Kyiv, 15 April 1998 (RFE/RL) -- In an ill-lit, run-down cluster of hostels on the edge of Kyiv, 15-year-old Valik has come to collect a clean needle, with which he will inject himself with 'poppy-straw,' a heroin substitute commonly used by drug addicts in Ukraine.
"Even if someone knows I've got AIDS, if they've really got a craving for a high they'll inject themselves anyway with my syringe," said Valik, who has been addicted for a year. Valik does not have AIDS, but he has contracted viral hepatitis. "If anyone uses my needle after me they'll get hepatitis," he said.
The clean needles are being distributed by city social workers and volunteers as part of a harm-prevention program launched by UNICEF and the city youth social services in an attempt to slow down the rapid spread of AIDS and other infectious diseases among intravenous (IV) drug users, and protect the population at large.
"If there is no proper preventative work done among this group, contamination of other people outside this risk group is only a matter of time," warned Lidia Andrushchak, national consultant for UNICEF's (the United Nations' Children's fund) Young People's Development Program and one of the project's coordinators.
The project, which began March 25, has established one mobile and one stationary 'trust point' in three regions of Kyiv, where IV drug users can trade in used hypodermic needles for clean ones, receive free condoms, and get advice from psychologists, doctors and church representatives. Of the 1500 drug users registering in Kyiv monthly, 70-to-90 percent are intravenous users; those most vulnerable to AIDS through the use of shared and dirty needles. The spread of HIV-positive cases among them is swift. Between 1987 and 1995, there were 42 cases. By 1996, that had almost doubled. In 1997, the number had reached 505. Nationwide, 70 percent of all HIV cases are attributed to intravenous drug users.
A similar program was launched by UNICEF a year ago in Odessa, a city known for its large number of drug users. But attempts to offer needle exchange in Kyiv met with stiffer official resistance, said organizers. Last year, a needle-exchange program in one of the capital's suburbs failed to get off the ground for lack of funds and official sanction, said Victoria Vakarina, a city youth services coordinator. But after observing the Odessa program, officials from three Kyiv districts agreed to allow pilot projects in their areas.
Winning over the regional administration was only part of the battle. The mistrust of drug users is another issue. Much of the project's credibility relies, not on the conduct of the organizers, but on the city police, and, in that regard, the fears of Eduard, a 30-year-old addict who complained of constant police harassment and said he was afraid to visit the 'trust point' for that reason, might well be justified. Although the project has the official approval of the city and the Justice Ministry, law enforcement officials have withheld their blessing.
The Interior Ministry "may be forced to send more police to (areas with needle-exchange centers)" because drug pushers would tend to frequent those neighborhoods, said Vasily Levoshko, head of the ministry's anti-drug unit. Levoshko said his department has not actively opposed the project, treating it as a medical issue. But, "If you want our opinion, we are against this program," he said. "If you open a chess club in Kyiv who will gather there? People who play chess. If you open needle-exchange points who will gather there? First, drug users -- and then sellers will come." Levoshko added that the year-long delay has not been long enough. It's too early for this project to be started in Kyiv," he said. "It's better to direct this money towards treatment of these people."
The program's advocates point out that the 'trust points' and the volunteers who staff them intend to fight, not drug addiction or crime, but the spread of a lethal disease. "We don't want to hamper law enforcement bodies in their job, but we also don't want them to interfere with our work," said UNICEF's Andrushchak. "We need them to understand the philosophy of harm reduction. There's no alternative right now."
The habits of those drug users, of which the project surveyed 150 in Kyiv, paint the worst possible scenario for the spread of AIDS. Ninety-nine percent said they had used dirty needles at least once, and many buy drugs already in syringes. Of those questioned, 63 percent said they have casual sex, while only 40 percent use a condom. Half have non-users as partners.
UNICEF workers say statistics from Odessa show that city's project has been effective in changing such habits through counseling. A survey of visitors to Odessa's needle-exchange centers showed that virtually all were using disposable syringes, and were more likely to use condoms. Only 20 percent of the users surveyed were registered with police or hospitals, indicating that the help offered by the centers was reaching the large number of drug users not counted by official statistics, UNICEF said.
Lily Hyde is a Kyiv-based journalist who specializes in feature reports on social, educational, and cultural issues.