Prevention programs for people who inject drugs (PWID) and their partners
In 2020, 42 organizations implemented HIV prevention programs among PWID. Program clients received sterile injecting equipment (primary and secondary syringe exchange), condoms and alcohol wipes, counseling, HIV and hepatitis C testing as well as early tuberculosis detection services. The services were provided at stationary sites, outreach routes, in mobile clinics and pharmacies.
Within GF, PHC, CDC financing 242,933 PWID received minimum package of services (syringes or needles, condoms, counseling) and 261,592 PWID were tested for HIV with rapid tests and received testing results. In 2020, 5,053 PWID tested positive for HIV. 3,948 clients sought further diagnostic services in HCF, with 3,254 PWID confirming their positive results. 3,470 PWID were registered in AIDS centers, with 3,268 PWID starting ART (including those who were tested or confirmed their results in the previous period).
Prevention programs for sex workers and their clients
33 NGOs provided HIV and STI prevention services to sex workers in all regions of Ukraine during 2020. The projects offered the following services for all clients: counseling, condoms, lubricants, HIV and syphilis testing, early tuberculosis detection.
Within GF, PHC, CDC financing 49,326 SW received minimum package of prevention services (condoms, consultations) and 47,219 SW were tested for HIV with rapid tests and received testing results. 332 SW received positive testing results, 154 SW got further diagnostic services in HCF upon referral, 121 SW confirmed their positive results, 130 SW were registered in AIDS centers and 138 SW started ART (including the clients tested in previous periods).
Prevention programs for MSM
30 NGOs provided prevention services to MSM in 2020. The projects offered the following services to their clients: condoms, lubricants, counseling of social workers and health professionals, testing for HIV, syphilis, hepatitis B and C, early tuberculosis detection.
Within GF, PHC, CDC and USAID financing 44,513 MSM received minimum package of services (condoms and counseling) and 47,300 MSM were tested for HIV with rapid tests. 304 MSM received positive results, 252 MSM sought further diagnostic services in HCF upon referral, 244 MSM confirmed their positive testing results, 246 MSM were registered in AIDS centers and 208 MSM started ART (including the clients tested in previous periods).
Prevention programs for trans*people
10 NGOs provided prevention services to trans*people during 2020. NGOs offered the following services to their clients: condoms, lubricants, counseling of social workers and health professionals, assisted HIV testing, syphilis, hepatitis C, and early tuberculosis detection.
2,677 trans*people received minimum package of services (condoms and counseling) within GF projects. 2,472 trans*people received assisted HIV testing with rapid tests and received testing results. 9 clients tested positive for HIV, 5 sought further diagnostic services in HCF upon referral, 5 confirmed their positive testing results, 5 were registered in AIDS centers and 6 started ART (including those tested in the previous periods).
HIV biobehavioral surveys among key populations
Biobehavioral surveys among key populations at risk to HIV infection – PWID, SW and MSM – is an important component of control over the epidemic situation in Ukraine, with HIV prevention and reduction of HIV prevalence being one of the key objectives in the country response to the epidemic.
In 2020, the team of the Public Health Center of the Ministry of Health of Ukraine, with the methodological and technical support of the ICF Alliance for Public Health, conducted a biobehavioral survey among PWID. In 8 cities of Ukraine, 6,001 PWIDs were interviewed and tested, with an HIV prevalence rate of 20.3%. At the regional level, this figure ranges from 35.0% in Cherkasy, 28.4% in Mariupol, 28.0% in Mykolayiv to 6.4% in Kharkiv. As in previous years, the highest prevalence of HIV is observed among the older age group: among PWID under 25 it is 2.2%, among 25-34 – 10.7%, among 35-44 – 23.3%, and in the age group of PWID over 45 years reaches 32.6%. According to the study, the annual incidence of HIV among PWID decreased 2.5 times – from 2.44% in 2017-2018 to 1.06% in 2020.
Previous rounds of HIV biobehavioral surveys among the key populations – PWID, sex workers and MSM – was conducted in 2017-2018 by Alliance for Public Health in cooperation with the Public Health Center of the Ministry of Health of Ukraine.
5,043 survey participants from among SWs were tested for HIV in 27 cities from all the regions of Ukraine, except Luhansk oblast. The results confirmed the trend towards gradual reduction in the level of HIV prevalence in this population – from 12.9% in 2009 to 7.0% in 2015 and 5.2% in 2017-2018. The highest levels of HIV prevalence were observed in Cherkasy (26.7%), Mariupol (18.3%), Bila Tserkva (14.0%), Kherson (11.7%) and Kropyvnytskyi (10.9%). It is also important to note that in those cities a bigger share of sex workers as compared to other cities reported their practice of injecting drug use. Thus, HIV infections may be associated not only with the provision of sex services, but also with drug injecting practices. In general, among sex workers who stated that they do not inject drugs, HIV prevalence was only 3.1% as opposed to 35.6% among the sex workers who stated that they injected drugs in the last 12 months. As well as in the previous years, a higher level of HIV prevalence was observed among older members of this group: HIV prevalence among sex workers aged 25 years and above was 6.4%, while among younger members of the SWs community – 1.4% (in 2015, the respective indicators were 9.9% and 0.7%).
Within the survey, 5,972 MSM were tested for HIV in 25 cities from all the regions of Ukraine, except Luhansk oblast. The results of biobehavioral survey demonstrated that in 2017 – early 2018 HIV prevalence among MSM was 7.5%, which statistically remained at the same level as in 2015 – early 2016 (8.5%). In the previous rounds of survey, the respective indicators were 6.4% (2011) and 5.9% (2013). The highest levels of HIV prevalence among MSM were observed in Donetsk (22.8%), Cherkasy (14.3%), Odesa (13%), Mykolaiv (7.3%) and Kyiv (7.1%). As well as in the previous years, a higher level of HIV prevalence was observed among older members of this group: in 2017, HIV prevalence in MSM aged 25 years and above was 8%, while among younger members of the MSM community it was 6.7%.