Miracles from despair

Rampant drug abuse and sex trafficking have made Ukraine the site of Europe's worst AIDS epidemic, as political turmoil and unemployment have frayed its social fabric. But some women have decided to stand up and save themselves and their daughters -- and to prove that courage can create hope.

Devastating news for a young mother
Tatyana had no idea of the devastating news she was about to learn as she sat in a Kiev hospital bed cradling her newborn baby girl in January 2003. When the nurse uttered the words, "You are HIV positive," Tatyana simply stared back, bewildered. She had heard whispers about HIV but had no idea what it actually was. As the nurses explained, the 16-year-old came to understand the severity of her fate: she was infected with an incurable disease in a country lacking the resources to properly treat her.

Tatyana was not a drug user, nor was she sexually promiscuous. When she was first tested for pregnancy, she also had a blood test, which came back negative for HIV. However, when she was back in hospital months later to deliver her baby, new blood tests determined that she was HIV positive. What accounts for the discrepancy? "I remember the nurse at the first blood test coming into the hospital room with an unwrapped needle to take my blood," she says in a raspy voice, her head bowed and fingers fidgeting nervously. "I was too shy to ask the nurse if the needle was clean because she was the nurse and I thought she was the expert." Tatyana suspects she contracted HIV from that dirty needle.

After learning what HIV actually is, Tatyana fell into a deep depression. "I thought I would be completely isolated, that nobody would like me," she says. Sadly, hers is a fate that is becoming all too common for women in Ukraine, a country in the midst of an AIDS epidemic. The doctors, social workers and volunteers who help Tatyana and others like her are trying to stem the tide of an immense social upheaval that is threatening their country's health.

A collective sense of hopelessness
In 1991, just five years after the catastrophic Chornobyl nuclear explosion, Ukrainians gained independence from oppressive Soviet rule and sweeping economic reforms were promised. All too soon, however, widespread corruption plunged Ukraine into poverty and despair. Escalating unemployment and widening inequality between the ruling class and the remainder of the population led to a collective sense of hopelessness. It didn't take long for criminal networks to flood the country with illegal drugs, readily available through the porous borders of Central Asian countries that connect the heroin fields of Afghanistan with Ukraine. Cheap heroin, in turn, fuelled rampant drug abuse. The crime rings also zeroed in on the desperation of millions of unemployed by targeting the country's most vulnerable citizens: unemployed women willing to take on any type of work to support themselves and their families. Thousands have been lured into the sex trade via bogus job offers and sold into slavery in Turkey, Russia, Germany and other countries.

Because it is illegal to possess an unauthorized needle in Ukraine, narcotic users share the few needles they have, spreading the HIV virus. In the sex trade, vulnerable young women are often denied the right to use a condom. So today Ukraine is not only battling drug and human trafficking epidemics but also an escalating HIV epidemic. The virus is poised to spread to the general population: A recent United Nations AIDS report predicted that by 2010, six per cent of Ukrainians will have HIV. (In Canada the rate is 0.3 per cent.) Official statistics from UNAIDS estimate that 360,000 of Ukraine's 47 million people are already living with HIV/AIDS, but many Ukrainian medical experts, including Dr. Svitlana Komar, chief consultant for the Ukrainian AIDS Centre on Pediatric Issues, believe the actual number is five or six times greater. Ukrainian women account for 40 per cent of those infected, and without access to antiretroviral drugs, these women are at risk of having babies born with HIV, too.

"The more I work in this area," says Komar, "the more I realize it's mostly a social, economic and political issue rather than a medical issue. Our health ministry is our national disgrace," she says. "Nongovernmental organizations should not be substitutes for the state, but they are."

Photographs by Heather Buchan. Produced with the support of the Government of Canada through the Canadian International Development Agency.

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A testament to women's resilience
Ukraine's government has been slow in responding to the epidemic, partly due to the stigma associated with HIV/AIDS and partly due to the costs involved. The fear of discrimination prevents many women from seeking medical treatment. In the past, people who acquired sexually transmitted diseases were put in sanitariums. And Ukrainian drug users and sex workers could also be imprisoned for breaking antidrug and antiprostitution laws.

Yet optimistic inroads are being laid by a few courageous and determined Ukrainian women. These dedicated frontline workers -- some doctors, some social workers, some counsellors, some HIV positive themselves -- make tireless efforts to combat the AIDS epidemic, drug addictions and sex trafficking of women plaguing their country. They are a testament to women's resilience. They have stepped up to the plate where their government has failed them.

