The large scale of the twin epidemics, HIV and drug use, represents one of the major public health problem in Ukraine. It is estimated that about 360,000 people are currently living with HIV/AIDS (PLWHA) in Ukraine (UNAIDS/WHO estimates 2004) while the population of Injecting Drug Users (IDUs) is estimated to be up to 560,000 (Social Monitoring Centre, 2003). Of the officially registered PLWHA at the end of 2004, more than 60% contracted HIV through sharing of injecting equipment during injecting drug use.
At any given time there are more than 10 million people imprisoned worldwide. Taking into account the high numbers of both new and released prisoners, there are more than 30 million prisoners worldwide every year. Continued drug use frequently occurs in prison and this is usually associated with a high risk of HIV transmission.
HIV prevalence rates in prisons are always higher than in the community. In countries with a high HIV prevalence rate within the community, HIV prevalence in prison will be about double. In countries where the HIV epidemic is mainly affecting injecting drug users, prevalence rates in prison are 10 times higher than in the community or even higher. The vast majority of people committed to prison eventually return to the wider community. Therefore, reducing the transmission of HIV in prisons is an integral part of reducing the spread of infection in the broader society, as any diseases contracted in prison, or any medical conditions made worse by poor conditions of confinement, become issues of public health for the wider society when people are released.
Needle exchange program have been proven to be an effective harm reduction measure to reduce the risk of HIV transmission, among IDUs and their sexual partners. Many countries have implemented those programs in the community, helping drug users to minimize their risk of contracting or transmitting HIV, and an increasing number of prison systems has also successfully introduced such programs in prison settings. This recognizes that drug use is a reality in prisons, and that due to the high risk of HIV transmission behind bars, prison systems need to make available the same level of HIV prevention and care that is available in the community outside prisons.. Ukraine made a very important step in that direction when it decided to start needle and syringe programs in the Penitentiary system.
On 24 March 2007, the State Department of Ukraine on Enforcement of Sentences issued a decree establishing an organizational committee and working group, tasked with implementing an action plan on harm reduction measures in Ukrainian penal institutions. The Deputy Head of the Department, Mrs Natalia Kalshnik, was nominated as the head of the Organizational Committee. Mr. Ralf Jürgens, a consultant working for the Canadian HIV/AIDS Legal Network, will act as the Deputy Head of the Organizational Committee. It was also decided that Dr.Zaza Tsereteli, Regional Advisor for HIV/AIDS for UNODC in Ukraine and Moldova, will be a member of the Organizational Committee.
According to the action plan, two needle and syringe pilot studies will be undertaken in Colony 53 in Mykolaiv Region and in Colony 48 in Lviv Region from September 2007 to September 2008, and will be monitored and evaluated with the assistance of WHO and UNODC. The Canadian HIV/AIDS Legal Network will continue providing technical assistance to the State Department, assisting with the introduction of the pilot projects, as well as with scale-up of access to antiretroviral treatment and with introduction of substitution therapy in penal institutions.
For more information on HIV/AIDS in prisons in Eastern Europe and on needle and syringe programs in prisons, see the website of the Canadian HIV/AIDS Legal Network at www.aidslaw.ca/prisons (English) and http://www.aidslaw.ca/ru (Russian).