Nobody expected when Ukraine gained its independence back in the early 1990s that Eastern Europe would fall a victim to a potentially devastating HIV/AIDS epidemic. And it would have been equally less expected that Ukraine would end up with one of the fastest-growing infection rates in Europe with a new case recorded every 10 minutes. Nor would have these facts encouraged veteran British pop star Sir Elton John, founder of an AIDS charity who recently gave a free outdoor concert in Kyiv to raise AIDS awareness in Ukraine.
"It is estimated that by 2014 there will be more than 100,000 infected children [in Ukraine] alone, of which 42,000 will be orphaned. There is so much to be done if we are to control the relentless spread of this terrible disease," said John after arriving in Kyiv.
According to the World Bank's socio-economic forecast of the HIV/AIDS epidemic, 40,000 children will become full orphans and up to 169,000 children will lose one of their parents due to HIV/AIDS in Ukraine by 2014. Most of these children will inherit HIV status from their parents. In an attempt to avert this grim future, the Elton John AIDS Foundation has developed a five-year project aimed at supporting foster families, decreasing stigma and discrimination against HIV positive children, addressing their psychological needs and teaching parents and guardians on how to talk about HIV with children.
Ukraine’s AIDS problem growing
Over the last six years, the group has already funded twenty three HIV/AIDS related projects in Ukraine totalling more than USD 2.6 million.
A decade after the World Health Organisation classified Ukraine as a low HIV prevalence country, the country suffers the worst HIV/AIDS statistics in Europe. Nearly half a million people (477,000) of the 47-million nation have been infected with HIV since the first reported case in 1987 and each day brings 32 new HIV cases and 8 AIDS deaths.
The disease, which was initially spread by intravenous drug users, is now becoming widespread and within the next decade as many as one in 50 people in the country or 820,000 could be HIV positive.
Annual AIDS deaths are approaching 10,000 and by 2014 AIDS-related deaths could account for almost one-third of all male deaths and 60% of female deaths in the 15-49 age group, according to the World Bank.
Until now, the spread of HIV in Ukraine was restricted to certain groups, mainly drug users. The epidemic's more recent tendency to spill into the general population is however reflected in official Ukrainian AIDS Centre data indicating that the share of infections caused by intravenous drug use decreased from 83.6% in 1997 to 46.5% in 2004, while the percentage of heterosexually transmitted infections grew from 11.3% to 32.4%.
High-risk groups remain the worst affected by the epidemic: the average prevalence rate among drug users is 37.2% and 22.2% among commercial sex workers. At the same time, the wider population is increasingly at risk, mostly through heterosexual contact.
The HIV/AIDS epidemic could have serious consequences for Ukrainian society and could even jeopardise future development. In the medium term, it will affect economic growth, investment, social welfare, life expectancy and population growth. "If current trends continue without effective control of the epidemic, the longer-term impact could be much more devastating. The cost of inaction or ineffective action would be prohibitive," the World Bank warns.
Collective failure has prevented Ukraine from controlling the spread of the virus and low understanding of its potentially devastating impact contributes to stigma, denial and inadequate responses.
Elena Franchuk, head of the Kyiv-based ANTIAIDS Foundation says: "The majority of people know about AIDS, but they don't think it could be their problem. That's why they behave as if they are below the threat. But AIDS is not a distant problem any more. It's not a problem of risk groups as it used to be. There is no more somebody's problem, it's everybody's problem from now on. It's not true any more to think of HIV as a disease of the most at-risk population. We should think of HIV as our disease that affects ourselves, our relatives, our friends and neighbours. We are all on the edge."
Spread worst in the regions
Among the worst-affected regions are those in the southeast industrial oblasts of Donetsk and Dnipropetrovsk, as well as Odessa and the Mykolaiv. Accounting for only a quarter of the total population of Ukraine, these regions will bear an estimated 36-43% of accumulated HIV cases by 2014 and 31-38% of annual AIDS-related deaths, the World Bank says.
The regions need particular attention because the negative effect from HIV/AIDS is aggravated there by a high share of employment in industrial sectors with often unsafe labour conditions and high risk of trauma, environmental degradation.
The economic threat
HIV/AIDS threatens to affect economic growth in Ukraine, through many branches of the economy including households, businesses and the government. Medical expenses associated with treating HIV/AIDS can become catastrophic at the household level, driving poor households below the poverty line. This is particularly true in countries such as Ukraine with weak social and private insurance systems.
Total annual AIDS care expenditure is estimated to reach USD 125 million by 2014.
The loss of productive time spent on income-generating activities could also lower the tax base, shifting more of the tax burden to the healthy remainder who may in turn respond by reducing their labour supply.
In terms of sectors, the most affected are found those producing non-energy materials and processing metallurgy and, with output falling by up to a third. Given the relative share of these sectors in the country's trade structure, the estimated fall of 40% in exports of these sectors translates into a 5.5% fall in GDP, an 8% fall in total welfare, and a 9% fall in investment by 2014. Although the World Bank’s figures are clearly leaning towards a worst-case scenario, they are nevertheless sobering.
The official response to HIV/AIDS
The World Bank has praised increasing HIV/AIDS public awareness as the government, NGOs and international agencies have improved the national response, but the bank still stresses that there is still much to be done.
The National AIDS Committee was established in 1992 and replaced by the National AIDS Control Coordinating Council under the Cabinet in 1999. The Ukrainian National Program on HIV/AIDS Prevention for 2004-2008 was prepared, and various prevention programs are being implemented. As part of the public health system response, 35 regional AIDS centres are operating, providing preventive, diagnostic, medical and counselling services through activities coordinated by the Ukrainian AIDS Centre. At the district level, similar services are provided in district hospitals, through infectious diseases departments and consultation clinics. As of October 2005, 2,866 patients were receiving highly active anti-retroviral therapy, but this is only about 15% of those needing it, according to the Ukrainian AIDS Centre.
Hospitals and hospices still suffer from old equipment, lack of medicine, miserable conditions and a negative morale among staff, especially in the regions. The society still sees those suffering from AIDS as social outcasts, while sex education still leaves much to be desired.
"Today it's not enough to inform about disease and ways of transmission. Today our target is to change patterns of behaviour and teach the whole country how to live in the age of AIDS,” says Elena Franchuk.
