(L to R) Natalya Lukyanova, Red Card Campaign Coordinator, Andriy Shevchenko, Ukrainian National Team football player, Dr Ani Shakarishvili, UNAIDS Country Coordinator in Ukraine
Credit: UNAIDS/K.Gladka

The ‘Give AIDS the red card’ campaign, an initiative that uses the power of football to eliminate stigma and discrimination against people living with HIV, kicked off on Thursday 27 October in Ukraine. Organized by the Government of Ukraine, the new campaign was launched within the framework of the European Football Championship 2012 to be co-hosted by Ukraine and Poland in summer 2012.

“To reach out to young people, we speak ‘football language’ because football unites us regardless of our social, gender, ethnic or religious differences”, said Ravil Safiullin, Head of the State Service for Youth and Sports of Ukraine.

The new campaign also aims to promote safe sex and condom use along with addressing gender inequality, sexual exploitation, and domestic violence. To that end, images of celebrities with the campaign messages will be place on billboards and on metro stations around Kiev and the other country regions. Posters will also be distributed in educational institutions as well as railway stations. Finally, public service announcements will be broadcasted via national media.

The Red Card campaign starts simultaneously in all regions of the country and is supported by the football star Andriy Shevchenko and other celebrities such as singers Ani Lorak and Gaitana and the World’s Strongman 2004 Vasyl’ Virastyuk.  UNAIDS, UNICEF and UNFPA as well as civil society organizations such as the All-Ukrainian Network of People Living with HIV, the International HIV/AIDS Alliance in Ukraine and La Strada are also supporting the campaign.

“This initiative emphasizes the growing commitment of the Government of Ukraine and the society at large to tackle key social problems facing the country,” said Dr Ani Shakarishvili, UNAIDS Country Coordinator in Ukraine. “We hope that the campaign will help remove existing barriers to an effective national AIDS response and it will bring Ukraine closer to the UNAIDS vision of Zero new HIV infections, Zero AIDS-related deaths and Zero discrimination”.

The HIV epidemic continues to grow in Ukraine and it has become the most severe of whole of Europe. Only one third of the estimated 350 000 people currently living with HIV is aware of their status and has access to HIV services. Furthermore, only 26 000 people living with HIV are currently on treatment. According to the Stigma Index research conducted in 2010, more than half of Ukrainians living with HIV are victims of some sort of stigma and discrimination.

The Elena Pinchuk ANTIAIDS Foundation has launched a competition to develop social media and mobile phone projects for HIV prevention. The competition will reward innovative, start-up projects to show proof of concept and the potential for future scale up to make a real impact on the HIV epidemic.

"To be more efficient with the AIDS messaging we have to use the same language and the same communication platforms as our target audience,” said Ms Pinchuk, founder and chair of the foundation. “Our goal today is to make modern technologies work for HIV prevention. Our dream is a future where AIDS is only mentioned in the past tense."

The initiative offers opportunity to software developers, public health practitioners, HIV programme managers as well as mHealth and social media for health communications professionals to create innovative projects using social media and/or mobile phones for HIV prevention.

Accepting applications from 30 June to 1 October 2011, projects applying for funding should be either youth-led or have a youth focus, aim to prevent new HIV infections, raise awareness about HIV prevention and/or decrease stigma and discrimination against people living with HIV. Winning projects will be awarded with full or partial funding up to 10,000 USD for the maximum implementation period of one year.

“Young people are in the forefront of the AIDS epidemic—both as those affected and those leading the social and behavioural changes that will prevent HIV,” said Michael Bartos, Strategy team leader from UNAIDS. “The new era of social movements led by ‘digital natives’ will transform the AIDS response and this competition will help create its leading edge,” he added.

Applications will be assessed by a panel consisting of leading technology and HIV prevention experts including Chris Hughes, Executive Director of Jumo International, Inc and a co-founder of Facebook, Garth Japhet, CEO of Heartlines, member of the High Level Commission Scientific Advisory Panel, Bill Roedy, former Chairman and Chief Executive, MTV Networks International, Debbie Rogers, Lead Strategist, Praekelt Foundation and Elena Pinchuk, founder and chair, Elena Pinchuk ANTIAIDS Foundation.

“Young people connect with each other through social media and mobile. As this is their primary means of communication, the next generation of HIV prevention must be through this, said Mr Roedy. “Let's help create the prevention revolution with this technology and go forward with the aim to have an AIDS free generation.”

Winners and amounts granted will be announced on 1 December, World AIDS Day 2011: www.antiaids.org, www.unaids.org  and http://www.hivpreventioncommission.com/ 

For more information about the competition and how to take part visit ANTIAIDS

The ANTIAIDS Foundation was founded by Elena Pinchuk in 2003 and is the first and the sole charity established with private funds against AIDS in Ukraine. The foundation operates at multiple levels—from national programs to direct support to individuals affected by the HIV epidemic. To find out more visit. www.antiaids.org.

