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Law Enforcement and Drug Treatment: A Culture Clash

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Science  09 Jul 2010:
Vol. 329, Issue 5988, pp. 169
DOI: 10.1126/science.329.5988.169

A raid on an opiate-substitution treatment center in Ukraine has highlighted the tense relationship between police, injecting drug users, and harm-reduction advocates.

Open-and-shut case.

Oleg Vaschenko is one of many clients of this clinic who say a police raid was harassment.

CREDIT: MALCOLM LINTON

ODESSA, UKRAINE—On 11 March, Tatyana Afanasiadi went to the Odessa Oblast Narcological Dispensary for her dose of buprenorphine, an opiate-substitution drug distributed there each day along with methadone. Afanasiadi, 31, is not just one of the clinic's more than 200 drug-dependent clients, about half of whom are infected with HIV: She is a lawyer and head of the Union Together for Life, a nongovernmental organization that catalyzed the opening of this pioneering opiate-substitution treatment (OST) program, and she helps run the office. This role thrust her into the middle of a high-profile showdown with police that loudly broadcast the sharp tension throughout Eastern Europe between law enforcement and harm-reduction efforts like OST that are designed to slow HIV's spread.

According to Afanasiadi, as she was leaving the clinic that Thursday morning, three men dressed in civilian clothes approached, greeted her by name, slapped handcuffs on her wrists, and took her to an unmarked car with tinted windows. “At first I thought it was a scheme where police grab drug users and then ask them to identify another user they're already looking for,” she says. Afanasiadi then worried that they were going to plant drugs on her and demand a bribe, so she stressed that she didn't have any money. When that had no impact, she tried another tack. “I told them I'm ill and tried to frighten them with my HIV infection, but they were knowledgeable, and it didn't work.”

The men, who she says refused to show identification, took Afanasiadi to their police station. Unbeknownst to her, the clinic was being raided because of allegations that it did not have the authority to distribute substitute opiates and suspicions that staff members, including Afanasiadi, were selling the drugs on the side. At the station, with two female observers present, Afanasiadi had to remove her clothes, which were carefully inspected for stashed drugs. “They were extremely disappointed,” she says. They next sent her to a gynecologist for a vaginal exam. “It was quite a disgusting procedure,” she says of the ordeal. When that turned up nothing, they searched her home, which she shares with her husband and 6-year-old son, and her car. That evening, with no evidence against her, they locked her up. The clinic's doctor, Ilya Podolyan, was also detained, as was a nurse.

Broken trust.

Tatyana Afanasiadi says police undermined efforts to convince IDUs who seek help that they'll be protected.

CREDIT: MALCOLM LINTON

After a high-powered attorney intervened, the police freed Afanasiadi the next day without charging her. But Podolyan remained in jail for 4 days. The police also confiscated files from the clinic. Without the staff and the records, the clinic remained shuttered, leading to a massive protest by clients that Saturday that attracted much media attention and sent waves of concern that have rippled far and wide. “This is a very dangerous signal,” says Yuri Kobyscha, an HIV/AIDS epidemiologist who works with the World Health Organization in Kyiv. This site, like most OST projects in Ukraine, is supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The fund's Ukraine portfolio manager, Andreas Tamberg, has strongly condemned the raid and arrests as “a violation of human rights” and “epidemiologically foolhardy.”

Afanasiadi says the raid on the clinic undermines a broader agenda to encourage injecting drug users (IDUs) to seek help and, if they're still injecting, take advantage of other harm-reduction programs such as needle exchange or treatment and counseling for their HIV infection. “IDUs are really hard to connect with any services,” says Afanasiadi. “We invite people into substitution treatment and guarantee anonymity and protection in some ways, and at the end of the day, we can't guarantee them anything.”

Since the raid, events have taken a turn for the worse. On 28 May, the Ministry of Internal Affairs in Odessa indicted and rearrested Podolyan, charging him with 42 counts of illegally distributing buprenorphine. The International HIV/AIDS Alliance in Ukraine, which administers the Global Fund grant to the clinic, held a protest press conference on 3 June, documenting that this case is one of several in which police have interfered with OST programs and appealing to the country's general prosecutor to intervene in what it branded the “systematic unlawful criminal prosecution of narcology doctors.”

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