Overview of the regional and national activities of the #SoS_project team in April-July 2020
Stay safe, stay strong and wear a mask / #WearAMask Challenge
We are introducing our sixth regional digest overview.
The main topic of the second quarter of 2020 was clearly COVID-19, human rights issues, the sustainability of public health programs in the countries of the region, and in the context of the response nongovernmental organizations appropriately accepted the challenges of the first wave of COVID-19.
A descriptive regional Community Initiatives Map was created with over 50 stories of NGOs confronting the challenges of the coronavirus crisis from March to the present day.
With the involvement of international experts, Practical Recommendations were developed for health systems in EECA countries on transforming a sustainable response to HIV/TB/HCV in the context of COVID-19.
A number of recommendations, reports, documents and publications were developed and published in the countries, which were relevant with a view to the challenges of the current time.
NGOs from EECA countries took up the challenge not only of HIV, but also of the first wave of COVID-19. But this is not enough.
“We cannot say that COVID-19 has become a quiet time for the workers of nongovernmental organizations that provide HIV services. On the contrary, the coronavirus has thrown the light on health issues in society, and the current period should definitely be a time to take actions. Enhanced actions in response to HIV. We must work faster, better, and, obviously, for less money, – says Tetiana Deshko, Director of the International Programs Department of the ICF “Alliance for Public Health”. – I’m sure it is high time to mobilize in order to achieve the key global community goals on AIDS”.
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1,152 people with HIV, or 4.5%* of all people living with HIV in Kazakhstan stay in the penitentiary institutions of the Republic of Kazakhstan as of June 31, 2020. More than 1,000 people living with HIV in prisons receive antiretroviral therapy, which is 3.2 times more than in 2012.
Lyubov Vorontsova, Director of the #SoS_project in Kazakhstan, shared the experience of the Central Asian Association of PLHIV in the context of HIV and COVID-19 prevention and treatment in penitentiary institutions, as part of the online conference “Prisons in the context of COVID-19”.
“Preventive work in the context of health in the penitentiary system can be more effective only where close interaction and mutual understanding is established among all stakeholders: government agencies, penitentiary institutions and non-governmental organizations”, Lyubov Vorontsova says, “We work to ensure that people in custody have the opportunity to exercise their right to the highest attainable standard of physical and psychological health guaranteed by the state”.
She noted that the Central Asian Association of People Living with HIV (CAA PLHIV) has set a number of key tasks for HIV/TB prevention and support for PLHIV who are in prisons with the support of #SoS_project. The partners of CAA PLHIV in the penitentiary component in Kazakhstan are the Office of the Ombudsman in the Republic of Kazakhstan, the National Preventive Mechanism (NPM), the ICF “Alliance for Public Health” and the Network (“100% Life”).
Key activities in the 2019-2021:
- Improve the efficiency and accessibility of HIV services delivery (continuity from testing to care) in prisons.
- Promote access to and respect for human rights in prisons.
- Develop a Concept for achieving the 90-90-90 goals in the penitentiary system of Kazakhstan.
- Apply the results obtained in Kazakhstan in other EECA countries.
According to Ms. Vorontsova, a number of strategically important activities were implemented during the first year of work.
Thus, she noted that in September 2019, #SoS_project partners from the Network “100% Life” and representatives of the Secretariat of the Ombudsman of the Verkhovna Rada of Ukraine visited the country. They visited Kazakhstan to discuss the implementation of changes in the monitoring system for the observance of the right to health, as well as access to HIV treatment and prevention services. The main areas of cooperation and work were recorded at a joint meeting of CAA PLHIV, UNAIDS, CCM with the Ombudsman in Kazakhstan, and are being consistently implemented.
In the same 2019, a training workshop “Monitoring the observance of the right to health of persons in custody and convicts” was organized for members of the NPM of Kazakhstan. During the event, the participants developed a national algorithm for ensuring control over the observance of the right to health of people held in custody and convicted in the prisons of Kazakhstan.
