PART 1 : Solving Challenges to Reach more People

Klepikov:
My name is Andriy Klepikov. I am the Executive Director of the International HIV/AIDS Alliance in Ukraine. In Ukraine the prevalence is 1.4% of the adult population which is about 360,000 HIV positive people. This is the highest percentage in all countries of Europe and Central Asia. When we started only 137 patients received ARV treatment. With the Global Fund money we managed to scale up to over 3400 right now. Treatment now is available in every part of Ukraine and we are supporting over 90,000 injecting drug users.

Q. Not long ago, the grant to Ukraine had some issues; how did the country recover from this and begin making progress so soon?

Klepikov:
Just to update you briefly, Ukraine received one of the first Grants of the Global Fund operations all over the world with an umbrella of some 92 million over 5 years. The grant initially provided was suspended in early 2004. After serious negotiations, International HIV/AIDS Alliance was appointed as steward of the grant and now we are to fully legitimize as Principal Recipients. Alliance is a UK-based charity and currently we are the biggest NGO in Ukraine. With the support of the Global Fund, USAID and other donors, we are implementing the most substantial programme in the country with a budget which exceeds the national budget. So I am very proud that we have made huge progress.

Q. And what were the main objectives of your programme?

Klepikov:
Basically the main gap at that time was lack of access to ARV treatment. With the Global Fund money we managed to scale up. Our main prevention focus is on vulnerable groups: first of all, injecting drug users, but also commercial sex workers and men having sex with men. With injecting drug users we are supporting almost 50 projects all over Ukraine.

Q. How many people are covered by these 50 projects?

Klepikov:
We are covering, through services and information over 90,000 injecting drug users; so it’s a huge coverage but our target’s even more ambitious: By September 2008 we committed to increase coverage to over 150,000.

Q. Has all this progress been achieved just after the funding resumed?

Klepikov:
Yes… I think Global Fund intervention is really crucial for Ukraine… I think it made possible all the main changes. All major progress happened in Ukraine during the last 2 years. Both at the national level, and in the level of personalities - as human beings.

PART 2 : Preventing HIV/AIDS Among Injecting Drug Users:
Why is it important?

Q. Why is it important to target injecting drug users?

Klepikov:
This is another very important area: focused prevention- because in Ukraine we have a concentrated epidemic, first of all fueled by injecting drug use. It’s home-made opium which is a very cheap drug called Shirka- a dose is cheaper than alcohol, so that’s why the virus spreads very quickly in Ukraine.

Q. Besides the professional reasons, what motivates you to fight AIDS among injecting drug users? Do you know anyone that’s affected?

Klepikov:
Yes of course! Actually, several of my friends injected drugs, so basically for me it was also one of my motivations to work in the HIV/AIDS area, to help them. We used to be neighbors. I knew this person from an early age- but when we moved to other places I didn’t see him for a while, and later I recognized that he used drugs and became drug addicted. So I helped him and made a reference to a clinic, and an NGO provided free services.

Q. Clearly, you are reaching many more people like your friend. What services are they receiving?

Klepikov:
We are able to support a full range of services including harm reduction, which is restricted by some donors. Needles and syringe exchange points, condom distribution, the whole range of prevention services are available for injecting drug users- including substitution therapy, which is also a revolutionary change, I would say, introduced with Global Fund support. Currently we have more than 200 drug users receiving substitution therapy and most of them are on ARV treatment, which is a very important linkage for Ukraine because most of HIV infected adults are injecting drug users. So, substitution therapy is very important. Basically, it is very important that the Global Fund gives a unique opportunity for doing appropriate prevention work.

Q. You mention syringe exchange points; substitution therapy…Isn’t drug use illegal in Ukraine?

Klepikov:
Drug use by itself is not illegal, but all other operations related to drug use are illegal, like storage or keeping drugs at home or in the pocket. But work with injecting drug users is supported by the government (policy on AIDS.)

Q. How do you reach out to injecting drug users with such services?

Klepikov:
We apply different approaches, sometimes its just mobile points which reach drug users on their way to buy drugs, so they can receive clean needles and syringes. Sometimes we have volunteers who visit drug users in their places.

Q. Thank you, and is there anything you would like to add?

Klepikov:
Unfortunately it is a very common way of contracting HIV and I know several people who got the virus through this… some of them are my friends, so its very spread…and when these people use drugs they don’t think far, don’t think about potential consequences or don’t have information at the time… but its very important to help them- not to blame them. To think about the future, not the past- how to live today, survive tomorrow, how to help other people not to make mistakes which are possible to avoid.

© Photos by Gideon Mendel for International HIV/AIDS Alliance.