Author: Tetiana Palamar

In 2021, the REActors registered multiple cases of violation of the rights of OST program clients. Such violations included interruptions in essential drug supply and illegal detentions of OST program clients by law enforcement authorities. In January – November 2021, 379 OST program clients reported violations to the REAct system. 

On the International Solidarity Day commemorated on December 20, Ivan Viktorov, REAct coordinator in Kyiv oblast, tells about the difference in receiving OST in public and private OST sites, possible causes of interruptions in drug supply, their consequences for the clients of private OST sites, and about the role of non-governmental organizations in protecting the right of key populations to receiving vital treatment. 

1. Receiving OST in public OST sites under OST program and in private facilities, for example, through pharmacies – what is the difference, advantages and risks for the clients? 

The difference is that the client receiving OST medication with a prescription in a pharmacy does not need to adhere to the schedule of issuing OST drugs, while the state program has certain requirements for the patient. According to the routine OST administration order, the client must visit the OST site at a scheduled time on scheduled days to pick up medications. Another possible mechanism is issuing OST drugs for self-administration for a 7–10-day period. But there are certain eligibility criteria, too: the client must be registered with a state OST program with a conventional OST drug administration schedule for no less than 3 months (in context of the quarantine; earlier this term was 6 months – editor’s comment). This requires the client’s physical presence at the OST site, limiting their free time. For example, for employed clients, this requires them to be absent from work, and the employer may find this an issue. Therefore, people buy prescriptions and pay for medications to live without certain obligations.

2. How many clients are enrolled with state OST program and how many receive medications in private OST sites? What is the statistics in Kyiv? 

The statistics on public OST sites is available from Ukraine’s Center of Public Health website (as of 01.11.2021, 16 617 persons receive OST services in health facilities – editor’s comment); as for the private sites, I can only estimate: there are about 70 OST sites in Kyiv, each serving about 400 clients. So, the total number of private OST clients is about 20 000. One patient can be registered with several private OST sites. This increases the risk that these drugs are then privately sold. The private OST sites have no shared database to trace the clients already registered with the program. A patient comes to the site, pays, and gets the prescription.

3. Which barriers do the clients face in receiving OST drugs from private sites?

Methadone is not always available in pharmacies, so the private OST sites cannot guarantee uninterrupted OST drug supply to the client. Pharmacies can also stir artificial price increase, meaning that later they will be able to sell more at higher prices. There were cases of closure of the OST sites and seizure of all documentation, including the patient’s personal data. Sometimes police officers sweep private OST sites, which does not usually harm the site, but for the patients, it is a risk of disclosure of diagnosis, personal data because often law enforcement officers seize medical documentation (logs, patient files).

4. You mentioned instability of receiving OST drugs in private sites. What are the possible reasons for such situations? 

First of all, this could be done to transfer more patients to the governmental OST program. But there are several issues: for enrollment with the governmental OST program, the client must be registered in the internal OST client registration system, and this can prevent getting “a normal job”. Besides, the state program sets a number of requirements for the OST clients that I have already mentioned, and they may not be suitable for everyone. Some may be depressed because this may look like the so-called “drug addict” stigma. Interruptions in drug supply occur, as a rule, at the end of the year. There can be several reasons for it: the substances for OST drug manufacturing are procured at the end of the year due to the allocations; the untimely receipt of funds from regional communal enterprises “Pharmacia”; manufacturing of large quantities of drugs for the state order, including for exporting.

5. Is there a mechanism to prevent such situations with treatment interruption due to delays in drug supplies to private OST sites?

No. The private sites cannot guarantee uninterrupted OST supply because no one traces such clients – they issue a prescription, take the money for the prescription, and that’s all. Only public OST sites guarantee their clients’ uninterrupted OST drugs administration, therefore there is no risk of treatment interruption and clients returning to illegal street drugs.

6. What are the consequences faced by the OST clients if their drugs are unavailable in the private sites or their supply is delayed? 

If the drugs are unavailable in the pharmacy, people will go to the so-called “corner boys” (drug dealers – editor’s comment), but their price will be several times higher. If the addicted person has no money, he/she may commit a crime for the need of medications or go out to the street to get drugs, and this means overdose in 90% of cases. Unfortunately, a person can die in absence of timely care.

