final program.qxd - Parallels Plesk Panel

In 1995 HIV started to spread rapidly within the population of injection drug users (IDUs).
About 81% of the 5400 new officially registered cases in 1996 were among drug users (fig.
2), while the highest number of HIV positive drug users was registered in 1997 - 7448
persons (84% of the total registered cases). A dramatic decline in drug use related HIV
incidence, as well as in total annual incidence, occurred in 1999 (respectively 42% and
32% year decrease). This was mostly the consequence of implementation in April 1998
the Government Decree 'About prevention of Acquired Immunodeficiency Syndrome and
social advocacy of the population', which for the first time declared the principle of
voluntary HIV testing in the country. To date, the annual number of newly reported HIV
cases continues to rise and exceeded 13,700 in 2005, almost 10% more than the 12,500
cases diagnosed in 2004 and almost double the number diagnosed in 2000 (fig. 1).
The epidemic is rapidly spreading beyond the ten regions in southern and eastern Ukraine
where over two thirds of all HIV cases have been reported to date. Sharp increases in new
reported infections are also occurring in central regions of Ukraine previously thought to
be minimally affected.
Figure 2.HIV transm ission trends in Ukraine
(% of som e transm ission groups am ong new ly diagnosed HIV
infections by year)
% of tran sm ission groups
90
Heterosexual
80,7 83,6
80
Injection drug use
76,0
Mother-to-child
70
61,2
64,7
62,5
60
56,6
52,4
50
48,1 46,3
40
30,4
32,4
28,5
30 25,9
26,9
22,7 23,0
16,2
18,3 18,2
20
15,7
13,1 11,3
13,1
11,7
9,0
10
4,4
1,1 1,7 2,2
0
1987- 1996 1997 1998 1999 2000 2001 2002 2003 2004
1995
Year of report
To date, among other vulnerable groups the highest HIV prevalence continues to be
among injecting drug users, ranging today from 10% to 66% among 13 HIV sentinel
surveillance sites in 2005, with the most affected southern and eastern cities (Donetsk,
Odesa, Mykolaiv, and Simferopol) as well as the capital of the country (Kyiv) and a city of
the central region - Zytomyr. Because HIV testing is limited to government facilities, those
at greatest risk are not being reached, since marginalized populations are the least likely
to use government facilities. This could result in significant under-identification of new HIV
cases. In fact, number of HIV tests among injecting drug users nationwide decreased by
153.2% between 1996 and 2004, despite this, however, HIV prevalence among drug
users is steadily increasing showing the rate of 14.8% by the end of 2004. A recent
survey embraced 14 regions and about 3,450 injection drug users reported that in
average 21% of the participants might be HIV positive.
Prevalence rates decreased or remained stable in recent years in several cities. However,
these trends probably reflect increasing participation bias over time due to progressive
exclusion of known HIV-positive individuals from the tested population, rather than true
decreases in prevalence. Also, these trends might be a consequence of high AIDS death
rates among infectious drug users in these regions. For example, in Donetsk where HIV
prevalence among IDUs remains relatively stable from 2002 to 2004 (around 40%), AIDS
death rates increased by 123% during the same period.
“ Focusing FIRST on PEOPLE “ 54 w w w . i s h e i d . c o m