Zimbabwe is a country that is currently being sanctioned by the United States and therefore may be experiencing trouble receiving support from PEPFAR toward HIV/AIDS services. With 80% unemployment the country has many infected people who do not have access to medications, mainly because they cannot afford to go to private hospitals. Those with means (many work in the diamond mines) do have access to medications and the private hospitals. Those who don't must cross the border into South Africa illegally or go without medications and eventually die.
As we all know, we need to take these medications religiously for them to be their most effective. The painful truth for those who courageously cross borders to obtain their life saving treatment is that,even if they safely make it to the medical facility, they may not be able to receive a full months supply. The more trips they have to make, the greater the risk of being caught.
Tuesday I had what many would call a strange coincidence. In a venue with over 20,000 people covering 2 city blocks and 4 floors of exhibits, meeting rooms, food courts, and the Global Village, I ran into the same woman 3 times within a 2 hour period at 3 entirely different places. I took this to mean she was someone I truly needed to speak to. So I introduced myself to Johanna Soavedra, the LA representative to Coalision Translatin, a National Advocacy group for Transgender rights.
Unfortunately Johanna and I did not have much time to speak to one another but when I asked her how difficult it was for trans people to access their meds she said it was a major obstacle. They fear discrimination, stigma, and violence, not because of their HIV status, but because of their sexuality. And would you believe that later on that day, while outside making a cell call to my wife describing this unique occurrence, who walks outside into the same area but Johanna. Now I have never been close to anyone in the transgender community but after seeing her for the fourth time in one day, I plan to make a few more calls to Johanna, for I know there is an important message to be exchanged between the two of us.
While spending some time in the Positive Lounge I met Maria from Russia. What surprised me most about access to treatment in Russia was how similar Maria made their funding streams sound for AIDS services. If you lived in a part of their country where the HIV population was excessive all of your meds and services were free of charge. You could actually pick up a 4 months supply of your ARVs. In areas with less of an AIDS population, unfortunately, you could go four months without your lifesaving treatment. The extent of additional local government funding is the key to whether or not supportive services will be provided from region to region.
I must say, however, that the most enlightening conversation I had all week was with Olena Chuprina, the Project Manager and Psychologist councilor for Nikolayev Regional Public Youth Movement "Penitentiary Initiative" for HIV/AIDS in Ukrane prisons. Most of what I learned about her agency I received with the help of an interpreter. However Olena's english was not too bad.
There are 6 prisons in the Nikolayev Region. through prison prevention programs Olena eventually finds out which prisoners test positive for HIV. In the Ukrane prison system sexually transmitted HIV is #1 compared to years ago when it was IV drug use.
Her organization has an HIV specialist who performs a prick test to determine who is positive. The specialist will then prescribe ARV's which, through a partnership between the Global Fund & the Ukrane government, are supplied to the prisons. The prison doctor then distributes the ARV's to those prisoners who decide to come forward to get them. Obviously stigma is an obstacle to treatment in the prisons as well.
According to Olena the Ukrane is #1 in the prevalence of AIDS throughout Europe. Therefore the central government scaled up their funding, establishing HIV/AIDS Centers for all citizens, making many services easily accessible.
Olena's biggest challenge is to get those who are positive in to care and to stay in care. One incentive her agency provides to those who stay in treatment is a months supply of nutritional supplements. These are very much appreciated by prisoners, as there is not much substance to daily prison meals.
Olena's organization provides ARV treatment education to prisoners, as well as, when and how to take them. They even provide transitional services to make sure those prisoners who are released gain access to care and stay in care on the outside.
Of the 1000 prisoners in this penitentiary there are 200 infected inmates of which 100 still remain in care. And it is because of such a successful retention rate that Olena's organization was a recipient of the International AIDS Conference Red Ribbon Award in 2010. I thank her and her interpreter for taking the time to share her agencies success story with me.
This conference more than met my expectations and provided me with far more knowledge then just the usual scientific breakthroughs, treatment successes, etc. I now had ample ammunition regarding just what is and isn't working when it comes to accessing treatment from the stories I had hear from around the world. As I headed into a round of legislative visits I had scheduled for Thursday afternoon, I felt these stories could be used to sway a members vote, especially one who was anxious to repeal the Affordable Care Act.
I also want to say that after attending a session in the youth pavilion on "disclosure and dating" I was very impressed and assured that our younger generations living with HIV are doing their part to educate their peers and help us reach our ultimate goal of an AIDS free generation. It may not happen in my life time, but the future appears brighter for generations to come.