Dear President Yanukovych,
We write to express our deep concern regarding ongoing harassment by state prosecutors and law enforcement targeting substance abuse treatment patients, care providers, and HIV organizations throughout Ukraine. We urge you to take immediate action to put an end to these tactics, which are seriously compromising national efforts to curb the spread of HIV/AIDS and undermining recent progress in addressing the epidemic in Ukraine.
Ukraine is home to the worst HIV/AIDS epidemic in Europe and one of the fastest-growing epidemics in the world. In recent weeks there has been a pattern of harassment of HIV organizations and patients receiving opiate substitution treatment that calls into question the new government's commitment to mounting an effective HIV response. These distressing events actively undermine Ukraine's new national law on HIV/AIDS, enacted January 15, which identified substitution treatment and needle exchange as essential elements of the country's national HIV prevention strategy.
On January 18, 2011, the Ministry of Interior's department of drug enforcement issued an order to collect personal data of patients enrolled in opiate substitution programs across Ukraine. Since then, police have been pursuing patients at clinics and at home. Police are also denying access to services, including to provision of necessary medication, if patients do not provide confidential information, including their HIV status and criminal record.
Non-governmental organizations working on HIV prevention and treatment have also been ordered to surrender project document, including materials required to sustain international donor funding, effectively paralyzing essential HIV prevention and outreach programs for drug users. The heads of the International HIV/AIDS Alliance in Ukraine and the All-Ukrainian Network of People Living with HIV have been summoned for questioning by the Prosecutor's Office in relation to their work on substitution treatment and HIV prevention.
These current heavy-handed tactics appear to be part of an ongoing campaign targeting people who use drugs and those who work with them that worsened in 2010. Police have raided drug treatment clinics; interrogated, fingerprinted, and photographed patients; confiscated medical records and medications; and detained medical personnel in cities nationwide. Many raids appear to have been conducted without probable cause and in violation of Ukraine's rules for police operations. The raids have disrupted treatment, and two doctors are being charged with drug trafficking, an offence punishable by up to 10 years in prison.
Human Rights Watch has conducted extensive research on HIV/AIDS and injection drug use throughout the world, including in Ukraine. Our research has consistently documented the link between harsh law enforcement policies and practices and increased HIV/AIDS risk. We have found that in Ukraine, as in many other countries, police presence at or near harm reduction programs drives people who use drugs users away from these services due to fear of arrest or other punishment, and increases the risk of HIV and other negative health outcomes.
Opiate drug dependence plays an important role in fuelling the HIV/AIDS epidemic in Ukraine. Opioid-substitution therapy has proven to reduce drug use as well as criminal activity, overdose deaths, and behaviors such as syringe sharing, and to improve uptake and adherence to antiretroviral treatment for HIV-positive opiate users. The World Health Organization, the United Nations Office on Drugs and Crime, and UNAIDS have recommended opiate substitution therapy, with buprenorphine or methadone for instance, as a critical part of comprehensive HIV prevention, treatment, and care for people who use drugs.
Police harassment and abuse of people who use drugs, and outreach workers violates fundamental human rights protections against cruel, inhumane and degrading treatment. State interference with the delivery of HIV information and services, including legally available opiate substitution therapy, violates rights of access to health care information and services.
The Ukrainian government has taken a number of positive steps to fight HIV/AIDS, chiefly in the area of legislative and policy reform, including its new HIV/AIDS law. Ukraine has expanded provision of antiretroviral therapy for people living with HIV/AIDS. As of January 2010, 15,871 people were receiving medication. Substitution therapy must be a critical part of Ukraine's national HIV program, and Ukraine has made recent progress in its provision. The country has expanded the number of people with opioid drug dependence receiving mediation-assisted treatment with methadone and buprenorphine from none in 2004 to about 5,550 in 2010. This progress, however, is seriously threatened by the actions of the police and prosecutors described above.
Limiting access to substitution therapy will have a devastating impact on the human rights to health and life of all Ukrainians living with, or at risk of, HIV/AIDS, as well as those in need of treatment for opiate addiction. We urge you to take immediate action to end police and prosecutorial harassment and abuses that interfere with injection drug users' ability to access substitution therapy. We also urge you to continue Ukraine's previous progress in ensuring that methadone and other drugs used in substitution therapy are immediately available to those requiring treatment.
Joseph Amon MSPH PhD
Health and Human Right Division
Human Rights Watch
Azarov Mykola Yanovych
Parliament Commissioner for Human Rights
Head of Verkhovna Rada of Ukraine Committee on Healthcare Issues
Bakhrieieva Tetiana Dmytrivna
Pshonka Viktor Pavlovych
Minister of Interior
Mogylyov Anatoliy Volodymyrovych
Minister of Health
Yemets Illya Mykolaiovych