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Europe Wednesday, 26 July, 2000, 16:31 GMT 17:31 UK
Ukraine - shooting for an AIDS epidemic
Olenka Frenkiel with Tatiana, an HIV-positive heroin addict at Crooked Pond hospital, Odessa
By Olenka Frenkiel

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"I had everything" says 32 year old Tatiana, a former nurse now dying in Odessa' s AIDS hospital , "a good job, a career, wonderful parents, we had a house in the country, a beautiful husband and a wonderful child. But when you take drugs you don't care about any of that, All you want is your next fix".

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Tatiana fell prey to Eastern Europe's peculiar form of drug abuse known as "kompot": a home-grown opiate made from the seed pod of the poppy. It's boiled up with various additives and sold by the syringeful. "You go to a certain part of Odessa where there's man in the window, it's a bit like buying tickets for the circus. "

Ukraine is in the grip of the worst HIV epidemic in Europe, and much of it is down to drug use. With a population smaller than that of UK, it has more than ten times as many HIV-positive people. What's even more worrying, though, is the speed with which HIV is spreading, and the speed with which it is developing into cases of full-blown AIDS.

Dr. Anatoly Ptashnik, a bluff, former military doctor in charge of Krivaya Balka, "Crooked Pond", the main AIDS hospital in Odessa, explained to us: "The opiate solution the addicts use is very dirty and when it's injected all sorts of micro-organisms get into the body. It's also reinforced with junk like vinegar, paint thinner and red phosphorus. I won't bore you with the list of ingredients but you can practically find the entire periodic table in there - bacteria, flu-viruses and even tuberculosis are pumped straight into the blood stream, including HIV."

A statue of Richelieu in one of Odessa's most elegant avenues
Odessa is a beautifully designed city on the Black Sea. It's always been a cosmopolitan port: before being part of independent Ukraine, in the era of the USSR, it was part of the Soviet Empire; and before that, part of Greater Russia. It was Catherine the Great's vision of her Paris on the Black Sea. And the first shots of the Russian Revolution are said to have been fired here, when the crew of the Battleship Potemkin mutinied in 1905.

But if Odessa is where revolution entered, here too was where HIV was imported.

In the few short years since Ukraine's independence and the end of communism, many of the social 'safety nets' which could contain an HIV epidemic have been fraying. The general chaos of the collapse of the USSR turned family life upside down, and some safer patterns of sexual behaviour were broken. Ukraine today is experiencing huge movements of people, pursuing a better income and a better future in the cities or overseas.

Even children are suffering the knock-on effects of the epidemic
Many of these changes caught Ukraine by surprise. But the aggressiveness of the HIV epidemic caught its health system almost totally unprepared. In this new era, where the government no longer had power, the expertise or the money to fight AIDS, the only help available has come from international institutions like the UN, and European and American foundations. Ukraine's public health action on HIV has, so far, been a hotchpotch, cobbled together with ideas and money from NGOs and international health organisations.

These bodies introduced a policy which they claimed had already worked in the West: harm reduction. Rather than stigmatising drug use or unsafe sex, or terrifying the public, they argued, the state could stop HIV being spread by distributing clean needles and condoms to those who needed them most - drug injectors and prostitutes.

Tatiana Semikop, a major in the Odessa police force, was horrified when she first heard how she and other officers would no longer be asked to lock up drug addicts and prostitutes, but instead help them on their way with condoms and clean syringes.

'Harm reduction' includes giving advice on how to sterilise needles
"I tell you I was completely baffled. As a police officer I just couldn't understand why we should be handing out needles to drug addicts. I was dead against it. We had to change our whole mind set on drug abuse - we were told it had worked in Europe and in the United States... so we agreed to a pilot project here. It was the first in the country."

Yet what we found, recording in Odessa, was that these schemes hadn't always reached the people they were targeted at. When we talked to prostitutes on the streets where Semikop was meant to be giving out condoms, they said they hadn't seen any such thing happening. And even if addicts did use clean needles, explained Dr. Ptashnik, the drug solution itself is so dirty that it wouldn't make much difference.

What's worse, some of the prostitutes admitted "Sometimes when clients pay more money to girls, they do it without condoms. It's prohibited but some girls do it." Clients, too, told us they didn't need or want to use condoms with prostitutes they visit regularly.

When I asked how the working girls protected themselves without condoms, one showed me a "chemical remedy" in the form of a vaginal cream, which claimed to protect against HIV. But no such claim has ever been scientifically proved.

Tatiana Semikop (left) in the offices of her health education group Faith Hope Love
Harm reduction might seem like a step forward. But just like the state health system, the outreach programmes still don't have adequate budgets. As Tatiana Semikop explained, some staff she knew hadn't had a paycheck for months. Within 10 years Ukraine expects a million and a half deaths from AIDS. The picture is made grimmer still by the combination of ineffective programs, and a lack of independent and up-to-date information.

Most worryingly, prostitution now seems to be the key vector by which HIV is spreading to the wider population in Ukraine. While drug addicts are socially and often sexually isolated, the prostitutes have many 'mainstream', married clients. In the summer, Odessa's prostitute population triples, going from 2000 to 6000, with women from Black Sea region travelling to work in the sex industry. Ukraine's epidemic is not just a national disaster; it's potentially an international menace.

Odessa prostitute vox pop July 2000
describes the reality of Ukraine's sex trade
Zemfira, Russian pop hit about AIDS, July 2000
hit song about AIDS, 'Spid'
See also:

24 Nov 99 | Europe
15 Jun 00 | Europe
14 Apr 00 | Media reports
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