The UNAIDS High Level Commission on HIV Prevention was launched on the 21 of July 2010 and includes more than 15 world renowned leaders. The Commission leads a global advocacy campaign to build broad support for effective HIV prevention programmes, and is co-chaired by Professor Francoise Barré-Sinoussi, Nobel Laureate in Medicine for her role in the discovery of HIV, and Archbishop Emeritus Desmond Tutu, Nobel Peace Price Laureate. To find out more visit: http://www.hivpreventioncommission.com/  



Minister of Heath of Kyrgyzstan, Sabyrbek Dzhumabiekov (left) and, UNAIDS Deputy Executive Director, Programme, Paul De Lay addressing participants at the universal access consultation. Kiev, 17-18 March 2011

Insufficient investment in programmes to prevent HIV infection among key populations at higher risk is hampering efforts to achieve universal access to HIV prevention, treatment, care and support in Eastern Europe and Central Asia. That’s according to participants at the regional consultation that took place in Kiev, Ukraine on 17-18 March 2011.

Government and civil society representatives from 30 countries across the region participated in the universal access consultation. The objective was to discuss gaps in the region’s response to HIV as well as identify key priorities for future action.

“Eastern Europe and Central Asia remain far from achieving universal access, in spite of significant efforts,” said Dr Denis Broun, Director, UNAIDS Regional Support Team, Europe and Central Asia.

The region has seen progress in preventing mother-to-child HIV transmission. HIV treatment coverage has been slowly increasing in recent years. Yet only one out of four people needing treatment are receiving it—the lowest coverage rate in the world.

Insufficient availability of treatment as well as prevention programmes—especially for the key populations at higher risk of HIV such as people who use drugs, men who have sex with men, prisoners and sex workers—were seen as the major gaps in the region leading to the increase of new infections. 

One of the discussions centred around the significant dependence that the region has on international financial support, specifically in the form of Global Fund grants. Participants stressed that national funding levels were low and called for countries to increase their domestic investment in the AIDS response. “Countries should not wait until funding from the Global Fund and other international donors ends. Sustainability of the HIV prevention, treatment, care and support should rely on national budgets,” stated participants in their final recommendations. “Governments should look at AIDS funding not as ‘spending’ but as investing in the economy, in the workforce and the future."  

Representatives of non-governmental organizations noted that, in general, civil society is not involved in budgetary decision-making when it comes to allocation of government funds. As a consequence, the effectiveness of the overall AIDS response remains low due to the limited capacity of the State to respond to the needs of people at higher risk of infection.

According to participants, there is a lack of sufficient HIV prevention programmes providing information to young people, raising awareness and promoting condom use to prevent sexual transmission of HIV. The existence of HIV-related travel restrictions, criminalization of HIV transmission and same-sex relations and the repressive police practices towards people who inject drugs were identified as significant barriers to establishing relationships of trust with people most-at-risk. Participants also agreed on the need to create legal environments to facilitate the intake of HIV prevention services by populations at higher risk of infection.

The recommendations made by participants will be included in the universal access progress report that will be presented at the United Nations General Assembly High Level Meeting on AIDS that will take place in New York in June 2011.

“The HIV situation in the region is critical. By contributing to the recommendations at a time when they are developed, we have a chance to ensure that the voice of people living with HIV is heard,” said Vladimir Zhovtyak, head of the Eastern European and Central Asia Network of People Living with HIV.

Participants in "Race for Life" charity event receive award. Credit: UNAIDS

“A healthy future starts with you” was the slogan of Race for Life, a charity event held on 9 October in Kiev, Ukraine. Over 3000 people gathered in Kiev’s city center to support people living with HIV, raise money for children born with HIV, and express their readiness to join hands to halt the epidemic.   

Ukraine is one of the countries most heavily affected by HIV in the region. According to UNAIDS estimates, around 440 000 people are living with HIV in Ukraine, representing over 1% of the adult population. Every day, some 50 new cases of HIV are registered in the country.

In recent years, various sectors of Ukrainian society have united their efforts to respond to the country’s rapidly-growing HIV epidemic. The Ministry of Education, Kiev city administrations, media organizations, the private sector, non-governmental organizations and community organizations were among the organizers of this year’s race.

“Race for Life is a tool for social mobilization in the overall response to the epidemic, especially in public awareness,” said Svetlana Cherenko, Chairman of the Committee on Combating HIV in Ukraine’s Ministry of Health. HIV prevention among youth is one of the country's main priorities.

Initiated by the UN Office in Ukraine in 2001, Race for Life was held annually until 2005. The event was organized again this year to convey healthy lifestyle and HIV prevention messages to youth.

