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Ukraine: Photo Art Helps Fighting AIDS

Maryna Reshetnyak — Wed, 04 Jan 2012 05:46:56 +0000

On the occasion of the World AIDS Day (November –December, 2011) a photo exhibition of the project “AIDS- Open Faces” took place in ‘Lavra’ gallery in Kiev. The exhibition was devoted to people whose life was affected by HIV/AIDS and it was organized by the private charity Elena Pinchuk AINTIAIDS Foundation. The pictures of HIV positive people and their families presented on the exhibition had been taken by a well-known photographer Brent Stirton from New York agency ‘Getty Images’.

The images shown at the exhibition (available online) are fascinating and many of them are not easy to look at. Brent Stirton together with the activists of the foundation and other partner NGOs traveled all over Ukraine and filmed street children in Odessa, gypsy settlements, families with HIV positive children and HIV positive orphans, injection drug users, prostitutes and imprisoned people, reported the web-site of AITIAIDS Foundation. The project contains pictures of very sick people as well as ‘stories with happy end’ – images of people whose lives were saved with the antiretroviral therapy which is currently available in Ukraine thanks to international support or images of people who stopped using drugs or images of HIV positive orphans who found new families.

It was the second time when Brent Stirton came to Ukraine to film people affected by HIV. The first time was in 2005. In his video appeal Stirton compares the impressions from his first and second photo shootings.

A journalist and a blogger Olga Ivanenko who helped Brent Stirton to organize the filming in Ukraine both in 2005 and 2011 shared her reminiscence of work on the project in her blog. She wrote:

В 2005 году я принимала участие в проекте – помогала иностранному фотографу в его работе над документальным фотопроектом о проблеме ВИЧ/СПИДа в Украине. Несмотря на многочисленные ограничения в использовании снимков, фотографии Брента Стиртона до сих пор “живут” в сети своей жизнью. Они достаточно спорны и провокативны, они – “на грани”, и потому вызывают ожесточенные дискуссии и споры.

В этом году Брент Стиртон приехал в Украину снова и отснял еще одну документальную серию об проблеме ВИЧ/СПИДа в Украине. Мы встретили некоторых “героев” первой серии. Встреча с одними радовала – они смогли начать новую жизнь, нашли поддержку, получают антиретровирусную терапию. Встреча с другими огорчила – они не изменили своих привычек, постарели (хотя это странно звучит, когда говоришь о 25-30 летних). Некоторых уже нет в живых. Как и шесть лет назад, мы также встретили невероятных людей. Когда у них диагностировали ВИЧ, от них отворачивались близкие и друзья, их увольняли с работы, им угрожали… Но они выстояли. Доказали себе и другим, что они сильные, и что жизнь продолжается. Хотя теперь она зависит от строгого графика приема лекарств. А также, к сожалению, от того, провело ли государство очередной тендер по закупке лекарств для АРВ терапии…

In 2005 I took part in a project – I helped one foreign photographer in his work on the documentary photo project on HIV/AIDS issues in Ukraine. Despite many limitations on use of the images, Brent Stirton’s pictures still ‘live their own live’ in the net. They are fairly disputable and provocative, they are on a margin that is why they are argued and discussed so much.

This year Brent Stirton came to Ukraine again and filmed one more documentary series on HIV/AIDS in Ukraine. We met with some of the ‘heros’ of the previous photo shooting. It was a pleasure to meet some of them – they had been able to start a new life, found a support, started receiving antiretroviral treatment. Meetings with the other were upsetting – they had not changed their life habits, they get aged (it sounds strange when you use this word talking about people of 25-30). Some of them have passed away. As six year ago we met fascinating people. When they were diagnosed with HIV they were turned down by their relatives and friends, they were fired from their jobs, threatened… But they had survived. They have proved to themselves and to others that they are strong and life continues. However they life now is depends on strict schedule of taking the drugs. And, unfortunately, on the question whether the government completed a new tender to purchase the antiretroviral medicines.

Olga noted that the participation in the photo project completely changed her stereotypes about HIV positive people. She posted:

Некоторые из героев сюжетов переворачивают представление о тех, кого принято считать “опустившимися”. Как бы низко ни пал человек, многие все же способны сохранить человечность – ухаживать за парализованной матерью, переживать за свою жену и ребенка и делать все, чтобы защищить их после своей смерти…

Some of the heroes of story completely turn over my notion of those who considered being degraded. Does not matter how descended people are, many of them can still stay human – to take care about paralyzed mother or worry about their wives and children and to do everything to protect them after they pass away.

