HIV / AIDS in Ukraine

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The HIV / AIDS epidemic in Ukraine in 2007 was the worst in Europe.

The number of new infections later, in 2017, was around 13,000 people, compared to 21,000 people in 2005 when around 400,000 infected people lived in Ukraine, a number that had decreased to 240,000 by 2017. In 2005 the numbers corresponded to an infection rate of 0.46% of the adult population (aged 15-49 years), this number fell to 0.29% by 2017.

The HIV epidemic is a sexually transmitted disease . The HIV epidemic in Ukraine differs from that in Africa on the one hand and Western Europe and North America on the other, among others. a. due to its relatively late emergence at the beginning of the 1990s, due to the population groups mainly affected by it and due to their co-infections . The main route of spread of the HI virus in Ukraine is intravenous drug use. The already marginalized milieu of drug addicts and prostitutes was and is primarily affected . The most important co-infection is tuberculosis .

Spread of HIV in Eastern Europe and Central Asia
Lavra - National AIDS Center in Kiev

situation

distribution

Routes of HIV transmission in Ukraine
HIV prevalence in Ukraine by region

From 1987 (first official HIV notification in Ukraine) to the end of 2007, a total of 122,314 HIV infections were reported to the State AIDS Center. At the end of 2007, 22,424 people had AIDS stage and 12,490 had died. In more than 78% of the cases, the age group of 15 to 49 year olds was and is infected with the HI virus, an estimated 15% of them were between 15 and 24 years old in 2007.

In the mid-2000s, the numbers were on the rise: 16,078 new infections were reported in 2006, 18.6% more than in 2005. At the end of 2007, 17,669 new diagnoses were registered, again 10% more than 2006.

The registered HIV infections could only insufficiently reflect the extent of the HIV epidemic. UNAIDS and WHO estimated the actual number of infected people at the end of 2007 at approx. 440,000 [255,000–640,000]. An estimated 190,000 HIV infections of these affected women. The number of recorded HIV infections is also comparatively low, since only those who have direct contact with the official test offers can be recorded, and people who are particularly at risk avoid being tested. They feared additional discrimination and they had little to hope for: In 2007, antiretroviral therapy was available for just 7,657 AIDS patients . That is 35% of the reported patients.

The projections also took other indicators into account. For example, HIV tests on people who inject drugs showed an infection rate of over 60% in several oblasts . At the end of 2007, intravenous drug use was also the main mode of transmission at 40%, with the percentage of new infections among intravenous drug users falling slightly every year.

There were regions where one percent or more of all pregnant women were HIV positive. The number of HIV transmission through sexual contact has increased since the late 1990s and by 2010 had become the second largest route of HIV transmission. In 2007 the share was 38.4%.

The spread of the reported HIV infection varied greatly from region to region. The regions most affected are in the south and east of Ukraine: the Odessa region (414.2 per 100,000 inhabitants), the Dnepropetrovsk region (408.8 per 100,000 inhabitants), the Donetsk region (389.6 per 100,000 inhabitants), the Mykolaiv region (374.4 per 100,000 inhabitants) and the Autonomous Republic of Crimea (238.8 per 100,000 inhabitants), in particular its largest city Sevastopol (309.4 per 100,000 inhabitants). In the capital Kiev, too , the number of HIV diagnoses, at 200.5 per 100,000 inhabitants, is above the national average of 174.9 per 100,000 inhabitants. At the same time, the infection rate in western Ukraine was at a low level.

The epidemic was considered concentrated, that is, it was concentrated in the high-risk groups of the marginalized milieu of drug users, prostitutes and inmates. However, with the increase in sexual infections, there was a risk that the epidemic would spread to the rest of society.

history

The HI virus reached the Soviet Union around 1987 (the year of the first officially registered case), i.e. around five years after the virus first appeared. Until 1995, there were only a few reports of HIV infections in Ukraine, so that the World Health Organization (WHO) classified the country as one with a low risk of spread at the time.

