2001 UKR: Children and Young People Affected by HIV/AIDS in Ukraine
HIV started to spread among Ukrainian children in 1995 when the second stage in epidemic development began. Dynamics in registered HIV+ children and children with AIDS provides evidence that there is immediate need for energetic preventive measures to be taken by all stakeholders. The main route of younger children infection is virus transmission from HIV+ mother during pregnancy, delivery or breast-feeding The next outburst of HIV infection hits the adolescents, especially children with loosened family ties and inadequate life skills. The major routes of HIV infection in this group are parenteral (through injecting drug use) and sexual.
Purpose / Objective
In summer 2001, the Ukrainian AIDS Centre at the Ministry of Health of Ukraine, supported by UNICEF, conducted a special thematic study aimed at assessing HIV/AIDS prevalence among children in regions of Ukraine and at identifying weak points in operating epidemiological monitoring system. Regions with varying epidemic situations were identified for carrying it out. Not only epidemiological, but also social and medical aspects of the problem were looked into in the regions.
The status of 746 children has been subject to analysis, with 722 of them born from HIV-positive mothers and 24 children infected through injecting drug use. The regional break-up of the surveyed children was as follows: Dnipropetrovsk region - 366 children, Mykolayiv region - 261, Kherson region - 42, the city of Sevastopol - 33, Cherkasy region - 28, and Ivano-Frankivsk region - 9.
Key Findings and Conclusions
HIV/AIDS epidemic growth rates in Ukraine are gaining momentum. Available data on epidemic development trends is insufficient for efficient planning of counteractions. The statement about epidemic seepage to "stock" populations in the regions where the epidemic broke out earlier than in the other regions is the most grounded. Today, implementing Second generation epidemic surveillance over HIV/AIDS that provides for epidemic surveillance focusing on behavioural patterns and high-risk subpopulations, and relies upon sentinel surveillance, is the first priority issue.
The beginning of the second stage of HIV spread in Ukraine also marked the beginning of epidemic process among the child population. The major route of young children infection is virus transmission from HIV-positive mother during pregnancy, delivery or breastfeeding. The next outburst of HIV infection hits adolescents. In this group, parental (through injecting drug use) and sexual routes of HIV transmission take the lead.
Available data testify to HIV epidemic seepage to women not belonging to risk groups (increasing share of sexual virus transmission). The overwhelming majority of HIV-positive pregnant women (65%) are young women aged below 25. Most children (70%) born from HIV-positive mothers come from dysfunctional families comprising risk groups representatives. A considerable portion of mothers in this group does not give adequate attention to their own health and to their future child's health, and are unaware about HIV vertical transmission risk. Nevertheless, every third child was born in a "normal" family, which signals the need for awareness-raising and preventive activities among all reproductive age women, first and foremost, among pregnant women.
Government programme for preventing HIV transmission from mother to child was started in Ukraine in 2001. The programme envisages large-scale information campaign among target groups, pre-test and post-test counselling, pregnant women's testing on a voluntary basis, provision of free medications for preventive antiretroviral therapy, special medical assistance methods during delivery, providing free milk formulas for infants born from HIV-positive mothers and introducing early HIV infection diagnostics - PCR.
Tentative expert evaluations of the programme implementation have identified the following problems: inadequate medical staff's training, lack of monitoring and effective control over programme implementation, lack of individual protection means and post-contact HIV-preventive preparations for medical staff, lack of social assistance and supervision system for mother and child.
Social isolation of a considerable portion of HIV-positive women belonging to risk groups also precludes efficient preventive measures and calls for involving non-governmental organisations with experience in working with such groups in programme implementation.
The majority of HIV-positive children (80%) live with their biological families. Her/his parents have abandoned every fifth HIV-positive child and stays at public care institutions or medical in-patient clinics. 70% of families with HIV-positive children belong to dysfunctional families that do not satisfy even the child's fundamental needs in food and provide no conditions for the child's normal development. The needs of most children living in "normal" families are also not satisfied in full. 40% of such families have low incomes. Nearly 85% of parents in surveyed dysfunctional families with HIV-positive children are young people aged below 30. 65% of men and 35% of women belong to the age group 18-25. Not a single case of an HIV-positive child having been placed into a foster family care has been recorded among HIV-positive children.
