In rebel-held Ukraine, ac­tivists strug­gle to cur­tail HIV spread

Kuwait Times - - HEALTH & SCIENCE -

DONETSK: As clashes drag on in east Ukraine be­tween gov­ern­ment forces and Rus­sian-backed rebels, health ac­tivist Natalia Gurova is fight­ing an­other bat­tle of her own. Gurova man­ages a pro­ject in her in­sur­gent-con­trolled home city of Lu­gansk hand­ing out clean sy­ringes and con­doms to drug-users and sex work­ers who are most at risk from HIV and hep­ati­tis.

That puts her at the fore­front of the per­ilous strug­gle against the spread of in­fec­tions as more than three years of con­flict and rebel rule have hit vi­tal treat­ment pro­grams. “Ev­ery­thing has wors­ened,” Gurova, from the All-Ukrainian Pub­lic Health As­so­ci­a­tion, a char­i­ta­ble or­ga­ni­za­tion, told AFP. Get­ting sup­plies such as con­doms, lu­bri­cants and hy­gienic wipes into re­bel­held ter­ri­tory re­mains a con­stant chal­lenge as they run the gaunt­let of check­points to cross the tightly guarded front­line.

While Gurova still man­ages to keep these pro­grams go­ing, sub­sti­tute treat­ments for drug ad­dicts in­clud­ing methadone have stopped en­tirely. This has seen users who were be­ing weaned away from in­ject­ing them­selves turn to dan­ger­ous lo­cal al­ter­na­tives-and bol­stered the threat of the spread of dis­eases. “There are more cases of HIV in­fec­tions among users and it is very dif­fi­cult to make con­tact with them,” Gurova said. Along­side this prob­lem, ac­tivists say there has been a rise in the num­ber of sex work­ers in the grey zone along the front­line.

Bat­tle for sur­vival

Prior to the start of the con­flict in April 2014, ex-Soviet Ukraine-es­pe­cially in its eastern re­gions of Donetsk and Lu­gansk was al­ready bat­tling one of the most se­vere HIV epi­demics in Eastern Europe. But thanks to pro­gres­sive poli­cies the coun­try was mak­ing progress and had man­aged to re­duce the rate of HIV in­fec­tions, most dra­mat­i­cally among young drug users. Af­ter the war flared up in 2014, ex­perts soon warned that the con­flict risked jeop­ar­diz­ing any gains that had been made.

As Kiev lost con­trol over Donetsk and Lu­gansk, health ser­vices and key treat­ments for in­fec­tions were hit. In 2015, in­ter­na­tional ac­tors man­aged to stave off an im­mi­nent cri­sis by ne­go­ti­at­ing with Kiev and the rebels to keep sup­ply­ing an­tiretro­vi­ral drugs to thou­sands of HIV pos­i­tive peo­ple in the sep­a­ratist ter­ri­to­ries. Emer­gency funds were pro­vided and the United Na­tions now es­ti­mates that about 10,000 adults and chil­dren with HIV in rebel-held ar­eas are re­ceiv­ing the drugs.

Pre­ven­tion hit

But while ne­go­ti­a­tions have been suc­cess­ful in get­ting the most ur­gent treat­ments through for now, in terms of pre­ven­tion the sit­u­a­tion still looks dire. Doc­tor Igor Pirogov, who works at a hos­pi­tal treat­ing drug users in rebel cap­i­tal Donetsk, said that the war has se­ri­ously dis­rupted at­tempts to curb ad­dic­tion.

“Most of our pa­tients put on a uni­form, got a weapon and went off to fight” for the in­sur­gents, Pirogov said. “Many even said openly that they were us­ing more drugs dur­ing the war than when it was peace­ful.” The in­ter­na­tion­ally ap­proved opi­oid re­place­ment treat­ments that had be­come the norm in Ukraine have ended. Due to se­cu­rity re­stric­tions the Ukrainian au­thor­i­ties say they are un­able to de­liver sub­sti­tute drugs across the front­line. For their part the rebels seem to have fol­lowed in the foot­steps of their back­ers in Rus­sia-where methadone is banned-and turned the clock back on pro­gres­sive treat­ments. Ac­tivist Gurova said that about 900 pa­tients had lost ac­cess to the methadone pro­gram, lead­ing many to turn in­stead to dan­ger­ous lo­cal al­ter­na­tives. At the same time she said more women around the con­flict zone have turned to pros­ti­tu­tion-also putting them at greater risk. “There are no jobs, no work, no earn­ings-this is the only op­tion for them-so it all leads to an in­crease in the num­ber of sex work­ers,” she ex­plained.

Prob­lem for Ukraine

As it has waged war against the in­sur­gents on the bat­tle­field, the gov­ern­ment in Kiev has shown a ten­dency to dis­own the health cri­sis in rebel re­gions. While the sit­u­a­tion in ar­eas un­der in­sur­gent con­trol has de­te­ri­o­rated, the rest of the coun­try has con­tin­ued to make head­way tack­ling HIV as au­thor­i­ties have pushed on with the poli­cies that were yield­ing re­sults. “The de­cline in the rates of HIV epi­demic growth is en­cour­ag­ing”, Pavlo Skala from the Al­liance for Pub­lic Health told AFP.

But ex­perts warn that any im­prove­ments be­ing made risk be­ing un­der­mined by a uptick of in­fec­tions in Ukraine’s re­bel­held re­gions and that Kiev can­not turn a blind eye to the prob­lems hap­pen­ing across the front­line. “Sol­diers stand on the de­mar­ca­tion line be­tween the two ter­ri­to­ries and they can con­trol the bor­der,” Skala said. “But they can­not con­trol the spread of epi­demics.”

DONETSK: A pa­tient waits to be treated in the tox­i­col­ogy unit in a hos­pi­tal treat­ing drug users in the rebel cap­i­tal. — AP

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