Between 1987 and 1994 a total of 183 new diagnoses were reported. Nevertheless, it must be assumed that the epidemic began unnoticed during the period of social upheaval between 1991 and 1995. This is supported by the first accumulation of overt AIDS cases around the year 2000 (HIV has an incubation period of approx. 7-10 years.) On the other hand, from 1990 onwards, the use of injection drugs became extremely widespread. In 1990 there were 22,466 “Narkomani” registered in Ukraine, in 1999 74,554. Although the drug users persecuted by punishment do everything they can to avoid registering. The Ukrainian Ministry of Health assumes a 5–10 times higher number of unreported cases. Young people injecting drugs were the first population group in Ukraine where HIV infection spread very quickly. The most commonly used drug was and is a cheap, homemade opiate , "shirka" (something like "droning").

With regard to HIV infection, several components of this drug use were and are risky: First of all, it was and is usually not easy to get fresh injections. There are not yet any syringe exchange points or sufficient comprehensive offers of harm reduction programs. In particular, adolescents who use intravenous drugs are hardly ever reached. But then it is also a common tradition throughout Eastern Europe to “let the needle circle” when consuming drugs. H. to share a syringe for socializing. After all, the preparation of the drugs is by no means safe. The homemade drugs are often sold in the syringe. The vessels in which the drug is mixed are also shared. However, the common practice in the 1990s of dissolving the opiate directly in blood in order to be able to inject it has apparently died out. If the drug's manufacturers were infected with HIV, so were all of their customers. That these practices could become the basis of such an HIV epidemic presupposes that drug addiction also spreads epidemically. According to estimates by the International HIV / AIDS Alliance, between 323,000 and 425,000 people in Ukraine were using injectable drugs in 2008.

Causes and extent of the drug epidemic

The main cause of the epidemic spread of drug addiction was the collapse of the Soviet Union. Many companies had to close, and massive unemployment led to poverty and a lack of prospects. On the other hand, during and immediately after Ukraine's independence, there was a period of lower statehood. There were legal free spaces and young people in particular lacked orientation. Insofar as the Soviet ideology was also a substitute for religion, the social value system was also destroyed with the collapse of the old state.

Regions that were among the most industrialized in the country during the Soviet era and which have now suffered the most abrupt fall due to the collapse of industry were particularly hard hit.

The need for drug consumption, the explosive growth of the drug market, was met by the easy availability of drugs in Ukraine. This is probably one of the reasons why drug addiction and, as a consequence, the HIV epidemic spread faster and further in Ukraine than in other former Soviet republics. Factors why there was and still is not only such a large amount of drugs, but also so many types of drugs, are: Ukraine is a transit country for the transport of opium from the greater Middle East to Europe. The soils in Ukraine are so good that opium poppies grow well in the country itself. Some cities in Ukraine are traditional locations for the chemical industry. On the other hand, there is a lack of state control of the drug market.

So that could opioid - analgesic tramadol , after his admission in 2004 within a few months by the black market one of the most popular gateway drugs.

The collapse of the Soviet Union was the prerequisite and one of the causes for the outbreak of an HIV epidemic in Ukraine, other reasons lie in the Soviet or even Russian past. The production and (especially the joint) use of simple opiates such as “compote” and “shirka” or ephedrine - derivatives such as “wind” was already common in the Soviet Union. However, these drugs only came into vogue in the late 1990s, encouraged by the returning Afghanistan veterans, many of whom had become used to opium there. Despite the defeat suffered , in the eyes of many young people these soldiers had the sheen of “freedom and adventure”, so that they found many imitators.

The almost natural rapid expansion of drug consumption among young people should, however, also be seen against the background of the much older mass alcoholism that comes from the Russian tradition. Even today, alcoholism is one of the greatest health risks in the successor states of the Soviet Union , especially for men. And teenagers whose parents drink are particularly prone to using drugs.

