human rights watch

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Ukraine, which tops ex-Soviet states in the HIV incidence rate with 1.4 percent of the adult population infected, has a fledgling substitution therapy program. But it recently upset anti-AIDS groups with a proposal to ban methadone.

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Ukraine is home to an estimated 360,000 people living with HIV/AIDS, the vast majority of them infected by injection drug use. An extensive body of research and evaluation has documented the effectiveness of substitution maintenance therapy, in particular with methadone, in reducing illegal drug use as well as criminal activity, overdose deaths, and behaviors such as syringe sharing that are associated with high risks of HIV prevention. In light of this evidence, the World Health Organization (WHO), the United Nations Office of Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued a joint statement in 2004 recommending that substitution maintenance therapy, including with methadone and buprenorphine, be integrated into national HIV/AIDS programs, both as an HIV prevention measure and to support adherence to antiretroviral treatment and medical follow-up for opiate dependent drug users. This recommendation applies particularly to countries such as Ukraine, where opiate dependence plays an important role in HIV transmission risk. The joint U.N. recommendations also emphasized the importance of ensuring access to a range of substitution therapy options, noting that no single treatment method is effective for all opiate-dependent individuals.

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