In 2020, the pandemic slightly shifted the schedule of activities, but on June 11, a meeting of the Country Coordinating Committee was held, at which the NPM presented a report on the situation of persons with socially dangerous diseases in prisons. It is important to note that this was a joint initiative of the ALE Central Asian Association of People Living with HIV and the Office of the Ombudsman in Kazakhstan. The presentation itself was drafted by members of the NPM of Kazakhstan.
Key findings of the report:
– Convicts do not have access to all medical and social services available to other citizens;
– There are not enough clinicians in the penitentiary system to provide such access to health care
To date, CAA PLHIV, with the support of #SoS_project, the 100% l Life Network, have developed a worksheet for studying health care in prisons – as a monitoring tool for NPM members. Importantly, the worksheet has been expanded with a COVID-19 prevention access monitoring component. This document has been sent for approval to the NPM Coordination Council for further use as a permanent tool during monitoring visits to prisons.
Lyubov Vorontsova said, “We are preparing the module “Public participation in monitoring the right to health and access to HIV-related services in prisons” as a component of the online training on human rights and HIV in Kazakhstan. This module will include a component on monitoring access to prevention and treatment of COVID-19″.
She also noted that the project team has further plans:
– Development of recommendations for NPM in Kazakhstan to achieve the goals of the 90-90-90 strategy in the penitentiary system of the Republic of Kazakhstan.
– Creation of a working group to implement recommendations for NPM in Kazakhstan on achieving the 90-90-90 goals in the country’s penitentiary system, as well as the development of a Concept Note for the implementation of these recommendations.
– Implementation of the practical application of the monitoring tool (worksheet for studying health care in prisons) and the inclusion of the collected information in the report of the Ombudsman in Kazakhstan for 2021.
*Note that in total, according to estimates of early 2020, the number of people living with HIV in Kazakhstan was 31,378, and according to officially registered data, only 25,753 people know about their status.
Alliance Model of HCV Treatment Featured in WHO Compendium of Good Practices in the Health Sector Response to Viral Hepatitis in the WHO European Region
July 28 is proclaimed by WHO as World Hepatitis Day. On World Hepatitis Day 2020 WHO Regional Office for Europe published Compendium of good practices in the health sector response to viral hepatitis in the WHO European Region (https://apps.who.int/iris/bitstream/handle/10665/333494/9789289055161-eng.pdf?sequence=1&isAllowed=y).
We are proud that Alliance input in global and national hepatitis elimination process, its yearlong experience in HCV community based treatment, is demonstrated in Compendium amongst European region good practices in viral hepatitis response.
Alliance HCV treatment program “Scaling up Access to HCV Community Based Treatment for Key Populations” was launched in 2015. For 5 years 5000 patients were granted HCV diagnostic, treatment and social support for free. Presently with the support of the Global Fund 1800 HIV/HCV coinfected patients are getting HCV treatment, 90% out of them are PWID and their partners, 10% prison population. Till the end of 2020 additional 1500 HIV/HCV coinfected patients form KPs will get HCV basic diagnostic, treatment and social support services for free within Alliance program.
Following WHO recommendations, Alliance practices public health approach by using pan-genotyping DAA drugs, produced by leading international generic manufactures, and simplified HCV diagnostic. Every participant of Alliance HCV treatment program is granted social support. Education on HCV transmission ways and on safe behavior practices as well as three sessions on HCV reinfection prevention are integral to treatment process. Owing to case managers good practices and patients’ commitment, retention on treatment among program participants, who completed therapy this year, reached unprecedented 99,5%.
Alliance takes pride of setting trends in innovative HCV treatment with DAAs in Ukraine and making it accessible for the most in need populations; of implementing modern HCV diagnostic with GeneExpert machines directly on treatment sites; of getting the lowest for Ukraine price for DAA drugs; of 98% of treatment success. This year we started to implement cascade of HCV services by referring HIV prevention and harm reduction programs clients with positive results of HCV rapid tests to HCV treatment program.
