Ukraine's demographic time bomb: rising number of AIDS/HIV cases (01/10/99)

Ukraine's demographic time bomb: rising number of AIDS/HIV cases

by Nathan Hodge
Special to The Ukrainian Weekly

KYIV - Situated not far from the Pecherska Lavra, Kyiv's Infectious Diseases Hospital has an unpresuming facade. Hospital staff here endure the routine indignities of Ukraine's health-care system: unpaid wages, chronic shortage of pharmaceuticals and declining support from the Ministry of Health.

The hospital also copes with another burden: it treats a rising number of AIDS patients. Olha Selnykova, the director of the State Institute for Infectious Diseases, said that the situation here is a "demographic time bomb," and other medical experts warn that Ukrainian health authorities have been dangerously slow in responding to the crisis.

With 35,000 registered cases, Ukraine faces an alarming rise in the recorded incidence of HIV infection, and new reports estimate that Ukraine may have the highest infection rate in Europe. Up to 1994, Ukraine registered an insignificant number of cases, mostly among foreigners. In 1995 authorities identified 185 cases of HIV infection, mostly among drug users, and 228 cases of AIDS were recorded in 1996. Ukraine has no systematic collection of AIDS data, but current figures, even if they fall short, show an astronomical rise over a very short period of time.

The United Nations agency UNAIDS projects the true number of HIV-positive people in Ukraine at between 60,000 and 180,000. In a UNAIDS report based on information collected by the AIDS epidemiology laboratory in Kyiv and the department of demography of Ukraine's Academy of Sciences, epidemiologists warn that, in a rapid-spread scenario, there could be almost 1.5 million HIV infections by 2010, and as many as 1.8 million cumulative deaths from AIDS by 2016.

At present, the bulk of registered cases are among intravenous drug users. With the increased availability of cheap opiates and the growth of a local drug culture, public health experts fear that "bridge" populations will carry the disease into the general population. "The actual number of undiagnosed infections we presume to be much higher," said Valerii Ivasiuk, the former chair of the National Committee for the Prevention of AIDS and Drug Abuse.

"The rule of thumb is that for every case diagnosed up to 10 go undetected."

According to Mr. Ivasiuk, Ukraine is "utterly unprepared" for a wave of new diagnoses. "AIDS is rapidly becoming epidemic, but the Kuchma administration has abdicated all responsibility in face of this crisis," he said.

Mr. Ivasiuk's criticism of the administration's AIDS policy follows in part from the decision to remove him as chair of the committee in January of last year and to liquidate the committee entirely in May 1998, but he has offered compelling evidence that the government has shelved preventative measures in the face of crisis.

On March 3, 1998, President Leonid Kuchma signed into effect a new law on "AIDS Prevention and the Public Welfare." Originally drafted by Mr. Ivasiuk's committee, it contained several amendments that fundamentally changed the regulations governing Ukraine's blood supply.

The law allows the transfusion of unscreened blood in "urgent cases" and exempts physicians from legal responsibility in cases where they infect patients through the transfusion of tainted blood.

Even as experts warn that Ukraine lacks appropriate technology for screening its blood supply, the Ukrainian government has banned the import of HIV testing equipment. In a decree signed on January 19, 1998, Prime Minister Valerii Pustovoitenko forbade the procurement of imported diagnostic systems "where appropriate quantities of Ukrainian-produced equivalents are available."

Mr. Ivasiuk has charged that the ban gives an effective monopoly on such equipment to a company called Diaprof-Med, the Ukrainian manufacturers of a test system, which, he claims, produces false results in up to one third of tests.

"In the West, these test systems are required to have 99.8 percent reliability," he said. "Independent laboratory tests have shown that Diaprof-Med's systems produce false results in 25 to 33 percent of cases."

According to Mr. Ivasiuk, several highly placed Ministry of Health officials have ties with Diaprof-Med, which stands to profit from exclusive state contracts for blood screening equipment. In particular, Mr. Ivasiuk named Yurii Spizhenko, the former minister of health and a current national deputy representing the pro-presidential National Democratic Party; Viktor Mariievsky, the former chief sanitary doctor of Ukraine and present director of the State Institute of Epidemiology; and Dmytro Martynenko, the deputy director of the Health Ministry's Committee on Immunobiological Compounds, as having financial interests in the company.

"If we look at the number of diagnostic tests for HIV that the Ministry of Health orders annually, we are talking about an enormous business," said Mr. Ivasiuk.

"Then consider how many cases could go undiagnosed," he added. "They are abetting the spread of AIDS in the interest of profit."

In November, Diaprof-Med issued a strenuous rebuttal of Mr. Ivasiuk's charges about the reliability of its test systems in the weekly newspaper Zerkalo Nedeli. Experts from the State Committee for Immunological Compounds pronounced Diaprof-Med's tests "98 percent effective" and blamed false results on the ineptitude of lab technicians. The same issue featured a flattering profile of Dr. Spizhenko without mentioning his or other health officials' alleged ties to the company.

The Ministry of Health has also shown a strong interest in defending Diaprof-Med from Mr. Ivasiuk's claims. In the same article in Zerkalo Nedeli, current Minister of Health Andrii Serdiuk said that Mr. Ivasiuk had "no experience in epidemiology or infectious diseases" and accused him of "getting involved in politics."

At a recent press conference, Raisa Bohatyriova, the first vice minister of health, also repeated Diaprof-Med's claims of "98 percent effectiveness" for its test system.

Mr. Ivasiuk is particularly dismissive of Dr. Serdiuk's claims, insinuating that he also is involved with Diaprof-Med. "He [Serdiuk] is just interested in feathering his retirement nest," he retorted.

Officials at Diaprof-Med have also denied that there is any connection between the company and Ministry of Health officials. Vasyl Slavsky, a company spokesperson, told the Kyiv Post newspaper that conflict of interest claims were unfounded, and that neither present nor former Ministry of Health officials had any ties to the company.

A call to Dr. Spizhenko's office at the State Committee on Medical and Microbiological Compounds, however, confirmed that he works with Diaprof-Med, although his employees would not state what his position is in the company. Dr. Spizhenko could not be reached directly for comment, but his legislative staff, when asked for contact number at Diaprof-Med, gave the state committee's number.

Anatoly Padchenko, head of the Ministry of Health's Epidemiology Department, told the Associated Press in November 1998 that Ukraine's economic crisis made it too expensive to import HIV testing systems. "The decision was made purely for economic reasons," he said. According to company representatives, Diaprof-Med's system costs only 60 cents - an economical alternative to imported systems which cost twice as much.

Olha Selnykova, the director of the State Institute for Infectious Diseases, Kyiv's chief AIDS treatment center, said the Ministry of Health was ready to license other HIV test systems as soon as they appear.

"All this controversy about Diaprof-Med goes to show that we should have increased blood screening," she said.

Commenting on the response of the Ukrainian government to the AIDS crisis, Andrej Cima, the UNAIDS Intercountry Advisor for Armenia, Georgia, Moldova and Ukraine, said, "It's easy to say that the response of the government is not sufficient, but on top of all the other issues that Ukraine faces, it is to an extent understandable."

"The important thing is to find the correct approach, without confrontation," he concluded.

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