As world makes progress on HIV, Ukraine struggles

Oksana Grytsenko

Embracing a white teddy bear, eight-year old Amina smiles nicely inside a playroom at the Kyiv Center for HIV-infected children. What’s left out of the picture is the untold suffering her tender life has faced.

She has fought bouts of hepatitis, pneumonia and she still can’t walk because cerebral palsy, diseases that strike weakened immune systems. Amina was born with HIV, which in most cases is preventable.

Amina is one of about 230,000 Ukrainians who live with HIV. Since the disease was first registered in 1987, some 27,800 people have died from AIDS-related illnesses. Almost 3,000 AIDS-related deaths were recorded in Ukraine in 2012 alone, official data shows. The number of new infections is still growing.

Ukraine’s situation looks particularly grim on the global background. A recent UNAIDS report said that the numbe of people newly infected with HIV is falling, and that an eventual end to the AIDS epidemic “is more than merely visionary. It is entirely feasible.”

But Amina lives in a different reality.

“When she was only nine months old the virus started hitting all her internal organs, she was like a vegetable,” said Oksana, Amina’s mother, a former drug addict, adding that antiretroviral therapy gave her daughter “a new life.”

This so-called cocktail drug treatment that supports the immune system has given prolonged life to some 36,000 HIV-positive people in Ukraine.

By Nov. 1, there were 5,374 Ukrainians who have officially applied for, but are not yet receiving, the antiretroviral therapy. And the estimated number of people in need of antiretroviral pills is 170,000, according to the World Health Organization. Ukrainian officials explain this huge disproportion by the difference in national and WHO criteria applied to prescribe this therapy.

Despite the number of people globally infected with HIV stabilizing, the deadly virus is still spreading with immense speed in Ukraine, with about 50 new cases registered every day. Together, Russia and Ukraine account for 90 percent of newly reported HIV cases in the region of Eastern Europe and Central Asia. Experts say that around half of HIV-positive Ukrainians are not aware of their status.

Andriy Mandrykin, 35, said he found out about his disease in jail, where he was sent for attempted robbery and was given seven years. He believes he was infected by injected drug use, and says there are about 10 more HIV-positive prisoners out of 60 in his cell. “I think I would die without ART [antiretroviral] therapy,” Mandrykin said sullenly looking at the floor of a prison hospital in Bucha, Kyiv Oblast.

Prisoners, along with drug addicts, sex workers and men having sex with men, are the groups most vulnerable to getting infected by HIV and contracting related diseases like tuberculosis or hepatitis. “Those who get into pre-trial detention centers have a 90 percent chance of being infected with tuberculosis,” said Andriy Klepikov, head of International HIV/AIDS Alliance in Ukraine. He added that imprisoned drug addicts neither have access to clean syringes nor to substitution methadone therapy.

Foreign donors still fund 50 percent of HIV/AIDS programs, the largest being The Global Fund, an international foundation that targets three modern pandemics – AIDS, tuberculosis and malaria. Ukraine has become the largest recipient of Global Fund’s financing in the region, having received $300 million to date, including $275 million for anti-AIDS and $25 million for anti-tuberculosis programs.

But the country has constantly been at the brink of losing grants over government inaction, discriminatory legislation and new corruption allegations.

In 2004, Global Fund halted cooperation with Ukraine’s Ministry of Health after a scandal revealing that the government was purchasing antiretroviral medications at inflated prices that sometimes exceeded real costs by 27 times.

HIV advocacy groups claim that the medical procurement problem persists. “In [the public] procurement system corruption unfortunately still exists,” said Hanna Koshykova of All-Ukrainian Network of People Living with HIV. “For some drugs their [government] prices are 1.5 or two times higher than ours.”

However, government officials deny the allegations. “Corruption has become a popular buzzword, and all troubles with medical procurement are explained by corruption,” said Alla Scherbynska, deputy head of Center for AIDS protection.

But her boss, Natalia Nizova, said many people are deprived of antiretroviral treatment not because of the lack of money, but because many of those infected with HIV don’t address their medical needs.

Klepikov of the AIDS Alliance said his organization is currently suing the health ministry for criminalizing syringe exchange, a crucial initiative that prevents the use of used syringes, and an important precaution for stopping the transmission of HIV among injection drug users. “Basically social workers who carry used needles and syringes risk getting three years in prison,” he said.

Social work with drug addicts has already brought considerable success in the fight against AIDS. The number of newly registered HIV positive people who were infected by injection drug use since 2008 has decreased in comparison with the number of those infected through sexual contact.

Meanwhile, epidemiologists fear that the number of HIV cases among men having sex with men will increase in the coming years, as this group has become more visible and open to HIV testing.

Advocacy groups point to a scandalous draft law that prevents the “promotion of homosexuality” that could lead to the spread of the disease among this group. Activists say the law makes it difficult to reach out to gays whose lifestyle will inevitably become more discreet.

“With the passage of such legislation the HIV epidemic in Ukraine will be only fueled,” said Kent Klindera, head of the US-based GMT initiative, the foundation supporting gay men around the globe, including Ukraine.

Jean-Elie Malkin, director of the UNAIDS Regional Support Team for Eastern Europe and Central Asia, said that Ukraine’s anti-AIDS policy surprises him. “I see a paradox in Ukraine between the fact that we know where the problem is. The paradox [is] between this knowledge and the fact that we are not going to scale when it comes to these interventions,” he told the Kyiv Post.

Kyiv Post staff writer Oksana Grytsenko can be reached at grytsenko@kyivpost.com.

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