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MICHEL KAZATCHKINE: PROSPECT OF COMBATING AIDS IN ARMENIA IS WORRISOME
Interviews | March 31, 2015 13:35
exclusive
Michel Kazatchkine
On March 25-27, Michel Kazatchkine, United Nations Secretary-General's
Special Envoy for AIDS in Eastern Europe and Central Asia, visited
Armenia. On the last day of his visit, Mediamax's correspondent talked
to the UN Secretary General's Special Representative.
- Mr. Kazatchkine, it's your first visit to Armenia. What agenda of
issues have you brought to Yerevan?
- During my visit, I met with Deputy Prime Minister Vache Gabrielyan,
Ministers of Justice and Health, other officials of the healthcare
field and civil society representatives.
The goal of my visit is to find out with our partners what AIDS/HIV
prevention issues Armenia faces. Nowadays, the infection can be cured
and prevented. Issues related to preventing and combating of AIDS/HIV
are of more social and political nature than health. For instance, the
majority of people treated in the AIDS Prevention Center in Armenia
are delivered excellent quality care, and in this sense, the Center
provides a service equal to the quality of Western countries. However,
the fact that around 60% of people infected with AIDS/HIV are not
aware of it in Armenia is disputable.
Michel Kazatchkine
Photo: Mediamax
A question arises: where is this 60%? Why haven't they been examined?
Why don't they know about their status? They are not aware as the
society has numerous stereotypes and discriminative approach to
people with AIDS/HIV, as the information is not yet available to
larger masses. The goal of my visit is to voice the issues with all
the interested parties and address them. I do understand that Armenia
has many other issues - the state budget is not large, the economic
situation is tough, there is a conflict on the border etc., and it's
dangerous as the situation contributes to dissemination of AIDS/HIV.
- Russia and Ukraine are leaders by AIDS/HIV dissemination rate
in Eastern Europe and Central Asia. What can you say about South
Caucasus countries?
- Indeed, the situation in Eastern Europe and Central Asia states is
worrisome. It's the only region in the world where the epidemic keeps
growing. Overall, over the past 5 years, the number of new cases of
the epidemic fell by 25%, the deaths caused by the epidemic reduced
by 1/3, the treatment is becoming more accessible while Central
Asia and Eastern Europe register 45% growth, the death cases have
also increased.
You're right, Russia and Ukraine are the leading countries of the
region. There are currently more than 1.3mln people with the AIDS
in Russia, that means that over 1% of Russian people live with the
infection. It's extremely concerning.
The epidemic is also spread across all the South Caucasus countries,
of course, not on such a large scale as in the 2 above-mentioned
countries. The epidemic volumes in Armenia are comparatively small
but Armenia's population is small, too. Overall, around 4 thousand
infected people are registered in Armenia today. 40% of them are
examined and are being treated. The remaining 60% of the infected
haven't been examined and don't know about their status. Most likely,
they are labor migrants who in the majority of cases leave for Russia,
get infected there and then come back and infect their spouses. The 60%
also includes people using drugs which number, however, has decreased.
The number of drug addicts in Armenia now makes around 12 thousand.
Homosexuals are also among people infected with AIDS/HIV but unaware
of their status. These people are mostly discriminated, which is
why we don't have information about them and they don't apply to be
examined. Prostitutes are also among "latent" infected.
Michel Kazatchkine
Photo: Mediamax
Analyzing Armenia's work and especially the steps taken over the past
10 years, I can say that the progress is impressive. But, of course,
there still are issues. First of all, the issue of "latent" infected
people. The second is the issue of migration. The studies show that
50% of the examined people with the infection are labor migrants who
mostly leave for Russia. How can their infection be prevented or how
can they be treated?
Migrants, especially those who leave for the countries registering
such a high level of epidemic - Ukraine and Russia - are in the risk
group. A question arises: how can these people be found? I proposed
particularly the following: to create an opportunity of taking an
AIDS/HIV test in policlinics. Confidence should be built so as people
wouldn't be shy to see a doctor, and doctors should be retrained.
