1. Delivery system for Substance Abuse Treatment: Ukraine Anatoliy M. Viyevskiy, M.D., Ph. D. The Head Narcologist of The MoH of Ukraine Istanbul, Turkey September 2005

2. UKRAINE  Capital:Kyiv  Estimated population47,442,100  Europe’s biggest country by size

3. UKRAINE

4. GENERAL OVERVIEW  Population47,442,100  Birth Rate8,7 births per 1000  Death Rate17,7 deaths per 1000  Average Age39,5 years  Life Expectancy68,24 years  Age Structure0-14 years18,1% 15-64 years58,0% >65 years12%

5. Ethnic Groups  Ukrainians - 77,5%  Russians - 17,3%  Others (Poles, Jews,  Tatars, Hungarians, Slovaks etc.) - 5,2%

6. Languages  Ukrainian67,5%  Russian29,6%  Others2,9%  Literacy:98,9% of the population can read and write

7. Major Religions  The Orthodox Christian Church – approx. 15000 religious communities all over the state  The Greek Catholic Church – 3468 religious communities  The Baptist Church – 2461 religious communities  The Evangelic Christian Church – 1444 religious communities  The Roman Catholic Church – 991 religious communities etc. etc. Generally 29785 religious communities of the 55 religious confessions in the country

8. How religious Ukrainians are?  52,8% of Ukrainians are visiting churches (The National Inquiry)  52,0% of them are visiting churches just on holidays  Generally 39,9% of the population of Ukraine haven’t determined whether they believe in God.

9. Economy  Labor Force22,614,200  Unemployment Rate:4,2%  Major Industries: mining, steel producing, machinery construction, natural recourses, food industry.  Agricultural products: grains, corn, fruits, vegetables, beef, pork, poultry.

10. 10 months ago different pictures from this place - Maidan were well known throughout the world

11. …The first polish Solidarity demonstrations participants adopted the ban on alcohol… The abstinence decision was one of the ways how to avoid violence. The same way have chosen the Ukrainian opposition in the fall of 2004 on the “orange” Maidan”. “Fighting for democracy is for sober people” – said one of the participants in the revolution campus. (Robin Room)

12. The owners of the majority of bars, restaurants and shops in the center of Kyiv stopped selling alcohol beverages for all weeks of Orange Revolution absolutely voluntarily.

13. 10 months later. Ukraine after democratic revolution. What are the news for people with substance abuse problems and their families?

14. Questions, questions, questions???… 1. Drugs/alcohol… Are they the problem for new Ukraine in principle or not?

15. Questions, questions, questions???… 2. Harm reduction philosophy and biopsychosocial approach. Is it good for Ukrainians?

16. Questions, questions, questions???… 3. What do we (Ukrainians) really want to know about stigmas in our society? How are we going to deal with this piece (if we are going to deal with it in general?)

17. Questions, questions, questions???… 4. HIV/AIDS… The virus is still doing it’s fatal job non reacting on our post-Soviet moves. More and more people are dying because of it. What has to be done?

18. Questions, questions, questions???… 5. The monitoring of drug/alcohol situation. Where is Ukraine now? Are we ready to know “the true figures”? etc.

19. Drug/alcohol… Are they the problem for new Ukraine in principle?  Tobacco - 35% of population >15 years old are smoking every day, 40% of population are smokers.  Alcohol - estimated per capita use - 11 liters  Alcohol addicts (registered) - 655988  Drug use (Ukraine-British Council Inquiry) - appr. 500.000  Heroin use (registered) - 75254  Meth/Amthetamine use (registered) - 1779

20. Drug/alcohol… Are they the problem for new Ukraine in principle? (cont.)  The poppy straw home-made extract is dominating all over the country.  Heroin is used approx. in 20-25% of cases only in big cities with more than 1 million of inhabitants – Kyiv, Odesa, Dnipropetrovs'k.  The popularity of ecstasy and amphetamine/methamphetamines is growing.  Cocaine is used in small number of cases.

21. Drug/alcohol… Are they the problem for new Ukraine in principle? (cont.) In April, 2005 The Draft of Drug & Alcohol Policy (National Strategy) was elaborated according to the Governmental Order. Now it passes the governmental discussion.

22. Harm reduction philosophy and biopsychosocial approach… The draft of The Concept of State Drugs and Alcohol Policy is based on harm reduction philosophy and biopsychosocial approach.

23. Harm reduction philosophy and biopsychosocial approach… (cont.) Some people in the law enforcement system and few NGO’s (mostly those toughly oriented on the restoration of Soviet Union) keep strong position against decriminalization of the drug situation. They are the hottest opponents to substitution therapy programs implementation in Ukraine, first of all, they’re against methadone maintenance.

24. Harm reduction philosophy and biopsychosocial approach… (cont.) The reform of substance abuse treatment system is one of the goals of the new Concept.

25. HIV/AIDS…?  Living with HIV/AIDS (officially registered) - 62365 children - 6185 children - 6185  HIV/AIDS related deaths - 3592  The estimated number of HIV - infected ~ 400,000  IDU’s keep the lead among them - 54% (in 1998 - 82%)  The speed of HIV epidemic in Ukraine is one of the highest in Europe

26. HIV/AIDS…? (cont.) Available Substance Abuse Treatment  Inpatient detoxification – all over the country  Outpatient detoxification – the same  Physician counseling – the same  Buprenorphine substitution therapy – just 2 facilities  Outpatient counseling – just few places  Residential rehabilitation – appr. 50 centers  Therapeutic communities – appr. 20 centers  Faith/religious – based treatment – appr. 40 centers  Psychotherapy – just 7 centers

27. HIV/AIDS…? (cont.)  The new National coordinative mechanism against HIV/AIDS is under quick construction during last 6 months. It’s headed by The Vice- prime-minister of Ukraine. The very new feature – according to the Governmental Order all branches of National coordinative mechanism (it’s very new for Ukraine) are managed by NGO’s people including The People Living with HIV National Network.

28. HIV/AIDS…? (cont.) The main problem: we are still too late.

29. The monitoring of drug/alcohol situation  From November 2004 the creation of The National Drug and Alcohol Observatory (NDAO) was initiated in joint UNDP-EU- Ukraine project.  The Official NDAO Mandate draft and the NDAO Budget 2006 draft are elaborated already.

30. The monitoring of drug/alcohol situation (cont.) Some of law enforcement people don’t want to support the Drug and Alcohol Observatory idea. “Our information has not to be analyzed by public” – said one of the police top officials.

31. The governmental adoption of The Concept of The State Drugs and Alcohol Policy and final adoption of The National Drugs and Alcohol Observatory Official Mandate and the state budgeting for Year 2006 could be the good sign for people with drug/alcohol problems in Ukraine. This would mean that the deep turn to people needs in this field in Ukraine becomes real. The point of challenge

32. THANK YOU FOR ATTENTION