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)

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New York City Kicked off the global protest on the eve of World AIDS Day, and were followed by 12 other cities

POST Press Release (please feel free to share this post on your website, but remember to link it back to here! Thanks!)

On World Aids Day, 2011, just a few short days ago, harm reduction organisations led by people who use drugs and supported by the International Network of People who Use Drugs (INPUD) gathered outside Russian embassies in cities across the world in the largest ever global show of solidarity by and for people who use drugs.

The protests, entitled ‘Shame Russia Shame’, was directed at Russia’s highly controversial drug policies which are believed to be driving the EEC regions HIV and TB epidemics. Injecting drugs with contaminated equipment is driving Russia’s HIV epidemic, now the fastest growing in the world and it is reflected in the numbers; as many as 80% of new infections are occurring amongst people who inject drugs (PWID), in a total HIV positive population of approx 1.3million. With this in mind, recent projections forecast an additional 5 million people could become infected with HIV in the near future, unless Russia drastically transforms the way it is dealing with its HIV pandemic.

INPUD member Erin O'Mara says Russia's drug policies are 'brutalising'

Erin O’Mara, (editor of UK’s Black Poppy Magazine and INPUD member) who coordinated the global protest said the human catastrophe unfolding in Russia is almost indescribable in its brutality and neglect.”Russia has more heroin users than anywhere in the world yet because they offer no safe alternatives such as methadone or buprenorphine, and corruption has driven the price of heroin above what many Russian users can afford, new home made concoctions like desomorphine (nicknamed krokodil) are gaining ground, with devastating health consequences for the user”. Erin adds, “To scratch the surface of Russian drug policies, you find some of the most brutalizing policies in the world; where their should be harm reduction, regulation, treatment and support, there is neglect, abuse, imprisonment, disease and death.”

New York City groups Harm Reduction Coalition and Vocal NY, led the first of the World Aids Day demos, reading speeches and presenting a statement of demands to the Russian Embassy, which included the demand for Opiate Substitution Therapies (OST) such as methadone to be both legal and accessible to the 2 million or more injecting drug users in Russia.

Mexico lays its candlelight vigil in memory of those who have died of AIDS.

Mexico soon followed, again on the eve of World AIDS Day, with their protest led by Espolea, an organisation who’s young people delivered their heartfelt candlelight vigil to remember those who have died of AIDS and those with HIV facing so much oppression in the Russian Federation. It was a very generous tribute from our young colleagues in Mexico at a time in the drugs war when they are facing such enormous troubles of their own. (see video below).

As December 1st -and World AIDS Day dawned,  the global domino effect began and cities from Canberra, Edinburgh, Barcelona, Berlin, Bucharest, London, Paris, Porto, Stockholm, Tblisi, Toronto, delivered their protests, and a unified SHAME RUSSIA SHAME rang out in front of Russian Embassies across the world.

Londons' Russian Embassy Protest

Speeches were given and a statement of demands were delivered to the Embassies which included demands to see the introduction of Opiate Substitution therapy (OST) and the scale up of needle and syringe programmes, which although currently funded by outside NGO’s and not by the Russian Government, numbers of services are still shockingly inadequate, with around 50 odd for the entire Russian Federation.

The city of Tblisi also took a brave step and protested outside their Swiss Embassy, which currently stands in for the Russian embassy which has been removed from Georgia for political reasons. Nevertheless, Georgians who have also seen the emergence of the drug Krokodil from across the Russian border were keen to show solidarity with their Russian drug using peers, as history has meant they were very aware of the might of the Russian police forces and their attitudes towards drug users. Georgians took a huge risk protesting in Tblisi but seemed buoyed by recent workshops in drug user organising and empowerment and peerwork with INPUD.

New Vector, in Tblisi in support of their Russian peers, and raising awareness of krokodil

Demonstrators had the special opportunity to read out a letter from Russia, from an INPUD member and drug user activist named Alex, who spoke directly to his peers across the world about Russia’s indifference and the strength he gains from a unified drug using community.

