Success stories Archives – #вТвоихСилах

Irina Kutsenko, a deputy of the Odessa City Council dealing with social issues in the city, received an international award #InYourPower. She became the first and so far the only government official nominated by civil society.

In an exclusive interview, she shared her story: about why she stayed on the sidelines for a long time and closed the OST sites and LGBT organizations; how she came to understand the importance of supporting the city’s HIV/TB program and the work of harm reduction programs, why it significantly helps to improve the health of citizens; about the experience of cooperation with non-governmental organizations, about building a dialogue with medical and security agencies; about conversations on inconvenient topics with deputies, as well as how to prioritize these issues on the municipal agenda and launch an information campaign that the city media will talk about.

So, now Irina Kutsenko is an active defender of community rights at the level of city authorities, a person with tremendous energy and extraordinary willpower. She continues to initiate changes in the city in relation to the most vulnerable groups of the population. She does everything to bring medical and social services in Odessa closer to the most advanced global approaches to harm reduction and combating HIV/TB . But it was not always like that.

“I was the deputy who closed the site of substitution therapy in my district, I collected signatures from people against gay culture and its spread in our city, that is, I was a deputy who conducted completely different activities,” says Irina. But after completing the course of the International Harm Reduction Academy, she began to actively dig into the problem: “I started reading in the Internet, listening to interviews of people, listening to life stories, and I understood that I was wrong!”.

Having changed her personal understanding of the problem and the ways to solve it, Irina gradually begins to cooperate with public organizations to make Odessa a safer city and people more socially protected.

“When representatives of a public organization came to me with a harm reduction project in the city, I already understood what they were talking about. At that moment, I realized that the NGO today knows more than any of the officials. At first I was just listening,” the deputy recalls.

The first task of Irina Kutsenko and members of the public was to find a common language, when everyone is doing their own thing. “We needed everyone – doctors, authorities, and public organizations – to unite into one common work,” she recalls. “Before, everyone was separate.”

The main step towards changing the situation in the city was the fact that disparate society representatives began to communicate. The dialogues took place with the participation of deputies, in the mayor’s office, with the necessary arguments and eloquent statistics, which were often hidden or uninformative for the authorities. As a result of this work, the mayor of the city supported the initiative, and today in Odessa steps are purposefully implemented within the framework of the already signed Paris Declaration. Odessa is also the first city in Ukraine to take on commitments under the Zero TB Cities initiative and is systematically moving towards overcoming the tuberculosis and HIV epidemics. In 2 years, this results from joint efforts and a radical increase in the effectiveness of tuberculosis treatment through the provision of treatment “at primary care” – from 52% to 71%.

However, as the mayor of Odessa Gennady Trukhanov said, it was not easy for the city itself. The deputies debated heatedly during two sessions. The city authorities, in addition to local everyday problems, also need to tackle global challenges, in particular – to help medical workers in the fight against epidemics. After all, everyone is interested in this. “Mayors are assessed by the state of the city: roads, roofs, warmth, comfortable public space. This is all true. And we can achieve cleanliness in the cities, but with the spread of all dangerous infections in the world, God forbid, the time may come when there will be no one to walk along these roads,” the Odessa mayor emphasized.

Also, within the framework of the program, outpatient treatment of tuberculosis was introduced instead of in-patient model, and medical practitioners began to actively test visitors for HIV at polyclinics, educational institutions, and purchased a large number of tests. Thus, the city was able to increase the HIV detection rate and provided an opportunity to make treatment available for people.

“Of course, there are still many problems, but, step by step, we are changing the situation in the city,” says Irina Kutsenko. “We understand that the projects are coming to an end, but those declarative things that were signed by the mayor, and we, as deputies, will have to implement both in this convocation and in the next one, because this is a matter of the life of our citizens”.

Interview timecode:

00:01 – a short content of the interview, consisting of vivid statements of the charismatic deputy

00:58 – how it all began

02:13 – dialogue with the people who need help

04:05 – meeting of the fraction:

“Well, guys, I’m going to tell you something completely different now … We must legalize sex work and open substitution therapy sites. They thought I was crazy. “

05:23 – dialogue with public organizations, the mayor and the Paris Declaration: Odessa approach

08:45 – HIV and TB, stigma and treatment initiation under a motivation program for health workers

11:28 – projects “go away”, but the issue of people’s lives remains on the agenda

11:45 – harm reduction services in municipal pharmacies in Odessa

12:40 – how the city HIV / TB program was developed for 65 million hryvnia

15:02 – life hacks and shame: how NGOs helped convince MPs to support the city’s HIV/TB programs

17:15 – “It’s all right with the Duke “: mural, media resonance and HIV testing

18:56 – creation of the second center of integrated social services for harm reduction in Ukraine (the first is in Sumy)

19:17 – new format of cooperation with law enforcement agencies

19:43 – “we are on the sidelines until they explain to us”

22:45 – “speak a simple language”

23:00 – how to calculate the budget of the city program

At the start of the #InYourPower information campaign, we said that we believe in the power of political decisions in favor of people’s health, and in the immense expertise of communities whose joint efforts will help stop the HIV/TB epidemic. We promised to find examples of such successful stories, to talk about them using specific cases with decisions in favor of HIV programs with proven feasibility and efficiency.

