Alliance for Public Health (hereinafter – Alliance) decided to make a contribution into marking the International Day against Drug Abuse and Illicit Trafficking, within the global Support. Don’t Punish! advocacy campaign, and inform stakeholders, governmental authorities and mass media about the real microscopic volumes of the leakage of substitution therapy drugs into the illicit market.

Opioid substitution treatment (OST) program – the biggest in the countries of Eastern Europe and Central Asia – has been implemented in Ukraine for 12 years already! Today this effective and evidence-based approach to the treatment of drug dependence and prevention of the spread of HIV and hepatitis C allows 8,727 patients with chronic opioid dependence to receive treatment in 173 healthcare facilities in all regions of Ukraine, apart from temporarily occupied areas in eastern Ukraine. 7,779 patients receive methadone-based substitution therapy (with tablets or liquid methadone) and 948 patients receive buprenorphine tablets.

Over this period, there were numerous studies, which proved the effectiveness of OST. This therapy for people who use drugs is guaranteed by p. 8 art. 4 of the Law of Ukraine “On Prevention of the Spread of Diseases Associated with Human Immunodeficiency Virus (HIV), Legal and Social Protection of People Living with HIV” dd. 12.12.1991 N 1972-XII and by the National Targeted Social Program on Countering HIV/AIDS in 2014-2018 approved with the Law of Ukraine dd. 20.10.2014 N 1708-VII. A series of orders of the Ministry of Health of Ukraine regulate the procedure of OST provision, volumes of the drugs to be used and control over their turnover.

Since 2005, 1,462 kg of methadone and 34.4 kg of buprenorphine were delivered to the country in accordance with the annual quotas of narcotic substances for OST approved by the Cabinet of Ministers of Ukraine within the relevant National Program, which is co-implemented by Alliance for Public Health. In Ukraine, the average daily dose of methadone in OST programs is 80 mg, buprenorphine – 10 mg per patient.

One of the traditional arguments against introduction of OST, which were voiced by representatives of the previous law enforcement system, which for many years maintained strong resistance to implementation of this method of treatment at all levels, were unjustified assumptions concerning allegedly enormous volumes of the OST drugs leakage and illicit trafficking in those drugs. In previous years, such statements have been repeatedly heard from the head of one of the most corrupted departments of former militia – Department against Drug Trafficking of the Ministry of Interior of Ukraine – mostly with references to confidential “information collected” and “criminal cases initiated”.

Today Alliance decided to inform all interested parties, including current law enforcers and mass media, with the real statistics of the “leakage” of OST drugs and illicit trafficking in such drugs and show that they make an absurdly small share in the total scope of drug turnover in our country.

In the recent months, Alliance analyzed court judgments related to OST or narcotic drugs used in OST, which were entered into the Unified State Register of Court Judgments.

As a result, we identified and analyzed 333 basic and 84 associated with them court judgments on criminal cases and administrative offenses, issued during the period of almost 10 years!

The analysis showed that within those cases law enforcers documented and withdrew only 25 grams of methadone and 0.32 gram of buprenorphine, which got into the illicit market from OST programs.

Thus, the proportion of OST drugs, which leaked into the illicit market in this period of time due to various circumstances is really meager as compared to the volumes of drugs imported or procured in Ukraine during the same period: for methadone it is0.0017% and for buprenorphine – 0.00093%!

For reference, earlier in June during just one police intervention in Kherson officers of the National Police withdrew over 2 kg of illegal methadone (which is in no way related to OST programs) produced in a clandestine laboratory from an organized drug crime syndicate, which is 77 times more than the quantity of the main OST drug, which got into the illicit market in all the years of OST program implementation in Ukraine!

So we have to say that concerns of skeptics and unjustified assumptions of corrupted law enforces on the dangers of OST are in no way confirmed in practice.

By the way, arms from military warehouses, currency assets and valuables from banks or jewelry stores also sometimes fall into the wrong hands. But it seems that in those areas the scope of leakages is not that meager…

***

For information: This press release is issued within the global «Support. Don’t Punish!»advocacy campaign, which is marked on 26 June 2016 in over 100 cities of the world. On this day, tens of thousands of civil society activists from all over the world traditionally appeal to their governments to stop cruel and senseless policy of the War on Drugs. Official website of the campaign: http://supportdontpunish.org

Alliance for Public Health is a leading non-governmental professional organization which makes a significant impact on the epidemics of HIV/AIDS, tuberculosis, viral hepatitis and other socially dangerous diseases in Ukraine through providing financial and technical support to relevant programs, which cover over 280,000 members of most vulnerable populations, which is the highest indicator in Europe. Alliance traditionally takes part in «Support. Don’t Punish»! campaign. Information about last year’s event: http://www.aidsalliance.org.ua/ru/news/pdf/01-12_2015/06/Drugs_Alliance_26.06.2015_ukr.pdf

1 For comparison, according to the official data of the Supreme Court of Ukraine only in 2015 all Ukrainian courts heard 12 thousand cases related to offences in the area of trafficking in drugs, psychotropic substances, their analogues or precursors (articles 305–320 of the Criminal Code).

