Rights for access restricted. Alternative UNGASS Reports
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13.10.2010

LATVIA
Society "Association HIV.LV"

Assessment of involvement of civil society in preparation of the national reports for UNGASS in 2008 - 2010.
The first information on the preparation of the report became known by the representatives of NGOs 16.12.2009, at a meeting of the Coordination Commission to reduce HIV infection, tuberculosis and sexually-transmissible diseases
It was stressed that "the special role of non-governmental organizations, who need to develop a consensus on one of the sections of the report." However, it was referred only to "The National Composite Policy Index."
The stakeholders’ meeting on developing of the joint position was organized by the Regional Office of United Nations Office on Drugs and Crime (UNODC).
All Latvian non-governmental organizations working on HIV/AIDS, were invited via the internet mailing list to participate in the meeting, but on Jan. 25, 2010 only four representatives worked on the policy index of NGOs and regional offices of WHO and UNODC.
At the meeting of the Coordination Commission to reduce HIV infection, tuberculosis and sexually-transmissible diseases on Feb. 17, 2010 there was a briefing on the preparation of the national report on the meeting attended by only one NGO representative. After that no more questions related to the National UNGASS Report were discussed on any level with any representatives of HIV/AIDS NGOs'.
Draft of the report was not distributed for discussion
Representatives of GO were given passwords to an information system for monitoring the response in the countries so that they could review the progress of a national report and inclusion of data online. Thus, additional opportunities for representatives of NGOs to monitor the progress of writing the national report were provided. There was no indication that  any representatives of NGOs took advantage of this opportunity
The final version of the report was not distributed specifically.
Regional offices of international agencies, WHO and UNODC as always played a coordinating and catalytic role.

Problems existing in the country, but not mentioned in the National report
In Latvia, there is a Coordination Commission to reduce the infection of HIV, tuberculosis and sexually transmitted diseases (under the Ministry of Health), whose membership has been expanded considerably in 2008 and in its composition are 5 non-governmental HIV / AIDS organizations. However, the Commission is of a recommendatory nature and its protocol solutions are noted, but not binding.
An Advisory Board for Pharmacy is acting as well under the Ministry of Health, which includes representatives of all the pharmaceutical companies. However, the interests of patients are represented by a single organization on cooperation between people with special needs "SUSTENTO". There were repeated requests to include representatives of the HIV/AIDS NGOs in the composition of the council, but this has not yet occurred.
In Latvia there are acting "Recommendations for a rational pharmacotherapy of HIV infection in a limited state budget condition”, they does not comply with the recommendations for the HIV/AIDS treatment published by the World Health Organization in 2009 (in particular, ARV treatment is appointed by the number of CD4 cells below 200 or in the presence of concomitant diseases of the C category). An offer of non-governmental organizations to establish a reasonable period of limitations on the appointment of antiretroviral therapy was not accepted
The ability to use generic medicines prequalified by WHO, in order to reduce the cost of HIV treatment and significantly increase an access to treatment in Latvia is not even considered.
The State recognizes that treatment in Latvia should be provided for 700 up too 1200 patients, but the relevant authorities do not take measures to attract patients for treatment. Budget allocations for HIV treatment cover only 50% of the required amount. Currently 483 patients receive antiretroviral therapy.
Only 3169 patients were observed by doctors out of 4702 reported PLWH in Latvia (at 1 May 2010) - it is 67,4% of registered cases. Although one third of all PLWH is not observed by the doctors, responsible agencies believe that this the problem of the patients themselves, and not even consider the possibility of finding these people.
Secondary testing of pregnant women, as well as re-testing of prisoners in penitentiaries is not held out and is not specified in the regulations, which creates a risk for the spread of infection through vertical transmission and in conditions of prison life.
State funding for primary and secondary HIV prevention, as well as in programs to limit the spread of HIV infection in 2009 - 2013 years, is extremely inadequate

Recommended actions to address the problems:
1. Non-governmental organizations should develop a joint long-term advocacy plan to address the above problems.
2. Include professional lawyers in the “Coordinating Commission to reduce HIV infection, tuberculosis and sexually-transmissible diseases” to legally correct protocol decisions for their further advancement in decision-making structures.
3. Include HIV NGOs representative in the Advisory Council for Pharmacy in order to increase the ability to influence pricing of the pharmaceutical market in the country.
4. Propose to the Ministry of Health to establish a reasonable period of “Recommendations on rational pharmacotherapy of HIV infection in a limited state budget conditions”, beyond which the recommendations of WHO automatically come into effect
5. Need to develop a program to improve adherence to treatment and social support, adopt the best practices of neighboring countries, to implement these programs in low-threshold centers with appropriate funding from the state.
6. Arrange peer counseling cabinet in the Latvian Infectology Center.
7. Develop practical guidance for family doctors on the management of patients with HIV infection and include ambulatory care of patients with HIV in the quality criteria of the family doctor.
8. Introduce mandatory training for general practitioners on specifications of diseases in PLWH.
9. Take practical steps to organize integrated services.

