Lucia Pîrțînă: Can you imagine a doctor with a bag full of HIV tests, condoms or syringes among a group of drug addicts or sex workers? They will never be accepted
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24 iulie, 2017, 11:09
Vizualizări: 2478
The healthcare system in Moldova cannot prevent and control HIV by itself. First, it does not have sufficient resources, and second – the workers won’t be accepted in the risk groups.
Author: Elena Cioina
The healthcare system in Moldova cannot prevent and control HIV by itself. First, it does not have sufficient resources, and second – the workers won’t be accepted in the risk groups. Also, the obligation of a doctor is to treat patients and not go on field visits and distribute disposable syringes, condoms or HIV tests to persons who use drugs or engage in paid sexual activities. This is the role of non-governmental organisations that employ people from these communities, who know best how to intervene and how to communicate with these people. What are the State’s capacities and instruments in controlling HIV and is it ready to overtake the coordination of all activities, including of services covered by the non-governmental organisations? This subject was discussed with Ms. Lucia Pîrțînă, Programme Coordinator at Centre PAS, and former Coordinator of the National HIV/AIDS Control Programme.
Ms. Pîrțînă, as a former Coordinator of the National HIV/AIDS Control Programme, can you tell us if the healthcare and social systems have the capacity to control HIV? What are their strengths and weaknesses?
In my opinion, the medical system has gained sufficient experience and skills to control HIV infection. At this moment the fifth national programme is on-going and during tis period different studies on the epidemics and its characteristics have been conducted; different institutions were established and organised to manage this Programme and many specialists and the civil society have been trained, etc. Hence, as you say, there are some strengths: we know about the epidemics, we know about the prevention measures, we have a testing strategy which is diversified for accessibility, we have access to a specific treatment, prevention of HIV transmission from mother to child, etc.
The weakness, in my opinion, is the prevention among key population because in the Republic of Moldova, the HIV epidemics is concentrated namely in these groups. Although targeted, these groups do not access and are not accessible to the medical service. No one can achieve any success in this field without the support of the civil society, field workers and peers.
What is more important in controlling the HIV: harm reduction programmes or medications, or these do not exclude each other?
That is correct – one does not exclude the other. Harm reduction programmes are part of HIV prevention programmes and have their role in preventing new cases of infection, and the treatment is important in enhancing the life quality and extending the life of the already infected persons.
Are the authorities prepared to take over the prevention services? What are the instruments they intend to use and where exactly they have to improve?
Separately, at this moment, the authorities are not ready. Because since the implementation of preventive activities, and I refer here to the key groups, these activities have been financed by the Global Fund and were coordinated and implemented largely by the Principal Recipients (Centre PAS and the UCIMP), sub-Recipients and non-governmental organisations. Obviously, these organisations are very experienced in this field; they developed implementation mechanisms and instruments. We would like to specify that the Ministry of Health declared its interest in taking over the funding of prevention programmes in 2013, with the involvement of civil society in prevention. Different measures were undertaken; the necessary regulatory framework was developed and amended, meetings, workshops, etc. were organised. However, we do not have sufficient human resources, understanding and political commitment to finish what we have started.
If the State becomes the principal implementer of the National HIV/AIDS Control and Prevention Programme, will it be able to provide quality social services? Or, as the MP Pistrinciuc said, are we going to witness a medicalization of the issue and see less prevention of the disease?
The State has always been the principal implementer of the National HIV/AIDS and STIs Control and Prevention Programme and other national programmes. But since HIV infection is a multidimensional problem, it is not possible without the involvement of all governmental and non-governmental stakeholders. You are probably referring to the State as the main Principal Recipient. I want to specify here that the issue is not about who receives the money from the Global Fund or the desire of the State to manage the grants provided by the international organisation. The issue refers to the fact that this decision was made hastily and abusively, by ignoring the opinions of the important stakeholders and violating legal procedures.
With no doubt the non-governmental organisations have a very important role in disease prevention. What is the situation in the Republic of Moldova?