June 23 2016 became the last day of OST provision in the non-controlled by Ukraine territories of Donetsk and Luhansk oblasts. The last OST site, which had been still functioning in the city, was closed due to depletion of the stock of medical drugs. It was the last day when 23 HIV-positive patients received their minimum doses of methadone (5 mg). Before the military conflict, 370 patients received OST in Donetsk and Makiivka in the Donetsk oblast. According to the information available, only in Donetsk about 20 patients, most of them living with HIV, died due to the forced catastrophic reduction of the doses of OST drugs!

Detailed information about the Status of HIV/TB/HCV/OST Prevention and Treatment Programs in Donetsk and Luhansk oblasts can be found on our web-site.

POLITICAL DECLARATION BRINGS US TO THE NEXT LEVEL ON THE ROAD OF ENDING AIDS.

Ukraine jointly with other nearly 200 countries at the High Level Meeting on AIDS in New York has adopted “Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030”. Alliance for Public Health (Alliance) being represented by Andriy Klepikov at the Ukrainian official delegation joins the country in endorsing the Declaration.

It sets ambitious targets for Eastern Europe and Central Asia, and Ukraine in the nearest months has to identify own targets for within the broader regional ones: reducing the number of new infections by 75% (to 44,000) and increasing the number on treatment to 1.4 million by 2020 in the EECA.

The Declaration doesn’t refer to any particular country but in fact refers to the Ukrainian successful experience acknowledging that “some countries and regions have made significant progress in expanding health-related risk and harm reduction programmes”. Acting Minister of Health of Ukraine Viktor Shafranskiy in his speech also emphasized Ukraine’s work focusing on key affected populations and in particular people who inject drugs implemented in partnership between government and civil society. He highlighted the incredible progress Ukraine made in scaling up opioid substitution therapy.

In the Political Declaration the UN Member States emphasized the continued importance of an integrated approach to AIDS, tuberculosis, hepatitis B and C by including the following global targets:

· Reduce tuberculosis-related AIDS deaths by 75% by 2020.

· Reach 90% of all people who need tuberculosis treatment, including 90% of populations at higher risk, and achieve at least 90% treatment success by 2020.

· Reduce by 30% new cases of chronic viral hepatitis B and C by 2020.

· Treat 3 million people with chronic hepatitis C by 2020.

Political Declaration specifically lists “tailored prevention interventions, including outreach via traditional and social media and peer-led mechanisms, male and female condom programming, voluntary medical male circumcision, as well as medication assisted therapy programmes, injecting equipment programmes, pre-exposure prophylaxis for people at high risk of acquiring HIV, antiretroviral therapy, and other relevant interventions”. It pledges “to intensify efforts towards the goal of comprehensive prevention, treatment, care and support programmes that will help to significantly reduce new infections, increase life expectancy and quality of life, the promotion, protection and fulfillment of all human rights and the dignity of all people living with, at risk of, and affected by HIV and AIDS and their families”.

Nevertheless, it is important to note that endorsement of the Declaration by consensus became possible on the certain compromises. From one side, we are glad that an attempt to weaken the Declaration wording initiated by Russian Federation which intervened the negotiation process at its final stage, was not supported by other countries and was decline. From another side, there are disappointments that the Political Declaration insufficiently describes and addresses HIV epidemic among key populations, including people who inject drugs, sex workers, men who have sex with men, and transgender people. At the stage of political guiding AIDS response for the next years it is vitally important to be honest and crystal clear on the global roadmap. With this in mind a parallel with the official Political Declaration the Civil Society and Communities Declaration to End HIV: Human Rights Must Come First was adopted these days. Alliance for Public Health was among the first organizations which endorsed it. Jointly we call for the critical 10 steps necessary to make the “end of AIDS” a reality!

Political Declaration on HIV and AIDS is an eye opener on the road to ending epidemic. Communities and Civil Society Declaration helps to have both eyes opened and it’s provisions should be taken into account when implementation of Political Declaration on HIV and AIDS .

On June 8, 2016 UN General Assembly adopted Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030.

