While sub-Saharan Africa remains the region most heavily affected by HIV, a UNAIDS report [1] says that some of the most worrisome increases in new infections are happening in other places, such as Russia. Many HIV/AIDS experts have also expressed [2] concerns that Russia, as well as other former Soviet Union states, are facing widespread HIV/AIDS epidemics. But unlike many other parts of the world, the majority of HIV cases in Russia are due to intravenous drug use.
Russia's HIV epidemic continues to grow, though not as quickly as it did in the 1990s. Estimates vary, but it is thought that almost one million people [3] are living with HIV in Russia. Injecting drug use is the main way that HIV is transmitted — it was responsible for two-thirds [3] of newly registered HIV cases in 2006. Neil Smith, posting on docshop.com, elaborates [4] on the issue.
“Certain parts of Russia are plagued by HIV/AIDS outbreaks as a result of people sharing syringes and needles. The problem is so serious that the World Health Organization has tabbed Russia as the nation with the worst HIV/AIDS epidemic in all of Europe, encompassing nearly a million infected people. VOANews.com cites ‘intravenous drug use, especially among young people’ as the primary vehicle causing the rapid infection to continue and worsen with each passing year. Moscow and St. Petersburg are believed to be the most heavily impacted areas.”
Drug addiction, along with HIV/AIDS, only became major problems in Russia after the Soviet Union fell, as opened borders made it easier for illicit narcotics to enter. Now it is estimated that between 1.5 million and 3 million [3] people in Russia are intravenous drug users, injecting heroin and other opium-based narcotics. Many of these users inject with non-sterile syringes, increasing the risk of HIV transmission.
In his blog, Kh. Atiar Rahman talks about [5] the growing drug problem and its ripple effect.
“Unfortunately, the social base of drug addiction is expanding. Today this disease has percolated to all sections of society, encompassing the territory – world wide, especially the depressed areas. This is leading to an avalanche-like spread of AIDS…Most of the drug addicts — up to 53 percent — are persons with no definite occupation. It is they who strengthen the army of distributors now as well, which in its turn gives go to a crime flare.”
One method being used to discourage the spread of HIV through tainted syringes are needle-exchange programs. There were more than 50 [3] needle- and syringe-exchange projects operating in Russia last year. One such program is run by the Humanitarian Action Fund [6], based in St. Petersburg, who operate a mobile clinic on a refurbished bus. The bus makes nightly stops in areas frequented by drug users and provides clean needles and syringes, as well as other health and social services. This video, narrated by the organization's founder, Sasha Tsekhanovich, talks about their efforts and the stigma that drug users face.
Another method that many health experts [1] say is critical to controlling the spread of HIV among injecting drug users is substitution treatment [7]. For example, providing methadone, a synthetic form of opium, to heroin addicts to help wean them off heroin. Methadone treatment is not being administered in Russia, though, and the issue is considered taboo [8]. Earlier this year the country's chief public health officer said [9] that Russia was not ready to adopt practices such as methadone replacement therapy. A post on a Drug Rehab blog further explains [10].
“Methadone treatment is taboo in Russia because many feel that it is simply replacing one addiction with another. In fact, even bringing up the topic can provoke serious legal sanctions. Posting studies that show the effects, both positive and negative, of methadone treatment are illegal also. In fact, charges are often brought up against doctors that post these findings on their websites. Because methadone treatment is difficult to get in Russia, many find that the detox is ineffective and once they leave the drug rehab program, they use again.”
However, experts also point out that it's not just drug users [3] that are being affected by HIV/AIDS in Russia. Transmission through unprotected heterosexual sex has been increasing steadily since the late 1990s as well, and there's a substantial overlap between sex work and injecting drug use. Unkie Dave, blogging on Booming Back, says [11] the key to slowing down the HIV epidemic globally is to look at the whole picture.
“AIDS is a disease of poverty and ignorance, affecting the most vulnerable and marginalised in any society. In America it is a disease of black women, in Russia it effects intravenous drug users, in Thailand it affects sex workers, and so on. But by focusing on only one group in any culture, it gives the impression that all other groups are unaffected, leading to risky behaviour by the mainstream, and the further marginalisation of those at the edges.”
Photo of Close Up Syringe [12] by big_chocolate_monster [13] on Flickr.