“We must continue talking to young people about HIV transmission, about prevention, about personal responsibility. Everything is in their hands today—their health, their life and their future,” said Denis Broun, UNAIDS Regional Director for Europe and Central Asia, who also ran 3 kilometers in the race.

Credit: © UNICEF/UKRA01115/Pirozzi
UNICEF wants to help Ukraine’s many young injecting drug users protect themselves against HIV

Oksana is a teenage mother with a very young baby. She is also living on the streets of Kyiv, Ukraine’s capital. Having lost touch with her mother, who was sent to prison, she ran away from home to escape her abusive stepfather. She spends most of her day at the central railway station or the underground tunnels nearby but dreams of one day having a settled home for her son. These dreams are unlikely to be realised any time soon.

She is one of the many young people eking out a living on Ukraine’s streets who get no care and support. An unsafe social environment and high risk behaviour such as sex work and injecting drugs make young people living in the streets of Ukraine vulnerable to HIV. They are at the heart of an epidemic in the country worst affected by HIV in Europe and yet rarely have access to HIV prevention and treatment services.

One of the central aims of UNICEF in Ukraine is to try to help these most-at-risk young people, especially those who are homeless, to better protect themselves against HIV. Key activities include supporting outreach teams working with street children and adolescents, training social and health care workers and providing access to basic health services, education, training and housing.

According to the latest statistics, in 2006 more than 60% of injection drug users in Kyiv were living with HIV. In 2009, UNICEF conducted a study among street-based adolescents in several regions of Ukraine, which found high rates of drug use by injection, with two thirds of those having reported sharing needles. The study also revealed that one in ten male street adolescents had had sex with another male, often in exchange for money, clothes, or drugs.

Olena Sakovych is a UNICEF youth and adolescent development officer, who works closely with street children, as well as other most-at-risk adolescents. She is fully aware of the extent of the problem, with some young people initiating drug use by injection as early as age 13, and both boys and girls living on the streets often engaging in sex work at a similar age.

“These young people are the missing face of the HIV epidemic in Ukraine,” says Olena. “They need better care and more services. The situation here is critical. One of our main objectives at UNICEF is to make them visible to Ukraine’s political agenda and its AIDS response.”

The findings of the research informed the development of interventions and provision of health and social services to better address the needs of and help adolescents injecting drugs and engaging in sex work. In the city of Mykolyav, for example, outreach workers now recruit young female sex workers to a drop-in centre that offers a safe space, HIV counseling, and referrals to governmental health and social services centres, and non-governmental organizations that provide HIV prevention services, care and support.

Social workers accompany the women to those services, when necessary, which include gynaecological and infectious disease specialists, HIV treatment centres, and legal aid. Demand has far exceeded expectations. It was hoped that 50 under-aged sex workers would be recruited in the first six months. To date, well over a hundred adolescent girls have received services. A client satisfaction survey showed an increase in knowledge about HIV, as well as in motivation to seek help.

"UNICEF will continue to advocate for, and to support, country efforts to increase understanding of the epidemic and HIV prevention, protection, care and support services for most-at-risk adolescents,” says Susan Kasedde, UNICEF Senior Specialist on HIV Prevention among Adolescents. “In countries like Ukraine, until such services are made available, national epidemics cannot be stopped."

To this end, UNICEF promotes mobilization of governmental leadership; national and local political and community support; legislative and policy changes to enable wider access to HIV prevention and care services for most-at-risk adolescents, and strong partnership between the United Nations, government, civil society, young people themselves and people living with HIV.

“Ensuring that those most vulnerable to HIV infection like, young people on the streets, injecting drug users, those engaging in sex work, and men who have sex with men, have access to HIV prevention, treatment, care and support services is both a human right and a way to finally reverse the spread of the HIV epidemic,” says UNAIDS Country Coordinator Ani Shakarishvili. “Ukraine is continuing to make progress towards universal access but far more needs to be done. Strong political leadership and commitment will guarantee success. “

There is no doubt in the minds of health experts and activists that the official figures hugely underestimate the numbers of MSM living with HIV and newly acquiring HIV infection in Ukraine and elsewhere in the Region. Credit: UNAIDS/S.Dragborg

Judging by the official statistics, cases of HIV infection amongst men who have sex with men (MSM) in Ukraine, as in much of Eastern Europe and Central Asia, are so rare as to seem scant cause for concern.

“No statistics means no problem,” says Zoryan Kis of the All-Ukrainian Network of PLHIV (People Living with HIV). “The fact that the official numbers are very low is a danger for our work because we know that the epidemic exists but it is hidden.”

But there is no doubt in the minds of health experts and activists that the official figures hugely underestimate the numbers of MSM living with HIV and newly acquiring HIV infection in Ukraine and elsewhere in the Region.

In the 20 years since the first case of HIV infection was detected in Ukraine, only 158 MSM have been officially registered as living with HIV in a country with a total population of some 46 million people.

