NEWS AND VIEWS: The new face of AIDS in Ukraine (04/07/02)

NEWS AND VIEWS

The new face of AIDS in Ukraine

by Alexander B. Kuzma

In the 1930s the world stood by and watched as between 6 million and 10 million Ukrainians starved to death during the man-made Terror Famine perpetrated by Joseph Stalin. For decades thereafter, our community pledged to remember the victims of the Terror Famine and to honor their memory by swearing that never again would we allow so many Ukrainians to die from another Holocaust.

Today, a very different specter is stalking Ukraine. According to demographers and health researchers at the United Nations Office of Population, a rapidly unfolding epidemic threatens to devour as much as 40 percent of Ukraine's population by the year 2050, overshadowing the death toll of 1933-1934, the Stalin purges and Chornobyl combined. What makes this new threat particularly frightening and insidious is the lack of awareness surrounding the crisis and the reluctance to confront the enormity of the threat. With few exceptions, even staunch Ukrainian patriots and prominent leaders of the Ukrainian diaspora are loath to discuss it.

When Ukraine won its independence in 1991, AIDS was virtually unheard of as a problem affecting the nation. By 1994, only a handful of cases had been registered in the country. By the year 2000 there were over 35,000 registered cases of HIV infections, and 2,000 of these were among children, according the Doctors Without Borders - Odesa. Based on studies of unregistered AIDS patients, the World Health Organization (WHO) estimates that the actual number of infected persons is approaching 400,000, or nearly 1 percent of the population. The WHO warns that Ukraine now has the fastest growing rate of HIV infection in Europe.

Even today, our diaspora is inclined to ignore AIDS as a problem that primarily affects intravenous drug users, homosexuals and prostitutes. Consciously or not, we have ignored AIDS as an issue that is not appropriate for discussion in polite company.

Unfortunately, the stereotype of AIDS victims is quickly being overwhelmed by a fast-spreading epidemic that is now striking newborn children, married couples and patients undergoing surgery without properly safeguarded blood supplies. According to a feature article that recently appeared in The New York Times, AIDS has now moved well beyond Ukraine's most marginalized citizens. It has entered the mainstream of Ukrainian society and Ukrainians' lack of understanding of the illness and false sense of security carries very grave implications for the future.

The World Health Organization estimates that as much as one percent of the Ukrainian population is HIV-infected, and this number is expected to grow exponentially unless aggressive action is taken. As bleak as this prognosis may be, we have to face reality. For anyone who cares about Ukraine and its future, AIDS is fast becoming an unprecedented public health menace and arguably the number one threat to Ukraine's well-being.

With Chornobyl we saw how a public health disaster could drain the resources and sap the economic vitality of a fledgling nation. Ukraine and the world community have spent billions of dollars in addressing the aftermath of Chornobyl and trying to safeguard the public from further contamination. In many ways, Western aid programs have helped to blunt the impact of Chornobyl by providing the equipment and training Ukraine desperately needed to upgrade nuclear safety and to treat children suffering from cancer and birth defects. When given the tools they need, Ukrainian hospitals have scored dramatic successes in reducing infant mortality, improving remission rates for leukemia and saving the lives of children stricken with thyroid cancer. U.S. government-funded immunization programs have helped to extinguish cholera and diphtheria epidemics before they could devastate the Ukrainian countryside.

An even more massive effort will need to be launched to confront the AIDS epidemic now sweeping the country. So far, the bulk of AIDS cases have been identified in the regions of Odesa and Mykolaiv, with Kherson and Donetsk not far behind. If there is any good news, it is that relatively few cases have been diagnosed in the western and northern provinces - at least so far. Even so, the explosion of AIDS cases in the southern oblasts clearly shows that all regions of Ukraine are extremely vulnerable, and the world community has precious little time to waste.

The diaspora may be tempted to wash its hands of this issue. It would be much easier to pretend that the AIDS crisis in Ukraine is none of our business, that it poses only a vague or remote threat to our friends or relatives. But if we stop to think about our families' real life situation, we will find that the threat is not nearly as remote or exotic as it seems. It would be naive to believe that this is a threat restricted to prostitutes or drug users. Anyone who requires a surgical procedure or a blood transfusion will be at risk as long as Ukrainian hospitals lack effective blood-testing technology and as long as doctors fail to follow universal precautions.

