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REVOLUTIONS DO NOT STOP EPIDEMICS Nicolette Jackson, former Director of Communications for MSF Australia in Sydney, is now the Campaigner for MSF’s HIV/AIDS Programme in the Ukraine. Since her arrival in September last year she has witnessed the people’s revolution and ongoing problems for HIV/AIDS sufferers in the country. Well, it isn’t often that one gets to witness a revolution first-hand. The memory of the ‘river of people’ marching down the main street of Kreshchatyk to Parliament with their orange ribbons and banners - will be a lasting image for me of my time in Ukraine. There was a tangible sense of hope and goodwill in the air – rare in a country mired in corruption, poverty and cynicism. I came here to work as a Campaigner on an HIV/AIDS Programme that MSF has been running since 1999. Ukraine has the fastest growing HIV epidemic in Europe and the former Soviet Union. It’s estimated that over 1% of the population are infected with the virus. What started primarily as something that affected the intravenous drug using community; has ‘jumped’ into the wider community. Forty-five percent of infection now occurs through sexual transmission, rather than sharing dirty needles; and with condom use so unpopular in this country, the epidemic looks likely to continue to grow. Denial of the problem is still common in the general community: people seem unaware of the risks they face – believing instead that HIV is a disease affecting drug-users or prostitutes. Stigmatisation of people who are HIV positive is a big problem – most people don’t feel comfortable to disclose their status to all but a few of their closest friends. MSF’s team hears many stories of the discrimination and rejection our patients face – losing their jobs, being shunned by their families, sometimes they’re even refused treatment by doctors. One of the most productive and tangible ways to reduce people’s fear of HIV is offering hope that it does not have to be fatal. MSF began a small HIV treatment programme in 2003: providing life-prolonging antiretroviral treatment to people living in three of the most HIV-affected cities in the South of the country; including the port city of Odessa. MSF’s intention was to prove through its pilot programme that affordable, quality treatment was possible, and easy to replicate on a wider scale in Ukraine. MSF has helped to be a catalyst for change through its programme – thanks in part to our lobbying the annual cost of antiretroviral treatment has dropped from $10,000 to as low as $350 per patient per year: as generic versions of the drugs have been registered in the country. We have been able to show that affordable HIV drugs can be equally effective as their ‘branded’ counterparts. By the end of this year MSF will be handing over its patients to the Ministry of Health – the government has recently started its own HIV/AIDS treatment programme that will be expanded over time. International attention and money has flowed into Ukraine in the last few years and the UN initiative, the Global Fund to fight AIDS, Tuberculosis and Malaria, is here now as well making possible a large scale-up in the number of people who will receive antiretroviral treatment. The country feels on the brink of a new age: people I talk to have a sense of hope and a belief in the possibility of change – although they’re also pragmatic enough to know how huge the challenges are that need to be tackled. I will leave the country, our patients and my colleagues and friends with a sense of sadness and a wish for a better collective future for them all – they certainly deserve it!
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