Nine out of ten of the 42 million people infected with HIV live in Africa, Asia or Latin America. Countries like Zambia have been battling against the Aids epidemic for over twenty years. But new regions are now facing an AIDS crisis of their own. Eastern Europe is at the frontier of the epidemic.

The former Soviet Republic of Ukraine has one of the fastest growing HIV rates in the world. One in a hundred are now estimated to be infected by HIV. While the number of people actually dying from AIDS is still low - the virus is spreading with alarming speed. But by drawing on experience and knowledge from other parts of the world, countries like Ukraine could take the necessary steps to contain the epidemic.

Orphan brothers Mikey and Emmanuel.

With more than 200 AIDS-related deaths every day, Zambia already has over 600,000 orphans and the streets of Lusaka are becoming home to more and more children who have nowhere else to turn. The Mapode Centre in Lusaka provides food, education and accommodation for some of the city’s most vulnerable children. Many of the children fall victim to abuse and are often drawn into criminal behaviour on the streets. When they lost their mother to AIDS, brothers Emanuel and Mikey Changa Changa drifted into town.

“The big boys on the street tried to take our money and if we didn’t give it to them they beat us and so we often had to keep running away from them,” says Mikey (12). His brother Emmanuel (10) adds: “I like it here because I am sure of food here. I am sure of sleeping comfortably, I am sure of playing football, I am sure of seeing tomorrow.”

The situation in Zambia could deteriorate still further. As more people die, it's becoming increasingly hard for the devastated population to support itself. Dapheton Siame, Country Programme Director, International HIV/AIDS Alliance, explains: “Some of the recent studies have shown that we can not train up enough teachers to fill up those who have died. So what you end up with a shortage of teachers. Already we’re experiencing that – the number of nurses in the medical industry, engineers, who are dying. Now all of those have economic implications because who is going to run these things?”

The Zambian Government is introducing a network of voluntary counselling and testing (VCT) centres – a development integral to its prevention strategy against HIV/AIDS. Outreach programmes aim to reduce the stigma around HIV/Aids and help to decrease the HIV prevalence rates by confronting its secrecy.

Dapheton Siame, International HIV/AIDS Alliance

Dapheton Siame adds: “If people don’t know their HIV/AIDS status, they could be infected. And if they don’t know, then they could pass on the infection. We believe that if people know they are HIV negative, then that gives them the motivation for them to try and maintain that status.” And to take advantage of anti-retroviral drugs (ARVs) – if and when they arrive – you must know your HIV status.

Lack of funds, and battles over drug patents, have stopped anti-retroviral drugs - ARVs - reaching those who need them most - the world's poor. After the recently announced collaboration between the Clinton Foundation, the World Bank, UNICEF and the Global Fund, this looks set to change.

Tony Barnett, Research Fellow at the London School of Economics, says that ARVs are not the only answer to the problem. “But in the case of countries like Zambia during which they have got very elevated levels of infection, the anti-retrovirals will offer a window of opportunity where you can keep people alive. You can enable them to be parents, you can enable them to be producers and that is hope for the future.”

Tony Barnett, LSE

There are some hopeful signs in Zambia: in the 15-29 age-range, incidences of new HIV infections are levelling out, even declining in some urban areas. In the general adult population, though, overall numbers of infection are still increasing. Dapheton Siame says that the country still has a long way to go. “Personally, I have lost two of my young siblings who have died of HIV/AIDS. I’m keeping a number of orphans in my own home. So that’s the reality of it. I wouldn’t say the fight in Zambia is over because it’s not. We still have new people getting infected.”

While Zambia continues its 20-year battle against the HIV virus, many countries in Eastern Europe are just beginning the fight. But with insight from countries such as Zambia, will new crisis regions like Ukraine act to contain the epidemic before it spirals out of control?

“Worst case scenario for Ukraine will mean that more than a million people will die from AIDS by 2016. So it’s a very dangerous situation, and currently Ukraine has a lot of opportunities to avoid the situation,” says Andriy Klepikov, Ukraine Director of the International HIV/AIDS Alliance.

In contrast to Africa, the HIV epidemic in Eastern Europe is fuelled by injecting drug use – especially in the Ukraine. There are an estimated 30,000 injecting drug users in Kiev, Ukraine’s capital, and almost three-quarters of HIV infected adults in Ukraine are injecting drug users.

Dr Svetlana Karpilovskaya is a psychologist with the organisation Time for Life Plus. “We’ve got political freedom, but it’s the kind of freedom that nobody knows what to do with. Those who are using drugs are people who are striving for freedom. Either for the kind of freedom their parents didn’t have or they are striving for the freedom to feel themselves alive. As a result, they are chasing after freedom but getting trapped in an illusion of freedom.”

Ivan Shekker is a social worker and former drug user who is involved in outreach and awareness projects with drug addicts and sex workers in Kiev. “Young people are interested in delving into their psyche. They see poverty, they see problems and they want to get high now. They look at pensioners and ask what sort of life they will have… Ten dollars a month, death in poverty – so they want to get a high now.”

Ivan Shekker’s outreach work takes him out onto the streets of Kiev where he distributes condoms and clean needles to sex workers, many of whom are also intravenous drug users. Victoria Naumenko is a gynaecologist says that prevention is all-important: “The nation’s health is in the hands of the sex workers. And I think this is very true because a significant part of our male population use their services.”

Vlada and Julie

Ivan visits Vlada and her daughter Julie who both take drugs and are both HIV-positive. Julie sells sex for money. She says: “This is a neighbourhood famous for its drugs, so people are coming here to get drugs. Before he came along, we were giving away the same old syringes, even though we washed them out before.”

Andriy Klepikov explains that part of the problem is that AIDS is still looked on as an exclusively health issue in Ukraine. “No one is thinking in a broader context, thinking about the consequences for demography, for connecting AIDS with social conditions, with economic consequences, etc… I think to respond to AIDS, we need to make this problem more human, to cut stigma and discrimination, to link it with all society.”

Ukraine is receiving a 92 million dollar grant to support its HIV/AIDS programme. Dr Karpilovskaya is optimistic. “I think that maybe this will be the point from which our society our psychology will be changing. It’s when these people who’ve looked into nowhere can now be able to change and to help others to change as well.”

Tony Barnett stresses that money is not everything. “More money helps, but more than that, we have to remove other people’s moral agendas from the ties to money. If people want to distribute condoms, then we should support them in that. If people want to deliver sex education, then we should support them in that, if people want to distribute and control anti-retroviral drugs, then we should support them in that. But we should not tie the money to the moral agendas of rich countries whose politicians often have no conception of what’s happening in poor countries.”

TRANSCRIPT Read the full transcript of Crisis Control - Stemming the Spread of HIV/AIDS