from UNAIDS, UNODC and Global Fund for taking the initiative of organizing the first National HIV Conference in the country: a unique opportunity to pause – to formally and honestly assess the situation of the epidemic, acknowledge the challenges and mobilize all energies of the country to fast track the AIDS response and move towards the goal of ending AIDS.

I also wish to pay tribute to the Honorable Salidat Kairbekova whom I remember well and who contributed so significantly to public health in Kazakhstan.

I congratulate the Republic of Kazakhstan for the progress made in recent years in the fight against HIV. The country has taken a number of key initiatives and each of them is an important step toward achieving the 2020 goals: transiting to a predominantly domestic funding of the AIDS response; initiating work on relevant investment cases; reducing the price of medicines through pooled procurement and opening the way for accessing generic medicines; funding NGOs through social contracting; continuously supporting harm reduction for people who use drugs despite pressure from some groups who refuse scientific evidence of its effectiveness. I welcome the recently announced plans for scaling up harm reduction in the country.

It remains however that vulnerable groups of the population, people who inject drugs, sex workers, men who have sex with men and prisoners continue to be highly and disproportionately affected by HIV. A comprehensive analysis of national epidemiological data is key for prioritizing prevention interventions. Since needle exchange programs, opioid substitutive therapy and antiretroviral treatment are synergistic to prevent HIV among people who use drugs, both OST and access to treatment for people who inject drugs should be significantly further scaled up in the country. Laws, policies and practices should be reviewed and if necessary revised, to allow implementation of healthcare for vulnerable populations. And social contracting of NGOs and communities of peers further expanded, building on programs such as those that the Global Fund has been funding here for many years.

Another challenge faced by the country and by the entire Eastern European and Central Asian region is that of increasing rates of TB-HIV co-infection. Integrated services, early detection and adapted treatment regimens can save lives, prevent more costly MDR TB and avoid disproportionate social burden/impact on communities.

And finally, I would like to call on Kazakhstan, as the primary receiver country of labor migrants in Central Asia, and as a leader in addressing the health needs of migrants in the region, to continue working on bilateral and multi lateral agreements that would allow access to care for HIV and TB of all in need and termination of health-related deportations across the Eastern European and Central Asian region.

Operationalizing the 2016-2019 State program “Densaulyk” will be key to setting the goals, implementing HIV prevention and treatment programs and addressing co-morbidity with TB, MDR-TB and hepatitis.

I truly believe that Kazakhstan is well positioned to achieve the 90-90-90 targets, thanks to political will and successful partnerships. Here I would like to also recognize the work of the UN country team and of bilateral and multilateral partners, including USAID and the Global Fund.

As we enter the Sustainable Development Goals era, the initiative of holding a national conference demonstrates Kazakhstan’s commitment to meet the UNAIDS 2020 targets and the 2030 Sustainable Development Goals. The Sustainable Development Goals are the goals of all people for all people. It is for all of us here today to ensure that the journey is successful and its gains irreversible. This is what this Conference is about.

Thank you very much

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INTERVENTION ON THE HIV ACTION PLAN RESOLUTION

Remarks given at Sixty-sixth session of the WHO Regional Committee for Europe in Copenhagen, September 14,  2016

 

Madame Chair, Madame Director General,

 

I would like to thank the Regional Office for framing and drafting what I consider a relevant, comprehensive and strong action plan for the health sector response to HIV in the region.

I would also wish to thank you, Mme Regional Director, for your leadership and your call on day 1 of this meeting, for member states to urgently address the AIDS crisis in Europe.

The plan of action that is submitted for approval is fully in line with the approved WHO Global Health sector strategy on HIV, with the UNAIDS strategy and with the ultimate objectives of the political declaration adopted at the High Level Meeting on AIDS in June this year in New York.

We rightly celebrate successes in the region in decreasing and eliminating vertical transmission of HIV. But this cannot and should not take our attention away from the fact that Europe, and primarily the Eastern part of the continent, remains the only region of the world where the HIV epidemic continues to grow.

In Eastern Europe and central Asia, the number of newly HIV cases has increased by 57% in the last five years (more than 70 % since 2005), while incidence and AIDS-related mortality have decreased by 30-40 % globally in the last ten years.

HIV, in addition, is inextricably linked with TB, MDR TB and hepatitis C in the region. And as delegates would know, the wide extent of drug resistance in Eastern Europe represents a critical challenge to TB control, as reflected in low treatment success rates.

