Ukraine AIDS epidemic could lead to slower growth, fewer workers, warns new report from World Bank and International HIV/AIDS Alliance in Ukraine
Kyiv, Ukraine, 29 June 2006: If Ukraine’s AIDS epidemic is not curtailed quickly, by 2014 the country’s economic growth could decline by at least 6 %, warns a new study released today.
Titled Socioeconomic Impact of HIV/AIDS in Ukraine, the report finds that HIV/AIDS is a major obstacle to economic growth in the country, affecting households, businesses, and the government. Since the young and women are hit hardest by the epidemic, Ukraine’s already declining population would shrink even faster in a generalized epidemic. A worsening epidemic could also lead to reduced labour supply and worker productivity, ballooning health care costs, and decreased public and private savings and investment.
Conducted jointly by the World Bank and the International HIV/AIDS Alliance in Ukraine, with support from UNAIDS and other donors, the study assesses the medium- to long-term impacts of HIV/AIDS and evaluates the effects of prevention and treatment. Based on several scenarios, estimates are provided on socioeconomic effects with AIDS (both optimistic and pessimistic), compared to a ‘no AIDS’ baseline. Parameters are the rate of mother-to-child transmission, the rate of progression from HIV to AIDS, and availability of anti-retroviral therapy.
“Ukraine’s adult prevalence rate could rise from 1.4 % now to between 1.9 and 3.5 %, depending on projection assumptions,” says Shiyan Chao, lead author and Senior Health Economist in the World Bank’s Europe and Central Asia Region.
By 2014, the total number of HIV-positive people could range from 478,500 under the optimistic scenarios to 820,400 under the pessimistic one.
The spread of HIV/AIDS would exacerbate Ukraine’s already-adverse demographic situation: without AIDS, low fertility rates would drive the Ukrainian population down to 44.2 million by 2014; with it, an additional 300,000–500,000 would be lost, leaving a total population of 43.9–43.7 million.
While injecting drug use remains the primary source of HIV transmission in Ukraine (72% of cumulatively reported cases among adults), an increasing number of cases are emerging among the heterosexual partners of injecting drug users and among children.
The southern and eastern regions of Ukraine are the most affected – including the oblasts of Dnipropetrovsk, Donetsk, Odesa, Mykolaiv, and the Crimean Republic. While a third of the country’s population lives in these regions, they constitute two-thirds of all officially registered HIV cases. Western Ukraine remains the least affected.
The epidemic could hit such labour-intensive sectors as agriculture and mining particularly hard, in part because such activities are concentrated in the higher-prevalence southern and eastern regions. For example, output in the agriculture, hunting, forestry, and fishing industry between 2004–2014 were all expected to experience slight declines even without AIDS, but under the pessimistic scenario, they would experience a further decline of 1.2–1.3% compared to the ‘no AIDS’ scenario. Next comes transport and communications (a reduction of 1.2–2.2%), and construction (minus 1–1.8%).
Given the relative share of the above sectors in trade, the worst-case scenario anticipates a fall of 40% in exports of these sectors, which translates into 5.5% fall in GDP, an 8% fall in total welfare, and a 9% fall in investment.
Echoing the underlying demographic decline of 10.4 % from 2004–2014, HIV/AIDS will cause an additional 1–2 % reduction in the labour force nationwide. The epidemic could contribute to labour force shrinkage in the worst affected areas at rates of 2.7–3.6 % for Donetsk and 2.2–4.2 % for Odessa.
“The epidemic’s impact on economic, demographic and health status is potentially very serious," says Paul Bermingham, World Bank Director for Ukraine, Belarus and Moldova. "The World Bank remains strongly committed to work with the Ukrainian government, in partnership with other international organizations, to tackle HIV/AIDS epidemic in Ukraine.”
Ukraine’s response to HIV/AIDS
Ukraine’s national response to the epidemic has received increasing attending in recent years, and a national programme for 2004–2008 is being implemented, with patchy results to date. On the positive side, 35 regional AIDS centres are operating and more than 3,000 patients are receiving anti-retroviral therapy. Moreover, as a result of ART programme implementation the AIDS death rate yearly increase has dropped, as the AIDS Centre reports. However, speeding up the response requires intensified and better-coordinated efforts, particularly in terms of engaging non-governmental organizations and improving procedures for procuring and distributing AIDS drugs, treating tuberculosis, and funding local prevention, care and support projects.
“If we miss a chance to reverse the flow of the epidemic today through preventing new HIV cases, tomorrow we would be thinking of providing the growing number of positive people with treatment and care”, says Andriy Klepikov, Executive Director of the International HIV/AIDS Alliance in Ukraine. He emphasizes that “without rapid scale-up of focused prevention efforts, particularly among injecting drug users, HIV treatment will never become socially and economically sustainable”.
Policy recommendations
The five-year period from 2006 to 2010 will be decisive for addressing the HIV/AIDS epidemic in Ukraine. Success can only come from sustained national commitment, including allocation of appropriate funding from the domestic budget for key prevention, care and treatment activities. Supported by local and international resources, Ukraine can focus on realizing the most difficult components of HIV/AIDS work:
- implementation of substitution therapy programmes for injecting drug users through usage of substitutes (buprenorphine and methadone);
- large-scale coverage with prevention services of injecting drug users, who remain the most vulnerable group to HIV/AIDS;
- access to treatment for those HIV-positive people who have associated illnesses, first and foremost tuberculosis.
“The current transmission pattern signals a need for a prevention strategy focused on harm-reduction programmes (such as methadone substitution and distribution of clean needles) as well as sex education for youth. Even though the mode of transmission is evolving towards heterosexuals, injecting drug users still constitute the majority of those infected; a special effort must be made to reach them, particularly in the worst-affected regions,” the report concludes.
For any enquiries, please contact:
Taras Pepa (+380 44) 201 64 77
E-mail: pepa@aidsalliance.org.ua
or
Dmytro Derkach (+380 44) 490 66 71
E-mail: dderkatch@worldbank.org
