For people infected with HIV in Ukraine, there has often been little hope. For years they have been stigmatised, ignored, offered inadequate treatment and found themselves pushed to the edge of society, regularly forced to live without homes, support or even the official papers needed to find a job. Until now, however, there has been one clear beacon: a refuge desperately needed in a region that now has the world's fastest-growing infection rate.
In the centre of Kiev, beside the historic Pecherskaya Lavra monastery, is a building that since the 19th century has been at the forefront of the country's fight against infectious diseases.
In the 1800s, the enemy was tuberculosis. Since 2002, when the clinic was reopened by the then UN secretary general, Kofi Annan, it has been Aids. Inside the clinic are airy corridors lit by rows of large windows with clean and tidy rooms opening off them. Here, patients can be seen relaxing while the specially trained doctors do their rounds. The medical equipment, often funded by foreign donors, is recognised internationally as among the best in Ukraine; the pastoral care, with its counselling sessions and legal advice, is considered world-class.
But all this is now set to disappear, thanks to a decision that stands as a searing indictment of President Viktor Yanukovych's attitude to the disease and its victims. The clinic, the Lavra Clinic, which treats 1,500 patients, has been told it has to close so that the land on which it is built can be used as the site for a new hotel.
"We do not know where people are to go or if they will be properly treated," Svetlana Antonyak, the clinic's head, said. "Other medical centres do not have the experience to treat people with HIV. This is the elimination of the clinic. The elimination of all the experience gathered here. But the priority, it seems, is the land plot and the property that could be built on it."
The story around the closure reveals much about the priorities of a regime already under the international magnifying glass after the jailing of Yulia Tymoshenko, the former Prime Minister and Orange Revolution darling, following a trial that was condemned as a brutal example of political revenge.
First it emerged that the monks at Pecherskaya Lavra, which owns the land, no longer wanted drug users and homosexuals housed next door. Then it became clear that not only did President Yanukovych, who approved the closure order, regularly attend services at the monastery, but the land would be used to build a hotel.
I visited the clinic while in Kiev as a guest of the Elton John Aids Foundation, which supports a number of projects in Ukraine, to witness what is at risk of being lost. I was besieged by patients, terrified of what would happen when they could no longer receive treatment there. One argued that the monastery wanted them out because they saw the patients as "sinners". Another, who declined to give his name in case it prompted discrimination against him, berated his country for letting such an injustice occur.
"I understand how things in Ukraine work," the patient said. "It is all patronage, commerce and business, but why can't we coexist with the monastery? The church is meant to care for the destitute and instead we are being made to leave. I come from a small village where everyone knows each other and there is no way I can get medical treatment there as everyone will immediately know I have HIV. The stigma is still terrible."
An official from the government-run National Academy of Medical Sciences, responsible for the clinic, could offer little reassurance. The patients, the departmental head said, would be transferred to as yet unspecified "locations in Kiev and maybe the regions". As to the continuation of treatments, he "did not know" if they could definitely be preserved.
The tragedy is that the site's work has never been so badly needed. Some 1.6 per cent of Ukraine's population is now HIV positive; 60 per cent of those infected are aged between 20 and 34.
And the numbers are growing rapidly. Health experts fear that the disease could spread from high-risk groups, where up to now it has been concentrated, to the general population as well. Most at risk are the young people – up to 100,000 of them, many of them women – who are homeless in the country, particularly in the cities of Kiev, Odessa and Donetsk.
A survey by the US Centres for Disease Control and Prevention found almost 20 per cent of them were HIV positive, a figure that rose to 35 per cent for those with a history of prostitution and 42 per cent for those with a history of drug abuse.
In the absence of adequate state intervention, charities such as the Elton John Aids Foundation are doing what they can to fill the gaps, often working with local Ukraine municipal authorities that are more aware of the crisis in their midst. In Kiev, for example, the foundation helps to fund a charity called HealthRight that targets homeless young people through nightly street patrols that provide medical advice, condoms, counselling, warm clothing and the legal assistance required for them to receive the identity documents needed to get back into mainstream society.
Last year it also worked with the same charity to establish a centre where women could get access to HIV testing, counselling, medical help and even assistance for education and employment.
Sir Elton John, visiting Kiev to witness his foundation's work and to petition for greater assistance to people living with HIV, made it clear that proper progress could be made only when there was no longer a stigma in the country against those who were HIV positive and against the gay community at large.
"People are still ashamed to be tested, people are afraid to know they have HIV," the singer said. "It's disgraceful."
Getting women off the streets by giving them access to medical care, shelter and support gave them a chance for a new future, he added. "These girls are not criminals, they are victims," he said.
"All humans are born equal, all humans are going to die equal. But we are not treated equal during our lives. That is a disgrace and I am afraid Ukraine is far behind the rest of the world. Wake up, Ukraine. Wake up to people rights. You are living in the19th century. Get to the 21st century and start treating gay people as human beings."
Evgeny Lebedev is the chairman of Independent Print Ltd. More information on the Elton John Aids Foundation, and on Elton John's visit to Ukraine, can be found at ejaf.com