Another important factor in the spread of HIV in Ukraine is prisons and "prison colonies".

Prisons

A very high percentage of prisoners are drug addicts. Two laws also contribute to this. First, in Ukraine one can be sentenced to three years' storage or more for possession of even the smallest amount of illegal drugs. Second, the militia is still measured against a specific target, the number of "crimes convicted". It is not an exception, but the rule, that this debit is replenished with drug addicts who are easy to find. As everywhere in the world, drug use is greater in prisons than outside, but syringes are all the more scarce. Overall, the hygienic conditions are poor. Another problem is violence among inmates. Rape is a major transmission route for HIV. Furthermore, there are still no comprehensive preventive measures in Ukrainian prisons that would give prisoners access to preventive means.

There are around 150,000 people imprisoned in Ukraine at the moment, and far more before President Yushchenko took office after the Orange Revolution .

Transmission through sexual intercourse

The spread of HIV through sexual intercourse is increasing steadily. Of the 122,674 people with HIV / AIDS registered in Ukraine in 2007, around 40% were infected through drug injections and 38% through sexual intercourse. While there is still talk of an HIV epidemic focused on the high-risk groups, the increase in HIV infections during sex means that it is only a matter of time before the epidemic reaches the general population. The most important interface between the drug environment and the rest of society is prostitution. A great many women who are drug addicts or who live with drug addicts men use it to finance their drug use and their livelihood. The transmission route specifically via prostitution is not registered in Ukraine. However, initial surveys indicate a rapidly increasing spread.

The fact that prostitution is increasing sharply in Ukraine is due to the material need of these women as well as the increasing demand. There has been a sharp increase in sex tourism in Ukraine in recent years . As a result, sexual exploitation and human trafficking are also increasing . Surveys of prostitutes suggest that they are nowhere near regular use of condoms . In a 2007 study, only 48% said they always insist on safe sex . And this survey took place among women who had already been reached by prevention programs (because it was through these that the contacts for the survey came about). The situation of prostitutes has been improved by the fact that prostitution has no longer been a criminal offense in Ukraine since 2006.

The homosexual and bisexual transmission of the HI virus has so far not played the special role in Ukraine that it has in Western Europe and North America. 158 cases were officially registered from 1987 to 2007, a good third of them in 2007 (48 new infections). However, it can be assumed that as the spread via sex in general increases, so will the number of infections among homosexuals. However, this fact is difficult to judge, as many homosexuals who are tested positive for HIV prefer to specify a different mode of transmission. Homosexuality has not been a criminal offense in Ukraine since 1991, but it is still subject to discrimination. Accordingly, this group is also difficult to reach for preventive measures. According to surveys by the Global Fund, only an estimated 5% is achieved.

Infected children

Since 2004, pregnant women and mothers receiving highly active antiretroviral therapy (HAART) have been recorded. In 2006, 2,822 HIV-infected mothers had children in Ukraine; in 2007 the number was 3,430. The provision of HAART to these women, which reduces the risk of mother-to-child transmission of the virus, was 92.5% in 2007 (compared to 91% in 2006, resulting in 7.1% of affected newborns having HIV -positive).

However, adolescents and young adults are at a much greater risk from risky sexual behavior. A large study conducted in Ukraine in 2007 among young people aged 15–24 found that 5% of them had sexual intercourse before they were 15. At an age for which there are no educational offers.

The risk of children and adolescents who grow up in a milieu of drug addiction and prostitution is all the higher, as well as for the number of street children, which can hardly be estimated.

Street children

Children and adolescents who live on the street are particularly at risk of contracting HIV or other sexually transmitted diseases (as well as tuberculosis and much more). There are no official statistics on health and psychosocial problems in this risk group. Risky behavior that is harmful to health and thus diverse health problems are more than likely due to their living conditions and have been proven in extensive surveys (including poor nutrition and poor hygienic conditions, alcohol and drug consumption, psychological and physical / sexual violence and mostly abandoned schooling and limited knowledge about HIV) . In the rarest of cases, they receive adequate medical and psychosocial help. All the more important are projects that not only offer the children and adolescents essential support such as food or clothing, but also show ways for safer sex and safer use and enable access to medical and psychosocial advice and treatment.

