Tuberculosis and HIV in Ukraine

a photo reportage byMisha Friedman

Winner of the 2010 Images to Stop Tuberculosis Award

Kolya, 31, who is living with HIV and has tuberculosis, has a poor prognosis for recovery. Tuberculosis clinic, Mariupol.

A lab technician looking into a microscope. Tuberculosis clinic, Donetsk.

A metal basin holding a list of patients and their blood samples is left on the floor for processing at a lab in a tuberculosis clinic in Donetsk.

A woman undergoes X-ray at the tuberculosis clinic in Mariupol.

An outreach worker from Amicus, a local NGO, shows plastic bottles full of used syringes and needles, which he collectedfrom several drug users in exchange for clean needles and wet-wipes. Donetsk suburb.

Donetsk in the evening – through a bus window. The whole city grew out of a number of factories, and their smoking chimneys still dominate the landscape and pollute the air.

Hands of a patient with tuberculosis at a clinic in Donetsk. Formerly he spent some time in prison. According to local prison officials, about 1000 inmates in the Donetsk region have tuberculosis. About 16 percent of all male population of the region have been imprisoned at some time, according to Colonel Vladimir Shalashnyi, head of the medical department for all correctional facilities in Donetsk Oblast.

A reflection in a puddle of a typical residential building in Yenakievo.

A group of tuberculosis patients with various degrees of drug resistance have a smoke just outside a tuberculosis clinic in Donetsk.

Roza, an outreach worker (left), is kneeling across from Katya, 37, who is being treated for pneumonia in a district Donetsk hospital. Katya is living with HIV, uses drugs and possibly has tuberculosis. Her legs are scarred and infected from injections with dirty needles.

During the early morning rush hour a commuter bus stops next to the tuberculosis clinic in a Donetsk suburb. Most of the passengers on the busare relatives of inpatients or sick with tuberculosis themselves. Commuter buses in areas with high tuberculosis rates are hot spots fortransmission of the disease.

In Yenakievo miners have a smoke after finishing their 8-hour shift underground. Mining is a popular choice - despite the health risks - because it offers a relatively high salary of US$ 300 per month.

A passenger in a city tram is looking onto a brand-new state of the art football stadium, built to host some of the matches of the Euro 2012 football cup. The construction cost $400 million, paid by the Ukrainian government and the local oligarch. Donetsk

Valeriy, 40 years old, has tuberculosis – he did not finish his treatment and returned home, where he spends his days drinking and shelling walnuts for sale. He earns 50 cents (US) for one kilo of shelled walnuts in Novotroitskoye village.

Laundry worker next to her washing machine – she says it's as old as she is. As far as she knows, it's been in the clinic since 1984. This device handles the laundry of 150 in-patients at a tuberculosis clinic in a Donetsk suburb.

A doctor is preparing her tuberculosis patient for an X-ray at a tuberculosis clinic in a Donetsk suburb.

This man, who spent decades in prison, is blind and has drug-resistant tuberculosis. He spends most of the time half awake at a tuberculosis clinic in a Donetsk suburb.

Donetsk in the evening – as a flock of birds flies around the residential housing block.

Vladimir (left) and his wife Tatiana play with their son (fully healthy) David. Both were intravenous drugs users and are living with HIV. Vladimir has recovered from tuberculosis. They met at a summer retreat for people who are HIV positive. They are now doing counseling and outreach work for an NGO, seeking to help other people to quit using drugs and lead healthier lives.

A visitor to the HIV/AIDS Centre in Donetsk is putting his jacket on. He has came in to pick up his antiretroviral medication. He formerly useddrugs and had tuberculosis. Local NGOs assert that about 150 thousand people are HIV+ in Donetsk Oblast - that's over 3% of the totalpopulation.

Two younger tuberculosis patients are guiding an elderly patient (centre) to her ward. Low salaries and difficult working conditions for health professionals lead to inadequate and limited nursing care in most tuberculosis clinics, like this one, in a Donetsk suburb.

A seriously ill patient (left) sitting in a ward in Mariupol. He is living with HIV, has hepatitis and drug-resistant tuberculosis and uses intravenous drugs. Across the street from this tuberculosis clinic is a clinic for drug users, where patients get their daily doses of a synthetic opioid substitute drug.

At a tuberculosis clinic in a Donetsk suburb a doctor checks Andrei for signs of life and finds none. A drug user of many years, he died at the age of 46 from HIV-associated drug-resistant tuberculosis. He had checked himself into the hospital three days earlier.

A man who has drug-resistant tuberculosis sits on his bed, looking into the wall at the tuberculosis clinic in Mariupol. There are no government-paid psychologists on staff in tuberculosis clinics in Ukraine, and patients must carry their burden alone. NGOs are struggling to offer psychological help to those with HIV and former prisoners. Tuberculosis clinic in Mariupol.

BackgroundTuberculosis is still a deadly disease – even in Europe. Ukraine, like many other countries in Eastern Europe and Central Asia, is shouldering a high burden of tuberculosis. Additionally about 15% of people with tuberculosis in Ukraine have multidrug-resistant TB (MDR-TB), which requires lengthy, difficult and costly treatment.

In Dontesk, the capital of Eastern Ukraine - a heavily industrial part of the country - tuberculosis and difficult social conditions converge. Unemployment levels are high, and thousands of mostly young people are using intravenous drugs or engaged in sex work. Tuberculosis runs rampant in prisons. Many thousands of people are living with HIV, which often forms a deadly mix with tuberculosis.

The Images to Stop Tuberculosis Photo AwardThe Stop TB Partnership seeks to produce a comprehensive body of photographic work on tuberculosis to be used for advocacy purposes. Every year, an international jury selects a photographer who will receive a grant to produce a photo reportage depicting tuberculosis. The jury includes photography experts from around the world. The Images to Stop Tuberculosis Photo Award is supported by the Lilly MDR-TB Partnership and is developed with the generous guidance of world renowned photo-journalist Gary Knight.