7. If an OST client wants to shift to the state OST program, how soon can the client be enrolled? 

The government today is actively enrolling in the OST program; therefore, the client always has a choice of guaranteed provision of OST drugs. It takes a day to become an OST program client – you just need to bring your chest X-ray results. However, this may take longer, because much depends on the client’s will, how soon he/she agrees to enroll with the state program and the client’s commitment. Secondly, there is a certain procedure set forth in the regulations, according to which the patient must undergo the induction procedure (dose adjustment – editor’s comment). After that, the narcologist explains to the patient the need for the administration of such drugs and the motivation for uninterrupted intake, and then the client is administered OST. 

8. What is the role of non-governmental organizations in supporting OST patients?

To begin with, there are no social workers in the private OST sites, and their presence is not envisaged. The role of NGOs is in counseling clients on transfer to the governmental program, referral and follow-up of such clients, working on treatment adherence. I believe this is a meaningful contribution. There is an OST Hotline operating in Ukraine where clients from all regions can call to report issues related to substitution maintenance therapy. In the beginning, such issues are quickly addressed by NGOs, then we approach public institutions in power to respond. NGOs take efforts in community mobilization and empowerment, initiate amendments to laws and regulations, but unsolved problems remain. For example, we keep writing about issues in the community, but we are unsure if our voice is heard in some public institutions. 

9. What are the mechanisms of state control of receiving double quantities of OST drugs (from private OST sites and the governmental program)?

It is rather the responsibility of OST clients who get medications from private OST sites while being registered on the state program. However, if police find out this fact, such actions may qualify as the unlawful acquisition of drugs and their storage. This may have negative consequences for the client (there have been cases). In general, there are no mechanisms to trade duplications of OST receipt.

10. In general, what are the cases of police violating the rights of OST clients? How are these cases resolved and in whose favor?

About half of all cases of abuses by police officers registered by REAct system in Kyiv oblast, involve OST clients. Police officers often abuse their official powers regarding OST patients, because they still consider them “drug addicts”. Most common violations include illegal detention, police searches, narcological examinations (sometimes forced), seizure of OST drugs, solicitation of money for alleged non-initiation of criminal proceedings. This is despite the fact that the patients did not breach the law, they had absolutely legal prescription for OST drugs. Partner NGOs immediately respond to such cases which more often are resolved in favor of the patient. Our friendly organizations have highly qualified professionals on staff who have been working with key populations for years and know how to act in different situations. To raise awareness of police authorities in working with key populations, training modules are conducted with the support of the International Charitable Fund “Public Health Alliance” and other partner organizations. The training participants are presented data about violations of rights of key populations collected through REAct. 

Acknowledgments to:

Ivan Viktorov, REAct Project Coordinator in Kyiv Oblast 

Svitlana Tkalia, President, Charity Fund “Hope and Trust”, a REActor

In Eastern Europe and Central Asia, one in three reported violations involve police and law enforcement agencies. Representatives of these structures violate the rights to life, liberty, and security of the person.

On the eve of the International Human Rights Day, Andriy Klepikov, Executive Director of the ICF “Alliance for Public Health”, spoke about how to combat human rights violations against vulnerable groups and explained whether Ukraine has really managed to overcome the HIV / AIDS epidemic.

According to data collected by REAct, as of December 1, 2021, more than 1,700 vulnerable groups in Ukraine have faced human rights violations. Of them:

• 379 people – SMT patients,
• 322 – persons who inject drugs,
• 540 – people living with HIV,
• 167 – men having sex with men,
• 101 – sex-workers,
• 148 – people with tuberculosis,
• 59 – prisoners,
• 23 – trans*people.

For example, the rights of drug users are most often violated by government officials: in the health care system – 144 recorded cases, among the police – 94.

In terms of general statistics for the EECA region, the REAct system recorded more than 6,000 cases of rights violations among key communities. The focus of the study has traditionally been on rights violations in the context of access to health services.