WHO Compendium of good practices in the health sector response to viral hepatitis in the WHO European Region witnesses Alliance success in HCV control and encourages us for finding new approaches to equity in access to HCV diagnostic and treatment, bringing services closer to the patients on the way to hepatitis elimination and universal health coverage.
On occasion of World Hepatitis Day Alliance avails of this opportunity to present our deepest respect and gratitude to physicians and medical workers, to case managers and patients for taking responsibility and following healthy lifestyles!
Everybody can get HCV infection
HCV testing is the only way to get
HCV confirmative diagnostic and treatment
Viral Hepatitis C is curable
National Hotline on Viral Hepatitis: 0-800-50-33-10
5,000 patients received free up-to-date treatment of hepatitis C within the innovative program run by Alliance for Public Health!
In 2015, after many years of preparatory activities, Alliance for Public Health initiated a free program to treat hepatitis C virus (HCV). A year after, patients representing high-risk populaitons were the first in Ukraine to receive HCV treatment with current direct-acting antivirals (before HCV treatment was based on interferons, with multiple side effects, treatment interruptions and cure rates not exceeding 50%). In 2017, for the first time in our country Alliance initiated HCV screening, testing and treatment services to be provided to the first several dozens of inmates in penal institutions.
HCV treatment success rate in Alliance programs was up to 98%!
In 2019, with support of the Global Fund to Fight AIDS, Tuberculosis and Malaria Alliance procured 3,740 new HCV treatment courses. According to the WHO recommendations, we use generic direct-acting antivirals (DAAs), pangenotypic (universal) treatment regimens and simplified diagnostics approach. Only this year, over one thousand patients successfully completed their treatment, with the adherence to treatment reaching the record level of 99.5%!
Today, our program provides access to HCV treatment to the key population members with HIV/HCV co-infection from all over Ukraine, including temporarily uncontrolled areas as well as inmates in 13 institutions of the State Criminal-Executive Service of Ukraine. Only in 2020, we expanded treatment coverage to include Zakarpattia, Luhansk, Donetsk, Ternopil, Volyn and Chernivtsi regions.
Even with strict restrictions because of the COVID-19 pandemic, project case managers support every client, successfully ensuring uninterrupted therapy and high treatment adherence. The unique experience of preventing reinfections in the time of lockdown and creative approaches to knowledge sharing helped us to develop an awareness-raising brochure, containing answers to the most popular questions, which patients ask when talking to social workers.
In five years of Alliance HCV treatment program implementation:
- 5,000 patients have received or are currently receiving treatment
- There was an evolution of treatment from interferon-based to current pangenotypic/universal regimens
- Treatment and main diagnostics are provided to patients free of charge
- The procurement cost of direct-acting antivirals (provided to patients free of charge) has been reduced from USD 900 to the lowest price for Ukraine – USD 75 per standard 12-week treatment course
- A simplified approach to HCV diagnostics has been introduced
- For the first time, HCV diagnostics is done using GeneXpert systems directly in the treatment facilities of Ukraine
- For the first time, regional laboratory centers of the Ministry of Health are involved in HCV diagnostics
- A model has been introduced to educate patients from the key populations on the routes of HCV transmission, safe behavior, prevention of reinfections and its efficiency has been proven
- A cascade of services is provided by referring prevention program clients with positive results of HCV rapid tests to the treatment program
- Cascade of services is provided to the patients in the penitentiary system
- 100% monitoring of treatment quality is implemented
- For the first time, a study on the rates of HCV reinfection among successfully cured key population members has been carried out
- Sustainability of the program has been ensured with multiple sources of funding
Today, on the World Hepatitis Day, we would like to sincerely thank doctors, case managers and patients for their commitment and participation in the Alliance treatment program and for their invaluable contribution to elimination of viral hepatitis in Ukraine.
Hepatitis treatment program implemented by Alliance has been included in the Compendium of good practices in the health sector response to viral hepatitis in the WHO European Region.
The WHO data show that Ukraine is the only country in the European region, which has been included into the list of 28 countries with the highest hepatitis burden in the world. It is estimated that up to 5% of people in Ukraine are infected with hepatitis C, which totals one to two million Ukrainian citizens who require treatment.
