Country Case Studies on Sex Work and HIV Prevention 135
The first Ukrainian HIV case was reported in 1987. For several years, the epidemic initially seemed confined within a relatively small group of foreign students until an explosive epidemic emerged among injection drug users in 1995 (USAID. and Ministry of Health of Ukraine 2010). Injection drug use persisted as the primary transmission mechanism until it was overtaken by sexual transmission in 2008 (USAID. and Ministry of Health of Ukraine 2010). In 2009, an estimated 44% of new HIV infections were due to sexual transmission, with injection drug use responsible for 36% (UNAIDS and Ministry of Health of Ukraine 2010; USAID. and Ministry of Health of Ukraine 2010). As of 2009, the epidemic continues to be concentrated among most-at-risk populations including injection drug users (22.9%), men who have sex with men (8.6%), and female sex workers (13.2%) (USAID. and Ministry of Health of Ukraine 2011). Despite the high HIV prevalence among sex workers, Ukraine groups HIV cases among sex workers together with other sexual transmission cases for official registration purposes, rendering it difficult to know the extent of the proportion of HIV driven by sex work.(UNAIDS and Ministry of Health of Ukraine 2010). The rising portion of new cases attributable to sexual transmission strongly suggests the possibility that HIV may begin to spread to and through the general population. Indicative of the rapid spread of HIV to the general population, HIV prevalence among pregnant women is now among the highest in Europe at 0.31% in 2006 (TAMPEP. and European Network for HIV/STI Prevention and Health Promotion Among Migrant Sex Workers. 2007). The high tuberculosis incidence (100 cases per 100,000 in 2008) further complicates Ukraine’s HIV epidemic (USAID. and Ministry of Health of Ukraine 2011). Ukraine’s national response to HIV initiated in 1992 with the establishment of the National AIDS Committee however this committee was dissolved in 1998. In 1998, free HIV treatment was mandated, however the limited resources to carry out this mandate have effectively limited access to many in need. The 2005 establishment of the National Coordination Council on HIV/AIDS facilitated programming including opioid substitution therapy, HIV prevention, and harm reduction programming mandated for each oblast or district (USAID. and Ministry of Health of Ukraine 2010). The Ukrainian Institute for Social Research conducts regular behavioral surveillance with female sex workers, with support from the International HIV/AIDS Alliance in Ukraine, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Futures Group International. In 2008, Ukraine committed upwards of 102 million USD$ towards the goal of HIV prevention and control (UNAIDS and Ministry of Health of Ukraine 2010).