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 city's 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 currently 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 wildly condemned as a brutal example of political revenge.
First it emerged that the monks at Pecherska 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 its publication 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 co-exist 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."
A top 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. The figures are so alarming that there is concern among health experts 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 major 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 Kiev I was shown an abandoned Soviet-style apartment block where homeless young people live in squalor amid the crumbling brickwork. One teenage girl described how, as a 13-year-old, she had witnessed her father shoot her mother. She had lived on the street ever since. Another girl ran away from home after walking in on her mother to find that she had hanged herself after years of domestic abuse.
None had regular work. Many were unable to seek it because they lacked the identity documents required to be legally employed. The result was that many resorted to prostitution while drug abuse was also rife.
One young woman described how she and her friends liked to create a concoction they called "screw" out of surgical spirit, cough mixture and the phosphorous tips of matches, which they then injected intravenously. It was, she said, "fun", as it kept them awake for days. But despite both prostitution and intravenous drug abuse being key contributors to the spread of HIV, there was no evidence that the state was trying to educate them about the potential dangers they faced or encouraging them to use condoms or not to share needles.
The reason was that those in power in Ukraine have yet to face up to the extent of the crisis in the country, as it is still too often seen as the "gay disease", Dr Volodymyr Kurpita, the director of the All-Ukrainian Network of People Living with HIV, said. "The situation with Aids is uncontrolled but the government is not looking for the implementation of a real awareness programme," he said.
"In the Ukraine, even after years of education, our officials do not think it is their problem. There is an interesting comparison between Ukraine and Africa. In Africa the state often started to change when some of the government officials or their families began to be affected. But in Ukraine they think it is only affecting homosexuals or drug users or prostitutes.
"But during the last few years we have observed the infection outside these groups. We are seeing it among pregnant women. This is now affecting all Ukraine society."
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 fund a charity called HealthRight that specifically targets homeless young people through nightly street patrols that provide medical advice, condoms, counselling, warm clothing and the legal assistance required for the young people 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, psychological and legal counselling, medical help and even assistance for education and employment. But such charitable work is not by itself enough to combat a disease that is at risk of raging out of control in the Ukraine.
Elton John knows this. Visiting Kiev to witness his foundation's work and to petition for greater assistance to people living with HIV, he 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, people still have this 'Oh, he has HIV and Aids...' [mentality]. But it's not like that anymore. We've moved on!"
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," Elton John 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 the 19th century. Get to the 21st century and start treating gay people as human beings."
Evgeny Lebedev is the chairman of Independent Print Limited.
More information on the Elton John Aids Foundation, and on Elton John's visit to Ukraine, can be found at ejaf.com
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