The surveillance system existing in Ukraine as well as the limited access to diagnostics and treatment services do not allow getting accurate cumulative data on the burden of this disease. Meanwhile, there number of people who know about their HCV status is dozens times lower: according to the Public Health Center of the Ministry of Health of Ukraine, in January 2020 the estimated number of people with HCV in Ukraine was 1,342,418 people. Only 87,269 people receive medical follow-up services (6.5% of the estimated number).
As the disease is often asymptomatic (“silent infection”) and left without treatment, chronic hepatitis C is the main driver of hepatic cirrhosis and primary liver cancer. Peculiarities of the clinical HCV progression lead to its late diagnosis, often at the terminal stages of hepatic disease.
In November 2019, Ukraine joined the Global Health Sector Strategy on Viral Hepatitis by approving the National Strategy on HIV/AIDS, Tuberculosis and Hepatitis until 2030. Goals of implementing the National Strategy until 2030:
- 90% of new viral hepatitis cases will be prevented;
- 90% of people with viral hepatitis will be diagnosed and will know about their status;
- up to 90% of patients will receive treatment, which will be effective and will lead to full recovery (for HCV) or effective control of the disease (for HBV).
Compendium of good practices in the health sector response to viral hepatitis in the WHO European Region
Testing is the only possible way to diagnose viral hepatitis.
National Viral Hepatitis Hotline: 0-800-50-33-10
Alliance for Public Health
NGOs from EECA countries have stood up to the challenge not only of HIV, but also of the first wave of COVID-19. But that’s not enough
According to the new UNAIDS Global Report on the Global AIDS Epidemic, the world is making significant but dramatically uneven progress, especially in expanding access to antiretroviral therapy. At the same time, the COVID-19 pandemic also had a significant negative impact on the achievements of the countries of Eastern Europe and Central Asia in the fight against HIV/AIDS over the 30 years of the epidemic.
According to the report, Eastern Europe and Central Asia remain one of three regions where the HIV epidemic continues to grow. Therefore, there is an urgent need to scale up HIV services, especially in the Russian Federation.
The report also highlights a large gap between HIV testing and treatment initiation. Only 63%* of people living with HIV who know their HIV-positive status in the region are being treated. And only 41%* of all people living with HIV in the region have suppressed viral load.
The “Seize the Moment” report warns that the HIV response could be slowed down for another 10 years or more if the COVID-19 pandemic seriously disrupts HIV services.
“We cannot say that COVID-19 has become a calm time for the workers of nongovernmental organizations that provide HIV services. On the contrary, the coronavirus has thrown sharper light on health issues in society, and the current period should definitely be a time to take action. Enhanced action in response to HIV. We must work faster, better, and, obviously, for less money, – says Tetiana Deshko, Director of the International Programs Department of the ICF “Alliance for Public Health”, says, – I am sure it is high time to mobilize in order to achieve the key global community goals on AIDS”.
The UNAIDS Global Report emphasizes that it is important for countries to double efforts and act urgently to reach the millions of people still left behind. At the same time, it is worth paying attention to the catalytic regional NGOs that promptly adapted their work in the EECA region in the context of a double challenge to maintain the sustainability of the services provided for people from key populations who badly needed it from the very onset of the coronavirus crisis.
“It is infinitely gratifying that civil society organizations were able not only to continue their work to combat HIV infection, to make the situation safer in order to reduce the risks of COVID-19, but their responses also became responses to the new COVID-19 challenges”, Mrs. Deshko says.
The Alliance for Public Health, UNAIDS and the Asian Association of People Living with HIV have started collecting stories of vibrant, decisive action taken by nongovernmental and government organizations in the EECA region. Today, nearly 60 stories from around the world illustrate this critical work on the interactive online Community Initiatives Map. Any organization or initiative group can send their story, just filling out the form on the website.
