Rapid scale-up of HIV prevention needed in Ukraine, says World Bank

Keith Alcorn
Published: 08 August 2006

If Ukraine’s AIDS epidemic is not curtailed quickly, by 2014 the country’s economic growth could decline by at least 6%, warns a new study, Socioeconomic impact of HIV/AIDS in Ukraine, from the World Bank and the International HIV/AIDS Alliance in Ukraine.

“If we miss the chance to reverse the flow of the epidemic today through preventing new HIV cases, tomorrow we will be needing to provide the growing number of positive people with treatment and care”, says Andriy Klepikov, Executive Director of the International HIV/AIDS Alliance in Ukraine.

Ukraine was estimated to have almost 500,000 people infected with HIV by 2004, and the World Bank estimates that unless a major scale-up of prevention activity takes place, Ukraine could have up to 820,000 HIV-positive people by 2014, with an adult HIV prevalence of more than 2%.

According to the report, the five-year period from 2006 to 2010 will be decisive for addressing the HIV/AIDS epidemic in Ukraine. Success can only come from sustained national commitment, including allocation of appropriate funding from the domestic budget for key prevention, care and treatment activities.

“Without rapid scale-up of focused prevention efforts, particularly among injecting drug users, HIV treatment will never become socially and economically sustainable,” Andriy said.

However, the World Bank supended a $60 million HIV prevention and treatment grant to Ukraine in April 2006 when it became apparent that the Ukraine government had spent only 2% of the money allocated since the programme began in January 2004.

Funding may be resumed in September if the World Bank can reach agreement with the Ukrainian government on how the programme will be administered in the future, according to Health Minister Yuriy Poliachenko.

While injecting drug use remains the primary source of HIV transmission in Ukraine (72% of cumulatively reported cases among adults), an increasing number of cases are emerging among the heterosexual partners of injecting drug users and among children.

“If we miss a chance to reverse the flow of the epidemic today through preventing new HIV cases, tomorrow we would be thinking of providing the growing number of positive people with treatment and care”, says Andriy Klepikov. He emphasizes that “without rapid scale-up of focused prevention efforts, particularly among injecting drug users, HIV treatment will never become socially and economically sustainable”.

The southern and eastern regions of Ukraine are the most affected – including the oblasts of Dnipropetrovsk, Donetsk, Odesa, Mykolaiv, and the Crimean Republic. While a third of the country’s population lives in these regions, they constitute two-thirds of all officially registered HIV cases. Western Ukraine remains the least affected.

The epidemic could hit such labour-intensive sectors as agriculture and mining particularly hard, in part because such activities are concentrated in the higher-prevalence southern and eastern regions. For example, output in the agriculture, hunting, forestry, and fishing industry between 2004 and 2014 were all expected to experience slight declines even without AIDS, but under the pessimistic scenario, they would experience a further decline of 1.2 to 1.3% compared to the ‘no AIDS’ scenario. Next comes transport and communications (a reduction of 1.2–2.2%), and construction (minus 1–1.8%).

Given the relative share of the above sectors in trade, the worst-case scenario anticipates a fall of 40% in exports of these sectors, which translates into 5.5% fall in GDP, an 8% fall in total welfare, and a 9% fall in investment.

Echoing the underlying demographic decline of 10.4 % from 2004 to 2014, HIV/AIDS will cause an additional 1–2 % reduction in the labour force nationwide. The epidemic could contribute to labour force shrinkage in the worst affected areas at rates of 2.7–3.6 % for Donetsk and 2.2–4.2 % for Odessa.

“The epidemic’s impact on economic, demographic and health status is potentially very serious," says Paul Bermingham, World Bank Director for Ukraine, Belarus and Moldova. "The World Bank remains strongly committed to work with the Ukrainian government, in partnership with other international organizations, to tackle HIV/AIDS epidemic in Ukraine.”

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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