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Promoting safer fixing

by Galina Obukh

One public opinion poll in Russia revealed that 30 per cent of the population would vote to isolate people living with HIV/AIDS. The old Soviet proclamation "No drugs, no sex" has built an iron curtain in people's minds, making such topics taboo. In this region, Red Cross harm reduction programmes are trying to stem the spread of the virus in the face of overwhelming ignorance and discrimination.

It is simple mathematics. A heroin addict needs a minimum of two shots per day. That is two syringes per day, and 730 per year. The average cost of a disposable syringe in the Commonwealth of Independent States (CIS) is 16 US cents. That amounts to US$ 120 per year in syringes to help protect one intravenous drug user (IDU) from transmission of HIV or other infectious diseases. So, why not spend an extra several cents on clean syringes in addition to the US$ 20 that one needs to buy a gram of heroin? The reason is a lack of knowledge on safer fixing in local drug subcultures in the region. This ignorance comes from stigma associated with drug use.

"It was 1985 when I first tried heroin," says Svetlana, an active drug user from Belarus. "We had no information about it, no one knew what it was, one could prepare a drug in front of a militiaman and he wouldn't know".

Svetlana was among the first visitors to the Belarus Red Cross syringe exchange point which opened in the spring of 2002 in the small city of Molodechno. To date, it is the sole harm reduction initiative run by the Belarus Red Cross, and one of the few across the country. The idea of opening a syringe exchange point in this province was a lucky coincidence for local drug users. The visiting nurses service of the city's Red Cross branch had been reduced because of budget shortfalls. A large supply of unused disposable syringes was left behind. Knowing this, the local government proposed that the Red Cross start addressing the needs of the drug users in light of the growing HIV epidemic, and provided the premises for the needle exchange point.

"During the first few weeks the place was completely empty," says Nina Bliznyuk, a chairperson of the Belarus Red Cross Molodechno branch. Aiming to reach potential beneficiaries, Nina spoke out on local radio stations, ran advertisements in the newspapers and visited clinics explaining again and again the effectiveness of needle and syringe exchange programmes in preventing HIV. Her efforts were rewarded. She gained the trust of local drug users, and the Red Cross started exchanging 40 syringes every month.

Stigma associated with drugs is strong in this part of the world, and the Red Cross at times reflects this. Just as there is a lack of awareness on safer fixing among CIS drug users, there is a lack of confidence to provide them with this knowledge and other support within local Red Cross Societies.


A Russian Red Cross staff member distributes clean syringes to intravenous drug users in the southern Siberian city, Irkutsk.
©Galina Obukh / International Federation

 

In our own backyard

"The Red Cross here tends to do 'traditional' activities," says Yelena Tanskova, International Federation health officer. "A conservative attitude prevents staff and volunteers from facing new crises. Regional branches are taking the lead and starting harm reduction programmes with limited support from the national headquarters."

Thus, in June last year the Russian Red Cross committee in Irkutsk, in southern Siberia, started a needle exchange project, the first of its kind in the city. Just as in Belarus, it is also the only harm reduction initiative implemented by the National Society.

"We still don't have proper premises for an exchange point," says Nikolai, the project's outreach worker and a former drug user with seven years of experience. "We've tried negotiating in polyclinics and pharmacies, but no one wants drug-users hanging around, so for the past year we've been working in the streets. The wall of that house is our exchange point," he adds, pointing at a dirty pink, half-ruined building. "Most of our clients live in this area." And yet the Irkutsk project manages to exchange an average of 4,500 syringes every month.

There are 50 harm reduction projects carried out by various non-governmental agencies across Russia, trying to reach out to around one million drug dependent people, according to estimates by the ministry of health. Despite the fact that the ministry of health approved the World Health Organization's recommended principles on harm reduction, the value of this activity in HIV prevention does not sit comfortably in the minds of most Russians. There is a general perception that such projects promote drugs.

Getting a fix

Having no information on the dangers of sharing needles and syringes, drug users have their simple reason not to buy a clean syringe — lack of cash.

"You don't think about diseases when you are looking for your next fix," explains Svetlana. "Clean or not, any syringe will do, so it's good that there is a place where you know you can get clean needles at any time.”

After 16 years of what they call "a system" — regular, two or three times a day drug abuse — ruined her life and health, Svetlana's only wish is to stop and devote herself to her 12-year-old son. "I dream about the methadone therapy that would cure me of this disease," she says with hope, and then, coming back to the reality, "but it would never come to our small town." Regardless of the size of Svetlana's city, methadone therapy, or substitution therapy, is forbidden in Belarus and in Russia.


©Galina Obukh / International Federation

 

Heroin traffic

The US-Russia Working Group Against HIV/AIDS recently wrote a report that called attention to the growing problem of easy access to drugs and the rise in HIV/AIDS infection. The report explains: "Russia is wedged between opium-producing Afghanistan and major drug markets in Western Europe, making heroin and other opiates easily accessible. Russia's long and porous southern border, manned by underpaid and overworked customs inspectors, border guards, and interior ministry officers, is especially susceptible to drug trafficking and transport of illicit goods." Belarus, situated between Russia and Western countries, represents an easy transit corridor for drug trafficking.

Latest statistics shows that there are nearly 5,000 registered HIV cases in Belarus, and over 240,000 in Russia, while officials say that the real figure is five times higher. Over 80 per cent of all people living with HIV/AIDS in both countries have contracted the virus through drugs. "That is why harm reduction is needed," says Anna Parovaya, Belarus Red Cross youth coordinator of the HIV and AIDS programme. "But it is almost unrealistic to carry it out because of psychological resistance coming from the general population."


Galina Obukh
Galina Obukh was International Federation regional information officer based in Moscow.

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