 August 29, 2006, Washington DC - A new study conducted for the World Bank by the Open Health Institute assesses HIV/AIDS harm reduction services in the Russian Federation and identifies best practices at a time when the country’s problem threatens to tip over to a generalized epidemic.
Titled Harm Reduction Programs in the Civilian and Prison Sectors of the Russian Federation: Assessment of Best Practices, the study is based on interviews with a variety of harm reduction providers and users in civilian and prison contexts. According to the study, as of June 2006, 63 harm reduction programs were under way in Russia. Harm reduction programs seek to decrease the adverse consequences of drug use through needle exchange programs and other medical and social services; control the incidence of HIV/AIDS among intravenous drug users; and protect the population at large from a generalized HIV/AIDS epidemic. The study’s findings join a mounting body of evidence – including hard data from places like Australia and Canada - that suggest harm reduction programs are a necessary and cost-effective tool in the arsenal against the global spread of HIV/AIDS. Indeed, the HIV/AIDS epidemic in the Russian Federation is driven largely by intravenous drug users including prison inmates sharing contaminated needles. UNAIDS estimates 860,000 people are currently living with HIV/AIDS in Russia (other estimates range from 420,000 to 1,400,000) and 70% of the cases are connected with injecting drug users. The challenges of HIV/AIDS prevention So far harm reduction programs in Russia have operated with funds from DFID, international NGOs and more recently from the Global Fund. “We want to help consolidate these programs to make them sustainable and increase their scale so that they cover additional people,” says Patricio Marquez, lead health specialist and Team Leader of a Bank-financed Russia Tuberculosis and HIV/AIDS control project. “We need to create a consensus at the federal and regional levels that harm reduction programs are effective and that criminalization of drug usage in the context of an HIV/AIDS epidemic is not the solution. Increased enforcement does not lead to a drop in drug consumption but increases HIV infections among drug users.” The challenge is to reduce the stigma against addicts and against people living with AIDS so that the proper legal and political conditions are in place for a wide-scale preventive effort. Although the Russian government has significantly increased spending on screening and treatment programs in the last year, medical infrastructure will not be able to keep up with new cases unless prevention is taken seriously. The recent assessment of programs in Russia also makes clear that the scope of harm reduction activities should be broadened to provide not only clean needles but access to counseling, testing, and medical and social services, based on the view that drug users are vulnerable human beings in need of complex care. Worldwide, harm reduction programs have been shown to be effective in substantially reducing new HIV infections and free of serious adverse effects such as increasing drug use. Harm reduction programs have gained widening acceptance in the last five years and exist in all 25 members of the European Union, in many countries of Eastern Europe and the Former Soviet Union, as well as many countries in Asia including China and India (see map below), and are supported by major international agencies such as WHO, UNAIDS, UNICEF, UNODC, and the World Bank.
Harm Reduction Programs in 2003 (Source: IHRA 2006)
But harm reduction coverage is still extremely low, particularly in prisons. Russian law, for example, forbids syringe exchanges in prisons and limits harm reduction programs there to HIV education for staff and prisoners, peer education and the provision of disinfectant and condoms.
 Identifying factors of success
Barriers and limitations aside, best practice efforts are emerging. A multi-year program for Russia’s prison system, under way since 1999, set up HIV/AIDS prevention and health promotion efforts in the prisons of four regions. In addition, a Harm Reduction Bridging Project as well as an initiative called ‘GLOBUS’ are further expanding these types of programs, both inside and outside prisons. A Russian Harm Reduction Network is also expanding its activities around the country as part of these scaling-up efforts. A new grant from the Global Fund will help the network double its coverage of injecting drug users in the next two years. In every instance the involvement of local non-governmental organizations with first-hand knowledge of the IDU community is critical to success. Government support is also critical. “While NGO, Government, and donor efforts are ramping up, only a tiny fraction of Russia’s injecting drug users are getting help – funding and capacity building must rise exponentially if real progress is to be made in stemming the epidemic,” stresses Marquez, who explained that the World Bank is supporting these efforts across the country through the government’s $286 million project. By focusing on high risk drug-injecting people, AIDS experts hope to prevent the spread of the virus to the general population through a bridge group of partners, wives and girlfriends. “We’re at a turning point,” says Marquez. There is some evidence that Russia, like its neighbor Ukraine, is already experiencing the epidemic’s “second wave,” when the virus breaks out of a concentrated high risk group. * * *
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