Getting to Zero in Ukraine

Imagine if crossing the street against a red light got you kicked off a lifesaving medication. This is exactly what is happening to people who use drugs in Ukraine.

Ukraine has one of the fastest growing AIDS epidemics in the world (currently, the second highest rate of HIV infection in all of Europe). Yet, government interference in medical practice continues to make it harder for those most in need to access treatment.

Opiate substitution treatment (OST) with methadone or buprenorphine has long been proven to stop the spread of HIV among people who use drugs by providing a medically managed and supportive alternative to the daily grind of addiction and giving people the space they need to stabilize their lives. Methadone is listed as an essential medicine by the World Health Organization. 

Substitution treatment was introduced in Ukraine in 2003 and there are now approximately 7,000 patients on treatment. However, repeated attempts by the government and police to intervene in the ways that drug users can access this treatment have all but stalled uptake into substitution programs in the country.

The latest such example of government interference is Ministry of Health Order #200. This order (or “prikaz”) contains many points which present serious barriers for scaling-up OST or even maintaining the same number of patients, and will make the lives of patients more complicated. Before being admitted into an OST program, potential patients must first provide “official,” documented proof of two failed rehabilitation attempts—without medication—during the past year. This administrative hurdle is not only onerous for people seeking medical help, it is completely contrary to best practices in addiction treatment.

The Order also lists a number of reasons for which patients can be kicked off treatment—always without further notice or opportunity to go through managed withdrawal—including:

• 10 days absence from the program
• A positive urine test for opioids
• Any administrative violations
• Any driving-related prohibition

To be clear, this means that an OST patient who gets a jaywalking ticket for crossing the street on a red light can be kicked out of the program and denied access to life-saving preventative therapy.

In enacting this regulation, the State HIV Service ignored all propositions put forward by stakeholders and medical practitioners. It was approved by the Ministry of Justice without open debate.  

On the eve of the International AIDS Conference in Washington, DC, attention is once again being focused on the fact that there is no “getting to zero” in HIV transmission without a clear focus on the treatment needs of people who use drugs. Two leading commissions have called this month for decriminalization of drug use and an end to discriminatory laws and policies that impede HIV (see the Global Commission on Drug Policy and the International Drug Policy Consortium). 

Now more than ever, the Ukrainian government should be embracing and expanding OST as a key clinically proven means of preventing the spread of HIV, not placing more bureaucratic and administrative barriers in the way of care. Instead, Ukraine appears to be leaning towards Russia, where methadone has long been banned and even talking about it is increasingly prohibited.

Russia has the highest rate of HIV in Europe. This is not the path Ukraine should follow.