Joint UN Programme of Support

The Joint UN Programme of Support on AIDS in Ukraine 2012-2016

The Joint UN Programme of Support on AIDS for 2012-2016 (JPS) is a living document summarizing the coordinated efforts of the UN Agencies, the UNAIDS Secretariat, and IOM to support the Ukraine’s national response to the HIV epidemic in one single five-year strategic framework.

The purpose of the JPS is to articulate the joint approach which the UN Agencies are taking in strengthening cooperation with the Government and other partners in Ukraine in countering and accelerating efforts in combating HIV epidemic, to define their roles and responsibilities, and to serve as a planning mechanism by which the Joint UN Team on AIDS can best technically support the implementation of the National AIDS Programme and reach Zero New HIV Infections, Zero AIDS-related Death, and Zero Discrimination in Ukraine.

The development of the JPS has been driven by the UN Agencies’ common goal to maximize the effectiveness of the assistance which Ukraine is receiving to combat the HIV epidemic and to mitigate its consequences in the interests of country’s development.

The JPS is subsumed under the Government of Ukraine-United Nations Partnership Framework for 2012-2016 and the main priority areas of individual and collective work of the resident and non-resident UN organizations, identified in accordance with the joint strategic planning for 2012-2016 and workplanning for 2012-2013.

The JPS is an expression of strategic choices made by the UN Country Team and the Joint UN Team on AIDS on how to best support in 2012-2016 the effective implementation of the National AIDS Programme and reach the National Targets for Universal Access and the Zero goals in Ukraine.

The strategic areas of support and partnership identified in the JPS reflect the goals of the Political Declaration for 2012-2015 and the UNAIDS Strategy for 2011-2015, of which the five priority areas of support for the JPS have been selected in response to the identified gaps in and priorities of Ukraine’s response to the HIV epidemic.

Priority Area 1: Universal Access for People Who Use Drugs and Prisoners

Priority Area 1: Universal Access for People Who Use Drugs and Prisoners

As the unsafe injection of drugs continues to be the leading mode of HIV transmission in Ukraine, people who use drugs by injection remain a priority for HIV interventions, with harm reduction programmes now in place in all regions of the country. However, these programmes cover only one-third of the estimated 278,00-387,000 people who inject drugs and provide only a minimal package of prevention and care services.

While the National AIDS Programme’s goal is to reach with substitution maintenance treatment (SMT) 20,000 opioid dependant injecting drug users by 2013, the current coverage is only little over 6,632 clients that corresponds to only 2.7% of the number of opioid drug users in Ukraine. People who inject drugs comprise only 8.3% of those that have access to anti-retroviral treatment (ART) while they represent the majority of the cumulative people living with HIV. Prisoners remain another highly vulnerable group as only small scale and narrow scope HIV prevention and care services are provided in correction facilities in Ukraine. Currently only 12% and 15% of prisoners have access to HIV testing and prevention services, respectively.

The JPS strategic Priority Area 1 and the corresponding Outcome is to ensure that by 2016, the coverage of needle and syringe programmes, SMT, timely and uninterrupted ART, care and support for people who use drugs, prisoners and those living with HIV is increased, through strengthened leadership, capacities, policies and legislation that are evidence-based and human rights focused.

Within this specific outcome, UNODC will serve as a convening agency with the support of WHO and UNAIDS in the implementation.

The specific activities will be implemented under the following five Outputs:

  • - Policy and legal frameworks concerning narcotic drugs, criminal justice, prison management and those related to HIV reviewed, revised and harmonized to support evidence-informed and human-rights based comprehensive approaches in addressing HIV epidemic among people who use drugs and in prison settings.
  • - Service protocols, guidelines and quality standards of HIV related services for people who use drugs and in prison settings are developed, regularly updated in line with international guidelines and standards, and used by service providers.
  • - Capacities of government and civil society organizations are improved to deliver comprehensive, integrated, gender-sensitive and age-specific HIV prevention and care interventions for people who use drugs and in prison settings
  • - Model of integrated and easily accessible services system that would allow for the implementation of evidence-informed, large-scale and comprehensive interventions for people who inject drugs and in prison settings developed and disseminated.
  • - Strategic information on people who use drugs and people in prison settings as well as on accessibility of comprehensive HIV prevention, treatment, care and support services for them available for policy and programme enhancement, and for resource mobilization.

