To defend her access to life-saving opioid substitution therapy, Marzhan Zhunusova overcame her fear of flying and, for the first time, took a flight to Astana, the capital of Kazakhstan. She was visiting the city to take part in a country-wide mobilization of people accessing the country’s harm reduction pilot programme, with people from all over Kazakhstan publicly showing the importance of opioid substitution therapy.
After injecting drugs for more than 25 years, Ms Zhunusova had lost hope for a better life. “When I first heard about opioid substitution therapy, I thought that it may be the way out and that it could help me. Drugs, my HIV-positive status, I thought my life was over. I’m 45 years old and only now thanks to methadone have I started to live life fully.”
The campaigners marched in Astana on 27 June and were joined by activists from other groups, including people living with HIV and gay men and other men who have sex with men.
The people who mobilized for the event share similar backgrounds. Their use of drugs may have deprived them of their health and their dreams. Some do not have jobs or have served time in prison. Many are isolated from society and the majority are living with HIV.
Ibrahim Dolgiev tried drugs for the first time in the 1970s, when he was 22 years old. “After many years of trying to stop using drugs, for the past year I’ve been in the opioid substitution therapy programme. It has been a salvation for me. My life has changed dramatically for the better, and for the first time in many years I can get through the day without heroin,” he said.
The people taking part in the mobilization came together to express their hope that the opioid substitution therapy programme will remain and that it will be further expanded.
In partnership with international and national partners, UNAIDS provided the Government of Kazakhstan with evidence-informed arguments on the effectiveness of opioid substitution therapy in controlling the HIV epidemic among people who use drugs.
“Access to opioid substitution therapy is one of the main factors enhancing adherence to antiretroviral therapy among people who use drugs,” said Alexander Goliusov, the UNAIDS Country Coordinator in Kazakhstan.
“Over the past three years, people who use drugs in the opioid substitution therapy pilot project in Pavlodar demonstrated 100% adherence to antiretroviral therapy,” said Zhannat Musaevich Tentekpayev, Chief Doctor of the Pavlodar AIDS Centre.
Unfortunately, however, the future of the programme in Kazakhstan remains uncertain, and no one has been enrolled in the programme since December 2017.
At the end of June 2018, a government commission announced that the pilot programme would continue, but that it would not be expanded to other regions of the country. An investigation into the cost-effectiveness of the programme is under way and the results will be presented by November. The Kazakhstan Union of People Living with HIV has appealed to the President of Kazakhstan not to close down the programme, noting that support for effective national responses to HIV is critical to making progress towards the 90–90–90 targets.
"While the law enforcement agencies are deciding whether the opioid substitution therapy programme is appropriate or not, the number of people accessing the programme remains very limited. The programme has to be not only maintained, it must exit its pilot status and be available and accessible everywhere in Kazakhstan for people who inject drugs,” said Oksana Ibrahimova, the coordinator of the Kazakhstan Union of People Living with HIV.
Today, there are 13 opioid substitution therapy centres in Kazakhstan, in nine of the 16 regions of the country. Since the beginning of the programme in 2008, more than 1000 people have been enrolled. Currently, 322 people are enrolled in the programme, the majority of whom have stopped using drugs, become employed and are enjoying a family life.
