Drug use is widespread in Ukraine, which also has one of the highest rates of increase in AIDS cases among all European countries. The two phenomena are closely linked. RFE/RL Kyiv correspondent Lily Hyde visits the Ukrainian city of Mykolaiv, afflicted with both addicts and AIDS cases, to see how the twin problems are being addressed.
Mykolaiv, Ukraine; 12 August 1999 (RFE/RL) -- In the southern Ukrainian city of Mykolaiv, crumbling Soviet monuments, unlit streets and empty shop windows all speak of a place fallen on hard times.
Mykolaiv was once famous for its shipyards. The pre-revolution battleship Potemkin was built there, and a monumental Soviet sign in the city center still welcomes visitors to the "City of Ships."
But now the huge cranes stand idle, and some locals have found a new name for their town. They call it the city of drug addicts.
Mykolaiv has one of the highest incidence of drug use in Ukraine. The city of 500,000 has 4,000 registered drug users -- that is, those who have checked in for treatment. Unofficial estimates put the number of drug users ten times higher, at some 40,000.
Heroin has not yet made it to Mykolaiv. The city's drug users instead inject liquefied poppy straw, homemade from the opium poppies grown in villages throughout Ukraine. In Mykolaiv, it costs just $1.25 (six hryvnias) for a dose of one cubic centimeter. Locals say it is easier to buy poppy straw than bread.
Unemployment, poverty and drug addiction have long been known in Mykolaiv. But today a new plague, directly linked to drug addiction, has struck the city --AIDS. Mykolaiv, which had barely heard of the deadly virus five years ago, now has one of the fastest growing HIV infection rates in Ukraine. HIV is the virus which causes AIDS.
Mykolaiv's first registered HIV-positive case was in 1994. A year later there were over 700. By April 1999, that number had jumped to 1,683 HIV-positive cases, of which 77 had developed AIDS.
AIDS is spread in Ukraine largely by the sharing of needles. Nationwide, 70 percent of Ukraine's more than 40,000 registered HIV-cases are attributed to intravenous drug users.
In the detoxification ward of the regional AIDS hospital in Mykolaiv, these two problems --drugs and AIDS-- meet. Men and women are kept here behind barred windows and a locked door. They are all addicted to poppy straw, and have checked in for a two-month-long abstinence period in order to end their addiction. All of them are infected, through their addiction, with HIV.
The patients clamor for cigarettes, for coffee, for painkillers --all of which they say are not allowed or are unavailable-- and they complain loudly about the clinic's poor conditions. But committal to the ward is voluntary, and most of the patients already knew what to expect: they have been here before.
Twenty-four-year-old Natasha has used poppy straw for seven years and tested positive for HIV five years ago. She tells RFE/RL she didn't used to believe addicts who said they couldn't give up drugs.
"I believed, I knew it wasn't for me, it was only youth, adolescence. It would leave me when I had a family. Then I found out I was infected [with HIV]. There were problems with my children, my mental state was breaking down, and I started on drugs again. Periodically I go for treatment and I regularly believe I've given up [drugs]. But when I come out of the hospital nothing has changed, attitudes are still the same, I can't find work."
Drug abuse is a rapidly growing problem throughout Ukraine, especially in southern and eastern cities. Drug addiction, along with AIDS, is generally viewed here as one of the ills of the West that only reached Ukraine after independence. But in fact Mykolaiv has had a name for drug use since the mid-1980s, when users even had their own style of dressing, called "strict fashion."
Drug taking is no longer as fashionable as it was 15 year ago, but it is more widespread. These days, most users are too poor and sick to think about what they wear. In addition to HIV, many suffer from hepatitis, tuberculosis, collapsed veins and chronic abscesses. Many of today's addicts first turned to drugs to escape the miseries of unemployment, or even as a physical painkiller in a city where hospitals are often unable to supply basic medicines.
The AIDS center provides free consultations. And a local association, known as Blagodiynist, offers free treatment for drug users at the city's hospitals for infectious and sexually transmitted diseases. But few drug users take advantage of the offer. Maria Tomina, a psychologist working with Blagodiynist, believes poor education and unemployment have contributed to the popularity of poppy straw, but that drug users' self-hatred is also a factor.
"The fact that people are without work is important, but not the deciding factor. It is important what kind of family they were brought up in, how much they were loved, how much they were taught to respect themselves and love themselves. If they learn that, they won't be drug addicts. Our drug users don't love themselves, they don't value themselves. They don't go to the doctor, the hospital to treat an abscess. No, they go around with it getting worse, more painful, until they have a blood infection. Why? They are willfully killing themselves."
Recently, Mykolaiv's AIDS epidemic has begun to spread outside the high-risk group of drug users. Until last year, 99 percent of HIV sufferers were infected through contaminated shared needles. But according to Doctor Irina Petrovskaya of Mykolaiv's AIDS center, one in five of all registered cases in the past 18 months were transmitted sexually or passed on to babies from HIV-positive mothers.
Many of the town's female drug users have turned to prostitution to finance their addiction. The prostitutes themselves say that 90 percent of them are addicted to poppy straw, and many have already tested positive for HIV.
The doctors and psychologists who work for Blagodiynist now believe that drug prevention programs alone are inadequate to combat the rapid growth of HIV. They have adopted a more direct method --damage reduction. They teach safer sexual and drug-taking behavior to drug users and prostitutes in order to reduce the risk of HIV.
Last year, the association also set up a needle exchange program, funded by philanthropist George Soros' Open Society Institute and by the Lindesmith Center in New York. Drug users can now exchange used syringes for clean ones, and also receive counseling, condoms, information on safer drug use and free treatment for sexually transmitted diseases. The needle-exchange program has attracted over 2,000 clients, most of whom come regularly for clean syringes.
Blagodiynist workers are well-known and liked among drug users and prostitutes. As a result, some who come to the association say they do so not only for condoms and syringes. They say they also come for the comfort of speaking to people who understand their problems and want to help.