Outcomes hinge on increased resources, harm reduction, outreach to men who have sex with men, women in sex work, clients, injecting drug users, partners, and prisoners
Released in December, before the dissolution of Ukrainian control of Crimea and continued threats to the autonomy of the rest of the country, Lives on The Line, Funding Needs and Impacts of Ukraine’s National HIV/AIDS Program, 2014-2018, offered, like A Christmas Carol, a choice of futures. In one, for example, responses to the country’s epidemic continue for the next four years at the level set in 2012. In another, stronger efforts over the next four years to reach those most affected by HIV with the least access to services include universal access to antiretroviral treatment. The difference? More than 29,000 people remain uninfected who would not have otherwise, and the lives of nearly 40,000 people are saved.
With one of the worst HIV epidemics in Europe taking its greatest toll on people who use injecting drugs, Ukraine has seen results from harm reduction efforts that included syringe exchanges and opioid substitution therapy as well as HIV testing and antiretroviral treatment, the report on the analysis notes. Those efforts should be strengthened however, and more efforts to reach more people are needed, the report adds. That includes filling gaps in efforts to reach injecting drug users, and adding to “less developed” efforts to reach women involved in sex work and their clients, men who have sex with men, partners of people who inject drugs and prisoners.
The analysis, put together last year by the Health Policy Project, The Ukrainian National Academy of Sciences, and the State Service of Ukraine on HIV/AIDS and Other Socially Dangerous Diseases, used existing data and mathematical modeling to look at the outcomes of three possible response scenarios involving the country’s 2014-2018 National AIDS Programmes goals, against the then current level of response. In addition to the baseline of 2012 investment level, the scenarios are: increased investment, according to the National AIDS Programme’s goals with emphasis on “key risk groups” and antiretroviral treatment for people living with HIV reaching 60 percent of those in need of services, a more ambitious effort seeking to reach 80 percent (the percent considered “universal access”), and a fourth scenario, in which Global Fund assistance, which funds the bulk of efforts reaching the “key populations” of people who use drugs, women involved in sex work, and men who have sex with men is not replaced by government support when it expires in 2016. The last scenario, the analysis projects, would lead to more than 6,500 additional HIV infections.
The most cost-effective approach, the analysis finds, is the most ambitious. The authors conclude the government could afford to do more, and also urge efforts to replace the Global Fund money after its expiration in 2016. In those ways, while using realities specific to Ukraine’s epidemic, the analysis reaches conclusions applicable to other countries. In addition, with the nation now in a state of crisis that imperils even the least ambitious of the scenarios presented in the report, it highlights the precarious position of those most in need of HIV prevention and treatment.