Ukraine HIV Rates Alarm

Up to 80 percent of people living with HIV/AIDS in Ukraine are under the age of 30, compared to just 30 percent in the U.S. and Western Europe. Originally a drug-driven epidemic, the share of heterosexually transmitted infection has increased dramatically from 15 percent to almost 40 percent in the space of just five years. While the cumulative official total of HIV cases in Ukraine was 65,495 as of April 1 this year, with a further 6,813 registered with AIDS, the World Health Organization estimates that realistically, the total could already be nearing 600,000. Yet, there was little mention of Ukraine at the recent international conference on HIV/AIDS in Bangkok. U.S. President George W. Bush's $15 billion HIV/AIDS plan, focusing exclusively on countries in Africa, the Caribbean and Asia, takes no account of the seriousness of the epidemic in Ukraine, or in Europe and Eurasia generally.

Boasting a highly educated population and positioned strategically between Russia and the newly expanded EU, Ukraine has struggled to rebuild its economy following the collapse of the Soviet Union in 1991. The country is beset by health and demographic problems associated with an aging population and decreasing birthrates. Even before factoring in deaths from HIV/AIDS, the population is expected to decline from about 47.3 million in 2005 to 45.9 by 2010. In the absence of scaled-up interventions, the impact of HIV/AIDS in Ukraine is projected to accelerate the country's demographic decline, further decreasing the population by between 900,000 and 2.1 million (1.4 percent to 3.1 percent) by 2016. Because the epidemic predominantly affects young people it will lead inexorably to a reduction in society's most economically productive sector, hampering the country's transition to a market economy. Increased service demand from HIV/AIDS patients will encumber an already overstretched health system, absorbing between one-fifth and one-half of Ukraine's total health budget by 2010. This will reduce prospects for sustainable social and economic development and reverse gains already made since independence, leading possibly to political and social unrest. Instability in such a strategic location could also impact on surrounding states, making HIV a security threat not only for Ukraine itself, but also for its regional partners.

The TB epidemic in Ukraine and its convergence with HIV makes tackling the crisis even more urgent. As a recent WHO report highlights: "both diseases are devastating, but the devastation of the HIV/TB co-epidemic surpasses the devastation of either disease on its own." TB is the biggest killer of people with HIV worldwide, with HIV-positive individuals more than 100 times more likely to contract TB than those who are HIV negative. TB is also the only major opportunistic infection that can spread through the air from a HIV positive person to otherwise healthy individuals, making HIV an important factor in the spread of TB.

Affecting 1.5 percent of the population, TB is the most widespread infectious disease in Ukraine today. Currently averaging 70 per 100,000, (compared to 5 per 100,000 in the U.S.), rates of TB in Ukraine have been high for a number of years, jumping 73 percent since the fall of the Soviet Union in 1991. According to WHO estimates, the prevalence of HIV among adults with TB is already at 5.7 percent. The dramatic rise in multi-drug resistant TB (MDR-TB), is a further complicating factor, with rates of up to 25 percent registered in some regions and the disease is propagating fastest within the prison system. MDR-TB in HIV-infected individuals is even more difficult to treat than non-resistant TB strains and leads to rapid death among HIV patients. Unfortunately, however, chronic lack of resources and drugs, as well as absence of post-prison healthcare are aggravating the spread of disease. HIV and TB continue to be treated separately and there is little collaboration between institutions. Integration of HIV and TB services is essential to curbing an imminent collision of epidemics. While the recently initiated World Bank supported project intends to tackle the issue of HIV/TB co-infection in prisons in a small-scale project in the southeastern Donetsk region, there is, as yet, no project specifically targeting co-infection among the general population anywhere in the country.

There is widespread concern that present trends cannot be reversed even if all donor supported, Global Fund, EU and other international and domestic programs are implemented at currently budgeted levels. Massive scale-up of prevention, harm reduction and treatment programs is urgently needed in order to stem the burgeoning epidemics. The Ukrainian government, however, has no plan to extend and sustain current interventions following completion of the Global Fund and World Bank-supported projects in 5 years time. Although the scale of the crisis far exceeds Ukraine's capacity to respond, securing long-term national leadership to tackling HIV/AIDS and TB and increasing investment in general healthcare is crucial - both in terms of reversing the present public health crisis and to the assurance of future economic and social stability.

Recent calls for increased political commitment by EU member states to bolster health systems of their neighbors like Ukraine and to establish effective surveillance for communicable disease are prudent and necessary. Increasing migration within the newly expanded European Union, across the border with Ukraine and Russia, as well as to other parts of the globe, heightens the risk of spread of HIV, TB and other infectious diseases. More than 1 million people reportedly leave Ukraine annually in search of work abroad, while the numbers of illegal migrants to Ukraine approaches 550,000, according to UNDP. Thus, the parallel rise in HIV and TB morbidity rates increases the risk not only of onward transmission within Ukraine itself, but also for cross-border spread.

The crisis facing Ukraine is not just a national problem, but a global emergency and demands a global commitment to intervention. Concerted action now can dramatically reduce the human and socio-economic costs of HIV and TB in the country. The urgency is clear.
 

By Cristina Galvin and Murray Feshbach, USAID Research Project HIV/AIDS Russia/Ukraine. Woodrow Wilson International Center for Scholars, Washington, DC. They contributed this piece to The St. Petersburg Times. The views expressed are specifically those of the authors and do not necessarily represent those of USAID. 

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ко-мент Ба-Лдей Аги :

• при такой структуре передачи инфекции (40% половым путём) скорость не может быть столь высокой, что показывает опыт РФ, где доля половой передачи в два раза ниже, а скорость роста числа ВИЧ+ заметно снизилась
• 600 000 = это число ВИЧ+ в РФ, умноженное на два; при том, что население Украины раза в три меньше (49 млн); оценка ВОЗ явным образом завышена, при этом мотивы завышения (имхо) не раскрыты. Возможно по этой причиние проект глобального фонда на Украине был приостановлен -- мб, не обнаружили ожидаемого числа ВИЧ+?
• making HIV an important factor in the spread of TB = это непонятно
• to establish effective surveillance = украинская (бывшая советская) система регистрации однозначно лучше евросистемы. В принципе регистрация -- единственное, что совковая система здравоохранения делала хорошо. К сожалению, дальше этого не шла -- анализ полностью отсутствует до сих пор ;(не только на Украине).
• also for cross-border spread = это уже просто неприлично, не стоит забывать, что ВИЧ не является хохляцким изобретением, а занесён туда, мб, из той же Европы + ВИЧ поражённость и Европы и США выше
• is not just a national problem = мягкое обоснование гуманитарной бомбардировки ?