From Wikipedia, the free encyclopedia
Ukraine has one of the fastest growing HIV/AIDS epidemics in the world.[1][2][3][4][5]
Experts estimated in August 2010 that 1.3 percent of the adult population of Ukraine was infected with HIV, the highest in all of Europe.[6]
Identified in the country in 1987, HIV/AIDS appeared to be confined to a small population of foreign students until the mid-1990s, when a sudden and explosive epidemic emerged among
injecting drugusers in the southern and eastern regions of the country. In 2007 about 0.96 percent of Ukrainians, or about 440,000 citizens, were estimated to be living with HIV/AIDS,[7] up from 1.46 percent of the population in 2005, or 685,600 citizens, according to UNAIDS.[5] The number of
HIV/AIDS cases in Ukraine reduced by 200 or 3.9% to 4,900 in the period of January–November 2008, compared with the corresponding period of last year. Ukraine has one of the highest rates of increase of HIV/AIDS cases in Eastern Europe.[8]
Although HIV/AIDS has to date remained concentrated among marginalized and vulnerable
populations, it may be spreading to the general population. The majority of those infected are under 30 years of age; a full 25% of those affected are still in their teens.
Editor: In another article I have hiding around here somewhere a doctor tells a story of going into Kiev to help with the epidemic and says it’s like walking onto a college campus and all the young students are dying. I definitely think the Ukrainian girls are the most beautiful in the world, but if you go there, choose to meet ONE after you write several letters, use a condom and if you intend to marry ask for a blood test. And don’t be afraid to ask her frankly if she has been inclined to go to night clubs and play the field with many lovers or if she’s the more traditional sort of woman. The majority of women there are good and decent, healthy people. You just have to be wise and careful before getting “involved.”
I think they are most beautiful because their territory has been a crossing point for many racial subgroups and they’re a homogeneous mix of people from Rome, Turkey, Russia, Scandinavia, Slavic people, and so forth.
Contents [hide]
1 Situation
o 1.1 Spread of AIDS
o 1.2 History
o 1.3 Causes and Extent of the Drug Epidemic
o 1.4 Prisons
o 1.5 Transmission through sexual intercourse
o 1.6 Infected children
o 1.7 Street Children
o 1.8 Spread of AIDS among children 2 Preventive Measures
o 2.1 Harm Reduction programs
3 National response 4 Statistics 5 References 6 External links
[edit]Situation
[edit]Spread of AIDS
In the mid-1990s, transmission was primarily through injecting drug use. By 2001, however, the proportion of new cases of HIV/AIDS attributable to injecting drug use had declined to 57% from 84%
in 1997. During that time, heterosexual transmission increased from 11% to 27%, and perinatal transmission increased from 2% to 13% as a proportion of total cases.
Registered HIV prevalence in Ukraine (late 2007)
UNAIDS estimates that the number of people infected with HIV/AIDS in 2003 was 360,000 (range 180,000 to 590,000), representing an adult prevalence of 1.4%. According to the Ministry of Health—
which estimates that by 2002 there were more than 500,000 people infected, or nearly 2% of the adult population—the epidemic has now spread to every oblast in the country. Prevalence in the southern and eastern oblasts (Odessa, Mykolaiv, Dnipropetrovsk, and Donetsk) is about three times higher than rates in the rest of the country.[9] A major reason for this is the fact that the urbanized and industrialized regions in the East and South of Ukraine suffered most from the economic crisis in the 90s, which in turn led to the spread of unemployment, alcoholism, and drug abuse, thus setting the conditions for wider spread of the epidemic.[10]
Among the issues driving the HIV/AIDS epidemic are high levels of migration and transactional sex;
widespread stigma and discrimination (which prevent injecting drug users, sex workers, men who have sex with men, and other marginalized people from seeking and receiving prevention and treatment interventions); inadequate health and other social services; rising rates oftuberculosis, sexually transmitted infections, and substance abuse; and a general lack of information about the kinds of risky behaviors that contribute to HIV/AIDS. According to the Ministry of Health, Ukraine has already surpassed the “optimistic” projections of an HIV/AIDS rate of 2% in 2010.[9]
[edit]History
HIV officially reached the territory of the former Soviet Union in 1987, about 5 years after the virus itself was discovered. Until 1995 there were only a few known cases of HIV infections in Ukraine. The country was therefore deemed to be “low risk” by the World Health Organisation (WHO) in terms of spread at that time.[11]
