Undisputable worth of Ukrainian harm reduction organisations revealed by eight-year analysis
People who inject drugs who are in contact with harm reduction organisations are more likely to use condoms and sterile needles, and be on opioid substitution therapy or HIV treatment.
An analysis of five nationwide surveys conducted in Ukraine over eight years has found that people who inject drugs who are reached by harm reduction non-governmental organisations (NGOs) have consistently better outcomes relating to HIV prevention, testing and treatment.
These better outcomes were seen despite NGO clients being more marginalised as they are more likely to have been imprisoned, be economically more impoverished and inject more frequently.
A greater proportion of NGO clients were found to be living with HIV than non-NGO clients – with prevalence high at 29% – but they were more likely to be on treatment than those who had not received NGO support.
Data from national surveys carried out by the Alliance for Public Health, one of the largest harm reduction NGOs in Ukraine, was used for the analysis.
The first survey, conducted in 2009, involved around 3,900 people. Surveys in 2011, 2013 and 2015 involved between 9,000 and 9,500 people each, and the final survey in 2017 involved around 10,000 people.
All survey respondents had injected drugs in the last 30 days, were aged 14 or above and lived in one of 31 cities, covering all of the country’s regions. Roughly 80% of respondents were men and 20% were women.
Across all surveys, around one‐third of those questioned were NGO clients, a level that remained stable each year.
The analysis found that NGO clients were more likely to have received HIV testing in the last year or to have taken a test at least once. They were also more likely to have used condoms the last time they had sex and sterile needles the last time they injected. They were also more likely to be on opioid substitution therapy.
A greater proportion of NGO clients were living with HIV than non-NGO clients (29.2% vs 17.8%). This was also the case for hepatitis C (64.5% vs. 48.1%). But NGO clients living with HIV were far more likely to be registered at an AIDS centre and on antiretroviral treatment than other people who inject drugs who were HIV positive. The proportion of NGO clients reporting ART access also increased the longer they attended a clinic, from 54.2% if they attended the clinic for two years or less, to 71.4% if they attended the clinic for six or more years. In comparison, 46% of non-NGO clients reported being on ART.
NGO clients were more likely to be female, older, and to have been in prison. There were also financially worse off, earning a mean monthly income in 2017 of around US$190, around US$25 less than non-NGO clients.
These findings are limited by the fact that behaviours and uptake of interventions were self‐reported and so may be inaccurate. In particular, the question of whether or not someone was a client of an NGO could have been misunderstood by participants, which could skew the results.
Despite this, the analysis clearly shows that harm reduction NGOs in Ukraine are effective at both preventing HIV and improving the lives of people who inject drugs in numerous ways.
As Ukraine continues to move towards an HIV response that is entirely domestically funded these findings are a timely reminder of the need to ensure organisations that provide effective HIV prevention, testing and treatment services for people who use drugs can continue their work – once the international support that has funded them for so long is no longer available.