Yekaterina Li, Technical Advisor and Program Manager, EpiC Kazakhstan
Maggie McCarten-Gibbs, Technical Officer, FHI 360

Oral pre-exposure prophylaxis (PrEP) was officially approved and launched in Kazakhstan in April 2021 as an HIV prevention measure for all key populations (KPs). PrEP first became available in state-run local AIDS centers, which also offer services such as HIV testing and treatment. While HIV services were provided for free at these centers, other barriers have limited KP clients’ access to PrEP services. The AIDS centers require numerous health exams before prescribing PrEP and operate during hours that are not convenient to all clients. Clients, including men who have sex with men (MSM), also face stigma, have few options for KP-friendly HIV services, and often have limited knowledge about PrEP.

At the end of 2022, there were an estimated 35,000 people living with HIV (PLHIV) in Kazakhstan. The Republican AIDS Center (RAC) reported that 13% of PLHIV did not know their HIV status. Almost 10,000 PLHIV were not on treatment or were virally unsuppressed, meaning they could pass HIV on to their sexual and drug-sharing partners. Due in part to a lack of viral suppression, there has been an increase in HIV prevalence among MSM, increasing from 6.5% in 2021 to 6.9% in 2022, according to the Kazakh Scientific Center of Dermatology and Infectious Diseases.

To address these issues, the PEPFAR- and USAID-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project introduced a community-based PrEP program in January 2023, through Your World, a community-based organization (CBO) in East Kazakhstan that provides HIV prevention, testing, and treatment. This program leveraged community-based HIV counseling and testing platforms to refer HIV-negative, at-risk MSM to non-clinic-based PrEP initiation and continuation services.

Before this program, CBOs could perform rapid HIV testing, but clients needed to be retested at state-run AIDS centers before starting PrEP. To simplify the process, the EpiC project, Your World, and the East Kazakhstan AIDS Center in the city of Ust-Kamenogorsk agreed on a joint algorithm to avoid double screening. They also agreed to offer clients PrEP services at the community level, with expanded service hours at the Your World office. Clients can now complete the required screening — which includes sensitive questions — at the Your World office with support from KP-friendly staff. Clients can bring the completed screening tool to the AIDS center if they wish to receive services there. The local AIDS center now has a “KP-friendly cabinet” — a separate room that specifically serves KP — where designated staff collect screening forms and initiate clients on PrEP. Clients can also complete a rapid HIV test and, once the test results are confirmed, receive PrEP at the Your World office. Alternatively, they can have PrEP delivered by CBO peer navigators at a location and time that is convenient for them.

To raise awareness about these services and to support clients in accessing them, EpiC trained members of the MSM community as peer navigators to deliver community outreach and advertise services provided by the project. Peer navigators are available to answer client questions about PrEP, share their individual experiences, and accompany clients to appointments. In support of community peer navigators, EpiC developed informational materials on counseling clients about PrEP, such as flipcharts with infographics for clients, and posters and booklets with counseling topics and messages for peer counselors. EpiC also supported Your World to raise awareness about PrEP via social media posts that explain PrEP, including the difference between daily and on-demand PrEP, and to create demand for the service in Ust-Kamenogorsk city.

As of March 2023, 20 clients had accessed and continued PrEP through Your World, enjoying the freedom of receiving consultations and pills whenever and wherever is most convenient for them. Aleksandr (pseudonym) was one of the first community members in the region to start PrEP. “I’ve been taking PrEP for four months and I plan to continue taking PrEP so that it’s one less thing to worry about. For me, it’s about safety and inner peace,” he said. After accessing PrEP services through EpiC, Aleksandr became a PrEP ambassador within his community to help more people benefit from PrEP. “With PrEP, you can play it safe in advance. There are guys who trust me and tell me about different situations, and they do not know about PrEP. I tell them that PrEP protects against HIV. After these conversations, a couple of my friends also started taking PrEP,” Aleksandr shared.

Offering free access to PrEP and providing information and support from peer navigators enables Aleksandr and other EpiC clients in East Kazakhstan to take charge of their own HIV prevention and to live their lives with greater peace of mind.

Featured image: PrEP, lubricant, and condoms available to at Your World in Ust-Kamenogorsk, Kazakhstan