AIDS Day in Ukraine: Online Test, Quest for Adolescents

Author: Yana Kazmirenko, Ukraine

On December 1, an online HIV test was presented in Kyiv

On December 1, a wide range of activities marked the World AIDS in Ukraine. On this day, the first in Ukraine online test for HIV was presented in Kyiv. It is available at HIVtest.com.ua or via a mobile application ‘HIV test.’

“The test makes an audit of your health, rapidly assessing the risk of infection, and offers information about the nearest testing sites,” said Dmitry Sherembey, the Chairman of the Coordination Council of the All-Ukrainian Network of PLWH.

Four weeks before the campaign, organizers placed billboards with the intriguing social advertising – a dangerous blade hidden in a juicy burger ­– in the streets of Kyiv. Dmitry Sherembey reveals the intrigue: for many people HIV is invisible, with 130 thousand out of 250 thousand people living with HIV in Ukraine not aware of their diagnosis.

The test contains about two dozen of questions – their number depends on the respondent’s lifestyle. For example, the question “Do you use condoms when having sex or not?” is relevant in Ukraine, where 51% of people living with HIV get infected through the sexual route of transmission. After a person answers all the questions, the test will show the probability of HIV infection and will show the information about the nearest clinic or confidential counseling room to get tested. The online test has been developed for two months and, according to Dmitry Sherembey, it shows the result that person is getting after the testing in 40% of cases.

Testing should become a routine procedure

Dmitry Sherembey shows the online test on his phone

According to Pavel Skala, Director of the Policy and Partnership at the Alliance for Public Health, the annual campaigns dedicated to the World AIDS Day should be changing and moving forward. On one hand, public awareness on HIV is growing, but on the other hand – people are losing interest in the repeating topics.

Testing should become a routine procedure for every Ukrainian, emphasizes Roman Ilyk, the Deputy Minister of Health. He says that over 50% of cases are diagnosed at the third and fourth clinical stages of HIV infection, when the person’s health is poor. 80% of people who die are 25-49 years old. The Ministry of Health called on Ukrainians to get tested for HIV and underlined that early detection of the disease allows to timely access treatment.

Interactive activities for teenagers

Every year, civil society organizations conduct campaigns for teenagers dedicated to the World AIDS Day. Alexander Mogilka, the coordinator of the social support project for adolescents at the Kharkiv Day Care Center for Children and Youth “Compass” thinks that the success of Ukraine in curbing the HIV epidemic largely depends on the progress in working with this target group. This year, “Compass” organized a quest called “The Safety Route” in Chervonohrad, Kharkiv region.

Teenagers from Chervonohrad walked the Safety Route

“The format of this game was developed by the German agency GIZ. The teams are to go through several checkpoints: contraception, routes of HIV transmission, environment assessment. When you answer a question, you may go to the next point,” tells Alexander.

He claims that 70% of “troubled” teenagers have experience of using drugs. Usually, these are children from dysfunctional families.

“Before, teenagers could access drugs through dens, but now they can just use internet and stashes hidden in agreed venues. There is a sad contrast: the drug business is developing and taking new forms and the prevention is lagging behind,” sums up Alexander.

He underlines that to develop new formats of working with young people – combining quests, flash mobs, and social campaigns – is a new challenge for civil society organizations.

Donbass: the HIV Epidemic Growing on Both Sides of the Border

Member of the Donbass battalion Aleksey with his wife. When he was taken captive, his wife secretly brought him medications. Photo: Mikhail Fridman

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”

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

A social worker visits an HIV-positive TB patient in the TB treatment clinic in Donetsk. Photo: Mikhail Fridman

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.

AFEW Grieves Over the Loss of Yury Sarankov

We, at AFEW network, are shocked by the sad news that our colleague Yury Sarankov passed away.

