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Analysis
February 2014 |
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The numbers are especially
troubling given that HIV infection rates
are falling in much of the rest of the
world, with a 33 per cent drop overall
since 2001 (
DDN
, October 2013, page
5). ‘They’re managing to control the
numbers due to scaled up prevention
efforts and access to treatment, but in
Russia the numbers are still rising,’ she
says. ‘The majority of people who are
getting HIV are drug users and if you
don’t have harm reduction programmes
and needle exchange programmes
then there’s no prevention.’
And as there are increasingly few
prevalence studies being carried out
among drug users it can be hard to
even establish the real extent of the
problem, she says. ‘Russia is so huge
and it depends on the region. In
Moscow the last estimates, around four
years ago, were that HIV prevalence
was below about 14 per cent, but the
prevalence studies documented up to
75 per cent in the city of Biysk, in Altai
Krai, and in Samara Oblast it was above
60 per cent. But I think the average
number is still just under 40 per cent.’
Even the government’s claims that it
is addressing HIV by providing medica-
tion such as antiretrovirals to anyone
who needs them should not be taken at
face value, she says. ‘A couple of years
ago I was interviewing a large number
of drug users for a WHO project and we
found that, to have adequate access to
medication, the doctors were saying,
“you should treat your HIV but before
you start your medication you should
do something about your drug use.”
But because there is no access to
substitution treatment, no rehabilitation
centres, no help, people go away and
they get lost and they come back only
when they’re dying.
‘If you don’t provide adequate drug
treatment then it’s impossible to treat
people with HIV, so when the
government says, “everybody who
wants medication can get it”, it’s
hypocrisy,’ she continues.
‘Theoretically it’s true but they’re not
able to get through this labyrinth of
bureaucratic procedures to start
treatment, and they’re not able to even
maintain their HIV treatment because
they go into drug relapses.’
The figures for hepatitis C infection
among people who inject drugs also
make grim reading, standing at more
than 70 per cent according to recent
estimates. ‘In some places it’s even
above that – approaching 90 per cent –
and hep C treatment is not available in
Russia at all,’ she says. ‘Or it’s available,
but only to the few people who can buy
it – it’s very expensive – and even then
not to drug users. With HIV at least
some people have treatment, but with
hep C it’s a really bad situation.’
One fundamental root of the
problem is that, in Russia, people who
use drugs have no human rights, she
states. ‘If you take the national drug
strategy there’s no mention of human
rights, and even if we talk to human
rights organisations in Russia they’re
not really interested in drug users.’
And there’s no mention of harm
reduction in the strategy either,
presumably? ‘Harm reduction is
mentioned, yes, but it’s mentioned as
a threat. The strategy is based on the
principle that there should be a zero
tolerance approach.’
Given how isolated the Russian
government’s position has become, is
there anything that the international
community could realistically be doing
to put pressure on them? ‘I don’t know
if it’s even possible to influence them,’
she says. ‘They have a strong
standpoint in the international arena,
they are very powerful and basically
they can do whatever they want. Even
at the high-level UN meetings on
human rights they present substitution
treatment as a threat. The
government’s position is basically that
everyone in the world is wrong, and
they are right and that they should use
this strong repression and base policy
on zero tolerance with no regards to
human rights or the health of people.
This position is not changing, and
there’s no flexibility.’
One thing she would like to see that
could potentially make a difference,
however, is for western clinicians to
stop engaging with medical and
clinical trials in the country, she states.
‘If would be good if they didn’t give
health officials and drug treatment
officials the money for these trials for
antagonist treatments, for example.
‘American researchers come to
Russia with their clinical trials because
no one’s really interested in naltrexone
in the US. They pilot their studies, the
Russians receive huge funding and
then the Russian officials present it as
the Russian way of treating drug
addiction, as some kind of miracle
treatment. Of course everybody
understands that it’s nonsense. OK, it’s
one medication option, but it’s never
been the most effective, and even if
they do the clinical trials of new
preparations they should compare
them to the gold standard addiction
treatment, which is substitution. So it’s
not very ethical to do this in Russia.’
As well as providing more grounds
for the Russian government to oppose
substitution treatment, the main
motivation is ‘basically economic’, she
stresses. ‘It’s a very corrupt public
health policy. If they’re being fed by
their colleagues from the US and
wherever with this clinical trials money,
and they’re selling this expensive, not
very effective medication, then of
course they’ll keep doing it. So it would
be good if at least on a professional
level there was a change of position
from the western researchers using
Russia for this purpose.’
en.rylkov-fond.org
In Moscow... HIV prevalence was below
about 14 per cent, but the prevalence
studies documented up to 75 per cent in
the city of Biysk.
‘Treat hepatitis C? It is cheaper to bury.’
Activists draw attention to hep C outside
the Ministry of Health on Rakhmanovsky
pereulok in Moscow.