This is an important communication and I am pleased and honored to be part of it. Thank you for the invitation.
The Alliance in Ukraine is reporting today that for the first time in ten years, there has been a decrease in the number of new HIV infections in Ukraine (-2%), with a significant reduction in the number of new infections registered among people who use drugs.
This is in contrast with the trends in the region where the number of new HIV infections, the number of AIDS cases and mortality from AIDS have been increasing dramatically since the early 2000’s.
The decrease in incidence reported today in Ukraine among people who use drugs is of significance.
Forty to sixty percent of the HIV infections in the region are occurring in people who use drugs. People who use drugs are socially marginalized, discriminated, criminalized, have poor access to services and to treatment, worldwide and particularly in the EECA, an important theme of this conference.
The results released today by the Alliance have not been confirmed yet, to my knowledge, by the Ukrainian authorities, but I can say they are acknowledged by the international community. Convergent epidemiological evidence such as the fact that newly diagnosed people are of older and with an longer history of infection before diagnosis actually strengthens the robustness of these results.
As I see these results, I would like to make three points:
1. My first point is that there are lessons to be learned, particularly for the region, in reflecting on the combined factors that have allowed here for success:
Among those factors: first, a strong advocacy, remarkably conducted by the civil society, based on epidemiological evidence, based on human rights, sensitizing decision makers and the public opinion on the human impact of the disease and the poor access to services of people in need.
Second, resources. For obvious reasons, I am pleased and proud to acknowledge the investments that the Global Fund has made in the fight against HIV/AIDS and TB in Ukraine for now ten years.
Third, political commitment. With ups and downs, there is an overall recognition by the government of the threats of the epidemic and of the need to act. I have clearly perceived that in my meeting with Prime Minister Azarov last year and when meeting recently with the minister of Health, Mme Bogaterova.
Fourth, and most importantly, this is the result of a joint effort between the public sector and the non-governmental sector. NGOs such as the Alliance or the network of people living with HIV in Ukraine have over the years and under the pressure of the crisis, moved from advocacy to acquiring the technical knowledge and to implementation of programs. They have been an example of efficiency and accountability in delivering on the Global Fund grants.
And last, programs are beginning, but only beginning, to be at scale, allowing for impact. This is far from being the case in the region.
2. My second point is that success is not linked to treatment alone or to prevention alone, but to the combination of the two. Expanding access to testing and to antiretroviral treatment but, at the same time, expanding significantly on access to peer education and support, needle exchange programs, and opioid substitution therapy.
A lesson for many countries in the region that hardly invest in prevention.
3. My third and last point is that, as we celebrate these results, we should also realize how fragile the situation is.
Fragile when it comes to funding in difficult time s in a region where 90 % or so of the financing of AIDS programs, particularly preventative programs is relying on international funding.
Fragile when it comes to acknowledgment of the problem by the public opinion and to political commitment.
Fragile because discriminatory laws and policies are still there preventing prevention work and access to services of the most vulnerable people.
Fragile because of the risk of spread of the epidemic beyond the key populations at high risk, as we are now clearly seeing it happen in the Russian Federation.
Fragile also because AIDS is not the only threat in the region and when it comes to the most vulnerable such as people who use drugs in the region: TB and multi resistant TB which is under-diagnosed and far from being treated at the needed scale is a huge threat, and so is hepatitis C (over two thirds of people who inject drugs in Ukraine are infected with hepatitis C).
We know what it is that we should do. If we do it and expand further on our efforts, the battle can be won.
Congratulations to the Alliance and to everyone who is fighting AIDS, TB and hepatitis in Ukraine.