Olga thinks that the main task of the project is to make the society to think about the people affected by HIV/AIDS. She wrote:

Вторая серия – не менее провокационна и спорна. Она тоже вызовет бурю дискуссий о людях, живущих с ВИЧ, и о том, нужно ли это все показывать. Дискуссии – это хорошо. Мы все, причастные к созданию этого документального проекта, считаем, что это часть нашей жизни и об этом нужно говорить. Нельзя просто закрыть глаза и сказать “я этого не вижу, значит этого не существует”. Если это заставит задуматься и что-то изменить в своей жизни хотя бы одного человека, значит время и усилия были потрачены не зря.

The second part of the project is not less provocative or disputable. It also initiates a storm of discussions about people living with HIV and about whether it worth to be shown. Discussion is a good thing. All of us, involved in the project, believe that this is a part of our life and it should be talked about. You cannot just close the eyes and say “I do not see this, so it does not exists”. If this make to think and to change something in his life at list one people, than all the time and efforts were spent not for nothing.

Drop-In Center: Addressing the Health Needs of Drug Users

Maryna Reshetnyak — Wed, 13 May 2009 19:34:01 +0000

Activists of Drop-In Center

Pavel Kutsev, a co-founder of the Ukrainian organization “Drop-In Center,” raises the issue on his Web blog about the specific health needs of people living with a drug addiction.

A patient of methadone substitution therapy himself, Pavel makes the point that the current substitution therapy system makes it difficult for a patient to receive medical care associated a hospital stay. Ukrainian law requires patients to come to methadone sites every day personally to receive the therapy, which makes it a challenge to receive extended medical care at a different site. There is only one hospital in the city of Kiev that is authorized to give patients methadone. Sometimes it's even hard to get qualified medical care at this hospital that would incorporate the specific needs of drug users.

A few days ago Pavel shared the story of one of his friends who died due to the fatal error of medical personnel at this hospital. Below are the excerpts from the story:

When my medical tests were ready I was literally half dead. My body temperature was almost 41C (115.8 F) and my liver probes showed that my liver was almost in coma. This describes my health condition… But we did not even consider the option of going to a hospital…as we are drug addicts, two out of a few thousand patients of the Ukrainian substitution therapy program. We could not afford to miss a dose of methadone, the drug we need like an air. For our bodies, the bodies of the drug addicts, methadone is needed to support the immune system. Without the drug our bodies just stop fighting infections…Only after taking a dose of methadone can other medications prescribed by doctors be effective. And only after taking a dose of methadone can I get a few hours of sleep…

My doctor advised me to get a course of liver treatment in the hospital where I can received methadone. The only hospital where methadone was provided was AIDS Center…I knew that like others, my problem was time. I had to handle all the issues associated with my hospitalization, including all medical tests, in 24 hours. This is the time I could survive without a dose of methadone. Usually I start to not feel well at 4 a.m. and if I do not consume my methadone between 10 a.m. and 11 a.m. I just can not live…

While standing in line at the methadone site to receive my dose, I heard the story of another patient. A girl named Lida, who was also married and had symptoms similar to mine: asthenia, very high temperature, fever, fainting… She did not ask for medical help as she was afraid that she would not get methadone in the hospital and would not be able to survive without it….One day she started to feel so bad that she was taken to the AIDS Center right away from a methadone site. Lida has been on substitution therapy for almost six months and, like all of us, could not live a single day without the medication.

When she arrived at the AIDS Center she was delirious because of her high body temperature…When the doctors learned that she had come from a methadone site, they immediately gave her a medication that is used to deal with an overdose of an opiate drug, and this medication may have killed her…Even a small amount of opiate in the blood of a drug addict helps the body function. Without the drug, an addict starts to suffocate, vomit and have convulsions…The medication Lida was given was for the rapid excretion of opiates out of the body. For a user with a long history of opiate consumption this medication provokes the abstinence syndrome, which leads to liver and coronary insufficiency. After the injection of this medication Lida fell into a coma and died the next day. As autopsy showed that she died because of pneumonia. Her death was aggravated by the absence of opiates in her body as a result of the treatment she received…

Later on we heard that the doctors from AIDS Center contacted the personnel of our site to make sure that Lida did not receive an overdose of methadone. Our doctor said it was impossible… Perhaps, the AIDS Center people first made the anti-overdose injection that killed her and only then asked…

Everybody who deals with narcology knows that for a drug addict the only and most important medication is a drug that contains opiates. That is why none of us who participates in the replacement therapy program will ever miss an intake of the mediation, that is why we are ready to stand in lines under any weather conditions. We just need to avoid going in a delirious state so that we do not get this “anti-overdose injection.”

