By Oksana Omelchenko, Den, Kiev, Ukraine, in Ukrainian 5 Feb 04, p 1
BBC Monitoring Service, UK, in English, Feb 07, 2004

The Ukrainian newspaper Den has expressed surprise at the decision by the UN Global Fund to Fight AIDS, Tuberculosis and Malaria to suspend aid to Ukraine amid the growing spread of AIDS/HIV in that country. The aid withdrawal was apparently meant as a "lesson" for the Ukrainian Health Ministry, which has differences with the fund over purchases of medicines for antiviral therapy.

However, the daily quoted an anonymous source "close to the Cabinet of Ministers" as saying that the government could decide to return the already received grants to the UN agency and finance anti-AIDS programmes from its own contingency fund.

The following is the text of an article by Oksana Omelchenko, entitled "An odd decision" and published in the Ukrainian newspaper Den on 5 February; subheadings inserted editorially:

For several days now Ukraine has been under the spotlight of the medical world. Probably no-one expected such a sharp "change in temperature" in relations with the Global Fund to Fight Aids, Tuberculosis and Malaria (you will recall that it endorsed Ukraine's request for 92m dollars for a five-year period to implement its project "Overcoming the HIV/AIDS epidemic in Ukraine"). Nevertheless, the fund decided to suspend this aid and reported this exactly a year after the signing in Geneva of the first agreements on the grant with the Health Ministry.

At that time, the Ukrainian side, through Minister Andriy Pidayev, said that "it would stick to a policy of close partnership in response to the development of the epidemic". Moreover, it was very proud of the fact that it had been granted the honour of being a member of the fund's board.

At the end of January, representatives of the organization's secretariat arrived in Ukraine to explain that they had "knocked together" 7.5m dollars, which they had already managed to transfer. The official brief was rather a sharp one: the objectives it had set would scarcely be achievable if the programme continued to be carried out through the main recipients who had been endorsed earlier. The reason - out of the 7.5m dollars which were transferred, only a little over 740,000 had been spent. And this, the fund believes, shows that the country will not be able to show it had reached its objective by April 2005.

On the other hand, the same official statement points out that Ukraine does still have some chances. "We understand that your countries needs money," the director of the fund, Richard Feachem, said, "and therefore it is all a matter of taking measures to put the programme on the right track". In addition, he stressed in an interview for the BBC that the suspension of finance would be a kind of lesson; in future it would put the money to more effective use.

HEALTH MINISTRY "TAUGHT A LESSON"

Clearly, the lesson was meant for the Health Ministry. Given the fact that the recipients of the money in Ukraine were the UNDP and the Ukrainian Fund to Fight HIV Infections, the demands fell upon the main medical department. Apparently, the process of taking this decision was an extremely bureaucratic one, but the Global Fund is a financial institution which wants its funds to be used effectively and to get results.

So far there has been no official comment on this. A Den correspondent was told that it has its own point of view on the situation. During a meeting between Deputy Prime Minister Dmytro Tabachnyk and representatives of the donor organization, the latter stressed that they had no claims against the country's coordination mechanism. Then suddenly, a few days later, they sent an official no. One version as to why the "direction of the wind" changed so sharply was that the two sides "could not get together" over the question of purchasing preparations for antiviral therapy.

This question, incidentally, is of little importance, or rather quite costly - some 67 per cent of the funds would be needed to purchase these substances. The Ukrainian side put out a tender, according to procedures established earlier by the fund, and informed the donor of the results. However, the donor said nothing for 80 days. Having failed to get its consent, the Health Ministry could not take any further steps. Earlier, the Global Fund had urged that the substances should only be purchased from UNICEF, but, according to the ministry, this would have set them back another 1.5m dollars.

UKRAINE MAY OPT FOR SELF-RELIANCE

The main question to arise from all this is how will it affect the HIV situation in Ukraine. The Global Fund's money was vital. After all, a total of 14m hryvnyas [2.63m dollars] has been allocated to fight the infection in the 2004 state budget. True, there is a programme for the period 2004-08 which plans to allocate 202.1m hryvnyas [37.9m dollars].

But taking into account the fact that antiviral therapy alone will cost approximately 1,000 dollars per person per annum, and it needs several thousands, the allocated sums, to put it mildly, would seem to be insufficient. The growth in the sickness rate typifies the situation in the country even more clearly. Every year, according to official figures alone, there are an extra 1,000 HIV-infected patients.

However, the Health Ministry can see a way out of the situation. They maintain they will fulfil their obligations to those who require antiviral therapy. There are enough medicines for this year, and then Ukraine plans to produce its own antiviral preparations, which will enable it to reduce the cost of the therapy threefold.

At this moment, as Den managed to learn from a source close to the cabinet, a decision on the return of the allocated money to the fund is possible. Most probably, it will come out of the government's epidemic fund - a "money box", which is used in the event of emergency epidemics. Moreover, since Ukraine has the support of the World Bank in the fight against HIV, and with the situation as it is, the amount allocated in the budget for HIV/AIDS problems, will probably be increased noticeably in the draft plan for 2005.