The important moment is that Declaration includes Harm Reduction programs as key direction of HIV prevention and point of inadequate coverage of vulnerable groups: “43: Note that some countries and regions have made significant progress in expanding health-related risk and harm reduction programmes … , yet note the lack of global progress made in reducing transmission of HIV among people who use drugs, particularly those who inject drugs, and call attention to the insufficient coverage of such programmes and substance use treatment programmes that improve adherence to HIV drug treatment services, as appropriate in the context of national programmes, the marginalization and discrimination against people who use drugs through the application of restrictive laws, particularly those who inject drugs which hamper access to HIV-related services, and in that regard, consider ensuring access to such interventions including in treatment and outreach services, prisons … and note with concern that gender-based and age-based stigma and discrimination often act as addition all barriers for women and for young people who use drugs, particularly those who inject drugs, to access services”.

This important political action took place in the framework of The High-Level Meeting on Ending AIDS(June 8 -10, UN General Assembly). The main aim of the Meeting is to focus the world’s attention on the importance of a Fast-Track approach to the AIDS response over the next five years.

Alliance for Public Health is represented by Andriy Klepikov, Executive Director and Anton Basenko, Senior Program Officer, who represents also HLM Stakeholders Task Force.

On June 7th Andriy Klepikov presented at the High-Level Meeting Side Event “Action on Extreme Poverty and Inequality to End AIDS: Addressing HIV, Poverty, and Inequality in Urban Settings to End AIDS.”

The session was co-chaired by Charles King, President and CEO, Housing Works, Ambassador Deborah Birx, U.S. Global AIDS Coordinator andLuiz Loures, Deputy Executive Director, UNAIDS.

City of Kyiv was selected as a site for the demonstration project for the Fast-track cities approach. Address from the City Major VitaliyKlitschko emonstrated his firm commitment leadership.

Alliance for Public Health with support of international donors providing the most substantial support to fight HIV and TB epidemics in Kyiv. Andriy Klepikov presented the civil society perspective of making Kyiv the fast- track city. At the same session Olga Gvozdetska presented the work of All-Ukrainian Network of People Living with HIV and its collaboration with the Major’s office.

On June 8 Andriy Klepikov participated in the special session “Ending TB deaths among people living with HIV: Time for action”. The overall aim of the side-event is to catalyse and intensify efforts in the response to end TB deaths among people living with HIV through firm political commitment, strong country ownership and adequate investments. It is also intended to highlight and bring into focus the problem of HIV-associated TB at the HLM as well as to provide a platform to elicit actions that will transform the implementation of policies and strategies.

The session was chaired by Eric Goosby, Secretary Genersl Special Envoy on TBand raised great interest, Aaron Motsoaledi, Minister of Health of South Africa and Isaak Adewole, Minister of Health of Nigeria presented at the session, as well as Ren Minghui, WHO, Mark Dybul, the Global Fund, Ariel Pablos-Mendez, USAID, Deborah Birx, PEPFAR, Lucica Ditu, Stop TB Partnership, Michel Kazatchkine, Special Envoy of Secretary General on AIDS in EECA presented at the meeting.

Andriy Klepikov in his comments emphasize importance of harmonizing more TB and HIV response, especially in moving forward new initiatives such as Fast track cities: “We cannot allow ourselves be fast on HIV and slow on

From 23 to 28 May Geneva (Switzerland) hosted 69th World Health Assembly, which is the supreme governing body of the World Health Organization (WHO) and makes strategic decisions at the international level. During the session, members of all WHO member statesapproved strategies on key healthcare issues, in particular infectious diseases: HIV, Viral Hepatitis, Sexually Transmitted Infections and other socially dangerous diseases (http://www.who.int/mediacentre/events/2016/wha69/ru/).

This year, the first Global Health Sector Strategy to Eliminate Viral Hepatitis by 2030 was approved. The draft strategy was developed with involvement of the representatives ofdifferent countries, based on the best practices and national models of response to viral hepatitis. If the implementing countries are able to ensure its implementation, it will help save over 7 million lives. For Ukraine it will mean approval of rather ambitious goals oneliminating viral hepatitis B and C by the end of 2030, which include, in particular, 90% ofdiagnosed cases of chronic hepatitis C and 80% of people covered with hepatitis C treatment.It is also important to point out hepatitis B vaccination – by 2030 its coverage should be 90%,including vaccination of newborns.

Ludmila Maistat, Senior Program Manager: Hepatitis, Alliance for Public Health, took part inthe activities of the WHO Strategic and Technical Advisory Committee for Viral Hepatitis (STAC-HEP), which was responsible for the development of the Global Strategy. It is good torealize that the Alliance expertise in implementation of the treatment program forvulnerable populations, which has been in place in Ukraine for over twelve months with 92%treatment success, has also been used to develop the Strategy.