“The biggest violators of human rights are representatives of the state system. This includes the medical sphere, the police and law enforcement agencies. In particular, we recorded refusals to provide medical services, and there were cases when the police confiscated drugs – both antiretroviral treatment for people with HIV status and substitution maintenance therapy drugs for drug addicts. We intervened, and then measures were taken – everything was returned. And violators were disciplined for their actions. However, this topic is not discussed globally in Ukraine. “

According to UNAIDS, by the end of 2030, 7,700,000 people living with HIV could die worldwide. First of all, because of the barriers associated with human rights violations. To a greater extent, this concerns the lack of access to drugs or medical services, the inability to obtain medical advice, discrimination, denial of treatment, etc. Doctors often disclose the patient’s diagnosis to outsiders and misbehave with trans*people.

With regard to tackling the HIV / AIDS epidemic in Ukraine, the situation has improved in recent years.

“If five years ago every second HIV-positive person in Ukraine knew about his status, now it is two thirds. Thus, it is better than it was, but still far from ideal. In Ukraine, the programs and coverage of testing and treatment with antiretroviral therapy have expanded, which has reduced mortality. And this is another very important result. But life brings its own unpredictable moments, such as the COVID-19 pandemic. After all, the pandemic around the world has reduced the level of HIV testing and the number of people being treated. And here Ukraine is no exception. “

According to the results of 2021, 70% of all HIV-positive people in Ukraine who learned about the status of this year did it with the help of the projects of the ICF “Alliance for Public Health”. In fact, every three out of four people. In this way, the Alliance not only tests everyone in a row, but also tries to identify the riskiest cases.

Read more information on the “Novoe Vremya” website in the full version of the interview with Andriy Klepikov by the link.

The international community recognized the need of broad application of the human rights-based approaches and their integration in HIV programs in order to address the HIV/AIDS epidemy. 

The REAct project operates in Ukraine with the objective to identify the existing right-based barriers for key populations to obtaining HIV and TB services.

To commemorate the International Day of Human Rights, we present you with brief information about REAct project results in January – November 2021. 

Overall, 1796 cases of human rights violations were reported by 1731 clients, 87% of cases were resolved. 

Most often violation of rights, stigma, and discrimination are directed at men (1015 cases). People living with HIV (540 cases) and OST clients (37 cases) are traditionally among the key risk groups.

Most commonly, human rights are violated in Dnipropetrovsk (478 cases); Cherkasy (179 cases); Odesa (171 cases), Kherson (106 cases), and Lviv (95 cases) oblasts.

The main abuser is traditionally the state (74%); most commonly, the key group representatives faced refusal to provide care or services (50%) and emotional violence (30%) mainly related to the refusal in providing outpatient and inpatient medical care not related to HIV and TB (17%), and verbal abuse (57%). 

More information about the results of our work is available in the analytical report posted on the project website.

On December 10, the world celebrates Human Rights Day, as exactly on this day in 1948 a milestone document was signed – the Universal Declaration of Human Rights. But, after 73 years, are the rights and freedoms proclaimed in the Declaration guaranteed in practice? We analyze it in the material below.

The ICF “Alliance for Public Health” has launched a regional information campaign “Declaration or Decoration of Human Rights?” to draw public attention to the glaring number and variety of human rights violations in the region of Eastern Europe and Central Asia, especially concerning the most marginalized groups of society vulnerable to HIV and tuberculosis.

The COVID-19 pandemic has worsened the human rights situation in the region: during 2020-2021 the REAct system registered more than 6,000 cases of violation of rights, stigma, and discrimination in 7 countries.

“The evidence collected reveals the legal barriers, harassment, and criminalization of HIV-vulnerable populations. This makes it difficult or impossible for them to access health services, prevention and treatment of HIV, tuberculosis and other diseases. ” – states Andrey Klepikov, executive director of the ICF “Alliance for Public Health”.

“Declaration or Decoration of Human Rights?” information campaign, based on evidence collected through REAct and the 30 articles of the Universal Declaration of Human Rights, illustrates that the rights of vulnerable groups continue to be violated ubiquitous in practice.

Campaign offline presentation in Istanbul within Health Sustainability Forum

“According to REAct data, the main violators of rights in the EECA region are representatives of state institutions – medical professionals, police, courts. Since it was the states that proclaimed their commitment to respect, protection, and promotion of human rights and freedoms by signing the Declaration. It is the states, through their state institutions and state structures, that must protect and guarantee human rights, and not vice versa – violate them. “ – Andrey Klepikov declares.

