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Russia’s H.I.V. Crisis

By Julia Pyper

After a year and a half of using heroin, 17-year-old Alexei Kurmanaevskii asked his mother to help him find treatment for his addiction. In the decade since, Kurmanaevskii—a resident of Kazan, a Russian city about 450 miles east of Moscow—went to a clinic about once every six months. But the short-term treatments he received failed every time. In 1996, he discovered he had hepatitis C. Four years later, he was diagnosed with H.I.V.

“After that, I didn’t see any possibility of recovering, ” Kurmanaevskii says in a video he posted to YouTube.

Kurmanaevskii is one of 1.8 million intravenous drug users in Russia, who in 2009 accounted for between 60 and 70 percent of all Russian H.I.V. cases. Thirty years after the AIDS epidemic began, the number of people infected with H.I.V. is holding steady or in decline in countries throughout the world. Between 2001 and 2009, the number of newly infected adults and children decreased by over 25 percent in 22 sub-Saharan countries.

Yet in Russia, the figures continue to increase. UNAIDS reports that the number of people living with H.I.V. in Russia has nearly quadrupled over the last decade, reaching 1 million in 2009, up from approximately 250,000 in 2000. The number of women contracting the virus is also rising as the epidemic spreads from men who inject drugs to their sexual partners.

The unrelenting spread of H.I.V. in Russia stems in large part from the government’s drug policies and its refusal to implement harm-reduction programs for drug users. According to the World Health Organization, treatment with opiate substitutes like methadone and buprenorphine is the most effective way to reduce drug dependence. But in Russia these treatments are illegal. This leaves many Russians vulnerable to contracting H.I.V., and civil society groups with few ways of offering support.

In 2008, after trying every kind of drug addiction treatment possible, Kurmanaevskii asked a “narcologist”—the Russian term for an addiction specialist—for opiate substation treatment. He was told it was not an option. A year later he made the same request to the Russian Ministry of Health and received the same response.

Last year, Kurmanaevskii filed a lawsuit against the Russian government with the European Court on Human Rights over the illegality of opiate substitution treatment. “International intervention is the only answer I see in the near future,” he says in an interview. “Because of international action, the Russian government is going to have to defend its actions.” The case is still pending.

The refusal to implement opiate substitution treatment, which is practiced in 75 countries around the world, comes from the view that drug addiction is a moral rather than a medical issue.

 “It’s a long history of denial of the most basic service that could save and support many lives,” says Joanne Csete, a professor of family health at Columbia University, about the Russian government’s refusal to legalize opiate substitution programs. “It’s a denial of the scale of the problem Russia has, and not just H.I.V., but hepatitis and other health related issues caused by the use of narcotics. And it’s disdain for people who live with addiction.”

As advocacy and support initiatives go unacknowledged by the government, more and more humanitarian organizations are seeing the situation as a lost cause and pulling out of the country. The global health and development organization FHI no longer runs programs in Russia. Neither does the international H.I.V. and AIDS charity AVERT. In 2005, the Open Society Institute, a private grant-writing foundation founded by George Soros, shut down its Moscow office. The organization continues to support civil society groups within Russia remotely, but staff see the conditions becoming increasingly dismal.

“As services are going down the situation gets worse,” says Tatyana Margolin, the public health program officer at the Open Society Institute. “I think that in general the Russian government’s trajectory has been moving much more inward and against outside influence. The government doesn’t care about these people.”

Maria Golovanevskaya, who works on public health issues at the Open Society Institute, blames the government, the Ministry of Health and the Federal Drug Control Agency for stifling the discussion surrounding H.I.V. and AIDS. According to Golovanevskaya, the Russian government’s emphasis on the criminalization of drug use encourages increasingly unsafe practices.

 “We see that drug users are being pushed out to the margins by repressive drug policies—which seek to imprison, rather than to treat—but also by the state health system, which is de facto inaccessible for drug users,” says Golovanevskaya.

In response to limited government support, NGOs and civil society groups are increasingly turning to the Internet to reach addicts and patients in need of better information. “Websites with careful and comprehensive information about H.I.V./AIDS is the best way to bring this information to youngsters,” says Anna Fedoryak of the Moscow-based Global Business Coalition on H.I.V./AIDS, Tuberculosis and Malaria. “If they have a question about sex, or AIDS, or any other disease related to sex, they will Google it rather than ask teachers or parents.”

The Global Business Coalition’s “StopAIDS: Affects everyone” campaign website comes up first in a search for “AIDS” on Yandex, the most popular Russian search engine, which Fedoryak takes as proof that the campaign is making a difference, especially amongst youth.

Joost van der Meer, the executive director of the Dutch organization AIDS Foundation East-West, is similarly hopeful about the benefits of Internet technology. His organization launched an e-learning program in 2010 and is developing it to offer online conferences, chat forums, webcasts, tests and case studies aimed at increasing the exchange of information on H.I.V./AIDS.

“Our e-learning program is at its early stages, but we think it is a particularly beneficial resource for Russia,” says van der Meer. “It is the only solution with which you can make an impact in the largest country on earth—which spans nine time zones, has many stakeholders, and has such a severe epidemic.”

At the Open Society Institute, Tatyana Margolin oversees a project called Hand-Help.ru, online legal-aid forum, which has become a premier research site on drug policy in Russia. Drug users, their family members and even police officers use the website to ask certified attorneys questions about drug possession and changes in drug laws.

“It’s about saving lives,” says Margolin. “Whatever it takes.”

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Julia Pyper is a freelance journalist who works in Washington and New York.

 

(Photo courtesy of Flickr user Bert Becker)

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Could you list the 75 countries precticing opiate substitution treatment ? thank you
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