|
Estimated at 1.46% [0.8%–4.3%] in 2005, Ukraine has the highest adult HIV prevalence of any country in Europe or Central Asia (UNAIDS, 2006a). Annual HIV diagnoses have more than doubled since 2001, reaching 16 094 in 2006 and exceeding 8700 in the first six months of 2007 (Ministry of Health of Ukraine, 2007). By mid-2007, a total of 113 000 cases of HIV infection had been reported since the beginning of the epidemic in 1987. As elsewhere in the region, official figures understate the actual size of the epidemic because they only reflect infections among people who have been in direct contact with official testing facilities. The actual number of people living with HIV is agreed to be considerably higher, and was estimated at 377 600 [250 000–680 000] at the end of 2005 (Ministry of Health of Ukraine, 2006). South-eastern Ukraine continues to be the most affected area, especially the regions of Dnipropetrovsk, Donetsk, Mikolaiv and Odessa, as well as the Autonomous Republic of Crimea. These regions, together with the capital city, Kyiv, represent more than 70% of all registered cases of HIV currently in Ukraine (Ministry of Health of Ukraine, 2007). However, HIV infection is also spreading rapidly in several central and western regions. In 2006, Kherson, Sumy, Ternopil, Kyiv oblast and the Crimean port city of Sevastopol reported increases of more than 50% in the number of newly registered HIV cases (Ministry of Health of Ukraine, 2007). Injecting drug use remains the main mode of HIV transmission, and the number of injecting drug users newly diagnosed with HIV infection increased from 3964 in 2001 to 7127 in 2006 (EuroHIV, 2006b, 2007). In the first half of 2007, 3639 new cases of HIV infection were reported among injecting drug users—the largest increase among any population in Ukraine — indicating that injecting drug use remains the driving force behind the spread of HIV in the country (Ministry of Health of Ukraine, 2007). Exceptionally high HIV prevalence has been found among injecting drug users and female sex workers. In recent HIV sentinel surveys in six cities in 2007, HIV prevalence among injecting drug users ranged from 10% in Lugansk to 13% in Kyiv, and 89% in Krivoi Rog (Ukrainian Institute for Social Research et al., 2007a). HIV prevalence among sex workers ranged from 4% in Kiev to 24% in Donetsk and 27% in Mykolaiv (Booth et al., 2006; Ministry of Health of Ukraine, 2007). Most injecting drug users are sexually active, and risky sexual behaviours are common among them, increasing the opportunities for HIV transmission. In two recent surveys, 73% and 81% of Ukrainian injecting drug users reported having had sex in the previous month, and a little more than one third (37% and 38%) of those surveyed reported they had used a condom during that period (Booth et al., 2006; International HIV/AIDS Alliance in Ukraine, 2007). As in the Russian Federation, a significant overlap exists between injecting drug use and sex work (WHO, 2006a). Consequently, a growing proportion of new HIV diagnoses can be attributed to unprotected heterosexual intercourse: 35% in 2006, compared with 28% in 2001 (Ministry of Health of Ukraine, 2007). The largest proportion of these new HIV infections is directly attributable to unprotected sex with an injecting drug user. An ongoing behavioural study of people who had become HIV-positive in 16 regions of Ukraine noted that pregnant women who reported sexual contact with an injecting drug user had a sevenfold increase in the likelihood of transmission (Bolshov et al., 2007). Among these respondents, only 6% of newly infected women reported consistent condom use with their regular sexual partner. In contrast, sexual contact with an injecting drug user was not a significant factor for men recently infected through sexual transmission, with only 6% of men reporting sex with a female injecting drug user in the last year. Prevention programmes in Ukraine tend to have a more widespread coverage than those of other countries in this region. For example, 46% of injecting drug users and 69% of female sex workers reported that they were covered by at least one HIV prevention service in the last 12 months (Ukrainian Institute for Social Research, 2007b). Across this region, the HIV epidemics are concentrated mainly among injecting drug users, sex workers and their respective sexual partners. The number of pregnant women diagnosed with HIV has doubled since 2002, and reached 3207 in 2006 (Ministry of Health of Ukraine, 2007). Nationally, HIV prevalence among pregnant women is among the highest in Europe, and was estimated at 0.33% in 2006, having risen from 0.002% in 1995 (EuroHIV, 2006b). However, Ukraine has taken substantial steps to limit HIV transmission from mothers to children. In 2006, 95% of all pregnant women were tested for HIV, and 93% of HIV-positive women who delivered babies have been receiving antiretroviral prophylaxis to prevent HIV transmission during pregnancy and delivery (Zhilka, 2007). As a result, the national mother-to-child transmission rate has been reduced to 7%, with rates as low as 4% at some sites (European Collaborative Study, 2006; Zhilka, 2007). In 2006, only 35 HIV cases were officially reported among men who have sex with men, representing more than one third of the 110 cases officially registered since 1987. Recent research has revealed the extent of the previously hidden epidemic among men who have sex with men in Ukraine. A study in four cities found HIV prevalence ranging from 4% in the capital, Kyiv, to 23% in the city of Odessa. Among the HIV-positive men in this study, only 34% reported condom use the last time they had sex with a male partner (Ukrainian Institute for Social Research et al., 2007a). |
HIV/AIDS