Yury worked in AFEW from the very beginning. Starting in Russia, when AFEW was not yet founded and activities were implemented under the flag of Medecins sans Frontiers (MSF), he specialized in developing and implementing harm reduction activities. Later, he moved to Kyiv to give harm reduction a boost in Ukraine. He was there when AFEW was established in 2000 and continued working on harm reduction. Yury was a rather introvert person and you would not always notice him, but when the subject of injecting drug use and especially harm reduction was discussed, and how, in the early days, the establishment of harm reduction was often blocked, he raised his voice. Yury became well-known as a harm reduction expert and as the editor of a harm reduction digest that he was spreading by the e-mail through the AFEW network.

In the last couple of years, Yury decided to stop his work with AFEW. However, he continued to work as a consultant on men who have sex with men (MSM) and LGBT issues. He kept the link with AFEW, and until his last days, he remained the member of AFEW-Ukraine fund. We have lost a strong advocate for HIV prevention, the rights of key populations affected by HIV, and also a very nice man and a very dear colleague. Our condolences go to his family, friends, and colleagues.

“Kyianka+”: Understanding the Lives of Ukrainian Women Living with HIV

Author: Yana Kazmirenko, Ukraine

Vera Varyga (in the center) is often sharing the success of Kyianka+

Members of “Kyianka+” self-help group conduct regular meetings to exchange positive emotions, share success stories and learn how to resist psychological abuse.

Vera Varyga, leader and founder of the “Kyianka+” self-help group for women living with HIV, receives at least three anonymous phone calls a day to their hotline phone number +38 (067) 239 69 36 from women who have just learned about their HIV status. This hotline number is promoted at the HIV testing locations. Vera’s words may have a significant influence on the future lives of these women and their ability to accept their status and move on.

“Kyianka+” group, operating with support from ICF “AIDS Foundation East-West” (AFEW-Ukraine), was created three years ago, and has already helped more than 150 women. Women living with HIV attend monthly meetings, participate in master classes and get psychological counselling.

“It was very difficult for me to accept my HIV status. I received my first psychological assistance from another woman living with HIV only two years after I was diagnosed. During my first self-help group session, I cried a lot, but women supported me, believed in me and showed me that I am not an outcast. Now, in my groups, I see other girls crying like I was,” says Vera.

In the district hospital of Kharkiv region, Vera had to deal with cruel and unfriendly attitude from staff, which was typical of the Ukrainian provincial medical facilities back in the early 2000s. People diagnosed with HIV were perceived as socially dangerous elements, almost criminals.

Today Vera is a role model – a self-assured woman, a mother of two healthy boys, a beloved wife. She is very friendly, laughs a lot and loves her coral lipstick.

Difficulty of disclosure

At “Kyianka+” sessions, women share their concerns and success stories, trying to find their own way to get on with their lives.

“For example, we conduct role plays during which we model HIV-status disclosure to different people: mothers, partners, children, bosses or health workers. Mothers usually face the most difficult task of telling their sons or daughters about their status. Preparation for such disclosure takes more than a year, and we recommend having a psychologist present: it is hard for a mother not to burst out crying in such a situation,” Vera explains.

Vera is proud of the atmosphere in her group: all the girls get along well, not least because of the set of rules that they developed together:

  1. Confidentiality: nothing discussed in the group can be shared outside of the group.
  2. Attendance is not allowed for women who currently use drugs – they have other values. If they succeed in quitting – they are always welcome.
  3. No criticizing: all women are free to express their opinions.
  4. No medical advice or recommendations: treatment can only be prescribed by a doctor.
  5. The group is for mutual support: you get help and you give help.

All responsibility is on her

Men and women react differently when they hear about HIV-positive status. Men usually need a clear plan, while women often feel panic and become depressed. In our culture, the challenges of solving health problems and thinking about the future of the family often fall upon women.

“Our task is to teach a woman to love and respect herself, to find time for treatment and to make her health a priority. It is like an emergency situation in a plane: first put on your mask, and then put a mask on your child,” Vera says.

Traditions are another area of concern for Ukrainian women: what will the parents say? How will children, neighbours, colleagues react? Is my husband going to leave me? Women have to deal with stigma: everything they had thought about HIV before becomes part of their personal story.

