Armed conflicts change countries, deform them and lead to expected or unexpected consequences. It concerns absolutely all spheres of life citizens, including healthcare.
According to zone of our responsibility, we are the most interested in finding answers to the question: Is the armed conflict in the East of Ukraine threatened by the epidemic and the active spread of HIV-infections in the territory of Ukraine?
According to The State Institution “Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine” before the beginning of the military conflict in this territory lived a quarter of all people living with HIV registered in Ukraine. In Donetsk and Luhansk regions was large network of health facilities and NGOs involved in providing services to HIV-infected and high-risk groups for HIV infection. Thus, the epidemic process of HIV infection in the East of Ukraine prior to the start of the anti-terrorist operation in the Donbas was quite active, and the state took all possible measures to ensure the control of the epidemic in these territories.
According to the results of the Operational Survey of the Services for the Prevention, Treatment and Support of HIV/AIDS in the Armed Conflict in the East of Ukraine, the infrastructure for providing HIV/AIDS prevention and treatment services to uncontrolled Ukraine’s government territories has not been preserved. The volumes of all types of services and their access to target population groups have decreased. Thus, in health care facilities reduced access to HIV counseling and testing, and the provision of services for the prevention of mother-to-child transmission of HIV was reduced. Almost no services are provided for the prevention and treatment of opportunistic infections. The number of Health Care Measure in which laboratory support for antiretroviral therapy is carried out has been reduced. No substitution maintenance therapy is provided. In the absence of sufficient funding, non-governmental organizations reduce the delivery of services in the framework of prevention programs for vulnerable groups of the population.
All this created the preconditions for the migration of HIV-infected residents from the territories of Donetsk and Lugansk regions to the government-controlled territory of Ukraine.
Over the past decade, the world community has gained considerable experience in preventing the spread of HIV in areas affected by armed conflicts and humanitarian catastrophes. According to UNAIDS, "people destabilized by armed conflict, including refugees, internally displaced persons, and especially women and children, are at increased risk of HIV transmission". HIV is a critical factor that should be taken into account in the context of forced displacement of people.
At the same time, the UNAIDS report "HIV in the Humanitarian Crisis: Opportunities and Challenges" states that the link between the humanitarian crisis and the HIV epidemic is not always evident. Emergencies can increase the vulnerability to HIV, but this does not necessarily lead to high-risk behaviors or the continued spread of HIV. People who are confronted with conflict or natural disasters often lose their source of income, and some may be compelled to allow high-risk behavior to meet their basic needs. Social and sexual standards can be violated, and women can easily become vulnerable, because in conflict and displacement, they often become victims of rape. At the same time, the humanitarian crisis can play a protective role, since it sometimes reduces the level of population movement and increases access to quality medical and other social services, especially if the movement of people is long lasting.
Thus, the result of the armed conflict in the Donbass does not necessarily have to be a surge of the HIV epidemic in the rest of Ukraine.
Currently, the epidemic situation with HIV in our country is controlled and predictable.
According to mathematical modeling in the Spectrum program, the estimated number of new HIV infections in Ukraine will gradually decrease in the next 4 years, and the estimated number of deaths from AIDS will be halved. And these data include the Autonomous Republic of Crimea, the city of Sevastopol and the whole territory of the ATO-zone.
Despite political and financial problems against the background of the armed conflict in the East of Ukraine and the difficult economic situation, Ukraine managed not only to not stop the implementation of the National Program on HIV / AIDS Response for 2014-2018, to avoid interruptions in the provision of HIV prevention services and treatment, but also to significantly increase state leadership in countering socially dangerous diseases, in particular in terms of program funding.
Since 2015, the issue of simplified registration of HIV-infected internally displaced people and the appointment of antiretroviral therapy has been regulated. Since 2016 Slovyansk and Severodonetsk have been actively involved in the Donetsk and Luhansk region AIDS Centers providing medical care, including internally displaced persons.
With the support of the International NGO "International Institute of HIV/AIDS and Tuberculosis" in the area of the antiterrorist operation HIV testing of soldiers is provided and awareness-raising campaigns are conducted to reduce the risk of HIV transmission among soldiers and residents of the gray zone of the conflict.
The study clearly indicates data on spatial "redistribution" of infections, rather than new cases of HIV infection. That is demonstrates a scientific proof of the fact that people living with HIV remove from the area of an antiterrorist operation to the territory controlled by the government of the country.
As part of the available statistical information of the Public Health Center of the Ministry of Health of Ukraine on HIV-positive people living with HIV, on October 1, 1712 HIV-infected internally displaced persons were under medical supervision under the government-controlled territories of Ukraine, 118 of them moved from the Crimea and Sevastopol, 1260 from uncontrolled government territories of Donetsk region and 334 Lugansk region. One third of them are under medical supervision on government-controlled areas of Donetsk and Lugansk regions. All internally displaced persons requiring antiretroviral treatment have the opportunity to receive it.
Moreover, according to Yatsek Tyshka, Head of the UN Office on HIV/AIDS in Ukraine, Ukraine, with the assistance of international partners, has succeeded in creating a mechanism that allows anti-retroviral treatment of 8,000 people in uncontrolled Ukrainian government territory.
Thus, with the support of national and international partners, the state takes all possible measures to minimize the impact of armed conflict in the Donbas on the epidemic situation with HIV in Ukraine.
Ukraine remains a region with a high HIV prevalence. According to updated HIV/AIDS estimates, in Ukraine at the beginning of 2017 238 thousand people were living with HIV, while in the age group more than 15 years the prevalence of HIV was 0.61%.
During 2017, 50 HIV/AIDS cases, 26 AIDS cases and 9 deaths from AIDS were recorded every day in Ukraine.
According to the official information of the Center of Public Health of the Ministry of Health of Ukraine, for the last 30 years (for the period from 1987 to 2017), 315,617 cases of HIV infection have been officially registered among Ukrainian citizens, including 102,203 cases of AIDS and 45,023 deaths from AIDS-related diseases. That is, we can say that over 30 years we have lost 45 thousand of our citizens who died because of AIDS.
In October 1, 2017, there were 139,394 HIV-infected citizens in Ukraine (329.6 per 100,000 population), of which 42,666 were diagnosed with AIDS (100.9) in health care facilities under medical supervision. The highest rates of HIV prevalence were recorded in Odesa, Dnipropetrovsk, Mykolaiv, Kherson, Kyiv, Chernihiv oblasts and Kyiv.
According to preliminary data, during the 2017, 18 193 HIV-infected persons were taken to the country for supervision (the incidence rate was 42.4 per 100 thousand population, the rate of growth of the indicator, compared to 2016, was + 6%), 9 306 patient was diagnosed AIDS (incidence rate - 21.9, rate of growth - + 5.8%) and 3,313 people died of AIDS (mortality rate - 7.8, rate of growth - + 2.6%). Tuberculosis has become the cause of death for half of those who died of AIDS (51.1%). Among HIV-infected people registered in 2017, 60.5% were sexually transmitted infections, 20.9% - by parenteral administration of narcotic substances.
This article uses material from the site of the WEB-site of "Center for Public Health of the Ministry of Health of Ukraine": https://phc.org.ua/