Like its neighbor Russia, Ukraine is currently struggling against epidemics of dangerous contagious diseases, such as HIV, Hepatitis C, and multi-drug resistant tuberculosis. While the country has made remarkable progress thanks to the partnership of the post-2014 government with civil society organizations, Ukraine also faces an added burden. It must care for those at-risk citizens who live under Russian occupation, both in the Crimean peninsula and in the Russian occupied territories of the warzone in the east.
On Wednesday and Thursday, United Nations Special Envoy for HIV and AIDS in Eastern Europe and Central Asia, professor Michel Kazatchkine, held a conference at Kyiv’s Alliance for Public Health and then visited some of the city’s harm-reduction organizations specializing in activities including needle exchanges, free medical testing, and condom distribution.
Speaking at the conference, Kazatchkine explained that the main vector for the spread of HIV in Ukraine and other Soviet countries was intravenous drug use, and that virus experienced rapid growth in the former Soviet Union area between 2005 and 2015.
According to Kazatchkine, the phenomenon is a “concentrated epidemic,” meaning that the epidemic is prevalent among certain sub-groups of the population, but not the general population as a whole.
One of main reasons for the prevalence of the epidemic is the poor healthcare system inherited from the Soviet Union. Approximately 30 percent to 35 percent of HIV-positive people in Ukraine have access to treatment, though only 50 percent know about their HIV-positive status.
Despite the discouraging statistics, Kazatchkine said he sees progress in Ukraine thanks to the work of NGOs in partnership with the government. Unfortunately, a significant portion of Ukraine’s territory is under control of Russia and its proxies, and this has created serious obstacles for those trying to help fight the spread of HIV and AIDS.
The Crimean peninsula, for example, was formally annexed by the Russian Federation in 2014. As such, it has become fully subjected to Russian law. This has led to problems for patients in opioid-substitution therapy programs. While such programs operate successfully in Ukraine, Russian law does not permit opioid-substitution therapy. The program managed to continue in the occupied territories of the Donetsk and Luhansk, but eventually had to be terminated when supplies of the substitute drugs ran out.
Other harm-reduction programs in the eastern occupied territories have had more success, as Russia disavows any authority over the so-called “Donetsk and Luhansk People’s Republics” (DNR and LNR).
Natalia Hurova works in occupied Luhansk as a coordinator for harm-reduction programs with the All-Ukrainian Public Health Association. “We have been operating since 2014 in Luhansk and three small towns,” Hurova told VOA.
“We actually perform operations the same way we did before the conflict. We have contacts with the local authorities and they let us perform our activities,” she said.
Despite official permission, the situation remains complicated by the front line, along which fighting still occurs daily. In the case of Luhansk, there are no official crossings directly into the city. Instead, supplies must first come through Donetsk, and then cross a “state border” between the two self-proclaimed republics. Hurova said this actually requires filling out customs papers for shipments.
For Hurova, the biggest challenge is maintaining opioid-substitution therapy, as the local authorities do not support the program. Some addicts enrolled in the program managed to travel to government-controlled territory to continue their treatment, but this is not possible for everyone. Some of those who could not make the move went back to illegal drugs, many of which are homemade and extremely dangerous, such as “desomorphine,” commonly known as “krokodil.”
Despite the setbacks, programs like needle exchanges and condom distribution still manage to function in the occupied territories thanks to special arrangements.
“We have a corridor through which we receive supplies,” said Hurova.
In spite of seemingly overwhelming challenges coming from a hopelessly outdated and corrupt medical system — along with foreign occupation, and war — workers in the fight against HIV and other epidemics remain positive about the future.
Andriy Klepikov, executive director of the Alliance for Public Health, told conference attendees that his country has seen “a number of positive signs and successful programs.”
The APH still works in Crimea and the occupied part of the Donbass region, and has set a goal of “90/90/90” for HIV and AIDS, meaning 90 percent of the population tested, 90 percent access to treatment, and 90 percent successful results of viral suppression among treatment recipients.