Ukraine's HIV infection rate, 1.3% of over-15s, is the worst in Europe. Ukraine and Russia account for 90% of all HIV cases in the region.
Fewer than one-fifth of Ukrainian HIV patients receive anti-retroviral treatment. Botswana and Rwanda manage more than 80%.
In both Russia and Ukraine the epidemic is driven by intravenous drug use, with addicts accounting for around half of all cases.
Yet the Ukrainian government seems uninterested in prevention programmes.
"There's a line in the national AIDS programme budget for prevention," says Andriy Klepikov, head of AIDS Alliance Ukraine, "but its value is set at zero".
Places like the Drop In Centre in Kiev's Holosiiv district are funded by international donors.
The centre offers drug users tea, coffee and information, and is a base for harm-reduction initiatives such as itinerant needle exchanges.
When I visited, eight patients on the local methadone programme gathered to air their complaints.
They're grateful to the centre for providing them with somewhere to sit and chat, they say.
They find the atmosphere at the state-run (but foreign-funded) methadone clinic hostile.
"Police are stationed nearby and they regularly search us," says Pavel Kutsev, the centre's chairman, himself an addict of 30 years.
Drugs, the group agree, are a cash cow for the corrupt police: they take bribes from those they find in possession, they take a cut from the dealers, or even sell drugs directly.
Fewer than one-fifth of Ukrainian HIV patients receive anti-retroviral treatment. Botswana and Rwanda manage more than 80%.
In both Russia and Ukraine the epidemic is driven by intravenous drug use, with addicts accounting for around half of all cases.
Yet the Ukrainian government seems uninterested in prevention programmes.
"There's a line in the national AIDS programme budget for prevention," says Andriy Klepikov, head of AIDS Alliance Ukraine, "but its value is set at zero".
Places like the Drop In Centre in Kiev's Holosiiv district are funded by international donors.
The centre offers drug users tea, coffee and information, and is a base for harm-reduction initiatives such as itinerant needle exchanges.
When I visited, eight patients on the local methadone programme gathered to air their complaints.
They're grateful to the centre for providing them with somewhere to sit and chat, they say.
They find the atmosphere at the state-run (but foreign-funded) methadone clinic hostile.
"Police are stationed nearby and they regularly search us," says Pavel Kutsev, the centre's chairman, himself an addict of 30 years.
Drugs, the group agree, are a cash cow for the corrupt police: they take bribes from those they find in possession, they take a cut from the dealers, or even sell drugs directly.
Drug users are also useful scapegoats for other crimes: "If you detain them without access to drugs they will sign any papers you want," says Kostiantyn Pertsovskyi at AIDS Alliance.
It's not exactly heroin that most Ukrainian addicts use, but rather cheaper liquid opiates made in the country.
These are more dangerous than straight heroin: even if the syringes are clean, the liquid itself may be contaminated with HIV thanks to dirty equipment used by the dealers, or sometimes deliberate use of blood as a mixer.
So "substition therapy" — weaning users off opiates and on to controlled alternatives like methadone — is clearly crucial to reducing the risk of infection.
But aside from the discouraging atmosphere at methadone centres, the programme is, participants say, half-baked.
There is no co-ordination between methadone distribution and anti-retroviral treatment, notes Mr Kutsev.
Patients are sometimes forced to make long and expensive journeys across Kiev.
Moreover, without the prospect of proper rehabilitation, methadone can be a life sentence.
"My daughter injects drugs", says Oksana, a patient at the clinic, "but I would advise her not to go on methadone. The drugs she could potentially quit, but not this."
Yet funding for alternatives is a distant dream.
It's not exactly heroin that most Ukrainian addicts use, but rather cheaper liquid opiates made in the country.
These are more dangerous than straight heroin: even if the syringes are clean, the liquid itself may be contaminated with HIV thanks to dirty equipment used by the dealers, or sometimes deliberate use of blood as a mixer.
So "substition therapy" — weaning users off opiates and on to controlled alternatives like methadone — is clearly crucial to reducing the risk of infection.
But aside from the discouraging atmosphere at methadone centres, the programme is, participants say, half-baked.
There is no co-ordination between methadone distribution and anti-retroviral treatment, notes Mr Kutsev.
Patients are sometimes forced to make long and expensive journeys across Kiev.
Moreover, without the prospect of proper rehabilitation, methadone can be a life sentence.
"My daughter injects drugs", says Oksana, a patient at the clinic, "but I would advise her not to go on methadone. The drugs she could potentially quit, but not this."
Yet funding for alternatives is a distant dream.
Ukraine's government has recently agreed a co-funding deal with the Global Fund, an international organisation, worth $85m over the next two years, but AIDS Alliance says that the government's bit will be spent almost entirely on medical treatment rather than prevention.
"They usually procure medicines at a higher price than they need to," says Mr Klepikov. His (widely shared, if unproven) suspicion is that kickbacks are at work.
The rate of new HIV infections in Ukraine is stabilising: it was up this year, but only by 1%.
This improvement is largely the result of prevention programmes, says Mr Klepikov, who laments the lack of funding for such schemes.
Another annual report published this week may help explain Ukraine's performance on HIV/AIDS.
Transparency International's Corruption Perceptions Index showed Ukraine slipping 18 places to 152nd out of 183 countries.
"They usually procure medicines at a higher price than they need to," says Mr Klepikov. His (widely shared, if unproven) suspicion is that kickbacks are at work.
The rate of new HIV infections in Ukraine is stabilising: it was up this year, but only by 1%.
This improvement is largely the result of prevention programmes, says Mr Klepikov, who laments the lack of funding for such schemes.
Another annual report published this week may help explain Ukraine's performance on HIV/AIDS.
Transparency International's Corruption Perceptions Index showed Ukraine slipping 18 places to 152nd out of 183 countries.
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