Do we Treat or Harm: how Ukraine is Fighting against Tuberculosis

Olga Klimenko in the children’s ward of the tuberculosis dispensary. Photos from the personal archive

Author: Yana Kazmyrenko, Ukraine

At the entrance to any public polyclinic in Ukraine, an announcement is greeting a patient: visit a doctor is possible after a fluorography only. The obligatory lungs X-ray maintains a semblance of the fight against tuberculosis. In Ukraine, most of the patients get to know their status very late. The country has not been able to take the tuberculosis epidemic under control for more than twenty years. Ukraine has the world record of multidrug-resistant forms of tuberculosis and is still treating patients, sending them to prolonged isolation in overcrowded dispensaries.

An activist of the All-Ukrainian Association of People who have had tuberculosis ‘Stronger for TB’, Olga Klimenko, was diagnosed with tuberculosis in 2015. By the time of hospitalization, she was sick for at least six months. In 2016, Olga published a book The world inside me. Confession of the tubercular woman in which she described her life experience with the disease.

Now Olga is trying to help patients with this diagnose. On the webpage of her community in Facebook The world inside me, requests appear every day: to transfer money for the purchase of inaccessible drugs, which for the most part are not licensed in Ukraine, to purchase washing machines for tuberculosis dispensaries or diapers for recumbent patients. Last month, Olga was “coaching” 34 patients.

“I do not know when and where I contracted tuberculosis. No one knows. Everyone remembers the last long-lasting flu after which he or she felt weakened and broken down. Ukrainians usually do not go to the doctor, we go to the drug store and buy a full set of antiviral drugs. We remove symptoms, but do not cure diseases,” says Olga.

During the treatment, Olga had good and bad times. The most difficult was the separation from her daughter: the girl was sent to a special boarding school for children who were in contact with infected people, where her homegrown girl spent six months with children from dysfunctional families. Olga still did not forgive doctors who did not tell her that after two weeks from the start of the treatment she was not contagious anymore.

Ukraine is breaking records

Olga’s story is typical for Ukraine where the epidemic of tuberculosis is spreading for several years. More than 30 thousand of Ukrainians are diagnosed with a not active tuberculosis and more than 10 thousand – with an active form. Every day 90 people get their status. These figures are underestimated: according to the World Health Organization (WHO), every fourth patient in the country stays undiagnosed.

Back in 1995, WHO announced that Ukraine has exceeded the epidemic threshold – 50 cases per 100,000 people. Since then, the situation has only worsened – the conflict in the East of the country forced 1.5 million residents of Lugansk and Donetsk regions to resettle. In these regions, there were 15% of Ukrainians who were diagnosed with tuberculosis. Every fifth TB patient is HIV-positive.

Tuberculosis for export

The resettlers are at risk of tuberculosis in Ukraine. Photo by UNIAN

Compared to the other post-Soviet countries, indicators of Ukraine look particularly depressing. If in Ukraine the incidence rate according to the data for 2016 was 67.6 per 100 thousand people, in Belarus it was at the level of 39.9, in Kazakhstan – 52.2, in Poland – 17. The European average is 12 people per 100,000 population.

In the top 20 countries of the world, tuberculosis has already become an exotic disease. The epidemic in Ukraine frightens the neighbors – about 5 million Ukrainians work in the EU countries and Polish media write that a visa-free regime with the EU will allow tuberculosis to migrate to Europe. Warsaw is even discussing the possibility of medical control on the border with Ukraine.

Resistant mycobacteria

Director of the Public Health Center of the Ministry of Health of Ukraine Vladimir Kurpita says that the prevalence of multidrug-resistant tuberculosis (MDR-TB) is the main feature of the Ukrainian epidemic.

Many patients refuse to continue treatment the moment they start feeling better. They do not want to spend at least six months in the dispensary and to be unemployed, staying on the verge of poverty. Due to discontinued treatment the health situation worsens – mycobacteria becomes resistant to drugs. To treat this form, more toxic drugs should be used, the duration of treatment gets longer and it becomes several times more expensive. Now in Ukraine, 85% of the funds allocated for tuberculosis are spent for treatment of multidrug-resistant tuberculosis.

