In September 2004, more than 2,400 patients in Ukraine were given antiretroviral-drug therapy. Six months later, 90 percent of them were still alive and continuing with the treatment. But by UN estimates, more than 17,000 people in Ukraine still need antiretroviral-drug therapy.
Deepak Verma, chief operating officer for the Clinton Foundation's HIV/AIDS Initiative, agrees that the demand for the drugs outstrips the supply. "I will tell you that, you know, there's still a big gap in terms of how many people need the treatment versus how many actually get it," he says.
Still, according to Verma, Ukraine's central government is "doing a lot" to battle HIV/AIDS. "For example, the government has now mandated that each regional government -- the oblast government -- should set aside a portion of its budget to test at least 5 percent of its population," Verma says. "So now they are starting to put in place financial mechanisms to create the funding to do more testing."
Disease Spreading Beyond Outcast Groups
The new emphasis on testing comes just as the disease is starting to spread beyond its traditional carriers, commercial sex workers and intravenous drug users.
"What we see also is the epidemic beginning to shift out of these high-risk groups into the general population through just good old-fashioned, unprotected heterosexual sex," explains John Tedstrom, president of the New York-based Trans-Atlantic Partners Against AIDS. "And we see it happening especially among young people in both Russia and Ukraine. The vast majority of new HIV cases are found among people under 30 years old. In Russia, it's about 85 percent. And in Ukraine, about 80 percent of new infections are among people between, say, 18 and 30."
In Kazakhstan, the arrival of the disease is more recent, and HIV cases remain concentrated among drug users and prostitutes. But the infection rate is increasing. In 2005, the number of registered cases in Kazakhstan exceeded by three times the number in 2001.
"What you see is extremely rapid growth and that's mirrored also in countries like Uzbekistan and Kyrgyzstan," Tedstrom says. "Although Kyrgyzstan is not quite that dramatic, it's still growing fast, and it's a young epidemic."
Uzbekistan and Kyrgyzstan -- and also Belarus and Moldova -- have rapidly increasing numbers of HIV/AIDS infections, but they are not part of the Clinton Foundation's consortium of countries to receive help. Verma explains that the Clinton Foundation goes where it is invited, and former President Clinton has stronger relations with the presidents of Ukraine and Kazakhstan than with other leaders in the region.
Nevertheless, Verma adds, personal chemistry between presidents is not the most important requirement. "We want to go where there's serious political will to make a difference," he says. "Because, you know, what we don't want to do is fight to create political will, while we are also trying to fight to build the capabilities to address the disease."
Tests and treatment are considered essential tools in prevention. Of course, not everyone who tests positive behaves responsibly. However, armed with knowledge that they are infected, patients can at least make an informed decision about their actions. And if antiretroviral drugs are available, the diagnosis of HIV/AIDS can seem less frightening, as Clinton explained in a speech in New York earlier this month.
"If people know they're positive and they know they can get the medicine and they know they can live, the chances of their behaving responsibly and reducing the number of new infections is enormously increased," Clinton said.
Anthropologists who have studied other diseases have also found that the introduction of an effective therapy for a disease often reduces its social stigma. And with less social stigma, people may be less afraid to be tested.
The UN On AIDS
The United Nations has issued its annual report on the AIDS epidemic. Here are some of its findings:
- There are currently an estimated 40.3 million people living with HIV, the virus that causes AIDS. Of those, 17.5 million are women and 2.3 million are children under the age of 15.
- There were an estimated 4.9 million new HIV infections in 2005, including 700,000 children under the age of 15.
- An estimated 3.1 million people, including 570,000 children, died of AIDS in 2005.
- According to the report, more than 25 million people have died of AIDS worldwide since the disease was recognized in 1981.
- In Eastern Europe and Central Asia, the number of HIV-positive people reached 1.6 million in 2005, up from 1.2 million in 2003. The bulk of people living with HIV in the region are in the Russian Federation and Ukraine. "Ukraine's epidemic continues to grow, with more new HIV infections occurring each year, while the Russian Federation has the biggest AIDS epidemic in all of Europe," the report states. A private Russian survey cited in the report found "no postive changes in sexual behaviour, with condom use decreasing slightly among people in their twenties."
- In Central Asia, Uzbekistan and Kazakhstan have seen the most dramatic increases of HIV infections. In the Caucasus, the situation is described "relatively stable."
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