According to the 2007 UNGASS country report Ukraine has the most severe HIV epidemic in Europe, with just over 1.6 percent of the adult population estimated to be living with HIV. In 2007, 17,687 people were reported as newly infected with HIV, up 10 percent from 2006. Among them, the official number of new cases amongst MSM was just 48.

Together with the high degree of stigma attached to MSM in Ukraine, something the country shares with other countries in Eastern Europe and central Asia, this understating of the problem has contributed to authorities’ reluctance to back campaigns of prevention among MSM, activists say.

Beyond the official statistics, there is considerable data on MSM which paints a different picture. Various organisations, including UNAIDS, WHO and the International HIV/AIDS Alliance in Ukraine estimated that in 2006 there were between 177,000 and 430,000 MSM in the Ukraine, of whom between 3 and 15 percent of live with HIV, which is several hundred times the figure reflected in the official studies.

Stigma and discrimination

Official HIV figures in Ukraine, as elsewhere in the region, are based on the results of voluntary HIV testing during which people should normally be asked why they have sought a test.

But in countries where MSM face widespread discrimination and where there is a high degree of stigma attached to male to male sex, there is understandable reluctance on the part of MSM to give the true reason.

“Most of MSM are not open. They would not go and say: ‘I have had sex with men’. They would say ‘I have had risky behaviour, I have been injecting drugs or even I have visited the dentist and I am worried,” says Kis.

And often officials do not press for answers. “I have been tested four or five times, but I have never been asked for my sexual orientation,” Kis adds.

According to the European Centre for the Epidemiological Monitoring of HIV/AIDS, only 1,828 cases of HIV infection in MSM have been officially reported between 2002 and 2006 years in the 15 former Soviet countries making up the World Health Organisation’s Eastern European health region.

Turkmenistan and Tajikistan, report none, while Azerbaijan has only 10 and Belarus 29. The highest number is reported by Russia; but its 1,245 cases over the 5 years compares with more than 38,000 in Britain and 11,000 in Germany in the same period, countries with smaller overall populations.

Prevention services for MSM have improved in the last few years, but they remain significantly inadequate to impact and sustain behavioural change and thus reduce HIV transmission among this group of men in Ukraine.
Credit: UNAIDS/P.Carrera

Ambitious goals

In 2006, Ukraine set ambitious national goals for scaling up towards universal access to HIV prevention, treatment, care and support for groups at high risk of HIV. However, HIV prevention activities in the Ukraine, as in most of the rest of the region, are carried out by NGOs with financial backing from international donors, mainly the Global Fund for AIDS, Malaria and Tuberculosis.

For example, a two-year project called “Men Who have Sex with Men: HIV/STI Prevention and Support” was implemented in Kiev by the AIDS Foundation East-West, the Gay Alliance NGO and Noah’s Ark-Red Cross Sweden, with financial support from the Elton John AIDS Foundation amongst others.

The International HIV/AIDS Alliance in Ukraine, which is co-holder of the Global Fund grants, is currently undertaking 14 projects aimed at HIV prevention among MSM. They include outreach services, provision of information and education around HIV and sexually transmitted infections (STIs), behavioural change communication, promotion of safer sex, condom and lubricants distribution, counselling and rapid-testing for HIV, testing and treatment of STI, self-help groups and anti-stigma trainings.

“The scale and scope of prevention services for MSM has improved in the last few years, but they remain significantly inadequate to impact and sustain behavioural change and thus reduce HIV transmission among this group of men in Ukraine,” says Dr. Ani Shakarishvili, UNAIDS Country Coordinator in Ukraine.

The situation is similar elsewhere in Eastern Europe and Central Asia. For example, there are no state-funded HIV prevention programmes for MSM in Russia.

“Governments everywhere are reluctant to spend money on sex workers, on drug users, but MSM comes at the top of the reluctance list. It is probably the last programmes that the governments will start,” says Roman Gailevich, UNAIDS Regional Programme adviser.

The new programme marks an encouraging change of stance by the government.
Credit: UNAIDS/S.Dragborg

For the first time

Under pressure from international donors and an increasingly vocal and better organised local MSM community, the Ukrainian Government recently agreed to include and set targets for HIV prevention and treatment for MSM as a priority in its National AIDS Programme for 2009-2013.

“This change stems from comprehensive surveys in the community which show the real role of MSM in the HIV epidemic in Ukraine,” says Anna Dovbakh, head of team: policy & programme development at the International HIV/AIDS Alliance in Ukraine.

“Since 2005, activists of the LGBT (Lesbian, Gay, Bisexual and Trans-sexual) community have become more active and professional in their HIV advocacy and response,” she adds.

Activists and health experts say that the new programme, which is currently before the Parliament, marks an encouraging change of stance by the government.

But the jury is out on what real difference it will make, not least because the money for HIV prevention will continue to come from the Global Fund and other donors.

