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Michel Kazachkin: "If not to work much quicker, the situation will only worsen"

In July the 21st International AIDS 2016 conference was held in the Republic of South Africa, however the event was practically not discussed in the leading Ukrainian media, in spite of the fact, that in our country epidemic HIV/AIDS storms for many years, and at a conference in Durban the most important issues of financing of researches, techniques and projects in fight with HIV/AIDS were resolved.

Evgenia Smirnova is the head of the Small Heartwith Art public organization dealing with problems HIV/AIDS among children, have communicated on the conference sidelines to Michel Kazachkin - the special representative of the U.N. Secretary-General on HIV/AIDS in Eastern Europe and Central Asia. In the sphere of Michel Kazachkin’s competence – the unsuccessful region in which epidemic doesn't fall but grows. Ukraine is one of epidemic centers. And in a few years the country captured by war and corruption can remain alone with its problems as its authorities do not attach enough importance to the fact that every day in our country 54 persons are infected with HIV/AIDS.

- In Europe only 0,02% transmission of HIV from mother to the child are registered. In Ukraine and Russia the level of children infection remains sufficiently high, but for some reason "their voice isn't heard".

- In general, "the voice of children isn't heard" around the world because children don't act at microphones. I see two problems. The one - children who live with HIV/AIDS, which with HIV infection are already during 10-14 years. They grow now, they already understand in what situation they are. Many of them even don't know yet why they take medicine. I think, the region also lags behind in this understanding to some extent. That is many doctors still badly know how to talk to such children and parents are somehow lost too. But here, in Africa, and in Western Europe there are quite good models of approach to these growing-up children now. And I met in Russia recently – in Kazan – group of young people Tinerdzhayzer, who are actively working on this issue. They exactly stated. I am optimistic about the fact that these young people will come out and will carry on a conversation with society.

As you heard, in the region it's not too bad with the number of recently infected children, the results are enough good here. Two countries from the region among the four or five global leaders in overcoming HIV among children are Belarus and Armenia. In the Russian Federation and Ukraine figures are low enough too. But, of course, risk is big because there are HIV-positive women who still come to doctors on quite late term of pregnancy. These are women who live in difficult circumstances, have financial problems, they often are unemployed, without family. Of course, in such countries of the region as Ukraine and Russia, a situation is difficult. A health care system here, as I call it in English, is provider-centered. In other words, there is the health care system, but you have to come to it, and it doesn't come to you to help. Thus, for all people in vulnerable groups it is very difficult to receive the help. But in Ukraine, for example, after all there are fine civil organizations, fine networks of people which are engaged in outreach – that is, go to people, but don't wait that people come to them.

- In recent years Africa has taken very big step in overcoming epidemic. What initiatives should be adopted at South Africa and to recommend to public activists?

I could have quite long list, but if it is necessary to choose something one, then it is political leadership. In other words, the president of the republic, the vice president who acted in the first day, the Minister of Health – every day they talk about tuberculosis in all speeches. I look at Ukraine and I understand that the situation is difficult, all the time something changes, there is crisis in the country. But I didn't hear that the former or present president, or the prime minister loudly and clearly said: "Carefully, in our country one person in a hundred is HIV-positive". It has to be a priority, and it seems to me that all the time we somehow try to improve system, we care for purchases of drugs, we worry about creation of new public institutes of health care, we discuss how to finance the civil organizations. But force in leadership.

Ukraine is also the leader in TB-illness and resistant tuberculosis. In Europe, and even at world level, tuberculosis still spreads. And, of course, when there is a political leadership, it is followed also by financing. I understand that now in Ukraine there is an economic crisis, that the hryvnia has much lost, inflation, but at the same time the health care of citizens has to be the main priority of the government. I don't hear it and I don't see. How it is possible that there has already passed one year from that day when the previous Minister of Health Kvitashvili has reported about his leaving, and still there is no new minister? We have a crisis with HIV/AIDS, we have a crisis with tuberculosis, and if we don't act much faster, the situation will only worsen. That is, for all that you don't pay now for, you will have to pay much more expensively, but later.

