Pangaea Partners with Clinton Foundation in Ukraine

In November of 2005, the Clinton Foundation announced a new HIV/AIDS partnership with the government of Ukraine, as former President Clinton and Ukrainian Minister of Health Dr. Yuri Poliachenko signed an agreement enabling the Clinton Foundation to assist the government of Ukraine in scaling up their national HIV/AIDS treatment program. The Pangaea Global AIDS Foundation, led by Eric Goosby, M.D., is serving as a treatment partner for this initiative. Pangaea has played a similar role in China since May 2004 as part of the Clinton Foundation HIV/AIDS Initiative (CHAI) in that country.

The Clinton Foundation and the Ukranian government have identified four priority areas for collaboration:

• Obtaining antiretroviral drugs (ARVs) at international prices
• Strengthening regional clinical teams in HIV/AIDS care
• Introducing and scaling up substitution therapy for injection drug users (IDUs) in conjunction with the provision of ARVs
• Strengthening pediatric care for HIV infection

Ukraine, where the rate of HIV infection is estimated at 1.4 percent, is one of the countries in Europe most affected by HIV/AIDS. Since the beginning of the epidemic, over 88,000 people have been officially registered as HIV positive. Of these, 13,000 have been diagnosed with AIDS and over 7,500 have died. These numbers represent only a small fraction of conservative estimates that put the total number of people living with HIV at 377,000. Widespread use of intravenous drugs remains the main driver of the HIV/AIDS epidemic in Ukraine, with about 70 percent of HIV-positive people either being IDUs or partners of IDUs. Although the majority of IDUs are young men, a significant proportion (23 percent) of those diagnosed in 2004 were women. According to a national study conducted by the Ukrainian Ministry of Health, high-risk behavior remains prevalent among IDUs, with only 20 percent reportedly practicing safer sex and trying to avoid sharing needles.

The Pangaea team, including Dr. Goosby, Barbara Lawson, and Julia Martin, in close cooperation with their CHAI colleagues, is concentrating its initial efforts on a new program in the province of Dnipropetrovsk that is aimed at bringing injection drug users (IDUs) into treatment for both their addiction and their HIV.

According to Dr. Goosby, "We are seeing the intersection of HIV and injection drug use in our work throughout Asia, North America, and Europe. It's vitally important to find new ways to overcome the double dose of stigma and fear surrounding addiction and AIDS, as well as dealing effectively with the more complex medical issues that these patients present. If we don't bring injection drug users into treatment, we stand no chance of stopping the spread of HIV in places like Ukraine and China where drug use is driving the epidemic."

The new program in Dnipropetrovsk, which should begin rolling out later this year, will focus on developing a model for integrated HIV and substance use treatment in order to maximize quality of life for IDUs and reduce the risk of HIV transmission. The program will provide a full range of health-care services tailored to IDUs, including active methadone substitution therapy. Given that methadone is not currently available in Ukraine, the CHAI team will work with its partners in the Ministry of Health to see methadone become licensed and accessible for substitution therapy. The team will help develop new sites for methadone substitution therapy and assist in the mentoring and training of health-care providers, so that access to this form of treatment can be expanded in conjunction with the provision of ARVs.