“The lack of Governmental commitment to provide resources, support and services for MSM and to address the existing legal, financial and administrative barriers to service access for MSM indicates that the Government of Ukraine is still not fully prepared to address the HIV epidemic in MSM,” says Shakarishvili.

 Back to top

L to R: Dr Sigrun Mogedal, Ambassador for HIV/AIDS, Ministry of Foreign Affairs, Norway; Dr Peter Piot, UNAIDS Executive Director; Professor Serghiy Kvit, President, Kyiv-Mohyla Academy.

UNAIDS Executive Director Dr Peter Piot and UNAIDS Special Representative, Her Royal Highness Crown Princess Mette-Marit of Norway were in the Ukrainian capital Kiev this week to call for strengthened leadership in the AIDS response in the country which has Europe’s most severe AIDS epidemic.

During their two-day visit in Kiev, Dr Piot and the Crown Princess met with key representatives from government and civil society to support efforts to stop the spread of HIV and address the growing needs of people living with HIV.

Their mission began with a visit to the All-Ukrainian Network of People Living with HIV, which provided a glimpse into the successful involvement of people living with HIV in Ukraine’s response and the challenges that remain.

Dr Piot later addressed the Presidential Council of Ukraine where he commended the country on its progress in responding to AIDS and engaging with civil society including people living with HIV.He recognized President Yushchenko’s unprecedented leadership on AIDS and acknowledged the recent expansion of access to HIV prevention and testing for people who need them most, such as people who inject drugs. He noted the increased numbers of people accessing HIV treatment and the Government’s commitment to make treatment available to all those in need.

President Yushchenko thanked Dr Piot for his leadership in the global response to AIDS, and recognized the contributions of UNAIDS “for its significant support and reliable partnership in addressing the epidemic in Ukraine”.

The Crown Princess Mette-Marit of Norway, UNAIDS Special Representative, greets Ms Natalia Leonchuk, Executive Director, East European and Central Asian Union of PLWH Organizations at the beginning of a meeting with Representatives of All-Ukrainian Network of People Living with HIV. Kyiv, Ukraine 20 October 2008. Credit: UNAIDS/Yuriy Shkoda

Wanting to learn more on young people’s involvement in the country’s AIDS response, the Crown Princess met with a group of young people active in HIV prevention and peer education activities. Together, they shared experiences and thoughts on how best to involve youth and reach this important demographic in Ukraine.

This advocacy visit comes at a critical juncture in Ukraine’s response to AIDS. Latest figures from UNAIDS’ 2008 Report on the global AIDS epidemic estimates some 440,000 people are living with HIV in Ukraine and the adult HIV prevalence of 1.6% is the highest in Europe.

Ukraine’s HIV epidemic is concentrated among people who inject drugs, their sexual partners, sex workers, men who have sex men, and people in prison settings.

In meetings with civil society Dr Piot stressed the urgency to increase coverage and improve quality of prevention programmes among most-at-risk groups. Dr. Piot recognized Ukraine’s leadership in implementing intravenous drug substitution therapy, but stated that these programmes need to be scaled-up more quickly. Equally important is eliminating stigma and discrimination which is a major challenge in Ukraine and elsewhere in Eastern Europe.

Viktor Yushchenko, President of Ukraine addresses the meeting of Coordination Council on HIV/AIDS, Tuberculosis and Illicit Drug Control. Dr Peter Piot, UNAIDS Executive Director also participated in this meeting. Kyiv, Ukraine; 20 October 2008. Credit: UNAIDS/Yuriy Shkoda

The Ukrainian Government has placed youth awareness of AIDS as a national priority. Currently national indicators reveal that just 40% of young people in the country (15-24 years) know how to protect themselves against HIV infection and reject misconceptions about the virus. Unless prevention programmes reaching out to young people are significantly increased in the coming years, Ukraine could fall short of the UNGASS target that by 2010 at least 95% of young people know how to reduce their vulnerability to HIV infection.

Despite the significant progress made, Dr Piot urged national partners to mount an even greater AIDS response that focuses on preventing new HIV infections through the tailoring of prevention efforts to local contexts. To do this, and to meet other vital components of the national response, greater domestic resources will be required to ensure the sustainability of programmes that are currently supported from donors.

Dr Piot encouraged his counterparts in government and civil society to build stronger partnerships among all sectors of Ukrainian society – including the private sector – as a means to scale-up the country’s response to AIDS.

Professor Kallings a Swedish national, was appointed Special Envoy for AIDS in Eastern Europe and Central Asia by the UN Secretary-General in May 2003.

