How Ukraine is Winning It’s Longest Running Battle-HIV

Valeriia at the All-Ukrainian Network of People Living with HIV office in Kiev. Photo: Megan Birot

While Ukraine remains the country with the highest HIV prevalence rate in Europe, it is breaking ground in the battle against the virus.

It was over the phone Valeriia Rachynska was told her life would take a new turn. “I got your results, it’s positive. It’s the first test so you’ll need to do a second one as soon as possible,” she recalls of what the doctor told her.

“I was at work selling car parts, so I had no chance to cry in the moment because I was with clients. Part of me thought it was a mistake” she says.

“I felt like a spy you know, I was breathing slowly, smiling and I finished my sale, went outside and cursed.”

It was almost a decade ago the 36-year-old was told she was HIV positive. She had contracted the virus from her then partner Ivan, who was diagnosed weeks before her when hospitalised for other illnesses. He was told he had only weeks to live since he had developed AIDS and other infections.

“The doctors were really cruel sometimes. They told me, ‘don’t think about him, think about you because he will die very soon’, but I never thought about giving up,” she says. “I called dozens of HIV centers for advice and got educated about the virus because he deserved a chance to fight this.”

Ivan underwent treatment for his tuberculosis and antiretroviral therapy but died four years after his diagnosis due to complications with his liver. Today, Valeriia is still a fervent fighter of the cause. She works for the All-Ukrainian Network of People Living with HIV/AID (PLWH) in Kyiv, the largest patient organisation in Ukraine.

Ukraine’s silent epidemic

It’s estimated that 240,000 people live with HIV in the country, which also has the highest prevalence rate in Europe, according to UNAIDS. Last year alone, almost 15,000 new cases of HIV were registered, according to the Ministry of Health.

The pandemic gripping the country is especially affecting the youth. Over half of new infections are sexually transmitted, while intravenous drug use represents more than a quarter of new contractions. Other populations at risk include sex workers, gay men and prisoners. HIV positive people are most at risk of contracting infections like hepatitis C and tuberculosis, with the latter being the leading cause of AIDS related deaths in Ukraine (65 percent).

Recent research conducted by Oxford University and Public Health England (PHE) also found that half of the people affected by the virus in Ukraine are unaware of their positive status, while nearly 40 percent of those newly diagnosed are often in advanced stages. What’s more is only half of the estimated HIV cases in the country are registered, according to the Centre of Public Health.

“It’s very important for people who live with HIV to know that this is by no means a death sentence,” she says.

“We can still have sex, have healthy children and lives if we’re on good quality treatment, which is available now.”

Valeriia is proof of what she preaches. She’s on antiretroviral treatment and gets check-ups every three months. Five years ago, she gave birth to a healthy baby- a son named Timothy. She had re-married then divorced again. These days, she prefers casual dates. Some even lead to casual sex. “It’s a normal, “she says.

“Most HIV people are really positive, no pun intended, about their future. It means we appreciate life more. The problem I think is people who share their uneducated opinions and we always reply with compassion and share our information and facts with them.”

Dmytro Sherembey, in Kyiv promoting the HIV test mobile app. Photo: All Ukrainian Network of PLWH

What’s more, Ukraine is slowing gaining ground in the fight against the virus. According to Dmytro Sherembey, head of the All-Ukrainian Network of PLWH, for the first time in history, every Ukrainian with HIV now has access to free antiretroviral therapy, which reduces complicating infections and transmission.

“This year, we also launched a mobile app HIV test application, because today one of the major problems is that every second HIV-positive Ukrainian doesn’t know about their diagnosis. This is the last step, to get as many people diagnosed and on treatment.”

Rising from the ashes?

Over the last two years, the country achieved its highest retention rate of people with HIV who started treatment within a year. Almost 80 percent of people on antiretroviral treatment had a suppressed viral load, while the number of AIDS related deaths has decreased by half over the last 10 years.

While the country’s healthcare system was hit hard by the recession in the aftermath of the Euromaidan in 2014 and revolving door of ministers, is it now firmly intent on bridging the systemic gap between detection and treatment. Recent health reforms include the launch of eHealth services, the establishment of the National Public Health Institute, and improved HIV testing accessibility in regional healthcare centers.

Acting Minister of Health Ulana Suprun, who has been credited for spearheading the reforms, has vowed the country would contain the HIV epidemic by 2030.

Last year, the Ukrainian government also increased the HIV budget for the procurement of medication by 171 percent and the tuberculosis budget by 133 percent compared to the previous year and committed to another 25 percent increase in the next budget cycle.

“The response in Ukraine was mainly coordinated by civil society and international donors at the beginning of the epidemic. Since the Euromaidan, the government became more involved as a partner and is showing real progress in the fight against HIV,” says Jacek Tyszko, country director for UNAIDS.

“Statistically, we are doing better than Russia for example who has a much higher AIDS related death rate, where the epidemic is spreading more generally with not enough access to treatment. Ukraine’s epidemic is still very concentrated within key populations, with much lower fatality rates, and all those diagnosed get free treatment.”

Ukraine has adopted the UNAIDS Fast-Track Targets and 90-90-90 targets to have 90 percent of people living with HIV knowing their positive status and receiving sustained antiretroviral therapy to suppress the virus. The government also introduced a four-year HIV strategy to improve access to prevention programs for populations at risk of infection. Meanwhile, Kyiv and Odesa remain the only two cities in Eastern Europe to have signed the Paris Declaration on ending the AIDS epidemic in cities.

The Global Fund to Fight AIDS and PEPFAR have been the main international financial backers of the HIV response in Ukraine. The Global Fund extended a $120 million grant to the country until 2020, with the Ukrainian government expected to take over full funding of the HIV/AIDS response from 2021.