KYIV – Next to the landmark Pecherska Lavra monastery, a green building hides in obscurity. Its small wooden door leads to a corridor with walls painted a sad gray-green color. Behind the gray third-floor windows stand some of Ukraine's HIV carriers.
They are the early victims of an AIDS plague that international experts say is about to sweep the land. And some of them put more faith in God than they do in the cures on offer at the Infectious Diseases Hospital of the Kyiv Epidemeology Research Institute.
'If I manage to bring my life in order and peace to my soul, if I get rid of obstacles to communing with God, than he will cure me,' said Tatyana, 30, who like the other patients did not give her last name.
Tatyana has some reason to put her faith in God rather than Ukrainian medicine. She and the hospital's other 20 or so HIV carriers, including several with full-blown Acquired Immune Deficiency Syndrome, are fed one meal a day from nurses wearing rubber gloves.
The medical staff's ignorance about the disease highlighted by the rubber-glove treatment and the apparent willingness of some Ukrainian doctors to transfuse blood not screened for the virus – comes at a bad time for Ukraine.
The number of known HIV infection cases has skyrocketed from 384 in 1995 to 26,000 today, and officials say the real figure is closer to 350,000.
New cases are now accumulating at a rate of 1,500 a month. In Ukraine, some 70 percent are attributed to intravenous drug use. Officials and patients alike say ignorance is the disease's greatest ally.
Oksana, a 22-year-old patient sent to Kyiv from Simferopol, said that although she and her 28-year-old brother shot up drugs for years, they never believed they could be infected.
'We always thought this would not get to us. We heard rumors that someone got infected in Sevastopol, but it was all very abstract and distant,' she said.
Oksana said dealers she knows often dilute drugs they sell with water from syringes they have used. 'Only now do I understand that all my friends who use drugs are infected,' she said.
More disturbing evidence is supplied by a new United Nations report on the spread of AIDS across the region. Bernard Schwartlaender, senior epidemiologist of the Joint United Nations Program on HIV/AIDS, said last week that small-time dealers in the former Soviet Union sometimes mix in blood with heroin-based drugs to test their quality. Schwartlaender said drugs with a high acid level can cause blood to coagulate and the dealers appear to be mixing a few milliliters of blood per batch of liquid drugs. Unaware of the potential dangers of HIV-infected blood, many dealers have been mixing the blood with their entire supply, rather than testing a small sample of their product.
Intravenous users in Eastern Europe often fill up their syringes with liquid drugs directly from the supplier, said Schwartlaender. The HIV risk comes from the contaminated drugs themselves as well as from shared needles. 'All our nice messages (against sharing needles) might not be that valid any more,' said Schwartlaender. Details of infection rates in the region are sketchy because it is 'not well prepared both to monitor the problem and to cope with the problem,' he said. 'Denial of the epidemic has caught up with these countries,' said David Hayman, director of the World Health Organization's emerging diseases division. 'You can easily imagine, in a society that has never dealt with these problems, how difficult it is to enter… all these very, very difficult legal issues,' added Schwartlaender.
Tatyana recalls how her aunt acted when she visited her in the hospital.
'She was afraid to sit next to me, and she was in utter shock when she saw a nurse bringing me food in rubber gloves. I asked her what AIDS is, and she could not answer anything except that it's the plague of the 20th century.' The patients themselves don't know nearly as much as their counterparts in the West. They do not, for example, realize that the many pills they are issued daily in many cases do not include sophisticated retro-viral drugs routinely given to foreign patients early on to block or slow the onset of advanced AIDS. In fact, they are grateful to receive any free medicine at all.
'If you need cures when you are getting out of the hospital, they give you enough to complete the full course of treatment,' said Aleksey.
But the 28-year-old man, who has been admitted to the hospital several times since July with complications, said he never takes medicines after he checks out. 'Why should I, if I feel fine?' he asked.
Aleksey likely would not get what he needs even if he knew better. Ukrainian doctors say they simply do not have the money needed to import expensive drugs that should be used in combination and rotated regularly to keep the virus from adapting. So doctors reserve the retro-viral medicines for patients in the late stages of the illness. Protease inhibitors, another class of anti-AIDS drugs, are virtually unknown.
'They are not used here, because they are too expensive, and few of them are registered with the Health Ministry,' said Alla Scherbinskaya, manager of the Health Ministry's Center for HIV Prevention.
That may be one reason why, according to Scherbinskaya, HIV-infected intravenous drug uses in Ukraine live an average of five years, compared to 10 years in the West. Babies infected in uterus by their mothers and people who catch HIV through a blood transfusion usually last just a year, she said.
Alla Vovk, head of the HIV and hepatitis departments at Kyiv's Infectious Diseases Hospital says her AIDS patients are still 'better provided with drugs than any other type of patient in our hospital.'
The national Committee For Prevention of AIDS and Drug Abuse spent Hr 400,000 this year on drugs for Vovk's hospital and its branch in Odessa. How much is spent on AIDS treatment at other clinics funded by the Health Ministry and local governments is anyone's guess, because the ministry does not keep such statistics. Even Tatyana's ward in Kyiv is spartan. 'We get one meal a day at one o'clock, and have to stay hungry for the rest of the time,' she said.
The patients cannot afford some of the paid medical tests they require. To get by, they donate blood, and apply the small payment toward their fees. The blood is supposed to be used for AIDS research.
(Material from The Associated Press was used in this story.)
