Donbass: the HIV Epidemic Growing on Both Sides of the Border
Author: Yana Kazmirenko, Ukraine
HIV is rapidly spreading in the east of Ukraine, which for over three years remains the area of military actions. For two years, pregnant women have not been tested for HIV, and medications could only be delivered illegally.
The armed conflict between Russia and Ukraine divided Donbass into two parts: areas controlled by the central Ukrainian government and the so-called Donetsk and Lugansk People’s Republics (DPR and LPR). The latter are controlled by pro-Russian separatists.
This Russian-Ukrainian conflict demonstrated the differences in the approaches of the two countries to HIV/AIDS treatment and prevention. Thus, in Russia opioid substitution treatment (OST) for people who inject drugs is banned. After Ukraine no longer supplied OST drugs to Donetsk and Lugansk, relevant programmes were also terminated in the areas not controlled by the Ukrainian government. According to experts, the war brought the region back to the 90s in terms of the spread of HIV.
Only half of those in need take the therapy
Sergey Dmitriyev, member of the Coordination Council of the All-Ukrainian Network of People Living with HIV says that there are 16 thousand HIV-positive people living in the areas of Donetsk region not controlled by the Ukrainian government. Only half of them take the therapy. In the Lugansk region, the situation is similar: 2.7 thousand people living with HIV registered, 1.4 thousand – taking the therapy.
On the territory controlled by the Ukrainian government, 13.6 thousand people with HIV positive status are registered, and over seven thousand receive the therapy. It is not surprising that the level of HIV prevalence here is 676.9 per 100 thousand people, which is 2.2 times higher than the average indicator in Ukraine. The highest rates are recorded in Dobropole (1,459.6 per 100 thousand people) and Mariupol (1,154.5).
Apart from the official statistics, the number of undetected HIV cases is at least the same as the number of cases registered as the epidemic in Donbass has long gone beyond the vulnerable populations.
AIDS centres across the border
Natalia Bezeleva, Head of the NGO “Club Svitanok,” thinks that during the three years of armed conflict only services and deliveries of medications have been re-established in the region. Currently, in the Ukraine-controlled areas , here are 22 sites to prescribe antiretroviral therapy. She remembers the deficit of antiretroviral drugs as a bad dream – her organization had to smuggle the drugs for over a year. Since 2016, the Global Fund has also joined the delivery of supplies, providing the necessary drugs, while UNICEF – the United Nations Children’s Fund – has been bringing the supplies to the “LPR” and the “DPR”.
Ms. Bezeleva illustrates failure of the established HIV/AIDS diagnostics and treatment system with the following fact: in 2014, the Donetsk regional AIDS centre remained on the territory not controlled by the Ukrainian government. Polymerase chain reaction (PCR) tests have not been transported through the newly created border, so for two years, no HIV diagnostics was done for children. Another big challenge was the deficit of doctors – most health professionals left the area of the armed conflict.
According to Ms. Bezeleva, the situation improved in 2016, when the Donetsk regional AIDS centre was opened in Slavyansk. Today, thanks to the support of the Global Fund PCR tests of adult patients are taken to Kharkiv and children’s PCR tests are delivered to Kyiv. There are also first achievements in diagnostics: in 2016, over 113 thousand people or 5.8% of the total population of the region were tested for HIV, and in the nine months of this year 84 thousand people have already been tested.
The military: testing for the contracted soldiers
Even in the peacetime, the military face the risk of infections, in particular HIV, tuberculosis and hepatitis, which is 2-5 times higher than in the general population. At war, this risk grows 50-fold.
In the area of armed conflict, there are 60 thousand of Ukrainian soldiers. According to the result of the research study conducted by the Alliance for Public Health, about 4% of the military enter the conflict area with an HIV positive status, while the percentage of HIV-positive soldiers leaving the area is doubled and reaches 8-8.5%.
Activists of civil society organizations say that the military should be covered with prevention programmes and convinced that they need to be tested. Another important issue is equipping the military first aid kits with condoms.