Moldova has many non-governmental organisations that are active in HIV field: large organisations such as HIV Prevention and Harm Reduction Union, League of Persons living with HIV or Positive Initiative that manage smaller organisations, initiative groups with their own role. Some organisations develop strategies, plan and design services, review the normative framework, and provide the public institutions with technical expertise; others provide prevention services to one or more key groups; some provide psycho-social support services or both types of services. It is important to take into account the needs and to cover all key groups. It is important to provide access to services and hear what they have to say.
So, their role is that of those residents from African villages who had to observe who is coughing to be taken afterwards to a doctor to check whether they have TB or not. Practically, anywhere in the world, people who have nothing to do with medicine are involved in prevention. Are there are precedents when the medical system deals with what I am trying to explain, and if yes, how efficient are these services?
Working directly with the beneficiary outside the medical system is not genuine to this system due to many reasons: on one hand the medical workers will never take a bag of tests, condoms, syringes, etc. to the field visit, and on the other hand, even if they do, there is a risk that they might not have access to the key group communities. How do you imagine a doctor accepted by drug addicts and sex workers? How will these people trust a medical doctor to test them for HIV or provide counselling? In these cases, the services van be provided by different peers (former or current representatives of the respective key group). I cannot give you an example of countries where there activities are provided by the medical system and even if it tries, I do not believe in its efficiency based on the above-mentioned arguments.
How can a person from the risk group be convinced to take a HIV test?
Through counselling, consultation, persuasion, and arguments. It means you have to test this person at the place he/she spends most time and is comfortable with, where he/she feels safe and at the time when it suits him or her.
How difficult is it to convince an HIV positive patient to treat him/herself? Who helps the doctors in this situation?
It requires a lot of work too. Of course, there are patients with different background, different levels of information, acceptance of diagnosis, etc. and respectively, the implication level of specialists who have the duty to convince the patient to receive treatment differs from case to case. There are patients who require only medical consultation and see the doctor as the only support. Most often, the doctor cannot face these challenges alone because he/she has little time with the patient, does not have sufficient competences, labour conditions, etc. Hence, the doctor might be assisted by psychologists, peers, social assistants trained in the field. These people have specialised techniques in communication, justification and success stories. And they can meet the needs of the patients, can give them the necessary time and information. I am saying all of these not because I want the public to hear it. I am telling you this from my experience working in a clinic.
As a Coordinator of the National HIV/AIDS Control and Prevention Programme, you succeeded to promote and approve 2 National Programmes and develop an application to the Global Fund within the new financing model for 2015-2017. I would like you to be objective and tell us how much did the State succeed to implement from the previous programme, because the new one is on-going?
Taking the risk, I would say about 80%. We achieved all the activities. Perhaps the indicators did not achieve the expected results, but most important is that we have started to acquire the tests and medicine with the state budget funds and we did initiate the process for prevention service transfer.
What are the key points in the new HIV/AIDS control programme and what are the risks following the National Coordination Council scandal?
The new programme is a continuation of the old programme. The key activities are to prevent, support and care. As for the risks, I believe they pertain to the implementation. I am not in favour of big changes based on unfounded ambitions. I would rather study the situation, plan certain activities, gradually accept certain changes, and ensure that the services are not interrupted. It looks like all these have not been considered in the given situation. Hence, I sense a huge danger of interrupting certain services. This, while not in the near future, will lead inevitably to a worsening situation of HIV in the country in the long-term.
Only one non-governmental organisation, Positive Initiative, supported the decision of the NCC made on the 29th of June meeting for Moldova to have only one Principal Recipient of the Global Fund – the Government. Somehow unusual for an NGO, because the rest of the civil society voted against invoking the infringement of many procedures in deciding how to apply the grant provided by the external donor. Is this organisation capable to prevent and control the HIV in Moldova and can it represent the rest of non-governmental organisations in the field?
This is not the only organisation. It is an organisation that activates in the field, lately enforced, but it does not represent all the key groups. I cannot imagine how it will succeed in implementing the prevention activities in the groups it has no experience working with, how will it cooperate with the five non-governmental organisations that did not support the decision of the NCC, which are preoccupied about this situation and the possibility of service interruption.
Ms. Pîrțînă, thank you for this interview.
Categoria: Interviuri
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