KIEV, Ukraine — Ukraine’s AIDS nightmare may be about to become worse.
At the moment the ex-Soviet republic is already the country hardest-hit in Europe, with an estimated 360,000 individuals suffering from AIDS or HIV.
But experts say that they have been tracking an alarming trend in the past years: HIV is increasingly moving from isolated, individual niches into the general population. And both health officials and NGOs agree that the country's response is vastly underfunded.
Recently, a small, yellow bus entered a back parking area amid the crumbling white high-rises in Kiev’s Obolon bedroom community and halted in front of a small convenience store. This is the frontline in the battle against HIV/AIDS in Ukraine. In a few minutes, its clients gradually appeared: eight men apparently in their 20s or early 30s, dressed similarly in jeans and windbreakers, with close-cropped hair.
The bus belongs to AIDS activist organization ENEY, and the young men had come to be tested for HIV. All are drug users — the sector of the population, along with sex workers, battered hardest by the disease in Ukraine. According to ENEY workers, about 40 percent of all addicts may be infected.
Inside the bus, Anton, a medical technician with Latin script tattooed up both his arms, drew blood from each in turn, and after 10 minutes delivered a verdict — seven were healthy, but one was HIV-positive.
“Today was a relatively good day — quiet. No fights, and the police did not hassle us,” said Anton, as the bus pulled away.
An estimated 1.3 percent of Ukraine’s adult population is believed to suffer from HIV/AIDS. Officially, just over 100,000 people are infected, but government officials concede that the number is probably much higher. Some 19,000 have died since 1987.
According to the United Nations’ organization UNICEF, eastern Europe and central Asia are the world regions where the HIV virus is spreading fastest.
The Ukrainian government’s response — though focusing on the right areas with the correct methods — has been insufficient. “Ukraine has all the set-up, but it needs to do much more,” said Anna Shakarishvili, the director of the United Nations’ HIV/AIDS program in Ukraine.
According to Shakarishvili, less than half of those infected with HIV/AIDS receive treatment, while only one-third of drug users have access to preventive measures, like clean needles.
Compounding the problem is the fact that Ukraine is overwhelmingly dependent on international donors for providing the funds and means to deal with the problem — while the world economic crisis means that many of these resources are being curtailed.
Ukrainian health officials agree that the government’s reaction has fallen short, but they say that they can only do so much with the money that the central government budgets them. Svitlana Cherenko, head of the health ministry’s HIV/AIDS unit, said that they need five times the $40 million that is now allotted to combat the disease adequately. Of this sum, however, the ministry only received about $24 million.
There is one bright spot however, said Cherenko: The rate of infections has slowed considerably.
“If we were looking at a 40 percent increase year-on-year in the beginning of the decade, now it's dropped down to around 5 to 7 percent,” she said.
Ultimately, a society-wide outbreak could prove far beyond the capabilities of Ukraine’s antiquated, cash-strapped and corruption-rife medical system, which has been exacerbated by the ongoing economic crisis.
“Some projections are already available,” Shakarishvili said. “Unless Ukraine’s efforts are not upscaled, we will be seeing about 25,000 new infections every year.”
ENEY is one of a handful of NGOs battling the AIDS epidemic. Its name is a play on the letters “NA” — or “Narcotics Anonymous,” a nod to the organization’s beginnings a decade ago as a drug-addicts’ offshoot of Alcoholics Anonymous.
In short order though, the group’s remit expanded to trying to stem the flood of HIV infections. Its mobile testing laboratory also checks for syphilis and hepatitis, and contains a small back room to administer onsite gynecological consultations.
Crucially, ENEY workers pass out free condoms and sterilized needles in boxes of 100, traveling on a weekly basis to areas in Kiev with high numbers of drug users. The group helps some 9,000 individuals, members say.
All of ENEY’s workers are former drug addicts, and the majority are HIV positive. Among their collective is the granddaughter of a former deputy health minister. The organization receives all its money from the Global Fund to Fight AIDS, Malaria and Tuberculosis. They receive nothing from the Ukrainian government, they say.
“We’re seeing more and more people with HIV from sex,” said Vladimir Moiseev, one of ENEY’s leaders , who worked as a bassist and music producer before joining the group. Moiseev added that earlier the group overwhelmingly encountered people who had been infected with HIV through the use of dirty needles.
A major impediment to prevention is an ingrained culture to avoid discussing AIDS or to recognize it as a threat to the nation at large. Though billboards promoting the use of condoms and safe sex are in evidence around Kiev, experts like the U.N.’s Shakarishvili say that the majority of the country’s youth are still badly informed about the disease. Prejudices also persist. Despite legislation to the contrary, those who are HIV-positive can be turned away from hospitals or forced to check out early.
Apathy also reigns. Moiseev, who himself is not infected, said that he must push his cohorts to regularly take their anti-viral medication, which is provided free of charge in Ukraine. They in turn more often than not must harangue the people whom they work with to receive treatment, once they are diagnosed.
“It’s not customary in our country for people to go to the hospital,” said Moiseev, an imposing gentle giant with a shaven bald head. “I have to kick my co-workers in the ass, and they do the same with our clients. Because I want them to live longer.”