Teaching to share and to help

Anna Lilina, a 30-year-old woman from Kyiv, was diagnosed with HIV when she was three months’ pregnant. Doctors’ prescriptions saved her daughter from getting HIV. Back in the municipal AIDS Center, Anna learned about the self-help group, but she only went there later, when in trouble. She and her daughter were thrown on the street by her boyfriend, whom she had met at the hospital.

Anna Lilina took part in a photo shoot that raised awareness about violence

“My relatives gave me money to pay for the first and last months of the apartment rent. He suggested I moved in with him and spent the money to renovate his house and fix his car. When the money was gone, he forced me out into the street in winter,” Anna says.

Anna needed support and sympathy. Therefore, two years ago, she came to the self-help group.

“After every self-help group session, I get so much energy that it feels I have wings and I can fly, but with every stressful situation, I return to the ground, and feel depressed,” Anna confesses.

It is not only positive impressions that women share at the group. They also started exchanging clothes, baby formulas, information about babysitters and apartments for rent, vacancies and tickets to theatres.

Professional training courses in manicure, floristry, office-management and the English language help these women to change their lives and start making an income. Master classes are also an important part of the therapy, through which women do not only develop new skills and get a profession, but also make steps towards opening up.

Anna remembers how she tried to convince a guy who infected her to start taking antiretroviral therapy. He, however, was saying that AIDS is an invention of American doctors who want to make money. He did start taking the therapy, but only after he had fainted and had to be hospitalized.

“I do not mind anymore that I have HIV. I have met real friends and learned how to be happy about simple things. Volunteer work and organizing help for people in need – this is my new talent, and in the future I would like to become a social worker,” Anna shares.

The number of women in need of Anya and Vera’s help will only increase, as in April 2016 Kyiv joined the Fast-Track Cities initiative to accelerate and scale-up AIDS response, one of the goals of which to ensure that by 2020 ninety per cent of people living with HIV know their status and receive therapy.

Who needs you?

Group master class on felting toys

“Kyianka+” members have a secret Facebook chat to share their thoughts and concerns. The online group allows participants to interfere and help each other in critical situations. Among the most discussed are postings about psychological abuse, especially in discordant couples with an HIV-positive woman and HIV-negative man.

Vera says that her clients often have difficulties with setting the boundaries and counteracting manipulation. If a woman does not make it clear that her status is not a humiliation, her partner’s manipulative actions may reach new levels. For example, he may decide to take charge of the family budget.

“I was stunned by the stories of our clients. To avoid a break-up, one woman’s husband was threatening his wife to tell everyone about her status. Another man said he would disclose this information at their son’s school. In another family, a husband and wife had not invested time to discuss the situation, and once, during a picnic with close friends, they had a fight. The man got drunk and yelled: who needs you now, you AIDS-ridden cow? This story echoed deeply in me – back in the day when I was pregnant, a doctor yelled at me in a similar way: you are ridden with AIDS, and you still want to have a baby?” Vera shares her emotions.

She is certain that with this one phrase that man said everything he thought about his partner and their relations. It is possible to forgive him afterwards, but it is not possible to trust him again. This breaks up the family, and all his reassurances and pleads for forgiveness are in vain – the couple had to discuss the situation earlier. After the picnic the couple broke up, and now they are undergoing therapy.

The Facebook post about blackmailing had a lot of responses: the participants shared links to study psychological tricks of manipulators, and the women who had similar experiences helped others with advice and recommendations on how to stand firm and raise their self-esteem.

Vera is very happy to see this meaningful participation of women. She hopes that her clients will eventually leave their worries behind and start living full lives, and that the most active of them will help organize such groups in every Ukrainian city.

Rapid HIV Testing was Discussed in Kyiv

Psychologists, social workers, medical personnel and other employees of four social bureaus in Ukraine gathered for the three-day training Conducting Voluntary Counselling and Testing on HIV with Rapid Tests that AFEW-Ukraine conducted on June 7-9.

