Download Murmansk Steering Commitee meeting

Minutes from the Barents HIV/AIDS Steering Committee meeting, Lulea, Sweden
23 March, 2006
Meeting Agenda
1. Opening of the meeting
2. Adoption of the agenda
3. Adoption of Murmansk meeting minutes
4. Discussion on Steering Committee Annual Report /adoption of Report
5. Progress reports
a) Murmansk LTSC project
b) Barents Program activities
c) SEEC activities in the Region
d) Norwegian Government activities
e) Finish Government activities
6. Information from the Russian regions/possible future projects
a) Archangelsk
b) St.Petersburg
c) Karelia
7. Other activities in the Region
a) Information by Christina Ralsgård; Karolinska University Hospital
8. Preliminary planning for next meeting
9. Any other business
10. Closing of the meeting
1. Opening remarks.
The meeting participants were welcomed by Berit Sunnerö, representative of Norbotten County.
She briefly presented the goal and objectives of work carried out by the department of Social wellbeing of the county. Among the main areas of activities were mentioned: prevention of alcohol
abuse and violence against women, support to women crisis centre, licensing of health care services
and their control; support to the children in problematic families
Kerstin Odman welcomed the participants on behalf of the Ministry of Health and Social Wellbeing of Sweden. She underlined the importance of the Barents HIV/AIDS program, and its role in
further development of EUND initiatives. Mrs.Odman thanked the Swedish East-European
Committee (SEEC) for organizing and hosting the meeting in Lulea. She also thanked Norbotten
County for contributions towards the meeting.
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Arkadi Rubin, the Co-Chair of the Steering Committee, emphasized the strategic importance of
Barents Regional cooperation, and especially the HIV/AIDS Program, for the Russian Federation.
By the end of 2005, more then 300 000 cases of HIV were registered in Russia. Some increases in
new cases were seen also in NW Part of Russia
Harald Siem thanked officials from Norbotten County, Ministry of Health of Sweden, SEEC and all
Swedish hosts for the warm welcome. He underlined that the Barents HIV/AIDS Program is seen
as not only a complex response towards HIV/AIDS, but also as establishment of good network and
neighbouring relations, which supports the open and easy collaboration with Russia that has been
witnessed over the last 10-15 years. That kind of collaboration is to everybody’s benefit.
Zaza Tsereteli introduced and welcomed a new member of SC from Sweden. Dr. Teemuur Noori,
who is working at the National Institute of Public Health – Sweden, as Public Health Planning
Officer for the National HIV/STI-project.
2. Adoption of the agenda.
The agenda of meeting was adopted.
3. Adoption of the Murmansk meeting minutes
All comments and suggestions to the draft were taken into consideration. The final version of
minutes was adopted. Minutes from Murmansk meeting will be published on Barents Secretariat
and ND web pages.
4. Discussion on Steering Committee Annual Report /adoption of Report
At the end of 2005, the Annual Report of SC for Barents Euro-Arctic Council (BEAC) working
group on Health and Social aspects (WGHS) was prepared and distributed among the group
members for their comments and suggestions. The last draft was presented at the meeting for final
comments and approval. Mikka Salminen and Kerstin Odman suggested adding some projects to
the list of projects implemented under the Barents HIV/ADIS program umbrella.
Siem clarified an issue with regard to the letter which was prepared by the Chairman and was
addressed to the ND Secretariat, asking them to help promote the wide HIV program among
interested parties. Later on, the Finish Ministry of Health recommended postponing the letter. That
was explained due to changes at the Secretariat management and new Chair at the EUND
Partnership. It was decided by the Chairman of SC to follow this recommendation.
He also proposed to add activities under the Clinton Foundation initiative into the Barents project
list.
Marija Antilla from STAKES, asked to clarify the situation with Danish Church Aid, the DCA
project proposal which was discussed at the Murmansk meeting. Tsereteli informed that DCA is
revising their proposal based on comments which they have received from the Expert Group on
HIV/AIDS for EUND. DCA has decided to focus on St. Petersburg and Leningrad Oblast.
