December 1, 2009

ODESSA, Ukraine/GENEVA – The midday heat hangs heavily in the seminar room of the Bavarian House Odessa (BHO) in Ukraine, but Vitali Gorbunow grips the attention of his audience – 25 men and women. As he strides across the room, the psychologist trainer gestures with his hands and feet, looks directly at each participant sitting in the circle, and wipes the perspiration from his brow. "If your immune system were a baking ware, how would you feel at the moment?" asks the agile man in jeans and a sports shirt. The answers are hesitant at first, then they come faster, more spontaneously and finally the whole group bursts out laughing. "Like an almond cake," says a doctor, "a meringue I ate as a child," says another, "a few dry biscuits," calls an assistant doctor. "I feel like a Kiew cream-cake," adds a gynecologist.

"This kind of interactive training is little known in Ukraine but it is a most effective way of cracking open rigid opinions," explains Gorbunow, who has many years' experience. "I have had doctors and gynecologists who recommended that pregnant women with HIV have an abortion, yet the chances of having a healthy baby stand at over 90 percent!" This is the kind of fixed mentality that the former Ukrainian army officer wants to change.

HIV and AIDS are taboo topics in Ukraine's southern city of Odessa, where the virus is spreading like an epidemic. For years now, the rate of new infections has been among the highest in Europe. According to official data from the Ukraine government, at the end of 2007 over 122,000 people were officially recorded as having HIV and AIDS. UNAIDS (Joint United Nations Programme on HIV/AIDS) and the government estimate, however, that the real figure could be up to 440,000, or around 1.63 percent of the population aged between 15 and 49 years. In 2006 there was a nearly 17 percent increase in new infections, while 2007 recorded an additional ten percent.

Gorbunow will not stand by and do nothing. For eight years he has been dealing with the HIV and AIDS issue in the Black Sea city. Since completing a training course run by German specialists in 2005 he has been working as an instructor at the BHO, which has taken action to counter the rapid spread of HIV and the huge increase in the number of AIDS patients.

The Bavarian state ministry for work, social order, family affairs, women and health in cooperation with the Evangelical Lutheran Church in Bavaria (Germany) founded the BHO in mid-1993 as a contact center for German culture. In 2001 the social work center was established in BHO with support from the German government's organization for technical cooperation (GTZ), the German state of Saxony, the Rotary Club "Porta Praetoria" from Regensburg and the diaconal services of the Evangelical Lutheran Church in Bavaria. Besides HIV prevention activities, it carries out numerous social and medical support projects for the needy.

In cooperation with BHO, the German Evangelical Lutheran Church in Ukraine (GELCU) in Odessa developed an extensive HIV and AIDS program for prevention and therapy. The aim was to stem the epidemic by training school students and mentors, along with multipliers such as doctors or teachers. The Lutheran World Federation (LWF) has been supporting these successful training courses for the last four years.

Sexuality and Sex Education

"The topics of sexuality and sex education are still taboo in our society, although far more infections are transmitted in Odessa by unprotected sexual intercourse than through injecting drug use," says Irina Swetaschowa. The GELCU training program coordinator cites four factors for the HIV epidemic in her country. "People here are terribly afraid of AIDS. While very few understand the modes of transmission most of them still act irresponsibly and say: ‘That does not concern me.' In addition, the state does virtually nothing to raise awareness, merely concentrating on handing out free medication." Those who are HIV positive in Ukraine soon feel the social consequences – doctors often refuse to treat such patients, their families turn away, teachers throw infected students out of school and children are placed in care homes.

AIDS education is urgently needed but is left to non-state institutions such as BHO or open-minded churches like GELCU. Bishop Uland Spahlinger, whose 250-strong Lutheran congregation in Odessa is one of the biggest in the country, speaks of a "cold shoulder mentality" toward those in need. "The church is challenged to be the advocate of human dignity and reliability precisely in this context of state disregard for social distress. The church must get involved," the bishop asserts. He adds, "Its mission is, first, to focus on compassion for the needy. Second, it must arouse understanding for the ethical and practical responsibility of individual members in daily life. This means raising awareness in the broadest sense."

Convincing Results

The church's diaconal center offers a mobile psychosocial service for people affected by HIV and AIDS. The BHO has also launched a hotline and mobile medical assistance. In order to break the taboo on the issue as fast as possible, Odessa's Lutheran church first organized training for trainers such as Gorbunow and Swetaschowa, who have in turn trained over 4,000 teachers to offer classes on AIDS prevention. From November 2005 to September 2007, with the financial support from the LWF, these specialist teachers held classes for all students between the age of 13 and 17 in the city of Odessa, totaling 22,000.

"The results were impressive," reports Swetaschowa. "At first only 30 percent knew anything about the dangers, transmission methods and protective measures, but at the end it was 98 percent!" The figures also persuaded public officials and politicians: AIDS prevention is now included in health education in the whole Odessa region. The teachers involved receive a bonus from the school authorities. In a press statement in February 2009, the chairperson of the territorial education administration in the region, Dmitri Demtschenko, especially thanked GELCU and the LWF for their commitment. "Together we have created a basis for successful instruction," he stated.

In-Service Training for Doctors and Nurses

Members of the next group have taken their seats in the BHO seminar room. Since April 2009 Gorbunow and his colleagues have been training doctors and nurses, with 500 of them expected to complete the program each year. The participants stand up, each displaying a sign. "Talking together," one says, "living together" or "gynecological examination without protective gloves." Gorbunow asks them to stand in line "according to the degree of infection risk." The medical personnel discuss the matter, move back and forth and finally form a semi-circle.

The first, easy situations are put in the correct order and remain without comments. However the "repeated use of medical instruments" is placed in the middle, something the trainer cannot comprehend. "That is impossible!" Gorbunow protests, running his fingers through his hair. "I've given you so much information over the last two days and you still think that is an acceptable risk! Move to the back!" The doctor obediently takes her sign and lines up next to "unprotected anal intercourse" and "a syringe picked up in the park."

"The seminar is timely and extremely interesting," remarks Elena Yatmanowa during coffee break. The 37-year-old heads the general medicine ward at the public hospital in the Primorski district. "We often have HIV patients," she says, and is surprised that some colleagues at the seminar know little about the virus. "The problem is everywhere and there is enough information around if you are interested," she remarks. Yatmanowa definitely wants to recommend the course. "I will send all the staff on my ward here by December," she says. Next door, two of her nurses are already participating in the seminar for nursing staff.

LWI correspondent Constanze Bandowski also interviewed Dr Vitali Nowoswitnij, director of the Odessa City Center for HIV and AIDS prevention and control, on the spread of the HIV and AIDS pandemic in Odessa and ways of tackling it. Read the whole interview at: http://www.lutheranworld.org/News/LWI/EN/2446.EN.html.

A summary of the situation in Odessa and GELCU projects in Odessa is available at this link: http://www.lutheranworld.org/News/LWI/EN/2445.EN.html.

For more information about World AIDS day reflections and resources, please visit the LWF Web site at:http://www.lutheranworld.org/What_We_Do/HIV-AIDS/LWF-HIV_AIDS-WAD09.html.

Lutheran World Information
A feature by LWI correspondent Constanze Bandowski.