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WOMEN AND THE AIDS EPIDEMIC IN UKRAINE: AN INFORMED LOOK by Svitlana Kupryashkina "Democracy ultimately depends on individual citizens believing that they have a role to play in the life of their countries. It depends on people choosing — not being compelled to — but choosing to participate in society... and seeing that this is passed on from one generation to the next." — Hillary Rodham Clinton. Lviv, November 18, 1997 Ukraine is the second largest country in Europe with 49 million inhabitants. Over 68% of the population lives in cities. The male/female ratio is 46% to 54%. Persons of working age (17-60) amount to 55.6%. At present, state allocations for health services cover only 30% of health needs. The current socio economic situation in Ukraine has created favorable conditions for the spread of HIV. The epidemic has occured at a time when Ukraine is in the process of transition, therefore straining the health care system when it is at its most vulnerable. From 1987 to 1994, only 167 cases of HIV infection were registered in Ukraine. In 1995, the World Health Organization characterized Ukraine as a low prevalence country. Current data, however, reveals that HIV is reaching epidemic proportions in the country, particularly in high-risk groups. These typically include intravenous drug users, commercial sex workers, individuals engaging in unsafe sex and tuberculosis patients. It is believed that the disease first appeared among drug users and then spread to the general population. Although the rapid spread of HIV was first reported among drug users in southern Ukraine in 1995, the epidemic has spread dramatically. The most highly affected regions are the Donetsk, Odesa, Mykolaiv and Dnipropetrovsk oblasts, the Crimean Republic and the city of Kyiv. Regions that have never been in the risk zone are now also threatened. Current information on the number of HIV-positive people in the country indicates that of the total of 40,000 people who have tested positive for the disease, only about 22.000 have been officially registered. It is estimated that the true number of HIV-infected persons is about 110.000 or even higher. Approximately 600 of these have AIDS. The majority of those infected are young people, and of these, 15% are children and teenagers. The disease is no longer a drug user's disease; it is predominantly transmitted through sexual intercourse. Foreign estimates suggest that the number of HIV infected persons in Ukraine will grow to 1.6 million within fifteen years. Ukraine is a society in transition. Real income is worth between one-fourth and one-fifth of pre independence levels and social services, subsidies and pensions have been severely hit. The significance of the transition is that it creates an environment in which the spread of HIV is expanding, while, at the same time, the means to deal with it are contracting. At an individual level, employment varies with gender and geography. It influences individual households as well as communities. The association between high unemployment, alcohol abuse, domestic violence, drug use, increased migration and the potential increased rates of multiple sexual partners, together with the growing number of women engaging in regular or occasional prostitution, means that there are regions and communities which are particularly susceptible to increased disease incidence. The situation for young people and women is especially difficult. For centuries, the Ukrainian woman was considered a Berehynya, the guardian of the home and hearth. During the decades of Soviet rule, women were turned into laborers, successfully combining home duties with workplace duties. When Ukraine opted for independence in 1991, the policies on women and family in Ukraine began to change; almost immediately, a movement to cultivate more traditional stereotypes was evident. Women's rights were perceived as something related to the old Soviet system, and any discussion of women's rights often engendered animosity. Issues of health, sexuality, and women's reproductive health are not yet a major component of the social agenda. Only a number of women's NGOs, most of them funded by the West, are serious advocates for women's rights. The negative results are staggering: - Abortion remains the biggest factor influencing that state of reproductive health. The number of abortions in Ukraine currently exceeds the number of births. - In recent years, the number of sexually transmitted diseases, including HIV, has grown dramatically. In the last five years alone, the rate of syphilis among women between the ages of 16 and 18 has grown from 5.2 cases per 100,000 to 63.3 cases per “НАШЕ ЖИТТЯ”, ЛЮТИЙ 2001 19
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