Ukraine has the highest concentration of HIV+ people anywhere in Europe. In 2005 it was declared the country experiencing the fastest acceleration of infection in the world, at that time it was mostly due to IV drug use. Now it’s a 50/50 between sexual transmission and IV drug use with infected needles. Six years later some things are better, some remain the same and some are worse. This post-communist country has had many teething problems transforming into a fledgling capitalist democracy. One of the most difficult is the constant struggle for power within an ever-changing, ill-resolved government with a legacy of corruption. The consequences for those who are HIV+ have been dire.
Every change in government has involved a new tender war between the major pharmaceuticals as they struggle to outbid and out-bribe each other as they jostle for the attention of the new Ministry of Health. This has meant that for thousands, access to life-saving Anti-Retroviral therapy has stalled every time a new government has come into power. Back in 2005, the government had not yet fully embraced the idea of providing ART’s to sick people. Nowadays that has changed and if you can afford it, you can get on a subsidized program for medication. However, if you are not already established on a list of registered recipients, and you find you are HIV+ and in need of ART’s, you cannot get on the list until the new government has mapped out their relationship with the new pharmaceutical provider. In many cases, this can take at least a year, a year in which thousands of people will die simply because their names do not appear on that vital list.
There is a long history of people living with AIDS carrying a heavy stigma in Ukraine, with most Ukrainians seeming them as criminals. This is improving but lingers on in the attitudes that make not getting onto a list a death sentence. Mass unemployment and a genuine lack of opportunity also characterize much of Ukraine. This has infused fatalism in many of her people and a slide into alcoholism and IV drug use are often a simple escape from a hard life without alternatives. Prison and addiction are often a by-product for thousands and once inside that system there is little hope. Prisons in Ukraine have a reputation for no compassion for those living with HIV although there is some evidence that testing for HIV is becoming more commonplace in prisons across Ukraine. That said, multiple ex-prisoners who were interviewed said that prisoners who contracted full-blown Aids were often released when death was imminent so responsibility would not fall on the authorities.
Drug use remains heavy across Ukraine. Heroin is ever present but there is a new drug in Ukraine, originating in Russia, “Krokodil” is an ephedrine based drug, utilizing cough medicine and enhanced with eyedropper fluid. It has a tremendous effect on human flesh and bone, literally eroding bone and flesh away from addicts. It has a longer high and is cheap to produce and many addicts cook “Krokodil” at home. Of the many that I saw, some were partially paralysed, others had lost the lower part of their jaw. It is a truly frightening drug. Prostitution is an ever-present part of any drug landscape and Ukraine is no exception. This is reinforced by unemployment in a never-ending spiral that will remain the case as long as unemployment and lack of opportunity remain the norm for most Ukrainians.
There are some positive changes. HIV+ orphans are for the first time being accepted and being adopted. In 2005 there was little evidence they would ever leave the very few orphanages that would take them. Now there are a number of fantastic facilities and genuine care. There are also regular adoptions and a lesser stigma at the idea of adopting an HIV+ child. There is even a Russian Orthodox Church sponsored orphanage in the West of Ukraine that has the most impressive facility of all. They have adopted 44 HIV+ children who are looked after with exceptional care. This is a huge change in a country where traditionally the church has taken a dim and prejudiced view of those living with HIV. Hopefully this move will become more widespread and ordinary Ukrainians will increasingly see the connection between those struggling to live with HIV and themselves. It remains a truism that HIV affects us all and Ukraine is beginning to recognize that.