Tetiana Deshko also noted that after analyzing the work performed under a double challenge, the Alliance for Public Health team saw that COVID-19 not just complicated the work, but the crisis made them focus on the clearest, most systemic methods of providing HIV care.
“We found out that there are a number of HIV service recommendations following COVID-19, and we should adhere to them after the peak of the pandemic. In particular, we saw that distribution of substitution therapy drugs for injecting drug users, who account for almost half of new HIV cases in our region, was provided at home for long periods, which could both reduce the cost of providing this service and make it more patient-oriented”, Tatyana said. “We saw that distributing the sufficient number of consumables — including syringes, condoms, and tests, for longer periods also helped people to stock up on consumables and practice safer behavior”.
Online work becomes crucial throughout the world. Online counseling on safe behavior, response to crisis situations, introduction of the practice of using test vending machines, syringe vending machines, dispensing antiretroviral medications for a longer period, sending medicines by mail are crucial. According to Tatyana Deshko, all these steps enabled implementing HIV services and reduce the risk of COVID-19. “We must continue them in the future”, she emphasized.
“We tried to monitor the human rights situation using a special database – an online system for documenting, online monitoring and immediate response to violations of the rights of key groups and HIV-positive people (REAct). We worked in 5 countries: Ukraine, Tajikistan, Georgia, Moldova and Kyrgyzstan, where we observed the situation with the rights of key populations. Unfortunately, we have noted many cases of violation of these rights, while more than a hundred cases of violation of rights were recorded in the first 6 months”.
The situation is different in these countries, but it is still the law enforcement agencies who are responsible for the most cases of the key population rights violations, Ms. Deshko notes. The health officials keep the second place. Key populations, people living with HIV, often face cases of humiliation or violence. This is the analysis that is very clearly outlined in the UNAIDS report, showing that the issue of respect for the human rights of key populations is one of the main obstacles in the response to the HIV and COVID-19 epidemic.
We contacted experts from Kyrgyzstan, Moldova and Ukraine, the leaders of NGOs or projects who have recovered from coronavirus infection and asked what needs to be done so that people could cope with HIV and COVID-19. And that’s what they answered.
Aybar Sultangaziev, Chairman of the Partnership Network Association (Kyrgyzstan): “The catastrophic unpreparedness of healthcare systems, lack of supplies of medicines and medical equipment lead to high mortality and disability of the population due to COVID-19. This is happening against the background of hugely inflated public procurement prices, limited funding and a complete lack of forecasts of the situation development. All this is forcing civil society to take the initiative and, in fact, stand up against the storm of the epidemic. Studying the world experience in treatment and the subsequent promotion of improvement of treatment regimens also apparently concerns only the civil sector, while meeting resistance from conservative specialists”.
Yevgeniy Aleksandrovich Goloshchapov, Director of the Advocacy Department, CSO “Positive Initiative” (Moldova): “We have identified two threats: due to problems with supplies, medicines stocks may run out and people will have no treatment, and due to the economic crisis, it is possible that tomorrow there will be no funds to buy medicines. In this situation, NGOs need to develop broad partnerships to ensure continuous access to treatment, as well as for transparency and efficiency in the use of resources“.
Nataliya Nesvat, Chair of the Board of CO “100% Life” branch in Cherkassy (Ukraine): “In parallel with COVID-19, HIV and TB epidemics continue to grow, and in this situation the role of strong NGOs and communities is more important than ever. After all, it is the people affected by HIV and TB who are trapped in the cut-off from necessary services: diagnostics, hospitalization, timely receiving of HIV medications, other medicines and food. But, along with this, NGO workers, more than anyone else, must understand their full responsibility and adhere to all precautions to minimize the risk of COVID-19 infection. Otherwise, access to vital services and, possibly, to the last hope will be lost”.
All-Ukrainian competition for the media “Drug policy of Ukraine in the age of coronavirus: problems and solutions”
The International Charitable Foundation “Alliance for Public Health” invites the journalists of national and regional mass media to take part in the All-Ukrainian contest on the actual drug policy mainstreaming in Ukraine. The application can be submitted by the authors who have published (or broadcasted) their texts/stories from January 1st to November 13th, 2020.
