Pubdate: Wed, 23 Jan 2002
Source: New York Times (NY)
Section: Health
Copyright: 2002 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Ian Fisher
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)

AIDS IN UKRAINE JUMPS TO THE GENERAL POPULATION

ODESSA, Ukraine -- No one outside a small sympathetic circle knows that 
Iren is infected with H.I.V., not even her mother. Telling, she said, would 
only "make trouble." It would also invite unkind assumptions, given the way 
AIDS has cut through Ukraine, the nation with the worst problem in a region 
where the disease is spreading with alarming speed.

"People would think I used drugs or I was a prostitute," said Iren, who 
asked that her full name not be printed.

Neither is true of her, and that fact marks a long-dreaded departure in the 
short history of AIDS in Ukraine. Until 1994, the disease was virtually 
unknown, with only 187 cases diagnosed. Then drug addicts and prostitutes 
became infected as society became freer, if poorer, with the fall the 
Soviet Union.

While the infection rate is still low compared with that of Africa, between 
300,000 and 400,000 people in Ukraine are now estimated to be infected with 
H.I.V. That makes Ukraine the first nation in Europe with 1 percent of its 
adult population infected. Throughout Eastern Europe and Central Asia, 
there has been an abrupt spike in H.I.V. infection rates.

Around the region, the number of infections is 15 times higher than it was 
three years ago, largely because of intravenous drug use, according to the 
United Nations.

In Russia alone, at least 75,000 people are estimated to have contracted 
H.I.V. in 2001, mostly through shared needles. Dr. Peter Piot, executive 
director of the overall United Nations AIDS program, warned recently that 
an even larger epidemic in the former Soviet countries "may be imminent."

The disease is still spreading most among those at life's margins, as Iren, 
who works for an agency that helps people with H.I.V., sees every day here 
in Odessa, a Ukrainian port city that has been a center for the disease -- 
as well as for local activists who fight it.

But now H.I.V. is also moving with a sad, slow force to people like Iren, 
38, an economist and mother, who says she contracted H.I.V. from her 
husband, a drug user who died of AIDS a year ago. Now more people, mostly 
women like Iren, are contracting it sexually, not as prostitutes or through 
shared needles. More pregnant women are testing positive for H.I.V., and 
the disease is being passed more often to newborns.

"There is a shift to the general population," said Andrej Cima, the head of 
the United Nations Joint Program on H.I.V./AIDS in Ukraine. "That is clear."

This shift is worrying enough, health officials say, but it comes at a time 
of continuing alarm about the overall rate of infection here and the 
inability of the cash-strapped government to rein in its spread despite 
relatively progressive policies.

Health officials, both in the Ukrainian government and the United Nations, 
argue that now -- with the disease starting to bore its way into the 
general population -- is the moment to step in with a huge investment to 
fight a further spread of the disease.

The idea is to concentrate on the disease's reservoir, intravenous drug 
users, as well as young people who often turn to drugs because of few jobs 
in a generally bleak economy. Toward that end, the United Nations is 
working to raise between $30 million and $50 million for a broad three-year 
program against AIDS.

With enough money, said Alla Shcherbinskaya, director of the government's 
Center for AIDS Prevention, "I think we will be able to make the epidemic 
stall in the next five years."

"Of course," she added, "we will not be able to stop it. But we can stop it 
from growing."

Ukraine is generally considered among the most advanced nations in the 
region on AIDS issues: President Leonid D. Kuchma is one of the few leaders 
to talk publicly about the disease. He has declared 2002 the official year 
of fighting AIDS.

But if Ukraine is the best, it may not bode well for the rest of this poor 
and isolated region -- a fact summed up by two bodies that lay in the 
backyard of a state-run AIDS clinic here one recent day. The two had died 
of AIDS, and the only hearse available had broken down.

"This is something which can make a person depressed," said Sergey Fedorov, 
an AIDS activist who described the bodies just after seeing them at the 
clinic. For one, he said, the government does not now have the money to run 
an effective program against AIDS, never mind transport its victims to the 
grave.

In a country where awareness about AIDS seems quite low, he said that a 
scene like the bodies could only add to a sense of fatalism.

"People think that when they get AIDS, the next stage is death," he said.

Mr. Fedorov, a handsome, healthy-looking 28-year-old, is a rarity in a 
nation where the stigma against AIDS patients is great. A former 
intravenous drug user, he decided two years ago to go public with the fact 
that he is also H.I.V. positive.

Not everyone -- his mother included -- applauded his decision. But other 
activists and health officials credit his frequent appearances on radio and 
television with creating a human face for the disease. Slowly, he said, 
awareness is rising. He added that it was likely to rise more now that it 
was not only drug users who were contracting H.I.V.

"We are sort of in a beginning stage of people understanding that it is a 
threat for everyone," he said. "But it is only a beginning."

There is a slight change of focus here among AIDS groups in Odessa, who 
have worked with little government help to create a wide net of services. 
Most of the effort has been to educate drug users and prostitutes, two 
groups not widely accepted, and by using methods as contentious here as in 
the United States.

"The first time I heard that in order to stop the spread of H.I.V. we had 
to give out syringes to addicts -- it was a big shock to me," Tatiana E. 
Semikop, a major who has worked for Odessa's police force for 17 years. 
"How was I, a police officer, supposed to give out syringes?"

Ms. Semikop, who for five years has also headed a large AIDS agency, Faith, 
Hope, Love, said she changed her mind when she saw that it worked. While 
her group and others continue to focus on drug addicts and prostitutes, 
they have begun to branch out -- now that, by her estimate, 60 percent of 
new infections are transmitted sexually.
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MAP posted-by: Beth