On 30 June, international guest stars Elton John, Queen and Adam Lambert shook up the Euro 2012 fan zone in Kyiv. “The reason why we came? The fight against AIDS”, Queen guitarist Brian May declared before the show. “And we do not plan to make any money on this”. To the delight of thousands fans, the entrance to the fan zone was free and huge piles of condoms were given out, also for free. The volunteering by these pop idols comes at a critical time for HIV-crippled Ukraine. About 400,000 people are infected with HIV, the virus that causes AIDS. It is the only European country, along with Russia, where the epidemic continues to grow.
For artists and activists, the Euro 2012 football championship was a large stage for raising awareness. In early June, before the first whistles echoed in stadiums, the Dutch NGO “AIDS Fonds” had addressed a dramatically alarming open letter to the President Viktor Yanukovych. “Each day, 58 Ukrainians are infected with HIV. Each day 7 Ukrainians die of AIDS. This come with far-reaching consequences – every other day Ukraine loses an entire soccer team (…) Football-loving Ukraine will be doomed very soon: empty fields, no players, no fans, no life…”. The tone is set: by European and even by world standards, the AIDS situation in Ukraine is disastrous.
Since 2004, the Global Fund to fights AIDS, Tuberculosis and Malaria has allocated 316 million dollars to Ukraine, that is one of its largest grants worldwide. The conclusions are more than bitter. With about 170,000 people in need of Anti-Retroviral Therapies (ART) in December 2010, less than 23,000 were receiving it. That was as many as in Myanmar, which had received ten times less money than Ukraine. By May 2012, official statistics had risen to 30,350 persons under treatment. Yet, at the same time, 8,443 new cases of HIV infections have been diagnosed since the beginning of the year. In other words, more ARTs have just covered the furthering spreading of HIV. To this day, just 16% of patients receive appropriate care.
30% OF THE MONEY GONE?
Old habits die hard. And many are eager to blame corruption and the misuse of funds as the main roots of the unsolved problems. Back in March, the first draft of a country audit by the Global Fund denounced widespread embezzlement of allocated subsidies, in particular from the principal recipients of the aid, that is “Alliance-Ukraine” and the “Ukrainian Network of People Living with HIV”. Among others, the report highlights the misuse of funds in the organization on overly expensive training, in the renovation of apartments and in opaque and unfair tenders. According to the report, an Alliance-Ukraine open tender for procurement of mobile clinics was based on “specifications for vehicles which were smaller than needed and inadequate to serve as mobile clinics”. It distorted the criteria of the $500,000 contract, which eventually was not awarded to the most competitive bidder. The audit also points out an unjustified policy of high salaries. Such accusations are largely dismissed by Kostiantin Pertsovskiy, Alliance-Ukraine senior communications manager. “There may have been some mistakes due to our lack of experience. But there has been no embezzlement, otherwise the Global Fund would have asked us to give back the money. It’s as simple as this. And yes, our salaries are high, but this is because we want to hire the best specialists”.
That argument seems quite unconvincing to the director of an NGO fighting against AIDS in Kyiv, who has chosen to remain anonymous. “If you compare the NGOs that work on the field and the prestigious Alliance-Ukraine, the salaries can vary from 800 to 8,000 UAH for the same position! This makes no sense. In general and according to my estimates, approximately 30% of the Global Fund money disappears in schemes like this one”. According to him, the Global Fund could simply retreat from Ukraine within a few years, if the situation does not improve. An improvement the principal recipients of the aid are already working on, according to Kostiantyn Pertsovskiy, who recalls that caring about the HIV epidemic in Ukraine is all in all a new concern. “You have to consider everything we have been doing for the past decade. We literally started from scratch. We have our own shortcomings, yet we have been granted the highest level of trust by the Global Fund. I don’t believe they will give up on us or on Ukraine”.
But beyond corruption and embezzlement, it seems that the core of the problem lies in deeper, structural issues. In April, the U.S. organization AIDS Healthcare Foundation (AHF) sent an open letter to the Global Fund, requesting the reprogramming of 75% of its grant, namely to focus on prevention and on access to treatment. “At first, the epidemic was spreading within so-called risk categories of the population, that is drug users, sex workers, men having sexual relations with men, street children, etc. But because of a lack of access to treatment, the spread of HIV has not been contained and now threatens all segments of society”, AHF Regional Advocacy Manager Constance Boris regrets.