Professor Kallings a Swedish national, was appointed Special Envoy for AIDS in Eastern Europe and Central Asia by the UN Secretary-General in May 2003. He was the founding President of the International AIDS Society in 1988. As its Secretary-General from 1994 to 2002, he played a key role in shaping the IAS as the world’s first global society for scientists and health care workers committed to the prevention and treatment of HIV. He has also been an adviser to the World Health Organization, Chairman of the Global Commission on AIDS and Senior Adviser to the Global Programme on AIDS on Scientific and Policy Affairs.

In the second of a series of interviews with the UN Special Envoys for HIV/AIDS, Professor Kallings shares his views on his role and the challenges facing the AIDS response in Eastern Europe and Central Asia.

Professor, what motivates or inspires you to work on AIDS?

As a boy during the 1930s I was struck by the ravages of tuberculosis on the Swedish countryside, in particular, witnessing a bonfire made of all the belongings of a whole family annihilated by tuberculosis made a deep impression on the mind of me as eight years of age. On a clay field in the ice-cold March wind, still with snow in the furrows, I watched everything burning, the grandfather's clock, furniture, clothes, even a beautiful shotgun on the top. The local health authority did not know better than to order everything burnt to eradicate the bacilli - that big was the fear of the disease.

As a doctor I specialized in clinical microbiology and infectious diseases, especially interested in opportunistic infections among immune-compromised patients, such as children with leukemia.

When I became Director of the Swedish Institute for Infectious Disease Control public health was in focus for my responsibilities. In addition, I was all the time engaged in international projects, not the least with World Health Organization.

The second strong motivation, and also my inspiration, is meeting with people affected by HIV in poor countries, be it in African villages and hospitals or in brothels in Mumbai, India or Chiang Mai, Thailand, or among injecting drug users in Belarus or Ukraine. The courage, warmth and concern of the people I have met for fellow human beings in spite of their own misfortune have touched and inspired me deeply.

How do you see your role as Special Envoy of the UN Secretary-General for HIV and AIDS?

My role as a UN Special Envoy as I see it, is to reach the highest political leadership of countries to address the central and sensitive issues directly circumventing bureaucracy and conventional avenues. I am not paying courtesy visits, but heading for results. There are no special rules for a Special Envoy—that is what makes them special!

For instance, my meetings with President Viktor Yushchenko of Ukraine have resulted in directives of key importance to the National AIDS Programme, including allowing the importation of methadone for substitution treatment for injecting drug users.

What unique qualities do you bring?

My white hair serves me well. Knowledge, experience, and always having justified and verifiable views. My words can have the impact of a volley hitting a ship at the waterline.

How can you make a difference?

I can make a difference by being well prepared, basing recommendations on impartial facts, while being empathic and intensely engaged.

What's your proudest achievement as Special Envoy for HIV and AIDS?

As Special Envoy, the proudest achievement has not happened yet! Before that, my proudest achievement was to bring the International AIDS Conference to Durban, South Africa in 2000. That was a landmark event and opened the eyes of the world to the enormous catastrophe of HIV. The "Durban effect" cannot be overestimated. Without that global awareness I do not think that the 2001 UN General Assembly Special Session on HIV/AIDS would have happened, nor the creation of the Global Fund to Fight AIDS, TB and Malaria.

What are the main challenges facing the Special Envoy in Eastern Europe and Central Asia?

The main challenge in Eastern Europe is to overcome the traditional, deeply-rooted contemptuous view of drug users, sex workers and homosexuals.

Also much of my efforts focus on getting civil society recognized by Governments in Eastern Europe. During the Soviet Union, non-governmental organizations (NGOs) did not exist as by definition the State was supposed to take care of everything the people needed and civil society activities were considered as subversive actions.

Still today, in some countries, NGOs are looked upon with suspicion as potential Trojan horses supported by Western countries. Therefore, I am attempting to bring people living with HIV and NGO representatives to sit alongside me at the table of the Presidents, which has made a difference and been welcomed for instance in Ukraine.

Another Special Envoy activity is to bring focus to neglected areas such as prisons which are breeding grounds for intravenous drug use, HIV, hepatitis C and tuberculosis (TB). For instance, I visited a prison with prisoners living with HIV and multi drug resistant TB outside Tbilisi, Georgia together with the First Lady who has a key role in the national HIV programme. Despite some progress in the region, I still see no harm reduction and substitution treatment allowed in prisons in Ukraine, while those programmes are widely available outside prison settings.

What in your view are the particular challenges facing this region?

Improving living conditions, including expanded employment possibilities for young people as well as improving the self esteem of both girls and boys and including education on sex and personal relations in schools are all important social challenges, as well as improving gender equity.

The widely different socio-economic conditions between nations and within parts of countries make the HIV epidemics in Eastern Europe and Central Asia very heterogeneous.

Another problem is that the region faces a future health care crisis unless many more people currently living with HIV get antiretroviral treatment to prevent them developing AIDS and becoming ill.

What do you think are possible solutions?

