Terms of reference
Consultancy to carry out a comprehensive analysis of existing harm reduction services
in the Kyrgyz Republic
Position:
International Harm Reduction Specialist (Outreach, NSP and NGO operations)
Duration:
Mid September – November 2011
Location:
Kyrgyzstan (Bishkek, regions)
Background:
The Kyrgyz Republic is experiencing an increasing growth of HIV infections among MARPs. The
HIV epidemic is mainly driven by injecting drug use (still more than 60% of infections in 20101).
Since 2004, the HIV case rate has increased by more than three times, reaching 12.5 per
100,000 population in 2009. At the same time, the number of HIV cases that were acquired
through heterosexual contact has increased more than fivefold from 2004 to 20092.
In 2010, drug injections were accountable for 67% of all reported HIV cases in Kyrgyzstan.
Sentinel surveillance conducted in the country in Bishkek and all oblasts (regions) of the country
showed 14.6% HIV prevalence among IDUs. The HIV epidemiological situation among IDUs
differs from region to region and the most affected regions include Osh and Chui oblasts and
Bishkek. Estimated number of IDUs comes to 25,000 countrywide3, which means that about
0.8% of the population aged between 15 and 49 inject drugs. The country is located in the
crossways of opiate traffic from Afghanistan to Kazakhstan, Russia and Eastern Europe.
According to official data the registered number of persons living with HIV as of July 1 st, 2011 is
around of 36004, and that 62% of people living with HIV (PLH) are registered injecting drug
users, with young men predominating over women. According to UNAIDS, the actual number of
PLH is three times higher than the registered cases, i.e. up to 9,800 people.
In 1999, Kyrgyzstan introduced Harm Reduction Programmes in Bishkek and Osh. In 2006,
harm reduction (HR) was integrated into the national policy on HIV prevention. At present 30
trust points function across the country providing needles, syringes and other products and
services to prevent HIV among IDUs, of which 14 are located in Chui oblast, 3 in Osh oblast, 1
in Jalalabad oblast and 12 in Bishkek. There are 19 NSE points available in penitentiary
facilities. The majority of registered drug users including those that inject drugs are located in
the same regions that report the highest number of HIV cases: Chui oblast (28% of officially
registered drug users), Osh city (21%), Osh oblast (19%), Bishkek (15%) and Jalalabad oblast
(11%), (data of Republican AIDS Centre).
HIV prevalence among IDUs in 2010 was 14.6%, which was more than twice as high as in 2008
-6.7%, HIV prevalence among other vulnerable population groups (13.7% - among prisoners;
3.5% - among SWs; 1.1% - among MSM).
1
Kyrgyzstan - 2010 Country Progress Report:
http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/2010progressreportssubmittedbycountries/kyrgyz
tan_2010_country_progress_report_ru.pdf
2
European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in
Europe 2009. Stockholm: European Centre for Disease Prevention and Control; 2010.
http://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/hivaids/publications/2010/hivaidssurveillance-report-2009
( accessed on April 9 2010)
3
UNODC, 2006
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The data from the National AIDS Center, Ministry of Health, Kyrgyz Republic
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Kyrgyzstan has been implementing National Manas Taalimi Health Reform Programme 20062011 where HIV and AIDS is one of the priority programmes. Recently a team from WHO
Regional Office for Europe has conducted a review of the implementation of the national HIV and
AIDS programme in the Kyrgyz Republic and shared with the MOH their concerns on serious
gaps and limitations in the programme. The WHO formal report will be available soon. A new
National HIV and AIDS Strategy is being drafted and will be available by late 2011.
Harm reduction is one of the main priority activities in the country’s applications to the Global
Fund to Fight AIDS, TB and Malaria (GFATM) grants for R2, 7 and 10. This priority in the
development of the application was based both on the epidemiological situation and on the
existing gap in reaching Universal Access (UA) target in terms of IDUs behaviour, which states
that at least 50% of IDUs will have safe behaviour by 2010 (currently 35%).
In order to evaluate effectiveness of existing harm reduction services, receive recommendations
on their improvement and to facilitate achievement of UA targets through the next National HIV
and AIDS Strategy, a comprehensive study of Harm Reduction programmes in Kyrgyzstan is
required. It is also planned to investigate other low-threshold services that these programmes
provide, as well as their overall impact on drug users’ behaviour and quality of life. The study
will address both IDUs in the community and in prisons. From this study, a costed operational
plan will be developed to guide achievement of objectives related to harm reduction under the
National HIV and AIDS Strategy.
The International Harm Reduction Specialist will be a part of the multi-disciplinary team and be
responsible for the Outreach, NSP and NGO operations assessment. The other team members
will be: Harm Reduction Specialist (team leader, policy and planning), Harm Reduction
Specialist (MAT and medical aspects) and Costing Specialist. There will also be a number of
local consultants to obtain costing data and records of outreach, MAT clinics etc.
Objective:
With support and guidance of a team leader to carry out an evaluation of harm reduction
activities both in the community and in prisons in KR, including comprehensiveness and quality
of harm reduction services based on the existing international standards and guidelines as well
as national regulations (including HR standards approved by MoH in late 2009) with a view to
making recommendations on their improvement.
The tasks of consultant:
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Desk review of relevant documentation, official reports, statistical data, etc.;
Discussions of study documentation and research methodology with partners including
sampling method, report format and structure (preferably, using triangulation method for
analytical research);
Site visits to regions of Kyrgyzstan (mainly Osh, Jalalabad, Chui oblast, Bishkek, including
penitentiary facilities);
Meetings/interviews of representatives of Government and NGOs, PLH and representatives
of MARPs;
Preparation of a report reflecting strengths and weaknesses as well as findings and
recommendations for improvement, including indictors to assess quality of harm reduction
services;
Preparation of costed operational plan; in conjunction with other team members
Discussions of the draft report and plan among partners;
Participation in official presentation of the report and plan to present the findings.
Outputs/Deliverables:
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Evaluation Report
Costed Operational Plan
Fee for consultant:
Commensurate with experience.
Minimum Qualifications and Experience:
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Advance University degree in Public Health, Medicine, Social Sciences or other related
field;
At least 5 years of progressive experience in Harm Reduction and HIV and AIDS related
field;
Experience in conducting similar research in area of Harm Reduction for HIV prevention
Strong analytical and excellent writing skills;
Ability to meet deadlines and prioritise multiple tasks;
Strong research management skills and ability to work in a team;
Ability to travel to the sites;
Fluency in Russian, English an advantage
Timeline for the team:
Activity
Team reviews reports, prepare evaluation instruments
Duration
Weeks 1-2
Team Leader in Bishkek: initial meetings, data collection
on policies, plans, strategies, agreement on evaluation
Week 3
questions and methods
Full team in KR: site-visits, data collection, quality
standards, costs
Week 4
Full team in KR: finalise data collection, develop main
areas of draft evaluation report
Week 5
Develop evaluation report
Weeks 6-7
Present draft evaluation report to stakeholders, get
comments
Week 8
Finalise evaluation
operational plan
report,
develop
draft
costed
Weeks 9-10
Present draft costed operational plan to stakeholders, get
comments
Week 11
Finalise costed operational plan
Week 12
2. 5 to 3 months
Expressions of Interest should be emailed to:
ckelly@carhap.in.kg
by 8th September 2011
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