Ukraine steps-up to fund opiate substitution treatment for people who inject drugs
Key affected populations in middle-income countries are hardest hit by global funding cuts, but Ukraine has made a bold move to fund its own response for people who inject drugs.
Ukraine has made a positive step in facilitating access to vital HIV prevention services through its decision to fund opiate substitution treatment (OST) for people who inject drugs in the country, starting from 2017.
Harm reduction interventions such as OST and needle exchanges are integral components of the HIV response where injecting drug use is a driver. This is no truer than in Ukraine, where injecting drug use and associated sexual transmission define the epidemic – around 21.5% of the 310,000 people who inject drugs in the country were living with HIV in 2015.
But Ukraine’s response is largely resourced and funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), with key technical support from UNAIDS and key civil society organisations such as the Alliance for Public Health in Ukraine. With their help, Ukraine’s HIV response has become a model for effectively addressing HIV epidemics among key affected populations. It has experienced impressive declines in HIV prevalence among people who inject drugs from a peak of 41.8% in 2008 to almost half that in 2015, through the delivery of key harm reductions services for this group.
In the wake of limited international funding and resourcing for the response, it is middle-income countries such as Ukraine that are feeling the squeeze.
As a result, Ukraine has one of the highest proportions globally of people who inject drugs who report using sterile injection equipment for their last injection. And in just ten months, community outreach officers have been able to increase uptake of methadone substitution therapy and antiretroviral treatment by a staggering 36%.
However in the wake of limited international funding and resourcing for the response, it is middle-income countries such as Ukraine that are feeling the squeeze. HIV prevention for key populations in low- and middle-income countries accounted for less than 2% of total HIV resources in 2015. Most money for these groups comes from international donors, not national governments, who often have little appetite to acknowledge, let alone respond to the needs of drug users, sex workers or men who have sex with men, among others.
For example In the Philippines, another middle-income country, HIV prevalence among people who inject drugs has risen from 1% in 2008 to 44.9% in 2014 because the government has chosen to ignore the health needs of this group.
In contrast, the government of Ukraine has allocated around US$ 500,000 to enable 8,000 people who inject drugs to continue to access OST in 2017, after funding from the Global Fund ends. Pavlo Rozenko, Vice-Prime Minister of Ukraine remarked, “We have taken a major step forward to increase public funding of HIV and TB programmes in Ukraine. This is our ideological choice. It’s not just because of Ukraine’s international obligations. We do this primarily for those people who are faced with these serious diseases and who need our help.”
But funding isn’t the only issue in Ukraine. Conflict in the east of the country and Crimea have cut off antiretroviral treatment and harm reduction services to thousands of people living in these regions. Ensuring they can access services for their health and human rights, in addition to a scale-up of domestic funding, is the way forward to ensuring progress made thus far is not in wasted.