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Revolution in Ukraine
Swapping needles for kindness


Red Cross staff and volunteers use information, food and care to reach people who are often shunned by society.


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.












“It is really nice to be treated with kindness”

Géraldine Drot
Géraldine Drot is chief editor at the
French Red Cross.



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