Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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Harm reduction is key to ending HIV transmission


Aids Alliance

According to WHO and UNAIDS, Ukraine is home to Europe’s worst HIV epidemic. Every day 57 people are newly infected and 11 die of AIDS. Yet last year, for the first time in over a decade, new data shows that HIV incidence is now in decline.

This is cause for celebration.  At last we have epidemiological data to show that our harm reduction approach to addressing HIV and drug use works.

It’s important to understand the challenging context in which Alliance Ukraine and its partners* are working.  Ukraine has nearly a quarter of a million people living with HIV.  HIV rates are particularly high amongst people who inject drugs – 21.5% HIV prevalence rate compared with 0.8% in the general population.  Many people find drug use a way to escape from the harsh realities of unemployment and economic depression. 

Alliance Ukraine, with the support of the Global Fund to Fight AIDS, TB and Malaria, implements the largest HIV prevention programme in Eastern Europe and Central Asia.  They take a harm reduction approach to addressing HIV and drug use. This means providing a range of evidence-based services and programmes - such as peer education, needle and syringe programmes and methadone programmes - that enable people who use drugs to protect their own health and the health of their families and communities. The programme is national in its reach, and highly targeted, focusing on where HIV transmission is occurring.

Pushing the boundaries

One of the most controversial aspects of a harm reduction approach is opiate substitution treatment.  Providing opiate substitutes such as methadone can drastically reduce the risk of HIV infection in drug users by reducing injecting.  In Ukraine, more than 7000 people receive opiate substitution treatment through.  However, not everyone is happy.  Alliance Ukraine estimates that street drug dealers are losing some £30 million of business a year because of the methadone programme. When people use methadone, they either stop or dramatically reduce their use of illicit drugs.

Key to the Ukrainian success has been linking HIV, drug treatment and TB services.  Alliance Ukraine adopted an integrated approach in 2008.  Providing all of these services at a single point of care is proving highly successful.  Last year, in 300 cities, towns and villages across the country, Alliance Ukraine and its partners ensured 170,000 people who inject drugs had access to HIV prevention services such as needle and syringe programmes, condoms, overdose prevention and rapid testing and counselling for HIV and sexually transmitted infections whilst accessing methadone and TB services.

Ukraine: a model for others?

The Alliance is keen to point to the experience of Ukraine as part of our work to encourage policymakers to focus on HIV prevention and the rights of people who use drugs to access harm reduction services.

Andriy Klepikov, Executive Director of Alliance Ukraine said “Our Ukrainian programme experience is already being used in a number of countries. Through the Kyiv Regional Technical Support Hub we are sharing our unique programming skills within the Eastern Europe and Central Asia region, and globally through the Alliance’s Community Action on Harm Reduction programme, which has resulted in substantial developments in these countries.”

The demand is great.  Last July, the Global Commission on Drug Policy published a report which talked about how the global war on drugs is driving the HIV pandemic among people who use drugs and their sexual partners. The report said “Throughout the world, research has consistently shown that repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated.”

That’s why we are supporting the campaign ‘Support. Don’t Punish’ which calls on governments to bring an end to the criminalisation and punishment of people who use drugs.

Susie McLean, the Alliance’s senior adviser on HIV and drug use said “In the countries where the Alliance works, we see on a regular basis how the routine criminalisation and incarceration of people who use drugs fuels HIV transmission and undermines efforts to get HIV treatment and care services to HIV positive drug users. 

“We know that a harm reduction approach to HIV and drug use works – just look at the evidence in Ukraine.  It is vital that global drug policy responds to this evidence.”

Alliance Ukraine will be holding a press conference at the International Harm Reduction Conference in Lithuania on Monday 12 June.  On the panel will be Michel Kazatchkine, UN Special Envoy on HIV/AIDS for Eastern Europe and Central Asia, Lord Norman Fowler, former UK health secretary and Nicolas Cantau, Regional Manager, Eastern Europe and Central Asia, Grant Management Division of the Global Fund.

Useful links

* Alliance Ukraine has been implementing Global Fund supported programmes as a Principal Recipient since 2004 with its co-Principal Recipients, the All-Ukrainian Network of People Living with HIV/AIDS and the Ukrainian Centre for Socially Dangerous Disease Control of the Ministry of Health, and their Sub-Recipients.

    Our experience is being used in a number of countries.