This event aims to raise public awareness and informedness of modern methods of drug abuse prevention and treatment, in particular to emphasize the expansion of substitution maintenance therapy network, increase access to the state program on HIV/AIDS, hepatitis, tuberculosis for drug addicts.
Besides, the competition should help to reform Ukraine’s repressive drug policy and decriminalize drug addicts. This is important to show by the example of developed countries, where the work of the law enforcement system is focused on combating organized drug trafficking.
The competent jury will determine one winner in the categories of “Television and Radio”, “Printed Press”, “Online Press”, “Blogging”. The authors of the best materials will receive diplomas and financial incentives. The winner in each category will receive a cash prize of UAH 5,000. The competition also provides for individual awards, for example, for a series of materials or the creation of a special project on the theme of the competition.
Requirements for competitive works:
- Materials can be prepared in any language of national minorities with a translation into Ukrainian or Russian.
- Publications should focus on Ukrainian realities and world best practices, demonstrate the real state of affairs and offer solutions to the problems of drug addicts.
- Preference will be given to publications that focus on expanding access to SMT and promoting the decriminalization of drug addicts with a focus on combating the organized drug trafficking by the law enforcement system, raising issues of stigma and discrimination.
- Also, publications may include the issue of adolescent drug addiction and the rapid change of the drug scene from opioid drugs to synthetic psychotropic substances, the lack of appropriate government rehabilitation programs.
- Texts provided by the media representatives must be original and free of plagiarism.
- To participate in the contest, you must enter information about the posted material in the registration form at the link: https://forms.gle/QxAmGd6KSpup8vxZA
The deadline for submission of materials is November 13th, 2020 (6 p.m).
The winners of the competition will be chosen by an independent jury, which will include representatives of the ICF “Alliance for Public Health”, partner organizations, winners of past competitions.
The best materials will be published on the information resources of the ICF “Alliance for Public Health”, so when submitting an application for the competition, the authors automatically allow such publications.
All-Ukrainian competition for the media “Drug policy of Ukraine in the age of coronavirus: problems and solutions” is part of the projects “The Partnership to Inspire, Transform and Connect the HIV response” (PITCH) and “Accelerating progress in reducing the burden of tuberculosis and HIV infection by providing universal access to timely and quality diagnosis and treatment of tuberculosis, expanding evidence-based prevention, diagnosis and treatment of HIV, creating viable and stable health systems” (implemented with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria).
June 26 is the International Day Against Drug Abuse and Illicit Trafficking and the International Day in Support of Victims of Torture
Every 11th convicted person in Ukraine punished for the violations, which in most democratic countries are not considered to be criminal offences!
Today Ukraine, along with 90 other countries of the world, traditionally joins the global Support. Don’t Punish campaign calling for humane drug policies!
Alliance for Public Health first initiated this campaign in Ukraine back in 2013, and today we keep up the tradition to draw the attention of decision-makers, national media and all responsible citizens to the inadequate repressive state policies affecting hundreds of thousands of drug-dependent Ukrainians. As the recent expert estimates show, in the government-controlled territories of Ukraine there are about 317,000 people who inject drugs, most of whom have chronic drug dependence. Only 13,000 (4%) of those people have access to free treatment in government-supported opioid substitution treatment programs, which allows them to break the vicious criminal circle related to their daily need to get illegal drugs.
Today: every ninth prisoner in Ukraine serves a sentence for drug possession.
Every year, about 10,000 people in Ukraine are convicted for drug-related crimes (in 2019 – 9,600 people). In the recent three years, there has been a stable trend: at least 83% of people convicted for drug-related crimes serve their sentences for illegal drug possession without intent to sell (art. 309 of the Criminal Code of Ukraine). In 2019, 8,000 people were convicted for such crimes, i.e. every 9th of 70.3 thousand people convicted in Ukraine. However, many people do not know that every 11th person convicted for such crimes in Ukraine (in 2019 – 6.2 thousand) serves a sentence for the acts, which are not even considered criminal offences in most civilized democratic countries (Criminal Code of Ukraine, art. 309, part 1) because the “threshold amounts” of most widely used illegal drugs approved with the Order of the Ministry of Health of Ukraine No. 188 (2000) are 200-600 times lower (!) than in the countries of the European Union, which Ukraine has been trying to become part of for so many years! Even such unfriendly and undemocratic country as Russia has in 100 times (!) less repressive “threshold mounts” for most widespread drugs.