The only possible solution is to scale-up access to HIV prevention and treatment services. That has not happened yet, but the region has that capability should the political will be there. Good attempts on a small scale are fine but only a full response will help. In these efforts, the leadership of the governments is a key. I also look forward to developing activism around HIV prevention as activism in HIV treatment alone won’t get us too far with combating the HIV epidemic.

Which successes in the AIDS response make you optimistic about the future?

There seem to be some inborn difficulties to coordinate efficient responses in some countries and several countries continue to overly rely on foreign aid instead of increasing spending from their own national budgets. However, the greatly increased awareness about the AIDS epidemic among the political leaders compared to only a few years ago makes me optimistic.

UNAIDS Country Coordinator in Ukraine,
Dr Ana Shakarishvili, speaking at the
UNAIDS global staff meeting in October
2007. Photo Credit: UNAIDS 

In the first of web special series focusing on the work of UNAIDS staff at country level, http://www.unaids.org/ talks to UNAIDS Country Coordinator in Ukraine, Dr Ana Shakarishvili, about the response in the country, her role and her motivations.

In the two years that Ana Shakarishvili has been the UNAIDS Country Coordinator in Ukraine, she has seen a lot of changes. The high profile of the epidemic in the country has led to a dramatic increase in attention from donors and other partners. “Our work entails a lot of coordination between UN agencies and very active support to the UN Theme Group and Joint Team on AIDS,” says Shakarishvili. “Dealing with different agencies with different mandates, and different personalities, is an inseparable part of our lives.”

 In addition to typical UNAIDS work around advocacy, coordination of the AIDS response and monitoring and evaluation, the Ukraine office provides technical support in many areas. “In other words our daily lives are enormously busy. We work overtime, there’s no day that ends early,” says Shakarishvili. “But in terms of the daily work, the greatest thing we share is real teamwork. There is an amazing level of coordination and understanding between each partner and that is something we are proud of.”

Ukraine has the most severe epidemic in
Europe. Over 400,000 people were
estimated to be living with HIV in Ukraine
in 2006. Photo Credit: UNAIDS

Ukraine has the most severe epidemic in Europe, and despite the support of government and donor programmes, the epidemic continues to grow. “It is even more concerning that we now have an unprecedented high level of resources available in the country, including two grants from the Global Fund amounting to $243 million,” says Shakarishvili. It was this conundrum that led the government’s National Coordinating Council on AIDS to request an ambitious piece of research that will evaluate the national AIDS response so far. This external evaluation, which is being coordinated by UNAIDS, will look at the work of all partners in 130 programmatic areas.

“We will have a database on what is working and what needs to be done in the future,” says Shakarishvili. “Nothing at this kind of scale has ever been done in the world. And we are really proud of that. It does put us in a rather interesting position of being responsible for pulling together efforts for this evaluation that will inform further discussions at both national and sub-national levels about what should be done next.”

The importance of this evaluation cannot be overestimated: it will feed directly into the government’s new national AIDS plan which is to be developed in 2008. The UNAIDS office and the cosponsors will play a major role in this process, helping the government to revise its national AIDS programme, including national and sub-national access targets. “We are trying to help the government develop a totally new format for the national AIDS plan which will be well-costed with clear universal access and monitoring and evaluation targets and technical support requirements,” says Shakarishvili. “Up until now the national plans were vague and were more like a framework than a clear plan.” For the first time the government plan will also include contributions of all sectors of the government as well as civil society organisations, the private sector and the donor community.

Dr Shakarishvili notes that one of the biggest challenges of working in Ukraine is the political instability that the country has experienced in recent years. Frequent elections and changes in government affect the continuity of the work and the capacity and commitment of government to make sustainable progress. “The NGOs, and civil society organisations are very mobilised and very strong especially at the national level, compared with other countries that I have seen. There is a coalition of NGOs uniting over 70 NGOs providing HIV services. But there is still somehow a level of complacency in the governmental sector. We need to encourage more and greater leadership on the issue particularly from the governmental sector. The decree of President Yushchenko that was issued just after the World AIDS Day a few weeks ago, calls for urgent scaling up of response to AIDS and increased accountability. That gives all of us much hope,” she says.

Ukraine has managed to increase the
number of people on treatment from 200
in 2004/5 to currently over 7000.
Photo Credit: UNAIDS

Despite the challenges there has been progress. “We are really seeing some differences at the national level, which is a result of joint advocacy, including that from the UN.” Aspiration also comes from daily contact with the civil society organisations that provide many HIV services in the country. “We call ourselves one big family. We work pretty much together with the government, parliamentarians, NGOs, communities of people living with HIV, development partners and the private business. Its a huge sector.”

Shakarishvili joined UNAIDS after a long career in the Centers for Disease Control and Prevention in the US. “I love it here”, she says. “Despite the large work loads, what motivates me at the moment, is this momentum to do more in Ukraine, to really make a difference by changing the way the epidemic is going and preventing that from becoming generalized. There is enormous potential that this country has, a real belief that Ukraine should be able to slow down this epidemic and achieve universal access targets in a few years.”

