How to Stem Russia’s HIV and Drug Epidemics

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% 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% of all HIV infections.

The Russian authorities have come under strong criticism for their policies aimed at dealing with injecting drug users and the resulting 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, once 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 80% 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% 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 programs 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 an 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 — despite the fact that treatment 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.

Neighboring countries, such as Ukraine and Kyrgyzstan, have proved the effectiveness of drug treatment and harm reduction programs, scaling up the opiate substitution therapy and providing needle and syringe exchange programs.

Although it has been proven 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 the Human Rights Watch finds, "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 suboptimal adherence due to poor quality drug dependence treatment programs."