Preventive measures

In all of the preventive measures described here, it must be taken into account that the main causes of the HIV epidemic in Ukraine lie in the country's social crisis . If the effects of this crisis - such as massive poverty and a lack of prospects or a lack of solidarity - cannot be improved, an AIDS policy will ultimately not be successful either.

The HIV epidemic is a social disease that cannot be defeated in isolation. In order to be able to contain the epidemic, structural changes in the socio-political area are required, which are not limited to the health sector. The changes imply a diverse catalog of measures, ranging from legislation and standard-setting to the financing and implementation of individual projects.

After the orange revolution, the Ukrainian government acknowledged the problem of the existence of the HIV epidemic and its social threat to the population, also under international pressure. Nevertheless, political and economic instability in Ukraine is delaying fundamental measures. Assuming that behavior and conditions are mutually dependent, changes in structural conditions are decisive - and lengthy - steps to contain the epidemics. (Especially since the other epidemics must also be included, drug abuse and the spread of tuberculosis).

Ultimately, however, their success can only be limited if the widespread discriminatory and even hostile attitudes towards risk groups and their diseases do not change. A broad-based approach to the general population is therefore of crucial importance, with information campaigns on transmission routes and protection options and with strategies that oppose discrimination and make it clear that the HIV problem is not only that of the socially marginalized groups. In addition, target group-specific prevention projects need to be promoted further. Important target groups here are, on the one hand, the 15–24 year old age group, who make up an estimated 15% of all HIV reports.

On the other hand, the official risk groups also need more prevention offers (people who use intravenous drugs and their partners, prostitutes), as they have so far only been insufficiently reached by the offers, as well as children and young people who live on the streets and people in prisons. In order to be able to check the influence of the previous preventive measures, the development of a national HIV registration system is important, or a system that keeps the HIV data among the groups that are difficult to reach. Neither of these could yet be implemented, so that the measures taken so far are only partially comprehensible.

In order to measure the scope and success of anti-AIDS and especially prevention programs in the coming years, z. B. the International HIV / AIDS Alliance 2007 the standardized recording system SYREX.

Monitoring and evaluation are also included in the national strategic plan for 2009–2013.

Harm reduction programs

The range of harm reduction programs is also of great importance in containing the epidemic . Syringe exchange programs are particularly important here. However, the effects will be small as long as drug use is a criminal offense.

The success of drug substitution programs in many countries is based on the fact that they allow drug addicts to prevent withdrawal symptoms through legal and hygienic drug use and to participate in social life again through the controlled dosage of the not very intoxicating drugs. In this way, the vicious circle of drug consumption, drug-related crime, the precarious social situation and the urge to escape into intoxication can be broken.

Substitution programs require a surrounding stable society that is able and willing to integrate drug addicts and offer them an alternative to the hopelessness that made them resort to drugs. Since these factors do not currently exist in Ukraine, the introduction of substitution programs there on a large scale is questionable. Especially since it is not clear whether the state control mechanisms were sufficient to prevent the substitution drugs from enriching the illegal trade.

Substitution programs have been carried out as pilot projects in Ukraine since 2003. At the end of September 2008, around 2220 people were offered in 38 locations in Ukraine. Mostly buprenorphine ( trade name e.g. Subutex ® ) is used, which is much more expensive than methadone and for which there is less experience worldwide. However, buprenorphine is more readily accepted by the general public and policy makers; H. viewed as a drug ( pain reliever ) as opposed to methadone , which is viewed more as a drug at state expense.

Governmental and non-governmental organizations

In addition to the government, important actors in the implementation of new strategies and measures are non-governmental organizations (NGOs). In 2007 there were 150 NGOs in all regions of Ukraine working to fight HIV / AIDS.

