My name is Eugene. I am a man of 27 years old and I live in Kiev, the capital of Ukraine. I work as an outreach counsellor in a harm reduction project at the Nika Kyiv Foundation. Although I am not personally affected by HIV, I have many friends who are living with the virus. They are injecting drug users (IDUs) or they take substitution therapy. This group faces several challenges. Some of them have critical CD4 levels, but their doctors do not even mention the necessity to start with antiretroviral drugs. When they contact their infectious disease specialists with a request to start treatment, they come up with excuses like ‘You are an injecting drug user, so you are likely to forget to take the medicines in time’*. Another excuse is ‘You have hepatitis, let us fix your liver’. Then they prescribe various products to protect the liver, which are too expensive for them to buy. About 80% of injecting drug users have hepatitis C. According to protocols, they should start HIV treatment immediately, but many do not have access.
In Ukraine, the criminalisation of people who use drugs is another challenge for those who also live with HIV. They know that they can be put behind bars any moment. When a person on antiretroviral therapy is caught by the police while he does not have the necessary pills with him, the treatment might stop, for three days up to several months. Without an opportunity to get the necessary pills or the possibility to contact friends or relatives, they are doomed to have treatment gaps. This is why some decide not to start the required therapy. The doctors know about these cases. And they use them as justification to reject requests for treatment.
They come up with excuses like “You are an injecting drug user, so you are likely to forget the HIV medicines
People who use drugs are more vulnerable to HIV than members of any other community. And once they have the virus, their drug use, its criminalisation, and their sometimes criminal way of life hinder access to HIV treatment. Therefore, the Nika Kyiv Foundation supports people who use drugs and are living with HIV. During needle and syringe exchange work and trainings, we disseminate information on HIV treatment protocols among injecting drug users. And we support them in adhering to HIV treatment. A person who uses drugs first searches for a dose, which is vital to him. And a scheme of three to nine pills, two to three times a day, is hard to follow for him. One pill per day would be ideal, yet, unfortunately such schemes are not accessible. Soon, we will also work with infectious diseases specialists, in order to make HIV treatment more accessible to people who use drugs. We want to change their attitudes and create more tolerance.
* Studies have shown that active drug users are no less compliant with multiple pill taking ARV regimens than anyone else, the idea that they are is based on stigma and mis-information.