“This training was useful because we had a closer look at the regulatory framework in the field of HIV testing, in particular in the work with minors because this procedure always caused many questions,” says Alina, the social worker from Kharkiv. “Besides, it was useful to get the information about personal and professional risks of HIV infection, what to do if such situation happens, and now everything is clear. The session of practical training in the development of pre- and post-test counselling skills has been a pleasure for me. The trainers showed what mistakes a counselor can make during counselling and how to avoid them.”

The aim of the training was to provide the participants with the knowledge and skills on the methodology of counselling related to HIV testing with rapid tests. During three days, the trainers focused on the overview of the HIV epidemic in the world and in Ukraine, aetiology, epidemiology, diagnostics, ways of HIV transmission. Stigma and discrimination, the impact of stigma on the epidemic, legal framework of HIV/AIDS, key elements of ethical and effective HIV counselling practices, pre- and post-test counselling were also discussed during the training.

The training was held within the framework of the project ‘Bridging the Gaps: Health and Rights for Key Populations’ with the financial support of Dutch Ministry of Foreign Affairs. In August, AFEW-Ukraine plans to hold a coordination meeting for regional partners to plan the next ‘Bridging the Gaps’ project year.

Compass Centre in Kharkiv, Ukraine: when Policeman Becomes an Uncle

img_0039“I come here often,” Senior Inspector of the Juvenile Prevention Department of National Police of Kharkiv region, Ukraine, Andrii Stadnik is sitting by the table in the centre Compass of Kharkiv City Charitable Foundation Blago. He is smiling and pointing at the table. “Look, here I even have my own cup to drink from…”

Andrii Stadnik started to work in police in 1998. He says he is very happy with his job now. In Compass he meets many children who are grateful for not being send to prison, and he likes to be able to help them. The regulars of the centre even call him uncle Andrii, and this shows very good relations between people in the Ukrainian culture.

18 years old Oleksandr (Sasha) is sitting in front of Andrii, at the same table. Sasha is one of the main characters in the film that was made about the centre Compass a few years ago. Once he was detained by Andrii Stadnik and stayed under police control for some time. Now, after the client management program at Compass, Olexandr is doing much better. He even found a job as a security guard. “Now I somehow feel as Andrii’s colleague,” Sasha smiles.

“The criminal juvenile cases decreased tremendously last years, due to the approach when juvenile police is collaborating with a youth centre that offers client management. These alternative supporting ways are more constructive and more effective,” Senior Inspector of the Juvenile Prevention Department is telling us. “Previously there were 2000 cases per year, and now it is 362. The formulas of substances that circulate on the streets change so fast that young people can often not be prosecuted, but by giving youth an option and an alternative for other options, young people have less problems and also cause less problems for the society they live in.”

img_0036There are 492.000 children in the region in total. 897 families are under juvenile department control in Kharkiv region in Ukraine. The Juvenile Police checks these families, sees how they are doing, and if there are cases of child abuse, financial problems, and so on. Kharkiv Juvenile police is also inviting colleagues from other smaller cities or villages, and teaches them how to work with the Centre Compass. Through this cooperation they found out that young people from the region have difficulties with coming to the Centre since Kharkiv is too far for them. That is why now once a week a social worker of the Centre travels to the villages to counsel young people in need there.

Kharkiv City Charitable Foundation Blago has a long history of working with key populations, including people who use drugs, sex workers, men having sex with men and street children. The organisation started to work with adolescents using drugs since 2012 within the framework of “Bridging the Gaps: Health and Rights of Key Populations” project, through ICF “AIDS Foundation East-West” (AFEW-Ukraine.) Bridging the Gaps project supported the opening of the centre Compass that specifically serves vulnerable adolescents and young people, focusing on youth using drugs. The centre offers psychological counseling services, medical help, testing for HIV, hepatitis B and C. It is a daycare facility with social workers, psychologists and medical workers. The centre is providing case management services to youth using drugs, and also works with youth in prisons, and vocational schools.

