First Harm Reduction, Now Client Management: AFEW in Belarus

This month, AFEW launches a new project ‘Implementation of a Client Management Programme for HIV/AIDS Prevention, Treatment and Support in the Republic of Belarus’. This landmark initiative will create client management systems with a particular focus on non-discriminatory, accessible and joined-up services for injecting drug users, men who have sex with men and sex workers. Expected outcomes will be better access to effective protection services for these key populations at risk and to antiretroviral therapy for people living with HIV.
This project follows on from AFEW’s introduction of harm reduction methodologies for injecting drug users in 2005 to 2008, the success of which generated strong interest on the part of the Belarusian government and civil sector to develop their partnerships with the organisation.
The current project initially focuses on stimulating a provider-patient dialogue through two steering committees in the cities of Minsk and Svetlogorsk. Client management networks of governmental and non-governmental service providers will then be developed in each city, with the aim of expanding them to seven other regions of the country by the end of 2012. Click here for detailed information about the project’s aims and methodologies.
Because activities are closely related to the ‘National Programme on HIV Prevention 2006-2010’ and involve capacity-building of local civil organisations, there are good prospects for their long-term sustainability and impact.
Funding is provided by the Ministry of Foreign Affairs of the Netherlands under its Matra Social Transformation Programme, which supports projects that are designed to strengthen interaction between national and local government and civil society, and to encourage consensus on measures to strengthen democracy and the rule of law. In particular, it encourages the development of knowledge exchange and twinning networks between the Netherlands and Matra countries.

methadone_decision

Ukrainian government decision on methadone will help scale up HIV prevention with drug users
(Intl. HIV/AIDS Alliance, 29 January 2008)
http://synkronweb.aidsalliance.org/sw53188.asp?trackingid=46&newsletterid=173

On 19 December 2007, in a move welcomed by Ukrainian AIDS-service NGOs and international organisations, the Ukrainian Ministry of Health decided to allow the importation of methadone, which is used to treat drug dependency and prevent HIV infection among injecting drug users. The move comes after years of coordinated advocacy efforts led by the Alliance in Ukraine, and will allow the scaling-up of existing substation therapy programmes.

Ukraine is experiencing one of the fastest-growing concentrated HIV epidemics in Europe. According to recent statistics, over 60% of people living with HIV in Ukraine acquired the virus through injecting drug use. The first batch of methadone to be imported into Ukraine at the start of 2008 will provide substitution therapy for 2,220 people over a six-month period. The methadone will be administered through 23 licensed state medical institutions across Ukraine.

Ukrainian AIDS-service and harm reduction organisations see methadone as a new boost to existing buprenorphine based substitution therapy programmes. Currently, 536 people (almost two-thirds of whom are HIV-positive) receive substitution therapy with buprenorphine through Global Fund-supported projects. Methadone - a much cheaper medicine - will allow the scale-up of these existing substitution therapy programmes.

Methadone has been the subject of controversy since the beginning of the Global Fund-supported programme in Ukraine in 2003. Civil society organisations in Ukraine, led by the Alliance, and international donors have been calling on Ukraine's government to support the introduction of methadone-based substitution therapy for drug users. In November 2007, the Global Fund announced it would suspend the programme if the government didn't support the introduction.

In November 2007, after increased pressure on the government from civil society organisations, Ukraine's president Viktor Yuschenko called a special meeting of the cabinet and civil society representatives, including the Alliance, to coordinate efforts to respond to HIV.

"As a synthetic opioid drug used to prevent withdrawal symptoms in patients who are addicted to opiate drugs, methadone is often viewed as an officially distributed narcotic," explained Alliance Ukraine's Pavlo Skala. "However, it is the only effective evidence-based method of HIV prevention in concentrated epidemics among injecting drug users."(врёт сукин сын)

"We have massive HIV prevention and drug-related harm reduction programmes run by national and international NGOs, specially tailored for injecting drug users. However, without specialised medical services, in particularly substitution therapy, our prevention efforts will be incomplete and have little effect," said Alliance Ukraine's Sergiy Filipovych. "Moreover, without the introduction of methadone-based substitution therapy, Alliance Ukraine as principal recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Ukraine wouldn't be able to reach some of the targets set."

By July 2008, the number of patients receiving substitution therapy is expected to rise to 3,000, and by 2009 it will reach 6,000 people - a target set by the Global Fund and agreed by the National Coordination Council to fight HIV/AIDS and Tuberculosis in Ukraine.