On May 21, Alliance for Public Health (Alliance) together with Zaporizhia branch of the Network of PLWH held a training “National Police, Harm Reduction and Human Rights” for officers of the regional unit of the Department for Countering Drug-Related Crime of the National Police of Ukraine of the Main Administration of the National Police in Zaporizhia oblast (covering Dnipropetrovsk and Zaporizhia oblasts).

Alliance in partnership with Law Enforcement and HIV Network (LEAHN) continues conducting educational activities to raise the level of awareness of people working in the National Police on the need to respect human rights of the participants of harm reduction/HIV prevention programs. Earlier, similar training events have already been held in Lviv, Kharkiv and Vinnytsia oblasts.

During the one-day training, the participants were familiarized with national legislation and international recommendations, justifying the need in and the importance of harm reduction and opioid substitution treatment (OST) programs, and also with the important medical components. From Alliance, the training was held by Tamara Tretska, OST Program Manager. The training was also attended by drug treatment doctor Denis Chepelkin; representatives of Zaporizhia office of the Network of PLWH – Director of the organization Ihor Lytvyn, Head of Prevention Programs Halyna Azarova and Head of Advocacy Anna Tulupova.

On the eve of the training, Alliance received a copy of an unlawful official request to disclose personal data of all drug dependent people who are registered in Zakarpattia oblast. Thus, training participants had a chance to review this impudent violation of the current laws in order to prevent similar violations in terms of access to personal data and violation of the rights of drug dependent people, including OST patients. During the intensive discussion, the participants asked a lot of questions on the examples of practical use of the updated regulations, in particular on the delivery of OST drugs based on prescriptions or directly to patients as well as related to storing, transporting and otherwise handling OST drugs. Those questions were answered by trainers and experts.

One of the speakers was the regional representative of the Association of Substitution Treatment Advocates of Ukraine (ASTAU), Denys Korshunov, who spoke about the positive impact of the increased access to OST for drug users on the improvement of the criminal situation in the region.

All the participants received certificates upon training completion.

Though the scandalous Head of the Department of Countering Drug-Related Crime of the National Police of Ukraine, Illia Kiva, has already been dismissed, his “innovative” idea to create a “database” of all drug dependent people in Ukraine is still alive and even actively brought into life.

Patient confidentiality? Personal data protection? Presumption of innocence? Apparently, for the National Police these are just empty words, but not the inherent principles of their daily law-enforcement efforts. The society has just started forgetting the “brilliant” idea of Illia Kiva to introduce criminal responsibility for using drugs, so the Department of Countering Drug-Related Crime decided to remind about itself by starting to collect data about all patients of drug treatment clinics “due to the operational needs” to “create a database of individuals who use narcotic drugs for non-medical purposes”. [1]

Since January 2016, the Alliance for Public Health has been receiving information from the regions of Ukraine on the national policemen illegally collecting information about drug dependent individuals, allegedly as instructed by administration of the National Police of Ukraine. Until recently, there were no documented evidence of the existence of such instructions, but our partners on a regular basis informed us about the cases of visits by law enforcers to treatment institutions offering Opioid Substitution Treatment (OST), mass detention of dozens of drug dependent patients right in the territory of such medical institutions, in particular in Sloviansk, Lysychansk and other cities of Ukraine.

But one of these days Alliance got a documented proof of the existence of centralized instructions from the Department of Countering Drug-Related Crime of the National Police to collect personal data of all people registered with drug treatment centers – request of the First Territorial Administration (covering Lviv, Ivano-Frankivsk and Zakarpattia oblasts) of the Department of Countering Drug-Related Crime, reference number 196/40-TU/Z-2016 dated 19.05.2016 to the chief doctor of Zakarpattia oblast drug treatment center.

This fact is an evident proof of the National Police unduly initiating centralized collection of personal information on drug dependent individuals in breach of articles 19 and 32 of the Constitution of Ukraine, articles 8 and 14 of the European Convention on Human Rights, article 286 of the Civil Code of Ukraine, articles 7, 19, 24, 25 of the Law of Ukraine “On Protection of Personal Data”, articles 39-1 and 40 of the Law of Ukraine “Fundamentals of Healthcare Legislation of Ukraine”, and articles 7, 8, 25-28 of the Law of Ukraine “On the National Police”.

Such impudent and systematic violation of human rights is intolerable in a law-governed democratic state, which, besides, is declaring rigorous compliance with the strict conditions of personal data protection, stipulated by the Action Plan on Visa Liberalization by European Union for Ukraine.

