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HIV/AIDS in Ukraine

HIV/AIDS in Ukraine

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Ukraine is a country in Eastern Europe. It has an area of 603,628 km², making it the second largest contiguous country on the European continent, after Russia...

has one of the fastest growing HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

 epidemics in the world. Experts estimated in August 2010 that 1.3 percent of the adult population of Ukraine was infected with HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

, the highest in all of Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...

. Late 2011 Ukraine numbered 360,000 HIV-positive persons (increase in the rate has been close to zero compared with 2010).

Identified in the country in 1987, HIV/AIDS appeared to be confined to a small population of foreign students until the mid-1990s, when a sudden and explosive epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...

 emerged among injecting drug
The term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely...

 users in the southern and eastern regions of the country. In 2007 about 0.96 percent of Ukrainians
Ukrainians are an East Slavic ethnic group native to Ukraine, which is the sixth-largest nation in Europe. The Constitution of Ukraine applies the term 'Ukrainians' to all its citizens...

, or about 440,000 citizens, were estimated to be living with HIV/AIDS, up from 1.46 percent of the population in 2005, or 685,600 citizens, according to UNAIDS. The number of HIV/AIDS cases in Ukraine reduced by 200 or 3.9% to 4,900 in the period of January–November 2008, compared with the corresponding period of last year. Ukraine has one of the highest rates of increase of HIV/AIDS cases in Eastern Europe
Eastern Europe
Eastern Europe is the eastern part of Europe. The term has widely disparate geopolitical, geographical, cultural and socioeconomic readings, which makes it highly context-dependent and even volatile, and there are "almost as many definitions of Eastern Europe as there are scholars of the region"...


Although HIV/AIDS has to date remained concentrated among marginalized and vulnerable populations, it may be spreading to the general population. The majority of those infected are under 30 years of age; a full 25% of those affected are still in their teens.

Spread of AIDS

In the mid-1990s, transmission was primarily through injecting drug use. By 2001, however, the proportion of new cases of HIV/AIDS attributable to injecting drug use had declined to 57% from 84% in 1997. During that time, heterosexual
Heterosexuality is romantic or sexual attraction or behavior between members of the opposite sex or gender. As a sexual orientation, heterosexuality refers to "an enduring pattern of or disposition to experience sexual, affectional, physical or romantic attractions to persons of the opposite sex";...

 transmission increased from 11% to 27%, and perinatal transmission increased from 2% to 13% as a proportion of total cases.

Joint United Nations Programme on HIV/AIDS
The Joint United Nations Programme on HIV and AIDS, or UNAIDS, is the main advocate for accelerated, comprehensive and coordinated global action on the HIV epidemic....

 estimates that the number of people infected with HIV/AIDS in 2003 was 360,000 (range 180,000 to 590,000), representing an adult prevalence of 1.4%. According to the Ministry of Health—which estimates that by 2002 there were more than 500,000 people infected, or nearly 2% of the adult population—the epidemic has now spread to every oblast
Administrative divisions of Ukraine
Ukraine is subdivided into 24 oblasts , one autonomous republic, and two "cities with special status".- Overview :...

 in the country. Prevalence in the southern and eastern oblasts (Odessa
Odessa Oblast
Odesa Oblast, also written as Odessa Oblast , is the southernmost and largest oblast of south-western Ukraine. The administrative center of the oblast is the city of Odessa.-History:...

, Mykolaiv
Mykolaiv Oblast
Mykolaiv Oblast is an oblast of Ukraine. The administrative center of the oblast is the city of Mykolayiv.-Geography:The Mykolaiv Oblast is located in the southern half of Ukraine...

, Dnipropetrovsk
Dnipropetrovsk Oblast
Dnipropetrovsk Oblast is an oblast of central Ukraine, the most important industrial region of the country. Its administrative center is Dnipropetrovsk....

, and Donetsk
Donetsk Oblast
Donetsk Oblast is an oblast of eastern Ukraine. Its administrative center is Donetsk. Historically, the province is an important part of the Donbas region...

