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Kostia Pertsovskyi: In Ukraine, opioid substitution therapy for injecting drug users is under threat

9 Feb, 11 | by BMJ

Kostia PertsovskyiIn Ukraine the prevalence of HIV/AIDS is the highest in Europe, and injecting drug use is the primary driver. A new law passed in January 2011 reaffirmed state guarantees for harm reduction services, including needle exchange and substitution treatment, as well as confidentiality of HIV status. This law is a major turning point for the AIDS response, but Ukrainian law enforcement bodies are jeopardising its implementation.

In the past month law enforcers throughout the country have been compiling lists of patients who receive legal opioid substitution therapy (OST). Personal data is recorded, including HIV status and substance dependency, and clients of HIV services are being intimidated along with their families and medical staff. “In what way and for what purpose will those lists be used? This is a real issue,” said Alexander Yurchenko, chief doctor of the Kiev City AIDS Center.

Both UNAIDS and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which fund HIV programmes in the country, have called on the government of Ukraine to stop the disruption of HIV services. Human Rights Watch has written to the Ukrainian president, Viktor Yanukovych.

The Ukrainian interior minister, Anatoly Mogilev, made his opposition to OST clear at a press conference with Viktor Ivanov, director of the Federal Drug Control Service in Russia. As the minister spoke in Kiev, 700 km away policemen visited an OST clinic in Gorlovka. Patients were invited to a room, “just to have a talk,” one by one. Those who refused were threatened. All patients’ personal details were recorded.

“In my view, whoever created this programme in the country made a mistake,” Mogilev said. “My colleague [Ivanov] and I discussed this issue: in America this approach lacks support at the official level; it is implemented only in a few European countries; and this topic [OST] is problematic. We are discussing right now at the level of the cabinet of ministers about transforming it to, let’s say, a more civilized method.”

This is not true. Methadone and buprenorphine opioid substitutes are offered in 1433 licensed facilities throughout the United States to 253475 clients (Mathers B, et al. HIV prevention, treatment and care for people who inject drugs. Lancet 2010;375:1014-28). Also the provision of methadone or buprenorphine as maintenance therapy is common throughout Western Europe, with the only exceptions Andorra, Monaco, and Turkey (International Harm Reduction Association. The Global State of Harm Reduction 2010).

Leonid Vlasenko, a drug treatment doctor from Dnipropetrovsk with 30 years of experience, says that it’s thanks to OST that people almost quit injecting drugs and thereby reduce transmitting infections. Since late 1980s, when the first cases of HIV were registered in Ukraine, the share of infection transmission through injections went from 80-90% of all transmission cases, to less than half today. This year for the first time the number of new HIV positive cases fell by 7% in Dnipropetrovsk region compared with last year. Surveillance in 2010 shows a decrease in HIV prevalence among recent drug injectors in the country in general from 21% in 2008 to 16% in 2010.

State funding in Ukraine covers only 45% of the country’s AIDS programme and doesn’t cover OST drugs or prevention among high risk populations, which are funded by civil society and international donors. The government’s actions put at risk the substantial achievements in HIV prevention and treatment that have been made in the country, in particular, stabilising the epidemic among injecting drug users, which is one of the main drivers of the epidemic.

Kostia Pertsovskyi is senior communications manager, International HIV/AIDS Alliance in Ukraine.

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