Researchers, Public Health Experts Urge Russia to Expand HIV Prevention Programmes for People Who Inject Drugs as Regional AIDS Conference Opens in Moscow
Evidence-Based Programmes in Ukraine and Kyrgyzstan and Russian Scale-Up of HIV Treatment Highlight Potential for Action
October 28, 2009
Moscow, Russian Federation -- As Moscow prepares to host the 3rd Eastern Europe and Central Asia AIDS Conference (EECAAC) on 28-30 October, the Eurasian Harm Reduction Network, the International AIDS Society and the International Harm Reduction Association issued a joint call to the Russian Government to dramatically expand access to HIV prevention programmes for people who inject drugs.
Citing deep concerns over recent reports that the government's new strategic health plan will not support such programmes, the organizations called for increased financial resources, widespread availability of confidential and free drug treatment services, and the removal of legal and regulatory barriers that inhibit evidence-based HIV prevention and drug treatment programmes. The groups specifically urged the repeal of laws that limit or prohibit opioid substitution therapy (OST) and access to clean needles and syringes.
Of particular concern, a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria supporting HIV prevention programmes for people who inject drugs, sex workers and men who have sex with men ended August 2009. The Russian Government has not upheld a promise made during EECAAC in 2008 to finance the continuation of the services started by this grant. The funding crisis leaves projects in ten regions subject to staff layoffs and closures, despite the fact that they have averted an estimated 37,000 HIV infections.
"Russia's financial commitment to scaling up HIV treatment over the past five years has led to greatly expanded AIDS treatment access. It's time for the nation's leaders to make the same commitment to deliver universal access to services to prevent HIV infections," said Robin Gorna, Executive Director of the International AIDS Society (IAS) and Co-Chair of EECAAC. "The response to injecting drug use in Russia is driven by criminalization, but evidence tells us that criminalization is counterproductive to both effective drug treatment and HIV prevention. In order to stem the tide of infections, Russia must embrace proven HIV prevention programmes driven by public health principles."
An estimated one million people are living with HIV in Russia, 80 percent of whom are under 30. An estimated1.85 million Russians, two percent of the adult population, inject drugs, one of the highest rates in the world. In 2007, 64.5 percent of new HIV infections in Russia were the result of injecting drug use.
"The HIV epidemic amongst drug users in Russia could easily have been avoided if not for the negligence of past and present administrations," said Professor Gerry Stimson, Executive Director of the International Harm Reduction Association (IHRA). "Years of government inaction and obstruction have brought us to these staggering numbers. This is nothing short of a public health policy disgrace and government must recognize that controlling HIV depends on controlling HIV among people who inject drugs."
Despite considerable external funding, needle and syringe programmes remain very limited in the Russian Federation and there is no state funding for these programmes. Effective drug treatment is inaccessible and there are no confidential and free drug treatment services. Rehabilitation programs are rare and OST programmes are prohibited under the Federal Law on Drugs.
"In some regions in Russia, harm reduction services have been proven to slow the epidemic and are supported by local authorities. To cut off funding to these programmes is to waste years of investment, training, and expertise," said Shona Schonning, Program Director, Eurasian Harm Reduction Network. "If these lifesaving programmes are not continued and funded properly, the cost will be thousands more HIV infections and lives lost."
Neighbouring nations have demonstrated the effectiveness of drug treatment and harm reduction programmes. Ukraine is making major efforts to scale up OST to reach 20,000 people by 2013 and Kyrgyzstan has one of the most comprehensive approaches to harm reduction in the region. In Kyrgyzstan, nationwide scale up of OST is underway, including pilot OST in prisons. Needle and syringe exchange programmes are already available in most prisons.
"The evidence in support of these strategies is clear and denying the validity of existing research is an unacceptable response to this growing crisis," said Gorna. "If Russian leaders believe, as some have stated, that more regional evidence is necessary, then we must look to the Russian Government to support and fund this additional research."
The effectiveness of OST and access to clean needles and syringes is well-documented. According to the World Health Organization (WHO), OST reduces HIV prevalence and risk of HIV transmission and infection, while also reducing the proportion of users who inject drugs and the frequency of infection. For those infected with HIV, OST increases access and adherence to antiretroviral therapy. WHO also concluded that there is compelling evidence that increasing the availability and utilization of sterile injecting equipment by people who inject drugs reduces substantially the spread of HIV. The programmes are cost-effective, have no convincing evidence of unintended negative consequences, and show evidence of increasing recruitment into drug treatment.
An Integrated Supervised Injecting Program Within a Care Facility for HIV-Positive Individuals: A Qualitative Evaluation
This article was provided by International AIDS Society. Visit International AIDS Society's website to find out more about their activities, publications and services.