Universal access to art policy in place 5 july11


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USAID conference in Kyiv, July 2011

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Universal access to art policy in place 5 july11

  1. 1. Regional Workshop on Drug Use and HIV in Eastern Europe and Central Asia PEPFAR, Kyiv 11-15 July 2011Universal access to ART – Policy vs Practice Zahedul Islam ICF “International HIV/AIDS Alliance in Ukraine”
  2. 2. Access to ART in UkraineTotal # of registered HIV cases 182028Patients 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 patientsOut of them:-2826 patients are HIV +- 862 patients receive ART www.aidsalliance.org.ua
  3. 3. Data on the number of HIV positive patients on ART treatment and those who need ART (absolute figures and % of coverage by treatment)*.100000 9458390000 number of those who need ART80000 number of those who receive ART 761077000060000 2011 46% 5680150000 2010 51%40000 42754 2009 48% 33016 2008 40%30000 26693 25897 2007 35%20000 21770 22016 17632 15871 2006 27% 1421910000 10629 2005 21% 7657 3056 4777 0 0% 20% 40% 60% 2005 2006 2007 2008 2009 2010 2011 2012 2013 *Data of Ukrainian AIDS Center In 2010 ART was needed for: under UNAIDS, WHO estimations - 92000, 99000 – 160 000 (CD4 200 and 350 correspondingly)
  4. 4. HIV Laws in Ukraine• 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 January2011 www.aidsalliance.org.ua
  5. 5. Law guarantees• PLWHA with HAART (ART) and other medications for treatingopportunistic infections (p.15)• The state ensures NGOs’ participation in providing charities, medicaland social services targeted at treating HIV infection, care, support andsocial protection ( p.18 p.4)•The new HIV Law guarantees implementation of harm reductionprograms (including MAT and syringe exchange)In accordance with the Law, all the other guarantees and services are tobe enjoyed equally by all target groups including IDUs. www.aidsalliance.org.ua
  6. 6. Breakdown of PLWHA estimate by group Other 16% MSM fem. Partners 3%Injecting Drug MSM Users 34% 9% CSW Clients & Partners 9% CSW IDU Partners 7% 20% Inmates 2% Workbook estimates 2008 (MoH, UNAIDS, WHO)www.aidsalliance.org.ua
  7. 7. Commitment for access to key services per national program 2009-2013• To provide not less than 80% of PLWHA (who needART) with ART (before 2013);• 20 000 patients with MAT by 2013•100% access of HIV positive children to ART (from2009);• 100% laboratory support of patients using ART (from2009);• 60% of the MARPs has access to HR services www.aidsalliance.org.ua
  8. 8. Emerging risk for access to services for PWID• Resolution #634 (as of 29.06.10) issued by the Ministry of Healthof UkraineBrought into force amendments that significantly reduce the legalthreshold for “small,” “large” and “extra large” quantities of certaintypes of illegal drugs, including those most commonly used by IDUsin Ukraine. www.aidsalliance.org.ua
  9. 9. PWID access to services Resolution #634 (violation of human rights)-The Resolution endangers needle and syringe exchange programs-Higher rates of incarceration for IDUs will lead to further overcrowding inUkraine’s already strained prison system, and will lead to higher prevalence ofHIV, hepatitis and tuberculosis (TB) among prisoners.-More stringent criminal liability will make IDUs even harder for health and socialservices to reach.-The mandate to investigate, prosecute, and imprison a significantly largernumber of IDUs will reduce the criminal justice system’s ability to deal with moreserious offenses, and will increase government spending at the expense of healthcare.-The authority to impose severe criminal penalties for possession of very smallquantities of illegal drugs creates a substantial opportunity for corruption amonglaw-enforcement officers and judicial bodies.•The resolution violates the rights of IDUs and breaches the EuropeanConvention for the protection of Human Rights and Fundamental Freedoms www.aidsalliance.org.ua
  10. 10. Challenges to accessing ART by PWID• Lack of ART medications for PLWHA due to delays inprocurements and regional deliveries;• Lack of diagnostics for prescribing ART in some regions andprisons;• 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 www.aidsalliance.org.ua
  11. 11. Conclusion• Multiple legal documents indicate certain rights for PWID andguarantees services for prevention, treatment and care, speciallyin the new law approved in January 2011.• Existing policy (national program 2009 - 2013) has not beenimplemented to its fullest• Current changes in the policy towards scaling up MAT inUkraine contradicts recently approved HIV law where access toMAT is guaranteed.• Lack of state funding to implement national program• Need top level political commitment to realize policy in topractice www.aidsalliance.org.ua
  12. 12. Thank you!www.aidsalliance.org.ua