Ukraine is in the grip of a demographic crisis. Yet as tragic as the situation is, the growing impact of HIV and tuberculosis guarantee that the current troubles are only a shadow of what is to come for Ukraine - and Russia as well.
Western governments once hoped that Ukraine would become a major regional power when it achieved independence from the Soviet Union.
Instead, Ukraine is in rapid decline, touting one of the world's fastest rates of depopulation. Social breakdown, economic collapse, emigration, soaring death rates and plummeting birth rates have subtracted more than 3 million people from Ukraine's 52.1 million population in 1991, when the country upon independence.
Now, the scourges of HIV and tuberculosis are further devastating Ukraine's demographic outlook. Over the next 10 years, the most able-bodied segment of Ukraine's population will shrivel, leading to economic collapse if the pandemic remains unchecked. Even worse, the disaster is set to repeat in short order in Ukraine's biggest neighbor, Russia.
As a result, Ukraine is becoming a difficult neighbor and partner. The European Union has always held open the possibility of Kiev one day entering the club, albeit some day far in the future. As HIV and TB ravage the country, however, the EU is far more likely to reinforce the barriers on Ukraine's western border than seek to integrate Ukraine into Europe. Meanwhile, the United States will see the country as an increasingly useless security ally.
Increasingly, the demographics of disease have significant implications for economies. United Nations figures indicate that half of the world's HIV sufferers are 25 or younger - the most economically active portion of a population and the portion most likely to raise children. HIV, which is spread primarily through sexual contact and intravenous drug use, eventually develops into AIDS, an incurable disease that attacks the immune system.
Tuberculosis alone is easily treatable and rarely kills. But with antibiotics readily available, most Ukrainians simply treat themselves and stop taking drugs once they feel better. Over time, the TB bacterium becomes resistant to standard antibiotics. Now, multi-drug resistant tuberculosis (MDR-TB), a much more lethal and costly strain of the illness, is emerging throughout the former Soviet Union.
HIV and TB, especially MDR-TB, together make for a deadly combination. After HIV batters down the immune system, TB can easily slip in and kill the patient outright. Worldwide, TB is the leading cause of death in AIDS patients, according to the World Health Organization. The combination of diseases contributes to population declines and eviscerates economies because it kills otherwise able-bodied workers and entrepreneurs.
Geography and politics put Ukraine at particular risk. Positioned on the major transportation and drug routes between Russia and Europe, Ukraine suffers the highest HIV rate in its region, with 1 percent of the adult population carrying the virus as of the end of 1999, according to the United Nations. Only two states outside of sub-Saharan Africa have higher rates. The costs of anti-HIV medications which can top $1,000 a month, are far beyond the reach of most Ukrainians; the country's per capita GDP is a mere $840 annually, according to the World Bank. Moreover, since the old Soviet health network fell apart, TB has spread like wildfire.
The situation is about to get worse. Among efforts to reform its justice system, Russia is releasing 350,000 prisoners - nearly all of who have TB, one-third of them carrying the drug-resistant strain. As the disease stew that is Russian prisons spills out into the general population, it is all but certain that many TB-infected individuals will find their way across the Russia-Ukraine border, which stretches more than 1,000 miles. Russians, after all, are Ukraine's largest minority.
Meanwhile, HIV has begun jumping from drug users to Ukraine's general population, according to Andrej Cima, the Intercountry Program Advisor for the U.N. Joint Program on HIV/AIDS in Ukraine. Cima also reports that "approximately 90 percent of [HIV] infection [in Ukraine] occurs in the 15-24 age group." That means that of the 2.5 million Ukrainians in that age group, one-fifth are HIV-positive.
Ukraine risks losing not only an economically vital generation, but the next generation as well. The country appears headed for total demographic and economic collapse. Only two countries that have passed the 1 percent adult HIV infection threshold - Uganda and Thailand - have managed to pull back from the brink of collapse, but those countries enjoyed better funding to fight the disease. They also were better able to target their efforts: In Thailand, for instance, prostitution was the primary factor in HIV's spread, and citizens were receptive to addressing prostitution as both a social and a health issue.
In Ukraine, on the other hand, prostitution and drug use are still taboo subjects. Only a major social breakthrough would allow the country to address - let alone counter - its HIV pandemic.