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From Russia with alarm: Conflict fuels fast growing HIV epidemic

Teenagers using drugs in an abandoned structure in St. Petersburg. --Flickr, Artem

By Natalie Flath, aka Natasha, a health advocate and activist based in St. Petersburg, Russia. Flath, a Seattle area who is working on HIV issues there, will be attending a meeting aimed at trying to improve Eastern Europe’s losing war on HIV-AIDS.

Natalie somewhere in Russia
Natalie somewhere in Russia

SOUTHERN RUSSIA (out and about) – Red soviet hammer and sickle symbols border the streets in Russia for the May holidays. Russians are celebrating the victory over Germany in World War II.

As the slush and snow disappear and the flowers begin to blossom, I decided to escape the bustling city of St. Petersburg and travel to a small Russian village south of Russia, near Ukraine’s border, before drowning myself deep in the Eastern European and Central Asia HIV/AIDS regional conference co-hosted by UNAIDS and the Russian Ministry of Health, in Moscow next week.

With my colleague, Julia, her husband, and child, we drove through 350 km of bumpy roads mixed with pavement and dirt, to finally arrive in what I feel like is the middle-of-no-where Russia.

Greeted with colorful babushkas, fresh piroshky and tea, my colleague and I discuss that this voyage would not be possible if her husband, a former injection drug user, was registered in a opiate substitution harm reduction program.

Drug use is fueling the world’s fastest growing HIV epidemic across Eastern Europe.

There’s heated debate here about how best to fight it, whether to emphasize  law enforcement or public health approaches. And many believe the recent conflict between Russia and Ukraine is going to make matters worse.

Teenagers using drugs in an abandoned structure in St. Petersburg.
Teenagers using drugs in an abandoned structure in St. Petersburg.
Flickr, Artem

Over a year ago, in a small post-soviet city of Estonia, I visited my first opiate substitution treatment clinic. There, every single day, drug dependents seeking a solution to overcome opiate addiction are clinically administered Methadone – an opiate agonist prescribed to eliminate unsafe injection drug practices that ultimately prevent HIV transmission.

At the methadone clinic, the nurses handed out the treatment to each patient. They come in, sign their name, swallow the pill and stick out their tongue. They do this everyday. They do this for the rest of their lives.

The HIV epidemic in post-soviet countries has been on the rise, primarily fuelled by the exchange of dirty needles from illicit drug use. In Eastern Europe and Central Asia, injection drug use accounts for about 80 percent of all new infections.

Everyone recognizes the problem. But everyone also seems to have a different opinion on how to deal with it.

The Russian government, through their Federal Drug Department, is pretty firm on their stance that inpatient rehabilitation approaches or 12-step programs are the only plausible methods to stop injection drug use. Clean needle exchange programs are not supported, nor any other “drug promoting” practices.

UNAIDS, coordinators of the global HIV efforts, recommends implementing practices that reduce the usage of dirty needles in these communities. In their recent report, Harm Reduction Works: Examples from around the world, UNAIDS urges countries to scale up these services. In Kazakhstan, after the introduction of clean needle exchange and other harm reduction programs, the HIV prevalence has decreased over the past year.

When I asked Russian civil society leaders their opinions on the matter, the responses varied. Some say that high threshold harm reduction programs are needed to curb new HIV infections, meaning that after several failed sobriety tries, opioid substitution therapy should be used as the last attempt. Others advocate for rapid and full implementation of the internationally recognized methods.

Julia, the director of a women-led civil society organization sides on Russia’s ideology that methadone isn’t the best option.

“People on opioid substitution are not themselves and remain controlled by a substance,” she says. “My husband wouldn’t be able to go on vacation or leave the country. His life would be wrapped up around the drug.”

Julia points to her husband, noting he has been drug free for years now after cutting cold turkey at a Siberian rehab center, and then to her son.

“Look at our son – we’re free and happy.”

As government officials, international health experts, and civil society members gather next week for the meeting in Moscow, what can we anticipate from a politically diverse region sharing a common problem? Will they openly share best practices that effectively target the key affected populations in the region?

Ukraine has also implemented the UNAIDS supported harm reduction programs, which has shown to have a positive effect. The country has recently seen improvement in their epidemiological situation. The problem is that Ukraine has decided to boycott the conference due to political tension. The International Treatment Preparedness Coalition civil society group in Russia urged Ukraine to reverse their decision and attend as leaders in the AIDS response:

“We call on our colleagues to take part in the conference, because we believe that participation in it along with an opportunity and a right to state one’s view on concerns, achievements, and challenges related to the HIV programs would substantially benefit all the countries in the region. Professional, sensible dialogue between the scientific community, civil society, and PLHIV community should be what unites us and is more important than any political dividends.”

Civil society representatives continued to openly express their opinion that the Russian government’s major role in the conference will continue to enforce inefficient approaches in response to the HIV epidemic in the region.

“The Russian authorities have openly denied the respect for human rights and scientific evidence for the prevention and treatment of HIV among vulnerable groups. Since UNAIDS is a co-organizer who has not yet objected to such statements, we can only conclude that UNAIDS agrees with them.” Anya Sarang, director of a harm reduction organization, Andre Ryklov.

Civil society is calling for a greater leadership response by UNAIDS due to their lack of transparency and engagement with the community. In an open letter to the director of UNAIDS himself, Michel Sidibe, representatives wrote:

“Most Russia-based community organizations working in the field of HIV are not informed about the plans of UNAIDS related to the HIV response in Russia. These activities are organized and developed without any consultations with the civil society, which, in our opinion, makes them less effective, and in some cases even pointless.”

The civil society urged that the regional UNAIDS office inform the civil society about their activities, as well as about other UN agency initiatives, in timely manner.

Sidibe quickly responded to the letter backing his support with the civil society community, encouraging their full and meaningful participation:

“While UNAIDS respects the sovereign right of countries to pursue different policy approaches, our position and recommendations remain clear and unequivocal. In my opening speech at the conference, I plan to reiterate UNAIDS position and highlight our concerns on the rights of LGBT people, people who inject drugs, sex workers, the meaningful involvement of key affected populations and civil society, HIV prevention and people living with HIV in need of treatment. I will also emphasize that UNAIDS and its cosponsors continue to work with the Russian Federation and other countries to implement effective programs consistent with international best practices and UNAIDS policies and recommendations.”

Each civil society organization fills a niche in responding to the epidemic. Whether it’s advocating for treatment scale-up, identifying gender barriers to services, or delivering clean needles to marginalized drug users, they all have something in common.

The community just wants their voices to be heard, they want to hold their governments accountable, and they are asking for UNAIDS support.

Humanosphere often reports awhile back on the historical victory of the only disease to be eradicated from the earth – smallpox. When the eradication campaign begin, the only developed international disease response center was established in the US because of military pursuits.

It wasn’t until the Soviet Union put pressure on the US to organize a smallpox eradication campaign that despite the cold war, the USSR and US rallied together with the WHO to organize, spearhead and eradicate smallpox. Persevering through political turmoil, the countries found a way to collaborate, build partnership and succeed at one of the world’s biggest health victories of all time.

Will we ever celebrate this kind of victory again?

NatalieFlathNatalie Flath, who grew up in Tacoma celebrating her family’s Russian roots, graduated from Seattle Pacific University with a strong interest in global health and development. For the past year-and-a-half she has been working in St. Petersburg with two advocacy organizations, International Treatment Preparedness Coalition in Russia and the EVA Network, the latter a Russian NGO focused on women and children’s health needs.


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