The HIV response in Ukraine: Back from the Brink

How an awareness campaign helped rebuild Ukraine’s shattered HIV response

Joint Ukrainian-German concert with German band Heisskalt, Kiev 2016

Efforts to stem Ukraine’s HIV epidemic suffered a huge setback when social unrest and conflict erupted in 2013 and 2014. While it has yet to regain its former momentum, the HIV response is showing a surprising turnaround, in part due to a joint awareness campaign that is changing the way people think about HIV.

In 2012, Ukraine’s HIV response was about to turn a corner. Despite being home to the region’s second-largest epidemic, the country had just reported its first decline in HIV infections.

Then things were up-ended dramatically. The Maidan Revolution broke out, civil unrest spread, the regime changed and social reforms were launched to root out corruption and dismantle the antiquated Soviet system.

Conflict aggravates HIV situation

As reforms took hold and the country looked to Europe, Russia suddenly annexed Crimea and war broke out in the country’s East. Ukraine, once a stable middle-income country, watched as its currency plummeted by 300% in three months and conflict engulfed hearts and minds. HIV threatened to slip from view as the government shifted its priorities.

“One of the region’s worst epidemics has been worsened by war,” said Jacek Tyszko, Ukraine country director for the Joint UN Programme on HIV/AIDS (UNAIDS). “One of the epidemic’s three main epicentres is in areas of war, and if we can control the epidemics there, we can control the entire country’s epidemic – and thereby the region’s.”

Besides Kiev, Ukraine’s epidemic is mostly concentrated in the South and East and nearly a quarter of the country’s 238,000 people living with HIV (PLHIV) according to the estimated statistics provided by UNAIDS (Global AIDS Monitoring 2017) come from the three regions affected by conflict. Many have been internally displaced, straining the health system further.

National campaign helps raise awareness

Workplace Programme with teachers and trainers 

In 2007, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ), developed a project entitled HIV/AIDS Advisory Services and Institutional Capacity Building. Two years later, the project partnered with the Ministry of Health of Ukraine (and with UNAIDS since 2015) in a first nation-wide prevention awareness campaign. Based on an existing German behaviour change communication approach, Don’t Give AIDS A Chance, the latest wave of the Ukrainian campaign explored two themes: 0.06 mm of Latex Can Save Your Life focused on condom use, and To Believe or Not highlighted the importance of HIV testing.

The campaign made major inroads. A GIZ-commissioned study found that in Crimea, a focus of the campaign because of its high HIV prevalence, general knowledge of HIV and AIDS shot up from 67% to 89% in the four years from 2010 to 2014. Willingness to help an HIV-positive friend or relative nearly doubled from 10% to 19% during the same period.

The campaign’s broad success was being undermined by a combination of conflict, internal migration and the breakdown of health systems in the East due to war. Yet the need for HIV prevention was greater than ever: condom use was falling, the health care system came under increasing pressure from war, especially near border regions, and poverty fuelled sexual transmission of HIV.

“Given the difficult economic and political situation, people needed to be reminded of ways to protect their health and wellbeing,” said Tetyana Khimchenko, the project’s Deputy Team Leader for HIV.

It was essential to refocus attention on HIV. An evolving reform process, the appointment of a new health minister whose priorities lie in changing the Ukrainian health care system and tireless advocacy by the campaign’s partners all played a part in returning HIV to the forefront.

In 2016 two major events reminded Ukrainians of the importance of HIV prevention. The first, a concert to promote condom use, brought together Ukrainian and German musical bands, while the second provided free, anonymous HIV testing, an important initiative in a country where 64% of the population had never been tested for HIV.

Developing capacity is key to HIV prevention

In addition to raising awareness about HIV, the project also ensures institutions have the capacity to fight the epidemic.

“I think we’ve learnt a lot on the basis of Don’t Give AIDS A Chance,” said Vitaliy Karanda, who heads the International Cooperation Department of the country’s new Centre of Public Health. “One of the main successes for us is that more people – 74% to be precise – are now aware of HIV. Another is that we are now aware of the importance of ‘change agents’, of teachers and doctors.”

As part of the German contribution to Ukraine’s reform process, the HIV/AIDS project builds institutional capacity by training doctors and teachers, many with little prior knowledge of HIV.

“I can see how the attitude towards HIV and HIV-positive people is changing among my colleagues,” said Irina Soloshenko, a teacher in Pavolograd School #9, in Dnipropetrovsk region. “The training also promotes tolerance and teaches youngsters to respect others and create a less stigmatized society.” Ms Soloshenko is one of nearly 11,066 teachers and 2116 family doctors who received HIV training under the German-supported project. Teachers trained students and other teachers in HIV prevention methods, while doctors learned about voluntary counselling and testing, issues related to discrimination and tolerance, and HIV and AIDS knowledge, which is often insufficient.

Ukraine’s HIV response: Back on track

All evidence points to the HIV campaign’s success. Recent research in Dnipropetrovsk, where the campaign is active, shows a leap in people’s understanding of risky behaviours that can lead to HIV infection, from 37% in 2015 to 50% in 2016 (Volosevych, I. et al., 2017). Demand for HIV prevention information is at an all-time high among young people and Ukraine boasts the region’s most progressive condom use. More than 8000 people have already visited the campaign’s interactive education website, which helps increase the general public’s HIV knowledge.

Today, despite Ukraine’s political and economic challenges, the HIV epidemic appears to be stabilizing. The government increased its HIV budget by 132% and prioritized prevention in the ambitious four-year reform it launched in 2014 to develop an efficient public health system. It curtailed corruption and cut costs by transferring drug procurement to international agencies. Stigma and discrimination, while still in evidence, have weakened: in 1991, half of all Ukrainians believed PLHIV should be isolated from the rest of the population. By 2016, that figure had dropped to 23 % (Volosevych, I. et al., 2017).

Meanwhile, the number of PLHIV on treatment continues to rise. In 2007, according to UNAIDS, 3000 people were being treated for HIV. By the end of 2017, a total of 100,000 people living with HIV are expected to be on treatment.

The ongoing conflict in parts of the country continues to hamper the HIV response, but Ukraine has demonstrated its resilience by working with partners and turning its response around – a fortunate success in a country facing one of the most profound reforms.

Further reading:

Volosevych, I., Konoplytska, T., Moon, N. (2017) Public awareness of HIV epidemy in Ukraine in 2016.

Leyla Alyanak, October 2017

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