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 2 million injecting drug users (IDUs), 60 to 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 more than 1 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.
Russian authorities have come under widespread criticism for their policies in 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, prioritizes prevention of HIV infection and transmission, and features needle exchange programs and treatment with substitute drugs taken orally.
It is estimated that 80 percent of 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, 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, a 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) 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 U.N. agencies strongly support their use in prevention and treatment, these substitute drugs are effectively banned by Russian health and law enforcement officials — this in spite of the fact that OST has been shown to reduce HIV prevalence and the risk of HIV transmission. It also has been shown to reduce the numbers of IDUs, according to the World Health Organization.
Although it has been proven that appropriate psycho-social 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 increased risk of the spread of HIV and the development of drug-resistant HIV strains due to a lack of access by drug users to antiretroviral treatment and their suboptimal adherence to poor-quality drug- dependence treatment programs.”
Cesar Chelala, M.D. and Ph.D, is an international public health consultant and the author of “AIDS: A Modern Epidemic,” a publication of the Pan American Health Organization.