Reuters Report from Russia

HIV/AIDS prevelance worldmap

HIV prevalence world map

By Amie Ferris-Rotman

MOSCOW | Wed Dec 21, 2011 5:32pm EST

(Reuters) – In 2010, President Dmitry Medvedev said heroin was a threat to Russia’s national security. This year, Russia pledged to finance programs to reduce the harm done by drug use, including an HIV crisis that is one of the most severe in the world.

But even though the number of new HIV infections in Russia jumped 10 percent over 2011, health workers and global HIV authorities say Moscow has not honored that promise.

This is not due to a lack of cash – Russia is doubling its budget for HIV in 2012 from 2010 levels. At issue is how it will use the funds. From next year, no money will go to such internationally recognized efforts as needle exchanges. None has ever gone to heroin substitution: the Russian authorities oppose it. Moscow doesn’t believe these approaches help slow the spread of HIV/AIDS.

“Working on drug dependency is more effective than needle exchange and methadone programs,” said Alexei Mazus, who heads the Moscow Centre for HIV/AIDS Prevention, one of around 100 such venues across the country run by the health ministry.

In areas where needle exchanges have taken place, he said the health ministry had seen new HIV cases increase, not fall. Russia’s health ministry said last year it had evidence that HIV rates have tripled in areas where foreign-run needle exchange programs were running.

The United Nations says so-called “harm reduction” programs – needle exchanges, and using methadone as a substitute for heroin – are effective in slowing the spread of HIV. Methadone reduces the risk of infection by dirty needles because it can be swallowed, rather than injected.

A major WHO study found HIV rates fell more than 18 percent in cities with needle exchanges, while they rose 8 percent in areas that did not have them. The British and U.S. governments both approved needle exchanges in recent drug policies drafted to combat HIV. But in Russia’s drug strategy for 2010-20, heroin substitutes are banned.

Projects such as giving drug users and sex workers clean needles, HIV awareness training and medication have been funded by the United Nations in Russia for the last seven years. Next year that funding comes to an end and with it, so will most of these schemes.

Some health workers and global HIV authorities are angered and baffled by Russia’s approach, which they say will only aggravate the problem.

“When a few programs were funded and running it was then difficult to see how things could get worse. Now we know,” Damon Barrett, a senior human rights analyst at Harm Reduction International in London, told Reuters.

RICH RUSSIA

Separated from world no. 1 opium producer Afghanistan by former Soviet Central Asia, whose borders are porous, Russia has more heroin users than any other country. Moscow puts the total at two million, although the United Nations says there are half a million more, and local non-governmental organizations (NGOs) say there could be as many as three million.

This year, Russian health officials estimate 62,000 people were newly infected with HIV, a 10 percent increase on 2010 and the upper limit of a prediction made last year by the International AIDS Society. Officially, Russia has had almost 637,000 cases, including over 100,000 deaths in the year to November.

The UN puts the number of people living with HIV today in Russia at over a million.

Since 2004, NGOs in Russia have received a grant from the UN’s Global Fund to Fight AIDS, Tuberculosis and Malaria. The Fund says the $351 million it has provided has reached half a million Russians. It has supported over 70 harm reduction programs across the country. The 20 or so that remain will stop receiving UN money at the end of this month.

This is for two reasons, says Nicolas Cantau, fund portfolio manager for Russia at the Global Fund. First, Russia has become richer, and the Fund’s resources can be given to impoverished countries. For rich countries to be eligible for Global Fund resources, 10 percent of the population must be infected: South Africa is the only country in the Group of 20 richest nations to qualify.

Russia has been a donor as well as a recipient, and has given the Fund $265 million up to date. But the Fund now wants something in return: It says Russia should begin financing its own harm reduction programs.

BROKEN PROMISE

At a United Nations meeting in New York in June, Russia pledged to do just that from this year. Its deputy health minister Veronika Skvortsova said Moscow also gave “general support” to a declaration for “Zero new infections, zero discrimination, and zero AIDS-related deaths”.

A spokesman for the health ministry said Russia has put aside money for free HIV testing, for the first time ever. But he declined to comment in detail on why harm reduction programs have yet to materialize. “They are not considered useful in fighting this disease,” he said. Some health workers are incensed.

“As it turns out, they were tricking us,” said Anya Sarang, who heads the Andrey Rylkov Foundation for Health and Social Justice, a small Russian NGO. “Now we are in the final month of the year. Have they actually done anything? No,” Sarang said.

The Global Fund’s Cantau is dismayed. “All the things that we have done will be lost without further funding,” he says. “It is disappointing”.

