On the morning of January 19, a police car drove up to a local drug treatment clinic in Chernovtsy, Ukraine. Inside, patients had already been lining up for hours to receive their daily dose of the opiate substitution treatment methadone. Several policemen strode into the clinic, rounding up patients and forcing them into a room where each was coerced into signing a release form on voluntary disclosure of confidential information.
The officers demanded patients, one by one, complete a questionnaire that asked for sensitive information including their HIV status, criminal record, and methadone dosage as well as their families’ attitudes toward opiate substitution treatment (OST). Those who refused to share these personal details were threatened with denial of methadone, a call to their neighbors, employer, family members, or even a trip to the police detention center.
The patients in Chernovtsy were not alone in suffering this humiliating and traumatic ordeal. On January 18, the Ukrainian Ministry of Interior’s department on drug enforcement directed its regional offices to collect personal data from all patients participating in substitution treatment, and in the days that followed, police showed up unannounced at all168 OST sites nationwide. Other law enforcement agents have pursued OST patients at clinics and at home, likewise threatening to and actually withholding medication to extract confidential information—again, including the patients’ HIV status and criminal record—while advising the doctors to cooperate in order to avoid harsher measures.
At the same time, local non-governmental organizations working on HIV prevention were ordered to surrender relevant reporting documents, effectively paralyzing vital HIV prevention and outreach programs for people who use drugs. The heads of the International HIV/AIDS Alliance in Ukraine—an Open Society Public Health Program grantee— and the All-Ukrainian Network of People Living with HIV have been summoned in for questioning by the federal Prosecutor’s Office about their work on substitution treatment and HIV prevention. For more details, read the International HIV/AIDS Alliance’s press release.
Equally troubling are recent statements made by the Ukrainian Minister of Interior, Anatoly Mogilev, at a joint press conference with the Russian drug czar, Viktor Ivanov, on January 28. “I'll tell you,” Mogilev said, “in my view, whoever created this program in the country made a mistake. My colleague [head of Russian Federal Drug Control Ivanov] and I discussed this issue: in America, this approach lacks support at the official level, it is implemented only in a few European countries and this topic [OST] is problematic. We are discussing right now at the level of the Cabinet of Ministers about transforming it to, let’s say, a more civilized method.”
Although this statement by the Ukrainian Minister of Interior is factually incorrect—OST is widely used throughout the European Union and nearly 300,000 patients are in treatment in the United States—it paints a grim picture for the future of OST programs in Ukraine. It likewise provides an unsettling glimpse into the nascent collaboration on this issue between Ukraine and Russia (where OST is banned).
Ironically, these distressing events are in stark contrast to Ukraine’s new national law on HIV/AIDS, which was enacted just days before on January 15, and which identified substitution treatment and needle exchange as essential elements of the country’s national HIV prevention strategy. This move to institutionalize harm reduction and substitution treatment had widely welcomed by both local and international actors working to address the HIV epidemic in Ukraine, where some 350,000 people live with the disease.
Nonetheless, widespread police harassment has persistently gone hand in hand with any scale-up of substitution treatment in Ukraine, and that reality threatens to negate the positive gains that had been made in containing the spread of HIV over the past five years. Not only do these abuses deter patients from seeking necessary medications, but medical professionals also exercise extreme caution as a result, steering the already-troubled process of OST delivery even further away from patients’ needs.
Both on-the-ground organizations and patient-activists have proactively responded to this latest standoff with law enforcement officials. Ultimately, however, it is up to Ukraine’s government to send an unequivocal message of support for substitution treatment—one heard not just by patients and medical providers, but also its own law enforcement community. Because, until they are assured the government’s full support, patients and their allies will be forced to carry on their lonely struggle to choose, perversely, between personal safety and health.
Between this and accusing Crimean Tatars of wanting to turn Crimea into "another Kosovo," Mogilev sounds like a real piece of work.