Tomorrow: 30-time increase of the fines for drugs possession!
Our government decided to “decriminalize” or rather “depenalize” drug-dependent citizens starting from 1 July 2020, but in a very particular way!
In five days, Ukraine is going to enforce new legislation (Law N 2617-VIII dd. 22.11.2018), according to which illegal possession of drugs will be considered not a “criminal offence”, but a “misdemeanor”. It sounds not bad, but… With such change of terminology, the minimum fine for part 1 art. 309 of the Criminal Code of Ukraine will grow 20 times (from UAH 850 to UAH 17,000 – USD630) and the maximum fine will growing 30 times (from UAH 1,700 to UAH 51,000 – USD1900)!
Considering the lack of proper access of drug users to treatment and rehabilitation and realizing that people with chronic illness depend on illegal psychoactive substances every day, it may seem that in such a way the government decided to “earn some money”, i.e. fill the national budget with the growing proceeds from the boosted fines “imposed” on over 300,000 of drug dependent people in Ukraine. Of course, if every one of those people pays the maximum fine at least once a year, the state can earn about 15 billion UAH! However, both experts and family members of drug users understand that this is not how it works. Those people have long ago taken all the money from their homes to pay drug dealers and to bribe corrupted police officers. Indeed, today “drug corruption” is one of the most developed illicit enrichment schemes for numerous organized groups of “turncoats”, who recently have been regularly exposed by the State Bureau of Investigations, the Prosecutor General’s Office, the Security Service of Ukraine and the National Police. On the one hand, corrupted law enforcers traditionally “protect” organized drug business, on the other hand – they set up ordinary drug users using their own criminal schemes to extort money from them or their relatives for avoiding criminal responsibility. What will such “characters” do after there is a 30-time increase in the official “fines”?! Unfortunately, that is a rhetorical question! It is indirectly confirmed by the stable annual decrease in the number of convicted drug dealers with an increase in the number of drug users convicted for drug possession (see the diagram above).
Meanwhile, despite all the statements of the progressive Minister of Justice, Ukrainian prisons will continue to serve as the “training center” of organized crime and an incubator of infectious diseases because the usual prisoners are ordinary drug-dependent people, who have not been given any other options by the state apart from punishment!
Decriminalization of drug users is inevitable… in a democratic state!
Last week, there was a meeting of the new members of the Inter-ministerial Working Group to Revise Legislation on Narcotic Drugs under the Ministry of Health of Ukraine. One of the unanimous resolutions was the decision to revise the “threshold amounts of drugs” (Order of the Ministry of Health N 188/2000), which is now the key reason of the inadequately high level of artificial criminalization of drug users in Ukraine. However, we need to keep in mind that in the past such intentions were declared and even started to be implemented as draft regulations on numerous occasions. But without the decision-makers clearly understanding the existing situation and without the political will of high-level officials, Ukraine will not break this “vicious circle” and the number of issues related to drug use will only be growing.
The global Support. Don’t Punish campaign is called to draw public attention to such challenges and demonstrate the serious harms caused by the senseless “War on Drugs”. The campaign calls to implement drug policies, which are based on human rights, protect health and reduce the risks related to drug use.
In the challenging context of COVID-19 pandemic, Alliance for Public Health together with its partners continues efficiently responding to the needs of the vulnerable populations. In particular, urgent procurement was organized to provide all the implementing partners facing the highest risks as they continue to provide services to the key populations with the basic personal protection equipment (PPE). At the request of the State Penitentiary Service of Ukraine, such equipment was provided to the staff members of penal institutions and to the inmates who continue receiving opioid substitution treatment and hepatitis C therapy during the pandemic. Despite the shortage of PPE in the country, the need to comply with all the procurement procedures while many engaged institutions and organizations work remotely, we were able to respond to this vital request of our partners quickly and efficiently!
