Universal access to ART – Policy vs Practice

Universal access to ART – Policy vs Practice

Zahedul IslamZahedul IslamICF “International HIV/AIDS Alliance in Ukraine”ICF “International HIV/AIDS Alliance in Ukraine”

Regional Workshop on

Drug Use and HIV in

Eastern Europe and

Central Asia

PEPFAR, Kyiv 11-15 July 2011

Access to ART in UkraineAccess to ART in Ukraine

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Total # of registered HIV cases 182028

Patients receiving ART 22 016

- Out of them 1 732 patients are active IDUs (less than 1% of total HIV cases)

As of June 30, 2011 there are 6287 MAT patients Out of them:

-2826 patients are HIV +

- 862 patients receive ART

14219 1763221770

2669333016

42754

56801

76107

94583

3056 4777 7657 1062915871

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0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

2005 2006 2007 2008 2009 2010 2011 2012 2013

number of those who need ART

number of those who receive ART

Data on the number of HIV positive patients on ART treatment and those who need ART (absolute figures and % of coverage by treatment)*.

**Data of Ukrainian AIDS CenterData of Ukrainian AIDS CenterIn 2010 ART was needed forIn 2010 ART was needed for: : under UNAIDS, WHO estimationsunder UNAIDS, WHO estimations - - 9200092000, , 99000 – 160 000 (99000 – 160 000 (CD4 200 and 350CD4 200 and 350 correspondinglycorrespondingly))

HIV Laws in Ukraine HIV Laws in Ukraine

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• First HIV law was approved in 1991 by VR

• New version of law was passed in March 1998

• Above law was later amended in 2001

• The last of the HIV law came in to force January 2011

Law guaranteesLaw guarantees

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• PLWHA with HAART (ART) and other medications for treating opportunistic infections (p.15)

• The state ensures NGOs’ participation in providing charities, medical and social services targeted at treating HIV infection, care, support and social protection ( p.18 p.4)

•The new HIV Law guarantees implementation of harm reduction programs (including MAT and syringe exchange)

In accordance with the Law, all the other guarantees and services are to be enjoyed equally by all target groups including IDUs.

Breakdown of PLWHA estimate by group

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Injecting Drug Users 34%

Inmates2%

CSW7%

CSW Clients & Partners

9%

MSM9%

MSM fem. Partners3%

Other16%

IDU Partners20%

Workbook estimates 2008 (MoH, UNAIDS, WHO)

Commitment for access to key services per Commitment for access to key services per national program national program 2009-2013 2009-2013

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• To provide not less than 80% of PLWHA (who need ART) with ART (before 2013);

• 20 000 patients with MAT by 2013

•100% access of HIV positive children to ART (from 2009);

• 100% laboratory support of patients using ART (from 2009);

• 60% of the MARPs has access to HR services

Emerging risk for access to services for PWID Emerging risk for access to services for PWID

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• Resolution #634 (as of 29.06.10) issued by the Ministry of Health of Ukraine Brought into force amendments that significantly reduce the legal threshold for “small,” “large” and “extra large” quantities of certain types of illegal drugs, including those most commonly used by IDUs in Ukraine.

PWID access to services PWID access to services Resolution #634 Resolution #634 (violation of human rights(violation of human rights))

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 -The Resolution endangers needle and syringe exchange programs

-Higher rates of incarceration for IDUs will lead to further overcrowding in Ukraine’s already strained prison system, and will lead to higher prevalence of HIV, hepatitis and tuberculosis (TB) among prisoners.

-More stringent criminal liability will make IDUs even harder for health and social services to reach.

-The mandate to investigate, prosecute, and imprison a significantly larger number of IDUs will reduce the criminal justice system’s ability to deal with more serious offenses, and will increase government spending at the expense of health care.

-The authority to impose severe criminal penalties for possession of very small quantities of illegal drugs creates a substantial opportunity for corruption among law-enforcement officers and judicial bodies.

•The resolution violates the rights of IDUs and breaches the European Convention for the protection of Human Rights and Fundamental Freedoms

Challenges to accessing ART by PWIDChallenges to accessing ART by PWID

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• Lack of ART medications for PLWHA due to delays in procurements and regional deliveries;

• Lack of diagnostics for prescribing ART in some regions and prisons;

• Registration of legal address is mandatory for accessing ART (marginalized)

•The problems of state financing and state purchasing;

• Discrimination against PWID

• Human rights violation specially for people who use drugs

ConclusionConclusion

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• Multiple legal documents indicate certain rights for PWID and guarantees services for prevention, treatment and care, specially in the new law approved in January 2011.

• Existing policy (national program 2009 - 2013) has not been implemented to its fullest

• Current changes in the policy towards scaling up MAT in Ukraine contradicts recently approved HIV law where access to MAT is guaranteed.

• Lack of state funding to implement national program

• Need top level political commitment to realize policy in to practice

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Thank you!