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The effects of global HIV initiatives on equitable access to HIV services at the sub-national level: Georgia, Kyrgyzstan and Ukraine

Date: Poster sessions
Source: Forum 11
Authors: Neil Spicer, Lecturer, Health Policy Unit, London School of Hygiene and Tropical Medicine, United Kingdom
with Gill Walt, Ruairí Brugha, Aisling Walsh, Tetyana Semigina, Gulgun Murzaleiva and Ketevan Chkhatarashvili


Global health initiatives (GHIs), including the Global Fund and the World Bank's HIV programmes, mobilize substantial new resources for HIV control. However, such initiatives carry risks: pressure to demonstrate rapid impacts means that country programmes may target easier-to-reach populations rather than extend access more equitably to marginalized groups. There has been limited research on the effects of GHIs, especially in `concentrated' HIV epidemic settings.

A network of health systems studies, the Global HIV/AIDS Initiatives Network (, is comparing the effects of GHIs across 15 countries within sub-Saharan Africa, the former Soviet Union (FSU) and other regions. Research themes include equitable access to HIV services, service scale-up, human resources and coordination of control activities.

This paper presents early results from the FSU country studies: Georgia, Kyrgyzstan and Ukraine, each with concentrated HIV epidemics, predominantly among young drug users and sex workers. It focuses on the effects of GHIs on equitable access to HIV services at sub-national levels, where access is mediated by interrelated factors at different levels ­ community, service delivery and health policy. The paper draws out general conclusions, especially applicable across FSU countries:

GHI money is supporting service delivery but multi-level country factors are obstacles to equitable access among women and men in risk-associated groups (sex workers, injecting drug users, prisoners and men having sex with men).

Human rights and legislative approaches potentially increase access for these risk- associated groups to HIV services in countries with previously poor human rights records.

Poor coordination between funding agencies, governments and nongovernment organizations risks undermining equitable access to HIV services.

The paper draws out comparative lessons and recommendations for policy-makers and practitioners by highlighting barriers to access, and policies and practices that help overcome them in different countries. The paper argues that further research is required to fill critical gaps in knowledge: firstly, to understand how to promote appropriate policy environments in countries that will develop generalized HIV epidemics if risk-associated groups are unable to access HIV services; secondly, to measure the relative impact of different service models for HIV prevention and control of HIV transmission.