Image description: A panoramic view of Crimea, Ukraine. (Nadia Fes via Unsplash)

This story was originally published in a UNAIDS pamphlet distributed to heads of state, United Nations delegates, and civil society members who gathered in New York in June 2011 for the UN General Assembly High-Level Meeting on AIDS. 

By Venuri Siriwardane/UNITY AIDSNews 

Last year, HIV activist Shannon Kowalski visited Crimea, Ukraine’s diamond-shaped peninsula that juts out into the Black Sea.

Her favorite memory of this idyllic place wasn’t the pebble beaches or posh health resorts. It was her tour of a clinic serving local intravenous drug users — a group that is highly vulnerable to HIV infection. There, she met people who relied on methadone, an anti-addictive drug used as a substitute for illicit “opiate” drugs.

“It was incredibly touching,” she said, of her conversations with patients. “They were able to hold jobs. They were able to be integrated into the community. It’s clear that these programs change people’s lives and give them control over their future and their health.”

Such programs, called “harm-reduction” measures, are a key part of Kowalski’s efforts to boost civil society’s role in the fight against HIV and AIDS in Europe. She is a senior program officer at the Open Society Foundations, a New York City-based non-governmental organization that supports harm-reduction programs for at-risk groups. These include access to clean needles, methadone and other analgesics, and sex education.

Advocates say it is a more realistic solution than preaching abstinence in Ukraine, where widespread IV drug use has spawned the largest HIV epidemic in Europe. At least 350,000 people there — or 1.1 percent of the population — were living with HIV/AIDS in 2009, according to UNAIDS. Russia is a close second, with 980,000 people, or 1 percent of the population.

Eastern Europe is ground zero in the continent’s fight against HIV/AIDS. The most common route of HIV transmission in countries such as Russia, Ukraine and Belarus is sharing of contaminated drug equipment. The number of people living with HIV in the region almost tripled between 2000 and 2009 to about 1.4 million, according to UNAIDS.

Kowalski says other countries, primarily in Western Europe, have successfully controlled the spread of HIV. Portugal — which had some of the highest levels of hard-drug use in Europe and a spiraling HIV epidemic — aligned law enforcement with public health policy by decriminalizing drug use in 2001. Instead of jail time, addicts were offered therapy and health care.

Most analysts believe the policy was successful. New HIV infections among Portugal’s drug users fell by 17 percent between 1999 and 2003, according to the Cato Institute, a Washington, D.C.-based libertarian think tank.

“The countries that have made the most progress are definitely those where civil societies and activism are the strongest,” adds Kowalski, noting the annual number of new HIV infections is relatively stable in Western Europe, at just 20,000 per year.

But infections continue to spike in the East, largely due to apathy among policymakers.

“We’re just waiting for the politicians to start to take this seriously,” adds Jens Lundgren, director of the Copenhagen HIV Programme, a research group affiliated with the University of Copenhagen. “We can move very, very quickly if there was a political green light from the governments of Russia, Ukraine and Belarus to take the HIV epidemic seriously.”

Harm-reduction, championed by activists as the region’s best hope for curbing the rate of HIV infection, is controversial among politicians. Many are reluctant to provide such services for fear of enabling or encouraging drug use. The Russian government is largely ignoring the problem and influencing its neighbors to do the same, says Kowalski.

"There’s no reason why countries shouldn't scale up these projects," she says. "Sadly, many of them are not doing it to the extent that they need to." 

Carla Pineda contributed research to an infographic that accompanied this report.