USAID conference in Kyiv, July 2011

1. Regional Workshop on
Drug Use and HIV in
Eastern Europe and
Central Asia
PEPFAR, Kyiv 11-15
July 2011
Universal access to ART – Policy vs
Practice
Zahedul Islam
ICF “International HIV/AIDS Alliance in Ukraine”

2. Access to ART in Ukraine
Total # of registered HIV cases 182028
Patients receiving ART 22 016
- Out of them 1 732 patients are active IDUs (less than 1%
of total HIV cases)
As of June 30, 2011 there are 6287 MAT patients
Out of them:
-2826 patients are HIV +
- 862 patients receive ART
www.aidsalliance.org.ua

3. Data on the number of HIV positive
patients on ART treatment and those who need ART
(absolute figures and % of coverage by treatment)*.
100000
94583
90000 number of those who need ART
80000 number of those who receive ART
76107
70000
60000 2011 46%
56801
50000 2010 51%
40000
42754 2009 48%
33016 2008 40%
30000
26693 25897 2007 35%
20000 21770 22016
17632 15871 2006 27%
14219
10000 10629 2005 21%
7657
3056 4777
0 0% 20% 40% 60%
2005 2006 2007 2008 2009 2010 2011 2012 2013
*Data of Ukrainian AIDS Center
In 2010 ART was needed for: under UNAIDS, WHO estimations -
92000, 99000 – 160 000 (CD4 200 and 350 correspondingly)

4. HIV Laws in Ukraine
• First HIV law was approved in 1991 by VR
• New version of law was passed in March 1998
• Above law was later amended in 2001
• The last of the HIV law came in to force January
2011
www.aidsalliance.org.ua

5. Law guarantees
• PLWHA with HAART (ART) and other medications for treating
opportunistic infections (p.15)
• The state ensures NGOs’ participation in providing charities, medical
and social services targeted at treating HIV infection, care, support and
social protection ( p.18 p.4)
•The new HIV Law guarantees implementation of harm reduction
programs (including MAT and syringe exchange)
In accordance with the Law, all the other guarantees and services are to
be enjoyed equally by all target groups including IDUs.
www.aidsalliance.org.ua

6. Breakdown of PLWHA estimate by group
Other
16% MSM fem.
Partners
3%
Injecting Drug MSM
Users 34% 9%
CSW Clients &
Partners
9%
CSW
IDU Partners 7%
20%
Inmates
2%
Workbook estimates 2008 (MoH, UNAIDS, WHO)
www.aidsalliance.org.ua

7. Commitment for access to key services per
national program 2009-2013
• To provide not less than 80% of PLWHA (who need
ART) with ART (before 2013);
• 20 000 patients with MAT by 2013
•100% access of HIV positive children to ART (from
2009);
• 100% laboratory support of patients using ART (from
2009);
• 60% of the MARPs has access to HR services
www.aidsalliance.org.ua

8. Emerging risk for access to services for PWID
• Resolution #634 (as of 29.06.10) issued by the Ministry of Health
of Ukraine
Brought into force amendments that significantly reduce the legal
threshold for “small,” “large” and “extra large” quantities of certain
types of illegal drugs, including those most commonly used by IDUs
in Ukraine.
www.aidsalliance.org.ua

9. PWID access to services
Resolution #634 (violation of human rights)
-The Resolution endangers needle and syringe exchange programs
-Higher rates of incarceration for IDUs will lead to further overcrowding in
Ukraine’s already strained prison system, and will lead to higher prevalence of
HIV, hepatitis and tuberculosis (TB) among prisoners.
-More stringent criminal liability will make IDUs even harder for health and social
services to reach.
-The mandate to investigate, prosecute, and imprison a significantly larger
number of IDUs will reduce the criminal justice system’s ability to deal with more
serious offenses, and will increase government spending at the expense of health
care.
-The authority to impose severe criminal penalties for possession of very small
quantities of illegal drugs creates a substantial opportunity for corruption among
law-enforcement officers and judicial bodies.
•The resolution violates the rights of IDUs and breaches the European
Convention for the protection of Human Rights and Fundamental Freedoms
www.aidsalliance.org.ua

10. Challenges to accessing ART by PWID
• Lack of ART medications for PLWHA due to delays in
procurements and regional deliveries;
• Lack of diagnostics for prescribing ART in some regions and
prisons;
• Registration of legal address is mandatory for accessing ART
(marginalized)
•The problems of state financing and state purchasing;
• Discrimination against PWID
• Human rights violation specially for people who use drugs
www.aidsalliance.org.ua

11. Conclusion
• Multiple legal documents indicate certain rights for PWID and
guarantees services for prevention, treatment and care, specially
in the new law approved in January 2011.
• Existing policy (national program 2009 - 2013) has not been
implemented to its fullest
• Current changes in the policy towards scaling up MAT in
Ukraine contradicts recently approved HIV law where access to
MAT is guaranteed.
• Lack of state funding to implement national program
• Need top level political commitment to realize policy in to
practice
www.aidsalliance.org.ua

12. Thank you!
www.aidsalliance.org.ua