Ever since 1995 Ukraine experiences an epidemic spread of drug addiction. As a result the HIV epidemic and a new tuberculosis epidemic were able to spread unchecked. About 47 million people live in Ukraine (WHO, 2008). Estimated 430,000 people above 15 years are infected with HIV; 190,000 of them are women. The assumed prevalence in the age group of the 15-49- year olds is 1.6% (UNAIDS, 2008a).
While in the epidemic's early stages the HIV infection was transmitted almost exclusively by people sharing needles, the virus now spreads increasingly into the general population through [unprotected] sexual contacts. Women working in the sex industry are multiply exposed. Plus, the mother-to-child transmission remains high, notwithstanding that according to UNAIDS (2008b) in 2006 95 % of all pregnant Ukrainian women were HIV-tested and that 93 % of the women tested positive received antiretroviral therapy during pregnancy and delivery .
Another risk group are street children, who start using drugs at an early age and have no access to counselling, testing and medical care (UNICEF, 2008).
Apparently numerous reasons contribute to the fact that the epidemic could spread in such an unchecked manner and is not under control even to this day (Elo, 2008): Not only was the epidemic ignored for a long time, but also its dimension denied. The epidemic made its impact on Ukraine, when the country was in a painful transformation process (which remains being far from concluded) following the dissolution of the Soviet Union. For many Ukrainians the collapse of the USSR meant unemployment and poverty as well as losing their bearings and hope. The economic and social system of the Soviet Union was destroyed; but so far it has not been replaced by another one. The majority of the population lives below the poverty line (Bennett & Janssen, 2000). Hence one can safely assume, that the vast majority of people are concerned with their own worries, that is, their bare survival. The Ukrainian society of today is characterized by a lack of solidarity.
Another fatal effect is the strong taboo of HIV infections, and that people with HIV and AIDS are heavily discriminated. Especially IDUs and sex workers, but also street children and orphans are subject to massive stigmatisation and discrimination. They're living on the edge of society. In legitimate fear of criminal prosecution and longstanding prison terms they live in secluded anonymity; thus making it difficult to reach them with target-group specific prevention and treatment.
Moreover neither the population nor the political decision-makers have adequately accepted harm-reduction programmes, i.e. substitution therapy (Elo, 2008). There are now some individual pilot projects with about 20-50 persons each, especially in the hardest affected regions of Ukraine - in the districts of Odessa, Mikolajew, Dnjepropetrowsk and Donetsk.
Cooperation networks to fight AIDS are to this day hardly existent. But even on international level not enough importance was attached to the problem.
The general access to care and medical treatment is an important factor for the course of the HIV infection/AIDS disease. The antiretroviral therapy (ART) can detain the onset of AIDS and (an early) occurrence of opportunistic infections for many years. But the drugs are an enormous financial strain on both, the health system as well as the people affected. True, the Ukrainian constitution continues to guarantee curative health care free of charge; but in reality exams and medication are often at the patient's expense.
In spite of international financial aid, only some thousand people receive ART, and if so, it is often only the so-called first-line treatment, that is a single line of treatment without the possibility of alternative options in case of resistances, or if the patients in question are unable to tolerate the therapy. There is also the fact that the ART regimen is complicated, requiring patients to take several pills at various times during the day, to avoid the danger of developing a drug resistance - for the rest of their lives. The required compliance often proves to be difficult under the lifestyle mentioned.
International aid for fighting [AIDS] is inextricably interwoven with national and political changes as well as with the willingness to change of the political and social powers in question. Prevention can become successful when it rates high on a long-term basis on the political agenda. Mass media and target-group specific prevention options and programmes are essential to create a social climate against stigmatisation and marginalisation of people infected with HIV and AIDS. Even without representative studies one can safely assume a very low standard of knowledge among the population regarding the risks of HIV and prevention possibilities. Only a few people know about their own infection due to the lack of incentives of getting tested. The treatment is expensive and the HIV positive diagnosis means additional marginalisation.
But not only public prevention programmes and medication are necessary modules in fighting the HIV epidemic. Diagnosis, therapy, and care for HIV are rather complex, and there are huge knowledge deficits in the health care profession regarding the course and/or treatment of a HIV infection. Accordingly important are further training courses for multipliers in the health system about current medical developments, internationally acknowledged therapy and care guidelines as well as the complex field of psycho-social influences on the quality of life of the affected people; always taking into consideration local conditions.
This portal strives to help fighting the pandemic by making public reports and analyses about the situation and on the course of the HIV epidemic as well as presenting the work of German-Ukrainian partner projects.
Bennett, J. und Janssen, S. (2000): Armut und Wirtschaftspolitik in TransformationslÃ¤ndern. Teil II: LÃ¤nderberichte: Ukraine, accessed August 2008.
UNAIDS 2008a: EPIDEMIOLOGICAL FACT SHEETS, 2008 UPDATE, accessed August 2008.
UNAIDS 2008b: 2008 Report on the global AIDS epidemic, accessed August 2008.
UNICEF 2008: Ukraine: Kinder vor AIDS schÃ¼tzen, accessed August 2008.
WHO 2008: WORLD HEALTH STATISTICS 2008, accessed August 2008.October 29, 2008 | Category: Situation