Posted by: Mark Breda, U. S. Agency for International Development (USAID/Ukraine)
It is New Year’s Eve at a prison in Ukraine and men stand around in a large cell, sharing a single blunt, filthy syringe as they mutilate their arms to inject drugs. “The scene is typical of Ukrainian prisons,” explained an ex-inmate who wished to remain unnamed.
In Ukraine, prison inmates often participate in risky behaviors that contribute to the spread of HIV. Some prisoners use old syringes over and over. Others manufacture their own injecting tools using pens and plastic tubes. Still others tattoo their bodies using non-sterile instruments or have unprotected sex with fellow inmates or visitors.
A recent USG funded survey of 1,300 prison inmates shows that HIV prevalence among inmates is more than 13 percent (10 percent among men and 33 percent among women), 20 times higher than in the general population. Forty-four percent of those surveyed reported injecting drugs during their lives and 17 percent admitted using drugs while in prison.
The state penitentiary service in Ukraine has been slow to implement Ukraine’s National AIDS policies. Only 60 of Ukraine’s 183 prisons receive HIV/AIDS treatment supplies. Poor prison conditions and abusive practices by prison staff increase inmate vulnerability to infection and sometimes obstruct treatment for HIV positive prisoners. Harm reduction services such as syringe exchanges, opiate substitution therapy, and even HIV testing are either not available or offered inconsistently.
After leaving prison, injecting drug users face challenges that may lead them to transmit HIV; many have no home, no job, and poor knowledge of HIV and sexually transmitted infections (STIs).
USG is partnering with the government of Ukraine and other international donors to address these tough issues with a two-pronged approach, and things are slowing beginning to change.
First, USG’s Project Start is collaborating with Ukraine’s Ministry of Justice to implement a HIV/STI/Hepatitis C risk-reduction program for inmates who are soon to be released. It begins two months before they leave prison and continues for three months after their release. The program includes seven one-on-one sessions with each client, providing a range of counseling and prevention strategies tailored to each individual.
Second, USG’s PLEDGE Project, implemented in partnership with the United Nations Office on Drugs and Crime, is promoting systemic change in Ukraine’s penitentiaries by advocating new harm-reduction policies through Ukraine’s legislature and directly with prison authorities.
Through USG efforts on the legislative side, a Joint Order for the treatment of detained persons was recently created with Ukraine’s Ministries of Health, Interior, and Justice. Also with USG support, Ukraine developed and approved a comprehensive National Anti-Drug Strategy. The strategy demonstrates a shift from previously repressive measures to a more human-rights-based approach for people who inject drugs, promoting increased coverage and accessibility for syringe exchanges, opiate substitution therapy and integrated services to address HIV/TB, Hepatitis C, and other related diseases.
Finally, USG, in collaboration with the United Nations Development Program and UNAIDS, has developed comprehensive HIV services for pilot prisons, including education about drug use for prisoners and prison staff.
This past July Serhiy Zinchenko, head of the Ukraine State Penitentiary Service Personnel Department, expressed the government’s new found support for a comprehensive approach to HIV/AIDS when he stated “We now understand the need to improve the situation in this sphere. It is important to learn international standards for treatment of prisoners, in particular related to their right to health care.”