Between 1987 and 1994, 183 infections were reported. It can be argued, however, that the beginning of the epidemic took place unnoticed toward the latter end of the social transitional between 1991 and 1995, after the fall of the USSR. The accumulation of cases of AIDS in 2000 supplies evidence for this theory, since HIV has an incubation time of about 7 to 10 years. In addition, an observable increase in the usage of injection drugs started around 1990. In 1990, 22,466 narcotics users were registered by the Ukrainian government. By 1999 the number of cases had more than tripled to 74,544 registered narcotics users. Of course, those drug users, threatened by punishment under law, would have done anything to avoid being registered. The Ukrainian Health Department estimates a five to 10 times higher number of unregistered cases. Young injection drug users made up the first segment of society, wherein HIV infections spread very fast. The most commonly used drug was, and still is, a cheap hand made opiate called ‘Shirka’ or "khanka", English rendering may be roughly ‘jag’or 'smack'
manufactured from the widely grown poppies in the countrysides. Concerning infections of HIV, several factors of the drug-use procedure pose specific threats. It was, and still is, not easy for many to find clean injection needles. Neither places to replace needles nor sufficient harm-reduction and treatment programs are available yet. Young injection drug users especially have difficulty receiving treatment. Plus it is a widespread tradition in Eastern Europe to share a needle due to the shortage of the disposable syringes and needles. And the production of the drugs themselves is also not safe. The hand-made drugs may often be sold in a syringe already. The containers used for mixing the drug components are shared too. Apparently one method of drug delivery has died out, namely the dissolving of opiates in blood, which would then be sold for direct injection. This was common in the 1990s, and has most likely died out due to AIDS and HIV awareness. Back then, if the producer of the drug was HIV positive, soon were all his customers. Because of the size of the HIV epidemic in Ukraine, it must be assumed that those habits were accompanied by an epidemic of drug addiction.
The International HIV/AIDS Alliance has estimated figures claiming that in 2008 between 323,000 and 425,000 people in Ukraine were using injection drugs.[12]
[edit]Causes and Extent of the Drug Epidemic
The main cause for the epidemic spread of drug abuse was the collapse of the Soviet Union. Many companies had to be closed. Mass unemployment led to poverty and lack of prospects for the future.
On the other hand, during and immediately after Ukraine has become independent there was a phase of low state control. Lawless areas emerged and especially young people lacked orientation. Due to the fact that the Soviet ideology had also been a substitute for religion, the system of values deteriorated along with the old state.
Badly affected regions were those that had been the most industrialised in the country during the Soviet period, which now experienced a sudden downfall due to the collapse of the industry.
The need for drugs and the explosive increase of the drug market was facilitated by the effortless availability of drugs in Ukraine. This is presumably why drug abuse, and consequently
the HIVepidemic, spread faster and wider in Ukraine than in other former Soviet republic. Why there have long been not only huge amounts of drugs, but also various kinds of drugs can be explained by:
1. Ukraine is a customary transit country for opium transport from the Middle East to Europe. 2. The soil is of good quality, and thus opium poppies flourish in the country. 3. Some Ukrainian cities are traditional locations for the chemical industry. On the other hand, the state has little control or only nominal oversight over the pharmaceutical industry.
For these reasons, it was possible that the opioid analgesic Tramadol, after its approval in 2004, becomes one of the most popular gateway drugs within a few months due on the black market.
The dissolution of the Soviet Union was the prerequisite and the cause for the outbreak of the HIV epidemic in Ukraine. Other reasons can be found in the Soviet and Russian past, respectively. The production and (especially collective) use of ordinary opiates like kompott, "mastyrka"
and schirka or ephedrine derivatives like wind was already common in the Soviet Union. Those drugs have become fashionable since the 1990s, stimulated by the home coming Afghan War veterans many of whom had got used to opium consumption over there. Despite the defeat, in the most adolescents' eyes the soldiers glowed with freedom and adventure, so that many imitated them.