Additional areas of intervention will be subject to the findings and recommendations of the midterm review. Criteria for selection of additional areas will include needs, impact, and coverage by
other projects, partner accessibility, and limited to a number between two to three additional areas
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of intervention. This SC will be in contact with DCA and we will consider inviting them to the next
SC meeting.
5. Progress reports
Murmansk LTSC project
Arkadi Rubin presented a report on the implementation of the low threshold support centre (LTSC)
project in Murmansk. The center was officially opened on November 23, 2005. The project was
launched by Minister of Health and Social Well–Being of Finland Liisa Hyssälä and Vice-Governor
of Murmansk Oblast Ludmila Chistova. Since November 2005, the LTSC services are carried out
on a daily basis. The Centre provides the following core services: HIV testing, viral hepatitis B and
C testing, counselling, referral to specialists, as well as monitoring of the epidemiological situation.
Currently the centre is operating 3 times per week: Monday (10am-18pm), and WednesdayThursday (12pm-19pm). A special advertisement has been put on public transports in Murmansk
city. New information material has also been prepared.
Rubin also presented current data on HIV/AIDS for the Murmansk Region. During the 2005,
Murmansk AIDS Centre had registered 241 new cases, which is 1.5 times more then in 2004. In
total 228 879 persons were tested on HIV, which is 26.5% of whole population. Most cases are still
registered among the IDUs (64%). But the heterosexual way of transmission is becoming the
leading cause of infection among women (56.4% of all cases). During the 2005, 34 HIV+ women
gave birth and no cases of MTCT were detected. In total from 120 deliveries only four children
have been infected from mothers.
All information concerning the Murmansk project and projects implemented by STAKES can be
found on STAKES web page. A EUND Partnership project data base is still not functioning, and
that is one of the main concerns for the HIV/AIDS EG group and for the new chair of the
Partnership. However, starting from 2006, it becomes possible to put general information on
ongoing activities in the field of HIV/ADIS on the Partnership webpage.
Hans Blystad suggested submitting information on projects to the Barents Secretariat in Kirkenes.
It was decided to discuss further that proposal.
b) Barents Program activities
Tsereteli had briefed committee members on current situation with HIV/AIDS Epidemic in Russia.
According to official data as of December 31, 2005, there are 333,332 registered cases of HIV
infection in Russia, although some Russian and international experts estimate that between 800,000
and 1.5 million Russians may be living with HIV, representing between 1-2% of the country’s adult
population. By the end of 2005, there had been 8,157 reported deaths of HIV-positive people in
Russia since the start of epidemiological monitoring. HIV/AIDS infection is now registered in all
regions of the Russian Federation. Regions with disproportionately higher rates of infection include:
Moscow; St. Petersburg; Svedlovsk, Irkutsk and Samara regions. Russia harbors one of the world’s
youngest HIV epidemics. Nearly 80% of all Russians living with HIV/AIDS are under age 30.
Injection drug users remain the primary community at-risk, although the HIV epidemic is
increasingly shifting beyond high-risk groups into the general population. Whereas sexual
transmission accounted for just 6% of all registered cases of HIV transmission in 2001, by 2004
nearly 27% of all new cases of HIV infection were attributed to unsafe sexual contact. Although
most cases of HIV infection are registered among men, women are increasingly vulnerable to
infection. In some regions, 34-50% of new cases are attributed to women. Among young people
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aged 15- 20, the proportion of new cases registered among women surpassed men for the first time
in 2003.
As for the Barents Program activities, at the end of 2005 there were 14 project proposals submitted
to the program. Out of them, ten are being implemented in different parts of the Barents region.
The SC committee and the Program Coordinator will continue its work to generate more projects
under the program. In this respect, further discussions with donor organizations, including SIDA,
will be organized.
c) SEEC activities in the Region
Kjell Astrom presented short overview of Swedish East European Committee (SEEC) activities.
The SEEC started its work in 1992. It is a joint venture between the Swedish National Board of
Health and Welfare, the Swedish Medical Society, the Swedish Medical Association and the
Association of Nurses. Funds come from the Swedish International Development Authority (SIDA).
