By BERTRAND AUDOIN and CHRIS BEYRER
Published: March 2, 2012
It is common knowledge that illicit drug use in the Russian Federation has reached critical proportions. It is also common knowledge that people who use drugs are among those most at-risk of infection with H.I.V. And it is common knowledge that since the beginning of the H.I.V./AIDS epidemic three decades ago simple tools such as Medication Assisted Therapy (methadone, buprenorphine) and clean needle-exchange services have proven very effective in decreasing drug abuse and reducing risk of infection with H.I.V., Hepatitis C and other diseases.
So why has this evidence had so little impact on the policies and programs of the Russian Federation?
Russia has one of the world’s highest levels of injecting drug use. The estimated number of injecting drug users is 1.8 million, and the estimated number of opiate users exceeds 1.6 million. A decade ago 100,000 people were H.I.V. positive in Russia. Today there are over 1 million, and injecting drug users represent some 78 percent of all H.I.V. cases in the country. This means that more than one third of all injecting drugs users are H.I.V.-positive — with peaks at three-quarters in some cities — and three-quarters of them are also living with the Hepatitis C virus. The human cost is devastating, and the social fallout is appalling: Russia now accounts for two thirds of the Eastern Europe and Central Asian H.I.V. epidemic, the fastest growing in the world.
Confronted with such a huge political and social issue, the Russian authorities have come up with answers of their own. For example, the recently adopted “State Anti-Drug Policy Strategy of the Russian Federation” reinforces the government’s opposition to the use of Medication Assisted Therapy, or MAT, for opioid dependence with essential drugs such as methadone and buprenorphine. Both of these agents are on the World Health Organization’s essential drug list but remain banned in Russia in a holdover from Soviet times.
Russia also restricts such measures as needle and syringe exchange programs. The new National Drug Strategy proclaims a “zero-tolerance” approach to drug use in a country that already incarcerates enormous numbers of young people for substance use — and does so without drug treatment for those who need it.
These policies fuel poor treatment, discrimination and vulnerability to disease among drug users. They are contrary to WHO and U.N. recommendations, and go against the “E.U.-Russia Roadmap on the Common Space of Freedom, Security and Justice,” which emphasizes the principles of nondiscrimination and respect for human rights. They also contradict the 2001 Declaration of Commitment on H.I.V./AIDS and the 2006 Political Declaration on H.I.V./AIDS, both of which have been signed by the Russian Federation.