The reaction to treatment of drug addicts is also one of the reasons.
They prefer to hide from the system as getting registered at an
addiction clinic, their data can be handed over to the police.
Talking about AIDS, we forget 2 other important diseases - tuberculosis
and hepatitis C. The digits suggest that among 99% of drug addicts
reported positive result of hepatitis. There are thousands of people
in Armenia who are infected with hepatitis C but they are not aware
of it. Unfortunately, treatment of hepatitis C is fee-for-service
and in case it's not treated, more than 1/3 of the infected die of
cirrhosis of the liver or cancer.
- We can conclude from what you say that the main source of the
epidemic in Armenia comes from Russia through labor migrants.
- We should be very careful while making such statements. The level
of the epidemic is really high in Russia and the practice shows that
often labor migrants who leave for Russia long-term get involved in
extramarital relationships and don't often think about protection.
These are real facts but I don't want my words to be perceived
on the political level. When we talk about diseases, there are no
innocent and guilty. It's the society's fault which doesn't manage to
prevent the disease. I regret to note that Russia registers setback
in terms of combating the infection reporting 70-100 thousand new
cases annually. Russia is a huge state and should be able to find
measures to prevent the epidemic. During my recent speech in Moscow,
I alarmed about it.
Michel Kazatchkine
Photo: Mediamax
-What solutions do you offer to prevent new cases especially among
the labor migrants? Maybe they need to be examined on a mandatory
basis immediately after returning from Russia to Armenia?
- The option of mandatory examinations has never worked effectively.
There should be confidence-building measures. My advice is to build
a reliable health system. It also includes the need for having a
retrained staff. Besides, the issue should also be addressed on
Armenia-Russia bilateral level so as the migrants could be able to
be examined and treated without losing their jobs.
- Recently, much is spoken about reduction of international funding
allocated to Armenia to prevent and treat AIDS/HIV in Armenia. What
can you say about it?
- Yes, there is a crisis of funding. The 60% of funding for prevention
and treatment was allocated by the Global Foundation, 20% - Armenian
government, and remaining 20% - other organizations. Since January 1,
2015, the Global Foundation has cut off funding by 50%. The reason
is that on the global scale, Armenia is not considered a poor state
any more; it's considered a country with an average income. The
international community thinks that as a state ensuring an average
income, ought to take care of its citizens' healthcare issues on its
own. The thing is that the Armenian state budget can't do it.
Besides, Armenia allocates 1.8% of GDP to the health system which is
too small. In other states, the healthcare is allocated on average 6-8%
of the GDP. In developed states such as France, the funding index is
15%. But health is a priority issue for people.
Michel Kazatchkine
Photo: Mediamax
The following tendency is observed in Armenia and overall South
Caucasus countries: the rich are getting richer and the poor are
getting poorer. People can't afford paid treatment. During my meetings
in Armenia, we discussed this worrisome issue. People assured me that
the state budget couldn't ensure the treatment without the assistance
from the Global Foundation but one should understand that allocating
1.8% of the GDP to the health field one can't move forward. The
state should make investments in the social sector. The country
can't register economic growth and development if the healthcare
situation in the country is not satisfactory. I am really concerned
about the issues. Can Armenia make the investments? There are many
open questions here. People didn't give me much hope about this issue
in Armenia. I am alarming about the issue.
- AIDS/HIV treatment in Armenia is free which is mostly covered
owing to the international assistance. Can we state that in case
Global Foundation's assistance stops, we won't be able to have free
treatment in our country?
- The system will be operating as formerly but if the Global
Foundation's assistance is fully stopped, the government will have to
undertake funding of drugs and treatment. If the government doesn't
do that Armenia will lose the impressive progress registered over the
years of combating the epidemic. It's like a man climbing a mountain
slowly and with difficulty and then falling down immediately. The
situation is really worrisome and I have alarmed about it many times.
Steps should be taken.