Today the Committee is favoring a stronger professional direction pective projects adjusted to the
needs in the counterpart country. Priority is given to prenatal care, child welfare, child and
adolescent psychiatry, physical handicaps, dental service, infectious diseases (especially
tuberculosis, HIV and AIDS) and district health care. For all these different priorities, there exist
groups of experts to prepare applications for projects.
The main objectives for the East European Committee are:


To transmit knowledge and influence attitudes through conferences, seminars,
workshops, etc. and site visits in order to promote good health and welfare in East
European countries
to build up model activities and achieve structural changes
Currently SEEC is supporting 11 projects in the Barents region. They are covering PHC, mental
care and HIV/AIDS. The Project in the field of HIV/AIDS is implemented by “Noaks Ark
Barents”, and was presented later by Asa Norderberg. Astrom proposed to include the project into
the Barents HIV/AIDS project list.
During the discussion, some concerns were raised towards increased control from Moscow and
central Ministries. The Russian participants clarified that the announced changes will have no
influence on the work related to health and social issues, and that all NGOs will continue their
work, if they are transparent and implemented under the Russian laws
d) Asa Norderberg presented Noaks Ark Barents. Noaks Ark Barents is a part of The National
Network of Noaks Ark in Sweden. It is a NGO, established in 2001 (the other Noaks Ark
organisations were established during the 80´s), and mainly works with HIV/STI and drug
prevention and psychosocial support to HIV positive and their closest.
The purposes of the planned project is to build-up and develop well functioning HIV/STI- and drug
preventive activities and psychosocial support work for HIV positive and their closest in
Murmansk, Karelia and Arkhangelsk, were the volunteers are playing an important role.
The co-operation project started 2002 with a camp arranged in Luleå. The participants were young
HIV positive people from Murmansk, together with staff from the AIDS centre and narcological
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dispensary. After the camp some of the HIV positive participants established a self-help group. A
camp for young HIV positive people from Karelia will be arranged later in 2006.
For the first time a video about HIV will be produced and broadcasted at TV in Arkhangelsk.
During 2003-2005 a number of seminars have been arranged in Murmansk, and since 2004 in
Petrozavodsk as well.
A quite large number of printed matter have been produced and distributed during the years. The
printed materials include the journal “Territory of life”, which is produced in Murmansk and is
addressed to young people and those working with young people.
The projects with Russia, financed by SIDA, will be phased out during 2008, and as a result it is
difficult to have a long-term strategy at this moment.
In addition to this project, Kerstin Odman briefed the SC on another project which is financed by
SIDA, and can be considered as a Swedish contribution towards Barents HIVAIDS Program.
“Sexual and Reproductive Health of Adolescents in Northwestern Russia”, implemented in
Archangelsk, Murmansk and Karelia. The Project is run by the Swedish Family Planning
Association (RFSU), and will last until 2007. The objective of the project is development and
expansion of sexual and reproductive health services for young people by the provision of training
to both health care practitioners and local and regional administrators from health and educational
authorities.
It was decided that the issue of inclusion that project into the Barents HIV/AIDS project list will be
discussed with SIDA representatives.
e) Mikka Salminen presented activities implemented by National Public Health Institute (KTL) in
2005, financed by the Ministry of Foreign Affairs (MoFA) under the Neighboring Area Cooperation
grants. The first was Low Threshold Network (LTN) worker meeting (continuous education
training programme) and second - Infectious disease specialist & laboratory worker training
symposium: “Implementation of effective antiretroviral treatment”.
During the LTN seminar 36 participants from four countries (Russian Federation, Latvia, Lithuania,
Estonia), had a three days seminar including site visits to the different LTC. Those seminars are
ongoing already for five years, and now there are discussions to hold them in other countries than
Finland. Latvia is proposed as a possible hosts, it has a well established LTC network.
Training for infectious disease specialist has been conducted in Zelenogorsk (Russia), on 89.12.2005. This training is part of collaboration with Health Committee of St.Petersburg
Government and the Health Committee of the Leningrad region. Sixtithree participants from St.
Petersburg & Leningrad Oblast did participate in two days training. The goal is to improve
collaboration and information exchange between the clinic and the laboratories, and training on
ARV treatment. Follow-up is planned for 2006.
