Pangaea Partners with Clinton Foundation HIV/AIDS Initiative in Ukraine
Innovative Program to Bring HIV+ Injection Drug Users into Care
November 1, 2007 - Two years ago, the Clinton Foundation announced a new HIV/AIDS partnership with the government of Ukraine, as former President Clinton and President Yushchenko agreed that the Clinton Foundation would assist the government of Ukraine in scaling up their national HIV/AIDS treatment program. Pangaea Global AIDS Foundation, led by Eric Goosby, M.D., is serving as treatment partner for this initiative. Pangaea has been playing a similar role in China since May 2004 as part of the Clinton Foundation HIV/AIDS Initiative in that country.
The Clinton Foundation and the Ukranian government have identified four priority areas for collaboration:
- Obtaining antiretroviral drugs (ARVs) at international prices;
- Strengthening clinical teams in HIV/AIDS care;
- Introducing and scaling up substitution therapy for injection drug users (IDUs) in conjunction with the provision of ARVs; and
- Strengthening pediatric care for HIV.
Ukraine, where the rate of HIV infection is estimated at 1.4%, is one of the countries in Europe most affected by HIV/AIDS. Since the beginning of the epidemic, over 110,000 people have been officially registered as HIV positive. These numbers represent only a small fraction of conservative estimates that put the total number of people living with HIV at 377,000. There are currently 74,500 persons who have sought some form of HIV care services in Ukraine, with approximately 5,600 on ARVs. By 2010, it is estimated that 50,000 will need ARVs – a large portion of those being injection drug users (IDUs).
Widespread use of intravenous drugs remains the main driver of the HIV/AIDS epidemic in Ukraine with about 65% of HIV positive people being either IDUs or partners of IDUs. An August 2006 study estimated that there are 144,000 HIV+ IDUs in Ukraine and an additional 95,000 HIV+ non-IDU partners of IDUs. According to a national study conducted by the Ukrainian Ministry of Health, high risk behavior remains prevalent amongst IDUs with only 20% reportedly trying to avoid sharing needles and practicing safer sex. The national estimated number of IDUs in Ukraine stands between 325,000 and 425,000.
The Pangaea team, including Dr. Goosby and Vice President for Programs Julia Martin, in close cooperation with their CHAI colleagues, is concentrating its initial efforts on a new program in the province of Dnipropetrovsk that is aimed at bringing injection drug users (IDUs) into treatment for both their addiction and their HIV.
According to Dr. Goosby, “We are seeing the intersection of HIV and injection drug use in our work throughout Asia, North America and Europe. It’s vitally important to find new ways to overcome the double dose of stigma and fear surrounding addiction and AIDS, as well as dealing effectively with the more complex medical issues with which these patients present. If we do not bring injection drug users into treatment, we stand no chance of stopping the spread of HIV in places like Ukraine and China where drug use is driving the epidemic.”
The new program in Dnipropetrovsk, focuses on developing a model for integrated HIV and drug treatment in order to maximize quality of life for IDUs and to reduce the risk of HIV transmission. The program will provide a full range of health care services tailored for IDUs, including active methadone substitution therapy. In conjunction with this program, increasing access to HIV testing for IDUs using rapid test kits is slated for introduction in the final months of 2007 in the Dnipropetrovsk region. The program includes easy access to testing and referral to care centers. The CHAI/Pangaea team participated in a highly collaborative and coordinated process with governmental agencies and non-governmental organizations that resulted in the approval of methadone for use in Ukraine by the Ministry of Health in June of 2007. In addition to facilitating the approval of methadone, a core partnership was formed that is participating in the initiation of an integrated HIV and drug treatment program for IDUs which includes accessible HIV diagnosis, methadone substitution therapy and antiretroviral therapy.
De-stigmatization workshop materials, cross-domain training curricula for narcologists and infectious diseases specialists and HIV testing awareness materials have been developed through partnerships with the Government of Ukraine, the International HIV/AID Alliance Ukraine, the American International Health Alliance, WHO, UNAIDS, Dnipropretrovsk regional and municipal governments and regional NGOs. Piloted in Dnipropretrovsk oblast, programs will be further applied in other Ukraine regions with all resources developed throughout this process available for wider use throughout the country.