One of these women is Dr. Svitlana Antonyak, head of the Lavra AIDS clinic at the Hospital for Epidemiology and Infectious Diseases in Kiev. Antonyak and her team of four female doctors spend days and nights beside their patients' beds, despite earning miserable salaries. (The discrimination faced by AIDS patients extends to their doctors.) Antonyak's ward of 26 inpatient beds provides diagnosis, counselling and medical care and antiretroviral (ARV) treatment for patients from four to 60 years old. More than 2,000 others are registered with the clinic, receiving treatment on an outpatient basis. Currently, 265 people are receiving ARV medication, funded by the Canadian International Development Agency (CIDA) through the Global Fund to fight AIDS, Tuberculosis and Malaria.

Antiretroviral drugs slow down the replication of the HIV virus in the body. Not a cure, they nevertheless protect people whose immune systems have been weakened by HIV from becoming ill from other infections. ARVs must be taken every day once a person's immune cell count drops to a dangerous level -- a gradual process that can take several years. Under Ukraine's law on the prevention of AIDS, every citizen has the right to free medicine, yet there are no mechanisms in place to provide the drugs. So, on the whole, in Ukraine there is very little access to ARV therapy.

Dealing with psychological issues
One of the hardest parts of Antonyak's job is dealing with psychological issues. "Some of our patients become very depressed and no longer have a desire to live," she says. "My female patients, who are not only living in this country's economic instability but also living with HIV, are very brave. This is a very heavy load for them."

One such patient is 34-year-old Iryna, who found out by chance that she was HIV positive in 2004 while donating blood. Iryna was not a drug user, nor had she worked in the sex trade. She had, however, been living with a boyfriend who used intravenous drugs and has since died. When recalling the day she found out her positive status, her eyes instantly well up with tears.

"Emotionally, I was terrible. I thought I was going to die. I remember when I left the hospital with my mom -- colours just faded and I was in a fog," she says, wiping away fresh tears. "I feel regret for the old days and despair for the future. All I thought of was how people would be afraid of me."

Fortunately Iryna received the psychological support she so desperately needed as well as proper medical assistance to treat herpes, a common co-infection of HIV. "Dr. Antonyak spent hours both day and night supporting me," she recalls. Inspired by her doctor, Iryna now works as a social worker at the Centre for Social Services for Youth with HIV/AIDS in Kiev, providing 36 clients with medical checkups, food rations and other social services.

Photographs by Heather Buchan. Produced with the support of the Government of Canada through the Canadian International Development Agency.

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A need for education
Lack of health education in Ukraine is one of the factors that has fuelled the epidemic. Olga Panfilova (see "My Child, Our Children," below) discovered her positive status in 1999. "I knew there was AIDS somewhere in Africa," she says. "When I was told, I thought, Well, I just have five years to live."

It's not just HIV positive women like Olga who need more education, however. The Canadian Society for International Health, with $2 million in funding from CIDA, recently launched the Positive Children Project in Ukraine to help health care professionals and social workers improve the way they care for HIV positive children. Canadian AIDS experts are being matched with Ukrainian counterparts to provide training and mentoring.

The epidemic is spreading to children because Ukrainian women account for 40 per cent of those currently living with HIV/AIDS in Ukraine. Pregnant women should take ARV drugs to prevent HIV infection in their unborn babies since the mother's blood can mix with the baby's blood during pregnancy or during labour and delivery. But ARV therapy is often not available, and over the last five years, the number of HIV-infected pregnant women has risen five-fold. An estimated 20 per cent of HIV positive babies are abandoned.

"We [Ukraine] need a goal to stop mother-to-child transmission," says Komar. "It's easy. Absolutely easy," she adds emphatically. "We have to implement hard, active ARV therapy during pregnancy for all positive women. As far as I know, there hasn't been one case of mother-to-child transmission in the United States for more than 10 years now."

Three years after being diagnosed HIV positive, Tatyana, now a 19-year-old single, unemployed mother, still has a healthy white blood cell count and doesn't yet require ARV drugs. But what happens when the day comes that she does? "I don't look into the future," she murmurs in a barely audible voice. The newborn she cradled in her arms on that fateful day is now a three-year-old girl named Marina, who, to Tatyana's relief, tested negative for HIV. "I just live one day at a time." That's all she and her Ukrainian sisters, who have faced and continue to face incomprehensible hardships, can do. But it's the dedication, compassion and tireless efforts of a handful of women like Antonyak and Komar, Olga and her children's program, and other groups supported by generous Canadians through CIDA that sustains the growing numbers of HIV-positive Ukrainian women and nourishes their hope from day to day. For it seems that for many, hope is all that's on their side.

Last November CIDA announced a further $60 million commitment to fight AIDS, including funds specifically for women.

