Development & Aid, Europe, Headlines, Health

UKRAINE: Punished for Fighting AIDS

Pavol Stracansky

KIEV, Aug 4 2010 (IPS) - Drug users and doctors legally prescribing substitution drugs to addicts — a key tool in the battle with the country’s growing HIV epidemic — are facing illegal police intimidation and imprisonment, HIV/AIDS activists in the Ukraine say. Fears are rising that the country’s approach to the disease could be changing for the worse.

Two doctors have been arrested, medical centres treating drug users raided by police, and drug users receiving substitute treatments detained en masse in a series of recent concerning events, they say.

They also point to the announcement of plans to close the country’s top HIV/AIDS treatment centre this month as a signal that the new Ukrainian leadership is moving away from its predecessors’ positive strategies in the fight against the disease in a country still struggling with one of the world’s worst HIV/AIDS epidemics.

Pavlo Skala, senior programme manager at the International HIV/AIDS Alliance in Ukraine charity told IPS: “The signs over the last few months have not been good. Things are going downhill with the Ukrainian leadership’s approach to HIV/AIDS treatment.”

According to the World Health Organisation (WHO) and UNAIDS, Eastern Europe and central Asia have one of the fastest-growing HIV epidemics in the world — there was a 66 percent rise in infections between 2001 and 2008. Russia and Ukraine are among those worst affected, with epidemics fuelled by injected drug use that has soared in the 20 years since the collapse of communism.

It is estimated that there are up to 300,000 injecting drug users in Ukraine, and in major cities as much as a quarter of them are thought to be infected with HIV.

The country is also believed to have one of the highest HIV rates in Europe with an estimated 360,000 people over the age of 15 infected, and an HIV prevalence rate of 1.1 percent in the adult population as of last year. In comparison the figure in Britain is 0.2 percent of the adult population.

Ukraine won praise from international health groups after adopting drug substitution treatment programmes in 2004 following the Orange Revolution designed to help combat addiction, and with it the spread of HIV. There are currently just over 5,000 injecting drug users registered in drug substitution programmes, with plans for as many as 20,000 to be participating by 2014.

International health experts say that the use of drug substitution therapy — whereby heroin addicts are legally prescribed doses of opiate substitute drugs such as methadone and buprenorphine in an effort to help them control and treat their addiction — has been proven to help slow the spread of HIV/AIDS in epidemics fuelled by injection drug use.

Prof. Gerry Stimson, executive director of the International Harm Reduction Association, told IPS the case was well illustrated in Ukraine’s neighbour Russia. Drug substitution therapy is banned in Russia, authorities refute international expert opinion on the treatment, and condemn it as simply giving addicts a different drug to use. Public support for it is punishable by jail.

Prof. Stimson said: “The proportion of all AIDS cases linked to injecting drugs in Russia is 65 percent. The proportion of all injectors who have HIV is 30-35 percent. In the UK, for instance, the prevalence among injectors is 1.5 percent. This difference is down to early and widespread roll out of methadone and needle exchange. Methadone is the standard treatment offered worldwide and numerous international studies have shown its effectiveness.”

But HIV/AIDS groups have warned that drug substitution programmes are now under threat following “systematic” detentions of doctors and patients.

Dr Ilya Podolyan, who works in a substitution therapy programme in Odessa, is facing trial on charges of drug trafficking after being arrested in May. Another doctor, Yarsolav Olendr, who also prescribes substitution maintenance therapy at a centre for drug addicts has been placed under house arrest at this home in Ternopol, western Ukraine, and been charged with violating laws on narcotics.

Local NGOs have reported mass detention of patients at treatment centres, arrests of medical staff, and incidents of police forcing disclosure of patients’ confidential information.

The Ukrainian International HIV/AIDS Alliance has also documented dozens of cases of human rights abuses of patients and medical staff including spot checks of medical facilities, unlawful removal of lists of drug dependent patients, illegal home searches, subjecting patients and medical staff to psychological pressure and hindering medicine supplies.

NGOs have appealed to the authorities to guarantee patient rights and that drug substitution therapy will not be threatened. But they say the situation has not improved.

Andriy Klepikov, director of the International HIV/AIDS Alliance in Ukraine, told Ukrainian media: “There is interference from law enforcement agencies in the realisation of medical programs of replacement supportive therapy. A systematic approach can be seen, in particular the detention of doctors and patients.”

Skala told IPS it was believed that corrupt police were acting on behalf of local drug lords to stop the programmes.

“Our sources tell us that local drug dealers are apparently unhappy with substitution therapy because they are losing customers. And with such high levels of corruption in the police it was not long before officers acted on behalf of the drug dealers and took action against these doctors,” he said.

With the recent police harassment and plans to close down the HIV/AIDS treatment centre on the grounds of the Pecherskaya monastery in Kiev under legislation banning non-monastery activities on the site, there is a fear that the new pro-Russian leadership is changing its strategy in the fight with HIV/AIDS.

One campaigner for the rights of people with HIV/AIDS in Kiev told IPS: “No one will ever say this officially but it is well known that the current Ukrainian leadership is now strongly connected to Russia and Russia does not like progressive methods of HIV/AIDS treatment, especially drug substitution therapy. What is happening here is under the influence of Russia.”