Ten things you should know about TB in Ukraine

Ten things you should know about TB in Ukraine

Did you know Friday is World Tuberculosis Day? You do now.

Ukrainian? In Ukraine? A Ukraine-watcher, whatever that means? Here’s a list of ten things you should know about TB in Ukraine:

  1. The TB incidence rate in Ukraine in 2016 was 67.6 per 100,000 persons – which, for perspective, is anywhere from ten to twenty times the rate in countries like the US, the UK or Canada (to say nothing of the absurdly high rates among First Nations and Inuit in Canada, but I digress).
  1. Fewer Ukrainians were diagnosed with TB in 2016 than in 2015 – a 4.3% decrease in the number of new diagnoses. Good.
  1. Ukraine has, alongside Russia, a spot on the World Health Organization’s (WHO) list of 20 countries with the highest estimated burdens of multidrug-resistant tuberculosis (MDR-TB). There’s more than 8,000 new cases of MDR-TB registered in Ukraine every year, and it’s increasing. That’s bad.
  1. Anyone can get TB in Ukraine, including children – especially if you don’t vaccinate them. OMFG BCG vaccine pls FFS.
  1. TB’s still a disease concentrated in at-risk groups in Ukraine. According to stats from Ukraine’s Public Health Center (thankfully renamed from the unwieldy “Ukrainian Center for Social Disease Control of the Ministry of Healthcare of Ukraine”), around 70% of new TB cases in 2014 were in so-called “socially vulnerable groups” like unemployed people of working age and drug/alcohol abusers. (NB. these are the most recent breakdowns they seem to have but I don’t see any reason why these would’ve changed at all over 2015/16).
  1. One the major groups of people at risk of TB, particularly MDR-TB, are people with HIV/AIDS. As I wrote about earlier this week, more than half (52%) of deaths from AIDS-related causes in Ukraine last year were from TB – much higher than the one-third of deaths globally from TB in people with AIDS.
  1. HIV/TB co-infection is increasing in Ukraine – a “noticeable increase” according to the Public Health Center, increasing year-on-year from 2013. All this “[reflects] the increasing burden of HIV infection in the country.”
  1. There aren’t any numbers on TB, HIV or anything coming out of the non-Ukrainian-government-controlled parts of Donetsk and Luhansk oblasts (“DNR”/”LNR”), but everyone assumes the TB situation there is pretty bad. One senior international official I spoke to last month told me “we hear about used needles, terrible conditions there” with the at-risk population in the east – largely in and around Donetsk, which has long been an HIV hotspot in Ukraine. “I’d say of course HIV is growing there, TB is growing there, because the conditions in which they are spending time in is terrible,” this official told me.
  1. As Oksana Grytsenko reported in the Kyiv Post a few days ago, Ukraine struggles to provide effective TB treatment. Read her piece. No point in me rehashing it here, other than to add this quote from the Public Health Center: “Especially dangerous is the untimely addresses for medical assistance, late TB diagnostics, and HIV/TB co-infection, which causes a high level of mortality due to TB and results from the lack of a comprehensive approach to the combination of preventive and treatment programs at the national and regional levels into a single system of counteraction”
  1. There’s cause for some cautious optimism, I think. To plug again what I wrote about HIV earlier this week, state funding for TB treatment is being increased in 2017 and activists I spoke to seemed confident that the Ministry of Health and the government as a whole is (re)recognizing HIV/TB as a priority. Still, we’ll see.

A look at some pre-День незалежності surveys

A look at some pre-День незалежності surveys

Data from two big surveys has come out right before Ukraine’s Independence Day on August 24.

Both surveys only spoke to residents of territories currently controlled by the Ukrainian government (i.e., no one from Crimea or the “DNR/LNR” took part).

I’ve taken a look at both of them and made some notes and some stunningly mediocre Word charts.

The future of Ukraine

When it comes to what they feel about the future of their country, it’s a mixed bag of emotions for Ukrainians.

While almost half (44%) of Ukrainians in the June/July poll said that felt hope when they think about the future of Ukraine, almost as many (38%) said they felt anxiety while almost one in four (23%) said they felt fear for their country’s future.