Among the plans for 2006, where Salminen singled out a Latvian run project on follow-up of
LTSC networking, collaboration on HIV & HCV surveillance and behavioral surveillance in
Estonia together with Tartu University, and finally collaboration on ARV drug resistance in
Estonia, in collaboration with Merimetsa Hospital in Tallinn and Tartu University
f) Antilla briefed on activities which are carried out by STAKES and are in the plans for 2006-2007.
In addition to support to the Barents HIV/AIDS Program, the Murmansk LTSC project and
assistance to the EUND EG on HIV/AIDS, the following projects are implemented by STAEKS:
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“Occupational Health and HIV/AIDS Perceptions Study” which is funded by the International
Finance Corporation (IFC), affiliated to the World Bank. The aims of the study are to analyze
perceptions of HIV/AIDS and occupational health issues in the private sector in the Russian
Federation. The study is carrying out in Moscow district, St. Petersburg and Petrozavodsk.
A second project is “Support to School Health Education in St. Petersburg” during 2004-2006,
funded by the Ministry for Foreign Affairs. The aim is to promote healthy lifestyle among the
youth. One component of that project is the planning of health education programmes for schools
on topics such as drugs, alcohol abuse, prevention of HIV/AIDS and other STIs, prevention of
violence and sexual abuse. Teachers were trained in 2005, implementation of HE programmes is
planned during 2006.
A third project is “Prevention and Control of Communicable Diseases in North West Russia 20032005”, funded by EU Tacis programme. The goal of the project was to prevent the spread of major
epidemics in the NW Russia. Objective to design of inter-sectoral preventive strategies for
controlling the epidemics of HIV/AIDS, TB, STIs and viral hepatitis based on concerted
collaboration of penitentiary and public health sectors, local authorities and civil society in St.
Petersburg and the Pskov region.
Among the new HIV/AIDS project proposals for neighboring area cooperation for 2007-2009,
which are under discussion at STAKES, Antilla singled out prevention of HIV-infections in
Leningrad oblast - aiming at first to strengthen the Oblast AIDS Centre (capacity building in
management, financial administration, monitoring and evaluation, and networking). Another
possible project is control of HIV/AIDS epidemic in the Republic of Karelia, with the goal to
stabilize the HIV-infection in that region. Tentative areas of actions are: prevention of infection in
risk groups; increasing knowledge on HIV/AIDS and the use of new health promotion methods
among the health workers and staff working with children and youth; support to media campaigns;
and social care and rehabilitation. More detailed plans will be discussed with the Karelia authorities
during 2006.
Finally she announced Finnish EU Presidency Conference on Drugs “Moving forward together”,
which will take place in Turku, Finland on 7-9 September, 2006. Participants of that Conference are
EU Member States, accession and applicant countries, Norway, representatives from the Russian
Federation, Belarus, Ukraine and Moldova. The Conference will promote a constructive dialogue,
provide information and share experience between drug policy authorities in order to improve the
effectiveness of drug prevention, drug treatment and prevention of drug related infections.
Conference themes are: Outreach work; treatment referral; low-threshold services and practices;
HIV and other drug related infectious diseases; support structures of administration and services .
g) Blystad from the Norwegian Public Health Institute briefed on activities which are carried out by
the Institute in 2005-2006. The Public Health Institute will continue the series of training for Head
Epidemiologists, including representatives from Murmansk and Karelia. The publishing of EPI
North Journal will be continued. The first issue of 2006 is all devoted to HIV/AIDS prevention
activities, including an article on the Barents HIV/AIDS program. A conference in Archangelsk on
HIV/TB in collaboration with Archangelsk Medical University planned for autumn 2006 will due to
illness have to be postponed until 2007. Support to the project implemented by Norwegian Church
AID, in connection to palliative care will continue.
