Health inequities, including in quality, availability and affordability of health-care services, lead to unnecessary suffering, avoidable illness, disability and premature death. These are real barriers to health for populations experiencing stigma and discrimination.
This World Health Day, marked on 7 April across the world, is an opportunity to bring the issue of health inequities into the spotlight. Nataliia Rudiuk, an infectious disease specialist who works in the Kyiv HIV/AIDS Centre, shares her story about the challenges faced by people living with HIV in Ukraine.
“I am always amazed to see how people survive and live a full and happy life. It is the most rewarding aspect of my work,” she explains. “From my medical practice, I remember one case where a patient’s relatives thought that he was living his last days, but now he has a happy family, children, work and, in fact, everything that a person needs. So, generally, he just needed some support and motivation at the beginning.”
Nataliia adds, “The greatest lesson that I have learned from working with people who are HIV-positive is to reserve judgement. HIV is a disease that can affect anyone. My role is just to help people to live their lives safely.”
HIV is not a death sentence, and every patient should know this fact
“I visited the Kyiv HIV/AIDS Centre for the first time when I was an intern, and now I have been working here for more than 10 years. As an intern, I was stunned by the diversity of medical cases, and when I received an offer to work here, I accepted it without any hesitation,” says Nataliia.
“I still feel devastated when I lose some of my patients, which unfortunately happens sometimes,” she adds. Although there is notable and encouraging progress, some patients continue to die because of systemic failures in the health system. Services do not always adapt to patients’ needs, and some people living with HIV in Ukraine continue to be excluded from treatment or have treatment delayed because of misunderstanding and stigma.
“In our Centre, some useful information materials about the importance of timely testing and therapy are available. But in Ukraine there is still an information gap, which needs to be bridged. After receiving an HIV-positive test, some patients just do not know what to do and where to go, and the internet is full of terrifying stories. This situation leads to a huge problem because many patients still do not have access to evidence-based information explaining that HIV is not a death sentence and that, on the contrary, people living with this disease can lead a full life, start a family and have children.”
Misunderstandings and stereotypes
“Some of my patients are still afraid of telling their doctors that they have HIV because they fear stigma and discrimination,” Nataliia points out. “For some of them, their family doctors even refuse to provide health services purely because of their HIV status. This situation arises because family physicians do not always know how to work with HIV-positive patients. In big cities such cases are rare, but at the regional level people are often stigmatized. As a result, many Ukrainians living with HIV are seeking out infectious disease specialists in big cities, but the situation should be changed.”
Misunderstanding and stereotyping among some health-care service providers can cause HIV to be under-diagnosed and left untreated. “While very experienced, some physicians in Ukraine still harbour stereotypes associated with HIV. For example, due to the common belief that older people cannot be infected with HIV, they are often diagnosed late. The result is that some older people living with HIV end up in a very serious condition.”
Improvements in medical education
Nataliia explains that incorporating some changes into medical education could be a real game changer. “We are already seeing more and more young and progressive health workers in Ukraine supporting people living with HIV and helping them to access effective treatment and live normal lives.”
2021: Year of Health and Care Workers
This story, developed for World Health Day 2021, launches a series of stories about health-care workers in Ukraine as part of WHO’s Year of Health and Care Workers campaign. Throughout the year, WHO in Ukraine will share inspiring stories about Ukrainian health workers to demonstrate their contributions, highlight the challenges they face and celebrate their successes.