Second initiative. Here, in Africa, epidemic scale is such that literally one of six people is the HIV-positive. Doctors and structures aren't enough. It is impossible to follow model of the AIDS centers here. So here huge work has been carried out for people had access to testing, could address in point of trust, could receive treatment directly where they live – and it works through paramedics, through civil society. I was in Kayelich that about Cape Town. There, if you have a HIV infection, you come to such young man who has passed a training – about 48 hours. He has about 20 questions: your growth, body temperature, how do you feel. If you answer "no" to one of these questions, then you meet the nurse. The nurse examines, takes pressure or temperature, and she has a leaf with 10 questions too. If something is wrong there, then you will be examined by some superparamedic or the supernurse. And you will only meet the doctor if something is absolutely bad. And our doctors in the AIDS centers observe hundreds, thousands of people. In Russia I saw doctors who have about six thousand patients, and there is about 15 minutes for each. How this patient can explain what's bothering him (her), but not only physically, but also socially, morally? A role of the doctor not only to prescribe medicine. Therefore, I think that it is important model. People who well feel, who have no problems – and we know that it, generally, most of those who are on antiretroviral therapy, – for them it is necessary to create very simple system of access to therapy as it is possible closer to the place where they live, or to the place where they want to get treatment. Because sometimes you don't want to get treatment where you live, because of discrimination and stigma. But also you shouldn't keep together all doctors as a jewelry or that specialists doctors do work which is done here by paramedics. There now, this is the second.

And the third is, of course, support of civil society and networks of the people living with HIV/AIDS. I don't say that it doesn't exist in Ukraine. On the contrary, exactly Ukraine is a fine example for other regions. But what I'm worried about it is financing of these organizations. It literally up to 90 percent depends on "Global fund", and now it will depart from the region, even from Ukraine, despite the fact that what heavy situation is here. "The global fund" and the donor countries say: "Listen, you are the country with average income, that is you have to finance yourself", but when there is no political leadership, when many other priorities, I also can understand it. Ministers say to me: "Listen, Michel, thanks a lot, but we have a military conflict, in our country money goes to our army". But I also see, I was in Kyiv 10 days ago, and it is visible that the poor grows poor, and the rich are richer and richer. In the downtown look at cars which stand there. So I think, the resources are available, the health care system can be financed by some taxes, but once again: the political will has to be stronger.

- Do you get the feeling that from clients of the existing HIV-service organizations in most cases have made consumers who, unfortunately, seldom want to do something by themselves?

- I understand that such questions can appear, but in this case it is necessary to be careful in estimates. We speak about epidemic, we speak about HIV/AIDS which is transmitted quickly and extends not only in Ukraine, and in the region. But not all over the world. As you know, for the last 10 years new cases of infection have decreased by 35 percent, mortality has dropped by 40 percent – but not in our region. So we still live at the time of epidemic growth. And when there is epidemic, I consider that this problem has to be in an absolute priority.

- In other words, does epidemic continue in the region?

- Listen, one of 200 people is infected with HIV. A good illustration – the subway. Look: people go out of the subway in Kyiv, probably, one of 60 – HIV-positive.

- In Ukraine 54 persons are infected with HIV infection every day.

- Yes, in 2016.

- And what expectations do you have concerning the next conference in Amsterdam and how Ukraine can approve itself at it?

- I am sure that our Dutch organizations, the Dutch Foreign Ministry and the Dutch scientific community will organize very good conference where focus will be directed to Europe and to Eastern Europe. What I would like to see is the beginning of dialogue at the political level. I wish the president Poroshenko or the prime minister Groysman arrived and told: "HIV/AIDS problem in my country is important for me. I here to show, how I take it seriously and because I want to hear what goes on in here, to understand and accelerate work in my country".

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