Alex writes: “To my despair, I live in a country where the means don’t justify the ends Where it’s easier to save the lives of healthy people by destroying those who are sick. Where ethics and humanity have given way to contempt and cruelty. Where they evaluate prevention not in terms of possibilities and outcomes but dollars and popularity. I express my deepest gratitude to all of you who share my protest.  For me, World AIDS Day does not exist in Russia. For me World AIDS Day in Russia means white carnations and condolence cards.I’m alive today thanks to your help and your faith in our united strength. I wish us resilient spirits, and that love fills all of our homes. I’m with you today.”

It was an exciting, moving and empowering event for all concerned, however everyone

The white slippers and carnations outside the Russian Embassy in Canberra, Australia

was acutely aware that Russian themselves were simply not safe enough to protest on World AIDS Day, no matter how peacefully. Although this protest had its roots in Moscow in 2009 on International Drug User Day, when 5 Russian activists were arrested after trying to lay red carnations and white slippers (the Russian symbol for the dead) at the steps of the Drug Control Service, the protest expanded on International Remembrance Day 2011. 3 countries took part and (Budapest, Berlin and Barcelona) remembered their peers outside Russian embassies, again laying the symbols of the protest. This world AIDS Day,was a call out to the world that we will not let our Russian peers be forgotten -that we will stand side by side them as we all fight to ensure that Russian citizens have the right to humane, evidenced based, enlightened drug policies and treatment.

For more information and/or quotes from INPUD members and city organisers, please do not hesitate to get in touch with INPUD.

Contact: INPUD Deputy Project Co-ordinatorL eliotalbers@inpud.net who can put you in touch with the right person or answer your questions.

NOTE: A huge thank you to the global coordinators based in London – Women of Substance, Black Poppy Magazine, and Ava Project (London)- -and our partners in Eastern Europe Andrey Rylkov Foundation, Eurasian Harm Reduction Network and all those organisations who took part in this event. INPUD members;  Plataforma Drogologica (Barcelona), Deutsch AIDS Hilfe (Berlin), Harm Reduction Coalition, Vocal NY (New York City) ,ASUD, Cannabis Sans Frontiere (Paris), AIVL, NUAA, CAHMA (Canberra)  CASOP (Porto) Association Intergration (Bucharest),Svenska Brukarforeningen (Stockholm), New Vector (Tblisi), CounterFit (Toronto) Chemical Reaction (Edinburgh) , Espolea (Mexico City)

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 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.

Dec 1st 2011

In Russia today, we are bearing witness to one of the biggest, avoidable catastrophes in the history of HIV – the lack of response to the epidemic in Russia. We must point directly to the specific responsibility that Russian medical and public health officials bear for creating and sustaining this disastrous situation. Of particular concern are Russia’s, brutalising drug policies and its recently revised Total War on Drugs, which has resulted in further pushing people who use drugs into hiding, prison, and enforced detention, and severely compromising efforts from the international community to revert the trajectory of HIV/AIDS. The world is approaching a crossroads; a strong and decisive downward trajectory in the epidemic is possible in all countries -but it will only happen if the people who are most vulnerable to infection are supported and their human rights realised. Governments have legal obligations to act. Indeed, the implementation of harm reduction measures is consistant with and required by states obligations under international human rights law. 1,2.

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Russian Drug Policy can lead to an additional 5 million people becoming infected with HIV in the near future.

MOSCOW, October 7, 2011 — On October 10–12, 2011, in Moscow, the Russian Government has organized the International Forum “Millennium Development Goal 6 in Eastern Europe and Central Asia”. Representatives from the scientific community, civil society and government will participate in the Forum. Millennium Development Goals are the targets that 193 UN member states, as well as over 20 international organizations, have pledged to reach by 2015. The Millennium Development Goal 6 (MDG 6) aims to slow down and begin to reverse the HIV/AIDS epidemic by the year 2015, including in Russia.