The All-Ukraine Network of PLHA and the International HIV / AIDS Alliance in Kiev, which are committed to improving the rights of people living with HIV / AIDS and improving access to, deserve special mention as recipients of Global Fund money medical and non-medical care, for the promotion of tolerance and the strengthening of the ability to self-help. The All-Ukraine Network of PLHA is the umbrella organization of Ukrainian self-help organizations and is represented with several hundred members in almost all regions.

Donetsk Regional AIDS Center

Other equally important actors are the state AIDS centers in Ukraine. There is now a state regional AIDS center in each of the 24 oblasts of Ukraine, as well as in Crimea and in the cities of Kiev and Sevastopol. The AIDS centers are tasked with providing primary treatment in their polyclinics and coordinating treatment and care from other health facilities in the region. Most AIDS centers also have their own epidemiological department and laboratory, which primarily conducts initial and confirmatory HIV tests. Often the AIDS centers are also responsible for awarding ART. Few AIDS centers have enough capacity to reach everyone in the region.

Some of the AIDS centers also have self-help groups or work with local initiatives. Psychological counseling services rarely exist. Since the AIDS centers cannot care for all those affected in the region, some state polyclinics are also responsible for the primary care of those infected with HIV, which are then equipped with so-called trust rooms. In addition to test offers, HIV / AIDS patients are given medical care by infectiologists there.

The development and implementation of the National Strategic Plan 2009–2013 , in which national and international, governmental and non-governmental organizations are involved, is currently (2008) leading the way . The responsible Committee on the Prevention of HIV / AIDS and Other Socially Dangerous Diseases , together with the Ukrainian Ministry of Health, coordinates and monitors the national HIV / AIDS programs (accepted by parliament in the 1st reading at the end of 2008).

financing

In the meantime, considerable national and international funds are also being used in Ukraine. In 2005 this was US $ 40 million and in 2006 it was US $ 55.7 million. The share of Ukrainian state funds was 15% in 2005 and 20% in 2006. Most of the funds therefore come from international donors:

Share of donors against AIDS in Ukraine in 2005
Share of donors against AIDS in Ukraine 2006

The largest international donors in 2005/2006 were:

  1. Global Fund with US $ 37 million
  2. USAID 10.9 M $
  3. UN organizations 3 M $
  4. European Commission 1.7 M $
  5. International Renaissance Foundation (OSI Ukraine) 0.7 M $
  6. SIDA (Sweden) 0.3 M $
  7. NOVIB 0.2 M $ * 8. Elton John AIDS Foundation $ 0.2M
  8. UK DFID 0.14M $

The German Federal Ministry of Health committed itself in 2008 with around one million euros.

State of the health system

In the Soviet tradition, health care in Ukraine is largely state-run. Theoretically, i. H. according to the law, this state health system guarantees patients free treatment. Treatment takes place in hospitals and polyclinics. However, the equipment in many hospitals is poor and outdated. There are very few resident doctors and few private clinics in Ukraine. There is little known about interdisciplinary networking of treatment and care in the medical as well as in the non-medical field. In practice, patients often have to buy services in addition to the free care. This can affect particular diagnostic techniques, treatments, and medications. Hospital patients or their relatives often have to bring their own bedding and food.

There is no health insurance based on the solidarity principle that could cover these benefits. Given the current economic situation in the country, it would hardly be feasible because most people earn too little to be able to pay the necessary cash contributions.

The state of the health system can be considered one of the reasons that people in Ukraine have a sharply reduced life expectancy. According to the WHO, it was 70 years (at birth) in 1990 and 67 years in 2006 (for women in 1990: 74 years, 2006: 73 years and for men in 1990: 65 years, 2006: 61 years)

Situation of those infected with HIV and those suffering from AIDS

The difficult situation of the health system affected all patients in the years when the epidemic peaked. A further complicating factor for HIV and AIDS patients was that there were still doctors who refused treatment out of uncertainty and fear of infection.

