BRITISH COUNCIL UKRAINIAN INSTITUTE FOR SOCIAL RESEARCH This Project was implemented with financial support from the Department of International Development of the United Kingdom (DFID) and the British Council for the Government of Ukraine THE SOCIAL AND ECONOMIC IMPACT OF HIV AND AIDS IN UKRAINE : A RE-STUDY Olga Balakireva Alla Scherbyns’ka Yulia Galustian Yuriy Kruglov Olexander Yaremenko Ukrainian AIDS Centre at the Health Ukrainian Institute of Social Ministry of Ukraine Research Nataliya Levchuk Volodymyr Onikienko Institute of Economy, National Council for Studying Productive Academy of Science of Ukraine Forces, National Academy of Science of Ukraine Lidiya Andruschak UNAIDS In co-operation with international consultants Tony Barnett, University of East Anglia, UK and Alan Whiteside, University of Natal, South Africa Edited by Veena Lakhumalani, The British Council, Ukraine 14 Kyiv City - 2001 Contents INTRODUCTION Executive summary Section 1. THE NATURE OF HIV/AIDS AND THE GLOBAL EPIDEMIC Section 2. HIV AND AIDS DATA 2.1 HIV Data 2.2 AIDS Data 2.3 General conclusions Section 3. METHODOLOGICAL APPROACHES 3.1. Concepts of Susceptibility and Vulnerability 3.2. Description of Models for Projecting the Development of HIV/AIDS Epidemic in Ukraine and Incoming Data 3.3. Projecting the HIV/AIDS Epidemic in Ukraine: main results Section 4. UKRAINE AS A RISK ENVIRONMENT 4.1 Demographic Situation in Ukraine 4.2 Social and Economic Characteristics of the Contemporary Ukrainian Society 4.3 Attitudes to People with HIV and AIDS in Ukraine 4.4 Behavioural Factors Contributing to HIV/AIDS Epidemic 4.5 Bio-Medical Factors and HIV Susceptibility 4.6 Regressive Analysis of Influence of Regional Development Factors on HIV-Infection Prevalence 4.7 Conclusions Section 5. DEMOGRAPHIC AND SOCIO-ECONOMIC IMPACTS OF HIV EPIDEMIC IN UKRAINE 5.1 HIV/AIDS Impact upon Demographic Situation 5.2 Families’ Vulnerability 5.3 HIV/AIDS Impacts upon Economic Activity of Population 5.4 Susceptibility and Vulnerability of Some Economic Sectors 5.5 Social Support and Social Security to HIV-Positive People Section 6. PREPARADNESS OF THE HEALTH CARE SYSTEM TO DEAL WITH HIV/AIDS Section 7. HOW TO ORGANISE AN AFFECTIVE RESPONSE TO THE EPIDEMIC? APPENDIXES 15 INTRODUCTION This work seeks to throw light on the scale of the HIV/AIDS epidemic in Ukraine and attempts to identify some impacts the epidemic might have in the social and economic fields. Evidence throughout the world shows that HIV/AIDS decreases average life expectancy, increases the demand for medical services and highlights the problems of poverty and inequality. The inter-relation between HIV and economic development is complex. On the one hand, the epidemic affects economic development, and on the other, the epidemic development is dependent, to a large extent on the economic situation. This report focuses on the groups of population most vulnerable to HIV and attempts to identify the factors contributing to susceptibility to the virus. The epidemic is not limited to a certain community any more, it is spreading rapidly. Ukraine is becoming a society at a high risk of vast masses of the general population becoming infected. Today, it can be said that HIV threatens the future of the nation. This study has undertaken in order to analyse the social and economic context of the HIV/AIDS epidemic and to project possible demographic, social and economic impacts of the epidemic. As part of this research, projections were prepared to assess the scale of the epidemic years ahead in order to see its possible impacts. The projections presented are worth considering by health policy makers, especially in the field of HIV/AIDS prevention and dealing with demographic, social and economic effects of the epidemic. Ukraine became a sovereign country in 1991 with the population estimated at 49,036,500 on January 1, 2001.1 The first HIV case was registered in 1987, while 1994 is regarded as the first year of the epidemic. Between 1987 and 2001, 43,600 persons were infected.2 2,907 Ukrainians were diagnosed with AIDS, 1,473 died.3 Most of the infections are caused by intravenous drug use and unprotected sex. Unlike in comparable countries, the heterosexual epidemic overshadowed the homosexual epidemic - the registered of number homosexually transmitted infections are very few. The percentages of cases caused by unprotected sex and drug injection have changed recently. Throughout the last four years, the proportions of infections caused by intravenous drug use decreased from 83.6% (1997) to 56.6.