Proper Medication: A Step Towards A Normal Life

Maryna Reshetnyak — Mon, 09 Mar 2009 18:51:58 +0000

On February 2 Rising Voices posted a story about a public advocacy campaign being conducted by members of the organization Drop-In Center. The campaign is focused on the needs of participants in substitution therapy programs in Ukraine. The group is advocating for the use of a different type of medication for these programs. The drug currently being provided by health care authorities has an excretion time that's only half as long as similar medications out there. A medication with a longer excretion time from the body would allow the patient to go for a longer period without needing the next dose of a drug.

During February and March members of harm reduction programs continued this fight to receive medications that will work effectively. Pavel Kutsev, leader of the Drop-In Center, wrote a post on his Web-blog that has been signed by his counterparts. The post calls for the introduction of a new medication for substitution therapy, since the one being used doesn't help patients return to a normal life.

According to our poll, 47% of patients consume a lot of alcohol. In general only 10-12% of them feel well, 8 out of 10 people use additional stimulants…Only 7-8 people out of 96 say that the dose is adequate for them…for other people this medication just does not work. It does not help them survive even till the morning…We do not really live, do not really work, we are like puppets who are only able to walk to the site, hoping for a few hours of rest from the pain.

The official Web site of the association of substitution therapy patients posted open letters to the tender committee of the major donor for substitution therapy programs in the Ukraine, Alliance HIV/AIDS. The letters were signed by patients from two major Ukrainian cities. The participants of a substitution therapy program from Dnepropetrovsk stated that a few of them had consumed another methadone-based medication, and that the results of this therapy were much better. The patients of a Kyiv substitution therapy center, “Sociotherapia,” highlighted the following facts in their open letter to the tender committee:

According to the Ukraine's legislation, medications for substitution therapy cannot be prescribed, so it is not possible for us to consume the medication several times a day. Our request is to purchase a medication that would have a longer time of excretion from the body and less side effects, such as high tolerance, high diuretic effect, and oppression of sexual function.

The letter provides the following conclusion:

To achieve the goal of re-socialization, drug addicts should have a life…without the abstinence syndrome. So there is a need for medication that would last at least 24 hours without heavy side effects … Otherwise the effect of the therapy will be reduced to a few hours of relief from the pain and there won't even be a hope for sick people to have an active and adequate life.

Drop-In Center: Do Not Repeat My Mistakes

Maryna Reshetnyak — Wed, 25 Feb 2009 16:56:16 +0000

Pavel Kutsev has posted a touching story on his blog depo3p. In the story he describes his discussion with destitute teenagers about the harmful consequences of drugs.

Pavel is currently one of the activists in a harm reduction program in the Ukraine, and was a drug user for about 30 years. He is a co-founder and leader of the Ukrainian foundation for injection drug users called Drop-In Center.

Here is his story:

I got a phone call early in the morning…”Who could it be so early?” I wondered, looking at my watch. It is 7:15… Then I hear the cheerful voice of an elderly woman: “Good morning, Pavel! I know I woke you up, but you said I could call any time, especially if we are talking about the orphanage.” “Oh yes…I remember,” I lied, but immediately recalled that this woman had already called a few times …

“My name is Natalia Ivanovna.” It seemed she has read my thoughts and I bet she was smiling.

“Oh yes, sorry for this Natalia Ivanovna.” I lit a cigarette and recalled that some time ago I had promised a woman who had introduced herself as a director of an orphanage to visit her school and to talk to the children.

“They are in their 8th to 10th year of study; they need something non-typical, not boring, something that would touch them,” she said.

At first I said no, I remember. I told her that our community is very specific, we are not young and have lived with the drug addiction for many years and prevention is not our field.

“Well, there are so many organization in Kiev,” Natalia Ivanovna sighed. “But when I ask them to come and talk to our kids about this problem, nobody has time, everybody is busy with something more important…By the way, this is the third time I am calling you.”

“Really?” I felt cold in my stomach and decided that I MUST go there. “I am really sorry, I promise I’ll come”…

Then I realized that I was in trouble. Oh my God! What can I tell these youngsters who by age could be my grandchildren!?

“Just do not panic,” my wife tried to calm me down. “Take a laptop with you, ask them to make some tea, sit with them around a table and start talking about life. After all, why do people put themselves through various troubles?”

