Here is the 2nd text from Alexei Kurmanaevskiisey, the 30 year old Russian user activist who recently spoke at the United Nations on behalf of people who use drugs in Russia and some of its surrounding regions/countries, where as much as 80% of new HIV infections are amongst people who inject drugs. Yet OST (such as methadone or buprenorphine are illegal / imprisonable offenses), needle and syringe access programmes are virtually non existant, there is no access to Hep C meds at all, TB treatment is totally outdated – access to HIV meds if you use or have used drugs is very limited and the list goes on. This was Alexei’s ‘Intervention from the Floor, Panel 5, as he spoke about the realities of HIV and TB for people who use drugs, on the 10th June 2011, at the UN in New York.
You can watch Alexei’s intervention here (at 1.20 mins)
Irina Teplinskaya was one of the advocates from INPUD who worked with the WHO and UNAIDS on the development of a TB Advocacy Guide for People who Use Drugs. INPUD would like to commend the UN’s commitment to building TB advocacy capacity among drug user activists so we can advocate for high quality, appropriate and integrated services for people who use drugs who are affected by TB.
People who are living with HIV and use drugs in Eastern Europe and Central Asia are extremely vulnerable to tuberculosis. Access to health care by people from my community is extremely low due to the high levels of stigma in the health care environment. Repressive legislation has lead to high concentrations of people who use drugs in prisons, which are a major source of tuberculosis.
I also want to draw your attention to the lack of HIV and TB prevention services among people who inject drugs. This is due to many reasons, among them the lack of contact between health services and the drug using community. Harm reduction programs that can solve this problem and ensure the involvement of drug users in HIV and tuberculosis prevention programs receive inadequate political and financial support across our region.
Diagnosis and treatment of TB in our countries is carried out contrary to WHO guidelines and recommendations, Directly Observed Therapy – DOTS – is not actually applied, and the sole use of X-ray detection leads to late diagnosis particularly among people living with HIV.
Treatment of tuberculosis is isolation of the patient for the entire period of treatment, which can last from 6 months to one year.
The mandatory long-term stay in hospital without Opiate Substitution Therapy results in the patients themselves unable to remain in hospital throughout the course of the treatment, or we end up being expelled from hospital for illicit drug use within the confines of the medical ward. As such, we lose the opportunity to complete treatment and this is often the reason we have such high levels of drug resistant TB.
The result of OST being denied to patients with TB in hospitals in our region has meant that in some cities nearly 100% of people who use drugs living with HIV are unable to complete adherence or their treatment is regulary interrupted.
All this leads to the development of drug-resistant strains of TB, not only in this group of patients, but also then the wider population.
As a consequence of low economic development, regions across Eastern Europe and Central Asia, do not have the resources to diagnose and treat drug-resistant tuberculosis and in general, treatment-resistant TB is delivered via funding from international donors. However, the concerning lack of this expensive therapy is observed in almost all countries of the region.
Therefore, people who use drugs who are affected by drug resistance have no opportunity to receive treatment.
In conclusion, I want to once again draw your attention to the fact that lack of access to substitution treatment reduces the effectiveness of prevention and early detection of HIV and tuberculosis among people who inject drugs.
Due to the illegality of Opiate Substitution Therapy, and other harm reduction interventions, the Russian government and its powerful influence on the politics of the surrounding regions, is substantially reducing the efforts of the international community to combat the TB epidemic and reduce mortality from HIV / AIDS. The result of this is the premature deaths of thousands of people in my community. This speech is for them.