Access and Quality of Youth-Friendly Health Services in Ukraine Presented During Youth Week in Amsterdam

dsc00091AFEW-Ukraine’s Project Manager, Iryna Nerubaieva, will take part in the Share-Net Youth Week which is held in the Netherlands from 26th-30th September. Iryna will speak about increasing access and quality of youth-friendly health services for young key populations: people who use drugs in Ukraine.

The Youth Week, organized by Share-Net and its members, will link comprehensive sexuality education and youth friendly health services to broader discussions on gender, gender based violence and sustainable development. The Youth Week will take place in two Dutch cities: The Hague and Amsterdam. The whole program of the Youth Week is available here.

Iryna Nerubaieva from AFEW-Ukraine will be giving her speech on Tuesday, September 27, in De Balie, Amsterdam, during the workshop “Service Delivery and Quality Assurance”, starting at 2pm.

Iryna Nerubaieva coordinates innovative and pilot projects, such as the Immediate Intervention Programme for HIV-positive women and is also responsible for M&E and human rights components of the Bridging the Gaps programme in AFEW-Ukraine. Iryna has 10 years of experience in the sphere of HIV/AIDS prevention, which started from volunteering. Prior to her work in AFEW, Iryna worked for the Alliance for Public Health in Ukraine within Harm Reduction projects among populations most vulnerable to HIV (IDUs, MSM, SW, prisoners) and for Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) as a Consultant within the primary prevention project for children and youth “The Join in Circuit on AIDS, Love & Sexuality.”

Please, join us on Tuesday, September 27 at 2pm for the workshop!

Dutch Student Researched Families of People Who Use Injected Drugs in Ukraine

2007_Russia_DrugsA qualitative study “Family members of the people who inject drugs should promote the positive image of harm reduction services” was recently made by the graduate student of Vrije Universiteit Amsterdam Sandra Hagoort, and AFEW in Ukraine.

Master of Health Sciences Sandra Hagoort explored the role of the family of people who inject drugs (PWID) in the utilization of harm reduction services and how could the family stimulate those people to increase the uptake of harm reduction services in Ukraine. With the help of AFEW-Ukraine in the capital city of Kyiv, Sandra disseminated the surveys and did interviews with the family members, PWID and people who work with PWID.

Sandra chose Ukraine for her research because of the incidence and prevalence rates of HIV that are still high in EECA region. “This number is especially high among people who inject drugs which was the group I wanted to focus on, – Sandra says. – I did my study according to the conceptual model which is mainly based on the behavioural model of Andersen. Most important aspects of this model are the population characteristics and the external environment of the PWID.”

HIV is indeed an increasing problem among the PWID in Ukraine. Harm reduction is an evidence based approach which has been proven to reduce the incidence of HIV among PWID. These services are available in Ukraine, however, the uptake is low because of stigma and discrimination. To overcome this barrier, the family of the PWID might play a stimulating role to use more harm reduction services.

“You always hear about HIV in Africa, but I thought, EECA would be a different and interesting angle. I remember the interview I had in Ukraine was with the mother of someone who uses drugs, – Sandra Hagoort says. – During the interview with the mother, I realized that we forget to assist family members of people who use drugs. This was also confirmed by the social workers later on. I realized that the mother was close to despair about how to help her son.”

As a result of her studies, Sandra Hagoort found out that emotional and practical support were both provided by the families of PWID. Moreover, attitude and knowledge were important themes. Stigma towards IDUs as well as to family members of IDUs was reported. The fact that PWID who are under 18 years old are not allowed to obtain harm reduction services without parental consent was also considered as a barrier. In order to increase the uptake of harm reduction services, the communication between the PWID and their families should be improved. This can be done by family counselling in which both parties can express their needs and more support can be provided. After that, a positive attitude towards harm reduction services has to be created. The best way to do this is that family members themselves promote the positive image of harm reduction services.

Now Sandra plans to publish the results of her study in a scientific journal.