| In Ukraine, as in
most countries of the former Communist bloc, the issues of
HIV and drug use are rife with prejudice, taboos, lack of
understanding and discrimination. Drug users and people living
with HIV are ostracized and isolated, exacerbating their predicament.
So it came as a surprise to Volodya, 24, when he received
a friendly reception at a Ukrainian Red Cross programme at
a medical clinic.
“A friend told me about the syringe exchange programme,”
he says. “It is really nice to be treated with kindness
and to be informed about the diseases that I am at risk of
contracting. They have given me documentation, and we discuss
it together.
“Now I feel protected and, thanks to the psychological
support, I know that it is possible to live with HIV, whereas
before I was utterly depressed.”
Alarming rise
Volodya and other injecting drug users can come to the Red
Cross clinics for confidential advice, safe from the persecution
that they often receive from the public who see them as criminals.
Drug users receive sterile syringes, primary health care and
clothes and, if they request it, can have a one-to-one talk
with a staff member.
The programme is desperately needed. Ukraine is badly affected
by HIV, with an adult prevalence rate of 1.5 per cent. UNAIDS’
2006 AIDS Epidemic Update estimated that by the end of 2005,
377,000 people were living with HIV in Ukraine. Far from waning,
diagnoses more than doubled between 2000 and 2006, mainly
among injecting drug users but also, more recently, through
sexual transmission.
In 2006, in an effort to tackle this problem, the Ukrainian
Red Cross Society launched an innovative — if not revolutionary
— project aimed at reducing the risk of HIV among people
who inject heroin and other opiates. The pilot project was
developed with the support of a variety of actors, including
Ukrainian HIV centres, scientific research centres, local
and international non-governmental organizations, the International
Federation, the Italian and French Red Cross Societies, and
the French Interdepartmental Mission for the Fight against
Drugs and Drug Addiction.
Former drug users
In the project, Red Cross committees in the provinces of
Kiev and Zaporizhzhya set up seven clinics within existing
medical and social centres. The clinics offer syringe exchanges
and paramedical services. They also do preventive work, raising
awareness of HIV transmission and drug abuse, not only among
the users but also among their sexual partners, families and
the wider community. In addition, the clinics offer a voluntary
specialized advisory service covering health, such as screening,
access to antiretroviral drugs and substitution treatment,
and social issues.
In Zaporizhzhya, the committee of the Ukrainian Red Cross,
under the direction of its president, Constantin Silin, set
up three clinics for needle exchanges and to care for drug
users. One of the clinics is inside the committee’s
headquarters.
The clinics are complemented by mobile units staffed partly
by social workers, most of whom used to inject drugs. Zhanna,
a former drug user, has been a member of the team at Zaporizhzhya
branch for two years.
“This work has enabled me to pick myself up,”
he says. “I want to help others do the same. I know
almost half of the injecting drug users in the town and can
communicate with them easily. I organize support groups, I
talk to them on the phone, I provide them with food, I give
them advice and meet up with them in the street or in their
homes.”
High demand
The workers’ experience of drug use helps them connect
with others. One young woman, who wishes to remain anonymous,
was hired by the Kiev committee although she still uses drugs.
“I talk to the beneficiaries as an equal,” she
explains. “My role is to tell them about the risk of
infection and the need to use sterile syringes or at least
to clean them. Many are unaware that HIV can be transmitted
by contaminated needles. I also invite them to come for a
confidential consultation.”
Today, more than 4,500 people use the services. In Kiev,
90 adults living with HIV and 23 children (of whom 11 have
HIV) receive care at home. In Zaporizhzhya,30 people should
soon be entitled to receive substitution treatment using Buprenorphine
and Methadone. Across Ukraine, 530 people are currently undergoing
this treatment, through the Ministry of Health and a grant
from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
This should rise to 2,000 by the end of 2007, but it is still
only a small drop in the ocean of needs.
Since 2003, the Red Cross in Kiev has been operating a home
care and social support programme for people with HIV. The
programme is aimed primarily at low-income families, people
with AIDS and single mothers at risk. The programme started
with 130 people, and in September 2006 a further 90 participants
were added to the pilot project. Eighteen nurses and a psychologist
visit the participants in their homes two or three times a
week. Regular visits enable the team to keep an eye on their
general state of health and to develop their hygiene and nutrition
skills. For the participants, it avoids the trauma of hospitalization
and allows them to maintain a social life.
Widespread stigma
Through its holistic approach and extensive network, the
Ukrainian Red Cross and its local branches have been able
to contribute to changing the way drug use and HIV are perceived.
All the participants have encountered difficulties in reintegrating
into society and simply being accepted.
Zhanna puts it succinctly. “The whole population is
desperately lacking information on these issues. Stigma is
widespread. We need to have an information campaign to raise
awareness among the general public, the police and specialist
medical personnel of what we are doing so that we can expand
our activities throughout the country. It is vital, if we
are to change attitudes.”
Through its contacts with medical circles, non-governmental
organizations and the authorities, the Ukrainian Red Cross
is now well placed to play a central role in HIV work, in
particular by reducing harm.
The next step will be to roll out the project nationally
and to extend it to other Eastern European countries that
face similar difficulties linked to the dire economic situation
and decaying health systems.
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