My child, our children
Ukrainian medical experts believe there are more than two million HIV-positive people living in Ukraine, 40 per cent of them women. Olga Panfilova, 32, and her eight-year-old-daughter Yana (above) are both HIV-positive. Once an intravenous drug user, today Olga works at the All-Ukrainian Network of People Living with HIV/AIDS, an organization that receives funding from CIDA through UNICEF, as the manager of their program for children. "I joined because helping others helps yourself," says Olga. She establishes centres for HIV-positive children, trains staff and finds foster homes for AIDS orphans.

So far the network has founded 11 centres; each supports 50 children from babies to 10 years old. Olga also promotes tolerant attitudes. "It's very hard to get your child into a school if it's known that she is positive," says Olga. "And, if it's disclosed that a child is HIV positive once she's in school, many times she's expelled. Most Ukrainians think HIV is contagious like a cold." Olga and her team also help HIV-positive children get proper treatment when caregivers don't adhere to antiretroviral therapy. "We think it's an unconscious desire to stop the suffering of the child," she says sadly.

Photographs by Heather Buchan. Produced with the support of the Government of Canada through the Canadian International Development Agency.

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Women stolen and sold
Twenty-one-year-old Irina Derebchinskaya was deceived by a college girlfriend. Three years ago, the so-called friend offered to help unemployed Irina get work as a cleaning lady in Turkey. The friend paid for Irina's flight, accompanied her to Istanbul and brought her to a hotel where a man, claiming to be the friend's boyfriend, took Irina's passport and told her she would work as a prostitute. She was put in a room with four other girls where she was forced to have sex with as many as four men a day. "My pimp decided the hours I worked. It could be during daylight, or they would wake me up at night. The clients offered me more money not to use a condom, but I stayed safe," says Irina. "I was so afraid. I wanted to go home. They said I had no rights and I had to earn back the money they paid for my flight if I wanted to leave."

Women account for 75 per cent of those who are unemployed in Ukraine and, like Irina, many thousands fall prey to bogus offers to work abroad as waitresses, models, nannies and maids. The jobs are advertised in newspapers, offered through job agencies or suggested by friends and relatives who themselves have been tricked or coerced into participating in the scams. Especially in poor rural communities, criminals offer large sums to people for betraying their sisters, nieces, cousins, daughters or girlfriends.

Other women voluntarily opt to work in the sex trade, hoping for fair pay, but are not aware of the debt-bondage often imposed by ruthless pimps, or that they will be denied the right to choose clients or safe sex methods.

Virtually every town and city in Ukraine has lost women and girls to sex trafficking, and, sadly, the stories are all too similar. When 18-year-old Snejana was offered a job as a waitress in Moscow in 2005, she jumped at the chance. After all, the person offering her the work was a girlfriend from her village on the outskirts of Odessa. So Snejana and her sister boarded a train for Moscow, paid for by the friend. When they arrived at the friend's flat, there was a man there who confiscated their passports and took them to a street near the railway station. As Snejana recounts the indignities she endured, she bows her head, staring at the floor: "There were 50 girls there, all from Ukraine. They priced us according to our looks. The pretty girls were more expensive -- $150. I was in the $100 group."

From 12 to 6 a.m., Snejana and her sister were forced to walk the street along with the others and have sex with Russian men under the ever-watchful eye of pimps, sitting in cars across the road.

According to the International Organization for Migration (IOM), which has received funding from CIDA, sexual slavery is the fastest growing crime internationally. IOM's education campaigns aim to prevent people from falling prey to traffickers; they also provide legal aid, counselling and medical care for victims and help them restart life in their home communities.

Not everyone is enticed with a job offer: Wendy Lu McGill, IOM's public information officer, recounts a case in which "young Ukrainian girls between 11 and 18 from rural areas were being kidnapped to Moscow and sold for their virginity. It was a huge criminal ring and the clientele were Russian men."

Photographs by Heather Buchan. Produced with the support of the Government of Canada through the Canadian International Development Agency.

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Although there are no official statistics on the number of trafficked Ukrainian women, Mariana Yevsyukova, a legal counsellor at La Strada-Ukraine, says that "Women from 18 to 28 years old and from small towns and villages are the most vulnerable." La Strada-Ukraine, which receives funding from CIDA through a partnership with the Organization for Security and Co-operation in Europe, is a nongovernmental, nonprofit organization with a full-time staff of 15 that is dedicated to preventing the trafficking of human beings, especially women and children. In 2002 La Strada-Ukraine introduced a nationwide toll-free hotline to provide women with information on their human rights and to consult with them on the validity of job offers. Since its inception, the hotline has received more than 29,000 calls. In 2005 La Strada-Ukraine helped 198 victims restart their lives, and speakers conducted lectures in high schools and universities to raise awareness.

