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Ukraine: AIDS, Tuberculosis Hit Hard

Within the next day, statistically speaking, tuberculosis will afflict eight more people in Ukraine. And HIV -- the infection that can cause AIDS -- will invade 15 new Ukrainian victims. Both diseases tend to hit the weakest and poorest people. RFE/RL correspondent Lily Hyde reports from Kyiv on the terrifying scale of the twin epidemics and investigates why the government took so long to respond.

Kyiv, 13 April 2000 (RFE/RL) -- Tuberculosis and AIDS are spreading rapidly throughout Ukraine.

That's grim news in a country already fast losing its population to early deaths, low birth rates, and high emigration.

The two illnesses have spread like flames in tinder in most of the former Soviet Union. But in Ukraine, the growth resembles a firestorm: TB is up by 75 percent since 1990, to 54 infections per 100,000 people; and HIV has soared from 400 cases six years ago to an estimated 250,000 now.

That's the fastest growth rate in Europe -- and in the former USSR, as well. Yet only recently has the government begun a prevention and treatment strategy, with the help of international organizations like the Red Cross, the United Nations and the World Bank.

Health officials speak of TB and HIV as social diseases, because they disproportionately afflict the most vulnerable members of society -- drug abusers and the poor.

Health experts say the two epidemics are spreading together. Alla Scherbinska, head of a state committee for AIDS prevention, told RFE/RL that half of those registered with AIDS last year also had TB. Scherbinska:

"Tuberculosis is an opportunist infection. That is, those who are ill with AIDS, those who have HIV, most frequently develop tuberculosis, and those who have AIDS die of tuberculosis. Therefore we are seeking a program that can fight against both tuberculosis and AIDS."

Prison inmates comprise another major risk group for TB. Overcrowded prisons are a breeding ground for disease, and prisoners often receive poor or nonexistent treatment. When yearly amnesties allow sick prisoners to leave prison, the contagion spreads into the larger populace. World Bank health expert Teresa Ho says HIV and its AIDS corollary are subject to a similar phenomenon. Ho recently headed a mission to Kyiv to establish AIDS and TB prevention programs. She tells our correspondent that HIV, too, is making the leap from the limited groups where it won its foothold -- in this case, intravenous drug users and sex workers -- into the general society.

"The HIV/AIDS epidemic, which started in very specific and limited high-risk groups, is now starting to spread to the general population in Ukraine, so it is very important now that the program to control HIV and AIDS should start focusing not just on a limited number of high risk groups, but also on the general population."

The World Bank's AIDS program plans to include a mass-media campaign on prevention. It also seeks to improve treatment and care for HIV/AIDS sufferers -- to increase their life expectancy, which at present is far below that in Western Europe.

TB prevention programs, supported by the World Bank and the Red Cross, aim to eradicate a new strain of the disease, called multi-drug-resistant, or MDR, TB. Drug-resistant TB does not respond to most known forms of treatment, and it usually spreads where treatments are administered incorrectly or cut short. In Ukraine, about half the TB patients have drug-resistant strains. The World Health Organization calls its proposed solution, espoused by the World Bank and the Red Cross in Ukraine, DOTS, for Directly Observed Treatment, Short-course. The DOTS treatment program requires that health workers monitor patients to assure they follow instructions and complete treatment.

Anatoly Tsarenko is the program coordinator for the Red Cross AIDS and TB program. He says Ukraine's medical professionals initially resisted the direct observation treatment method. They favored a more comprehensive and even more expensive Soviet model that called for a combination of immunizations, hospitalization, and long stays in sanatoriums.

"The DOTS program is vitally important for Ukraine, primarily because it can cover a large number of people at low cost providing medical help against TB. Not all our doctors are ready to adopt it yet; they grew up under the old system, which involved using X-rays and putting people in hospitals for a long period."

Ukraine's government failed to act in 1995 on a Health Ministry warning that TB had reached epidemic levels. The program now under way is the third in recent years, but it is the first to be adequately funded.