h) Vera Utiugova presented information on the situation in Archangelsk region and plans for
projects to be implemented under the Barents HIV/AIDS Program. The first cases of HIV were
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registered in Arkhangelsk in the beginning of 1992 and until 1997 there were only 15 cases. Since
1998 a slow growth in newly diagnosed HIV cases has been observed, which had stabilized for the
last two years. The total number of registered cases in Arkhangelsk Oblast by the end of 2005 is
278. The most of the cases are young persons from 21-30 years old. However increase in sexual
transmission now is observed, the virus is starting to spread among the general population. Since
2004, with the financial support of Norway, the AIDS prevention centre and the Archangelsk
Health Care department are implementing “Your Bus”, which serves the high risk groups on a daily
basis on certain, planned locations. The main services offered to IDUs is needle and syringe
exchange, distribution of condoms and printing materials with educational information on
prevention of HIV and STD, referral of clients to the AIDS center for testing on HIV and HVB and
HVC, counseling of IDUs. The bus serves also commercial sex workers and young people. During
the 2005 more then 1050 persons had contacted the bus for a different kind of assistance, 927 out of
them were tested for HIV infection. As a continuation the project, a proposal on a “Resource
centre” is submitted to the Barents program. The idea is to increase educational efforts towards the
young population and create a centre to carry out such activities.
Tamara Sologub, presented information on the situation and future plans within Leningrad Oblast.
The NW region of Russia is home to approximately 10% of the Russian population, yet 15% of the
HIV burden is in this area. The main age groups of people infected with HIV are young,
predominantly male persons in the age groups 20-29 years. The principal mode of transmission is
intravenous drug use (97,4% of cases in 2001 and 82% in 2004). At the end of year 2004, totally
from the beginning of registration of HIV in the NW region, in 10 regions, there were 43 656 cases
of HIV. Most of the cases were registered in St.Petersburg (28 000), Leningrad oblast (6 817) and
then Kaliningrad oblast (4 663). The rates are in St.Petersburg 585,1 per 100 000, Leningrad Oblast
405,2 case per 100 000. Among the most affected areas in Leningrad oblast are Preozersky (370
cases) and Tostnensky rayon (746 cases). 27 % of all cases are registered among the IDUs,
however in 58% the mode of transmission is registered as unknown.
Despite the fact that Leningrad Oblast is one of the most affected regions in NW Russia, it still
remains the only Oblast in Russia, where an AIDS centre is not established. Officially, it was
decided in 2001 to create a centre at the Republican Hospital for Infectious Diseases in Ust-Izhora.
However, the main function of the hospital was treatment of children born to HIV-positive mothers,
which were abandoned and left by their mothers. In the light of increasing number of HIV cases in
Leningrad Oblast, the Oblast authorities have decided to establish an Oblast AIDS Centre, as an
independent institution. The Oblast has allocated one million Rubles for renovation works. In
addition to that, budget for necessary equipment (including laboratory) and salaries for staff is also
earmarked. According the new decision the staff of Oblast center will increase from 6 to 44
persons. The recruitment will start by end of this year, when the building is expected to be ready.
7. Other activities in the region.
Mrs. Kristina Ralsgård from Karolinska Universty Hospital presented activities carried out in
Sweden for children born with HIV infections. Those activities started in 2002, when the first
young patient was registered at Huddinge Hospital. Doctors, nurses and medical social workers in
infectious clinics throughout the country have received information about psychosocial support to
those patients. The training has developed from an initial two days meeting into a four day meeting
last autumn. The programme includes group work to provide feeling of security and encourage the
participants to take part in the debates and lectures. Difficult life issues concerning illness, virus and
infection, medication, grief, guilt, shame and sexuality are tackled through lectures, group
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discussions and peer education. Since the beginning, 37 young adults have taken part in the
program.
8. Place and time for next meeting
It was decided that the next meeting of SC will be held in Archanagelsk, Russia. Date of the
meeting was not decided, but preliminary agreement was to hold a meeting in the middle of
October.
9. Any other business
By invitation of Spanish Ministry of Health, the group of Russian Health officials are visiting Spain
at the end of April. Co-chair of SC, the head of the Murmansk LTSC together with the Head of
Archangelsk AIDS Centre are the members of that group.
10. Closing of the meeting
The Chair thanked the Swedish hosts for an excellent organization of the meeting. The meeting was
closed.
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