Friday, February 23, 2007

A Dual Epidemic: HIV/AIDS and Injection Drug Use in Russia

I'm Meredith Prasse.

Before 1995, the total number of HIV infections in the entire region of central and Eastern Europe, with over 450 million inhabitants, was less than 30,000. The World Health Organization reported an estimated 0.6-1.9% prevalence, between 420,000 and 1.4 million cases, of HIV/AIDS in Russia in 2003. Between 1996 and 1998 alone, Russia experienced a 100-fold increase in new HIV infections, demonstrating the rapid onset of the epidemic in this region. Well over 70% of all HIV cases in Russia occur in injection drug users (IDUs), demonstrating the widespread exercise of unsafe drug-using practices among the IDU population in Russia. Sadly, only 10% of HIV-infected Russian IDUs currently receive HIV combination therapy, and only 15% of HIV-positive Russians receiving therapy are IDUs.

An epidemic of drug use is occurring alongside the HIV/AIDS epidemic in Russia. While the epidemic of injection drug use in Russia cannot be attributed to a single factor, there was a significant rise in drug use following the collapse of the Soviet Union. WHO estimates that between 1.5 and 3.5 million Russians are IDUs, and the prevalence of HIV in the drug-using population approaches 65% in some Russian cities, further demonstrating the connection between drug use and HIV in Russia. Between 1990 and 2002, the number of first-time drug users referred to treatment centers increased 6.5-fold, while the number of drug-associated deaths increased 5-fold between 1999 and 2000.

The challenges facing the Russian HIV/AIDS epidemic are multifaceted. An estimated 30-40% of IDUs in Russia use non-sterile needles or share needles, demonstrating the widespread unsafe drug use in Russia. Many IDUs reportedly re-fill their syringes by front-loading from the dealers’ syringes, and many dealers are IDUs themselves who inject from that very supply. During the drug preparation process, dealers in several different Russian cities have also reported adding blood to the drug solution as a ‘cleansing’ process, believing that the blood neutralizes toxic substances used to produce the drugs.
There are also significant legal and political dilemmas which complicate the Russian HIV/AIDS epidemic in IDUs. A combination of harsh drug policies and regular harassment by the police force pushes IDUs underground and decreases their chances of accessing preventive resources or care in drug treatment facilities. The synonymously corrupt Russian police arrests IDUs for possession of minimal amounts of narcotics in order to fill quotas. As a result, drug users refrain from seeking treatment or accessing clean needles in fear of incarceration or simply being registered as a drug user. IDUs that access formal treatment centers are officially registered and monitored by that facility for five years, and this official registration can have further negative repercussions such as restrictions on employment, drivers’ licenses, and military service. While treatment for drug dependence is an effective way to both eliminate drug dependence and decrease the risk of contracting HIV, the distrust in drug treatment services has resulted in low utilization of these resources by IDUs. Another legal dilemma for IDUs is that methadone, a common substitution for heroine users and an important part of HIV prevention for heroine users elsewhere, is banned for treatment in Russia.

While IDUs comprise the majority of the at-risk population in Russia, the threat to non-IDUs is on the rise. A majority of IDUs in Russia are young heterosexual men. These men have the potential to spread HIV to their partners: commercial sex workers, girlfriends, wives, etc., many who do not have the power or awareness to demand condom usage. In addition, commercial sex work is on the rise in numerous Russian cities, and the overlap between injection drug use and commercial sex work is high. It is estimated that between 15 and 50% of female IDUs practice commercial sex work, and many of them do so as a means of obtaining drugs. HIV transmission from sex workers to their clients is high, and these male clients may subsequently infect their non-IDU sex partners. Thus, IDUs and sex workers act as a bridge for sexual HIV transmission between IDUs and non-IDUs in Russia, facilitating a more widespread epidemic.

In the face of the continually increasing rates of drug use and HIV infection, the Russian government needs to implement policy changes to slow these increasing rates. This dual epidemic can be fought on many different fronts. Primarily, the government must increase support for safe needle exchange programs to reduce the spread of HIV among the IDU population. In addition, the ban on methadone-substitution therapy for heroine users should be lifted to encourage treatment options and reduce needle use. More generally, the government needs to put more focus on drug prevention programs. Future HIV prevention strategies targeting IDUs should include sexual risk reduction to reduce the potential spread between the IDU and non-IDU populations. With such alarmingly high rates of HIV infection among the IDU population, this problem cannot be ignored. The longer it is disregarded, the more this epidemic will seep into the non-IDU sectors of Russian society, facilitating an epidemic with a wider scope and greater force.

Works Cited
Bobrova, Natalia, Tim Rhodes, Robert Power, Ron Alcorn, Elena Neifeld, Nikolai Krasiukov, Natalia Latyshevskaia, and Svetlana Maksimova. “Barriers to accessing drug treatment in Russia: a qualitative study among injecting drug users in two cities.” Drug and Alcohol Dependence 82 (2006): S57-S63.
Dehne, Karl L., Lev Khodakevich, Francoise F. Hamers, and Bernhard Schwartlander. “The HIV/AIDS epidemic in eastern Europe: recent patterns and trends and their implications for policy-making.” AIDS 13 (1999): 741-749.
Human Rights Watch. “Russia: harsh drug policies fuel AIDS epidemic.” Available at Accessed on 16 November 2006. Human Rights Watch: 28 April 2004.
Kalichman, Seth C., Jeffrey A. Kelly, Kathleen J. Koslov, P Andrei, Alla Shaboltas, and Juliana Granskaya. “The emerging AIDS crisis in Russia: review of enabling factors and prevention needs.” International Journal of STD & AIDS 11 (February 2000): 71-75.
Lowndes, Catherine M., Michel Alary, and Lucy Platt. “Injection drug use, commercial sex work, and the HIV/STI epidemic in the Russian Federation.” Sexually Transmitted Diseases 30 (January 2003): 46-8.
Luo, Robert F. and Joseph Cofrancesco Jr. “Injection drug use and HIV transmission in Russia.” AIDS 20 (2006): 935-936.
Rhodes, Tim, Lucy Platt, et. al. “Prevalence of HIV, hepatitis C, and syphilis among injecting drug users in Russia: a multi-city study.” Addiction 101 (February 2006): 252-266.
Shaboltas, Alla V., Olga V. Toussova, et. al. “HIV prevalence, sociodemographic, and behavioral correlates and recruitment methods among injection drug users in St. Petersburg, Russia.” Journal of Acquired Immune Deficiency Syndrome 41 (15 April 2006): 657-662.
World Health Organization. “Summary Country Profile for HIV/AIDS Treatment Scale Up: Russian Federation.” Available at Accessed on November 16, 2006. WHO 2005.

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