To the World AIDS Day
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For a long time now, December 1 has been a day when I want to take stock, maybe the end of the year has that effect, but for the world community and for me as well, it is the World AIDS Day, which has been celebrated since 1988 on the initiative of the World Health Organization I, after the meeting of health ministers of all countries called for social tolerance and expansion of information exchange regarding HIV/AIDS.
Since then, World AIDS Day has been celebrated annually. The main goal of World AIDS Day is to draw society’s attention to this problem.
For a long time, I worked in the field of overcoming HIV/AIDS and related diseases and problems. Ukraine, together with the whole world, fought against the epidemic. And in this struggle there were victories and defeats, strategies and counterattacks, but everything was interrupted by the full-scale aggression of Russia. Approaches had to be fundamentally changed, and whether we like it or not, partial control over the epidemic has been lost again.
With the beginning of a full-scale war on the territory of Ukraine in February 2022, problems arose regarding the provision of HIV epidemiologic surveillance, the logistics of providing services for the prevention, testing, treatment of HIV infection, and clinical and laboratory monitoring of the course of HIV/AIDS among people living with HIV (PLHV), primarily in the southeastern regions.
The negative consequences, as well as the restoration of services to the population in the context of the HIV epidemic, will be uneven given the operational changes in certain areas associated with the activity of hostilities, the destruction of medical infrastructure, and population migration.
According to the evaluation data of the Public Health Center, as of January 1, 2023, there are about 257,000 HIV-positive people living in Ukraine. Of these, only 79% know their status, and only 77% receive antiretroviral therapy. Almost half of people with HIV infection (43%) find out about their status in the later stages.
Read also: What to do if you have been diagnosed with HIV – explained at the Central Hospital
The Center for Public Health also reports that, according to the seroepidemic monitoring of the spread of HIV infection (SEM), in the nine months of 2023, the volume of HIV testing services increased by 40.8% compared to the same period in 2022.
The number of rapid tests almost doubled compared to nine months of 2022 (+87.3%), from the lowest rate in Zakarpattia Oblast (+7.4%) to the highest in Chernivtsi (+381.0%).
The share of positive results of testing for HIV infection is 0.7%, at the level of regions, the indicator varies from low figures in Ivano-Frankivsk, Ternopil and Chernivtsi (0.27% each) to the highest in Odesa (1.36%) and Dnipropetrovsk (1.22%).
As of January 1, 2023, more than 158,000 people living with HIV were under medical supervision in health care institutions, which is 387.3 per 100,000 population.
According to official registration data, the highest prevalence of HIV infection per 100,000 population is in Odesa (1,128.4), Dnipropetrovsk (973.5), Mykolaiv (747.4), Kyiv (474.5), Chernihiv (434, 6), Kherson (424.0) oblasts and the city of Kyiv (642.2).
Compared to the same period in 2022, the dispensary group in Ukraine increased by 3%. The highest growth occurred in Kharkiv (+20%), Rivne (+10%) and Kirovohrad (+9%) regions.
Faced with new challenges, the pre-war health care systems and grant programs, which are aimed at HIV prevention, early detection, dispensation, increased the number and intensity of testing with rapid tests, but did not change, did not add new, more effective tools or forms of providing those the services themselves. Also, the mechanism for assessing the quality of medical services and social support services for people with the HIV virus did not work.
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We have seen an increase of more than 200% in rapid HIV testing in some regions, but actual detection has not increased. Analyzing the annual statistics on HIV/AIDS, we see that the annual detection of new cases of HIV infection before the full-scale war was at least 15 thousand people per year, but in 2022 this number decreased to slightly more than 12 thousand people, and in 2023 year, as of October, this number is 9,769 people. This illustrates the decline in detection rates.
At the same time, the number of people who learned about their diagnosis very late is increasing, which negatively affects the treatment of the patient himself, and is also the cause of the spread of the epidemic.
Hopes that primary health care will become the most important element that should detect HIV infection have not come true.
Family doctors do not participate in the active detection of HIV, although they have this diagnosis in their package. But family doctors often do not have express tests, which should be provided by the administration of the Primary Health Care Center.
Perhaps this is our Ukrainian habit of saving, perhaps it is passivity, or simply ignorance. Each medical institution that provides a testing service must have not only express tests, but also clear and regular, proactive communication, I call it “marketing of the medical service”, with the community for which this medical institution works. In this case, you should not rely on the patient’s activity.
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I see that all strategic decisions have been made at the national level, in particular, the Law “On combating the spread of diseases caused by the human immunodeficiency virus (HIV) and legal and social protection of people living with HIV” has been fundamentally updated.
But it is time to focus on the implementation of these decisions at the regional level. What it is about: not just to increase the number of testing through grant projects, but to carry out regional and local advocacy, so that in every medical institution, every family doctor wanted and could find out about the HIV status of his patient, because the state supports this both financially and functionally.
The next problem remains the low percentage of dispensation of people diagnosed with HIV. The focus of evaluating the effectiveness of prevention programs should be revised and shifted from the number of tested to the number of cured persons. This problem would be partially solved if the patient learned about his status from the family doctor, who today has a high level of trust from the patient and is in constant contact with the patient and his family.
I can’t help but mention here directly about people living with HIV. And today there are about 257,000 of them. The government and the Ministry of Health have all the necessary amount of medicines, thanks to the support of international organizations. You don’t need to worry about medicine, just take care of your safety, and you will be provided with medicine.
Bottom line: the epidemic remains under control, and this gives hope that it will be overcome. Aware of the consequences of hostilities, the migration crisis, psychological fatigue, a decrease in the incomes of the population, and sometimes their complete loss – everything could be much worse.
Only thanks to the high level of expertise of medical workers and the dedication of social workers of non-governmental organizations, we manage to keep the epidemic at this level and not give it a chance to become uncontrolled. Let’s not devalue these results of our work, in the conditions of war.
Lada BulakPeople’s Deputy from the “Servant of the People” party, specially for UP.Zhyttia
Publications in the “View” section are not editorial articles and reflect exclusively the author’s point of view.
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