The most common offenses are discrimination, misconduct, law enforcement violence, denial of access to health services, disclosure of health information and stigma from health care workers, physical violence against women by sexual partners and relatives, as well as by police officers.

“Analyzing the cases in REAct, we saw that there is no area of ​​life in which representatives of communities would not face stigma, discrimination, or infringement of their rights. Not only are human rights violated all the time, but it is also widespread. The info campaign just illustrates this. It was not difficult for us to find examples of violations from real-life under each of the thirty articles of the Declaration. And under the “hottest” articles like the right to freedom from cruel and inhuman treatment and torture, the right to freedom from arbitrary detention, we had to tearfully choose the loudest cases among hundreds of others … “- Coordinator of the REACT system in Eastern Europe and Central Asia and author of the campaign idea, Victoria Kalynyuk shares her impressions.

The Third Conference on Drug Policy and Implementation of Public Drug Policy Strategy until 2030 was held on November 24-25. 

The main conference objectives were a further development and implementation of the Action Plan through the use of the best international practices and most effective approach for its implementation.

The conference facilitated dialogue and experience sharing between the research and professional community, law-enforcement, and political circles of Belarus, Moldova, Ukraine, and other countries of Eastern Europe and Central Asia. Representatives of national and non-governmental organizations discussed modern evidence-based approaches to behavioral health, prevention of drug consumption and HIV/viral hepatitis C, treatment, care, and rehabilitation of drug users.

In one of the sessions Oksana Pashchuk, senior manager of REAct project, presented the analysis of cases of violation of rights of people who inject drugs (PWID) in Ukraine. The speaker noted that as of today, 314 reports from IDU were registered in the REAct monitoring and response system, 72% were fully resolved. 

Based on the obtained data, in 87% of cases PWID did not seek the protection of their rights in proper institutions, mainly due to lack of awareness and knowledge on how to seek protection (25%), and due to lack of confidence in the positive outcome (19%). However, if the clients did seek protection from the relevant authorities, in most cases their requests were ignored. 

Violation of rights most often was on the part of the state (77%), in particular, healthcare workers (144 cases). The most common offenses were verbal insults (79 cases), refusal to provide healthcare (50 cases), and extortion (22 cases). 

The speaker also presented recommendations about amending the current legislature in order to improve the situation in the country. For a long while, offenses by police and rehabilitation centers’ staff against PWID are reported and registered in the REAct system. Based on this, Oksana proposed to review and modify the threshold quantities of drugs defined in the tables endorsed in Order of the Ministry of Health # 188 as of 01.08.2000 “On endorsing the tables of small, large and especially large quantities of drugs, psychotropic substances, and precursors in illicit drug trafficking”, as unreasonable small quantities of drugs are used as the cause of prosecution of PWID by police.

As for the operation of rehabilitation centers, Ukraine lacks legislature regulating the provision of their services to people addicted to drugs. This results in violations of the rights of PWID and the absence of control over the operation of such centers. The work of the rehabilitation centers involves healthcare interventions, therefore must be subject to regulation by the Ministry of Health of Ukraine as the authorized public institution. 

Oksana highlighted that engagement of the Ministry of Health into this issue is necessary, with further development of the sectoral regulatory framework, based on best international practices and consultations with the civil society.

A webinar on the implementation of measures to reduce the stigma and discrimination of people affected by TB was held on November 23 by “Stop TB. Ukraine” Partnership. 

During the event, the representatives of non-governmental and national organizations discussed matters related to effective methods and successful experiences of overcoming the stigma and discrimination of people affected by TB. 

In one of the sessions Nadiia Semchuk, senior specialist of REAct project, presented the work of the REAct system. The speaker noted that as of today, 1694 reports of violations of rights of people vulnerable to HIV and TB, were registered in the REAct monitoring and response system, 77% were fully resolved. Thanks to the work of 69 organizations, the system operates in 18 regions of Ukraine. 