) is about three times higher than rates in the rest of the country. A major reason for this is the fact that the urbanized and industrialized regions in the East and South of Ukraine suffered most from the economic crisis in the 90s, which in turn led to the spread of unemployment, alcoholism, and drug abuse, thus setting the conditions for wider spread of the epidemic.

Among the issues driving the HIV/AIDS epidemic are high levels of migration
Human migration
Human migration is physical movement by humans from one area to another, sometimes over long distances or in large groups. Historically this movement was nomadic, often causing significant conflict with the indigenous population and their displacement or cultural assimilation. Only a few nomadic...

 and transactional sex
Transactional sex
Transactional sexual relationships are sexual relationships where the giving of gifts or services is an important factor. Transactional sex relationships are distinct from other kinds of prostitution, in that the transactional sex provides only a portion of the income of the person providing the sex...

; widespread stigma and discrimination (which prevent injecting drug users, sex worker
Sex worker
A sex worker is a person who works in the sex industry. The term is usually used in reference to those in the sex industry that actually provide such sexual services, as opposed to management and staff of such industries...

s, men who have sex with men, and other marginalized people from seeking and receiving prevention and treatment interventions); inadequate health and other social services; rising rates of tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

, sexually transmitted infections, and substance abuse; and a general lack of information about the kinds of risky behaviors that contribute to HIV/AIDS. According to the Ministry of Health, Ukraine has already surpassed the “optimistic” projections of an HIV/AIDS rate of 2% in 2010.


HIV officially reached the territory of the former Soviet Union in 1987, about 5 years after the virus itself was discovered. Until 1995 there were only a few known cases of HIV infections in Ukraine. The country was therefore deemed to be “low risk” by the World Health Organisation (WHO) in terms of spread at that time.

Between 1987 and 1994, 183 infections were reported. It can be argued, however, that the beginning of the epidemic took place unnoticed toward the latter end of the social transitional between 1991 and 1995, after the fall of the USSR. The accumulation of cases of AIDS in 2000 supplies evidence for this theory, since HIV has an incubation time of about 7 to 10 years. In addition, an observable increase in the usage of injection drugs started around 1990. In 1990, 22,466 narcotics users were registered by the Ukrainian government. By 1999 the number of cases had more than tripled to 74,544 registered narcotics users. Of course, those drug users, threatened by punishment under law, would have done anything to avoid being registered. The Ukrainian Health Department estimates a five to 10 times higher number of unregistered cases. Young injection drug users made up the first segment of society, wherein HIV infections spread very fast. The most commonly used drug was, and still is, a cheap hand made opiate called ‘Shirka’ or "khanka", English rendering may be roughly ‘jag’or 'smack' manufactured from the widely grown poppies in the countrysides.
Concerning infections of HIV, several factors of the drug-use procedure pose specific threats. It was, and still is, not easy for many to find clean injection needles. Neither places to replace needles nor sufficient harm-reduction and treatment programs are available yet. Young injection drug users especially have difficulty receiving treatment. Plus it is a widespread tradition in Eastern Europe to share a needle due to the shortage of the disposable syringes and needles. And the production of the drugs themselves is also not safe. The hand-made drugs may often be sold in a syringe already. The containers used for mixing the drug components are shared too. Apparently one method of drug delivery has died out, namely the dissolving of opiates in blood, which would then be sold for direct injection. This was common in the 1990s, and has most likely died out due to AIDS and HIV awareness. Back then, if the producer of the drug was HIV positive, soon were all his customers.
Because of the size of the HIV epidemic in Ukraine, it must be assumed that those habits were accompanied by an epidemic of drug addiction. The International HIV/AIDS Alliance has estimated figures claiming that in 2008 between 323,000 and 425,000 people in Ukraine were using injection drugs.

Causes and Extent of the Drug Epidemic

The main cause for the epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...

 spread of drug abuse
Drug abuse
Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts...

 was the collapse of the Soviet Union
Soviet Union
The Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....

