by John Sparrow
and Caroline Ohreen
The needle exchange programme of the Latvian
Red Cross is one part of a project to reduce HIV/AID transmission
among intravenous drug users.
From the Baltic to the Adriatic, Red
Cross harm-reduction programmes are lessening the consequences
of a dramatic increase in drug abuse.
Oleg, a 26-year-old drug abuser, has come to a centre in
downtown Riga, capital of Latvia, to exchange his used syringes
for clean ones. Oleg is not his real name and he doesn't want
to be photo-graphed, afraid his neighbours may see the picture
and discover he's an addict.
He's a reluctant talker but does venture an opinion. "This
place is needed," he says. "Even if you don't have
a needle or syringe to hand in, they will still give you new
ones on credit."
Oleg isn't alone and the need is reflected in numbers. Around
1,000 people a month visit the premises on Birznieka-Upisa
Street, a project supported by Latvia's Red Cross youth section.
As well as acquiring paraphernalia, drug abusers can test
for AIDS, and get information and advice that leaves them,
and the community, safer. To use the clinical term, the exchange
point practises harm reduction.
Latvia has seen a rapid increase in HIV infection since 1998,
when the number of reported new cases jumped to 163 from 25
the year before. At the end of 2000 a total 1,765 Latvians
were living with HIV and 80 per cent of cases were intravenous
drug users. The Latvian Red Cross is convinced that to turn
the tide needle exchange programmes must accompany their public
Some 1,300 kilometres to the south in Zagreb, Croatia, addicts
visit the basement of a Red Cross building with a similar
programme. HIV is not an emergency here and less than 1 per
cent of drug users have tested positive. But over the past
decade intravenous drug use has at least quadrupled in Croatia
and the Ministry of Health is taking no chances with the accompanying
threat of disease. Since 1998, the Croatian Red Cross has
run harm-reduction programmes with government blessing, and
today has three exchange centres: one in the capital, the
others in Pula and Zadar on the Adriatic.
Says Red Cross health coordinator, Sinisa Zovko, "Croatia
today is known to have 15,000 hard-drug users, most of them
on heroin. Eighty per cent have hepatitis B and C. Harm reduction
is about stopping the spread of any blood-related disease.You
cannot separate HIV from drug programmes. Along with safer
sex we must have safer fixing."
Red Cross Red Crescent policy on harm reduction has yet to
be formed. The prime focus globally is on awareness raising
and prevention programmes, as reflected in the peer-to-peer
education central to many Red Cross youth efforts. But with
the European Red Cross and Red Crescent Network on HIV/AIDS
(ERNA) adamant an upscaled response to the spread of HIV is
required to avert another catastrophe, there is a groundswell
of opinion that a position needs to be taken. In the meantime
National Societies are finding their own solutions.
Nowhere is the pressure greater than along a heroin highway
running out of Afghanistan. The flow of drugs north through
central Asia to Russia, then west into the Baltic region is
ever greater, and the intravenous use of them is the major
cause of what today is the world's most explosive HIV/AIDS
epidemic. Latvia and its northern neighbour, Estonia, are
among the casualties. The figures themselves may be modest
compared to Russia's but the growth rate is staggering. The
upward spiral in Latvia has a parallel development in Estonia
where the authorities report that an average 150 people a
month are being infected by HIV.
The most important element of harm-reduction programmes,
as identified in a recent report by the UN body responsible
for drug control, is that of reaching out to drug users. This
is often best done by peer support. A more comprehensive approach
was developed in Latvia when the National Society's youth
section consulted with the state AIDS Prevention Centre. A
need for clean syringes at exchange points was identified
and action was soon underway.
Egils Fuksis, director of the youth project, has been confronted
by people asking why the Red Cross is involved in giving needles
to abusers. "Many times I have explained that this project
stops needles and syringes, possibly carrying a hepatitis
virus, from being left lying around on the streets. It is
a question of public health to start with. But young drug
abusers, with their lives ahead of them, are also being given
a chance to survive. If they give up drugs the likelihood
of them avoiding HIV/AIDS is greater."
AIDS Prevention Centre statistics indicate the needle exchange
is working well. Last October, for example, 8,110 used needles
and syringes were collected by Riga's two exchange points
and street workers, while 8,300 clean ones were given out.
The Prevention Centre's deputy director, and Latvian Red Cross
adviser, Inga Upmace, is at pains to point out that the operation
has full government support. The accelerating spread of HIV
in Latvia alarms everyone. "We have an epidemic among
drug users," she says.
Latvia's first HIV-positive case was registered in 1987,
and it came through sexual transmission. Ten years later the
first five drug users carrying the virus were recorded, and
by then the total number of infections had grown to 88.
"The reason HIV/AIDS started to spread among drug users
in the mid-1990s was that more drugs, including heroin, were
entering the country," says Upmace. "It became easier
to buy drugs and they became less expensive."
Birznieka-Upisa Street was the first response in harm reduction
and today is one of six service and outreach programmes. Estimates
vary of how many users there are in Latvia but there could
be as many as 50,000. It takes time for results to be seen,
according to Upmace, but the first are now visible. "This
year we believe figures will stabilize," she says, and
points to southern neighbour Lithuania where needle exchange
programmes began in 1996. The Lithuanian incidence of HIV/AIDS
among drug users is lower.
The provision of needles and syringes is scheduled to end
in August 2002 but Egils Fuksis would like it to continue
alongside peer-to-peer education and other youth information
programmes. "We cannot stop now," he says.
The sentiment is understood in Zagreb where Sinisa Zovko
underlines needle exchange is a step in building relationships
with drug users, part of a wider drug strategy that embraces
awareness campaigns and, starting this year, will see Red
Cross advice centres established in up to 30 municipalities
the length and breadth of the country.
But Red Cross efforts to help drug users are above reproach.
A 1996 act of parliament approved harm-reduction programmes
as the country faced up to the drug problem. Zovko does not
see the dilemma that still troubles some in the Movement.
"I have heard the argument," she says. "Should
we help people to use drugs? For a health professional it
is not a question. Drug abusers are members of the community.
They are ill because of addiction, and they have rights. My
job is to help and advise them, reduce the risk they are exposed
to. We must help them to protect themselves and in doing that
protect the community."
Massimo Barra, chairman of ERNA and director of the Foundation
Villa Mariani that works with drug addicts corroborates this
"As a humanitarian organization, our objective must be
to allow them to pass through their drug-using phase, however
long that may be, and come out at the end with their health
unaffected". This is the main aim of harm reduction.
John Sparrow is Federation regional information delegate in
Caroline Ohreen is a freelance journalist based in Sweden.
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