Methadone Clinics Help Ukraine Succeed on HIV Prevention

HIV Commemoration in Kiev
People walk past quilts made by HIV positive people to commemorate AIDS victims, at Mikhaylovskaya Square in Kiev on May 13, 2011. Photographer: Genya Savilov/AFP/Getty Images

Ukraine is checking the spread of HIV for the first time in more than a decade by handing out methadone and clean needles to drug users, measures long embraced in the U.S. yet still opposed in neighboring Russia.

More than 8,300 people were receiving substitution therapy to keep them off injected drugs as of Dec. 1, more than all the other nations of the former Soviet Union combined, according to the International HIV/AIDS Alliance in Ukraine, which supports many of the nation’s clinics with money from the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria.

The approach is working. New HIV infections, which had been rising since 1999, fell in 2012 to 20,743 from 21,777 in 2011, according to the nation’s health ministry. In Russia, where the government bans opioid substitutes such as methadone and refuses to fund clean-needle programs, new infections jumped 13 percent to 70,453 in 2012.

“Ukraine is important because it’s an emerging policy contrast to Russia,” said Chris Beyrer, a professor at the Johns Hopkins Center for Global Health in Baltimore, and the president-elect of the International AIDS Society. “They have been making more progress on harm reduction and they have been making more progress, albeit painfully slowly, on methadone.”

Ukraine, along with Russia, suffered through a ballooning HIV epidemic among drug users after the collapse of the Soviet Union in 1991 eased access to opiates such as heroin. About 230,000 people are living with the virus in Ukraine, more than any country in Europe or Central Asia except Russia, according to the Joint United Nations Programme on HIV/AIDS, or UNAIDS.

Recovering Addicts

Alexander Tsukrenko is one of about 400 recovering drug users who attend a clinic in western Kiev, trekking an hour each way for handful of pills that are keeping him off illicit drugs. Some travel as much as three hours each way for treatment.

“This program gives me life,” said Tsukrenko, 46, who signs his name in the clinic’s register alongside the number 1,491 -- the number of days he has been performing the ritual.

Edward Ovcharuk, who used drugs for 17 years, has been on methadone for two months. The treatment has already changed his life, he said.

“I used to steal money from my family,” Ovcharuk, 33, said outside the clinic in Kiev. “I don’t need to steal anymore. I’m not waking up in the morning thinking about drugs.”

The International HIV/AIDS Alliance aims to expand the number of people receiving such therapy to 9,600 this year, Andrey Klepikov, the organization’s director, said in an e-mail.

Krokodil Shots

Still, while Ukraine has made progress on HIV, the drug scourge that has fueled it rages on. The alliance estimates that more than 250,000 people in the country are injecting opiates. Increasingly Ukrainian drug users are adopting a deadly concoction called krokodil, named for the gaping wounds it creates.

Users such as a 33-year-old woman who gives her name as Oxsana present a daunting challenge for HIV prevention.

Oxsana prepares krokodil in the basement of a decaying Soviet-era apartment block behind a strip club in the eastern city of Donetsk. She tips a mixture of crushed codeine pills, gasoline and citric acid into a small dish over a gas burner. She sprinkles phosphorous -- the flammable chemical used on the end of matchsticks -- over the liquid, reducing it to a brown paste that she scrapes off with a razor blade and taps into a small glass bottle. Oxsana adds a scoop of iodine, then a few drops of water, filling the room with acrid gray smoke.

Clean Needles

She draws the fluid into a syringe and sits under a bare light bulb searching for a vein on her left thigh. Her first effort fails, so she tries again, this time on the sole of her right foot. Then she turns to inject a friend, Marina, in her right arm with a clean needle provided by a charity worker.

The effects of krokodil only last about half an hour, requiring Oxsana to repeat the process as many as 20 times a day. She said the habit costs about 400 hryvnia ($48) a day for the two of them. Oxsana and Marina sell sex to fund their addiction, charging 150 hryvnia for oral sex and 250 hryvnia for intercourse. Both women say they have HIV, and both have been in and out of prison.

While the number of people on methadone is relatively small and doesn’t entirely account for the reduction in new cases, it’s part of a broader approach to preventing infections among risk groups that is bearing fruit, said Charles Vitek, the country director for Ukraine and Russia in the U.S. Centers for Disease Control and Prevention’s AIDS division.

“The provision of clean needles and information about the importance of clean needles and increased access to testing, all of those things work together to have a prevention effect,” Vitek said in a telephone interview from Kiev. “As long as continued prevention efforts go on and treatment expansion keeps going up, we should see a continued drop-off in cases.”

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