Outskirts of Kramatorsk. April 8th, 2016.

Outskirts of Kramatorsk. April 8th, 2016.

Kramatorsk, since October 2014, has become the provisional capital of the Donetsk Oblast after the government re-gained control of the city from pro-Russian rebels. The city appears calm, the warm sunshine reflecting off the bright blue and yellow paint slathered on almost every wall and lamppost. Spend a few hours in the city and you realize this is a place that has been reluctantly thrust into the spotlight; a traditional industrial hub, now at the centre of a tense standoff between two nations that are both ingrained in the city's history.
 
The city lies 20 km from pro-Russian held territory and every other person seems to be a Ukrainian soldier. Kramatorsk, is also home to a number of displaced refugees from the pro-Russian part of the Donetsk region. The relative calm and warm sunshine proves deceptive; many houses are riddled with cracks and bullet holes from the recent conflict. Trade and movement continues to some extent across the border - a border which is always referred to as temporary - but the locals provide only cryptic responses when asked about it.

Kramatorsk, is a good example of how conflict effects the most vulnerable in society. The economic, social and psychological stress that the war has inflicted on the men in the region has led to an increase in GBV (gender based violence). This displacement and stress has also led to a rise in intravenous drug use and the presence of a large amount of soldiers living amongst the local community has led to an increase in sex work, or 'survival sex' as one UN representative told us it has been referred to locally.  He is keen to point out that a lot of the soldiers are good people, but there is a lack of education and no effective program, isolated barracks or restrictions in place to manage contact with the local community. The presence of more IDUs (intravenous drug users) and unsafe sex has resulted in a higher prevalence of STIs and HIV transmission. A toxic situation, made all the more potent by the fact that no region-wide program can be implemented or reliable statistics collected

Maternity ward. Kramatorsk, Ukraine. April 8th, 2016.

Maternity ward. Kramatorsk, Ukraine. April 8th, 2016.

There are a number of initiatives set up on the Ukrainian government side of the border, as it is generally acknowledged that the Donetsk People's Republic has a different approach to GBV, and although they are willing to receive medical kits and supplies, they have been resolute in their denial that GBV, drug use and sex work is a problem in the area. Any comment made about the decision making process in Donetsk is usually followed by an inference that it is actually made somewhere else. Infused with this culture of denial, is the stigma attached to being a victim of any of these issues; the result is a large number of women crossing the border for support. Safe houses have been set up to help victims of GBV, with psychologists, lawyers and doctors on hand. One maternity centre helped women considered at risk, with one ward dedicated to premature births, just one of the many serious side-effects of drug use during pregnancy.
 
Ukraine has long suffered from one of the highest rates of HIV in Europe, yet a lot of progress had been made to prevent the spread of the virus. Now the conflict has thrown this into jeopardy and the country stands on the brink of an epidemic. Reliable statistics are hard to come by in the region of Donetsk, but one study showed Hepatitis C, a proxy of HIV, had a 18% prevalence amongst troops.
 
We met an HIV positive woman in her apartment (who wished to remain anonymous), she had three healthy children with her; she had given birth to them after her diagnosis. They had received the necessary ARV treatment; her first child had not and died soon after being born. Ukraine had made huge progress in reducing mother-to-child transmission to 2% but now the conflict will undo a lot of this good work and many children face being born HIV+ despite the existence of this therapy. Not only will they face the health risks but a potential lifetime of stigma; her husband also died from AIDS, and so deep-set was the stigma that no-one would help bury him.
 
The beauty of human progress in medicine and technology that has helped reverse the spread of HIV in the region is now being undone by the irrationality of human behaviour and politics. This is a crucial period in Ukrainian history and the actions taken now will help determine how this situation will look in years to come.