“There are fantastic people and competent organizations here, and we hope and trust that people and communities can make a difference. If we don’t rapidly scale up efforts and make an impact in Ukraine, there is less hope for other countries in the region, especially Russia.” On the other hand, successes in Ukraine will bring hope for others. “Ukraine has managed to increase the number of people on treatment from 200 in 2004/5 to currently over 7000, reach the coverage level of prevention programmes of 35% of injecting drug users, and finally allow the importation of methadone for substitution maintenance treatment for injecting drug users – these are the messages to the rest of the world,” says Shakarishvili.

Experience and evidence show that for an effective response to AIDS, it is essential to involve people living with HIV at all levels. Networks of people living with HIV are uniquely well qualified to help unify the response and maximize efforts to reach out to communities as well as influence national policy.

UNAIDS has produced a new report that describes
the background, structure and operation of the All-Ukrainian Network of People Living with HIV, as an example of best practice within the AIDS response.

In order to promote and help replicate the work of associations of people living with HIV, UNAIDS has produced a new report that describes the background, structure and operation of the All-Ukrainian Network of People Living with HIV, as an example of best practice within the AIDS response.

“The All-Ukrainian Network of People Living with HIV has an innovative structure, has undertaken high profile successful advocacy campaigns at both national and local levels and has a strong track record of delivering an ever-expanding array of services to people living with HIV,” the report says. “From the outset, people living with HIV have been responsible for the Network’s very rapid growth and strategic importance in the country’s HIV response.

”Ukraine has the most severe HIV epidemic in Europe, with an estimated 377 600 people living with the virus at the end of 2005. The Network was formed in the late 1990s by people living with HIV alarmed by the rapidly growing HIV epidemic in the country and the lack of resources and support available to them and others living with the virus. Since then, the Network has grown rapidly and steadily from its registration in 2000 to its designation as a co-Principal Recipient of a Global Fund grant to distribute funds for treatment, care and support. In 2006, it provided services and support to more than 14000 people living with HIV.

At the national level, the
Network’s advocacy efforts have
resulted in a number of high
profile achievements in recent
years.

The Network was established under four key strategy components: increasing access to non-medical care, treatment and support; lobbying and advocating to protect the rights of people living with HIV; increasing acceptance towards people living with HIV throughout society; and enhancing the organizational capacity of the Network.

Through its local branches and affiliated organizations, the Network provides services to thousands of people living with HIV across Ukraine. It also works with ‘indirect clients’, such as injecting drug users, health-care workers, journalists and law enforcement officials, as part of a broader effort to increase social tolerance, raise awareness about HIV transmission prevention and reduce stigma and discrimination.

More than 20 distinct types of services are offered around the country ranging from transportation and nutrition support to treatment literacy training and child-care facilities. Some local groups may even provide a teacher in instances when real or perceived discrimination keeps HIV-positive children out of public schools.

At the national level, the Network’s advocacy efforts have resulted in a number of high profile achievements in recent years, notably a series of meetings with the Ukrainian President in November 2005, where he committed to take personal control of the government’s response to the epidemic. Furthermore, recent advocacy and awareness-raising efforts at national level include continuing efforts to push the government to increase antiretroviral treatment and HIV testing availability through the public sector; working with the media to publicize issues such as poor service delivery; delays within the Ministry of Health; the high price of antiretroviral drugs; and corruption within the procurement and tendering processes.

Local branches of the Network also initiate smaller-scale advocacy efforts that relate to their local needs.

Local branches of the Network also initiate smaller-scale advocacy efforts that relate to their local needs. For example, one group successfully filed and won a court case defending the rights of HIV-positive parents to maintain custody of their children. In August 2006, another group successfully advocated for the provision of antiretroviral treatment in local prisons. Within two months, five inmates were on treatment and two prisons now also have the capacity to provide CD4 testing.

The Network seeks to form partnerships with as many stakeholders as possible. It currently works with government agencies, international organizations, donor agencies and domestic NGOs. “Although often there are strategic and procedural differences with some of the partners, the Network has refused to break ties even as it lobbies, privately and publicly, for policy change,” the report states.

The Network’s collaboration with international organizations, bilateral donors and civil society groups has consisted of financial support, technical assistance, advocacy collaboration and policy development at local, national and international levels. Although initially the Network was mainly the recipient of the assistance, as it has developed, it has played a growing role in identifying ways to share its expertise and experience.

Underlining the Network’s importance as an example of best practice, UNAIDS Partnerships Advisor Kate Thomson said: “This is a role model for positive networks the world over and provides us with a truly inspiring example of positive people coming together to make a difference in the AIDS response.”