PREVENTION BY COUNSEL

Russia has put aside around $600 million for HIV in 2012 – double what it had in 2010 – but only 3 percent of this will go towards prevention. Some money will go to HIV tests, and Moscow says it also provides free anti-retroviral drugs for all sufferers of the disease, although the UN says only a quarter of those in need actually receive them.

No funds will go to needle exchanges. Instead, Russia’s HIV/AIDS Prevention Centres will try prevent HIV with anti-drug adverts, and treat HIV with psychological counseling.

Mazus, the head of the Moscow Centre, said HIV sufferers need to grieve through counseling, which will also prevent them from passing on the disease to others.

“HIV is a behavioral disease. It’s not being transferred in everyday life. It is not dangerous,” he told Reuters.

Such views are scorned by foreign health bodies.

Instead of making good its June promise, Russia has “ramped up repressive measures known to fuel HIV”, said Harm Reduction International’s Barrett. He pointed to the ban on opiate substitution therapy.

 

“AGGRESSION”

 

Concerns have spread beyond health workers. On World AIDS Day, December 1, a drug-users’ network organized protests at 12 Russian embassies from New York to Stockholm to Canberra.

Hundreds of protesters rallied and held candles, some holding signs accusing the state of murder for its refusal to legalize methadone, while others held large red banners heaping shame on Russia.

The protests’ coordinator, Erin O’Mara, also editor of “Black Poppy”, a British magazine for drug users, said “the spotlight was on Russia and its shameful lack of response and indeed inappropriately aggressive, state-sponsored aggression towards… people who use drugs”.

In Moscow, protesters played funeral music and held up coffins as they paraded past the health ministry. The ministry declined comment.

Some foreign health workers in Russia fear its endemic corruption could make it hard for them to access what funds are available for HIV prevention

“It will be very tough to find money. We fear that the state’s funding for HIV will be pre-awarded,” said Yelena Agapova, from the AIDS Foundation East-West (AFEW), a Dutch organization set up in Russia 10 years ago.

Like dozens of NGOs in Russia combating HIV, her organization has received the bulk of its support from the Global Fund. It runs mother-to-child HIV prevention programs, prison HIV prevention and safe sex campaigns.

Though its Moscow office will stay in place with a skeletal staff, it says it will “significantly” downsize its projects from next year. Only a handful of similar organizations will continue working once flows from the Global Fund stop over coming weeks. They will be financed from Western awards and George Soros’ Open Society Foundation.

Harm Reduction International’s Barrett says the impact will be catastrophic: “It is a human disaster that Russian authorities are willing to watch unfold,” he said.

(Additional reporting by Catherine Koppel; Editing by Sara Ledwith)

The Rot is Setting in Across Russia

This issue goes straight to the heart of why we are protesting this world AIDS day.

 As methadone or other opiate substitution therapies look further away than ever for Russians, people are having to make their own concoctions; but by looking in desperation for something opiate based and cheap, Russian drug users have uncovered what is perhaps the most distressing and concerning issue to arise in the drugs field for a long time. As someone who has lived and worked within the drug field for 30 years, I personally have never seen a drug -or the situation that surrounds its use – that is as brutal as this; home made Desomorphine, or Krokodil.

Although invented in 1932 in Switzerland desomorphine was apparently invented in the USA in 1923 as a pharmaceutical preparation and was used in Switzerland under the trade name Permonid (strong opiate, fast onset, short duration). However, it doesn’t appear to have taken off as a drug due to its high addiction potential and short duration but it has appeared on the blackmarket, popping up in Siberia in 2002 and rapidly spreading across Russia. Over 7000 people were believed to have died from it only last year, a sharp rise from only a few hundred the years before.

Krokodil, named for the way it makes the skin scale, turn green and die, seems more to pertain to the extremely hazardous way it is made, using ingredients as mentioned in the article below. Extracted from codeine tablets which are bought for around £2 a pack, chemicals such as iodine and other extremely harsh solvents and the red phosperous scraped from match boxes, all get injected . Quickly they conspire to damage the nervous sytem, and rot the bone and skin from the inside, first targetting the softer thinner bones and tissue such as  thejaw and fingers and toes. I will be putting a selection of Krokodil articles on this post, and information on what Russia is doing on the issue. So far Russian officials have only sought to ban pain killers from over the counter sales, (to be available only on prescription), however this will only serve to blur the issue. The black market is alive and well in Russia, and pills and pharmaceutical drugs are rapidly emerging through various ‘other’ channels such as the internet. Russia needs real solutions, that deal with the issue itself, such as peoples dependence on opiates. Maintenence drugs like methadone would go a long way to helping prevent the desperation people feel when in the grip of a drug dependence.