According to Kurpita, treatment of regular tuberculosis lasts six months and costs the state about 30 euros, compared to the treatment of a complicated form of infection, which takes up to 20 months, and the price for that reaches 400 thousand euros. Currently, there are 1.2 thousand cases of such highly resistant bacteria diagnosed in Ukraine. In this sad rating, only India overtakes Ukraine.

Family doctors will start to treat tuberculosis

Experts agree that it is possible to defeat tuberculosis if compulsory hospitalization will be replaced by outpatient treatment. This step may reduce the chance for reinfection in the hospital. Now patients at different stages of recovery are getting treatment in hospital rooms for 5-7 people for years, and they have the risk of catching a nosocomial infection at any time.

A health reform that is currently ongoing in Ukraine, involves the transfer of patients with non-active tuberculosis under the responsibility of family doctors. The last ones are supposed to get extra paid for each of the cured patients.

“The main idea is that doctors will be in closer contact with patients, will know their health history. Responsible people will receive their pills and will lead a familiar lifestyle,” explains Olga Klimenko.

She dreams for three Ukraine-wide days off not because of some celebration but because of a mass medical examination for the all Ukrainians so that people could find out that they have some dangerous disease before it gets to the last stage.

Methadone Breakthrough: Ukraine to Independently Purchase Opioid Substitution Therapy

Patient receiving OST at Kremenchug drug treatment centre, Poltava region Source:

Author: Yana Kazmirenko, Ukraine

From 2018, opioid substitution therapy (OST) programme in Ukraine is financed by the Government. Activists are asking international organizations for a backup to prevent disruptions in the supply of life-saving medications.

The Government of Ukraine plans to independently procure substitution therapy programme medications in 2018. According to the World Health Organization (WHO), over 10 thousand people received therapy last year at 178 institutions throughout the country. It is planned to double the number of patients in 2018.

Ukraine wants to beat HIV

Ukraine can be proud of its implementation of OST because this is the largest-scale coverage programme in Eastern Europe and Central Asia. Since 2005, the programme to substitute opioids with methadone or buprenorphine was financed by the Global Fund. Patients under the care of a physician received syrup or pills.

“This is a major milestone for public health care in Ukraine,” says WHO representative Martin Donoghue. “For many years WHO and partners have worked with the Government and opioid substitution therapy received the endorsement and comprehensive financial support. This attests to the fact that Ukraine wants to beat HIV.”

People who inject drugs belong to key groups who are most at risk of HIV and its transmission. The numbers are a confirmation: HIV was diagnosed for 42% among OST programme participants in Ukraine, and 21.3% of new HIV cases account for the transmission through injecting drug use. Sexual transmission still remains to be the main way of transmission – 63.9%.

Financing doubts remain

WHO recommendations indicate that to control HIV/AIDS spread among people who inject drugs 20 thousand people shall receive therapy. Ukraine intends to reach these numbers by the end of 2018.

According to Director of charitable organization Meridian and Executive Director of All-Ukrainian union of people with drug addiction VOLNA Oleg Dymaretskiy, there are 368 thousand injecting drug users in the country. The majority uses several types of drugs, including medications from pharmacies. The activist has doubts regarding the timely supply of OST medications by the Government.

“I do not believe that transition to Government financing will be fully implemented in 2018. 13 mln. Ukrainian Hryvnyas a year ago were allocated for medications for 9.6 thousand patients, but they reached them only in December 2017,” says Dymaretskiy.

NGOs requested the Global Fund to back up the supply of medications, and, according to Dymaretskiy, received a positive response. To double the number of patients, the activist suggests increasing the number of OST offices along with prescribing therapy at the level of district poly-clinics.

OST will reach prisons

Our colleague told us about another initiative of VOLNA union – start-up of a programme on continuous treatment at institutions of detention, which will include detoxification and prescription of substitution therapy. Two thousand people withdraw from OST programme every year, one in ten – due to serving a sentence in prison.

