 Thank you very much dear colleagues. My name is Tanya Deshko. I work in H.E.V.D. Alliance in Ukraine And I would like to share with you the situation we are now in the development of our hum reduction program and and about our Expectations for the next year and the collapse of hum reduction that we see Ukraine is in the risk of Ukraine is as of now is one of the biggest hum reduction programs operating globally. Every year needle exchange programs reach to some almost 200,000 people who inject drugs in the country which is over 60 percent of the estimated drug-using population in Ukraine This program is performing with the support of the Global Fund to fight H.E.V.D. and malaria and The program has not only been delivering Programmatically but also delivering epidemic-wise. We are seeing the decline of new H.E.V.D. cases in people who inject drugs for the last five years We see that new H.E.V.D. cases are also declining in the general population Starting from last year we can see that new H.E.V.D. cases globally for all population of Ukraine are going down We are also seeing since last year the reduction in AIDS mortality and we see that not only the group of drug users But also that while the broader population is seeing the incredible impact of the harm reduction programs that have been active in the country Here you can see the illustration by the data provided by the Ministry of Health of Ukraine of program efficiencies So you can see the yellow The yellow ones are the numbers of new cases of HIV in people who inject drugs in Ukraine So you can see that they have been slowly but steadily declining and every other year We saw few new cases of HIV in people who inject drugs in the country More recently we started to observe another trend which is the stabilization of the epidemic in the general population So you can see that after the peak in the last several in 2011-2012 We are seeing fewer new cases in the general populations registered So clearly harm reduction programs have been producing an incredible effect over the HIV epidemic in Ukraine This is the data again which shows how the increase in coverage of harm reduction programs in Ukraine Has affected the new cases among people who inject drugs who are below 25 years of age So you can see what what an incredible curve what illustrative curve This has been produced in Ukraine Substitutional therapy again another intervention which is not that broadly but still present in Ukraine We have about 9,000 patients are no ST and you can see how the progress has been made in Ukraine with the the coverage of Operate substitution therapy increasing and reaching almost 9,000 patients until the time when we lost Crimea to To an evidence-based public health intervention more broadly I think it has not only been the loss for Ukraine as a country but it has been a loss for us as public health professionals Who have lost the territory with people who need that the vital service Substitution service that kept them alive and unfortunately 800 people have been cut off substitution treatment and we are now hearing back Death reports among people who used to be substitution therapy clients for the reasons of overdose or for the reasons of suicide And now more for more of pessimism and more of bad news coming from Ukraine and the news connected to the allocations which will be available to Ukraine under the new funding model, which the global fund used starting effectively next year For the funding allocation in Ukraine. So here you can see The the current level of funding until the previous year so you can see the available funding level for eight programs in in Ukraine and what will probably be the level starting next year This is majority do you this is entirely due to the fact that the global fund has changed this allocation? principle and has based allocation on the country income level and as Ukraine is now Rated as a high-middle income country the country will receive as a chance Substantially smaller allocation from the global fund despite the high disease burden despite the current political situation in the country which is incredibly Unfavorable towards any social cost allocation and any health allocations taken the board the country is in with Russia it Nothing has helped to revisit This level of funding that we we are able to receive from the global fund to make the situation This is here I would like to show what are the services that our program will be losing As a result of the level of allocation we are getting so this is the current service package that we can offer to people Drugs and this is what we have submitted to the global fund at the existing level so we will preserve some of the most basic Distribution of needles and syringes condoms information materials We will proceed with a rapid testing for HIV and for hepatitis C, but what we will lose will be will be STI testing and management It will be overdose prevention programs that will not that we will not be able to sustain any more Support by the medical professionals, narcologists and psychologists social support legal advice Yeah, so you can see that our service package will become well several times smaller if currently we're able to Operate at $30 per client per year plus commodities on top to that so from next year We will have to operate with $18 per client per year plus commodities This is something we have not it is still a prospective date and we don't know whether we will be able to cope with With this level of intervention and whether we will be able to sustain the current region the current attraction of services to our program clients I To make the situation even worse when when the issue of middle-income countries is brought on the table We are speaking about their potentials for increased domestic allocations that could replace international allocation, but unfortunately, that will not be the case because in Ukraine allocations for national age age budget will dramatically lower than what is stated in the national AIDS program and although we have planned for the levels of almost 100 million dollars in the current AIDS program for the current year This is the allocation level about a quarter. We have anticipated. It's what will happen in reality And actually it's for various reasons for the reasons of how the country is able to fund AIDS programs also the devaluation of our currency and the ability to purchase with the money we have So this is the funding prognosis the domestic perspective for AIDS spendings that We are living with in Ukraine and I would like to say that I will end my presentation now and would like to say that We have worked hard to revisit this situation and to try to Change it at least on an on a temporary basis We have appealed to the global fund to the global fund board for the global fund director to the international community working hum reduction describing how terrible the situation is and how difficult it will be for us to sustain the programming level at the current level but Most pessimistically it has not received any result as of now so our Current projection for the next year remains as I have shown you and We don't see that there are any realistic opportunities and realistic way forward to revisit or change this dislocation and I think there is For it's one of the examples, but I think quite illustrative for the region Actually where for the region maybe more broadly for the global AIDS response, which is getting very medicalized And it is very much relying on our views both as treatment as prevention and instead of prevention But also a very strong push which is coming from another big country Which is claiming its role as a superpower Russia who was very restrictive and very Very restrictive drug policies and very kind of conservative HIV response, which actually is Not a response in such in that country when you have almost two million people who inject drugs in Russia Having 46,000 covered with needle exchange and zero with substitution therapy is probably nothing I Think it's time for the global harm reduction community to To raise a stronger voice to protect its achievements in harm reduction protect its investment and actually Plan of action to not only to sustain but as to increase the harm reduction Location globally we should have similar targets as as we have for our is for example We speak about 20 by 20. Why don't we have 10 by 20 with 10 million people who inject drugs covered with basic needle exchange Services by 20, I think we should proceed with some agenda from a professional community because we are just losing the momentum and it's We understand it and we foresee and it's I think we're not in the position just not to act now So I would go for for global thinking about some global targets We may be putting in front of us in terms of coverage with key prevention interventions for people who inject drugs By 2020 and also some thresholds for funding allocation with the global fund so that we could anticipate that maybe 500 million could be allocated for harm reduction programs next year and at some point it could reach the necessary one billion or two billion David mentioned to provide some sufficient coverage for people who inject drugs Thank you very much for for your attention