Dr. Michael Grillo: If we find all HIV-positive people, we will have a chance to overcome the virus by 100%

HIV/AIDS is one of the most difficult problem of humanity. Today, Ukraine is a leader in Europe in terms of spread of HIV epidemic. According to estimates of international experts, about 240,000 people live with HIV in Ukraine. According to statistics, every day in our country 8 people die of AIDS. More than 100,000 people are not aware of their HIV-positive status, and only one in two knows about the diagnosis.

In 66% of cases in Ukraine, HIV infection is obtained through unprotected sex, and 20% through intravenous injection of drugs. Experts note that if HIV is diagnosed on time, it is possible to ensure a high-quality life if the patients start their antiretroviral therapy promptly.

On May 21, Kyiv hosted an international conference on perspective development of HIV/AIDS and tuberculosis prevention in the Armed Forces of Ukraine. The event was organized by International HIV/AIDS and Tuberculosis Institute, an NGO, in partnership with the US President's Emergency Plan for AIDS Relief (PEPFAR) in Ukraine and the region.

The event was attended by Dr. Med. Eliot J. Pearlman, MPH&TM, MPA (COL RET), Head of the Board of International Institute for HIV/AIDS and Tuberculosis, Dr. Michael Grillo, PhD, MS, Branch Chief and Director of Prevention, Education and Training, Mr. Sten Ito, DHAPP Ukraine desk officer, Lieutenant Colonel Serhii Lytovka (Medical Service), Chief of Central Public Health and Epidemiological Department of Ministry of Defense of Ukraine as well as other representatives of Medical Service of the Armed Forces of Ukraine and Preventive Medicine Service of Ministry of Defense of Ukraine.

We talked with Dr. Michael Grillo about the plans for project implementation in Ukraine.

- You said that PEPFAR is undergoing changes in general and in Ukraine in particular. What changes should we expect and what plan will you follow in Ukraine?

-  Our previous activity, indeed, shows results not as high as we would like. Analyzing the available data, we came to the conclusion that we need to change the course of action. In the past, we have focused mainly on the purchase of equipment, and now, in the framework of the US President's Emergency Plan for AIDS Relief, we plan to use targeted HIV testing strategies such as partner notification and social networks associated with positive clients since we know studies suggest these strategies will give us better yield.  This will have a two-fold benefit by providing health benefits, living a normal life for those living with HIV and if they remain on medications and are virally suppressed they will not transmit HIV to others which is a huge prevention benefit.

While implementing our activities in other countries, we have seen that suppression of virus in the human body and a healthy lifestyle allow a person with HIV-positive status to lead a normal lifestyle, work, start a family and do not feel any restrictions. Treatment that reduces the viral load allows them to avoid further transmission of virus, which means that if we find all HIV-positive people we will treat them, and then we will have a chance to significantly reduce incidence rates which will decrease transmission of HIV allowing us to gain epidemic control.  .

I also hope that we will be able to establish cooperation with the Ministry of Health of Ukraine and create a collaborative system in this way.

- Are there any deadlines for project implementation? How long will it last?

- We do not have a specific date for project completion. We will continue to move forward with program implementation and support the military HIV program.  My responsibility is to continue to support and implement the activities under PEPFAR.

- Is it planned to evaluate the medical and laboratory equipment in the Armed Forces of Ukraine in the framework of the project, and verify the equipment relevance?

- We have not yet discussed with the Ukrainian military leadership the specific measures we will implement, whether this be tests for HIV detection in the blood serum, or clinical tests for service members and their family members/partners in the event of HIV/AIDS detection. The purpose of our meeting today is to identify the Ukraine's needs and find the ways to accomplish the tasks in order to implement the decisions we made.

- You mentioned that testing each and everyone is not cost-efficient. The rate is low, and tracking what happened with a person after confirmation of his/her HIV-positive status is currently impossible the way the military is structured. Are there any ideas about how exactly we will be searching for HIV-positive people, and which population will you test at first?