“Substitution therapy changes lives of people who use drugs. It is the first step and acknowledgment: it is beyond my power to cope with addiction, but I will change the quality of living,” summarizes Dymaretskiy.

Massive HIV Testing Campaign for Residents of Kyiv and Odesa

Kyiv residents can do an express test not only at the mobile laboratory, but also at all district polyclinics. Foto: Informator

Author: Yana Kazmirenko, Ukraine

Over 250 thousand HIV tests will be done in Kyiv allowing to cover 10% of the employable population of the Ukrainian capital. Nikolay Povoroznik, the Deputy Head of Kyiv City State Administration, informed UNIAN Information Agency that in order to reach these numbers, city authorities will additionally procure 140 thousand express tests. HIV testing is the first step towards overcoming the epidemic because information about one’s positive status allows the timely start of treatment for the patient.

Kyiv is home to over three million people. According to experts’ estimates, there are 23 thousand HIV-positive residents. This is one-tenth of the estimates for Ukraine – 250 thousand people. As the Medical Superintendent of Kyiv AIDS Prevention and Control Centre Aleksandr Yurchenko clarifies, procured tests are not intended for residents of Kyiv from risk groups and categories not subject to mandatory testing (pregnant women, donors, patients prior to surgeries, etc – editor’s note.)

“Tests have already been procured and distributed. Screening is available at all polyclinics in the capital. The procedure takes 15-20 minutes. With mass testing, we will increase the HIV detection level to 5%,” forecasts Mr. Yurchenko.

Besides, the routes of patients with HIV are being optimized in the capital of Ukraine to ensure immediate referral for treatment, receipt of antiretroviral therapy and professional medical advice.

Medical professionals after testing have the task to promptly put patients under observation. At the end of 2017, 42% of HIV-positive patients were receiving therapy. A year ago, this number reached 30%. By the end of 2018, doctors intend to have 70% of patients who are aware of their status registered.

High expectations from reform and strategy

Nikolay Povoroznik forecasts that the number of people receiving antiretroviral therapy will amount to 8 thousand in 2018. The official has high expectations from the medical reform, which commenced in Ukraine in autumn of last year. HIV-positive residents of Kyiv will be able to receive prescription of antiretroviral medications at the level of district polyclinics and their health condition will be further monitored by the family doctors.

In 2016, Kyiv Mayor signed the Paris Declaration allowing Ukraine to join the Fast-Track Cities programme to expedite AIDS control measures. Over 70 major cities in the world joined the global movement. This year implementation of Fast-Track Cities strategy also envisions start of educational programmes, expansion of the number of substitution therapy courses, and start of operation of five offices for integrated assistance during substitution therapy, monitored treatment of tuberculosis, etc.

It is envisioned that in 2020 90% of people shall know their status, 90% of those infected shall receive therapy, and for 90% of patients the therapy shall be effective with a zero viral load.

Odesa to host City Health Conference

Odesa is a seaport in the South of Ukraine that is home to over one million people. Odesa followed suit after Kyiv undertaking obligations under the Paris Declaration in February 2017. Residents are provided with medications for prevention and treatment of opportunistic infections under the municipal Health programme using budget funds.

“After the Mayor of Odesa signed the Paris Declaration, it was decided to develop the special-purpose program for the city for 2018-2020 to counter the epidemic of HIV infection and tuberculosis. This document has been developed and is prepared for approval at the City Council session,” says the Medical Superintendent of Odesa AIDS Prevention Centre Vitaliy Novosvitskiy.

Last year the Department of health of Odesa City Council issued a number of orders for procurement (for the total amount of 1.5 mln. UAH), implementation and use of express tests at all health care institutions in the city.

According to the Ministry of Health statistics, the largest number of HIV infected in relation to population lives in Odesa region, where there are 865.8 HIV-positive patients per 100 thousand people. For 77% of those residing in Odesa, HIV was sexually transmitted. The latest surveillance data clearly shows that increase in the number of HIV-positive persons is closely linked to the dangerous sexual behaviour of injecting drug users and their partners. 11.5 thousand people are registered at the HIV/AIDS Prevention and Control Centre. The intention is to increase this number to 19 thousand by 2020. 4.5 thousand people are receiving antiretroviral therapy.