75% of HIV-positive children infected through injecting drug use are boys, 25% girls. Over a half (65%) of these children have health status categories III-IV. Nearly a half of HIV-positive children infected through injecting drug use is in conflict with law. 80% of HIV-positive children infected through injecting drug use live with their families; 75% of these families are dysfunctional in terms of social status.
Negative attitudes to HIV positive individuals and people living with AIDS prevail among Ukrainian population. A widely spread belief is that HIV and AIDS are diseases of social groups practising amoral and asocial life styles, "dregs of society" (IDU, female sex worker, MSM, and homeless people) Most people in the street believe that a "normal" person has no need to be concerned about this problem, if (s) he practises socially acceptable life style and has no contacts with risk groups representatives. Many people consider that representatives of vulnerable social groups in terms of HIV infection have chosen their asocial life style on their own free will, and therefore, their HIV and AIDS diseases logically ensue from their choice, so they should deal with their problems themselves. Refusal to provide medical services to HIV positive patients is a common phenomenon.
The need is evident for keeping the public better informed about the actual HIV/AIDS epidemic status in the country, routes of HIV transmission, difference between HIV and AIDS, medical achievements in fighting the diseases and efficient prevention methods. Contents and scope of HIV/AIDS coverage in Ukrainian national mass media are inadequate both for the adult and for the young audience. Developing partnerships with leading mass media will contribute to keeping the public better informed on significant social issues. Information infrastructure intended for children and youth is underdeveloped.
Supreme government bodies in all branches of power attach adequate importance to compliance with child's rights, HIV/AIDS prevention and treatment. Relevant documents are aimed at conformity to principles of confidentiality and respect for human rights and freedoms. Stating and law-establishing parts of legislation conform to international standards and, in particular, to Articles 2, 23, 24, 28, 33, 34 of the Convention on the Rights of the Child pertaining to disease prevention, and care and treatment provision for patients. However, review of HIV-positive children status in public care institutions gives grounds to argue that there are numerous cases of non-conformity to Articles 3, 5, 20 and 28 of the Convention on the Rights of the Child.
Government HIV/AIDS prevention programmes in Ukraine lack effective system of management, monitoring and its implementation efficiency evaluation. There are no uniform national standards and norms in place regulating care, treatment, medical services and social assistance for people and families living with HIV. Lack of such standards, especially regarding children, pregnant women, mothers with HIV-infected children or children with AIDS are a problem to be addressed without delay.
Government HIV-prevention programmes stipulate providing counselling to population at health care institutions. However, practical implementation of these activities is at its initial stage only. Provided counselling services are not efficient enough, particularly with regard to adolescents, young people and especially the groups running high risk of HIV infection.
A network of NGO is operating in Ukraine, engaged in preventing HIV/AIDS epidemic and in dealing with risk groups problems; however, it is underdeveloped and has a poor resource base. NGO has made certain progress in mobilising public opinion, providing information and counselling to young people, and promoting self-organisation and self-help among the most vulnerable social groups. A number of international organisations, including UN agencies, provides efficient assistance to government agencies and NGO, with their activities covering virtually every aspect in HIV/AIDS prevention. Inadequate attention is given to HIV prevention among children and to protecting HIV-infected children's rights.
Awareness-raising endeavours should take into account differences in information reception by various social categories, particularly school-age children; regional differences in information scopes and relative efficiency of diverse information channels (TV, printed mass media, etc.).
HIV transmission from mother to child awareness and attitude towards HIV-positive women on the part of medical staff require appropriate attention on the part of both the government and international organisations. Incorporating training courses in preventing HIV transmission from mother to child and HIV-infected children care into the curricula of medical educational establishments and professional upgrading courses, and developing relevant training materials are necessary for the successful implementation of the Programme for preventing HIV transmission from mother to child in Ukraine.
To prevent institutionalisation of HIV-positive children, it is necessary to develop and put into practice the system of social supervision over families with HIV-positive children, including financial support, psychological counselling and additional support to HIV-positive mothers.
In order to ensure the child's right to be raised in a family environment, supplementary administrative and organisational activities should be conducted, and regulatory documents should be completed pertaining to HIV-positive children placement into foster family care.
Standards for HIV-positive children care maintenance and treatment should be developed and implemented. A monitoring and control system over HIV-positive children status and exercising of their rights should be designed and put into practice.
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