It’s in our power. Therefore, we present the first material containing a whole collection of such cases and videos.

In Eastern Europe and Central Asia (EECA), the situation with HIV and TB remains drastic. Over 1.7 million people live with HIV in the countries of the region, and every year this figure is growing by 22-23%. The TB morbidity stands as high as 260,000, each third case is MDR-TB, this indicator is six times higher than the world level.

According to experts, focusing on two aspects: the personal responsibility of municipal leaders and an effective methodology, can reverse this gloomy record.

We talked about this issue and the specific tools for effective work with cities with Andriy Klepikov, CEO of the ICF ” Alliance for Public Health”, following his impressive presentation at the EECA Cities Leadership Forum.

Thus, speaking about the achievements and progress of the municipal response to the HIV/TB epidemics in the EECA region, he notes that one of the most effective ways to address the issue is to concentrate efforts on working with big cities. Speaking about personal responsibility and an effective methodology, he noted: “First, everyone should take the initiative in their own hands, not shifting it to other people or structures, be it NGOs, authorities or health facilities. And, second, it’s not necessary to “invent the wheel” while carrying on ineffective methods of combating the epidemic; it’s sufficient to adopt already working mechanisms, having studied the experience of others”.

Official video of the speech:

“By and large, overcoming HIV and TB is the task of cities”, emphasizes Andriy Klepikov. – Indeed, at least one third, if not half of all HIV-positive people in the country, are concentrated in cities, for example, in Sofia and Tbilisi. There are cities where more people live with HIV than in some countries. For example, in Kyiv alone there are more PLWH than in all Georgia. And therefore, the city has to single-handedly address comparable, or even more ambitious challenges than those on the country level”.

The CEO of the ICF “Alliance for Public Health” is convinced that in order to stop the HIV epidemic in Ukraine, it is enough to defeat it in 5 large cities: Kyiv, Odesa, Dnipro, Kryvyi Rih and Mariupol. And we already know how to do this.

“Our focus on cities and collaborating with mayors is key to tackling HIV/TB. As for the methodology – there is no need to invent anything, everything has already been invented. There are working principles on how to reach the level of an accelerated response to the HIV and TB epidemic. From our side, we have been working in cities for more than a year, and we are pleased to present a model that brings forth real results”, Mr. Klepikov said.

Based on his work experience in five cities of the region, the ICF “Alliance for Public Health” has developed a model for the city, which contributes to a significant improvement in the HIV/TB situation and helps to formulate a sustainable response to the epidemic by attracting municipal resources. The model itself, the examination and specific cases with a detailed description of “How to Stop the HIV/TB Epidemic in Cities” are collected in the handbook of the EECA Fast-track Cities project and published in the public domain (hurry up to grab it!) on the website for wide access to the developed expertise of all interested parties.

Andriy Klepikov emphasized that when working in cities, it is recommended to focus on three aspects: working with key populations, organizing effective services, and actively interacting with mayors, politicians, and officials – decision-makers, thus changing local politics. Therefore, active interaction with the authorities enabled achieving the development of services and improving work with key populations in a number of EECA cities. Thus, a safe drug use room opened in Sumy. In Odesa, municipal pharmacies are involved in a harm reduction program, and free syringes are now available there. And in Almaty, they created a safe space for key populations, including the community center for LGBT people.

In addition, projects relevant to a specific policy are being successfully implemented in a number of EECA cities. For example, in Almaty, with the help of rapid tests, we managed to identify one hundred and fifty cases of HIV infection and help almost all of them to start treatment – social workers did not wait for representatives of key populations in clinics, but went to where they were the most needed, using the electronic client accounting system.

In Kyiv, artificial intelligence was used to identify the most high-risk cases with regard to HIV. And in Odesa, a Fast-Track project was implemented with close cooperation with the city administration, which resulted in a rapid increase in the TB treatment efficiency, from 52% to 71%, by providing treatment on the primary healthcare facilities level.

The Moldovan city of Balti has shown a customer-oriented approach, and now people can obtain all the services for tuberculosis treatment, counseling, ART in one facility, without the need to travel all over the city. This initiative increased the recovery rate to 78%.

In his opinion, the EECA region in 2020 already needs results. And the results are a decrease in new cases of HIV, TB, and most importantly, these are saved lives. “Based on the experience and accumulated expertise, we understand, which programs are not just operational, but produce results measured by the lives of real people”, says Andriy Klepikov. – Cities are a promising area, where we should and can invest more: both resources, and time, and our energy and efforts. And we are open to the challenge. All these developments are not for me; they are for you. Everyone who is interested in receiving support from our team is welcome, we are open. It is very important to remember that we can stop the epidemic in the country by working effectively in cities. Cities can make a difference in our countries, and not just cities as a concept, but city leaders, mayors, and we, the residents. For us, this is the way forward. This is #InYourPower, in our power!”