Will HIV prove to be the winner of the Russian-Ukrainian conflict?

Russia’s annexation of Crimea may lead to substitution treatment being discontinued on the peninsula.

Viktor Ivanov, head of Russia’s Federal Drug Control Service, has already announced on television that the termination of methadone treatment in the Crimea was one of his most important tasks. Ivanov says that the methadone is not a medicine and that substitution programs do not have any therapeutic effect. (http://mir24.tv/news/society/10105992). Recently, some Russian officials tried to prevent a Ukrainian activist from making a presentation during the UN session on AIDS (http://www.ihra.net/print/1038).

In Russia, where the number of HIV-infected people is estimated at 1.3 million, for many years the authorities have consistently rejected proven tools that could effectively combat the AIDS epidemic among injecting drug users who constitute the vast majority of those living with HIV. For many years, in both Ukraine and in Russia, the HIV epidemic has been driven by infections related to injecting drug use. Several years ago, the Ukrainian authorities decided to introduce opioid maintenance therapy and it started to successfully slow down the spread of HIV in the country.

The situation in Russia is different. Here the use of methadone is being constantly prohibited. President Putin introduced anti-gay laws and bans the effective treatment for drug dependent persons, thus opposing moral superiority of Russian culture to “disintegration of values in the West”. His position enjoys strong support among Russian officials and psychiatrists-narcologists.

In recent years we have witnessed Ukraine’s efforts in the implementation of rational methods in the field of HIV and drug dependence treatment, especially the treatment of addiction to heroin and other opiates. Only in Crimea, about 800 people could return to healthier life and normal functioning thanks to treatment based on methadone or buprenorphine substitution. In place of pseudoscientific approach of narcologists, one of the most promising treatment programs in the region was created in Crimea. Instead of being constantly blamed for weakness, opiate dependent persons are provided professional medical and pharmacological care, as well as psychological support relevant to their situation. In the Russian system, it would be impossible, as its canons of treatment are determined by decrees from Moscow and the medical treatment of addiction does not take into account the facts and scientific evidence.

The staff clinic in Simferopol is professionally trained and prepared for an open discussion on how the provision of services and care for substance dependent patients should be shaped. Nurses who used to visit homes of drug dependent persons to make them undergo compulsory testing, are  now trained and become part of educators’  teams. Today, their home visits are related to the prevention of overdoses and provision of medical aid, instead of state supervision over whether someone abstains from drug use.

Interestingly, patients and their families together repaired the building in Simferopol, which serves as an informal community center, offering rest to those who have to travel from more distant regions of the peninsula to get their methadone. There doctors (not necessarily dressed in white uniforms) willingly exchange views with patients and their families.

However, it may soon be impossible to continue. What will happen to patients treated with methadone and buprenorphine? How will HIV prevention be for drug users in Crimea? Will the Russians, completely unable to cope with the HIV epidemic in their own territory, waste years of efforts of Ukrainian medical services? These questions have become a nightmare for the patients and the international community is increasingly concerned.

A few years ago we had here a foretaste of today’s situation, when the pro-Russian politicians tried to limit methadone treatment. However, the strong attitude of the community, in this case a group of mothers of drug dependent persons who protested outside the offices of the local authorities, led to  the anti-substitution proposal being abolished. Perhaps this kind of participation of citizens in public life makes substitution treatment something unacceptable for the Russian authorities. Officials and narcologists do not recognize the public debate around the treatment which would involve patients and their families.

Meanwhile, in Russia, where substitution therapy is constantly criticized, treatment of those dependent on opiates is mainly based on a model of long-term detoxification using high doses of sedatives, anxiolytics, and often neuroleptics.

However, the fact that the Russian approach is not very effective in reducing drug use or the number of HIV infections seems to matter little. After all, morality should be a sufficient remedy to HIV and drug dependence.


By Grzegorz Wodowski