We can stop the AIDS epidemic by 2030, but change needs to happen
01 Dec 2017
Interview with Natalya Lukyanova, UNDP Ukraine HIV and Health Programme Specialist
Since 1988, December 1 is World AIDS Day. This year, the international day promotes the theme “Right to health”. In this interview, our UNDP Ukraine HIV and Health Programme Specialist, Natalya Lukyanova, reflects on the specific challenges faced by Ukraine in its fight against AIDS.
On World AIDS Day 2017, the United Nations Development Program and the broader health community is drawing attention on the 15.8 million people across the world who still lack access to treatment. What is the status of the HIV epidemic in Ukraine and is access to treatment available to all those affected?
Ukraine continues to have a concentrated HIV epidemic among key populations at higher risk of HIV. These include people who use drugs, sex workers, men who have sex with men, transgender people and prisoners. The number of registered HIV cases is growing in most regions of the country. As of 1 November, this year, Ukraine had 312 091 registered HIV cases, with only 139 394 under medical surveillance. And from all people living with HIV which are indeed under medical surveillance, only 60% are receiving anti-retrovirus therapy (ART) – while an estimated 93% would need to receive it. According to Public Health Center of the Ministry of Health still 6,000 more people living with HIV would need to receive anti-retrovirus therapy, but they have no access to it.
Is there a specific situation in the conflict-affected areas of eastern Ukraine?
The Donetsk and Luhansk regions have traditionally a high HIV and TB prevalence. In 2014 the armed conflict in Ukraine affected their territory – we are talking of a population of approximately 5.2 million people. What happened then was that data about HIV epidemic in the non-government controlled areas of Donetsk and Luhansk regions stopped to be reported. The official number of reported cases for these regions has therefore dropped to less than half of what is was.
However, the rapid assessment data collected by HIV service organizations indicate a growth of risk behavior. This applies especially to areas close to the contact line, in the collective centers for internally displaced persons, where we see losses of prevention networks and increased use of drugs (including injecting).
We also need to consider that a vast number of people have been displaced throughout Ukraine as a result of the conflict. The control of HIV, tuberculosis and multidrug-resistant (MDR)-tuberculosis in Ukraine as well as surrounding countries will depend not only on the provision of medicines and healthcare services in the conflict zone, but also on providing access to treatment for those most at risk among IDPs and refugees at their new place of residence.
Is there a gender dimension to this? Are women affected differently than men?
Yes. In 2015, we conducted a survey on “Human rights of internally displaced people (IDP) living with HIV in Ukraine”. It showed that there are many more women IDPs than men, and they are more vulnerable to rights violation (as a cause and result of HIV and other sexually transmitted diseases) as well as to violence, requiring special legal support and services at the host communities.
This explains why since the beginning of the conflict UNDP has provided specific support to HIV positive and most-at-risk/vulnerable women affected by the military conflict, including IDPs, as a part of HIV humanitarian response program in Eastern Ukraine. We have particularly focused on areas where the number of registered internally displaced people living with HIV is the highest, focusing on protection of most vulnerable women and girls in risk of gender based violence.
What is being done specifically in these areas?
One of UNDP’s initiatives has been to initiate a mapping of gender-sensitive services for HIV positive women, and to develop and pilot Crisis Response Points. These are focal points for women and girls living with or affected by HIV in the regions of Donetsk and Luhansk.
During three months 56 women in risk of HIV or living with HIV have received legal and social assistance from UNDP focal points in Kramatorsk and Lisitschansk. In most cases, their rights violation resulted from violence and/or sexual harassment. Based on this, we have mobilized local stakeholders to pay more attention to address issues of gender-based violence and HIV/AIDS in the region.
To support local-level initiatives and to motivate women and girls who have been subject to sexual violence to refer for help and test for HIV, we have also launched an awareness raising campaign “Be aware=be protected” targeting key populations.
The 2030 agenda as described by the Sustainable Development Goals is very ambitious when it comes to AIDS, with a target to end the AIDS epidemic by 2030. Is this goal within reach in Ukraine?
Ukraine has indeed joined the UNAIDS “Fast Track” initiative to end the AIDS epidemic by 2030. However, goal set for 2030 will hardly be realistic if no substantial progress is achieved in the nearest years.
Let me highlight the most serious gaps: prevention programs for key population cover now 62% of people living with HIV, 46% of sex workers, and only 21% of men having sex with men. Since 2012, we have not seen any increase in coverage of programs for sex workers and men having sex with men.
As of now, coverage of most at risk populations by prevention programs do not adequately respond to the Fast Track strategy. It needs to be revised and government ownership for the prevention programs for most at risk populations must be established.
But there is still a decade before 2030, when Ukraine with the support of international organization can work to stop the epidemic. This goal is achievable if all national stakeholders find the most efficient and effective way to reduce new cases of HIV and ensure all rights of HIV positive people to healthcare and treatment. We also need to see a change in attitude towards risky sexual behavior and usage of drugs – Ukrainians need to be more aware of the problem and manage better their own risks, while also reducing stigma towards affected populations.