In 2017, Odesa infectious diseases hospital was modernized – a cubicle-ward building was added. This year the sea capital of Ukraine will host the City Health International Conference, in the course of which the best practices in fighting HIV will be addressed.

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 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.

Sex Work in Ukraine: Cancelling the Fines and Placing Condomats at Bus Stops Could Halt HIV Spread

Nataliya Isaeva is protesting and advocates for the fast decriminalization of sex work

Author: Yana Kazmirenko, Ukraine

Civil society NGO activists in Ukraine are developing a new legislation on sex work. According to them, eliminating the fines could help increasing access to medical care for women and men involved in sex work – a profession vulnerable to HIV.

“Sex workers try not to have too many condoms with them. If there is a police raid, discovering condoms and recording it in a protocol automatically means detention for sex work,” says Nataliya Isaeva, the head of the All-Ukrainian Charity Organisation “Legalife-Ukraine”, explaining the need to finally decriminalize sex work. Nataliya has been a sex worker since she was 16. Today, after being a sex worker for 15 years, she has HIV-positive status, a family, two healthy children and projects that offer support to her ex-colleagues.

Hostages and victims of violence

Even administrative charges for sex work that are still in force in Ukraine, make sex workers vulnerable to police violence. According to the Article 181-1, of the Ukraine’s Administrative Code, commercial sex is an administrative offence punishable by the fine of 15 tax-exempt minimum wages (UAH 225 or €7.5) as a maximum penalty.

“Today decriminalization is more important than legalization. Decriminalization would create an environment where sex workers could go to police to complain of violent actions against them,” Nataliya clarifies.

Preparing for the 22nd International AIDS Conference to be held in Amsterdam in 2018, “Legalife” activists have conducted a research on the types of violence against sex workers in Ukraine. They surveyed 175 women and anticipate high levels of “truthful answers”, given that the women were interviewed by activists who had been involved in sex work.

“Preliminary results show high rates of psychological violence against sex workers from police. Many have to deal with unwarranted aggression from their clients: people in passing cars throw bottles at them, and there was one case when they cut a rude word on a woman’s breast,” Nataliya is sharing.

Healthy women work longer

The Ministry of Ukraine’s Center for Public Health estimates the number of sex workers in the country at around 80,000. Some 7.3% of them have been diagnosed with HIV. Administrative liability drives sex workers underground and makes them conceal their occupation, even from doctors.

“Sex workers are usually not the ones to go and have their first HIV test on their own initiative. Decriminalization forms the prerequisite for medical screening and offering help to those in need,” Sergey Kharitonov, the head of HIV prevention and access to treatment projects for sex workers, NGO Convictus Ukraine is saying. Nataliya Isaeva, however, thinks that sex workers do try to take care of their health and contribute much less to the spread of HIV as opposed to what researchers believe.

“Women professionally involved in sex work prefer to use condoms, get tested and make sure they are in good health. The healthier they are, the longer they can work,” Nataliya explains.

Discovering status means banning from pick-up points

Experts from Convictus Ukraine have surveyed sex workers to find out what they do when they learn that they have HIV. Most of them leave work for a while, usually going back home. The story of Polina (34) from Kyiv confirms this. After she discovered her HIV-positive status in 2014, she went home to her parents for the first time in many years. Polina started using injecting drugs when she was 16. After the 9th grade, she travelled to Moscow, hoping to earn good money, and ended up in sex work through the advice from her friend. Amphetamine, heroin, dope – she could just almost write a manual on drugs. In early 2000s, she found out she had Hepatitis C, but she cannot remember when exactly she was diagnosed. After discovering her status, she applied for the opiate substitution therapy.