The fast spread of drug use among adolescents is to be seen in the context of the far older
population alcoholism, originating in the Russian tradition. Still today alcoholism is one of the largest health risks, especially for men in the former Soviet Union. Adolescents whose parents drink tend particularly to use drugs.
Further important factors for the spread of HIV in Ukraine are the prisons and penal colonies.
[edit]Prisons
Between 1996 and 2001 about 26 percent in various prisons across Ukraine tested HIV- positive. In a January 2005 study between 15 and 30 percent of prisoners tested HIV- positive.[13]
A very high percentage of the prison population of Ukraine are drug addicts. Two laws contribute to that. First, one can be sentenced to three and more years of detention for the smallest amount of illegal drugs. Second, the militia is still measured according to their output, i.e. the number of convicted crimes. It is not an exception but the rule that the target is fulfilled with drug addicts, who are easy to find. As everywhere in the world, drug use is higher in prisons than outside, but syringes are even scarcer. Altogether, bad hygienic conditions prevail in the prisons. Another problem is the violence among the detainees. A major transmission route for HIV is rape. Moreover, even today, no broader
preventive measures would allow the detainees access to preventive aids in Ukrainian prisons. Early 2005 rates of up to 95 percent of the prisoners were found Hepatitis C positive.[13]
Early 2010 there where over 147,000 people held at prisons and more than 38,000 at pre-trial detention facilities in Ukraine.[14]
[edit]Transmission through sexual intercourse
The spread of HIV through sexual intercourse is steadily increasing. Of those 122,674 people who have been registered HIV positive in Ukraine in 2007, 40 percent have been infected by injecting drugs and 38 percent due to sexual intercourse. Although experts still speak about an epidemic, which mainly concerns the risk groups, the increasing HIV infections because of sex indicate that it is only a matter of time before the epidemic hits the common population. The most important interface between the drug milieu and the rest of society is the sector of prostitution. This is how many women who are addicted to drugs or live together with drug - addicted men try to make a living and pay for their drug consumption. Transmission in the prostitution sector is not officially registered in Ukraine. First surveys, however, show a huge increase in numbers. The reason why prostitution is on the rise in Ukraine is because of the poverty of these women and the increasing demand. In the last years there was an observable rise in sex tourism in this country. Consequently, sexual activities and human trafficking are increasing, too. Some polls among prostitutes show that they do not use condoms regularly. In a 2007 survey, only 48 percent claimed to always insist on safer sex. This survey was addressed to women who had already been in touch with an educational advertising program. (This is why the people conducting the survey could contact them.) An improvement in the situation of prostitutes could be achieved because prostitution was made legal in Ukraine in 2006. Hopefully this will help to encourage prostitutes to seek out doctors or consult prevention contact points. The transmission of HIV among homosexuals and bisexuals does not play as great a role in Ukraine as it does in Western Europe or North America. From 1987 to 2007, 157 cases have been officially recorded, one third of them in 2007 (48 new infections). Indeed it can be assumed that along with the increase in sexual transmission in general, the number of infections among homosexuals is rising as well. It is difficult to assess this circumstance as many homosexuals who have proved to be HIV positive prefer to claim a different path of transmission. From 1991 on, homosexuality has no longer been an offence, but homosexuals are still discriminated against. Consequently, this group of people is also very difficult to reach via educational advertising. According to surveys carried out by the Global Fund only 5 percent of them can be reached.
[edit]Infected children
Since 2004, pregnant women and mothers who receive a HAART (highly active antiretroviral therapy) have been recorded. In 2006, 2,822 HIV positive mothers gave birth in Ukraine. In 2007, the number
increased to 3,430. The treatment of these women with HAART decreased the risk of transmission of the virus from the mother to the child by 92.5 percent in 2007 (In 2006 the risk was decreased by 91 percent, which led to a 7.1 percent decrease in HIV positive newborns). Teenagers and young adults, however, are exposed to a far bigger danger by risky sexual behavior. An extensive survey, which was carried out in 2007 among young people between the ages of 15 and 24, showed that 5 percent of them had sexual intercourse before they were 15. No prevention programs are aimed at this age group. The risk for children and teenagers who grow up in the milieu of drug addiction and prostitution as well as for the unknown number of street children is estimated to be even higher.
