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. Last Updated: 07/27/2016

HIV Threat Moves Mainstream

ODESSA, Ukraine -- No one outside a small sympathetic circle knows that Iren is infected with HIV, not even her mother.

Telling, she said, would only "make trouble." It would also invite unkind assumptions, given the way HIV and AIDS has cut through Ukraine, the nation with the worst problem in the region.

"People would think I used drugs or I was a prostitute," said Iren, who asked that her full name not be printed.

Neither is true of her, she said, and that fact marks a long-dreaded departure in the short history of AIDS in Ukraine.

Until 1994, the disease was virtually unknown, with only 187 cases diagnosed. Then drug addicts and prostitutes became infected with HIV, the virus that causes AIDS, as society became freer, if poorer, with the collapse of the Soviet Union.

While the HIV infection rate is still low compared with that of Africa, between 300,000 and 400,000 people in Ukraine, which has a population of 50 million, are now estimated to be infected.

That makes Ukraine the first nation in Europe with 1 percent of its adult population infected.

Throughout Eastern Europe and Central Asia, there has been an abrupt spike in HIV infection rates.

Around Eastern Europe, the number of HIV infections is 15 times higher than it was three years ago, largely because of intravenous drug use, according to the United Nations.

In Russia, at least 75,000 people are estimated to have contracted HIV in 2001, mostly through shared needles. Dr. Peter Piot, executive director of the overall United Nations AIDS program, warned recently that an even larger epidemic in the countries of the former Soviet bloc "may be imminent."

The virus is still spreading fastest among those people at society's margins, as Iren, who works for an agency that helps people with HIV, sees every day in Odessa, a city that has been a center for the disease -- as well as for local activists who fight it.

But now HIV is also moving to infect people like Iren, 38, an economist and mother, who says she contracted HIV from her husband, a drug user who died of AIDS a year ago. Now more people, mostly women like Iren, are contracting HIV through sexual transmission, not through shared needles. More pregnant women are testing positive for HIV, and the virus is being passed more often to newborns.

"There is a shift to the general population," said Andrej Cima, the head of the United Nations Joint Program on HIV/AIDS in Ukraine. "That is clear."

This shift is worrying enough, health officials say, but it comes at a time of continuing alarm about the overall rate of HIV infection in Ukraine, and the inability of the cash-strapped government to rein in its spread.

Health officials, both in the Ukrainian government and the United Nations, have said that now -- with the disease starting to bore its way into the general population -- is the moment to step in with a huge investment to fight a further spread of the virus.

The idea is to concentrate on the disease's reservoir, intravenous drug users, as well as young people who often turn to drugs because of few jobs in a generally bleak economy. Toward that end, the United Nations is working to raise between $30 million and $50 million for a broad three-year program against the spread of HIV.

With enough money, said Alla Shcherbinskaya, director of the government's Center for AIDS Prevention, "I think we will be able to make the epidemic stall in the next five years. Of course, we will not be able to stop it. But we can stop it from growing."

Ukraine is generally considered among the most advanced nations in the region on HIV- and AIDS-related issues: President Leonid Kuchma is one of the few leaders to talk publicly about the disease. He has declared 2002 the official year of fighting AIDS.

But if Ukraine is the best, it may not bode well for the rest of this poor and isolated region -- a fact summed up by two bodies that lay in the backyard of a state-run AIDS clinic in Odessa one recent day.

The two had died of AIDS, and the only hearse available had broken down.

"This is something that can make a person depressed," said Sergiy Fedorov, an AIDS activist who described the bodies just after seeing them at the clinic.

For one, he said, the government does not now have the money to run an effective program against AIDS, never mind the resources to transport its victims to the grave.

In a country where awareness about HIV and AIDS seems quite low, he said that a scene like the bodies could only add to a sense of fatalism.

"People think that when they get HIV, the next stage is death," he said.

Fedorov, a handsome, healthy-looking 28-year-old, is a rarity in a nation where the stigma against those with HIV and AIDS is great. A former intravenous drug user, he decided two years ago to go public with the fact that he is infected with HIV.

Not everyone -- his mother included -- applauded his decision. But other activists and health officials credit his frequent appearances on radio and television with creating a human face for the disease.

Slowly, he said, awareness is rising. He said it was likely to rise more now that it was not only drug users who were contracting HIV.

"We are sort of in a beginning stage of people understanding that it is a threat for everyone," he said. "But it is only a beginning."

There is a slight change of focus among HIV and AIDS support groups in Odessa, who have worked with little government help to create a wide network of services. Most of the effort has been to educate drug users and prostitutes, two groups not widely accepted by society at large, and by using unorthodox methods.

"The first time I heard that in order to stop the spread of HIV, we had to give out syringes to addicts -- it was a big shock to me," Tatyana Semikop, a major who has worked for Odessa's police force for 17 years. "How was I, a police officer, supposed to give out syringes?"

Semikop, who for five years has also headed a large AIDS support agency, Faith, Hope, Love, said she changed her mind when she saw that it worked. While her group and others continue to focus on drug addicts and prostitutes, they have begun to branch out, now that, by her estimate, 60 percent of new infections are transmitted sexually.