Successful Experience of the City Rada People s Deputy to Cooperate with NGO in Realizing Principles for IDUs Harm Reduction

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1 Successful Experience of the City Rada People s Deputy to Cooperate with NGO in Realizing Principles for IDUs Harm Reduction Tetyana A. Loginova, Sociotherapy Kyiv City Narcological Hospital Volodymir D. Bondarenko, MP to the Verkhovna Rada of Ukraine Irina V.Bazeliuk, Drop in Center Charitable foundation

2 Introductory note. The epidemic of HIV-infection started in Ukraine in year Most likely, the main source of transmittance into the society were Injection Drug Users (IDUs). After that dramatic increase of the infected people was registered. In 1994 were registered 183 cases of HIV infection, in ,000 cases. Prophylactic methods in post-soviet Union countries appeared to be ineffective in first years of HIV epidemic.

3 Introductory note. These pilot projects were supported by international organizations such as UNAIDS, UNICEF, and later on International AIDS Alliance. Change of the political situation in Ukraine helped to start using new approaches in prophylactic work such as Harm Reduction (HR).

4 History MOH of Ukraine orders about starting and scaling up of Substitution Therapy (ST). The Order Nr 161 ( buprenorphine) and Order Nr 846 ( methadone).

5 Registration of the substitution preparations. Drug Year Form, Company Buprenorpnine 1997 solution in ampoules, Ukraine, The Health to People Buprenorphine EDNOK 2001 in pills, Russan Pharma LTD (India) Methadone hydrochloride 2003 solution for per os using The Netherlands (BUFA) Methadone/Methadole 2006 in pills and solution for per os using Pharmascience Canada Methadone/Methadict 2007 Salulas Pharma GmbH/Hexal AG, Germany

6 Achievements ST is included in the Low of Ukraine. It establish the State Programme imp Act of AIDS for (02/19/2009 ). Buprenorphine and methadone are included in the National register of the based officinal preparations, approval by issued Resolution of the Cabinet of the Ministries of Ukraine Nr 333 from 03/25/09.

7 The quantity of the patients on ST in the Ukraine. Start (1/09) (expected)

8 Succession of the implementation of ST Pilot project Analysis of effectiveness Expansion of the Pilot project Methadone Expansion to all districts of Ukraine Governmental funds

9 What worked Consolidation and support of National and International organizations, first of all Global Fund; Citation of leading experience of ST in the world (one million in 65 countries and more than 500,000 in Europe) Focus of advocative efforts on politicians in the country (President, Premier Minister, Vice-Premier Minister, State Secretary of the Ministry of Health) Implication of non-governmental organizations, patients and parents into advocation

10 What worked Informational and educational work with medical personnel, official establishment, law-enforcement authorities and NGOs Active elucidation of ST problems by mass media Cost effectiveness ( average dose of methadone is cheaper in 4,5 times than buprenorphine)

11 I would like to cite our current Minister of education, Mr. Tabachnik. He said: Methadone is not a panacea. But there is nothing better for Ukraine today. This convinced the Government to make a decision on ST implication.

12 Examlpe 1. In 2003 a physician of Sociotherapy Kyiv City Narcological Hospital (medical director A. Vievsky), an injection drug user (IDU) and a lawyer initiated creation of the NGO for IDUs in Svyatoshyn district of Kyiv city. The action group drafted the NGO Statute and developed operational principles and objectives, including the major one to realize harm reduction in Kyiv city, and particularly, substitution therapy.

13 Support to NGO registration The MP and his assistants operated promptly our NGO was very soon registered in the district and received the legal status. The NGO got good backing from the MP in drafting the first projects. The letters of support were of critical importance in getting grants by our NGO. One of the conditions for the project activity was getting premise for the project team. In this case the MP s assistance was of great use. The municipal utility office allocated the premise to work with IDUsprobationers and to hold regular trainings for clients.

14 Example 2 On the basis of Narcological Hospital Sociotherapy in 1998 was founded first Cabinet of Trust for drug addicts. Voluntary Counselling and Testing (VCT) - service on HIV/AIDS consultations was available there. Pre- and post-testing consultations, testing (with following prescriptions for the patients to the city AIDS centre, when case positive HIV-result was found). Availability of VCT is the key to the universal excess of the IDUs to ST and ARV-treatment. ST is the tool for adherence HIV positive patients (IDUs) to ARV treatment

15 Educational work with nurses 1. We trained medical personnel of the hospital on the HIV/AIDS consulting. As a result much nicer and friendlier attitude to patients was noticed. 2. All social workers and psychologists were trained by International AIDS Alliance (free willing consulting and testing on HIV). 3. As a result of obtained knowledge in hospital educational modules on the prophylactic on HIV, tuberculosis and family planning for healthier way of life for patients were worked out.

16 Educational work with patients Patients are being trained on listed above topics; and by the transfer into rehabilitation department individual sessions by using motivational interview methods. Patients themselves are taking part in focus-groups, were actual questions IDU s problems are being discussed (which is then used as a material for informational brochures). These are highly important topics, such as Overdoses prophylactic, Women question (contraception methods for IDUs women), Substitution Therapy, How to live with AIDS? and many others.

17 Result Highly effective appeared to be the practice of involving IDUs, who is being in remission state or clients of Substitution Supporting Therapy (ST). The work of this category of people is based on principle peer education and useful knowledge, which can help to change unsafe behaviour to the safer one, works highly effective. For example: helping patient to switch from intravenous drug use to oral use Buprenophine and Methadole ST, advantage of HIV-testing with RT, informing them about all the services involved into the sphere of HIV-service.

18 Result We have a strong NGO substantially contributing to HIV/AIDS prophylactics and drug abuse prevention among young people. The NGO publishes The Butterfly newspaper and various preventive booklets. We take part in such events as the Health Day, the AIDS Day, the Day against Drug Abuse and the Memorial Day of the people who died of AIDS, etc. Thus, we think that our operation experience will be useful for the former Soviet republics where the similar work is not adequate.

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