Fighting HIV at its root: the promotion of Opioid Substitution Therapy

Fighting HIV at its root: the promotion of Opioid Substitution Therapy

The HIV epidemic is growing quickly in Tajikistan, with cases significantly up from the 429 officially registered in 2005 to 4674 in 2012. HIV prevalence is highest among at risk groups of population. Of particular concern is the high prevalence among Injecting Drug Users (IDUs), 13.5% in 2011. Tajikistan is one of the major smuggling routes for Afghan opiates, in particular heroin, and unsafe drug use is high. These high prevalence rates among IDUs has made injecting drug use the driving force of the epidemic, and interventions aiming to arrest the epidemic’s development need to focus on the needs of IDUs.

“Nothing was good when I used to inject drugs – 15 years of heroin. I divorced my wife, did criminal work to get a dose… I was often in prison.” Farrukh, Injecting Drug User (IDU) living with HIV

Highlights:

  • OST pilot programme attended by 114 clients, of whom 59 have HIV.
  • Referral of clients to integrated counseling and testing centers
  • OST sites opened in several Tajik cities

UNDP Tajikistan, as a principal recipient in Tajikistan to Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) grants, has been acutely aware of the importance of working with at risk populations, and since 2008 has advocated for Opioid Substitution Therapy (OST) programmes for IDUs living with HIV or at risk of infection. OST is a new, important, innovative but controversial treatment, where clients’ use of opioids, in particular heroin, is replaced with a free, daily, oral dose of liquid methadone. A UNDP sponsored OST pilot programme started in Tajikistan in 2010, and is a big success. As of the end of July 2011, it was attended by 114 clients, of whom 59 have HIV. The often marginalized clients, many with twin problems of living with HIV/AIDs and drug addiction, are enthusiastic to say how much the programme has improved their quality of life. Further, as injecting drug use with unsterile equipment is the main route of HIV transmission in Tajikistan, OST could be the key in stopping the epidemic developing, as it leads to less use of needles and infected equipment in circulation.

Me and my brother, who is also an IDU, stole things from home. Everyone was nervous… with the help of this program there is no need to commit crimes. Right now at home all is well.

Irina Alexsevna, social worker at the Dushanbe OST site, stresses that psychologically clients are much more peaceful, and more open, sociable and driven for the future. Further, clients have been referred to integrated counseling and testing centers, and others received further medical support for other illnesses diagnosed, such as tuberculosis, sexually transmitted infections (STIs) and Hepatitis B and C.

While UNDP is looking at ways to improve the service, increase client numbers and adherence to treatment, the success of the site in Dushanbe has led to OST expansion in Tajikistan. Staff from Khujand in the north of Tajikistan were trained on running OST, and opened a centre in March 2011 which currently has 58 clients. An OST site in Khorog (eastern Tajikistan) was launched in June 2011 and already has 64 clients. In 2013, the OST programme in Tajikistan will be expanded to Kurgan-tyube (southern Tajikistan), meaning there will be functioning OST sites throughout the country. Even more encouraging is how involved clients are: “I tell all my friends with the same problems about OST to come. It works.”