Faith, hope and love
After just one week, the police raided the hotel where Irina was kept, arresting the pimps and girls on prostitution charges. For two weeks, Irina was detained in jail before the police made the pimps pay for her deportation back home. And so, 20 horrific days after arriving in Istanbul, Irina stepped off a ferry in Odessa, Ukraine's largest seaport, with no money, no passport and nowhere to go.

She was found by Natalia Savitskaya of Faith.Hope.Love., a nongovernmental organization that like La Strada-Ukraine, receives funding from CIDA via the Organization for Security and Co-operation in Europe. Twice a week, Natalia stands at the base of Odessa's famed Potemkin steps and watches for girls without any belongings coming off the ferry from Turkey. When she spots one, she approaches and asks if she needs help. "They don't believe that I'm actually going to help them at first," says Natalia. "They are afraid and ashamed from what they've been through."

Natalia was Irina's saving grace. Faith.Hope.Love. not only provided Irina with psychological and medical assistance, including HIV/AIDS testing, but also put her in its re-integrational centre, where trafficked women returning to Ukraine can live. It is here that Irina met Snejana and the two became fast friends. Snejana's sister had escaped from her pimp and reported her ordeal at a police station. When the gang told Snejana to go to the station and say her sister had been lying, Snejana too filed a complaint. Though the sisters were then able to return to Ukraine, the pimps were never arrested.

The sex trade puts women at a much greater risk of HIV infection, through both sexual intercourse and drug addiction. And the recent criminalization of prostitution in Ukraine threatens to make HIV all the harder to combat, since prostitutes and ex-prostitutes are even less inclined to seek treatment for fear of incarceration. When women need medical attention, Faith.Hope.Love. flies them to a medical rehabilitation centre run by IOM in Kiev. For those women who test HIV positive, additional psychological counselling is provided by trained social workers.

Faith.Hope.Love. also provides skills training, and, through this program, Irina is now working as an assistant hairstylist at a local salon while Snejana is completing computer courses. Luckily, the HIV tests of Irina and Snejana both came back negative.

AIDS around the world
In 1981 reports began circulating in the United States about a mysterious disease that defied medical classification. By 1982 the disease was being referred to as AIDS (acquired immune deficiency syndrome) and by 1985, when AIDS cases had been reported in every region in the world and it was determined that HIV (human immunodeficiency virus) caused AIDS, the first International AIDS Conference was held
in Atlanta.

In the summer of 2006, 25 years after AIDS came onto the public health radar, Toronto hosted the XVI International AIDS Conference from Aug. 13 to 18. Scientists, doctors, health workers, policy makers, people living with HIV/AIDS and community members from around the world who are committed to the fight against AIDS gathered to share the latest medical research, answer important questions, enhance collective global action and foster accountability among all parties. To learn more, go to aids2006.org.

A century of friendship
Canada's long connection with Ukraine goes back to 1891, when the first recorded Ukrainian immigrants, Wasyl Eliniak and Ivan Pilipiwski, stepped off the ship Oregon in Montreal and took the train out west. By 1914, 200,000 more Ukrainians had settled on the prairie. Another 37,000 came to Canada after the Second World War, and 20,000 have come since 1991. According to the Ukrainian Canadian Congress, there are currently 1.2 million Canadians of Ukrainian background.

Since Ukraine achieved independence in 1991, Canada has contributed $302 million to support Ukraine's transition to democracy and a market economy. CIDA's 2005-2006 budget for Ukraine allotted $18 million to almost 30 projects committed to strengthening civil society as well as improving the environment, gender equality, overall health care and youth health and combating HIV/AIDS. CIDA has also contributed more than $46 million to the Chornobyl Shelter Fund, a project aimed at safely enclosing the remains of the Chornobyl plant so the ruins cannot collapse and release more radiation.

Meanwhile many private organizations carry out their own projects. Among them: The Children of Chornobyl Canadian Fund (chornobyl.ca) equips hospitals in the Chornobyl region and supports a summer camp for orphans; The Canada-Ukraine Foundation (wwwold.macewan.ca/nw/urdc/cuf) supports careers training, social welfare and health and medical assistance; The Ukrainian Women's Association of Canada (infoukes.com/uwac) defends the human rights of women; and the Ukrainian Canadian Congress (ucc.ca) sends volunteers to help run elections in Ukraine.

Photographs by Heather Buchan. Produced with the support of the Government of Canada through the Canadian International Development Agency.

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