Additionally, reports have Krokodil recently spreadng to Germany. Unless someone makes Russian officials wake up and implement harm reduction such as OST (methadone and buprenorphine), Needle exchange, and legalises effective drugs advice and information etc -we are going to see this death and destruction of lives continue to spread further than Russia.People who use or inject drugs have a right to access health services just like anyone else and be treated humanely and equally. The multiple concerns facing this marginalised and ultimately vulnerable population is creating a human catastrophe. We cannot continue to ignore this situation or these people, drug users are brothers, sisters, mums and dads -they are you, they are us.

For a link to an Independent article on Krokodil, click here. But please have a look at the videos below, I warn you they are extremely graphic and upsetting. And please, if you are moved to act, join us on Dec 1st at cities around the world, (see protest page above) or comment below to get in touch.

Why the Russian Drug Czar is WRONG!

The Russian drug Czar does not believe methadone maintenance is effective: HE’S WRONG!

Russian drug users have a right to health!

DEMAND THAT RUSSIA PROVIDE ACCESS TO METHADONE

russia_methadoneFACTS  Read the facts from Harm Reduction Coalition NYC -print out the flyer

Recently finishing his first year as exec Director of UN Office on Drugs and Crime, Yury Fedotov caused concern among civil society by giving the head of the Russian Federation’s Service for Drug Control, Victor Ivanov, prime position when this year’s UNODC’s World Drug Report was launched. When questioned as to Russia’s refusal to support opiate substitution treatment, Ivanov explained that “We can conclude there are no clinical trials to prove the effectiveness of this method [methadone] (For a short film about his response, click here). This alarming statement is indicative of either an extremely worrying lack of awareness for a man who is at the head of Russian drug control, or shows an unbelievable ignorance -whichever is correct, it shows him to be out of step with the vast majority of experts, scientists, doctors and researchers -as well as UN and WHO recommendations and conventions. This includes the UNODC which has firmly come down on the side of treating drug dependence as a health -not a criminal -issue.

Drug users to be jailed in Russia

Coat of Arms of the Russian Federation (1993-p...

Changes to the criminal code will see repeat drug users jailed in Russia

Here is a news item published in RT news during October as Russia made moves to change its criminal code, so that people who used drugs who were repeatedly caught, would automatically face jail or enforced rehab. They are planning to roll out state run treatment programmes in Russia which is disconcerting to say the least when looking at the current state of health care in Russia and the punitive treatment approaches for people who use drugs. How Russia plans to cope with its 2million strong drug using population if its forces them into rehab and jail isn’t clear, but it certainly throws up a red flag for human rights and harm reduction based organisations around the world.. Click here for the link to RT video on this. Below is the news report from RT.

Published: 06 October, 2011, 21:19 Follow link for this news story in full from RT  The country’s anti-drugs agency has drafted changes to the Criminal Code that would see repeat drug users go to jail.

The agency proposes to outlaw drug abuse, which covers any use of drugs prescribed for medical reasons. Those caught using drugs will be either sent to prison or sent to obligatory rehabilitation centers.

“Passing prison sentences for drug users is not our target,” said Sergey Yakovkev, aide to the head of Russia’s anti-drugs agency. “We want it to be an additional legal mechanism that would cause people to quit drug abuse.”

In 2004, the laws on drug use were significantly relaxed. When caught, drug users could simply pay a fine between 500 and 1,000 rubles or be detained for a maximum of 15 days. Instead of paying a fine, an offender could agree to call a doctor and go through voluntary treatment.

Annually, Russian anti-drug services confiscate more than three tons of heroin and arrest more than 100,000 people, while 7,500 people die of drug overdoses. In total, there are around two to six million drug users in Russia (according to different estimates) – five per cent of the able-bodied population.

The criminalization of drug abuse has been discussed for years, and the subject is still a source of much debate.

“Any civilized country pulling itself out of a drug crisis has done the following: on the one hand, it has criminalized drug use, while on the other, it has opened the door to medical and social rehabilitation,” Evgeny Roizman, director at City Without Drugs Foundation, told RT. “This has had a huge impact. But since we don’t have any law on compulsory medical treatment, this measure will only go halfway.”

“This idea is despicable for two reasons,” Oleg Zhukov, doctor and member of Public Chamber, told RT. “First, I think it’s immoral to jail a person for being sick. And second, this measure will only increase the number of drug addicts. When they get out of prison, people have a criminal mentality based on violence. And violence in any form is exactly what pushes them to drugs.”