The Ukrainian government’s considerable efforts to combat Europe’s worst HIV/AIDS epidemic are being undermined by its failure to end persistent violence and discrimination against people at highest risk of infection, Human Rights Watch said in a report released today.
The 84-page report, “Rhetoric and Risk: Human Rights Abuses Impeding Ukraine’s Fight Against HIV/AIDS,” documents how draconian drug laws and routine police abuse of injection drug users – the population hardest hit by HIV/AIDS in Ukraine – keep them from receiving lifesaving HIV information and services that the government has pledged to provide.
Based on firsthand testimony in Ukraine from dozens of people living with HIV/AIDS or at highest risk of infection, the report further documents how they commonly face discrimination from healthcare workers, who sometimes refuse to provide care altogether.
“The HIV/AIDS policies that Ukraine has put in place are generally good ones,” said Rebecca Schleifer, researcher with Human Rights Watch’s HIV/AIDS program. “But until the government addresses the chronic abuses of people at highest risk of HIV/AIDS, it will have little hope of stemming its HIV epidemic.”
Ukraine’s national AIDS law, recognized as a model in the region, incorporates human rights protections for people living with HIV/AIDS. These include specific provisions that bar refusal of medical care based on HIV status, and guarantee access to appropriate medication, the right to HIV/AIDS information as well as confidentiality of HIV test results. Its national law and policy support syringe exchange and opiate-substitution therapy, which the World Health Organization and UNAIDS have endorsed as essential to strategies aimed at HIV prevention and care for drug users.
However, Human Rights Watch found that abusive practices, problematic regulations, and a failure to implement crucial provisions of national AIDS policies render these protections meaningless for most Ukrainians living with or at highest risk of HIV.
Police abuse, sometimes amounting to torture, keeps drug users away from basic HIV-prevention services like needle exchange, in direct contradiction to government policy in support of such services. Due to the criminalization of even trace amounts of drugs for personal use, drug users are easy targets for police seeking to fulfill arrest quotas. Police also extort money and information from drug users, sometimes using the mere possession of syringes as an excuse to harass or arrest them or outreach workers providing services to them. Proposed changes in Ukraine’s drug laws to criminalize possession of smaller amounts of drugs than are currently prohibited threaten to exacerbate these abuses.
Healthcare workers’ discriminatory practices toward people they know or suspect to be HIV-positive severely compromise the health of people living with HIV/AIDS. Human Rights Watch found that people working in healthcare frequently refuse to treat such people. They also routinely disclose confidential information about HIV status, exposing people living with HIV/AIDS to further discrimination and abuse. As a result, many people do not seek HIV testing out of fear that their status, if HIV-positive, could be revealed.
Substitution therapy reaches only a fraction of the drug users in need of it. According to the World Health Organization, at least 60,000 drug users need substitution therapy but, to date, only 200 treatment slots are available. This failure to ensure drug users’ access to the full range of HIV prevention and treatment services – including substitution therapy with methadone, which is legal in Ukraine – significantly undermines efforts to fight both AIDS and drug use.
Drug treatment clinics are required to officially register drug users who are referred to them for treatment, and to share this information with law enforcement agencies. This practice keeps many drug users from seeking healthcare or drug treatment services, out of fear that their drug use will be reported to law enforcement.
Antiretroviral drugs are available only to a small percentage of persons in need of such treatment. As many as 416,000 people – 1.7 percent of Ukrainian adults – are living with HIV/AIDS in Ukraine. In 2004, with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the NGO International HIV/AIDS Alliance launched an antiretroviral program in Ukraine to treat people living with HIV/AIDS. Between April 2004 and December 2005, more than 2,600 people began antiretroviral treatment under this program. While this program has been said to be the most rapid treatment expansion in all of Eastern Europe, it still reaches only a small fraction of the 17,300 people in urgent need of treatment.
“Ukraine’s ambitious HIV/AIDS programs won’t succeed unless the government eliminates the abusive practices that undermine its prevention and treatment efforts,” said Schleifer. “Protecting human rights is essential if Ukraine hopes to expand access to antiretroviral treatment to the scale necessary.”
Human Rights Watch called on Ukraine to protect the rights of people living with HIV/AIDS and drug users to obtain healthcare services without fear of punishment, discrimination, or disclosure of confidential information.
The Ukrainian government should expand and enhance the scope of HIV services to drug users, including syringe exchange and substitution therapy with methadone. It should also ensure adequate training on HIV/AIDS, harm reduction, and safe drug use to police and healthcare professionals. Finally, it should invest in public education programs to ensure that all people in Ukraine have access to scientifically sound information about HIV/AIDS.