The International HIV/AIDS Alliance has expressed alarm at the future of more than 14,000 people in Crimea who inject drugs following its annexation by Russia.
Some 800 patients in the region are currently receiving opioid substitution therapy (OST). This treatment is prohibited in Russia and current stocks of methadone and buprenorphine on the Crimean peninsula will only last for another few weeks at most. With the blocking of highways that connect Crimea to the mainland, getting medical supplies through is challenging and there are concerns that a major public health crisis will arise as a result.
According to Andriy Klepikov, Executive Director of the International HIV/AIDS Alliance in Ukraine: "When the supply of these medicines is interrupted or stopped, a medical emergency will ensue as hundreds of OST patients go into withdrawal, which will inevitably lead to a drastic increase in both acute illness as well as increases in injecting as people seek to self medicate.
"The Russian Federation has extremely repressive drug laws," he said, "and its punitive approach to people who use drugs means that it now experiences one of the highest rates of new HIV infections in the world. Injecting drug users represent nearly 80 percent of all HIV cases in the country. "
Substitution maintenance therapy reduces the risk of HIV infection in drug users and in Crimea OST has been implemented for nine years with patients receiving daily treatment at healthcare facilities in Simferopol, Sevastopol, Yalta, Eupatoria, Feodosia, Kerch and other cities. Klepikov continued: "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."
In Ukraine, epidemiologists have observed a decrease in HIV incidence among people who inject drugs since 2007. The number of registered HIV cases among this group dropped from 7,127 in 2006 to 5,847 in 2013 thanks to an effective harm reduction approach which has resulted in a stabilization of the HIV epidemic.
In 2008, Ukraine introduced programmes providing HIV services and drug dependence therapy in an integrated manner for the first time. This model of care is proving highly successful and, in 2013, in some 300 cities, towns and villages across the country, Alliance Ukraine and its partners ensured that more than 196,000 people who inject drugs had access to HIV prevention services such as clean needle exchanges, condoms and rapid testing and counselling for HIV and sexually transmitted infections.
Klepikov concluded: "Russia has never supported HIV prevention services among people who inject drugs at scale, which is why the number of new infections both among this group as well as the general population is dramatically increasing there. We should not let 14,000 Ukrainian drug users be taken hostage in this way, cutting them off from life-saving medical services."