These personal experiences often result in support for local efforts with drug users, like community centres such as Heart to Heart, which is supported by Alliance Ukraine, but nationally these efforts are being blighted by state-led discrimination.
Currently new cases of HIV remain highest among people who use drugs. An estimated 23% of injecting drug users are HIV positive in Ukraine.
According to Svitlana Cherenko, head of the HIV/AIDS Committee at Ukraine’s Ministry of Health, the government recognises the importance of providing targeted services. Back in July 2010 she said: “To really control HIV we need to respond to the epidemic, especially prevention programmes with vulnerable groups, including drug users.”
This flies in the face of the current crackdown which is interfering with people being able to access substitution therapy.
Substitution therapy is a critical component of the package of harm reduction approaches that is vital not only in helping people manage their addiction, but also in supporting the decline of new HIV infections.
The rate of growth in HIV infections has begun to slow; services supported by Alliance Ukraine that are reaching marginalised groups most at risk from HIV are working. But without support, including substitution therapy, drug users in Ukraine face a bleak future.
Konstantin from the PLHA (People Living with HIV) Network knows this only too well. “I know people who don’t have the fight in them - and they die,” he says. “This is due to drug use. You see people deteriorate before your eyes.”
He also knows first-hand the results the right support can yield. “When I was diagnosed HIV positive over five years ago I thought my life was over. I didn’t know much about HIV and thought I had six months to live - so I continued to use drugs. I couldn’t see any point to changing my life.”
While at his lowest, Konstantin was introduced to support services by a friend. It proved a turning point. Last summer he ran 6km and is a keen sportsman. He, and other staff, are an inspiration to the 1,200 clients they support. “There’s a baby boom among the staff at the moment, with five couples recently given birth to healthy, HIV-free babies,” smiles Konstantin.
Outside of Cherkassy where there are growing numbers of drug users it can be even harder to access to substitution therapy. “Poppy season attracts more people into rural areas of Ukraine”, explains Father Nicolay, a priest of the Ukranian Orthodox church. In his experience, rural areas are prone to both higher levels of stigma and lower levels of services compared to the cities.
He faces enormous challenges in supporting people who use drugs. Four of the young people he worked with had died in the squat they all shared from injecting the same poisonous substance.
It is Father Nicolay’s ambition to create a rural rehab centre, and it looked close a couple of years ago until the global financial crisis hit. “There is a fear of reintegrating back into society,” he says. Without centres offering substitution therapy, the counselling and peer support that is offered is all too often no match for addiction.
ON THE RIGHT TRACKS
Father Nicolay is on the right track
though. Peer outreach work appears to be the most successful type of
intervention in Ukraine where drug users are at best skeptical of state
services, and at worst intimidated, abused, or arrested; fears which
this latest crackdown is compounding.
“It’s easier to get services
if a social worker accompanies you to the hospital - and to deal with
the police.” This an opinion shared by friends waiting for the services
of a ‘mobile clinic’ in a residential area of Cherkassy. The clinic
usually operates one night a week from a yellow bus, which is shared
between five local projects across one week - unfortunately it regularly
It takes more than a broken down bus to stop services here, instead a social workers’ lounge in a Soviet-style tower block is a pop-up clinic for the night (social worker usually means the same as peer support worker in Ukraine).
There are eight people waiting for rapid-HIV tests before the front door has opened. Among them is Alexey. He tested positive back in 1996, but as he recalls: “The hospital took the test without my consent, and I think they could have lied.”
His mistrust in official services has meant he has gone 14 years without any support, and without really knowing. His son was born HIV-free which provided him with hope for his own status.
A former drug user, he is now on substitution therapy, but not before losing his best friend to HIV. His younger brother and his cousin are both HIV positive, and he believes all three cases can be attributed to sharing needles. And in the past he shared needles with them.
Following a short wait after a pin-prick test Alexey’s worst fears are confirmed. Despite the devastating news he is better off knowing and he now has access to peer support which will help him navigate through the health system. Getting off drugs with the help substitution therapy contributed to finding the strength to request a HIV test, and being drug-free will help him stay strong and continue to support his wife and young child.
Alexey is one of more than 6,000 patients receiving substitution therapy in Ukraine who are affected by this crackdown. He, and others like him, may be deterred from accessing treatment unless they can do so confidentially, without fear of what the authorities will do with information about them, and how it may affect them and their families.
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It's easier to get services if a social worker accompanies you to the hospital