. Many companies had to be closed. Mass unemployment led to poverty and lack of prospects for the future. On the other hand, during and immediately after Ukraine has become independent there was a phase of low state control. Lawless areas emerged and especially young people lacked orientation. Due to the fact that the Soviet ideology
Ideology of Soviet Communism
The State ideology of the Soviet Union embodied a number of different theoretical streams, originating primarily from within the Marxist ideology of socialism, but with some minor threads emerging from within the Russian revolutionary movement such as the ideology of the Left...

 had also been a substitute for religion, the system of values deteriorated along with the old state.

Badly affected regions were those that had been the most industrialised in the country during the Soviet period, which now experienced a sudden downfall due to the collapse of the industry.

The need for drugs and the explosive increase of the drug market was facilitated by the effortless availability of drugs in Ukraine. This is presumably why drug abuse, and consequently the HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

 epidemic, spread faster and wider in Ukraine than in other former Soviet republic. Why there have long been not only huge amounts of drugs, but also various kinds of drugs can be explained by: 1. Ukraine is a customary transit country for opium
Opium is the dried latex obtained from the opium poppy . Opium contains up to 12% morphine, an alkaloid, which is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and non-narcotic alkaloids such as papaverine, thebaine and noscapine...

 transport from the Middle East
Middle East
The Middle East is a region that encompasses Western Asia and Northern Africa. It is often used as a synonym for Near East, in opposition to Far East...

 to Europe. 2. The soil is of good quality, and thus opium poppies flourish in the country. 3. Some Ukrainian cities are traditional locations for the chemical industry. On the other hand, the state has little control or only nominal oversight over the pharmaceutical industry.

For these reasons, it was possible that the opioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...

An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

Tramadol hydrochloride is a centrally acting synthetic opioid analgesic used in treating moderate pain. The drug has a wide range of applications, including treatment for restless legs syndrome and fibromyalgia...

, after its approval in 2004, becomes one of the most popular gateway drugs within a few months due on the black market.

The dissolution of the Soviet Union
Dissolution of the Soviet Union
The dissolution of the Soviet Union was the disintegration of the federal political structures and central government of the Union of Soviet Socialist Republics , resulting in the independence of all fifteen republics of the Soviet Union between March 11, 1990 and December 25, 1991...

 was the prerequisite and the cause for the outbreak of the HIV epidemic in Ukraine. Other reasons can be found in the Soviet and Russian past, respectively. The production and (especially collective) use of ordinary opiates like kompott, "mastyrka" and schirka or ephedrine
Ephedrine is a sympathomimetic amine commonly used as a stimulant, appetite suppressant, concentration aid, decongestant, and to treat hypotension associated with anaesthesia....

Derivative (chemistry)
In chemistry, a derivative is a compound that is derived from a similar compound by some chemical or physical process. In the past it was also used to mean a compound that can be imagined to arise from another compound, if one atom is replaced with another atom or group of atoms, but modern...

 like wind was already common in the Soviet Union. Those drugs have become fashionable since the 1990s, stimulated by the home coming Afghan War veterans many of whom had got used to opium consumption over there. Despite the defeat, in the most adolescents' eyes the soldiers glowed with freedom and adventure, so that many imitated them.

The fast spread of drug use among adolescents is to be seen in the context of the far older population alcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...

, originating in the Russian tradition. Still today alcoholism is one of the largest health risks, especially for men in the former Soviet Union. Adolescents whose parents drink tend particularly to use drugs.

Further important factors for the spread of HIV in Ukraine are the prisons and penal colonies.


Between 1996 and 2001 about 26 percent in various prisons across Ukraine tested HIV- positive. In a January 2005 study between 15 and 30 percent of prisoners tested HIV- positive.

