Feature story

Methadone substitution therapy helps prevent new HIV infections in Belarus

02 March 2011

A patient receiving his daily dose of methadone at the Minsk oblast clinic centre.

Twenty-eight-year-old Slava had injected heroin for 13 years. "I always thought I could quit. Just one more injection and quit. But in the end, I realized it was not possible to recover without external help."

So he signed up at the Minsk oblast clinic centre to be part of their methadone substitution therapy programme as soon as it opened in June 2010.

According to the UNAIDS, UNODC and WHO, opioid substitution therapy (OST), with methadone or buprenorphine, is highly effective in reducing injecting behaviours that put people who use drugs at risk for HIV. Also, people using OST have shown better access and adherence to antiretroviral treatment, meaning they are living longer and healthier lives.

"I waited for this programme for a long time,” said Slava. “The most important change in my life is that, thanks to the methadone treatment, I’ve returned to my normal life and I’ve resumed my studies.”

The rehabilitation center at the Minsk clinic which serves around 40 people needs no advertising. People tell friends about their progress and advise anyone who needs help to visit the centre. “Several HIV-positive injecting drug users who were not listed anywhere came to us voluntarily and received methadone as well as antiretroviral treatment here,” said Dr Golubitsky, chief of the substitution therapy cabinet at the clinic.

Several HIV-positive injecting drug users who were not listed anywhere came to us voluntarily and received methadone as well as antiretroviral treatment here

Dr Golubitsky, chief of the substitution therapy cabinet at Minsk oblast clinic

The clinic also provides information on HIV prevention and drug use rehabilitation and refers people to other relevant services like family planning and physiological support as well as information about vocational studies, training and employment.

Substitution therapy with methadone was introduced in Belarus three years ago and has since expanded from one pilot clinic to a network of centres within the state’s health system. Today, over 450 people in eight cities across the country are receiving treatment on a daily basis.

The methadone programme is funded by the Global Fund to fight AIDS, TB and Malaria and its implementation is coordinated by the UN Development Programme.

The country has shifted from zero capacity to provide methadone treatment to having a pool of treatment specialists as well as an established OST treatment protocol. Also the provision of OST services has expanded to provide comprehensive range of services covering different elements of a persons’ life.

Belarus had strict preconditions to joining an OST programme– a drug user either needed to demonstrate several unsuccessful attempts to give up heroin, be living with HIV, or have another infection like hepatitis C. Today, due to the success of the OST programme that policy has changed, and access to these services has been expanded. Under a new order of the Ministry of Health, every person who wants to stop injecting drugs can enter a substitution therapy programme.

Health professionals consider the change a very positive step because it gives an alternative to people who inject drugs. By making it easier for people to access substitution programmes it will in turn decrease the high personal cost of opioid dependence to individuals, their families and society at large by reducing heroin use, associated deaths, HIV risk behaviours and criminal activity.

Injecting drug use in Eastern Europe and Central Asia is the main mode of HIV transmission in the region. Drug users are the most HIV affected group in the population of Belarus with an HIV prevalence rate of 13.7%.