Ukraine’s war on drugs drives HIV epidemic

Punitive approachs to opioid users across Ukraine and the wider region are driving an epidemic. Madeline Roache reports

Sitting on the grass outside a narcology clinic in Kiev, Marina Misnik lifts her trousers and shows me the hardened, purple skin on her shins. More than ten years of using heroin has caused the nerves on her leg to collapse and turn into sores.

Misnik, 26, told New Internationalist she started using illegal opioids when she was 17. She found out she was HIV positive in her early 20s.

In 2014 Misnik’s husband died of an overdose, aged 31. That is when she decided to try to overcome her drug addiction and start opioid substitution treatment (OST).

‘Before OST, I couldn’t work or take care of myself. I used to steal from shops to survive. It wasn’t a life. Everything is easier now that I can think straight,’ said Misnik.

In 2014 Misnik’s husband died of an overdose, aged 31. That is when she decided to try to overcome her drug addiction

According to Pavlo Skala, Associate Director at the NGO Alliance for Public Health (APH), Ukraine’s harsh criminalization of drugs is stopping drug users from accessing OST and fuelling the country’s HIV epidemic. Low drug thresholds for incarceration – compared to Western Europe – have led to an extraordinarily high amount of drug users sentenced to prison, where they are cut off from accessing OST and other harm reduction measures, such as clean needle exchanges.

Under Ukraine’s law, the criteria for a prison sentence is possession of 0.005g of heroin. In the UK, a person must possess more than 2g of the drug to face the possibility of imprisonment. Experts say these low thresholds laws are highly ineffective, since it leads police to focus on consumers and small dealers, as opposed to organized drug traffickers.

Ukraine – after Russia- has the largest HIV epidemic in Eastern Europe and Central Asia with a prevalence of 0.9 per cent, or 240,000 people – infection rates doubled between 2010 and 2016.

OST – introduced in Ukraine in 2005 – replaces street narcotics with methadone or buprenorphine, which are less potent and longer lasting. Backed by the World Health Organization (WHO), it is considered one of the most effective methods of reducing opioid misuse, preventing HIV and reducing criminality. But in 2016 OST coverage was only at 3.2 per cent of those who inject. Every year, two thousand people are forced to withdraw from the OST programme because of prison sentences.

Drugs charges may also be on the rise. According to the Alliance for Public Health, 20 per cent more drug users were convicted in 2017 compared with the previous year. Every 9th person convicted on criminal charges is convicted for illegal drug possession, without the purpose of selling.

‘There is still a soviet-era gulag system in Ukraine that punishes drug users rather than helping them. In prison, people continue to use drugs, they share needles, which is why the HIV epidemic is concentrated in among inmates.’ Skala told New Internationalist.

Throughout the Soviet Union drug addiction was considered criminal and morally degenerative, as opposed to a medical issue, reinforcing the government’s predilection for a punitive drug policy. The notion of rehabilitation was absent. Drugs were also politicized: Soviet propaganda presented drug addiction as a vice caused by capitalism.

‘There is still a soviet-era gulag system in Ukraine that punishes drug users rather than helping them’

Minsuk said was convicted and given a two year sentence for dealing a street methadone during her first year at university in 2011. ’I carried on taking drugs in prison, they were everywhere. I don’t think drug users should be put in prison, they need to be somewhere where they can detox and get medical treatment’. She said she was rejected from re-enrolling at university on the grounds of her criminal record.

Tolerance toward drug users is low in Ukraine. A 2017 social poll by the Razumkov centre, a Kiev-based think tank, showed that out of 2000 respondents, tolerance was lowest toward drug users, alcoholics and homosexual people.

The Alliance for Public Health has long advocated for the government to introduce OST services in prison, but the authorities have been reluctant. ‘We won’t make any progress until after the presidential elections in 2019,’ said Skala. ‘No politician wants to decrease their chances by doing something as unpopular as supporting drug users.’

Punitive drug laws that are a legacy of the Soviet regime are driving up HIV rates throughout Eastern Europe and Central Asia (EECA). This is the only region where new HIV rates and AIDS-related diseases are both increasing. Drug use accounts for 80 per cent of all new HIV cases.

But at least half a million people in need of OST have no access to the service. OST is only available in prisons in only a handful of post-Soviet states. Despite the fact that Russia has the highest number of people who inject intravenously, with 57 per cent of new HIV infections in the country directly related to drug use, OST is banned outright. Viktor Ivanov, the head of Russia’s Federal Anti-Narcotics Agency, has derided NGOs supporting OST as serving ‘the interests of Western pharmaceutical companies’.

A UNICEF Ukraine infographic about HIV-positive mothers and children.
A UNICEF Ukraine infographic about HIV-positive mothers and children. CC-BY-2.0

In Ukraine and six other EECA countries Persons Who Inject Drugs (PWIDs) are required to register to receive treatment, including OST. Dr. Volodymyr Yariy, who administers OST in a Kiev-based drug clinic, told New Internationalist that the drug register is a major barrier to rehabilitating drug users.

According to Skala, registration often results in restrictions in employment, loss of privileges such as drivers’ licences, and targeting by police.

In some EECA countries, police exploit this situation. A 2014 study showed that in Russia, 60.5 per cent of PWID were arrested for needle possession, or had drugs planted on them by the police and were subsequently arrested.

Not wanting to make their drug status known and consequently risk arrest or detainment, PWIDs tend to avoid social and health service workers, and are forced to engage in unsafe practices that increase their susceptibility to infection.

‘The registry needs to be eradicated. It serves no purpose but to discriminate against drug users,’ said Yariy.

Ukraine and EECA are waging a superficial 'war on drugs that is detrimental to rehabilitating drug users and halting the region’s HIV epidemic. In a country that presents itself as pro-European and wants to join the European Union (EU), Ukraine must improve access to OST in line with international standards.

Access to OST is not just a medical issue, but also a human rights issue.

Misnik said she will do anything to keep her children away from drugs. ‘The first time you take heroin it’s instant death. You become a slave and there’s no going back.’