In the past few years, Russia has emerged as a self-proclaimed leader in the fight against HIV. Yet rates of HIV infection are skyrocketing among Russia’s own population as a result of the government’s negligence, discriminatory policies, and hostility towards evidence-based practices.
In the past decade, the prevalence of HIV in Eastern Europe has roughly doubled, while it decreased in regions such as sub-Saharan Africa and Southeast Asia. Russia and Ukraine together account for 90 percent of the region’s new HIV infections. On average, 160 Russians contract HIV per day. These astonishing statistics stem from Russia’s punitive drug policies: opioid-substitution therapy (OST) is illegal, syringe exchange programs are extremely limited, and those caught with drugs are sent to overcrowded prisons. The ramifications of these policies are obvious: an estimated 1 in 4 people who are injecting drug users are HIV positive, and up to 30,000 people die of drug-related deaths each year.
Russian leaders have chosen to combat this epidemic by attempting to cut off the supply of drugs. Russia continues to pursue aerial spraying of opium crops in Afghanistan and has been intensively pursuing security agreements with countries where trafficking occurs. Yet making heroin harder to come by has only worsened the drug problem in the country, as drug users have turned to cheaper, but far more lethal, home-cooked drugs. The use of desomorphine, dubbed Krokodil for the way it turns the flesh scaly and greenish before rotting commences, is now being used by upwards of 100,000 people in Russia.
This past October, the Russian government, in partnership with international donor organizations such as UNAIDS; The Global Fund to Fight AIDS, Tuberculosis and Malaria; and the World Bank, organized the first high-level meeting to discuss progress towards achieving Millennium Development Goal 6—“stop the spread of HIV, malaria, and other diseases” for Eastern Europe and Central Asia. While one of the key focuses of the forum was financial investment to achieve Goal 6, Russia’s law enforcement–driven approach to drugs has resulted in vast inefficient spending over the years.
According to a Eurasian Harm Reduction Network survey (2010), the Russian government’s estimated annual pretrial expenditures related to drug law enforcement (Articles 228-233 of the Russian Criminal Code) equal 2,878,750,000 rubles, or a little more than $100 million, not including the money spent on detention and imprisonment. In comparison, according to the budget law for 2011, 2012 and 2013, only $20 million was allocated in 2011 towards HIV and hepatitis B and C prevention among all population groups.
While Russian experts at the forum by and large sidestepped addressing the country’s own HIV epidemic as it relates to drug policy, most of the international speakers (which included the likes of UNAIDS executive director Michel Sidibé, Alvaro Bermejo of International HIV/AIDS Alliance, and many others) advanced more effective approaches to drugs—including decriminalization, OST, overdose-prevention measures, and needle exchange—as methods that are critical to achieving the MDG 6 goal by 2015. In his speech at the conference, Stephen Lewis, the former UN Special Envoy for HIV/AIDS, asserted:
It is heartbreaking and indefensible… that with nearly two million people who use opiates, most of whom inject, the Russian Federation still does not ensure access to these simple and low-cost services and, much worse, uses the power of the state—that is to say, the power of the law—to erect barriers to their provision.
The first such barrier is the government’s silencing of debate about drugs and drug treatment that strays from the party line. Outside the MDG 6 meeting, 10 of 20 HIV/AIDS activists were arrested for criticizing the Russian Ministry of Health. Even advocates within the medical community face open hostility, as exemplified by the case of Vladimir Mendelevich, the director of the Institute for Research of Mental Health Problems in the city of Kazan, who was prosecuted for creating a website to promote scholarly debate about opioid-substitution therapy.
Despite the wealth of scientific literature about how to successfully halt HIV epidemics, the Russian leadership shows no sign of modifying its drug policy to allow for more extensive harm reduction measures. The Russian Ministry of Health acts as a source of anti-scientific myths about key programs to prevent HIV among vulnerable groups, including substitution therapy and needle and syringe exchange programs for injecting drug users; it also deliberately misinforms the Russian leadership and the international community about the lack of effectiveness of these programs in Russia. Following a historic tradition, specialists in the region listen to the opinions presented by the Russian Ministry of Health, which directly threatens the development of evidence- and rights-based harm reduction programs in Eastern Europe and Central Asia.
Russia’s zero-tolerance attitude towards drugs, along with the resultant stigmatization of drug users and HIV-positive people, has failed in its intent to decrease drug use, while driving drug users to employ more dangerous methods of obtaining and consuming their substance of choice. Consequently, the strategy for bringing about change in Russia’s harmful drug policies must be two-fold: 1) continue to support activists, medical practitioners, and members of civil society in Russia who continue to fight for the rights of people living with HIV and people who use drugs, and 2) continue to build unequivocal international consensus that drug dependence is a public health issue, rather than a problem that can be solved by intimidation and force.