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15 Harrowing Photos That Capture The Reality Of Ukraine's AIDS Epidemic

Photographer Pascal Vossen travels to Ukraine with journalist Nils Adler to document the nation's tragic AIDS crisis.

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Pascal Vossen

Nastia, 26, is HIV-positive and works at a lower-end brothel. In Dnipropetrovsk, there are 200 brothels that employ an average of 20 to 30 sex workers; all the brothels are owned by four individuals. Nastia's colleagues are unaware of her HIV status and so she receives treatment in private.

An estimated 290,000 people are living with HIV in Ukraine. Since the conflict began in 2014, the government has failed to fulfill its commitment to the National AIDS Program, leaving the international organizations and local NGOs to deal with everything — from procurement of drugs to treatment programs.

Frustrated by the lack of data and coupled with the potentially disastrous effect this inaction will have on the country in a few years' time, we decided that the most effective way to tell this story would be to show the lives of the at-risk and suffering. This is a situation that — unlike the first epidemic — is largely avoidable, but action needs to be taken now and not later.

The country had made such great progress in reversing the spread of HIV — in 2012 the country's number of new HIV cases dropped for the first time. Yet human behavior — in the form of corruption, violence, discrimination, and inaction — was now undoing so much of this positive progress. The conflict in 2013 destroyed much of the health care infrastructure while displacing over a million people, and yet the government refused to purchase cheaper generic drugs and instead reduced its financial commitments to the National AIDS Program. On top of that, the stigma of being associated with the at-risk groups or being HIV-positive meant many people we met, who needed to be treated or tested, were too afraid to visit the centers.

We just didn't expect the government to not be taking this issue seriously — instead re-routing funds in a visceral reaction to the conflict. Yes, they need troops at the frontline, but this is an epidemic and the full effect of inaction now will only become obvious in a few years' time.

Pascal Vossen

Tatiana, 34, describes
 her
 husband's death from AIDS
 in 2015 as
 a
 lonely
 ordeal.
 “Only
 when
 he
 was 
paralyzed
 was 
he 
taken 
to 
the 
hospital,
 where
 he 
later 
died. 
Afterward, 
no one
 would 
help 
bury 
him.”

Pascal Vossen

A premature baby lies in an incubator at a maternity ward, 20 kilometers from the frontline. Premature births are common among pregnant drug users. This child's mother has crossed the border in order to receive treatment and so that her child would be granted Ukrainian citizenship. Thankfully, her tests show that her daughter is not HIV-positive, so if she survives this critical period, she should be able to lead a healthy life.

Pascal Vossen

Children at the Way Home Center in Odessa take part in an English class. Many of these children are orphans or from internally displaced families. The center also takes care of children who have parents suffering from HIV. The national AIDS programs in Ukraine over the past few years have been successful in reducing the number of mother-to-child transmissions of the virus. The conflict has threatened to undo much of this progress, due to the displacement of people and reduced access to treatment that is essential throughout the pregnancy.

Pascal Vossen

Antiretroviral medicines — used to slow the rate at which HIV copies itself in the body — are laid out on a table in an abandoned house now occupied by a community of HIV-positive ex-convicts, drug users, and internally displaced people. Although the medicine can help suppress the virus, the people here struggle with other illnesses caused by the pollution from the factory next door.

Pascal Vossen

Tanya, 19, from Odessa, is a homeless teenager. She was born HIV-positive and ran away from an abusive parent at an early age. She now lives in the city's underground heating system. She jokes that it can be freezing in the summer and sweltering in the winter, when the heating is on.

Pascal Vossen

Roman, 31, is "peaking": He continuously leans his head back and opens his mouth. He is standing in front of the dealer's house. Behind that is the shooting gallery, where the users go to inject drugs.

Pascal Vossen

Andrey, an inmate of the juvenile penitentiary in Pryluky, sits on his bed in the common sleeping area. He has been incarcerated for 2 years and 8 months. Andrey is one of the inmates who have taken in solace in religion and hopes to dedicate his life to God. The warden expresses hope that he will be one of the few boys who will avoid a life in and out of prison.

Pascal Vossen

The inmates of the juvenile penitentiary partake in a group session on HIV transmission. The psychologist leading the class tells them that HIV cannot be transmitted by mosquito bites, shaking hands, or through the air.

Pascal Vossen

Many of these boys will find it hard to find employment and will end up in prison at some point in their life. The HIV rates in prisons can be as high as 26%, while hepatitis C rates can be as high as 95% among inmates.

Pascal Vossen

Sergey, 52, was released on March 7 from prison. He has no work opportunities, so he stays at a shelter in Dnipropetrovsk with fellow ex-convicts. One of the men said, “It felt strange when I left prison; inside most of us seem to have HIV, but when I came out suddenly I felt like I was sick, like it was not normal.”

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