- This is exactly what we will discuss with Ukrainian military leadership. However, I will emphasize that testing should be targeted and directed. It is necessary to clearly specify who should take the test and where is the highest risk of infection. Also, I hope that we will be able to establish cooperation with the Ministry of Health of Ukraine and then the Ministry of Health will be able to test those at highest risk for HIV, and our work will focus on countering the epidemic across the specific groups of military populations where we will test the particular people with the most likely positive indicators for HIV. We plan to test the most at risk individuals as a result of communication with experts from the Ministry of Defense of Ukraine on the basis of their observations and statistics.

- What problems do you encounter in Ukraine? Does the armed conflict in Eastern Ukraine affect your work?

The conflict in Eastern Ukraine does not affect our work. Regarding the difficulties we face in Ukraine while performing our work, I cannot single out any special challenges. As in all other countries, we have communication problems due to the language barriers but this not a major barrier that we cannot overcome. When messages are transmitted from person to person, the information often is distorted. As a result, the message reaches the endpoint with a completely different context. Thus, our main challenges are misunderstanding these distorted communications. One way to overcome these language barriers is to have in person meetings so that we can be sure we are communicating effectively with the military and all other organizations, ministries and agencies

Additionally, our work is complicated by the fact that in Ukraine the HIV positive patients are not treated in the military system. Our work is most successful in those militaries where treatment is included in the process of military service.

- Do you observe positive changes in other countries you work with?

- Yes, we have positive developments in many of the countries we are working in, especially in our African countries. We test, care for, and treat our military members, their families and the civilians in the surrounding areas.  As a result, we are able to track and monitor our clients and provide them with exceptional military health care.  By ensuring our clients are on treatment and virally suppressed we keep them healthy so they can continue to serve their country and be active participants in their communities.  As I said, our strategy is changing as we are much more patient focused. My hope is that we can bring these positive changes to Ukraine as well. 

- People living with HIV most often become victims of discrimination. We know that you arrange training and education events that deal with stigma and discrimination. Will you provide such training in Ukraine?

- We plan to talk about this with the Ukrainian military leadership in the next few days. In our opinion, Ukraine no longer needs to just purchase equipment, now we prefer that the Ministry of Defense of Ukraine purchase the equipment and, in turn, we strive to get an opportunity to conduct training activities. Knowledge transfer is more important than transfer of property. Discrimination is a problem that exists in many countries. Everything takes time, including the change of thinking.

Last year we arranged a training event on discrimination and stigma for Medical Service personnel across the Ukrainian Ministry of Defense. It focused on the problem related to HIV. In addition, I recently read an article in the The New York Times describing the unfair treatment of women and sexual harassment in the military. I really want to acknowledge the existence of these problems, and want us to take the necessary steps to eradicate them. If we talk about discrimination against people leaving with HIV, we should first turn to the policy and find out what the policies are and how they may be interpreted as discriminatory. In some countries, military personnel leaving with HIV are not allowed to participate in military operations and deploy to war zone even if their condition is stable and they take antiretroviral therapy. Because of this policy the military personnel try to avoid testing, hide their disease and are not interested to confirm their status, positive or negative. At the same time, if you allow the personnel with positive HIV status to serve in the military, deploy overseas for peacekeeping operations, allow them to perform certain tasks in the war zone, of course, without their direct participation in military operations on the battlefield, then, they will stop being afraid. It is important to convey the information to all people that their life will not change significantly with the timely detection of virus and proper treatment. People living with HIV can have a normal lifestyle and they do not transmit the virus.

So, we want the guideline documents or policy be enacted that allow the service members with positive HIV status to continue their service, provided that he or she follows a healthy lifestyle, monitors the health status and has a suppressed virus load.

Policy focused on positive attitude towards people with a positive status that allows for military service in the Armed Forces of Ukraine and participation in military operations and deployments will generate a society that is not afraid of testing, not afraid to reveal a positive status as well as society that knows exactly that it is necessary to make step by step decisions to defeat the illness.

Thus, changing the attitude of society towards HIV, we will change the attitude towards our people's health in general. This will give a chance to stop HIV forever in Ukraine and all over the world.



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