[edit]Street Children
Children and teenagers who live on the street are very likely to be infected with HIV or other sexually transmitted diseases like tuberculosis. There are no official statistics about sanitary and psychosocial problems among this risk group. Risky behavior concerning their health and resulting problems are very likely because of their environment and have been proved by extensive surveys. This includes bad nutrition, unhygienic conditions, alcohol and drug consumption, psychological and sexual abuse, drop outs from school and a limited knowledge of HIV.
[edit]Spread of AIDS among children
Number of HIV infected women and children (late 2007)
The number of children with AIDS in Ukraine is on rise, since the number of mothers with HIV grows by 20-30% annually. According to the United Nations, the number of pregnant women with HIV was 0.34% in 2007, which was the highest index in Europe. According to the United Nations, of nearly 18,000 children born by HIV-positive mothers in Ukraine, 10,200 children have not contracted HIV and another 5,500 children under eighteen months have yet to receive final results of examination. In Ukraine 1,877 children have been confirmed as HIV positive and 244 have died of AIDS. The United Nations notes that the program of preventing mother-to-child transmission of HIV in Ukraine has cut the share of such transmission from 27% of the number of HIV cases in 2000 to 7% in 2006.[8]
[edit]Preventive Measures
Despite all preventive measures described here, one must take into account that the main causes of the HIV epidemic in Ukraine are embedded in the country’s social crisis. If the consequences of this
crisis – like mass poverty and lack of prospects or lack of solidarity – cannot be improved, the politics of AIDS will not be successful either.
[edit]Harm Reduction programs
A great influence in containing an epidemic is the availability of harm-reduction-programs. Programs for handing out sterilized needles are of greatest importance. The impact of those programs will be minor however, as long as the usage of drugs is a crime. The success of drug substitution programs lies in the ability to give drug addicts the chance to escape withdrawal symptoms and participate in social life with the use of legal and clean injections. Therefore, the vicious circle of drug use, drug-related crimes, precarious social status and the need to temporarily escape the latter can be broken.
Drug substitution programs require a stable society, which is capable and willing to integrate drug addicts and offers them an alternative to the lack of perspective that led them to drugs. Since those factors are not given in contemporary Ukraine, the introduction of drug substitution programs is doubtful. This particularly, because it is unclear if governmental control mechanisms suffice to prevent substitution drugs from being dealt illegally. Since 2003, drug substitution programs have been introduced in Ukraine. By the end of September 2008 they were offered to about 2200 persons in 38 locations.[12] Mostly Buprenorphin (Trademark ‘Subutex‘) is dispensed, which is significantly more expensive than Methadon. It is also less frequently used and thoroughly researched worldwide.
Buprenophin is more accepted by society and politicians however, because it is seen as a painkiller.
Methadon, in contrast, is viewed as a drug subscribed at public expense.[15]
[edit]National response
The policy and legal environment in Ukraine is generally favorable for combating the spread of HIV/AIDS, but there is a gap between national-level policies and laws and local-level practices. The National AIDS Committee was established in 1992 but was dissolved in 1998 because of budget disputes. In 1999, the government created the National AIDS Control Coordinating Council under the Cabinet and mandated that all regions establish HIV prevention programs. In 2001, a national plan for combating HIV/AIDS was approved; its goals included preventing the further spread of HIV, developing capacity to treat infected individuals, and providing social support and counseling for those living with HIV/AIDS.[9]
Although the HIV/AIDS law is one of the most progressive in the region, the government still treats HIV/AIDS primarily as a medical issue. Prevention activities have been largely funded by international organizations. Because HIV testing is limited to government facilities, those at greatest risk are not being reached, since marginalized populations are the least likely to use government facilities. Stigma
by the medical profession against persons living with HIV/AIDS is a major barrier to accessing information and services.[9]
The first Ukrainian advocate group of/for Ukrainian aids patients was launched on December 10, 2010.[16]
[edit]Statistics
I’m not going to add the statistical graphs. I don’t want you to
I’m not going to add the statistical graphs. I don’t want you to