As figures for HIV and AIDS continue to soar in Eastern Europe, Ukraine is the first country in the region to target those most at risk of getting the disease: workers in the sex industry. Correspondent Lily Hyde looks at the success of the project in Ukraine, and how its example can help other CIS countries threatened by the AIDS epidemic.
Kyiv, 9 October 2000 (RFE/RL) -- Ukraine's red-light districts are the last place you would expect to see an Indian woman in a traditional sari.
Veena Lakhumalani has spent many years teaching sex workers in India the vital knowledge and self-confidence to protect themselves from sexually transmitted diseases, notably HIV and AIDS. Now she has brought this experience to Ukraine, which has the fastest-growing HIV-infection rate in Europe.
UNAIDS -- the United Nations coordinating agency dealing with the disease -- estimates that as many as a quarter-of-a-million people in Ukraine are infected with HIV. Until recently the epidemic was confined to drug users who inject intravenously, but it is now reaching the wider population. Health ministry figures show the proportion of infections caused by sexual contact or vertical transmission from mother to child is now more than one-third.
Workers in AIDS prevention say the main route of infection to the general population is through commercial sex workers and their clients. But this group continues to be ignored by the government.
What's more, Ukrainian sex workers are disorganized, uninformed, and unprotected. They are exploited by law enforcement agencies, and health-care services and education in HIV prevention is largely denied them.
As a consultant for a project working with female sex workers, Lakhumalani has started to change that. The UNAIDS project is the first of its kind in Eastern Europe and the CIS. It aims both to educate Ukrainian prostitutes in sexually transmitted disease and HIV prevention, and to change social attitudes toward this risk group.
Non-governmental organizations, or NGOs, in 11 Ukrainian cities have contacted many Ukrainian sex workers to seek out their problems and isolate the risks of their work. They found that many sex workers, and their clients, were ignorant of how to protect themselves from sexually transmitted diseases, including HIV.
Many of the prostitutes already carry the infection, or other diseases such as syphilis or hepatitis. Poor living conditions contribute to ill-health, as does apathy. Some sex workers have such low self-esteem that it has been hard to persuade them that their health is worth saving.
The NGOs have tried to persuade the prostitutes to organize into self-help groups for protection and information-sharing -- an approach the women were wary of at first. Lakhumalani tells RFE/RL.
"These are women who have been victims of abuse and scorn, used to disparaging remarks and non-acceptance. And suddenly you have people saying, we think you should form your own organization. And they think, why? What's the point? A, we don't want to be identified as being sex workers, that's one problem. And the other is, well who's going to help us? We have to be self-reliant, there is too much competition among us."
Still, in several cities the women did set up self-help groups. The project distributed leaflets and condoms, and has tried to establish medical facilities. It also organized focus sessions that brought together representatives of many different sectors of society, whose cooperation is crucial if the spread of HIV is to be slowed.
Lakhumalani says sex workers are commonly, and incorrectly, viewed as the sole source of HIV:
"They are seen as the vectors of the disease, which is something we've had to work very hard to try [to] make people think otherwise. And that's why we got people to look at the environment, we got them to include clients and the bar owners and the security guards and the madams and the pimps. Because you can't blame the women only, and they shouldn't be thought of as the only people responsible. But it is so easy to blame a group which has always been thought of as scum."
At the end of its first year, participants say the project helped and influenced not only the women but also their clients. But now it has reached something of a dead end, says Olga Balakireva from the Ukrainian Institute of Social Research, which coordinated the project along with UNAIDS.
"We've reached a wider circle of problems -- beyond the project, but very important to it. We've come to the necessity of changing legislation, changing social attitudes, changing the responsibilities of participants in the sex industry, not just women but others, the organizers. We've come to the great problem of abuse of the situation by the law-enforcement agencies, we've reached the problem of neglect by our health services to clients not only from the sex industry but from other risk groups too."
Balakireva is uncertain what will become of the project now. Funding from the German government and technical assistance from the British Council has come to an end. But she hopes Ukraine's HIV-prevention work with vulnerable groups may provide a valuable model for other CIS countries which have not yet tackled the issue.
In Ukraine, the figures for HIV/AIDS had to get truly alarming before many government and social organizations took it seriously. Russia has also seen a rapid increase. But HIV has yet to really hit the countries of Central Asia. UNAIDS puts the number in most Central Asian countries at below 100, with only Kazakhstan showing a significant increase.
According to Olga Yun of the Bishkek-based NGO Tais Plus, there are only 40 recorded cases in Kyrgyzstan, and 29 were foreign citizens who have been deported. Her group provides health care and information for Bishkek's 2,500 sex workers.
Stricter Islamic attitudes in Central Asia mean prostitution and sexually transmitted illnesses are even more taboo than in Ukraine. But Yun hopes she can use Ukrainian experience to prevent HIV ever getting a hold.
"Last year they predicted an AIDS epidemic [in Kyrgyzstan], and we're very glad we have delayed it for even a year. If we can just save just one person from AIDS we think that will be to our credit."
But, she notes, in neighboring Kazakhstan, there are very high rates of HIV -- and that, she says, is very worrisome.