As for the violations of the rights of people affected by TB, 130 reports were received in 2021, 54% of which related to stigma and discrimination. According to the collected data, the majority of cases faced by people affected by TB included refusal to treat TB (38), verbal insults (20), and refusal to provide social services (16). The most common violations were on the part of the public institutions (89%). 

Oksana Tropina, a REActor, a SCO “Ukraine without tortures” member, presented two cases of successful response to address the violations of rights of key populations in Kherson oblast. The speaker noted that the system is actively used considering the large TB incidence in the region. Oksana said that there are quite many TB   patients in Penitentiary Facility # 7 in Kherson Oblast. After their release, they often face the realia they are not ready for. Often, they do not classify problems they encounter in obtaining services, as stigma and discrimination, therefore such cases demand special attention. 

The first case told by the REActor was about a man with TB who wanted to re-establish communication with his children upon release from the colony. The mother of the children reacted negatively, so he contacted the Service on child matters. The officials did not want to talk to him and closed the door in front of him after they heard about his disease. After that, the man contacted the REActor, who offered psychological support and conducted initial legal counseling. According to the man, reestablishing contact with children was the most important thing for him, so, together with Oksana, they approached the Service again for proper assistance. This time they negotiated a meeting with the former wife of the client. They talked, and she agreed to allow communication of the children with their father, upon condition that personal protection means are worn, and the man continues his treatment.

The other story was about a woman who was seeking care from the policlinic for she was not feeling well. Based on the results of the examination, she was diagnosed with TB. When her employer learned about her diagnosis, he started to pressure her and then told her to resign. At one moment the woman remained unemployed, without any means for living and treatment. She contacted the REActor for psychological and legal support. Together they decided to file a request to the Main Office of the State Labor Service, where the woman was provided clear explanations and instructions. The situation was positively resolved, and the woman continues working. 

During the Third session of the Eastern European and Central Asian Forum of Judges on HIV, Human Rights and Legislation, organized by the UNDP regional team, on November 11, representatives of government agencies and international non-governmental organizations discussed the problems of access to justice in the EECA region for people who use drugs, sex workers, LGBTQ and people living with HIV, including during the COVID-19 pandemic.

Analysis of the situation shows that the key types of violation of rights are the following:

• Discrimination in health care facilities and barriers to accessing services;
• Lack of social support and problems with housing, work;
• Arbitrary detention, police violence;
• Abuse of power by child protection services, deprivation of parental rights;
• Failure of the state to protect against gender-based violence (access to shelters, prosecution of perpetrators).

Ganna Dovbakh, Executive Director of the Eurasian Harm Reduction Association (EHRA), presented data on violations of the rights of PLHIV and representatives of vulnerable groups, collected in 7 countries of the region using the REAct monitoring system. The data was accumulated in Moldova, Ukraine, Georgia, Russia, Uzbekistan, Tajikistan and Kyrgyzstan.

In less than 2 years, para-lawyers collected 7056 appeals from key vulnerable groups. Most of the violations were related to the refusal to provide medical services. This type of incident was recorded in 1708 hits. Among other common violations, the speaker also noted intimidation, threats, violence, blackmail and coercion by the police to confess guilt. Such cases should be viewed as common practice and not as rare exceptions.

Moreover, Ganna noted that people are often not ready to talk about violation of their rights, because they are afraid that this will further worsen their situation. The speaker drew attention to frightening statistics compiled by the REAct, about a rather low percentage (less than 10% on average) of acquittals by judges in EECA countries, especially if the case is filed by the police. Therefore, illegal actions, torture, blackmail on the part of law enforcement agencies in relation to representatives of key communities have such a negative impact on people’s readiness to defend their rights.

As part of her presentation, Ganna also presented results on the most common legal barriers and human rights violations that beneficiaries experience when accessing public health services, which were collected under the regional project “Tiberius: Overcoming Legal Barriers for Key Populations – Towards 90 -90-90”, implemented by the EHRA. Namely:

• Lack of registration and documents, which leads to a lack of insurance and the need to pay for COVID-19 PCR before receiving inpatient treatment;
• Stigma and discrimination by healthcare professionals and government authorities;
• Refusal to provide social assistance by social welfare authorities;
• Disclosure of personal data and HIV status by healthcare professionals and service providers;
• Violence in family;
• Workplace discrimination.