% (2001) of the total, while the percentage of heterosexually transmitted infections grew from 11.3% (1997) to 26.9% (2001). The statistics on mother to child transmission are alarming: 196 cases were registered in 1997 (2.2% of the total) while 914 cases (13.1%) in 20014. Experts in the field believe the governmental statistics do not reflect the real situation. The estimated number of HIV infected in 1999 was 200000-240000 5. As in many other countries, the HIV epidemic in Ukraine is not a purely medical problem. The HIV/AIDS impacts might be classified as demographic (mortality and the number of orphans increase, while birth rate and population drop) and socio-economic at the levels of individuals, households, industry and the macro-economy. At the same time, it is important to remember that HIV is not a global catastrophe, it is rather an additional problem that unfolds like many others. A comprehensive multi-disciplinary approach is obviously needed to respond the HIV epidemic effectively. This message is addressed to everyone responsible for implementation of the Ukrainian National Programme on Combating AIDS, decision makers at the national and local levels responsible for HIV prevention, improving the surveillance system and providing HIV positive 1 Source: the State Statistics Committee of Ukraine (data available by January 1, 2001) 2 Source: Information Bulletin of the Ukrainian National AIDS Centre at the Health Ministry of Ukraine –No.21 – 2001. 3 Source: Information Bulletin of the Ukrainian National AIDS Centre at the Health Ministry of Ukraine –No.21 – 2001 4 Source: Information Bulletin of the Ukrainian National AIDS Centre at the Health Ministry of Ukraine –No.21 – 2001. 5 Source: HIV/AIDS Epidemic in Ukraine: assessment of the current situation/ The Project «Strategic of National Response to the epidemic of HIV/AIDS in 2001 – 2003» – Kyiv, 2000, p. 4. 16 people with medical aid and social support, as well as all governmental agencies and NGOs in the field of dealing with the epidemic. It is also addressed to the mass media and the society as a whole. The first attempt to postulate HIV/AIDS impacts upon the Ukrainian economy and society was a research study conducted in 1997 by Alan Whiteside (Health Economics and HIV/AIDS Research Division at the University of Natal, Durban) and Tony Barnett (School of Development Studies, University of East Anglia, Norwich). The research did not cover issues of medicine or epidemiology. It has endeavoured to project long term social, economic and demographic effects of the epidemic. The findings appeared to be of great importance for senior officials in Ukraine’s health care. The research provided for two scenarios: according to one, the epidemic would develop slowly as in West Europe, while according to the other, Ukraine might suffer from an explosive spread of HIV, similar to South East Asia. Projecting the epidemic and its impacts is a vital component of strategic planning of an effective response to the HIV/AIDS epidemic . Four years have passed since then. These years have been marked with significant social and economic changes in Ukraine. The situation with HIV definitely worsened. A law was adopted On Introduction of Changes to the Law of Ukraine on AIDS Prevention and Social Protection of Population (March, 1998). This period was marked with further development of civil society, including the non-state sectors in the economy, political parties, various NGOs and volunteer organisations. A variety of social projects and programmes have been launched, especially at local level. The general public attitude to people with HIV and AIDS has become much more tolerant. Throughout 2000, an assessment of the HIV situation and resources available to deal with the epidemic was conducted within the framework of a national campaign for strategic planning of a national level response to the epidemic for 2001-2003. The assessment was initiated by UNAIDS and run by the Ministry of Health Care of Ukraine. This study involved experts from many ministries, state agencies and research institutions. On July 11, 2001, a national programme of dealing with HIV/AIDS was adopted and on June 22, 2001, President Kuchma signed a decree, proclaiming 2002 ‘the year of combating AIDS’. Taking into consideration the recent changes, a new projection of the epidemic and its possible social and economic impacts is required. We wish to express our gratitude to: Veena Lakhumalani, The British Council in Ukraine Chris Desmond, University of Natal, Durban, South Africa S. Philipovich, and L. Bochkova, Ministry of Health of Ukraine Many thanks go to the research advisers: Tony Barnett, University of East Anglia Norwich, UK Alan Whiteside, University of Natal, Durban, South Africa V. Steshenko, Economics Institute at the National Academy of Science of Ukraine for the help and support in preparing this report. We also would like to thank Sergei Naboka, the translator, and our colleagues from the Institute of Social Research: M. Varban, N. Dudar, I. Demchenko, D. Dmytruk, N. Karavaeva, and T. Bondar. 17 Executive Summary 20 years after the first case was registered, the HIV/AIDS epidemic has become one of the most serious problems affecting individuals and societies. The epidemic has touched all countries and its effects are more serious than it was predicted. Evidence throughout the world shows that HIV/AIDS decreases average life expectancy, increases the demand for medical services and highlights the problems of poverty and inequality.