In April 2011, when Ambassador Eric Goosby made his first visit to Ukraine in his role of U.S. Global AIDS Coordinator, his previous work in HIV prevention, care and treatment through targeted interventions had already familiarized him with the country’s challenges. With the highest rate of HIV infection in Europe, and one of the world’s fastest growing epidemics, Ukraine had seen the virus predominately spreading among people who injected drugs. In such conditions, Goosby knew, a strong, comprehensive, and sensitive response that acknowledged the risks and needs of the hardest hit populations and drew on their input was critical to ensure the epidemic did not become even more widespread.
Goosby was impressed with an outspoken and active civil society on his visit, and recent developments had been promising, he wrote in his State Department blog. Four months earlier Ukraine President Viktor Yanukovich had signed a law giving new authority to non governmental organizations to provide and expand services to people who inject drugs. “We anticipate the collective response of government, civil society and donors working together . . .” Goosby wrote.
Supporting those hopes were a five-year United States-Ukraine partnership agreement signed a month after Yanukovich’s signature on the law granting greater scope for NGOs, and more than $360 million in grants from the Global Fund to Fight AIDS Tuberculosis and Malaria. And for the first time, in 2012, rates of HIV infection dropped, while the numbers of people with HIV receiving antiretroviral treatment began to rise.
These gains, and the continuation of the work that went into them were suddenly and “catastrophically” threatened two weeks ago, said organization and agency representatives quoted in this Inter Press report, with the Ukrainian Parliament’s quick, show-of-hands passage of a set of laws limiting speech, assembly, and the activities of nongovernmental organizations. Among them is a law requiring NGOs receiving funding from outside the country to register as “foreign agents” and pay tax on the money. According to those interviewed for the report, that includes civil society groups charged with carrying out some of the Global Fund grant’s most critical work — providing syringes, methadone, condoms, information and referrals for people who inject drugs, and raising awareness of the impact of criminalization and other structural barriers to comprehensive HIV services.
In addition to the impact of the law on the people needing services, the law, and other restrictive laws passed January 16, also would appear to effectively nullify the five-year United States-Ukraine partnership agreement which identified “NGO institutional capacity strengthening” as one of its “strategic interventions.” Increasing “the role of NGOs in providing services to MARPS* and enabl[ing] local governments to contract with NGOs to deliver HIV/AIDS services to MARPS” are included among the strategies.
These strategies were considered critical because the government’s response to injecting drug users and other marginalized populations as well as its engagement in HIV prevention had been found weak. “In July 2010 a total of 19,370 (21%) patients were receiving antiretroviral treatment,” the Global Fund’s audit released in 2012 noted. About 92,000 people living with HIV were estimated to be in need of treatment, the report said. In the letter attached to the report, Gabriel Jaramillo, then Global Fund Manager, wrote that the government needed to be more involved in the provision of opiate substitution therapy.
Referring to International HIV/AIDS Alliance Ukraine, the NGO that was a principal recipient of the grant, the Global Fund audit found: “Alliance-Ukraine has experienced major challenges in exempting procured goods and services from taxes and duties. Despite support from the Global Fund and efforts to solve this issue, tax was still charged on certain products.” The audit also found government processes slowed the delivery of commodities where they were needed, and denied humanitarian aid status to condoms and lubricants used to reduce risks of HIV transmission.
This week under fire from protesters as well as international outcry, Ukraine’s Parliament repealed nine of the 12 laws it passed January 16. Whether the “foreign agents” law was one of them remains unclear, as does, in any case, the strength of “country ownership” of an HIV response with a stifled civil society.
*Most At Risk Populations, used to refer to people who inject drugs, work in commercial sex, are men who have sex with men or transgender individuals.