 

Dear colleagues delegates, it is essential that we fully recognize that HIV and TB/MDR TB continue to be ongoing epidemic health emergencies in the region.

The European plan of action that is submitted to you is a robust plan that complements the TB plan of action for 2016-2020 approved last year. I urge you to approve it. As the Secretary General’s Special Envoy, I urge you to intensify access to effective prevention and to treatment for the many people in need in the region, with a strong focus on vulnerable populations, to remain committed and refuse complacency. I urge the regional office to strengthen its capacity for HIV and TB at country and regional levels.

Europe cannot persist in being be the epidemic exception in the global fight against HIV/AIDS.

 

 

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The Johns Hopkins – Lancet Commission on Drug Policy and Health Report in Russian

A Russian translation of the Johns Hopkins–Lancet Commission on Drug Policy and Health report is available here: JH-Lancet Commission Report vRU

The original version is available here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00619-X/abstract

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Addressing migrants’ access to health, HIV/AIDS and TB services in Eastern Europe and Central Asia

photo side eventRemarks given at the side event “Addressing migrants’ access to health, HIV/AIDS and TB services in Eastern Europe and Central Asia”, held during the Human Rights Council in Geneva, June 17,  2016

 

Honorable Delegates, Ladies and Gentlemen,

Thank you for being present at this side event on HIV and TB among migrants in Eastern Europe and Central Asia.

Thank you to the Permanent Representation of the Kyrgyz Republic, the Permanent Representation of the Republic of Kazakhstan, IOM, UNAIDS, WHO, OFID in Vienna, IFRC and Project Hope for co-organizing this event with us. Thank you to the panelists. And thank you, Honorable Daniiar Mukashev for agreeing to co-Chair the event.

The event is focusing on HIV and TB among migrants in EECA and there are a number of reasons to that.

  1. Some of the world’s largest international labor migration trends are registered among Central Asian countries and with the Russian Federation, be it legal or irregular. A large proportion of migrant workers come from the Kyrgyz Republic, Tajikistan, and Uzbekistan. But other countries are also sources of migration labor in the region, including Ukraine, Moldova, and Armenia.
  1. Eastern Europe and Central Asia (EECA) is the only region of the world that continues to see a growth in the HIV/AIDS epidemic with a 57 % increase in the number of new infections reported in the last five years. The overall coverage with antiretroviral treatment remains low in the region as well as access to prevention, particularly for the most vulnerable groups of the population, including migrants.
  1. EECA is also a region where TB is a major issue of concern for public health. EECA accounts for approximately a quarter of the world’s MDR TB burden in the world. A number of circumstances may contribute to TB among migrants, including conditions of living and work; limited access to diagnosis and treatment; late presentation due to fear of being deported; the complex patterns of migrations including high mobility due to temporary and seasonal migration patterns and high number of undocumented migrants.

 

This event takes place on the sidelines of the Human Rights Council and there are also reasons to that.

In his report during this session of the Human Rights Council, the Special Rapporteur on the human rights of migrants has remembered that under the international law, states have the obligation to ensure and the responsibility to respect and uphold the right to health, in a manner that promotes non-discrimination, dignity and freedom for migrants regardless of legal status.

The inclusion of migration in the 2030 Agenda for Sustainable Development is a call for leaving no one behind.

And of course, respecting the human rights of migrants can bring positive development outcomes, considering that labor migrants contribute to significant economic gains in the host country.

How is it that in 2016, deportations for Health reasons and restrictions on the circulation of people between countries in the region based on HIV status continue to happen?

Countries must work together to facilitate orderly, safe, regular and responsible migration and mobility of people. And countries in the region must recognize that there is a need for a comprehensive response to HIV and TB among migrants in EECA, if we want to fast-track HIV and TB and give priority attention to vulnerable groups, as the world committed to by adopting the 2030 agenda and in the political declaration adopted at the High Level Meeting on AIDS last week in New York.

Civil society and communities have an important role to play in reaching to migrants and countries must be ready to support their work. I am pleased that IFRC and project Hope also participate to our panel.

Human rights are universal. They are also the rights of migrants. The right to health and decent care. The right to freedom from discrimination. The rights to equality before the law, to privacy, to work and education. The right to share in the advances of science.

Thank you.

 

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