Tipping the Balance: Legal services are essential to health care for drug users in Ukraine

Abstract from the OSI report by Corinne Carey & Andrey Tolopilo, “Tipping the Balance: Why legal services are essential to health care for drug users in Ukraine”  

The rate of HIV has been on a steady incline in Ukraine, particularly among people who inject drugs. Several agencies have designed programs to help prevent HIV by ensuring access to sterile syringes, providing social services to drug users and people living with HIV or AIDS, and offering treatment for drug dependence, including buprenorphine treatment. However, a new report from OSI and the International Renaissance Foundation finds that few programs in Ukraine offer legal services to people who use drugs — despite the fact that legal services are easy to administer and complementary to health care.

The report profiles five organizations in Ukraine that have successfully integrated legal services into HIV prevention and treatment programs. The organizations—located in Kyiv, Kherson, Lviv, Nikolaev, and Poltava—have increased access to legal services by placing lawyers at locations where drug users already go for needle exchanges, counseling, and referrals to drug dependence treatment. Likewise, the programs have increased access to harm reduction by drawing in new clients who come for the legal services and stay for the HIV prevention services.

[The following section is an abstract from the report.]

With the assistance of international donors, a handful of harm reduction programs and traditional HIV/AIDS service organizations in Ukraine have established legal components to their existing programs. They have engaged a number of different approaches to doing so, from employing a full-time legal professional to contracting with private firms that provide services on an as-needed basis. These programs have increased access to legal services by placing lawyers at sites where drug-users access harm reduction services including needle exchange, counselling, and referrals to substance abuse treatment. Likewise, the programs have increased access to harm reduction by drawing in new users who come for the legal services and stay for the HIV prevention services.

Legal professionals working on behalf of drug users must work under tremendous pressure and with limited resources. Often they double as social workers or case managers, providing clients with moral support even if they can’t succeed in winning a case or dropping a criminal charge. In some cases they take on the role of private investigator, collecting evidence of illegal conduct by police in order to persuade a judge to reduce a sentence. Their work is improvisational and untraditional, often not perfectly captured by the term “legal services.” These legal professionals desperately need resources and technical assistance to meet the overwhelming demand for legal services, and to provide their drug-using clients with the level of professionalism they deserve.

Criminal defence is a critical component provided by harm reduction legal programs. Some programs supplement direct legal services with training for judges and prosecutors about the effect of incarceration on drug users who are sick—either as a result of withdrawal, or from symptoms stemming from HIV or Hepatitis C—and will become sicker while they are incarcerated, creating a bigger burden on society. These trainings are also designed to inform judges and prosecutors about the services that exist in the community to help drug users.