A very high percentage of the prison population of Ukraine are drug addicts. Two laws contribute to that. First, one can be sentenced to three and more years of detention for the smallest amount of illegal drugs. Second, the militia
Militsiya or militia is used as an official name of the civilian police in several former communist states, despite its original military connotation...

 is still measured according to their output, i.e. the number of convicted crimes. It is not an exception but the rule that the target is fulfilled with drug addicts, who are easy to find. As everywhere in the world, drug use is higher in prisons than outside, but syringes are even scarcer. Altogether, bad hygienic conditions prevail in the prisons. Another problem is the violence among the detainees. A major transmission route
Transmission (medicine)
In medicine and biology, transmission is the passing of a communicable disease from an infected host individual or group to a conspecific individual or group, regardless of whether the other individual was previously infected...

 for HIV is rape
Rape is a type of sexual assault usually involving sexual intercourse, which is initiated by one or more persons against another person without that person's consent. The act may be carried out by physical force, coercion, abuse of authority or with a person who is incapable of valid consent. The...

. Moreover, even today, no broader preventive measures would allow the detainees access to preventive aids in Ukrainian prisons. Early 2005 rates of up to 95 percent of the prisoners were found Hepatitis C
Hepatitis C
Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...


Early 2010 there were over 147,000 people held at prisons
Prisons in Ukraine
Prisons in Ukraine are regulated by the State Penitentiary Service of Ukraine that is part of the Ministry of Justice of Ukraine.There are 32 preliminary prisons, 131 penitentiary establishments for adults and 8 colonies for minor criminals in Ukraine. According to Amnesty International torture and...

 and more than 38,000 at pre-trial detention facilities in Ukraine.

Transmission through sexual intercourse

The spread of HIV through sexual intercourse is steadily increasing. Of those 122,674 people who have been registered HIV positive in Ukraine in 2007, 40 percent have been infected by injecting drugs and 38 percent due to sexual intercourse. Although experts still speak about an epidemic, which mainly concerns the risk groups, the increasing HIV infections because of sex indicate that it is only a matter of time before the epidemic hits the common population. The most important interface between the drug milieu and the rest of society is the sector of prostitution. This is how many women who are addicted to drugs or live together with drug - addicted men try to make a living and pay for their drug consumption. Transmission in the prostitution sector is not officially registered in Ukraine. First surveys, however, show a huge increase in numbers.
The reason why prostitution is on the rise in Ukraine is because of the poverty of these women and the increasing demand. In the last years there was an observable rise in sex tourism in this country. Consequently, sexual activities and human trafficking are increasing, too. Some polls among prostitutes show that they do not use condoms regularly. In a 2007 survey, only 48 percent claimed to always insist on safer sex. This survey was addressed to women who had already been in touch with an educational advertising program. (This is why the people conducting the survey could contact them.) An improvement in the situation of prostitutes could be achieved because prostitution was made legal in Ukraine in 2006. Hopefully this will help to encourage prostitutes to seek out doctors or consult prevention contact points.
The transmission of HIV among homosexuals and bisexuals does not play as great a role in Ukraine as it does in Western Europe or North America. From 1987 to 2007, 157 cases have been officially recorded, one third of them in 2007 (48 new infections). Indeed it can be assumed that along with the increase in sexual transmission in general, the number of infections among homosexuals is rising as well. It is difficult to assess this circumstance as many homosexuals who have proved to be HIV positive prefer to claim a different path of transmission. From 1991 on, homosexuality has no longer been an offence, but homosexuals are still discriminated against. Consequently, this group of people is also very difficult to reach via educational advertising. According to surveys carried out by the Global Fund only 5 percent of them can be reached.

Infected children

Since 2004, pregnant women and mothers who receive a HAART (highly active antiretroviral therapy) have been recorded. In 2006, 2,822 HIV positive mothers gave birth in Ukraine. In 2007, the number increased to 3,430. The treatment of these women with HAART decreased the risk of transmission of the virus from the mother to the child by 92.5 percent in 2007 (In 2006 the risk was decreased by 91 percent, which led to a 7.1 percent decrease in HIV positive newborns).
Teenagers and young adults, however, are exposed to a far bigger danger by risky sexual behavior. An extensive survey, which was carried out in 2007 among young people between the ages of 15 and 24, showed that 5 percent of them had sexual intercourse before they were 15. No prevention programs are aimed at this age group.
The risk for children and teenagers who grow up in the milieu of drug addiction and prostitution as well as for the unknown number of street children is estimated to be even higher.

