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
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
"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
©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.
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
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
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 was International Federation regional information
officer based in Moscow.
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