Based on six years of work documenting human rights violations in post-Soviet countries, including Ukraine, we have concluded that access to medical services for people who use drugs in prisons is either nonexistent, nominally available, or offered under such conditions that prisoners are forced to decline assistance. Harm reduction programs, antiretroviral therapy (ART), and treatment for tuberculosis and hepatitis are often inaccessible or of poor quality, despite international pressure and the ambitions of some countries to join the European Union.

Over six years, we documented 3,367 cases of human rights violations related to the lack of medical care for people who use drugs in prisons. Of these, 1,256 involved denial of opioid substitution therapy (OST), and 2,879 were linked to the refusal of access to HIV, tuberculosis, and hepatitis C treatment. In six countries in the Eastern Europe and Central Asia (EECA) region, we found that 70% of prisons had no access to harm reduction programs, and 75% of prisons provided OST only nominally or in critical situations, such as after imprisonment.

Qualitative data confirms that even when medical services are available, the conditions under which they are provided are often humiliating for prisoners. For example, 68% of prisoners interviewed in our research said they refused medical assistance due to fear of stigmatization or poor treatment by medical staff. In some cases, prisoners were threatened with physical punishment or further repression for attempting to seek treatment.

The root of the problem lies not only in the lack of resources or infrastructure but also in the stigma held by those responsible for enforcing laws. The legacy of the Gulag, punitive approaches, and deep-seated stigma towards marginalized groups persist in the culture of post-Soviet societies. True change must start with shifting societal and institutional values.