title: Slowing of the HIV epidemic in Ukraine: evidence from case reporting and key population surveys, 2005-2012.
abstract: BACKGROUND
  Ukraine developed Europe's most severe HIV epidemic due to widespread transmission among persons who inject drugs (PWID). Since 2004, prevention has focused on key populations; antiretroviral therapy (ART) coverage has increased. Recent data show increases in reported HIV cases through 2011, especially attributed to sexual transmission, but also signs of potential epidemic slowing. We conducted a data triangulation exercise to better analyze available data and inform program implementation.
  
  
  RESULTS
  We reviewed data for 2005 to 2012 from multiple sources, primarily national HIV case reporting and integrated biobehavioral surveillance (IBBS) studies among key populations. Annually reported HIV cases increased at a progressively slower rate through 2011 with recent increases only among older, more immunosuppressed individuals; cases decreased 2.7% in 2012. Among women <25 years of age, cases attributed to heterosexual transmission and HIV prevalence in antenatal screening declined after 2008. Reported cases among young PWID declined by three-fourths. In 2011, integrated biobehavioral surveillance demonstrated decreased HIV prevalence among young members of key populations compared with 2009. HIV infection among female sex workers (FSW) remains strongly associated with a personal history of injecting drug use (IDU).
  
  
  CONCLUSIONS
  This analysis suggests that Ukraine's HIV epidemic has slowed, with decreasing reported cases and older cases predominating among those diagnosed. Recent decreases in cases and in prevalence support decreased incidence among young PWID and women. Trends among heterosexual men and men who have sex with men (MSM) are less clear; further study and enhanced MSM prevention are needed. FSW appear to have stable prevalence with risk strongly associated with IDU. Current trends suggest the Ukrainian epidemic can be contained with enhanced prevention among key populations and increased treatment access.
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Kyiv, Ukraine.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Vitek
authors.affiliation: World Health Organization Collaborating Centre for HIV Surveillance, University of Zagreb, Zagreb, Croatia.
authors.forename: Jurja-Ivana
authors.initials: JI
authors.lastname: Čakalo
authors.affiliation: Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, Kyiv, Ukraine.
authors.forename: Yuri V
authors.initials: YV
authors.lastname: Kruglov
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Kyiv, Ukraine.
authors.forename: Konstantin V
authors.initials: KV
authors.lastname: Dumchev
authors.affiliation: International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine.
authors.forename: Tetyana O
authors.initials: TO
authors.lastname: Salyuk
authors.affiliation: World Health Organization Collaborating Centre for HIV Surveillance, University of Zagreb, Zagreb, Croatia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Božičević
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Baughman
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Hilary H
authors.initials: HH
authors.lastname: Spindler
authors.affiliation: Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, Kyiv, Ukraine.
authors.forename: Violetta A
authors.initials: VA
authors.lastname: Martsynovska
authors.affiliation: World Health Organization, Kyiv, Ukraine.
authors.forename: Yuri V
authors.initials: YV
authors.lastname: Kobyshcha
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Abu S
authors.initials: AS
authors.lastname: Abdul-Quader
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: George W
authors.initials: GW
authors.lastname: Rutherford
mesh_terms: D000293:Adolescent; D000328:Adult; D055030:Drug Users / Q000706:statistics & numerical data; D058872:Epidemics / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D011247:Pregnancy; D015995:Prevalence; D012044:Regression Analysis; D018570:Risk Assessment / Q000706:statistics & numerical data / Q000639:trends; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D014455:Ukraine / Q000453:epidemiology