However, today the growth of HIV incidence has not been contained, and in fact HIV incidence continues to grow. By December 31, 2010, 589,581 people with HIV were registered in the Russian Federation, compared to 529,828 people with HIV registered in 2009. Sharing of non-sterile syringes by injecting drug users remains the main route of HIV transmission – over 59.2% of all registered HIV cases, according to the Federal Scientific and Methodological Center for AIDS Prevention and Control. According to the Federal Agency for Drug Control (FSKN), there are estimated 5 million drug users in Russia. Thus, today 5 million people are under threat of contracting HIV, and in the future the epidemic in Russia could take catastrophic proportions.

“Clearly, in this situation HIV prevention among drug users must be a priority for Russia”, says Alexandra Volgina, activist, person living with HIV; Chair of the charity foundation Svecha. “In many countries that had to face drug dependence long before Russia and had similar epidemic situations, it was possible to significantly reduce HIV spread among drug users by implementing harm reduction programs. These programs include methadone substitution therapy and needle and syringe exchange. But the current Russian policy denies these methods that are accepted worldwide and recommended by the UN. This denial is not based on evidence.”

The emphasis of the fight against HIV in Russia is on using ineffective prevention measures in the background of repression against drug users and creation of an atmosphere of public intolerance towards people who use drugs. However, global experience shows that the spread of HIV in this group can be reduced also through changing drug policies to ensure their conformity with public health and human rights principles, and abandoning the repressions.

“There is an obvious connection between the spread of HIV among drug users and human rights”, says Mikhail Golichenko, Senior Policy Analyst at the Canadian HIV/AIDS Legal Network. “However, currently the Russian policy reflects quite the opposite of the developed countries’ experience.

Repressive Russian drug policy deprives people who use drugs of the right to health and the right to life itself. Harsh law enforcement measures result in drug users going “underground”, contracting infectious diseases, using prescription drugs and mixes and dying from overdoses; enforcement measures also result in the growth of the prison population. Together with a tuberculosis epidemic – at the end of the year 2009 there were 262,718 people with active tuberculosis registered at the Russian TB treatment facilities, – this makes achieving MDG 6 by 2015 absolutely impossible for Russia.”

Here are just some practical examples: the Russian government‘s estimated annual expenditures related to drug law enforcement (Articles 228-233 of the Russian Criminal Code) equal 2 billion 878 million 750 thousand rubles, or about 100 million US dollars. This amount does not include the money spent on detention and imprisonment.

To compare, only 20 million US dollars was allocated to HIV and hepatitis B and C revention among all population groups in 2011. The same amount will be allocated to HIV and hepatitis B and C prevention among all population groups in 2012 and three times less will be allocated in 2013. Considering the context and tendencies in the development of the HIV epidemic in Russia, clearly such policies are not leading to any positive results.

“No money at all is allocated towards HIV prevention among injecting drug users”, says Anya Sarang, President of the Andrey Rylkov Foundation for Health and Social Justice. “However, at the Moscow Forum on October 10-12 the Russian Government is planning to take on a leadership role in combating the HIV/AIDS epidemic in Eastern Europe and Central Asia. If Russia is acknowledged as the regional leader for reaching MDG 6 and its drug policy will continue to be based on repressive measures,then undoubtedly the region will become involved in a new round of mass human rights violations. This would lead to an HIV outbreak, new AIDS-related deaths, overdoses, denial of medical help based on discrimination. At the same time, economic and financial expenses necessary for effective prevention and for reaching MDG-6 will keep growing. Currently, a few days prior to the MDG 6 Forum, Russian and international nongovernmental organizations (NGOs) are appealing en masse to the Russian Government. One of these appeals says that the Moscow MDG 6 Forum, is a magnifying glass, allowing us to see these problems and Russia’s neglect of its own HIV epidemic and of the people who are at the highest risk.”

“To change the situation, the Russian Government must radically change the useless and expensive methods of combating HIV and the repressive policy towards drug users”, says Ivan Varentsov from the Eurasian Harm Reduction Network. “Before the opening of the MDG 6 Forum we want to call upon the Russian Government to support the necessary prevention programs for those at the highest risk of HIV, including substitution therapy and needle exchange programs. Otherwise, tackling the HIV epidemic and reaching the MDG by 2015 will be impossible.

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.

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