Jean-Luc Martinage in Kiev
Fighting stigma and discrimination against people living with HIV is at the core of the Red Cross Red Crescent AIDS response. In Ukraine, the Red Cross is one of the very few organizations actively involved in fighting against stigma while providing care and support through its visiting nurses programme.
“The Ukrainian Red Cross was the first organization to get involved with HIV in Ukraine when the first cases were identified. We were criticized for that at that time, but it is no longer the case,” recalls Alla Khabarova, executive director of the Ukrainian Red Cross. With the support of sister societies such as the American, French and Italian Red Cross, and in the past Netherlands Red Cross, we have been able to bring a significant response through our visiting nurses programme.”
“Working with people living with HIV and fighting stigma against them has been at the core of our policy. We are ready to do more if we get the necessary funding,” she adds.
Since injecting drug users is one of the groups most affected by HIV, the Red Cross HIV programme is implemented in partnership with NGOs such as ‘Eney’ (drug users anonymous) which runs a syringe exchange point located at the AIDS centre in the city of Kiev.
“Drug users, some of them living with HIV, can safely come to exchange syringes and needles, but I am also here to talk to them, share their concerns and answer their questions over a cup of tea,” says Volodymyr Moiseyev, one of the social workers taking care of the exchange point.
Rock music and a cup of tea
Volodymyr is a former guitar player in a rock band. He was himself a drug user for many years. “I managed to get out of drugs, but I have seen many of my friends dying. I also have a daughter and I know it is so important to prevent her from going through the ordeal I have been through,” he explains while looking for some Ukrainian ‘underground’ rock music on his CD player. “Very often, the lyrics refer to drug using and HIV,” he notes.
“Event though many young people are addicted to drugs, I see people from all age groups coming here. I can see up to 15 people every day including people over the age of 50,” he adds.”The visiting nurses service provided by the Ukrainian Red Cross helps us a lot in the sense that we can address clients who need additional support. The nurse will not only bring food parcels. She will also help with applications for benefits when necessary and provide all kind of services. They are so precious to people living with HIV,” he adds.
The reason why the exchange point has been so popular is that it is one of the few places in Kiev where drug users can come and get some support without fear of getting into trouble with the authorities. For those living with HIV, the threat is even bigger as they are likely to be rejected by their neighbours and family members due to the high level of stigma.
Stigma within the health system
“Discrimination in Ukraine against people living with HIV is very high,” explains Volodymyr Zhoutik, director of the All Ukrainian Network of people living with HIV. “Every day we receive testimonies from members having children no longer accepted in schools or being refused treatment at hospital when nurses and doctors become aware that they are living with HIV. In one case, an ambulance came on the scene of a serious accident. The person was bleeding. When the emergency medical personnel were told the victim was HIV positive, the ambulance just left...”
The stigma can be so high that many people living with HIV become affected by some kind of ‘self-stigma’ syndrome that is confirmed by Volodymyr Zhovtiak. It is as if they are so ashamed to have HIV that they would rather hide away, living with HIV and sometimes even dying of AIDS without anyone to talk to except the very few people who are aware of their status.
Fighting stigma among health and care workers seems to be an obvious priority. “We are fully aware of the situation but there is very little that we can do,” explains Dr Igor Pokanevych, head of the country office for Ukraine at the World Health Organization. “I believe that an efficient way to fight this stigma would be to sharply increase the number of hours given to HIV prevention at schools as well as at the medical schools. The national AIDS programme could do more prevention campaigns against stigma as the existing ones are currently conducted mainly by NGOs. The situation also differs between cities and villages where stigma is even higher,” he adds. The WHO representative also mentions the lack of reliable reporting of new cases as a problem, as well as the rise in the number of people co-infected with HIV and TB.
A worrisome future
“Some 360,000 people are currently living with HIV in Ukraine,” confirms Ani Shakirishvili, UNAIDS country coordinator. “Ukraine has the highest contamination rate among all countries that were formerly part of the Soviet Union. If the response continues to be inadequate, statistics are likely to further rise to up to 800,000 living with HIV by 2015 which would a big burden for Ukraine,” she warns.
“Harm reduction programmes are the cornerstone of the fight against HIV infection in Ukraine so they need to be strengthened so that the reduction of prevalence among injecting drug users continues to decrease. Involving communities as well as strong political will are essential,” she adds.
Mobile unit
Since it is crucial to reach people most vulnerable to the threat of HIV where they are, Volodymyr Moiseyev – together with his colleague Ania – travels with a mobile unit to different parts of Kiev on a regular basis. “The idea is that we need to go to the places people live in order to reach them,” explains Ania, who has been working with the mobile unit for the last two years.
“Not only can drug users exchange their used syringes for new ones, but they also have access to condoms and to prevention leaflets. They can also be voluntary tested for HIV. The result for the test is ready five minutes after the blood test. When the test is positive, a psychologist is there to immediately take care of the person, reassure them, bearing in mind that beyond the infection itself, they are so afraid of the stigma experienced in hospitals that they sometimes refuse to go. However, we convince them and eventually we go with them to the AIDS centre to make sure they do another test that will confirm the first one and that they get immediate treatment,” she explains. At the same time, elsewhere in the city, another mobile unit is doing a similar job, this time with sex workers.
As we leave Ania, who is now busy taking care of another client, we meet with 21-year-old Alexey who had just been tested inside the mobile unit. Alexey became addicted to drugs when he was just 15. “I was trying to do like the older guys in my neighbourhood,” he explains. “I was expelled from school and finally found a job.” However, no one where he works knows that he is using drugs. For him, there is no other solution than to keep things to himself except when he visits the mobile unit. Now Alexey wants to stop his addiction.”Anyway, now I can hardly find a vein on my body to inject myself as I have done it so often…”