Street Children

Children and teenagers who live on the street are very likely to be infected with HIV or other sexually transmitted diseases like tuberculosis. There are no official statistics about sanitary and psychosocial problems among this risk group. Risky behavior concerning their health and resulting problems are very likely because of their environment and have been proved by extensive surveys. This includes bad nutrition, unhygienic conditions, alcohol and drug consumption, psychological and sexual abuse, drop outs from school and a limited knowledge of HIV.

Spread of AIDS among children

The number of children with AIDS in Ukraine is on rise, since the number of mothers with HIV grows by 20-30% annually. According to the United Nations, the number of pregnant women with HIV was 0.34% in 2007, which was the highest index in Europe. According to the United Nations, of nearly 18,000 children born by HIV-positive mothers in Ukraine, 10,200 children have not contracted HIV and another 5,500 children under eighteen months have yet to receive final results of examination. In Ukraine 1,877 children have been confirmed as HIV positive and 244 have died of AIDS. The United Nations notes that the program of preventing mother-to-child transmission of HIV in Ukraine has cut the share of such transmission from 27% of the number of HIV cases in 2000 to 7% in 2006.

Preventive Measures

Despite all preventive measures described here, one must take into account that the main causes of the HIV epidemic in Ukraine are embedded in the country’s social crisis. If the consequences of this crisis – like mass poverty and lack of prospects or lack of solidarity – cannot be improved, the politics of AIDS will not be successful either.

Harm Reduction programs

A great influence in containing an epidemic is the availability of harm-reduction-programs. Programs for handing out sterilized needles are of greatest importance. The impact of those programs will be minor however, as long as the usage of drugs is a crime.
The success of drug substitution programs lies in the ability to give drug addicts the chance to escape withdrawal symptoms and participate in social life with the use of legal and clean injections. Therefore, the vicious circle of drug use, drug-related crimes, precarious social status and the need to temporarily escape the latter can be broken.

Drug substitution programs require a stable society, which is capable and willing to integrate drug addicts and offers them an alternative to the lack of perspective that led them to drugs. Since those factors are not given in contemporary Ukraine, the introduction of drug substitution programs is doubtful. This particularly, because it is unclear if governmental control mechanisms suffice to prevent substitution drugs from being dealt illegally.
Since 2003, drug substitution programs have been introduced in Ukraine. By the end of September 2008 they were offered to about 2200 persons in 38 locations. Mostly Buprenorphin (Trademark ‘Subutex‘) is dispensed, which is significantly more expensive than Methadon. It is also less frequently used and thoroughly researched worldwide. Buprenophin is more accepted by society and politicians however, because it is seen as a painkiller. Methadon, in contrast, is viewed as a drug subscribed at public expense.

National response

The policy and legal environment in Ukraine
Ukraine is a country in Eastern Europe. It has an area of 603,628 km², making it the second largest contiguous country on the European continent, after Russia...

is generally favorable for combating the spread of HIV/AIDS, but there is a gap between national-level policies and laws and local-level practices. The National AIDS Committee was established in 1992 but was dissolved in 1998 because of budget disputes. In 1999, the government created the National AIDS Control Coordinating Council under the Cabinet and mandated that all regions establish HIV prevention programs. In 2001, a national plan for combating HIV/AIDS was approved; its goals included preventing the further spread of HIV, developing capacity to treat infected individuals, and providing social support and counseling for those living with HIV/AIDS.

Although the HIV/AIDS law is one of the most progressive in the region, the government still treats HIV/AIDS primarily as a medical issue. Prevention activities have been largely funded by international organizations. Because HIV testing is limited to government facilities, those at greatest risk are not being reached, since marginalized populations are the least likely to use government facilities. Stigma by the medical profession against persons living with HIV/AIDS is a major barrier to accessing information and services.

The first Ukrainian advocate group of/for Ukrainian aids patients was launched on December 10, 2010.

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