After learning about her HIV status, Polina switched to opioid substitution therapy

“My body gets ugly from all the injections, but my look is my income. Thus, with a doctor’s paper certifying substance use, I applied for a paid substitution therapy service. It costs UAH 1600 per month. I saved up some money, and I also want to get Hepatitis C therapy,” Polina is saying.

After she was diagnosed with HIV, Polina started to take more care about her health. “I always use a condom, do not go to saunas for groups, etc.,” she says.

According to Polina, only her mother, partner and son know about her status. Her son lives with his grandparents in Russia. Polina hopes that opiate substitution therapy will “wise her up”, help her quit drugs and find her six-year-old daughter whom she abandoned after birth.

Polina’s colleagues find it hard to establish an alternative source of income, and that is why they go back to where they were. Many of them are afraid of undergoing further testing, fearing disapproval from doctors and friends in case “God forbid, someone finds out”.

“Most sex workers suffer from self-stigma which prevents them from accepting their HIV status. If they find out one of them is HIV-positive, the colleagues try to remove this person from the pick-up point by any means,” Sergey Kharitonov says.

New law under development

Activists admit that there is little chance for changing the status of sex work in Ukraine. Back in 2015, decriminalization attempts failed. Andrey Nemirovskiy, the Deputy of the Verkhovna Rada of Ukraine (Samopomich party), submitted and, following a lot of buzz in the media, revoked the legislation regulating sex work in Ukraine. The project failed, not least because of the influence of the Orthodox church, whose vast congregation could have cut off electorate support for the party.

New legislation is developed, but, according to Nataliya Isayeva, it will only be submitted after allies are found. Currently activists are conducting advocacy work among female deputies and developing amendments to other laws.

The project manager at NGO Convictus Ukraine Yulia Tsarevskaya believes that apart from the new law, it is possible to reduce the spread of HIV among sex workers with comprehensive programming. For example, the service of condom and lubricant distribution could be replaced by placing condomats in all cities (at the bus stops and metro stations.)

Youth is Invited to Lead the Amsterdam Youth Force at AIDS 2018

Nadiia Dubchak

The Youth Force for AIDS 2018 is looking for young people and youth organisations. Nadiia Dubchak, from Kyiv, Ukraine, is the co-chair of the Youth Force of AIDS 2018 Conference, and she is representing Eastern Europe and Central Asia (EECA). Meanwhile, Nadiia is looking for active people between the ages of 15 – 26 to help found and lead the Amsterdam Youth Force (AYF). AFEW International is supporting this initiative.

The engagement of young people in the International AIDS Conference in Amsterdam next year is fundamental. Every International AIDS Conference, a group of young people and youth organisations come together to create the Youth Force. Young people are essential in creating a response to HIV and AIDS that will reach the end of the epidemic. Young people are also people living with HIV, sex workers, people who use drugs, LGBTQI and many other groups that are key in creating a future without HIV and AIDS.

“I strongly hope that, as youth activists and leaders, we will act together, on behalf of the world teen and youth community, and make a significant contribution to AIDS 2018. Indeed, I would be thankful for your support and honored to convey your ideas to the Conference Coordination Committee prior to and during the Conference. We are now building up the Youth Force working groups which would guarantee an excellent performance and efficiency of AYF in different dimensions of AIDS 2018. We kindly invite youth-focused activists and young leaders from all over the world to join us,” Nadiia Dubchak is saying.

How to join

To become a part of AYF, please like their Facebook page to stay in touch and share info about their activities online. To join a working group, please write an email to including your basic contact details and a short motivation note. Also, you can use this email to pose any questions regarding AYF and your personal involvement. For those interested in contributing to AYF, you can add Nadiia Dubchak on Facebook.

How Kyiv Fights the HIV/AIDS Epidemic

Author: Yana Kazmirenko, Ukraine

The adoption of the Fast-Track Cities strategy resulted in launching of the HIV express-testing in all outpatient clinics in Ukraine’s capital. The strategy also allowed to increase the number of people who receive antiretroviral therapy.

