1. Drug Law And Practice: Application to Harm Reduction In Ukraine Galina Kitsenko (1), Nataliya Kitsenko (2), Tatiana Ysipenko (2), Zita Lazzarini (3, 5), Scott Burris (4, 5), Patricia Case (6) (1) Odessa State Marine University, Ukraine; (2) Odessa City Fund “The Way Home”, Ukraine; (3) University of Connecticut Health Center, USA; (4) Temple University Beasley School of Law, USA; (5) Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities, USA; (6) Fenway Community Health Center, USA Issue: Clinicians think of drug users as sick individuals who need treatment, medical monitoring and as vectors of infectious disease. From the economic vantage, drug users might be seen as individuals who do not contribute to the economy and require considerable expenditures. A legal viewpoint would suggest that drug users are those who violate the established rules and commit various crimes. Others might perceive drug users as asocial individuals who are not contributing to society. With drug use perceived in so many different ways, and with the necessity of new interventions to stem the spread disease, a multidisciplinary analysis of policy and law affecting drug users is particularly useful in uncovering potential new interventions. Key Findings 1.Since 2001, Ukrainian legislation does not contain administrative or criminal punishment for use of drugs. Associated actions such as possession, buying, production, or transportation of drugs are subject to criminal or administrative punishment. If the individual intent is sale of drugs, criminal sanctions are applied regardless of the amount of drugs found. 2.In Ukraine, drug users and HIV infected people are legally required to officially register in order to obtain treatment. This requirement presents a considerable barrier to treatment as registered individuals suffer severe discrimination. For example, registered drug users are denied the right to enter a university, get a driver’s license, travel abroad, enroll in the military, or get occupational licenses among others. 3.Substitutive therapy (ST) began in Ukraine in 2007,but is available only in the big cities. One harm reduction vector is to provide ST in such a way that anyone could get it without difficulties and treatment institutions would be closer to those who need ST, i.e. the network of medical institutions, which provide ST services to a wider group. 4.Many drug users are infected with HIV. No adherence of active drug users to treatment is at low level. Therefore the doctors think that prescribing ART to active drug users is not effective and is squandering of the medicines which cost a lot. 5. Legal change is required. Based on the legal analysis, the research team came to the conclusion that changing legislation is critical. Production and possession of drugs by drug users can’t be punished in the same way as production and possession of drugs by the individual with intent to sell, who doesn’t use drugs. The latter has an evident aim of sale and this is element of drug business. Individuals who use drugs are ill, not criminals. Possession and manufacture of drugs without the intent to sell is not a great danger for the society. Criminal responsibility for drug possession should be replaced by treatment. One of the vectors of harm reduction activities related to limitation of HIV risk is improving Ukrainian National legislation on modified responsibility for drug crimes taking into account that drug use is an illness. Methods: Using a community-based action research method called Rapid Policy Assessment and Response (RPAR), a research team guided by a Community Action Board collected written laws and policies, analyzed 910 court verdicts in drug-related cases in Odessa, conducted 3 focus groups, 26 individual interviews with key informants including health care providers, lawyers, law enforcement representatives, and NGO staff and with fourteen injection drug users to learn how the law, policies and their implementation influence health risks among IDUs. The cost of drug treatment “The price for out-patient treatment is not reasonable. Ten days of treatment costs 450 grivnas. In-patient treatment is paid by the IDU. It easy to get into such treatment, but it costs a lot and is not available to all. The main barrier for drug use treatment is absence of money.” IDU woman Substitutive treatment “Substitutive treatment program it is good. The IDU is not running in search for something to steal. He knows that in the morning he will get his dose under medical observation and he doesn’t have euphoria, no need to run in search for money for drug, the drug itself. Many find jobs and even try to create a family.” IDU Interview RESULTS Conclusions: 1. Drug law affects every aspect of drug user’s lives. 2. The registration system is an obstacle to getting treatment and other services related to HIV prevention. 3. Substitution therapy is available only to a small number of drug users. The scope of ST is too limited. 4. There are few behavioral approaches and methods available in Ukraine to work with active drug users in the field of adherence and ART This research was supported by NIDA/NIH Grant # 5 R01 DA17002-02 PI: LAZZARINI, ZITA. The findings and conclusions expressed are those of the authors and not necessarily of NIH, NIDA, or the US Government. “Law in practice” – the work of the Militia “Militia, especially patrol point duty service, decided who is to detain solely basing on their own understanding. If the person seems to be suspicious – he is stopped, detained and checked on the whole spectrum of delinquency” Key Informant Interview Key Point If the individual possessing drugs has an intent to sell, there is a criminal responsibility irrespective of the amount of drugs found. If there is no intent to sell, and only a small amount of drugs found there is no criminal offense. The law in Ukraine since 2001. Harm reduction vectors related to drug use Promote: Personal health consciousness in the general population Education: Of university law students about drug law Education: Of law enforcement workers and judicial bodies on communication with IDUs Abolish: Criminal responsibility for possession, sales, and manufacture of drugs without Intent to sell (article 309 part 1 of CC of Ukraine) Differentiate: Between criminal responsibilities for drug users and drug dealers Change: Social norms and discrimination against those with “drug user” status Improve: Access to Substitution therapy programs Change: The relationship of IDUs to drug treatment Encourage: Reduction of sexual/injection risk behaviors among drug users For RPAR Tools and Reports, visit www.rpar.org Put CAB Picture here Community Action Board Meeting