For the following years, an enormous increase in the need for treatment and care for people in the AIDS stage was to be expected. The number of reported AIDS diagnoses and those who died as a result of AIDS increased steadily. At the end of 2007, of the official 122,314 people infected with HIV (since 1987), 81,741 were still registered as alive and under medical observation. An estimated 80,000 patients required ART by 2011. In 2006, the largest number of AIDS diagnoses reported so far, with 4,723 cases. Without effective rapid action, it was estimated that up to 43,000 people would have died of AIDS in 2011 and there would be over 46,000 AIDS orphans.

Treatment and care presented a financial challenge to the health care system. International and national projects therefore focus on the HIV-specific education and training of health workers, etc. a. in infectious diseases, (outpatient) care and substitution. But diagnostic techniques were also needed.

Number of AIDS cases and AIDS deaths in Ukraine

In the treatment of AIDS and its opportunistic diseases, great strides have been made since 2004, thanks largely to the increase in treatment with highly active antiretroviral therapy (HAART) that has been available since 2004 ( mainly through the Global Fund). In 2005, 21% of adults and children with advanced HIV infection received HAART. In 2006 it was 27% (4,777 patients) and in 2007 it was 35% (7,657 patients).

However, in 2007 only 78% of the patients were still receiving treatment after twelve months. Some of them had died despite HAART, and some had stopped therapy for various reasons.

Especially the adherence of patients is a crucial aspect in the effectiveness of antiretroviral therapy. Consistent regular adherence to pill intake was probably very difficult for many Ukrainians in their life situation. In addition, HAART was free for patients in Ukraine, but the drug treatment of the sometimes serious side effects associated with HAART was paid for.

Also on the part of the practitioner, the antiretroviral combination therapy could only be used to a limited extent around 2010. a. because there was mostly only a so-called first-line treatment. If patients develop resistance to the active ingredients, there are few treatment alternatives. Because of the limited resources, most of the centers did not have any methods for determining viral load and resistance in order to be able to use HAART optimally. Many AIDS centers in Ukraine had to send the samples to Kiev for analysis and also had the patients pay for them.

AIDS and tuberculosis

In Ukraine, tuberculosis is the most common opportunistic infection among people infected with HIV and one of the leading causes of death in AIDS.

Tuberculosis is also a social disease. People with weakened immune systems, such as people who cannot eat adequately and healthily, are particularly susceptible to them. An immune system weakened by HIV increases the risk of transmission many times over. Tuberculosis is particularly common in poorer countries and countries with limited health care. There are also many people infected with tuberculosis in Ukraine who are not infected with HIV. Tuberculosis has also reached epidemic proportions in Ukraine. The two epidemics are moving towards each other.

The number of tuberculosis cases has been increasing in Ukraine since 1990. According to the WHO, the incidence of tuberculosis rose from an estimated 68 cases per 100,000 inhabitants in 1990 to 114 cases in 2006. (The estimates include those who were infected or died of tuberculosis during the reporting period, as well as those with an HIV infection). There is a strong correlation between the rise in tuberculosis infections and the spread of HIV.

The number of new tuberculosis infections estimated by the WHO has also risen continuously since mid-1995. The treatment of tuberculosis is very complex, difficult and costly and, similar to HAART treatment, requires a high level of adherence on the part of the patient in order to be able to successfully complete the treatment and to minimize the risk of developing multi-resistant pedigrees. Anti-tuberculotics have to be taken for a long time (at least six months), also beyond the actual symptoms.