The struggle against HIV/AIDS epidemic in Kyiv strengthened since the mayor Vitaliy Klitschko, signed the declaration in Paris. Apart from that, Kyiv was included into the Fast-Track Cities programme in April 2016 as a measure to fight AIDS. According to this programme, 90% of the citizens in 2020 should know about the disease, 90% of the infected ones should be getting treatment, and the treatment should be effective for 90% of the patients.

In the latest United Nations agency report on HIV/AIDS (UNAIDS) and UN-Habitat as of 2015, the Ukraine’s capital entered the list of 27 most HIV/AIDS infected cities in the world. Alexander Yurchenko, the head physician at Kyiv AIDS centre, hopes that Kyiv will not be included into the newest rating. The programme has seen first success. 800 medical workers were trained, and every outpatient clinic in Kyiv received express-tests. The result of the test is available in as little as 20 minutes. There were 2,500 more individuals (compared with the previous year) who had tested their blood in a year.

A record amount of 555 people was included into the dispensary registration with the help of express-testing only over the first quarter of 2017. To compare: only 1300 people were registered in 2016, according to Yurchenko.

In his opinion, the situation in Ukraine’s capital with a population of three million people has improved. There were only around 5,000 people getting treatment in 2012, and now there are more than 7,000. It is planned to give treatment to 12,000 people by the end of the year.

Migrants and HIV

Yurchenko attributes Kyiv’s high position in the world ratings of HIV spread due to its attractiveness for migrants. 400,000 people come to work in the capital daily.

“Men who have sex with men (MSM) also tend to come to Kyiv, as it is hard for them to even live in such regional centre as Cherkassy. They attract a lot of attention in smaller cities. In the capital, they can find work, hide themselves, and find partners,” continues the interviewee.

The prevailing factor of HIV spread in Kyiv in 2012 was an injecting way of transmission. Now the predominant way has shifted to sexual transmission.

For instance, the story of the oldest patient in the capital of Ukraine. The man admitted that his wife was refusing sexual intercourse with him and he had to use the services of sex workers.

“Doctor, now I know what I will die from,” the old patient said jokingly, after he heard his diagnosis.

“According to statistics, you will die from cardiac ischemia, but we will control and monitor your HIV,” Yurchenko remembers his dialogue with the patient.

Surviving thanks to the Foundations

Kyiv’s mayor Vitaliy Klitschko stressed that one of the main responsibilities that Kyiv took within the framework of the Fast-Track Cities programme is the provision of sufficient amount of antiretroviral medicines for treatment of people diagnosed with HIV/AIDS.

There would be significant progress in the implementation of the Fast-Track strategy if the government did not delay the supplies of medicines for antiretroviral therapy. This leads to patients receiving one month course of treatment instead of six or three months’ courses.

The variety of options in treatment schemes (around 38 of them) does not yet allow to pass the dispensing of medicines to the family doctors’ level. Yurchenko promised that there will be two or three variants of treatment made, and they will be passed on to the outpatient clinics as soon as the government supplies of medicines are in full scope.

Now patients literally survive at the expense of international and private foundations. On July 11, Kyiv has become the first Eastern European city where HIV-positive patients received dolutegravir (sixth generation medicine for antiretroviral therapy) at the expense of the Elena Pinchuk ANTI AIDS Foundation. The yearly course of medications will cost $170. This allows to increase the number of people who will receive the life-saving treatment in as early as 2018 at no additional cost.

The adoption of the law on mandatory HIV testing* can also bring the capital closer to the standards implemented by Fast-Track Cities. Alexander Yurchenko says that this law might be enacted by the end of the year.

As estimated by the experts, the number of HIV/AIDS infected people in the capital is 23,000 inhabitants. This is the tenth of the estimated figures in Ukraine – 250,000. There were 304,914 officially registered new cases of HIV infection in Ukraine since 1987. Since that time, there were 42,987 deaths from AIDS. The regions most affected with HIV infection, apart from Kyiv, are Dnipropetrovsk, Kyiv, Donetsk, Mykolayiv and Odesa regions.

*AFEW International is not aware of the law on mandatory HIV testing and will advocate against such law.

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.