These emotions have changed over the last ten years. Not surprisingly, anxiety is higher now than it was before 2013 (though it’s flattened out a bit since then) and fear for the future of Ukraine is higher, though this has been relatively stable since 2013.

future UA
Graph: Michael Colborne

The regional breakdowns are pretty interesting and run a little bit counter to what I was expecting:

  • Hope for the future of Ukraine is highest in Donbas (Donetsk and Luhansk oblasts, in government-controlled Ukraine) at 56%, but lowest right next door in eastern oblasts (Dnipro, Zaporizhia and Kharkiv oblasts) at 38%.
    • So the most hopeful Ukrainians are the ones closest to – and living in – a war zone?
  • Optimism about the future of Ukraine is lowest in Donbas (9%) and highest in central Ukraine (26%).
    • People in Donbas, it seems, are hopeful but not too optimistic about the future.
  • Anxiety is highest in eastern oblasts (44%) and Donbas (40%) but lowest in central Ukraine (31%)
  • Fear is also higher in eastern oblasts (30%) and southern Ukraine (25%) but lowest in western Ukraine (19%), central Ukraine (21%) and 22% in Donbas.

The age breakdowns weren’t that noteworthy IMO – have a look for yourself. I’d like to see breakdowns and analysis for other factors, like socio-economic status, rural/urban, level of education, employment status, etc., etc., etc.

The status of Russian in Ukraine?

Support for the Russian language having official status in Ukraine dropped to its lowest level ever in this series of surveys (30%).

RU lang
Graph: Michael Colborne

They didn’t provide any breakdowns for this, but I suspect the regional one would be in part what we’d expect (e.g., higher support in eastern Ukraine/Donbas), as well as with older Ukrainians.

Changing social attitudes (and some that change, then quickly change back)

While Ukrainian attitudes towards introducing the death penalty and isolating people with AIDS (!!) have declined since 1991, the same can’t be said for disapproval of premarital sex, homosexuality and the influence of western culture. While disapproval of premarital sex and the influence of western culture are largely the same as they were in 1991, barely over a quarter (27%) of Ukrainians think homosexuals should be treated equally, compared to 34% at the time of Ukraine’s independence.

social attitudes
Graph: Michael Colborne

There was only one regional breakdown given for these questions: western culture was more likely to be perceived as a negative influence in Donbas (49%), southern Ukraine (43%) and eastern Ukraine (39%) than in central Ukraine (29%) or western Ukraine (14%).

This Stalin guy again

Lastly, some Ukrainians still seem to like this Stalin guy, but the love has dropped off to 1991 levels – less than a third (30%) of Ukrainians think that Stalin was a great leader.

stalin
Graph: Michael Colborne

The regional breakdown is what I’d expect based on previous Stalin questions, save for Donbas. Almost half (46%) of people in eastern Ukraine thought Stalin was a great leader, compared to 43% in southern Ukraine, 31% in central Ukraine, 20% in Donbas and 13% in central Ukraine.

Still, I’d want to look deeper into the data, particularly at age, socio-economic status, other attitudes, etc., before painting almost half of eastern Ukraine with a broad fond-of-Stalin brush. It’s obviously beyond the scope of this survey but I’d also like to hear from some of these people themselves about why they think Stalin was a great leader. Soviet nostalgia? The feeling that Ukraine needs a super-strong leader in turbulent times? Propaganda?

Conclusions?

In conclusion, Ukraine is a land of contrasts. Thank you.

Seriously though, the overarching conclusion I’d draw is this: whatever direction attitudes in post-Maidan Ukraine are moving, we need to dig deeper into data like this to really understand why. Four or five-way regional breakdowns aren’t going to cut it.

Russia’s HIV epidemic dismissed as part of Western ‘information war’

Russia’s HIV epidemic dismissed as part of Western ‘information war’

(latest in Sydney Morning Herald)

Even as a UN conference began last week in New York, taking up the subject of ending AIDS, a Kremlin-backed research institute claimed the West is using HIV and AIDS as part of an “information war” against Russia.