Priority Area 2: Reducing Sexual Transmission

Priority Area 2: Reducing Sexual Transmission

The sexual transmission of HIV is emerging as the increasing trend in Ukraine and is closely linked to risky sexual behaviour among and with people who inject drugs, sex workers (SWs), men who have sex with men (MSM) and adolescents at higher risk of HIV exposure, and continues to be one of the most difficult modes of HIV transmission to address. Access to HIV prevention services is limited among SWs, MSM and transgender people, with only 61.2% of SWs and 53.1% of MSM being provided HIV prevention services in the last 12 months. Although the share of the burden of the HIV epidemic is prominent among these key populations at higher risk of HIV exposure, the policy and legal barriers often stand in the way of adequate access of these groups to the HIV prevention services.

The UN system calls for promoting respective changes in policies and practices addressing the needs of these key populations at higher risk of HIV exposure and of young people, as well as individual and community level behavioural change that result in sexual health, scaling up access to prevention commodities and services, and supporting the leadership of people living with HIV for ‘positive health, dignity and prevention’. In the Ukrainian context, it strives for these key populations and their partners to have access to integrated services for HIV prevention, reproductive health and sexually transmitted infections (STIs) services, and mainstreaming HIV and AIDS into broader healthy lifestyle curriculum and extra curriculum activities for youth. The UN system supports empowerment of the key populations to both demand and access comprehensive and acceptable packages of HIV prevention, treatment, care and support services, and the law enforcement agencies, the judicial and other systems to protect their rights.

The JPS strategic Priority Area 2 and the corresponding Outcome is to ensure that by 2016, integrated and combination HIV prevention of sexual transmission of HIV among key populations at higher risk of HIV exposure and their partners, and young people are scaled up through enhanced policies, capacities and systems strengthening.

Within this specific outcome, UNFPA will serve as a convener with the co-convening support of UNICEF (focusing on adolescents at higher risk of HIV exposure) and UNDP (with the focus on MSM), and the support of WHO, UNAIDS, UNESCO, ILO and IOM in the implementation.

The specific activities will be implemented under the following three Outputs:

  • - National policies, programmes and tools are developed / revised, enhanced based on the evidence and effectively implemented to better address HIV prevention among key populations (SWs, MSM), adolescents and youth at higher risk of HIV exposure.
  • - HIV mainstreamed into broader healthy lifestyle curriculum and extra curriculum educational activities aimed at HIV prevention among children and youth and reduction of stigma and discrimination towards people living with HIV.
  • - Key populations at higher risk of HIV exposure and their partners have access to integrated HIV, STI and reproductive health services of high quality.

Priority Area 3: Elimination of Mother-to-child Transmission of HIV

Priority Area 3: Elimination of Mother-to-child Transmission of HIV

As the High Level Meeting on AIDS and the Political Declaration called in June 2011, the virtual elimination of mother-to-child transmission (MTCT) is a high global priority. Ukraine is one of those countries that may reach that goal by 2015. The country made a significant progress since early 2000s with the MTCT rate being reduced from 27.8% in 2001 to 4.7% in 2009, but much more needs to be done to prevent mothers from dying and babies from becoming infected with HIV. In Ukraine, the use of ARV medicine for prevention of mother-to-child transmission (PMTCT) among people who inject drugs and other people, respectively, was: none 12% versus 5%; single-dose nevirapine only 27% versus 9%; zidovudine and singledose nevirapine 45% versus 68%; and ART 16% versus 18%.

For Ukraine to eliminate vertical transmission of HIV and reduce AIDS-related maternal mortality, the JPS strategic Priority Area 3 and the corresponding Outcome is to support Ukraine in that by 2016, access to HIV testing and ARVs, prevention of unwanted pregnancies and HIV prevention increased, especially for the vulnerable and at risk women.

Within this specific outcome, UNICEF will convene the implementation of the activities with the support of WHO, UNFPA, UNAIDS and UNODC.

The specific activities will be implemented under the following two Outputs:

  • - The National Strategy for elimination of the new HIV infections among children and keeping their mothers alive supported by comprehensive, costed and adequately budgeted strategic plan that is integrated into the new National AIDS Programme 2014-2018.
  • - All women, including those excluded, vulnerable and at risk, have access to quality PMTCT, HIV and reproductive health services provided in accordance with equity principles and international standards.

Priority Area 4: Universal Access to Treatment

Priority Area 4: Universal Access to Treatment

Increased access to treatment makes an impact on significantly reducing HIV-related mortality, enabling people to lead healthy lives. Ukraine has made a remarkable progress in scaling up ART programme in the recent years. However, it is estimated that only one half of the estimated 230,000 people currently living with HIV in Ukraine is aware of their HIV positive status and, as a result, only 106,225 people have been diagnosed with HIV and are in HIV care in specialized health care facilities by the beginning of 2012.