Also the recommendations of the positional Letter of the Baltic Positive Network to the heads of Latvia, Lithuania and Estonia should be implemented:
1. Prevention programs among vulnerable groups (including harm reduction programs) should be a priority because HIV prevention is a much cheaper then a treatment of HIV infection and dealing with the consequences.
2. Treatment for HIV infection should be appointed solely on medical conditions, on the basis of clinical protocols on HIV treatment for the WHO European Region, because HIV treatment is proven to be a best prevention.
3. Create conditions for implementation of patient-centered integrated services in order to use available resources with the highest possible efficiency.
4. To apply to the  international institutions and foundations requesting financial support for programs of prevention, treatment, care and support for people living with HIV on the grounds of reduction of available State recourses
5. To include the obligation to limit the spread of HIV infection, as a state function into a legislation of local municipalities.

LITHUANIA
Lithuanian national network of PLWH «Pozityvus gyvenimas»

Assessment of involvement of civil society in preparation of the national reports for UNGASS in 2008 - 2010.
There was no involvement of CSOs in the preparation of the national UNGASS report from the government side.

Engagement was assured only through the UN agencies in Lithuania.  By the initiative and with the direct mediation of UNODC representatives of three Lithuanian organizations participated in the national report preparation.

Lithuania has not conducted a poll on the National Composite Policy Index.

Once the report was finished, the drafts and the final version were not presented to civil society.

When completing the report, civil society representatives pointed out that the formulation of questions and suggested answers in the report are too superficial, and do not presuppose a realistic picture of the situation in the country and predispose the freedom of interpretations.

In preparing the report, representatives of the civil society and international organizations have faced the problem of inconsistency of some data, in particular the amount of HIV in prisons,  the total number of AIDS cases in comparison to those who have died of AIDS in previous years and in 2009.

Problems existing in the country, but not mentioned in the National report
There are doubts about the veracity of the data provided to the national report on HIV infection by regions, as far as the data submitted by the Lithuanian Centre for AIDS and communicable diseases were utilized using the registration of residence, not place of residence and receiving of services by a patient with HIV/AIDS. Therefore, there is a reasonable doubt in the reality of the shown situation and the geographical distribution of HIV in Lithuania.

Once started in April 2009 a reform in the health care system in Lithuania, the situation has become catastrophic in terms of access to treatment, as well as HIV care and support and testing.

In Lithuania, access to treatment with ARVs to all who need it is limited by the existing HIV treatment protocols. Being guided by these methods, HIV treatment in Lithuania may be initiated when the CD4 count is less than 200.

Funding for the purchase of antiretroviral drugs is not increased, while demand for treatment has increased significantly. Due to lack of funding, ARV treatment initiation for new patients will not be possible.

Since January 2010 not only with shortages of ARV medicines started, but as well with an immunological analysis of blood for patients with HIV. The funds provided to carry out immunological studies of blood in patients with HIV, were used for the purchase of vaccines against influenza. In 2010 free blood test is not available for PLWH in Lithuania.

Every citizen of Lithuania, who was diagnosed with HIV infection, automatically receives health insurance. The amount of health insurance for PLHIV includes free medical consultation, diagnostics, ARV therapy, and only 2 days of hospitalization. Such aid does not meet the needs of PLHIV.

At the present day no funds are allocated for the prevention and treatment of opportunistic diseases in Lithuania. The cost for the prevention and treatment of these diseases is to be fully covered by the patient.

In Lithuania, the state does not fund programs to provide peer counseling services, psychosocial support for PLWH and adherence to treatment. Anonymous HIV testing is also to be paid by the client and the tests costs about $ 10. Testing centers are located only in the administrative centers of districts.

There are no programs aimed at prevention among men who have sex with men (MSM) in Lithuania since 2008.

The cost of providing medical services for prisoners is fully covered by the Ministry of Justice of Lithuania. MoJ is unable to cover the costage of purchase the ARVs medicine for those all in need of treatment in penitentiary. For the Ministry of Justice tender, ARV drugs are considered as a subject to an increased rate of state tax, comparing to the Ministry of Health. Due to insufficient funding ARV treatment in detention for PLHIV is very exceptional.

Recommended actions to address the problems:

Treatment, care and support for HIV / AIDS

1. Provide patients with HIV / AIDS approach to quality health care for at least 40 hours per week.

2. To ensure and guarantee the free, regular screening of blood for patients with HIV / AIDS.

3. Ensure continuity of treatment of patients with HIV / AIDS quality ARVs.

4. Provide prevention and treatment of opportunistic infections in patients with HIV / AIDS.

5. To ensure control, prevention and treatment of co-infections.

6. To ensure public support for providing peer counseling, psychological care and social support.

Groups particularly vulnerable to HIV

1. Provide an approach to free HIV testing for persons in the risk of infection.

2. Provide an opportunity for HIV testing using rapid tests in the low-threshold offices and during social events.

3. Ensure risk approach to safe, counseling, psychological and social assistance to low-threshold offices.

4. Provide an approach to the means of harm reduction for drug users (needle exchange, provision of security tools, educational materials, etc.)

5. Provide drug treatment patients substitution therapy in prisons.

6. Ensure continuity of treatment of patients with HIV / AIDS in prisons.

7. Provide an approach to HIV prevention in prisons.

NGO sector

1. To ensure and guarantee the participation of NGOs in the implementation of national policies for prevention and control of HIV / AIDS and harm reduction.

2. Ensure the involvement of NGOs in prevention work with vulnerable groups

3. Involving representatives of PLWHA and civil defense in the coordinating committees of national programs for prevention and control of HIV / AIDS and drug addiction.