Recent studies highlight that about half of new contaminations result from unprotected sex between heterosexual partners. Yet, a recent survey by the Ukrainian Institute of Social Studies has revealed that only 20% of 15-17 year-old students are aware of the ways HIV is transmitted. In 2007, awareness among this age group was 22%. “The lack of information and awareness in Ukrainian society is one of the very foremost causes for the spread of the virus. For example, the use of condoms is not associated with having safe sex and pleasure as it is now in Western countries. Among Ukrainian youth, it is still a constraint associated with same-sex practices”, project coordinator at the French Red Cross Suzanna Mnatsakanova warns. “This is very worrying, as we know now that prevention is a treatment in itself”.
Nationwide prevention campaigns are usually quite discreet and free condoms may be hard to find, as they are most generally allocated to a few specific medical centres and gay clubs. In Kyiv, some of the few HIV testing centres have even been closed in the past few years. It takes more than an Elton John concert to raise awareness of HIV and repel stigmatisation of the disease and its victims.
STIGMATISATION & DISCRIMINATION
Persistent outcasting of some of so-called risk categories and further stigmatisation of HIV-infected people fosters the spread of the virus. When it comes to drug users, one numbers about 300,000 of them in the country. Although this group is not any more the most affected, its prevalence (contamination) rate is 22%. A firmer state support to reduction of drug consumption may prevent further infection. Yet the access to Opiate Substitution Therapies (OST), which help to a step by step reduction of the addiction to substances, remains surprisingly low. Some 6,400 people are on OST in Ukraine, which means about 2.1% of the drug-using population. Experts believe that a significant reduction in the spread of HIV would require having at least 40-60% of drug users on OST.
Lord Norman Fowler is a champion of HIV prevention and harm reduction in the UK. In the 1980’s, he initiated the “Don’t Die of Ignorance” campaign, which raised HIV awareness in the very early days of the epidemic. In April 2012, as he was visiting the Otdyha medical centre in the outskirts of Kyiv, he confessed his astonishment at the low use of OSTs in Ukraine, despite its proven positive effects in other countries. “We introduced in harm reduction in the UK in 80s and HIV prevalence among people who use drugs is now low,” he said.
NGO representatives repeatedly complain of the persistent stigmatisation by society and counterproductive and discrimination by police officers, administrative services and even medical staff. Administrative burdens are often imposed on NGOs’ activities, such as the destruction of infected syringes which has to meet strict technical criteria. Some organizations end up permanently stocking the syringes they collected, instead of going through the complicated destruction procedures. And end up stopping their collecting because of a lack of storage space.
For many years, medical treatment and equipment paid for thanks to the Global Fund’s grant were subject to taxes when imported to Ukraine. Not only did the state not pay for medical treatments, but it has been making money on them and raising retail prices. It was only on 21 June that the Verkhovna Rada made these products tax-free, as has been the case in most of the world for a long time.
When it comes to relationships with police, some officers are believed to be directly involved in drug trafficking. They assert pressure on OST demanding information on drug users and on social workers, whom they consider to be something like competitors.
NGO representatives underline the lack of motivation by doctors and nurses when dealing with HIV-affected patients and drug users. Oleksandr Lebega is in charge of OSTs at Alliance-Ukraine: he turns quite cynical when dealing with doctors’ requirements at the Otdyha centre for them to take more patients in. “Before they were saying they did not have enough space. We doubled the space. Then they asked for video surveillance. We installed cameras. Then they asked for more staff. We hired more people. Now they say they don’t have enough treatments! They are just not willing to receive more patients, as it’s an extra burden. Their salaries won’t raise and many of them don’t like dealing with drug users, whom they kind of despise”.
“In the end, beyond the amount of money, the number of treatments and the infrastructure, the level of stigma against affected people is the barrier to solving the problems”, Suzanna Mnatsakanova explains. She runs a home-based care program, which sends nurses to people’s homes to provide both medical, social and psychological support. “What we do is to fill the gap that so many patients encounter between the treatment and going on with their lives. The human impact is essential, but we are the only ones doing it in Ukraine. Our program has been entirely financed by grants from foreign organizations and governments and we can only reach a few households. I regret such a programme has not been a Ukrainian initiative. Sometimes patients look at me and ask how come the French Red Cross takes better care of them than the Ukrainian government. I don’t know what to answer them”.