The HIV and Tuberculosis Epidemic in Ukraine

In relation to Europe, Ukraine is facing the worst of the HIV epidemic. Ukraine, which is highly likely to be facing diplomatic pressure from the Russian government, is experiencing severe issues with HIV, similar to Russia. The percentage of Ukrainian adults infected with HIV increased from 0.96% in 2007 to 1.3% in 2010, causing them to have one of the highest rates of increase in Eastern Europe. Russia, on the other hand, accounts for some 70% of all registered HIV infections in the regions of Europe and Central Asia alone. With the estimated number of HIV cases being 3 million it is believed that in the next ten years 50% of the Russian population could be infected with HIV; and since the country has no state-funded needle exchange program and limited access to retroviral treatment for HIV they are facing a serious epidemic.

HIV is a problem that largely affects intravenous drug users (IVDU) but it is not solely within this population that it is spreading. For IVDUs opiate substitution treatment (OST) is used to aid in breaking their addiction with opiates. The drugs mimic the same effects of the opiates but allow the person to have more function and control in their daily life. In the Ukraine, there is a strong police presence near harm reduction clinics that can provide OST with drugs such as methadone. The police officers demand the completion of a survey by the patients asking them information regarding their criminal record, HIV status, and methadone use; OST can be withheld if the survey is not filled out. The presence of law enforcement drives drug users away from the clinics and further fuels the spread of HIV. HIV is also highly stigmatized in Ukraine and filling out this survey would label them as HIV-infected, forcing them to face the prejudices associated with the diagnosis. Joseph Amon of the Human Rights Watch stated in a letter to the Prime Minister of Ukraine: “We have found that in Ukraine, as in many other countries, police presence at or near harm reduction programs drives people who use drugs away from these services due to fear of arrest or other punishment, and increases the risk of HIV and other negative health outcomes.”

Even though there are services in Ukraine that are not present in Russia that are supposed to provide help to IVDUs infected with HIV an estimated 2% receive the actual treatment. And out of the approximate 45,000 who need antiretroviral treatment only 500 are actually receiving it. Unlike Russia, in some cities in Ukraine pharmacies provide syringes, condoms, and educational material to IVDUs to help prevent the spread of HIV. However, 1/3 of IVDUs still share needles.

Another issue accompanying the Ukrainian government and HIV are the issues surrounding the treatment of tuberculosis (TB). Tuberculosis is an infection that usually accompanies HIV because of their increased susceptibility and decreased immune system. TB is the leading cause of death amongst people infected with HIV. Treatment for TB is also extremely limited and inadequate, making the interaction between HIV and TB even worse. The situation is further worsened by the increasing number of multi-drug-resistant cases of TB, consisting of approximately 10-15% of all TB cases. Drug-resistant TB is especially spreading because of the shortage of medications, inadequate treatment, and the fact that it is difficult and expensive to treat. Joseph Amon, along with other Ukrainian citizens, is urging for more measures for responding to drug-resistant TB, more support for HIV organizations, and the elimination of the intimidation used on patients wishing to receive opiate substitution treatment.