By Dr. César Chelala
NEW YORK: Russia has one of the world’s most serious epidemics of injection drug-use, according to the World Health Organization (WHO) and UNAIDS. It is estimated that Russia has two million injecting drug users (IDUs), 60-70 percent of whom have HIV-related illnesses. In the past decade, the number of HIV-infected people has increased from an estimated 100,000 to over one million.
Sharing syringes by injecting drug users is the most prevalent cause of HIV transmission in Central Asia and Eastern Europe, where it is responsible for more than 80 percent of all HIV infections.
The Russian authorities have come under strong, widespread criticism for their policies aimed at dealing with the IDU/HIV epidemic. Education to control drug abuse has focused primarily on the promotion of drug abstinence. In addition, officials have relied on criminalization as the main deterrent. That approach has created obstacles to effective addiction treatment and HIV prevention.
Another policy, which has proven effective in other countries, is “harm reduction.” This approach, one dismissed by the Russian authorities, puts prevention of HIV infection and transmission first and features needle exchange programs and treatment with substitute drugs taken orally.
It is estimated that eighty percent of those Russians who are HIV positive became infected by using contaminated needles and syringes. However, despite the proven efficacy of harm reduction strategies in HIV prevention, the Russian authorities have failed to take advantage of them. A 2004 UNAIDS survey found that funding for needle and syringe exchange programs in Russia fell by 29 percent between 2002 and 2004 while the incidence and prevalence of infection and numbers of IDUs was on the rise.
Harm reduction strategies involve providing access to the drug methadone, needle exchange program and addiction counseling. While detoxification is widely available throughout Russia, more comprehensive, longer term treatment remains unavailable in many parts of the country. This failing is critical because research has shown that detoxification by itself is not effective treatment.
Russian law prohibits opiate-substitution therapy (OST) employing oral dosing with methadone or buprenorphine. Use of these drugs, however, has been shown to be the most effective approach for dealing with opiate dependence among IDUs. Although UN agencies strongly support their use in prevention and treatment, these substitute drugs are effectively banned by Russian health and law enforcement officials. This prohibition happens in spite of the fact that OST with them has been shown to reduce HIV prevalence and the risk of HIV transmission. It also has proven to reduce the numbers of IDUs, according to the World Health Organization.
Although it has been proved that appropriate psychosocial counseling is essential for a successful drug addiction treatment, Russian officials also fail to offer such counseling during and after detoxification treatment.
The close relationship between injecting drug use and HIV infection stresses the need for effective drug addiction treatment strategies. As stated by Human Rights Watch, “If Russia doesn’t take steps to address the problems of its drug dependence treatment system it runs the risk of continued and increasing spread of HIV, and even drug resistant HIV strains, due to lack of access by drug users to antiretroviral treatment and their sub optimal adherence due to poor quality drug dependence treatment programs.”
Dr. César Chelala is an international public health consultant and the author of “AIDS: A Modern Epidemic,” a publication of the Pan American Health Organization.