Yekaterina Poghosyan talked to Michel
Kazatchkine Photos by Mariam Loretsyan
http://www.mediamax.am/en/news/interviews/13689#sthash.tMNM4boP.dpuf
From: A. Papazian
Interviews | March 31, 2015 13:35
exclusive
Michel Kazatchkine
On March 25-27, Michel Kazatchkine, United Nations Secretary-General's
Special Envoy for AIDS in Eastern Europe and Central Asia, visited
Armenia. On the last day of his visit, Mediamax's correspondent talked
to the UN Secretary General's Special Representative.
- Mr. Kazatchkine, it's your first visit to Armenia. What agenda of
issues have you brought to Yerevan?
- During my visit, I met with Deputy Prime Minister Vache Gabrielyan,
Ministers of Justice and Health, other officials of the healthcare
field and civil society representatives.
The goal of my visit is to find out with our partners what AIDS/HIV
prevention issues Armenia faces. Nowadays, the infection can be cured
and prevented. Issues related to preventing and combating of AIDS/HIV
are of more social and political nature than health. For instance, the
majority of people treated in the AIDS Prevention Center in Armenia
are delivered excellent quality care, and in this sense, the Center
provides a service equal to the quality of Western countries. However,
the fact that around 60% of people infected with AIDS/HIV are not
aware of it in Armenia is disputable.
Michel Kazatchkine
Photo: Mediamax
A question arises: where is this 60%? Why haven't they been examined?
Why don't they know about their status? They are not aware as the
society has numerous stereotypes and discriminative approach to
people with AIDS/HIV, as the information is not yet available to
larger masses. The goal of my visit is to voice the issues with all
the interested parties and address them. I do understand that Armenia
has many other issues - the state budget is not large, the economic
situation is tough, there is a conflict on the border etc., and it's
dangerous as the situation contributes to dissemination of AIDS/HIV.
- Russia and Ukraine are leaders by AIDS/HIV dissemination rate
in Eastern Europe and Central Asia. What can you say about South
Caucasus countries?
- Indeed, the situation in Eastern Europe and Central Asia states is
worrisome. It's the only region in the world where the epidemic keeps
growing. Overall, over the past 5 years, the number of new cases of
the epidemic fell by 25%, the deaths caused by the epidemic reduced
by 1/3, the treatment is becoming more accessible while Central
Asia and Eastern Europe register 45% growth, the death cases have
also increased.
You're right, Russia and Ukraine are the leading countries of the
region. There are currently more than 1.3mln people with the AIDS
in Russia, that means that over 1% of Russian people live with the
infection. It's extremely concerning.
The epidemic is also spread across all the South Caucasus countries,
of course, not on such a large scale as in the 2 above-mentioned
countries. The epidemic volumes in Armenia are comparatively small
but Armenia's population is small, too. Overall, around 4 thousand
infected people are registered in Armenia today. 40% of them are
examined and are being treated. The remaining 60% of the infected
haven't been examined and don't know about their status. Most likely,
they are labor migrants who in the majority of cases leave for Russia,
get infected there and then come back and infect their spouses. The 60%
also includes people using drugs which number, however, has decreased.
The number of drug addicts in Armenia now makes around 12 thousand.
Homosexuals are also among people infected with AIDS/HIV but unaware
of their status. These people are mostly discriminated, which is
why we don't have information about them and they don't apply to be
examined. Prostitutes are also among "latent" infected.
Michel Kazatchkine
Photo: Mediamax
Analyzing Armenia's work and especially the steps taken over the past
10 years, I can say that the progress is impressive. But, of course,
there still are issues. First of all, the issue of "latent" infected
people. The second is the issue of migration. The studies show that
50% of the examined people with the infection are labor migrants who
mostly leave for Russia. How can their infection be prevented or how
can they be treated?
Migrants, especially those who leave for the countries registering
such a high level of epidemic - Ukraine and Russia - are in the risk
group. A question arises: how can these people be found? I proposed
particularly the following: to create an opportunity of taking an
AIDS/HIV test in policlinics. Confidence should be built so as people
wouldn't be shy to see a doctor, and doctors should be retrained.
The reaction to treatment of drug addicts is also one of the reasons.
