Gulipa Sabyrovna Sheishenova is the director of the Public Foundation “Health and education of the youth in the 21^st century” (ZIOM21), the first and only organization working with key population groups on HIV prevention, treatment, care and support in the region of Talas. In this blog, she writes about her organization’s partnership with the UNDP / Global Fund project and common achievements.

In Kyrgyzstan, new HIV infections mostly occur among key population groups. However, due to stigma among the society and healthcare workers and to self-stigmatization, many do not receive prevention, diagnostic and treatment services in time.

In order to work effectively with these groups of the population, it is essential to adopt a “peer-to-peer” approach. Non-governmental organizations and communities play a primary role in HIV control. Nowadays, thanks to the constant efforts of the civil society and to support from the UNDP / Global Fund project, HIV services have considerably changed, for the better. We are able to effectively prevent HIV, timely diagnose it and help HIV positive people live a long and healthy life. 

The challenges we faced

Our foundation was created in 2001. We started working with the UNDP project, financed by the Global Fund to fight AIDS, Tuberculosis and Malaria in 2013. Until then, members of key population groups in our region did not have access to HIV prevention, support, treatment and care services.

The situation was difficult when we started working on the ground, and we didn’t know what to start with. There were difficulties with everything: with access to target groups, with working with the AIDS center and local self-governance structures… A few years ago, there were many problems and obstacles at all levels; not only for us, but for HIV services as whole. Many services which are now delivered by NGOs were not accessible for community members. For example, testing and antiretroviral therapy (ART) were only available in medical centers, but due to stigma, our clients couldn’t, or didn’t want, to go there.

Therefore, many were those who didn’t learn about their HIV status on time and weren’t able to start treatment before getting complications. In addition, NGOs and public health institutions, including AIDS centers, did not cooperate and worked separately. 

Solving many problems under the UNDP / Global Fund project

Under the UNDP project, financed by the Global Fund, our employees were able to attend a number of trainings, seminars and meetings and exchange experience with other partner organizations. Our organization was entirely furnished and equipped. Thanks to joint efforts to increase our organization’s capacity, all of our field workers now have access to their groups, know the specificities of working with each group, and have the necessary skills and knowledge to consult clients on a wide range of issues and offer HIV screening and testing. Our organization is in good, fruitful terms with the AIDS center and local self-government.

All in all, the implementation of the Global Fund grants, under the leadership of the UNDP, has had a positive effect on increasing the capacity not only of our organization, but of all NGOs working in this field, and of the healthcare system as a whole.

At the moment, under the UNDP / Global Fund project, non-governmental organizations are working with all key population groups and provide a wide range of HIV services, including the following:

• HIV prevention, diagnostic, treatment and care services
• Consultations on HIV / AIDS, tuberculosis, STDs (sexually transmitted diseases), safe behavior, motivational consultations and adherence to ART
• HIV express testing
• Distribution of medical items
• Psychological support
• Referral to medical facilities and specialists for other services
• Social assistance: to help receive motivational payments for ART adherence for children, childhood HIV/ AIDS disability allowances up to 18 years old, disability allowances, child allowances for HIV positive mothers up to 18 months, distribution of food packages for people in need, household services, shelters, help renewing / obtaining documents, etc.  
• Legal assistance: documentation of rights violations and consultation on legal issues. 

The achievements of our long-term partnership

I can say with confidence that the capacity building of NGOs and the strengthening of the healthcare system brought about by the implementation of the Global Fund grants, under UNDP support, is directly affecting the quality of life of communities and their access to a number of services. A lot has changed for the better these past years.

UNDP purchases drugs for ART according to new protocols for HIV treatment: thanks to this, people living with HIV receive modern ART treatment schemes. In addition, ART is available not only in public AIDS centers, but also in primary health care center, which is more convenient for many clients.

Modern diagnostic equipment has been installed in AIDS centers, which use modern testing systems; equipment and technical devices have also been purchased for the laboratories and warehouses of the AIDS centers, to improve the medical infrastructure as a whole.

NGOs also offer HIV express testing, available for absolutely all members of key communities with no discrimination whatsoever. Thanks to NGOs, more key population groups are covered by prevention programs, and many of those who had before refused to take ART, or interrupted the treatment, are now back on it. NGOs also offer psychological support, and clients can receive the assistance not only of a number of specialists, but also of peer consultants, which is of great importance to communities. What is more, under the “street lawyer” project, NGO employees, who are mostly members of these communities, provide legal assistance and rights consultations to clients, and document rights violations. This is crucial to end stigma and discrimination. To this end, people working in NGOs and health care facilities, as well as community members, regularly participate in trainings on stigma and discrimination.

I’d like to point out that all of this does not only result from a vertical process. NGO staff and community members actively participate in all advocacy and rights protection activities, as well as in decision-making processes at the national level. In fact, the communities have become more informed and more welcoming to HIV control programs. NGOs and AIDS center are now working in close cooperation to reach the 95-95-95 targets. 

Reaching new achievements

Despite all of our efforts, there are still issues which we try to address on the ground. But there are problems that we cannot handle on our own, and it is essential for all interested parties to work together, with the help of international donors. These problems include:

• Legal barriers to access to prevention programs, including rights violations and harassment of community members;
• An urgent need for prevention programs among migrants;
• A need to strengthen advocacy activities to overcome legal barriers and bring changes to the legislation.

Our path to success is quite difficult. Success requires a lot of hard work, patience and courage, in order to overcome all challenges and obstacles. However, our hard work results in what we strive for, and our current perseverance inspires many.

I would like to take this opportunity to thank UNDP and the Global Fund for their immense contribution in strengthening NGOs and the health care system in our country. It is only together that we can win this fight.