Currently, institutions of the State Penitentiary Service of Ukraine have been provided with the following PPE:
– Alcohol wipes (70%, 30Х65 mm) – 500 thousand;
– Non-sterile medical nitrile gloves (IGAR 7-8) – 5.6 thousand;
– Antibacterial fluid for hands disinfection (100, 150 and 500 ml – 578 bottles, 75 liters in total)
– EconormDEZ Classic disinfectant (1,000 ml) – 10 bottles;
– Disposable protective face masks – 51 thousand.
The total cost of the PPE delivered is UAH 981,000.
In 2019, Alliance with support of the Global Fund to Fight AIDS, Tuberculosis and Malaria and other international partners contributed to the launch of the first pilot OST site in the penitentiary system of Ukraine. Currently, about 20 inmates receive OST services at this site. Besides, Alliance has been supporting a hepatitis C treatment program in penal institutions since 2018. In 2017, Alliance with the Global Fund support initiated comprehensive activities aimed at hepatitis C screening, diagnostics and treatment in the health facilities of the State Penitentiary Service. In 2020, Alliance provides hepatitis C diagnostics and treatment services to 350 inmates and other detainees with HIV/HCV co-infection. In addition, 250 people who receive treatment courses provided by the State Penitentiary Service of Ukraine, are provided with hepatitis C diagnostic services before treatment initiation and 12 weeks after treatment completion to assess the efficiency of antiviral treatment.
Besides, in the nearest future Alliance will provide the State Penitentiary Service of Ukraine with 3,000 rapid tests for hepatitis C screening among prison staff and inmates. The Alliance team highly appreciates its longstanding partnership with the Health Center of the State Penitentiary Service of Ukraine and would like to extend its gratitude to its representatives for their constructive approach and constant support.
Practical Recommendations to reshape a sustainable response to HIV/TB/HCV in the EECA countries within Covid-19 context
As a result of the COVID-19 pandemic, health systems around the world have to become more robust, flexible, and results-oriented.
Changes have been made in the approach that some health systems have taken to the delivery of a range of services, including interventions for the management of HIV and opioid dependence as well as the treatment of tuberculosis (TB) and viral hepatitis C (HCV) among key population groups. Many of these changes have been welcomed by communities, with a window of opportunity to revisit and refresh issues of drug use regulations, policing, amnesty for people in prisons and other closed settings.
In early May 2020, a LIVE discussion was held on Youtube (in English) and simultaneously on Facebook (in Russian) by the Sustainability of Services (SoS) Project of the Alliance for Public Health (APH) funded by the Global Fund to Fight AIDS, TB and Malaria, that brought together experts to consider opportunities to improve the sustainability of HIV programmes for key populations in 14 countries of Eastern Europe and Central Asia (EECA) as a result of the response to the COVID-19 pandemic.
Presenters included Volodymyr Kurpita, a regional expert on public health and HIV/AIDS based in Ukraine; Fifa Rahman, a specialist in International Trade/Intellectual Property Law and a UNITAID Board Member for NGOs; Anton Basenko, a regional expert on drug policy, community, gender and human rights with the Alliance for Public Health; and Niamh Eastwood, the Executive Director of Release, the British centre of expertise on drugs and drug law; the session was moderated by Andriy Klepikov, the Executive Director of the Alliance for Public Health and a member of the Glob- al Fund Board for the Developing Countries NGO Delegation.
The online event considered which developments should be retained and promoted as countries pass through the peak of the epidemic and grow accustomed to the presence of the virus at a more manageable level. Specifically, how recent actions at global and national levels in response to COVID-19 have provided opportunities to increase access to medicines and services, the role of human rights within health systems, and how to build upon the newly emerging good practices.