A comprehensive treatment of tuberculosis infections (e.g. according to the WHO / DOTS treatment guidelines) has not yet been achieved in Ukraine. 15% of the estimated TB patients who are also infected with HIV received antituberculotics and HAART in 2006. In addition, in Ukraine, similar to HIV and AIDS, there are also major problems with the offspring of health workers in tuberculosis treatment and care (low pay and high occupational risk of infection with TB). HIV / AIDS and tuberculosis are two separate areas in health care, although therapy should be closely linked. Interdisciplinary collaboration is difficult to implement in this way.

literature

  • L. Burruano, J. Seydel: The Spread of HIV / AIDS in Ukraine. In: Healthcare. 2006; 68 (8-9), pp. 571-574. Georg Thieme Verlag, Stuttgart / New York. ISSN  0941-3790
  • I. Olynik, R. Atun: Resistance to implementing policy change: the case of Ukraine. In: Bulletin of the Worl Health Organization. 2008, 86, pp. 147-154. [1] , (PDF)
  • A. Teltschik: Children and young people living or working on the streets: the missing face of the HIV epidemic in Ukraine. UNICEF 2006 [2]
  • C. Weber: Assessment 2007 in Donetsk. 2007 [3]
  • WHO: WHO Core Health Indicators database (WHOSIS) 2008. [4] , [5]

Web links

Individual evidence

  1. ↑ a b One woman's fight against AIDS in Ukraine ( Memento from December 6, 2011 in the Internet Archive )
  2. ↑ a b UNAIDS Data 2018 ( Memento from July 25, 2018 in the Internet Archive )
  3. ↑ a b c d e f g h i j k l m n o p q r s t u v w The United Nations Program on HIV / AIDS. United Nations , accessed December 12, 2012 .
  4. ↑ UNAIDS 2008a . EPIDEMIOLOGICAL FACT SHEETS, 2008 ( Memento of the original from September 17, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 902 kB) @1@ 2Template: Webachiv / IABot / www.who.int
  5. ↑ L. Burruano, J. Seydel: The spread of HIV / AIDS in Ukraine. In: Healthcare. 2006; 68, 8-9, pp. 571-574, Georg Thieme Verlag, Stuttgart. ISSN  0941-3790
  6. ↑ a b c d Alliance ( Memento of the original from September 6, 2009 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. . International HIV and AIDS Alliance, Kiev. @1@ 2Template: Webachiv / IABot / www.aidsalliance.org
  7. Jump up ↑ J. Pomerleau, M. McKee, R. Rose, CW Haerpfer, D. Rotman, S. Tumanov: Hazardous alcohol drinking in the former Soviet Union: a cross-sectional study of eight countries. In: Alcohol and alcoholism (Oxford, Oxfordshire). Volume 43, Number 3, 2008 May-Jun, ISSN  1464-3502 , pp. 351-359, doi: 10.1093 / alcalc / agm167 , PMID 18245818 .
  8. ↑ UNICEF 2006 . Unicef ​​and UNAIDS (2006) Risk and protective factors in the initiation of injecting drug use, Kiev. http://www.unicef.org/ukraine
  9. ↑ a b A. Teltschik: Children and young people living or working on the streets: the missing face of the HIV epidemic in Ukraine. UNICEF 2006.
  10. ↑ a b C. Weber Assessment 2007 in Donetsk. http://www.aids-ukraine.org/
  11. ↑ PLHA . http://www.network.org.ua./
  12. ↑ Global Fund . http://www.theglobalfund.org/en/
  13. ↑ USAID . http://www.usaid.gov./
  14. ↑ IRF . http://www.irf.kiev.ua/en
  15. ↑ EJAF . http://www.ejaf.org/
  16. ↑ DFID . http://www.dfid.gov.uk./
  17. ^ German-Ukrainian partnership initiative to fight HIV / AIDS. (No longer available online.) Archived from the original on February 20, 2010 ; Retrieved January 1, 2012 .
  18. ↑ a b WHOSIS 2008 WHO Core Health Indicators database (WHOSIS) 2008.
  19. ↑ a b I. Olynik, R. Atun: Resistance to implementing policy change: the case of Ukraine. In: Bulletin of the World Health Organization. 2008, 86, pp. 147-154.