How Ukraine is tackling Europe’s worst HIV epidemic

In May this year a doctor was detained by police on 42 charges of drug dealing at a clinic in Odessa, southern Ukraine. But the drug was the opioid substitute buprenorphine, and the recipients of Illya Podolyan’s prescribing were opioid dependent patients who were legally registered with the clinic to receive this treatment. The incident is likely to do with overzealous police and an error in the clinic’s licence rather than drug trafficking.1 2

Substitution maintenance therapy is proved to reduce risk of HIV infection in drug users.3 Although about 5550 patients legally receive the treatment in Ukraine, it remains controversial, largely as a result of the influence of narcology, a subspecialty of Soviet psychiatry that considers that drug dependence must be solved through abstinence. In Russia methadone and buprenorphine remain illegal.

Dr Podolyan’s ongoing detention is the latest and most worrying example of undulating friction between law enforcement agencies, patients who use illicit drugs, and the people who provide medical support and the gap between government policy and its implementation. “From the beginning enforcement agencies opposed substitution treatment. They said, ‘You will have drugs on the street . . . the government becomes a drug dealer,’” explained Pavlo Smyrnov, a deputy director at the International HIV/AIDS Alliance in Ukraine.

This non-governmental organisation and the All-Ukrainian Network of People Living with HIV are leading Ukraine’s response to its HIV epidemic. In 2004, the Global Fund for AIDS, Tuberculosis, and Malaria awarded the Ukrainian government a grant …