We have seen in the United States how informational campaigns and early testing have helped to level off and stem the tide of HIV infection. In Ukraine, a number of organizations such as Zhinocha Hromada, Doctors Without Borders and the Salus Foundation have developed very innovative programs to mobilize local communities against AIDS and especially to alert young people to the tremendous dangers involved. Unfortunately, these programs are woefully underfunded.

To its credit, the Ukrainian government and the Ministry of Health have now begun to recognize the AIDS crisis in its magnitude and have devoted the year 2002 to develop new strategies to combat the pandemic. Even with the government's increased involvement, it's expected that non-governmental organizations (NGOs) and international relief groups will play a key role in educating the public and putting in place the laboratories and medical resources needed to prevent the spread of the disease.

It will not be easy to mobilize Ukrainians against this new and unfamiliar kind of threat. We are accustomed to pointing the finger at outside forces and personalizing the enemy. Emotionally, it is much more gratifying and less complicated to focus on the victims of Chornobyl or the victims of Soviet repression. It will be harder to muster the same level of enthusiasm to combat a health crisis that began with victims whose lifestyles and personal choices may have contributed to their condition. But blaming the victim no longer makes sense when newborn children, surgical patients and spouses are becoming stricken.

Many diasporites have grown fond of pontificating about the low moral standards and the promiscuity of post-Soviet Ukrainians. We can choose to remain in denial, but putting on airs of moral superiority will not solve this problem. As a matter of Christian compassion and national self-interest, the struggle against AIDS must become a top priority for our Churches, our financial institutions and our youth groups - no matter how uncomfortable we may feel in confronting the reality of the epidemic.

At a minimum, we need to protect unborn children from HIV infection that can be transmitted from mother to child. Whatever our prejudices may be, we can all agree that children should be protected before their life even starts. Early prenatal testing and administration of drugs such as nevirapine have been shown to be extremely effective in protecting newborns and the unborn from their mothers' virus.

Prevention programs cannot stop with infants. For the children's sake, we need to protect the parents as well. Given the appalling conditions in many orphanages, Ukrainian society can ill afford an expanding generation of orphans whose parents are being decimated by AIDS, as is the case in Romania, Thailand, and much of the Third World. Ukrainian institutions (especially churches, schools and universities) need to launch a concerted drive to impress on sexually active adults how much they are placing their lives and their children's future in peril.

We need to devote similar resources to protect Ukraine's blood supply so that unsuspecting patients will not be infected by routine surgery, as was the case with tennis champion Arthur Ashe and Hollywood socialite Elizabeth Glazer. A particularly chilling case was reported in Donetsk a few years ago where a doctor donated his blood for five of his pediatric patients, not knowing he had been infected with HIV during a training program in the West.

The Ukrainian American medical community needs to be in the forefront of development programs to upgrade Ukraine's ability to test for the virus and to intensify prevention programs. There is an equally important role to be played by athletes, musicians, artists and philanthropists in expanding the informational campaign.

Even without AIDS, the health crisis in Ukraine was already daunting, and humanitarian organizations in the diaspora had their hands full combating the aftermath of Chornobyl and other widespread illnesses. Unfortunately, we can no longer ignore an even more monstrous threat that could cripple the entire medical infrastructure of Ukraine.

Our community's response to the AIDS epidemic will be just as much a test of our national character and our collective will as any of the epic military struggles or political movements that preoccupied earlier generations. The sooner we make the commitment to this crusade, the more lives will be saved and the more Ukrainians will be spared the agony that comes with this deadly illness.

* * *

For more information on the AIDS crisis in Ukraine, readers are urged to consult the United Nations AIDS website at www.unaids.org. Readers may also contact Irene Oleksiak at CCRF, 1358 Whalley Ave., New Haven, CT 06515; telephone, (203) 387-0507; e-mail, info@childrenofchornobyl.org.

Alex Kuzma is the executive director of Children of Chornobyl Relief Fund. CCRF is currently seeking to strengthen prenatal testing programs for HIV/AIDS in Lviv and Odesa.

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