HIV/AIDS in Ukraine

Ukraine has one of the fastest growing HIV/AIDS epidemics in the world. First 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 drug users in the southern and eastern regions of the country.

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.

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. 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.

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 of tuberculosis, 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. [http://www.usaid.gov/our_work/global_health/aids/Countries/eande/ukraine_04.pdf "Health Profile: Ukraine"] . United States Agency for International Development (December 2004). Accessed September 7 2008. PD-notice]

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.

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.

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