“Because they are stupid” I said.

“See! Then show them pictures from our booklets and newspapers. Then, turn on quiet music and show the pictures we made on the other side of life…Really, just make a slide show. Just let them see. Show them the girls serving strangers in the bushes next to a highway just to get a shot. Let them see decaying sores or how they take shots in the groin or neck…Show them pictures of Kirill, Zheka, Lekha, Ira, Tim and the pictures from their funerals…When you are done ask these kids whether they want to become drug addicts.”

I do not want to describe the eyes of the kids when they watched the pictures, where their peers in a year or two looked 20 years old, where they got crazy, remote…

I wanted to hear from at least a few of those kids who had listened to me. I asked, “What feeling do you have toward the people you have just seen on the screen? Do you feel contempt or indifference or sympathy?”

Twelve out of twenty told me what I very much wanted to hear. They felt sympathy.

We parted like good friends. The director, Natalia Ivanovna, told us that she had never heard such a sincere conversation with her kids. Some pictures even affected her, she who had served as a military medical surgeon for 11 years right on a battlefield in Afghanistan.

I do not know why, but that night I did not feel tired, even though I came home very late…..

P.S. The address of Boarding School #7 is Ukraine, Kiev, vul .Beletskayam 55

Ukraine: Medical Care for Drug Addicts

Maryna Reshetnyak — Mon, 19 Jan 2009 23:23:36 +0000

Ukrainian blogger Pavel Kutsev raises issues about injection drug users’ access to medical care in his recent post. Pavel is the leader of the non-profit Drop-In Center, a center for injection drug users in Kiev.

In his post Pavel identifies two main obstacles that drug users who need medical assistance must overcome: A lack of free medical care options specifically for drug users provided by the government and social institutions, and the stigma that injection drug users face, especially from most Ukrainian medical personnel.

To support his first observation Pavel presents the following statistics:

Approximately 100,000 alcoholics and 50,000 drug addicts are registered in Kiev today and there is only one governmental clinic where a drug addict can get free detoxification and medical services. In Kiev social services centers there are many posters on the walls advertising services of … private hospitals, where the price of staying overnight varies from $800 per month to $1,000 a day. The average salary in Kiev is $300 per month… So what should we do? Without a job, money, passports, medical history and with health problems…

The second major issue that drug users face is stigma from the entire Ukrainian society, including the medical community. Pavel points out that this stigma is so strong that often drug addicts can't receive any medical care, even when they desperately need it.

To illustrate this point, Pavel posts his wife's memories, who is also drug addict, of a visit to the hospital when she was sick:

Having realized that without the assistance of a surgeon I will kick the bucket very soon, since I have a very high body temperature on a freezing winter day, I go to Railway Hospital to see a doctor. The doctor is a professor, a friend of my mother’s friend. I know from experience that in my situation it is better to go to a doctor through a reference. All day long my husband and I wait in a corridor …Vasiliy Nikitich (the doctor) is busy with the administrative staff…While staying in the corridor I start feeling really bad, so bad that I would agree to let them cut a part of my poor ass just to stop the pain.

Finally we are invited into the doctor's office and asked what our problem is. In that moment our problem is everything: long waiting with high body temperature, absence of veins, lack of money, and, most importantly, an unbelievable pulsing pain in my ass – and this last problem has to be solved urgently. There was no reason to lie as he could ‘read everything on my ass’ so I said I was a drug addict. I told him everything. That I was on drugs for a long time, that I had made a wrong shot and now feel so bad that I was surprised I was still alive: abscess, high temperature…doctor please help…'Get out of here!!! Now!!! Go away!!’ the doctor hissed and his fat face became red like a tomato…

I was shocked, scared, and got stuck to the couch…'Get out of here! I have enough shit here without you! You have some nerve to come here and pretend that you are sick when there are real sick people around.’ The only thing I wanted at that moment was to become a piece of furniture, a microbe, to disappear…so this stupid sick women who had had an illusion that she had a right to medical care just didn't exist…

I ran out of the office with tears, anger, and a feeling of helplessness…

After crying on my husband’s shoulder we trudged home. We understood that if we got such a reception when visiting a doctor with references then if I had gone to a regular doctor I could have even be put into jail…

I lay down on the mattress (all the other furniture by that time had moved to a dealer for poppy straws) feeling total emptiness and indifference about my future. There wasn't even hope for help; the only thing I could do is to pray…