Strong partnership and strong will needed to avert public health crisis in Crimea
by Karen Madoyan
The political crisis currently enveloping Ukraine is complicating even the basics for many of us: gas prices are rising, along with food costs, and we are feeling insecure due to the presence of many armed groups taking to the streets. But for tens of thousands of people we work with in the now-annexed region of Crimea, the crisis could have life or death implications.
There are an estimated 14,000 people who inject drugs living in Crimea. Through programs supported by the Global Fund and implemented by partners of the International HIV/AIDS Alliance, these people have been able to voluntarily access medical services including opioid substitution therapy (OST), and other HIV prevention services.
But now, with the blocking of highways by Russian troops that link Crimea to the mainland, supply lines have been interrupted. With dwindling stocks of methadone and buprenorphine unlikely to be replenished for some time, Russia's ban on OST in its territory is practically certain to be extended to Crimea.
The risk is most certainly real. Viktor Ivanov, head of the Russian Federal Drug Control Service (FDCS) and one of the Russian officials currently under US sanctions, has openly criticized Ukraine's support for OST and announced that his top priority in Crimea is to ban methadone therapy.
We cannot allow people to be taken hostage in this way, to be cut off from life-saving medical services because of where they live.
OST helps reduce the risk of HIV infection among drug users because it helps wean patients off illicit drugs and begin their recovery as functioning members of society. Without access to OST, there is a strong likelihood that these patients will suffer withdrawal and potentially revert to illegal drugs, which in turn puts them at much greater risk of contracting HIV through dirty needles.
Ukraine has used OST throughout its territory since 2005, providing daily treatment at facilities around the country as well as around Crimea. In public facilities in Simferopol, Sevastopol, Yalta, Eupatoria, Feodosia, Kerch and other cities there are more than 800 patients who are administered their daily dose.
UNAIDS reported in 2011 that Russia and Ukraine account for almost 90% of the HIV epidemic in Eastern Europe and Central Asia -- and that the majority of that epidemic is driven by infection among people who inject drugs.
Any interruption to harm reduction programming is a disaster for health, human rights and the HIV epidemic in the region and we urge the authorities in Crimea to step in and ensure that critical supply chains are not disrupted and lives not put at risk as a result of territorial politicking.
We may still have time. Despite the worrying statements from Ivanov and the FDCS, it may take months before Russia assumes all legislative control of Crimea. There has yet to be any official statement banning the use of OST in Crimea. But while we may have time, it is not on our side, especially as stocks deplete. We remain committed to supporting this harm reduction program, and we know our partners are too.
National stakeholders and community representatives have asked Mark Eldon-Edington, the head of the Fund's grant management unit, to share what he learned during his recent visit to Ukraine with the Fund's leadership, and support our country to access additional funds from elsewhere so that we may continue to provide essential services across Crimea and to the displaced Crimeans seeking continued access to the life-saving services that may no longer be available at home.
We are encouraged by recent statements on 24 March by the de-facto health minister of Crimea, Piotr Mikhalchevskiy, appealing to Ukraine's new Health Minister Oleh Musiy to provide methadone and buprenorphine to ensure continuation of therapy for local patients. We are ready to stand as a guarantor for delivery. What is left is for Ukraine to demonstrate its political will and readiness to assist.
Karen Madoyan works with the International HIV/AIDS Alliance in Ukraine. The opinions in this commentary reflect his organization's position on Crimea and are theirs alone.