Injecting hope
Young IV drug users are the face of
HIV in the Ukraine. But from the ashes of broken lives, a
strong nationwide movement of HIV positive activists is emerging
Words Amanda Elliot
Ukraine
used to be called the bread basket of the Soviet Union. Now the country is
better known for having the highest per capita rate of HIV infection in Europe.
Many fertile fields that once fed the Red Army now produce opium poppies instead,
while the great port of Odessa is now the entry point of choice for illicit
drugs
trafficked between East and West. Southern Ukraine is the worst affected area
and accounts for 75 per cent of all people with HIV/Aids in the Ukraine at
the end of 2003. Ukrainian poppies are synthetically processed to make Marke
or Kompott, a cheap, highly contaminated opiate injected up to seven times
a day to achieve the same effect as heroin. Injecting-drug use remains criminalized
in the Ukraine and drug users face severe stigma. HIV and Aids is the biggest
health issue here and even threatens the country’s political stability.
Writing in the British Medical Journal this summer, Professor Diane DeBell,
an expert in public health in the Ukraine, warned: “The transmission
of HIV and related infections threatens to deplete
a generation of Ukrainian youth… and undermine the workforce.”
Collapsing into addiction
Experts trace drug use in the Ukraine back to the collapse of the Soviet Union.
Since Ukrainian independence in 1991, IV drug use has driven the epidemic,
although sexual transmission is growing at an alarming rate as is mother-to-child
transmission. UNAIDS estimate the country has 600,000 injecting drug users
and some 360,000 people living with HIV. Around 1.4 per cent of the adult
population is infected with the virus compared with 0.2 per cent in the UK.
Access to treatments has been slow. In January 2004 the Global Fund temporarily
suspended its grants to the Ukraine, concerned at the way the money (some
$25 million) was being spent and the slow progress in procuring antiretrovirals
(ARVs). The International HIV/Aids Alliance took over the Global Fund grants
last year. At the last count, 1,452 people were receiving ARVs with a target
of 5,000 by the end of 2008. But the Alliance has warned that extending provision
is hindered by the lack of treatment adherence programmes for HIV positive
injecting drug users.
Wasted
youth
The face of HIV in the Ukraine is young. Fifteen to 29-year-olds account for
about 80 per cent of HIV cases. Most are injecting drug users or their sexual
partners. Aleksey Moroz is one of these. A 26-year-old HIV activist living
in Donetsk, the Ukraine’s second largest city after Kiev and a massive
industrial centre. Against a backdrop of economic decline, Aleksey started
taking drugs aged 14 when he was offered some by friends who took them, mainly
out of boredom and disaffection. “By 18 I was using IV drugs regularly
on my own,” he says. “It started out as fun, but soon I had no
stability or normal life.” Like many others, he was a polydrug user,
injecting everything from Marke and ephedrine to over-the-counter drugs like
codeine. At 18, Aleksey fell in love with the woman who was to become his
future wife, also an addict. He worked in an industrial plant moving huge
vats. But even here Aleksey would inject the drugs he was so dependent on.
“That was my life then.”
Strife
and marriage
His girlfriend was 19 when she fell pregnant, but any celebrations were soon
obliterated.
“A friend of hers, another drug-user, came round and told her she should
go to the hospital but they wouldn’t say why.”The hospital tested
for STIs including HIV because they had shared needles. “She was shocked
and terrified but nobody explained to her what it meant.” Aleksey tested
positive too.
“We were the only ones who knew and we couldn’t tell anyone. There
was no treatment then and people knew nothing about HIV.”They decided
that, even with the diagnoses, they would still marry and have the baby.
“When the baby was born it boosted us. She brought light and joy into
our life.” But instead of being the answer to their problems, his new
daughter added one more: the wait to find out her HIV status.
“It was really stressful and I drank alcohol to relieve the stress.
Amazingly, she was HIV negative.” At that moment Aleksey said he dared
to dream of being alive when his daughter started school. It would be a while
before he knew he would be able to fulfil this promise.
Turning the corner
In 2001, Aleksey’s doctor invited him to a meeting in Kiev where, for
the first time, he met someone open about their status. This was the director
of the fledgling All-Ukrainian Network of People Living with HIV and Aids.
“Hearing another HIV positive person speak so freely and openly was
a significant moment,” says Aleksey.
The network was set up in 1999 by seven HIV positive activists to fight for
their rights and lobby for access to medical care, treatment and support.
Today the network has more than 300 members with branches, regional representation
and ‘initiative’ groups across the Ukraine. Crucially, the Network
is run by and for people living with HIV. It lobbies and advocates for their
rights and challenges the stigmatisation of HIV.
Funders include the International HIV/Aids Alliance, the US Agency for International
Development (USAID), the European Coalition of Positive People and the Netherlands
Agency for International Development. Thanks to these, the Ukraine now leads
the way in Europe for the involvement of people living with HIV.
Ditching the drugs for good
It would take another three years, a temporary split from his wife and an
ephedrine overdose before Aleksey would finally seek help and turn his back
on drugs. After the split, his wife started running a support group for HIV
positive drug users in Donetsk. The group began to attract many of their friends,
but Aleksey was still reluctant.“I just didn’t know how to go
to a support group. Just going there was a big thing.”
But it was the ephedrine overdose, after a long chemical-free period, that
triggered a change in him. “The overdose changed my life.” After
taking part in a 12-step programme to break his addiction, Aleksey felt strong
enough to engage with the network and help others. He is now Donetsk regional
representative for the All-Ukrainian Network.
Fighting
for the future
The Donetsk self-help support group has since flourished into an established
branch of the network. In 2004 it provided services to more than 1,000 clients
through its centre for psychological support, and Nadiay, a day care centre
for HIV infected and affected children and families. It has also set up a
self-help group in a local prison and does outreach hospital work.“Since
1998 things have improved for people with HIV, maybe because of the
network,” says Aleksey.“But many are still afraid to go to the
doctors and even when they do, they are neglected; their rights and confidentiality
are often violated. Some doctors still refuse to treat HIV positive people
because they are scared of being infected. We’ve even helped people
fight for their rights in the courts.”
And what about the future for Aleksey? “My life has changed. I have
now been clean for two years and 30 days. Now I just want to develop a career
helping others.”
• www.network.org.ua
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