On Dec 1st, 2011, World Aids day, people in 8 countries around the world will descend on Russian Embassies -To protest at the criminal treatment of people who use drugs – in the biggest catastrophe in the history of HIV in recent times. (See below for where and when).
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.
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 1million. With this in mind, recent projections forecast an additional 5 million people could become infected with HIV in the near future, unless Russia transforms the way it is dealing with its HIV pandemic.6
Russian authorities have repeatedly come in for fierce international criticism over their policy towards the treatment of drug dependence, which relies almost completely on the promotion of abstinence to the exclusion of harm reduction. Russian officials claim, incorrectly, that the effectiveness of opiate substitution therapy (such as providing methadone and buprenorphine) has not been adequately demonstrated, and as such it is prohibited by law. Yet, despite the addition in 2005 of these two drugs to WHO’s list of essential medicines, and multiple position papers by international experts calling for substitution treatment as a critical element in the response to HIV (IOM, 2006; UNODC, UNAIDS, and WHO, 2005), methadone or buprenorphine remain prohibited by law in Russia and promotion of its use – punishable by a jail sentence.
With over 30,000 people dying from drug overdoses every year, numbers that can be shown to markedly reduce with the implementation of OST, and 150 becoming infected with HIV each day (2/3rds of which are injecting drug users), also evidenced to drastically reduce with the roll out of Needle and Syringe Programmes (NSP), it is upon everyone who cares about humanity, to demand an immediate transformational shift in Russia’s approach to HIV prevention and its treatment of drug users. Access to NSP and OST is in itself, a human right; UN Ruman Rights Monitors have specifically stated harm reduction interventions as necessary for states to comply with the right to health. 5
Consistent evidence from around the world shows that treatment for opiate dependence works most effectively when the exclusive goal of abstinence is widened to foster multiple outcomes – including reduction in use of illicit opiates, exposures to blood-borne infections such as HIV and hepatitis, reduction in drug overdoses, better management of existing health problems etc. Evidence has repeatedly shown the clear benefits to the individual and society as a whole when drug dependence is viewed as a public health issue, as opposed to a criminal one. Evidence also shows OST, combined with a range of harm reduction measures such NSP, leads to a drastic reduction in the spread of new HIV infections in countries across the globe; none of this more clearly demonstrated today, than in Netherlands, a world leader in harm reduction where in 2010, only ONE injecting drug user contracted HIV. In the UK, another country that has harm reduction at the centre of its HIV prevention strategy, prevalence of HIV amongst drug injectors is at 1.5%, this against a Russian HIV prevalence backdrop of 30-35%. The evidence on harm reduction has been in for years. Why does Russia continue to turn its back?
The Russian government‘s estimated annual expenditure related to drug law enforcement) equal approx 100 million US dollars. 7. This amount does not include the money spent on detention and imprisonment. In stark comparison, only 20 million US dollars was allocated to HIV and hepatitis B and C prevention combined, among all population groups in 2011. By 2013, amounts spent will be three times less. 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 the injecting drug using population.6
Such punitive and even torturous approaches to tackling drug use are not only fuelling the HIV epidemic in the region, but also the stigma, hate and ignorance of drugs, and of people who use drugs. The insistence by both the Russian government and medical profession to treat drug users as criminals that need imprisonment at worst, and at best – enforced detention, has meant harm-reduction programs, including needle exchange, are officially accused of promoting drug use and activists have been arrested, harrassed and imprisoned for advancing harm reduction measures. Demonstrators who have protested and spoken out against the Russian response to HIV/AIDS are also regularly arrested and detained, including HIV positive people calling for access to ARV’s (drugs to treat HIV) and an end to treatment interruption fuelling drug resistant strains of HIV.
This World Aids Day, December 1st 2011, we will echo the urgent voices of Russian drug users who are living and dying in the grip of an HIV and TB pandemic with almost no recourse or chance to engage in or promote an effective response. . We will gather at Russian embassies around the world to demand Russia to change it current course towards death and disease. We want to see inappropriately aggressive, state sponsored hostility to drug users replaced by enlightened, scientifically driven attitudes and more equitable societal responses” 3 We demand our own countries to apply pressure wherever and whenever they can, voicing publicly our concerns about human rights abuses in the Russian response to drug use and HIV.
Sound, evidenced based and cost effective harm reduction solutions stand at the forefront of what has been shown to effectively prevent HIV infection in the drug using community. The personal narratives of people who use drugs and their allies on the front line of human right struggles must be recognised and remain a key part of today’s growing evidence base. People who use drugs must be seen as central players in the search for solutions rather than being framed and targeted as the problem.
Nothing About Us Without Us www.inpud.net
WHERE? Dec 1st at Russian Embassies in London, Stockholm, Berlin, Bucharest, New York, Sydney/Canberra, Spain (tbc), and Toronto.
2) UNODC World Drug Report Vienna 2009
3) Lancet July 2010 HIV in people who use Drugs
4) The right to the highest attainable standard of health; Article 12, comment 14 International Covenent on Economic, Cultural and Social Rights 2000
5) Barrett D et al; Harm Reduction and Human Rights, the Global response to drug related HIV Epidemics. London, HRI, 2009
6) News Release, Oct 7th 2011, Risk of HIV Hitting Catastrophic Levels; from the Canadian HIV/AIDS Legal Network; Eurasian Harm Reduction Network; Harm Reduction International;
7) Articles 228-233 of the Russian Criminal Code
- Protest at Russian Embassies Worldwide: Dec 1st World Aids Day (russianembassyprotest.wordpress.com)
- Russia at risk of HIV Hitting Catastrophic Levels (russianembassyprotest.wordpress.com)
- Russian Embassy Protest – Dec 1st 2011 (russianembassyprotest.wordpress.com)
- Shame Russia Shame! (russianembassyprotest.wordpress.com)
- ‘Eastern Europe has fastest growing HIV epidemic in the world’ – UN official (rt.com)