Concerns about a surge in HIV, tuberculosis and COVID during the war in Ukraine

In addition to being brutal Immediate impact of Russian aggression, Ukrainian people are facing an onslaught of infectious diseases. Some threats, such as the COVID-19 epidemic, are immediate as people flock to basements, subway stations, and temporary shelters to protect themselves from bombing. Without adequate water and sanitation, cases of diarrheal disease will definitely increase. The risk of polio and measles is high. In addition, access to diagnostic services and treatments for tuberculosis (TB) and HIV / AIDS has been disrupted due to the rubble of medical facilities and roads, which is already very burdensome.

“I am very worried about Ukraine. First and foremost, this can lead to long-term conflicts and completely destroy the health system,” said a Romanian doctor in Geneva, Switzerland. Lucica Ditiu, Managing Director of the Tuberculosis Eradication Partnership, said. The crisis was at the height of the devastation caused by the COVID-19 pandemic, during which time immunization and access to essential medical services plummeted.

when Russia invaded on February 24Ukraine was out of the worst Omicron wave, Peaked that month. At a press conference on March 2, Tedros Adhanom Ghebreyesus, Director of the World Health Organization (WHO), means that the COVID-19 test has been underway since the conflict began. Nationally, COVID-19 vaccination rates are dangerously low, around 65% in Kyiv, but as low as 20% in some states and regions, said Jarno Habicht, head of WHO’s Ukraine office. As stated, it increases the risk of serious illness. death. (In the UK, 73% of the population is vaccinated.) Long-standing distrust of vaccines among the population also hinders immunization efforts against other vaccine-preventable diseases such as polio and polio. I’ve been.

Challenges intensify

Ukraine was already working on the outbreak of vaccine-derived polio. Last year there were two cases in western Ukraine, most recently in December. Poliovirus was also isolated from 19 healthy contacts. (The outbreak is much greater than the number of cases alone suggests, as poliovirus paralyzes only about 1 in 200 infected people.) The conflict began on February 1, with about 140,000 children. We have suspended a three-week campaign to vaccinate against polio. It also affects polio monitoring and warns the Geneva-based Global Polio Eradication Initiative that the virus may have spread undetected.

And that’s a problem. “Measles is one of the first concerns of a humanitarian crisis,” says James Goodson, a measles expert at the Centers for Disease Control and Prevention (CDC), because it is so contagious. In Ukraine, there were outbreaks that began in 2017 and continued until 2020, with more than 115,000 cases. By 2020, double doses of measles-containing vaccines had a national coverage of up to 82%, according to the CDC. This is a big improvement, but it’s still not enough to prevent a fatal outbreak. Even more worrisome, in some states, such as Kharkov, vaccination rates were less than 50%. In Kharkov, a huge number of people are fleeing conflict.

“When people come in, we really need to expand monitoring of polio, measles, and COVID to ensure they are prevented,” Heather Papowitz, WHO’s incident manager for Ukraine, said in a briefing. I did. “Measles, polio, it is most important to consider providing a vaccine for COVID.”

Tuberculosis trouble

Ukraine is one of the highest burdens in the world for multidrug resistant (MDR) TB. An estimated 32,000 people develop active tuberculosis each year, and about one-third of all new cases of tuberculosis are drug resistant. In Ukraine, 22% of people with tuberculosis are infected with HIV, and tuberculosis is the leading cause of death for people living with HIV.Tuberculosis, a disease exacerbated by congestion and poverty Mycobacterium tuberculosis.. It slowly destroys the lungs and spreads through the respiratory droplets.

Drug-resistant tuberculosis occurs when people do not follow the difficult regimens of routine medicine. “If you’re infected with tuberculosis or HIV, you don’t have time to get treatment and do it. You have little time to get a child and do it,” says Papowitz.

“Discontinuing treatment leads to drug-resistant tuberculosis, including MDRTB,” says Ditiu. “If five years have passed without treatment, 50% of patients with pulmonary tuberculosis can die. During that time, you will infect many others around you.” And of multidrug-resistant tuberculosis When treatment is interrupted, she says, “you can develop tuberculosis, which is highly drug-resistant, with few drugs available.” Diagnosis and treatment of tuberculosis patients has already plummeted by about 30% between the 2020 and 2021 COVID-19 pandemics, leading to an increase in infection.

Even in Ukraine, which has the second highest burden of HIV / AIDS in Eastern Europe, access to HIV / AIDS treatment is at stake. About 1% of the population is infected, but the number is much higher in the at-risk group, 7.5% for men who have sex with men and almost 21% for those who inject drugs. “Don’t stop treatment. Given the nature of HIV, which causes AIDS and death, medicine is life-saving,” said Raman Heilevic, Country Director of the Joint United Nations Program on HIV / AIDS. increase.

Antiretroviral therapy (ART) can suppress HIV, maintain strong immune defenses, and protect against opportunistic infections such as tuberculosis. Prevents people at risk from becoming infected with HIV. Prevents mother-to-child transmission. When taken consistently, ART can keep the viral load low enough that a person cannot be infected with HIV.

Regional crisis

“Ukraine challenged the provision of antiretroviral therapies before the war, and the war expanded those challenges,” says Hailevich, who left Kyiv on March 4 for Moldova. According to UNAIDS, an estimated 260,000 people are living with HIV in Ukraine by the end of 2020. Of these, 69% are aware of their condition, 57% are receiving ART, and 53% have achieved virus suppression. The organization’s latest global goal is 95% for each of these indicators by 2025.

Although the country has made progress, “this war can bring us back 10 years ago,” says Valeriia Rachynska, a network of all Ukrainians living with HIV / AIDS. In indiscriminate bombardment, people may not be able to get medicine. “And even if you get to a medical facility, it has to stockpile medicine,” says Hailevich.

People who escape safely may have less than a month’s supply of medicines, or two weeks’ worth, Rachynska says. She adds that those who cannot move to safe places, and those in Russia-occupied areas, are the most vulnerable.

Exacerbating the problem, Ukraine expected mass shipments of antiretroviral drugs from India in early March. The US President’s emergency plan for the AIDS Relief Initiative is currently being mobilized to fly emergency supplies to Polish warehouses. From there, it is trucked to a medical facility in Ukraine.

Opioid alternative therapies (OSTs) such as methadone can be out of reach for former injectable drug users living with HIV. The country has supplies that last until October, but “if you’re in Kharkov, Mariupol, or a Russian-controlled area, Russia doesn’t approve the OST, so it’s unlikely you’ll get it,” Hailevich said. Says.

Rachynska’s network, which has relocated its office from Kyiv to western Ukraine, is not afraid to disclose HIV status when the client travels to other European countries and instead asks the client to go to the hospital and request medicine. I’m telling you. “Everything that is happening in Ukraine is affecting other countries as well,” she said. [where people are fleeing]”It’s a real regional crisis,” WHO’s Papowitz said at the briefing.