The region is one of only two in the world where HIV mortality and infection rates are getting worse.
KIEV, Ukraine -- Natalia Kovnir says she's heard a "million" horror stories from acquaintances about the moment they found out they were HIV-positive. Her story, she adds, is no different. "I found out about my diagnosis in 1997. I was taking drugs," Kovnir says. "The doctor uttered this phrase -- I've never forgotten it, in all these years. He said: 'It's your own fault. You got yourself into this. You'll live a couple more years, and then we'll be saying goodbye.'"
Kovnir has defied her doctor's grim prognosis. Fifteen years later, she is one of 230,000 people living with HIV in Ukraine -- a country at the epicenter of a region that remains stubbornly resistant to remarkable progress elsewhere in the battle against AIDS.
The United Nations AIDS agency (UNAIDS) says rapid improvements in treatment and prevention measures have reduced the rate of HIV infections by more than 50 percent in 25 countries across the world -- including in sub-Saharan Africa, where the disease has proved most devastating. An estimated 34 million people are currently living with HIV around the globe. But in a report timed to mark World AIDS Day on December 1, UNAIDS says it's now realistic to think about "getting to zero" -- zero new infections and zero AIDS-related deaths.
That optimism, however, does not extend to the former Soviet space. Together with the Middle East, it remains the last place on earth where the AIDS crisis is getting worse rather than better.
Bringing It Home
In the past decade, post-Soviet countries have seen the rate of HIV infections rise steadily, from 130,000 a year in 2001 to 140,000 in 2011. The number of AIDS-related deaths has also seen a 21 percent spike in the past six years. (The UNAIDS regional statistics cover a total of 28 countries in Eastern Europe and Central Asia, including the Balkans and former Soviet states now in the EU -- where the rates of infection are far lower.)
Jean-Elie Malkin, the UNAIDS director for the region, says the root of the problem lies in Russia and Ukraine but that the disease is quickly crossing borders. "Russia and Ukraine together represent more or less 90 percent of the epidemic in the entire region. But this increasing epidemic is seen in all the countries of the region," Malkin says. "There's not only an increasing epidemic among the vulnerable population of IDUs -- injecting drug users -- but from the IDUs, the epidemic is now moving to the general population through their sexual partners."
To some degree, migration has contributed to the spread of the virus. Increasingly, labor migrants from Tajikistan and Armenia are contracting the virus through drug use or sexual contact in Russia or Ukraine. They transmit the infection to wives or other sexual partners back home, who then run the risk of passing it on to their children. But to a far greater extent, it is poverty and government inaction that is driving the problem.
Exposing a 'Hidden Population'
Elsewhere in the world, needle-exchange programs have led to a significant drop in HIV infections among IDUs. And consistent access for HIV-positive patients to antiretroviral drug therapy has been proven to reduce by more than 90 percent so-called "onward" transmissions from one sexual partner to another, or from a mother to her newborn.