According to the official statistics, only 26,720 people living with HIV currently receive treatment in the country that corresponds to only 22% of the coverage of the estimated need in ART based on the 2010 WHO guidelines, which is one of the lowest in the world. Only a small proportion (8.3%) of those who are currently receiving ART in Ukraine are people who inject drugs. Another serious challenge for Ukraine is to tackle the high rate of tuberculosis (TB) co-infection among people living with HIV that reaches over 60% in some regions of the country, and the continuous growth of the TB/HIV mortality (0.1 in 1999 compared with 3.9 in 2007 and 5.5 in 2009 per 100,000 of population).

One of the core challenges for Ukraine to ensure universal access to HIV treatment, prevention and care through health care is the ineffective protection of the population from the risk of high health care costs and the inefficiencies of the health systems. It is therefore of utmost importance that HIV is included in the ongoing health sector reform and respective policy decisions, financed through new financial arrangements and mechanisms, and well integrated with other specialized services and decentralized for ensuring better access.

To support Ukraine in filling these gaps, the JPS strategic Priority Area 4 and the corresponding Outcome is to ensure that by 2016, universal access to timely, integrated, uninterrupted and high quality HIV and TB treatment for people living with HIV is achieved with enhanced policies, stronger evidence and strengthened health systems.

This specific outcome will be convened by WHO with the support of UNICEF, UNDP, UNAIDS, and the World Bank in the implementation.

The specific activities will be implemented under the following three Outputs:

  • - Evidence-based policies and tools for scaled up and quality treatment, care and support for adults and children living with HIV are developed, regularly updated and implemented in line with international standards.
  • - Integrated care models for patients with HIV, TB and drug dependence are developed, implemented, evaluated and expanded.
  • - National capacities for generation and use of the strategic information are strengthened to enable effective planning and implementation of the national and regional programmes.

Priority Area 5: Enabling Laws, Policies, Practices and Systems, Reduction of Stigma and Discrimination, Gender Equality and Protection of Human Rights

Priority Area 5: Enabling Laws, Policies, Practices and Systems, Reduction of Stigma and Discrimination, Gender Equality and Protection of Human Rights

Punitive laws, polices, practices, stigma and discrimination can block effective responses to HIV by driving people away from HIV services and reducing an individual’s ability to avoid HIV as well as impact people living with HIV. The enforcement of these problematic laws and policies, and on the other hand, punitive practices still exist even with the enabling legal and policy frameworks that are in place.

Over 50% of people living with HIV in Ukraine report being stigmatized and discriminated against. All of these factors restrict many people’s equal access to health, social, education and other services, employment, property and other rights. Law enforcement often drive people who use drugs, SWs and MSM underground and away from HIV services, which also is the case when laws criminalize HIV transmission. Hence, in Ukraine as in many other countries, it is important to put in place enabling laws and policies, remove punitive practices, and strengthen measures that ensure that all people benefit from HIV services and programmes and have access to justice, regardless of health status, gender, residence, sexual orientation, drug use or sex work.

The JPS strategic Priority Area 5 and the corresponding Outcome is to ensure that by 2016, Ukraine has the laws, policies, practices and systems in place that ensure effective HIV response, gender equality, and reduction of stigma and discrimination.

Within this specific outcome, UNDP and UNAIDS will convene the implementation of activities with the support of ILO, WHO, UNODC, UNFPA, the World Bank, UNHCR, UNESCO and IOM.

The specific activities will be implemented under the following seven Outputs:

  • - The State AIDS Law is operationalised and effectively implemented.
  • - The National AIDS Strategic Framework and Programme on AIDS for 2014-2018 are developed to incorporate comprehensive, evidence-informed, prioritized, efficient and coasted prevention, treatment, care and support programmes addressing vulnerable key populations at higher risk of HIV exposure, human rights and gender, and are effectively implemented and show impact.
  • - The national coordination structures and systems for AIDS are effective in multi-sectoral coordination and overseeing the implementation of the National AIDS Strategy and Programme and the Global Fund supported programmes, addressing punitive laws, policies and practices, efficiency gains, and showing the impact on the HIV epidemic.
  • - Health, law enforcement, judicial, education and other sector workers are empowered to reduce discrimination towards people living with HIV and other vulnerable populations in respective areas.
  • - The National Tripartite Cooperation Strategy on HIV and AIDS in the World of Work is adopted and implemented based on provisions of the global ILO Recommendation 200 to address HIV in the world of work with a focus on non-discrimination.
  • - Support in development and implementation of multi-sectoral gender strategy in HIV response and its integration in the national gender policies is provided.
  • - Appropriate mechanisms are in place to monitor and respond to violation of human rights, stigma and discrimination to inform the practices, policies and HIV and other programmes on the ground.