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