As part of achieving the Sustainable Development Goals, UN member states adopted the Political Declaration on HIV and AIDS: Ending inequalities and getting on track to end AIDS by 2030 at the UN General Assembly High-Level Meeting on HIV and AIDS on 8 June 2021.
Of all the countries, only Belarus, Nicaragua, Russia and Syria voted against the Political Declaration.
Turkmenistan did not vote as it has a mandate of permanent neutrality in the UN structure. As part of the implementation of the Political Declaration and the achievement of the Sustainable Development Goals, two strategic documents of WHO and UNAIDS were developed and approved: “Global AIDS Strategy 2021–2026: End Inequalities. End AIDS / UNAIDS”; “Global health sector strategies for HIV, viral hepatitis and sexually transmitted infections 2022–2030 / WHO”. For the first time, participating countries have adopted transformative and measurable targets to be achieved by 2026–2030 – which can make ending AIDS a reality.
In Turkmenistan, WHO and UNAIDS targets have not been approved, due to the country’s position that the disease has not spread in the country.
Key points of the country’s approved regulatory documents on HIV infection.
1. HIV diagnostics: diagnostic algorithms do not comply with WHO recommendations regarding the use of the immunoblot (Western blotting) method to confirm the presence of HIV infection. The use of rapid tests is not recommended, including in non-governmental organizations. There is no recommendation for retesting prior to inclusion in care and treatment programs. No recommendation is included regarding sensitivity and specificity of tests for diagnosing HIV infection in children and infants. No recommendation is included for HIV self-testing.
The transition to modern methods of HIV diagnostics makes the system more efficient, accessible and cost-effective. Refusal of Western blotting does not reduce the quality of diagnostics, but on the contrary, contributes to the early detection of HIV and timely initiation of treatment.
2. Antiretroviral therapy regimens: no recommendation for immediate initiation of antiretroviral therapy. The absence of Dolutegravir in the preferred first-line regimens does not take into account the updated WHO recommendations of 2018 and 2019. There are no specific sections on switching to second- and third-line schemes. There is no recommendation for prescribing ART to a special group of patients (pregnant women, adolescents, patients with concomitant TB, hepatitis, patients in advanced stages, etc.).
Immediate initiation of ART is the best way to maintain a person’s health, protect others, and combat the spread of HIV infection.
Dolutegravir is recommended in the first line due to its high efficacy (rapidly reduces viral load), immunity to resistance, good tolerability, ease of intake, versatility, cost-effectiveness.
Recommendations for switching to second- and third-line regimens, and the appointment of ART to a special group of patients reflect a personalized approach that will not only improve the quality of life of patients, but also make targeted use of financial and human resources.
3. Prevention and treatment of concomitant diseases: the approved documents contain general sections regarding the management of concomitant diseases in HIV infection without detailing and taking into account the latest WHO recommendations. There are no specific recommendations for the management of combined TB, viral hepatitis and other HIV-associated diseases. Recommendations for the prevention and treatment of relevant non-communicable diseases (cardiovascular diseases, oncology, diabetes, kidney diseases, bone diseases, cognitive impairment, depression) are also completely absent.
People living with HIV are at high risk of developing certain infectious and non-communicable diseases, including mental disorders. People living with HIV are more likely to develop these diseases than people who are HIV-free. Management of combined conditions is a comprehensive approach to prolonging life and improving its quality in people with HIV.
4. Levels of service provision: no recommendation on decentralization of services, redistribution, delegation and integration of services, including with the involvement of the non-governmental sector.
Decentralization and integration of services at all levels of health care, regardless of ownership and the civil sector, will allow for: increased availability of services, faster diagnosis and treatment, reduced stigma, resource savings, and improved treatment outcomes. This helps to reach more people and improve control over the spread.
5. Prevention of HIV infection: the documents do not contain recommendations for the use of pre-exposure prophylaxis of HIV infection. There is no recommendation for primary comprehensive HIV prevention among key populations and other priority groups (harm reduction programs, PrEP, U=U, reproductive and sexual health services, outreach work, opioid substitution therapy, gender-sensitive health services). There are no recommendations for the integration of community-led preventive services. There is no community monitoring.
Prevention of mother-to-child transmission of HIV is not free from stigma and discrimination. The practice of using separate rooms and disinfectants to treat the genital tract of women and children is contrary to WHO recommendations. A woman has no right to choose the method of feeding, regardless of the level of viral load.
HIV prevention programmes among key populations (people who use drugs, sex workers, men who have sex with men and transgender people) are important to reduce the spread of infection. They help to: reduce the risk of infection through access to information, condoms, sterile syringes, PrEP, PEP; provide testing and treatment in a safe, stigma-neutral environment; reduce stigma and discrimination through educational activities; raise awareness of transmission routes and prevention; maintain public health by preventing transmission of the virus. This is an important step towards eliminating the spread of HIV.
Violating the rights of women living with HIV leads to poor health and increases the risk of transmitting the virus to their children. Protecting rights, ensuring access to services and combating discrimination are key measures to prevent mother-to-child transmission of HIV.
Pre-exposure prophylaxis is 95%–99% effective in preventing HIV transmission.
DOCUMENTS USED FOR DESK REVIEW:
- Law of Turkmenistan No. 372-V of March 26, 2016 “On countering the spread of the disease caused by the human immunodeficiency virus (HIV infection)” (hereinafter referred to as the Law)
- Order of the Minister of Health and Medical Industry of Turkmenistan No. 297 of July 15, 2024 “On approval of the procedure for providing medical care to persons infected with the human immunodeficiency virus (HIV)” (registered with the Ministry of Justice of Turkmenistan on August 8, 2024 under registration number 1819).
- Order of the Minister of Health and Medical Industry of Turkmenistan dated December 28, 2020 No. 379 “Maintaining records of persons infected with the human immunodeficiency virus in accordance with the Procedure for conducting dispensary control, as well as conducting epidemiological control of HIV infection” (registered with the Ministry of Justice of Turkmenistan on January 29, 2021 under registration number 1437). This document is not publicly available.
- Order of the Minister of Health and Medical Industry of Turkmenistan No. 131 dated May 23, 2020 “On improving regulatory documents on the prevention of the spread of HIV-related diseases in Turkmenistan”. This document is not publicly available.
- Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030. UN.
- Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 2021. WHO.
- The Global AIDS Strategy 2021–2026 “End Inequalities. End AIDS”. UNAIDS.
- Global health sector strategies for HIV, viral hepatitis and sexually transmitted infections 2022–2030. WHO.
This study was prepared in collaboration with the author, who has over 20 years of experience in the field of HIV infection, a master’s degree in public health and publications in the field of HIV prevention, diagnosis, treatment and strategic information. The author remains anonymous for security reasons.