They prefer to hide from the system as getting registered at an
addiction clinic, their data can be handed over to the police.
Talking about AIDS, we forget 2 other important diseases - tuberculosis
and hepatitis C. The digits suggest that among 99% of drug addicts
reported positive result of hepatitis. There are thousands of people
in Armenia who are infected with hepatitis C but they are not aware
of it. Unfortunately, treatment of hepatitis C is fee-for-service
and in case it's not treated, more than 1/3 of the infected die of
cirrhosis of the liver or cancer.
- We can conclude from what you say that the main source of the
epidemic in Armenia comes from Russia through labor migrants.
- We should be very careful while making such statements. The level
of the epidemic is really high in Russia and the practice shows that
often labor migrants who leave for Russia long-term get involved in
extramarital relationships and don't often think about protection.
These are real facts but I don't want my words to be perceived
on the political level. When we talk about diseases, there are no
innocent and guilty. It's the society's fault which doesn't manage to
prevent the disease. I regret to note that Russia registers setback
in terms of combating the infection reporting 70-100 thousand new
cases annually. Russia is a huge state and should be able to find
measures to prevent the epidemic. During my recent speech in Moscow,
I alarmed about it.
Michel Kazatchkine
Photo: Mediamax
-What solutions do you offer to prevent new cases especially among
the labor migrants? Maybe they need to be examined on a mandatory
basis immediately after returning from Russia to Armenia?
- The option of mandatory examinations has never worked effectively.
There should be confidence-building measures. My advice is to build
a reliable health system. It also includes the need for having a
retrained staff. Besides, the issue should also be addressed on
Armenia-Russia bilateral level so as the migrants could be able to
be examined and treated without losing their jobs.
- Recently, much is spoken about reduction of international funding
allocated to Armenia to prevent and treat AIDS/HIV in Armenia. What
can you say about it?
- Yes, there is a crisis of funding. The 60% of funding for prevention
and treatment was allocated by the Global Foundation, 20% - Armenian
government, and remaining 20% - other organizations. Since January 1,
2015, the Global Foundation has cut off funding by 50%. The reason
is that on the global scale, Armenia is not considered a poor state
any more; it's considered a country with an average income. The
international community thinks that as a state ensuring an average
income, ought to take care of its citizens' healthcare issues on its
own. The thing is that the Armenian state budget can't do it.
Besides, Armenia allocates 1.8% of GDP to the health system which is
too small. In other states, the healthcare is allocated on average 6-8%
of the GDP. In developed states such as France, the funding index is
15%. But health is a priority issue for people.
Michel Kazatchkine
Photo: Mediamax
The following tendency is observed in Armenia and overall South
Caucasus countries: the rich are getting richer and the poor are
getting poorer. People can't afford paid treatment. During my meetings
in Armenia, we discussed this worrisome issue. People assured me that
the state budget couldn't ensure the treatment without the assistance
from the Global Foundation but one should understand that allocating
1.8% of the GDP to the health field one can't move forward. The
state should make investments in the social sector. The country
can't register economic growth and development if the healthcare
situation in the country is not satisfactory. I am really concerned
about the issues. Can Armenia make the investments? There are many
open questions here. People didn't give me much hope about this issue
in Armenia. I am alarming about the issue.
- AIDS/HIV treatment in Armenia is free which is mostly covered
owing to the international assistance. Can we state that in case
Global Foundation's assistance stops, we won't be able to have free
treatment in our country?
- The system will be operating as formerly but if the Global
Foundation's assistance is fully stopped, the government will have to
undertake funding of drugs and treatment. If the government doesn't
do that Armenia will lose the impressive progress registered over the
years of combating the epidemic. It's like a man climbing a mountain
slowly and with difficulty and then falling down immediately. The
situation is really worrisome and I have alarmed about it many times.
Steps should be taken.
Yekaterina Poghosyan talked to Michel
Kazatchkine Photos by Mariam Loretsyan
http://www.mediamax.am/en/news/interviews/13689#sthash.tMNM4boP.dpuf
From: A. Papazian