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HEALTH: Scare Haunts HIV/AIDS Patients in Ukraine

Pavol Stracansky

KIEV, Mar 22 2011 (IPS) - Fears are growing among HIV/AIDS sufferers in the Ukraine amid claims from some patients that they have been denied life-saving medicines by authorities as a crackdown is launched on drug substitution therapy.

Hundreds of patients receiving the treatment allege that they and their families are being intimidated by police who have forced them to divulge confidential health information, including their HIV status, in interviews.

Subsequently, they are worried that their medical details could now be used against them as and when authorities please.

“Patients are very scared. These interviews have been taking place and now patients do not know what will happen with the information they have given the police,” Pavlo Skala, a programme manager at the Ukraine International AIDS Alliance in Kiev, told IPS.

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 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. It is backed by the U.N. and the World Health Organisation (WHO).

The WHO and UNAIDS (Joint United Nations Programme on HIV/AIDS) say that 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. Ukraine is among those worst affected, with an epidemic 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 2009. 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.

But last year medical workers and groups involved in drug substitution therapy began reporting systematic harassment of NGOs and doctors working in drug substitution, including criminal proceedings against some for drug offences; and there were concerns Kiev was moving against the practice.

Now, in what HIV/AIDS support groups have described as a “cruel and dangerous” new approach, police appear to be targeting drug substitution therapy patients.

In testimonies given to support groups and passed to IPS, patients have described how they have been forced into police cars outside clinics and made or tricked into answering what officers have later claimed is a ‘voluntary’ health questionnaire.

Patients are told they cannot have their medicines until they have answered a set of questions.

Some who tried to refuse said they were physically threatened or told that there would be consequences, such as their families or neighbours being informed of their drug substitution therapy and HIV status, if they did not.

One patient who refused to give her personal details was told by an officer: “Right you bi…, we’ll show you something now. You’re coming with us.”

International institutions, including UNAIDS and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which fund HIV programmes in the country, have demanded an end to the crackdown.

Ted Nierras, head of the International AIDS Alliance’s Eastern European team, told IPS: “Collecting individuals’ personal data, including their HIV status, is a clear violation of human rights. A crackdown on substitution treatment patients, service providers, and NGOs does not help in reducing HIV infection and AIDS. We have heard reports that over 2,700 clients have been forced to disclose information before being able to access life-saving treatment — this must stop.”

The Ukrainian interior minister, Anatoly Mogilev, has repeatedly made public his opposition to drug substitution treatment. He has described the decision to legalise such therapy as a “mistake”.

In a letter sent to the prime minister last month, Mogilev asked him to “consider prohibiting the use of methadone in substitution maintenance therapy, as well as to commission scientists working in the area of pharmacology to develop a ‘softer’ drug for use in substitution therapy … manufactured by the domestic pharmaceutical industry.”

But the Interior Ministry crackdown is at odds with apparent government support for drug substitution therapy.

Prime Minister Mykola Azarov issued a directive last January scaling up drug substitution treatment programmes among injection drug users — a move described by doctors working to fight AIDS epidemics around the world as “bold and far-reaching”.

It is unclear why the Interior Ministry has intensified its opposition to drug substitution therapy programmes.

Some experts have speculated that corrupt police may be acting on behalf of local drug lords, afraid that their business is suffering, to stop the programmes.

Another theory is that Russia, as in many other spheres, is exerting influence on Ukrainian policy. 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, while public support for it is punishable by jail.

Diederik Lohman, senior health and human rights researcher at Human Rights Watch (HRW), which has written to the Ukrainian president Viktor Yanukovych over the harassment, told IPS: “Police often have targets for the number of cases they must solve per month and catching a drug user with an illegal substance is often an easy way to do so.”

Also, corruption in the police force is widespread, he said, and drug users are often an easy target for blackmail. It is also possible that this information will be used to try to discredit drug dependence treatment using methadone and buprenorphine.

Lohman said: “It is no secret that police in the Ukraine have always been sceptical — hostile — to the idea of substitution treatment. So it may be that they were acting on their own to try to discredit this type of drug treatment. But we also don’t know to what extent President Yanukovych is being led by Russia in his own approach.”

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