The Russian Institute for Strategic Research (RISR) presented a report to the Moscow City Council last week on HIV in Russia where, unlike almost everywhere else in the world, rates of HIV infection are on the rise.

According to RISR deputy director Tatyana Guzenkova and her colleagues, the real goal of the West’s fights against HIV “is the implementation of the economic and political interests of US-led global structures, relying on an extensive network of international and quasi-NGOs.”

But none of this comes as a shock to Anya Sarang, head of the Andrey Rylkov Foundation.

“We’re not surprised at these kinds of statements anymore,” she tells me from Moscow, where she works with drug users and sees the scale of Russia’s growing HIV epidemic firsthand.

“It’s the usual thing in Russia now to discard science for ideology.”

There are two models for fighting HIV, according to the RISR report. The Western model, it says, is made of “neoliberal ideological content, insensitivity towards national sensitivities and over-focus of certain at-risk groups such as drug addicts and LGBT people.”

The Russian model, on the other hand, “takes into account the cultural, historical, and psychological characteristics of the Russian population, and is based on a conservative ideology and traditional values.”

The Russian model

The science says the Russian model isn’t working.

Approximately 93,000 new HIV cases were reported in Russia in 2015 – a per-capita rate almost fifteen times that of Australia. A million people in Russia have HIV, including almost one percent of all pregnant women – the threshold for a generalised epidemic.
Dr Vadim Pokrovsky heads up Russia’s federal AIDS research centre and is a longtime critic of the Kremlin’s HIV policies.

“The last five years of the conservative approach have led to the doubling of the number of HIV-infected people” Pokrovsky told AFP last year.

The arch-conservative head of Moscow City Council’s health committee, Lyudmila Stebenkova, described Dr Pokrovsky last year as a “typical agent working against the national interests of Russia.”

Not surprisingly, Pokrovsky doesn’t think much of RISR’s report.

“They use some questionable sources of information and incorrectly interpret the data they present,” he tells me from Moscow.

“Their arguments are not convincing.”

The Western contraceptive industry

According to Igor Beloborodov, one of the RISR report’s co-authors, attitudes to condom use is one of the main factors behind Russia’s HIV epidemic.

“The [Western] contraceptive industry is interested in selling their products and encouraging underage people to engage in sex,” he told Moscow City Council.

He and his RISR colleagues argue in the report that condoms “create the illusion of the safety of sex” and should not be “gratuitously distributed” in Russian schools. The solution, they say, is to completely abstain from sex outside of (heterosexual) marriage.

Dr Pokrovsky is dismissive of arguments like these.

“This is traditional rhetoric that was used thirty years ago and still used in conservative circles throughout the world. It is not particularly troubling evidence.”

Pokrovsky also takes issue with the report’s argument that “risk elimination” – in other words, completely giving up drugs and extramarital sex – is superior to harm reduction approaches.

He stresses that “risk elimination” is actually impossible. “The experts who understand this know that people cannot just give up extramarital sex,” he says, “and people dependent on drugs cannot just stop using them.”

‘AIDS and drugs will solve each other’

Even though 60 per cent of HIV-positive Russians are injection drug users, methadone replacement therapy remains illegal in Russia despite clear evidence of its effectiveness.

It’s an approach that has led some commentators to question if the Kremlin is even that interested in the fight against HIV at all.

“I have had conversations with Russian government officials who have said things like ‘AIDS and drugs will solve each other,'” Daniel Wolfe, director of the International Harm Reduction Program at the Open Society Foundations (an organisation funded by frequent Kremlin target George Soros), told The Verge.

“So I think there’s some question about whether or not Russia is actually committed to protecting the lives of everyone, or whether drug users fall into the category of ‘socially unproductive citizens’ the state might just as well do without.”

In Moscow, Anya Sarang worries about the impact the “information war” rhetoric from the Kremlin and its allies might have on Russian with HIV.

“It send the completely wrong message,” she says of the RISR report. “Basically this report is saying that the HIV problem is something made up by western media.”

“The Russian population is really psyched up now with this whole anti-Western ideology and discourse,” she warns. “People might take this seriously and think ‘oh, HIV isn’t a Russian problem – it’s just a part of the information war.'”