Tatyana, A voice from people who use drugs at the United Nation

Dear Colleagues!

Today, I have the great honour and responsibility to speak at the opening of the High-Level Meeting.

I live in a country with the fastest-growing epidemic in the Eastern Europe, in a city with the highest HIV prevalence rate.

It was there, in my seaport city, that the HIV-infection epidemic began like an explosion among the people who use drugs. It was in my city that the first needle exchange programmes appeared. And it was in my city that the first organisation of people living with HIV was established.

I am 32, almost of the same age as the epidemic. I have been living with HIV and using drugs for 13 years. I have had hepatitis C for almost 11 years. I have a family, a husband, and an eight-year-old son. They do not have HIV, and they give me great support.

Three years ago I took part in an opioid substitution therapy programme, which enabled me to live, work; be an active citizen of my country, take care of my son. It helped me to love and to be loved.


1. I think that you ought to know how people who use drugs survive in my city, in my country and in my region!


70% of people using drugs in Eastern Europe and Central Asia are HIV-positive. More than 90% of them have various types of viral hepatitis. Only one person out of five has access to ARV therapy.

Each day, only in my country 8 people die of AIDS and 56 people get infected with HIV.

Drug treatment services and rehabilitation programmes are neither accessible nor of good quality. Harm reduction programmes are being oppressed. Several countries of our regions have a ban on harm reduction programmes.

Drug dependency is considered a crime, not a disease. Due to that many people who use drugs get imprisoned. How many of them survive in prisons?!! How many of them manage not to get infected with TB?!! Not to die of AIDS, overdose, hepatitis, or sepsis?!!

The Vienna Declaration states: Criminalisation of people using illegal drugs, ban on needle exchange and opioid therapy programmes boost the epidemic of HIV!

Drug dependency and HIV-infection require treatment, not prosecution.

2. In case of women using drugs the situation gets more complicated, because women are more vulnerable to HIV, and those who already are HIV-positive suffer from stigma, discrimination and, often, violence at home.

Tell me, please, where a pregnant woman who uses drugs is to go if her husband has left her, if she has no home, if she gets humiliated by doctors, if she is refused help and told to terminate pregnancy? If a woman decides to give birth, she cannot go to a drug treatment clinic, because she will get registered as a drug addict and will be deprived of her child. In most rehabilitation centres there are no suitable conditions for women with children! As to the so-called crisis centres, which might seem as a shelter from violence, HIV-infection is a ground for refusal. As a result, it is highly probable that a woman will sell commercial sex services, being exposed to violence, without access to HIV and STI prevention services.

At the same time, NGOs have already developed programmes oriented towards women. These programmes are already being introduced. We are learning to ask women what they want; we are learning to give them responsibility for managing their own lives, including planning activities against the epidemic. Whether such programmes and other prevention programmes will be continued and developed, depends on the decisions made at this Forum.

3. As I have already said, I am lucky to have access to opioid substitution therapy. I am grateful to my country for this progressive decision, which helped more than 6 thousand people to receive substitution therapy treatment. I would like to stress the word treatment!

People who use drugs can follow the ARV treatment regimen. Particularly when HIV treatment is combined with drug dependency treatment, including harm reduction programmes, substitutions therapy and detox, in combination with psychological and social support.

I take buprenorfin every day under the supervision of doctors. Over 5 years of opioid substitution therapy in my home city, I have seen many lives change thanks to this programme. People have returned to their families, found jobs, stopped committing crimes, started HIV and TB treatment.

Unfortunately, most countries of Eastern Europe do not have opioid substitution programmes. And even in those countries where these progammes are legal, they are often faced with pressure. Medical institutions and NGOs are still being pressurized by the law-enforcement authorities. Such environment makes it impossible to extend this programme and many other programmes to key populations. This is bearing in mind that more than 50 thousand people are waiting for help just in my country.


Punitive responses to drugs have been proven to impede HIV prevention efforts, pushing people underground, driving many deeper into dependency and away from help and support.


Last year, I was imprisoned because of my professional activities related to substitution therapy. Today, I cannot visit certain neighbouring countries, because my treatment is illegal there, just like street drugs.


4. Despite all the obstacles, my companions-in-arms and I have become stronger!

In my country, NGOs, people living with HIV and drug users are the leading force in the HIV/AIDS response.


The centrality of people living with HIV to the HIV/AIDS response is clear, but the voices of the most marginalised actors in the epidemic, including people who inject drugs, have not been widely heard. This is despite their engagement being core to developing acceptable services that ensure successful outcomes. Member States should commit to engaging with and working alongside people who inject drugs and other key affected populations to effectively prevent new infections and to treat HIV among people who inject drugs and their sexual partners.


5. So, what do we need now? We need political will of our states and participants of this High-Level Meeting!

It has happened so that my life and my health today depend on your political will. I have been on ARV for a year already, but tomorrow I am going to need hepatitis C treatment. Today, in my city, hepatitis C treatment is not available. Thousands of people are waiting for it. Thousands of people are waiting for ARV. For many people, the waiting had been in vain – they died without treatment. Even those of us around the world who receive life-saving medications experience stock-outs of drug products. That is why no compromises, like 80% of access, can be accepted. We, representatives of key populations, demand 100% access to ARV for all who need it. We demand a 100% access to treatment against TB, hepatitis, opportunistic infections, drug dependency, a 100% access to effective prevention programmes.

I pay taxes, I carry out social activities, and I take care of my son. I want my son, who is a second-grade pupil now, to see me free from criminal prosecution, healthy and full of strength and dignity when he is grown. I believe that you as leaders of your countries can help me by exerting your political will, which is so important for your citizens who are like me.


About Erin

Freelance writer and journalist for the global drug user press
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