Alliance’s national anti-retroviral treatment work threatened by Ukraine Committee move to ban methadone
27 July 2005
Moves by the Committee on Drug Control, Ministry of Interiors and Security Service of Ukraine to ban the use of methadone could further undermine efforts to prevent new HIV infections in Ukraine and delay the roll out of anti-retroviral treatment programmes. An estimated 70% of people living with HIV/AIDS in Ukraine are injecting drug users, making substitution therapy key to successful HIV/AIDS programming.
The Alliance has had informal discussions on the potential impact of a ban through the newly-established National Coordination Council on HIV/AIDS (which aims to prevent HIV/AIDS in Ukraine), and its Committee on the Rights of People Living with HIV/AIDS.
Substitution therapy is a vital tool in the management and care of injecting drug users living with HIV/AIDS, and in preventing new HIV infections. Drug-dependence treatment for injecting drugs users enhances the uptake of and adherence to anti-retroviral treatment by helping people manage their drug dependency. In addition, opioid-substitution treatment such as methadone reduces HIV risk behaviour, again by helping people to manage their drug dependency. Different drug use treatment works for different people and drug users need choices in managing their dependency issues and their HIV risks. But for large numbers of people, methadone remains the most effective drug treatment option.
The efforts of the Committee on Drug Control to ban the use of methadone have been criticised by both international and Ukrainian experts. The Ukrainian Parliament recently recommended implementing substitution treatment as an effective mechanism for the prevention and treatment of HIV/AIDS among injecting drug users in Ukraine. In a move expected to increase global access to effective drug treatment and HIV prevention, the World Health Organization recently added methadone and buprenorphine to its latest list of essential medicines for drug dependence treatment. Methadone is much cheaper than the alternative, buprenorphine. However, methadone continues to remain a political focus, mainly because of its availability on the illegal market, and because of the dangers associated with its illegal use. Buprenorphine, meanwhile is not available illegally in Ukraine.
The final report of the WHO/UNAIDS/United Nations Office on Drugs and Crime 2004 Joint Mission on Opioid Substitution Therapy in Ukraine recommends rapidly implementing and scaling up substitution treatment to between 60,000 and 238,000 people. To achieve this, far-reaching initiatives need to be taken by the Ukrainian government.
A final resolution with recommendations for scaling up substitution therapy and immediately implementing methadone maintenance therapy is currently being considered by the National Coordination Council on HIV/AIDS.
