At the middle of January the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria Michel Kazatchkine visited Ukraine. Ukrainian harm reduction activists used this opportunity to advocate the rights of opiate replacement therapy (ORT) patients.

The Association of the Substitution Treatment Advocates of Ukraine submitted the appeal to Mr Kazatchkine with an outline of current situation with the opiate replacement therapy (ORT) in Ukraine and a list of the most significant problems with its implementation. The activists of the Association urged the Executive Director of the Global Fund to discuss the strategy of ORT implementation with the government of Ukraine. The appeal was personally handed out to Mr Kazatchkine by the member of the Association Anton Basenko.

Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Image by ICASO. CC BY-NC-ND.

In its letter to Mr. Kazatchkin the Association expressed gratitude to the Global Fund for the financial support of the substitution therapy in Ukraine. Currently 6632 patients receive the treatment, 18.1% out of them have TB and almost 45% are HIV positive. Although in general the ORT programs in Ukraine are very successful there are a few issues which need to be solved with regards to its implementation. The Association, which main goal is improving of the quality and availably of ORT, listed the issues in the letter and on its web page.

The first issue the letter outlined was absence of government funding for ORT programs which, the Association believes, harms the image of the programs as Ukrainian doctors often tell the patients that the program will despair when the Global Fund stops the funding.

The second identified issue was luck of availability of HIV treatment and treatment of the opportunistic infections such as hepatitis, TB and other diseases for patients which require stay in a hospital and a continuation of ORT. The patients often have to make a choice whether to continue the ORT and hide from the doctors the other health problems or to treat other diseases and to stop ORT. 

The final serious issue is absence of an opportunity for the patients to receive Methadone through a pharmacy with the prescription of a doctor. This significantly slows down the process of re-socialization of the patients.

The activist Anton Basenko, who delivered the letter to the Executive Director of the Global Fund, concluded that today ORT programs in Ukraine became larger in quantity but not in quality.

The web-site focused on the issues of people living with the drug addiction Motilek  posted another letter of appeal to Mr Kazatchkine. In his very emotional letter the harm reduction activist and the ORT patient Igor discussed the tendencies in ORT provision in Ukraine and identified the possible threats. 

Igor claimed that the ORT program has significantly improved his life. He wrote:

Уже около 3-х лет я получаю заместительную поддерживающую терапию (ЗПТ) метадоном в одной из Киевских клиник. Мне 34 года. Из них 8 лет я кололся «ширкой» и 4 года провел в местах, как говорят у нас, не столь отдаленных.

Получаю ЗПТ, и вот уже пару лет, как почувствовал новый вкус жизни. Я осознал, что бездарно потратил в погоне за наркотиками много лучших лет своей жизни. Слава богу, я не заразился СПИДом. И это чудо. Многие ребята из моей прошлой «наркоманской» жизни сгорели от «дури» и от этой страшной болезни.

Я действительно называю эту часть жизни, когда я кололся, своим прошлым. Я остаюсь наркозависимым, потому что я получаю метадон каждый день, но я чувствую себя абсолютно нормальным человеком. Я не кайфую. Я просто живу как обычный человек. … Я работаю, женился, и мы с женой ждем ребенка. Сейчас это моя самая большая радость. Ей-то я и хочу с Вами поделиться. Этой радостью я обязан Альянсу, ГФ, врачам и медсестрам в больнице, куда я хожу каждый день. И я не хочу возвращаться в свое прошлое. Спасибо Вам, Мишель

Igor was very concerned with the future of ORT program is Ukraine and how it might affect his life. He was worried about the decision of the Global Fund to move the implementation of the program from the nonprofit organizations to the Ministry of Health Care of Ukraine. Igor believes the Ministry is very bureaucratic and very corrupted and this would negatively affect the implementation of ORT.

Igor was also alarmed with the decision of the Fund in three years to significantly reduce the funding for ORT programs in Ukraine. He urged Mr. Kazatchkin to make sure that Ukrainian government would continue the provision of the Methadone and Buprenorphine to all patients who need them.

The active steps of the harm reduction activists achieved positive results.  After the meeting of Michel Kazatchkine with the Prime Minister of Ukraine Mykola Azarov the official web-portal of Ukrainian government reported that Ukraine will continue implementing the substitution therapy programs in a large scale as a mean of HIV prevention.