The Alliance for Public Health would like to draw the attention of all responsible persons – chief law enforcement officers, Ministry of Health, Ombudsman of Ukraine, heads of the special committees of the Supreme Council of Ukraine, other government officials as well as representatives of civil society and media – and today it officially called to immediately intervene with this situation, stop the unlawful collection of information on drug dependent individuals and initiate a complex investigation (criminal proceedings, internal investigations, etc.) based on this fact to avoid such cases in future.

At the same time, Alliance would like to bring to notice of administrations of the treatment facilities, where almost 85,000 drugs users are registered, that disclosure of personal information, in particular containing patients’ confidential data, in response to such unlawful requests is unacceptable.

For information: The Alliance for Public Health as one of co-implementers of the National Targeted Social Program of Combating HIV/AIDS in 2014-2018 approved with the Law of Ukraine No. 1708-VII dd. 20.10.2014 is responsible for implementing HIV prevention programs, which cover over 212,000 drug dependent people in our country, including more than 8,600 patients of Opioid Substitution Therapy (OST).

At the end of 2014, in drug treatment institutions of Ukraine there were 84,739 officially registered individuals with mental and behavioral disorders caused by drug abuse.

[1] Quote from the request of the First Territorial Administration covering Lviv, Ivano-Frankivsk and Zakarpattia oblasts of the Department for Combating Drug Trafficking of theNational Police, reference number 196/40-TU/Z-2016 dated 19.05.2016 to the chief doctor of Zakarpattia oblast drug treatment center.

Situation Report as of 18 May 2016

On Sunday, May 15, Ukraine as well as countries all over the world marked the International AIDS Candlelight Memorial Day. According to the Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, 3,032 people died of AIDS in Ukraine in 2015, and 969 – in four months of 2016. Overall, since 1987 AIDS took the lives of 39,426 Ukrainians.

Traditionally, activists gathered at the Red Ribbon Memorial to express their concerns about the current situation in HIVtreatment within the initiative of the All-Ukrainian Network of PLWH. Alliance for Public Health joined the campaign, makinga focus on the urgent need to provide access to treatment for vulnerable populations. Andriy Klepikov, Executive Director of Alliance, pointed out that “unfortunately, though in the recent years we see that due to implementation of HIV prevention programs in vulnerable populations the number of new infections, in particular among people who inject drugs, has been considerably reduced, death rate among the members of this population remains almost unchanged – 45%. First of all, it is caused by the limited access to antiretroviral treatment. For example, an HIV-infected person who injects drugs has muchlower chances to received ART than an ordinary citizen who is in need of such treatment – the share of such patients among those who receive ART is only 12.5%.” According to the official data, as of April 1, 2016 there were 128,455 officially registered patients in Ukraine, with 63,029 (49%) of them receiving ART. Among the drug users, only 7,563 persons were receiving thetherapy as of the end of 2015.

One of the key causes of death among people living with HIV in Ukraine is tuberculosis and the situation with treatment of patients with HIV/TB co-infection remains critical. Only every other patient (56%) has an access to ART. One of the priorities of Alliance is treatment of multidrug-resistant tuberculosis – since 2013, 9,936 patients received such treatment with financial support of the Global Fund. According to the data available, though the incidence of HIV-associated tuberculosishas remained almost unchanged in the recent years (14.5 cases per 100,000 people), the mortality related to co-infection goes down (2,522 cases in 2013 as compared to 1,994 cases in 2014), which is a proof of treatment success. However, thereare big concerns related to the fact that currently most patients rely on donor funding in the procurement of medical drugs – in future this should fall into the competence of the state.

Alliance for Public Health supports its partners’ initiative to appeal to the Prime Minister of Ukraine with a request to takeunder his personal control the question of full funding of the National Targeted Social Program for Countering HIV/AIDSand, in particular, public procurement of vital medicines (for ART, OST, TB treatment, etc.)

Alliance grieves for those who died and, in its turn, tries to do everything possible to finally break the sad death ratestatistics in Ukraine (currently Ukraine accounts for 25% of AIDS-related deaths in Eastern Europe and Central Asia) and to ensure the achievement of global UN targets in response to the epidemic.

Alliance congratulates Jamala on her victory in the Eurovision song contest! It was a great news for us as in November 2013 we had an honor to work with Jamala during our charity campaign “Inspired for Life”, which was aimed at raising private and business funds for the needs of people living with HIV. Following this collaboration, two video clips were produced promoting HIV prevention and anti-stigma messages as well as calling all stakeholders to shape the state policy in HIV prevention to make it a national priority – for their own future.

HIV is not transmitted through friendship

HIV prevention should become a national priority