World AIDS Day has been celebrated worldwide on 1 December since 1988. Thirty-two years on, HIV transmission remains a major public health concern. According to a new report from WHO and the European Centre for Disease Prevention and Control (ECDC), “HIV/AIDS surveillance in Europe 2020”, it affects more than 2 million people in the WHO European Region, including Ukraine. The data also demonstrates that in 2019, 136 449 newly diagnosed HIV infections were reported in 47 of the 53 countries of the Region.
Dr Toke Barfod, an infectious disease specialist and consultant for WHO, has worked in HIV care in Ukraine and over the past year has visited hospitals in Kyiv, Odesa, Kherson, Chernihiv and Mariupol. On World AIDS Day, he shared his observations about the HIV situation in Ukraine.
“The HIV situation in Ukraine is bad, because almost 200 000 people are infected, and only just over half of them are receiving treatment. So many people in Ukraine still do not know that the problem of HIV can be solved. But there are reasons for hope. The Government of Ukraine is working hard in collaboration with WHO and other international organizations to solve the problem.
“There are very good possibilities for the situation to get better. The optimistic perspective is that, in a few years, HIV will be a much smaller health problem in Ukraine than it is today. In a few years, people will know that HIV can easily be treated, and they will want to get tested.”
Obstacles in overcoming the HIV epidemic in Ukraine
“Major obstacles are fear, shame and lack of knowledge. Many people are afraid of getting diagnosed, because they fear stigma, disease and death. This fear means that many people avoid getting tested and therefore, without knowing it, they continue spreading the virus to others for many years, until they eventually get very sick and sometimes die from it.
“Health-care workers should help communicate the message that HIV no longer needs to be such a problem. They should tell their patients, their friends and family, and the general public. And very importantly, they should also ensure patient confidentiality, so that patients can trust that their diagnosis will not be revealed to others. Doctors should do a lot more testing, and they should ensure referral to care. In this way, the epidemic could be stopped.”
HIV treatment in Ukraine
“Treatment for people living with HIV in Ukraine is well organized. Recently, the internationally used, very best drugs have become widely available in Ukraine. There are only minor adjustments in the choice of drugs needed,” explained Dr Barfod.
Martin Donoghoe, Senior Adviser on TB, HIV and Viral Hepatitis, WHO Country Office in Ukraine, added: “Increased public awareness coupled with the important health system reforms that increase access to HIV treatment are vital in overcoming the HIV epidemic in Ukraine”.
The main message to Ukrainians about the HIV epidemic
Dr Barfod went on to state: “Get tested and treated before it is too late! The reasons behind this message are: the virus has now spread to the general population, so everybody is at risk. For the first years of the infection, the virus shows no or very few symptoms, so you never know who has it, and you yourself might have it too. An undiagnosed person with HIV can transmit the virus to his or her loved ones, and may become very sick and die; whereas a person on effective treatment does not transmit the virus to others, and is likely to live a completely healthy life. The treatment is incredibly effective, it has very few or no side effects and is provided to everybody for free.
“The oldest person with HIV so far, turned 100 in 2019. He had been on treatment for many years, and recently died peacefully in his sleep. Generally, people who are on treatment for HIV can live as long as anybody else. What does it take? You need to get tested, before your immune system breaks down. You need to take the medicine every day, and you should go for check-ups at your doctor’s once in a while.”
WHO has been supporting Ukraine in preventing and treating HIV since the 1990s, and the implementation of WHO recommendations for HIV testing in Ukraine has resulted in effective testing strategies, optimization of HIV treatment and an increased number of people living with HIV knowing their status. In Ukraine, WHO works closely with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other international and national partners towards preventing and treating HIV in the country.