Plenary preview: HIV, drug policy and human rights

the case of Russia
anya sarang, andrey rylkov foundation for health and social justice

themes of this conference
‡ Drug policy ‡ Human rights ‡ Harm reduction HOW DO THEY RELATE TO HIV? LETS LOOK AT THE CASE OF RUSSIA!

‡ estimated number of drug users 5 millions ‡ estimated number of opiates users over 1.6 million ‡ 550 thousand officially registered DUs. 71% of them IDUs ‡ 504,537 PLWHA officially registered as of end 2008 ‡ average HIV prevalence in IDUs - 37.2%, reaching 75% in some cities ‡ in 1987-2008 about 80% of HIV infections related to IDU ‡ About 11% of all PLWHs are in prison settings.

background 2
‡ Hep C prevalence in IDUs reaches 90% in some cities ‡ More than 105,000 new cases of active TB were detected in 2009. In 2008 more than 16,000 people had both TB and HIV (18% growth compare to 2007). ‡ TB is the leading cause of death (62%) among PLWHs ‡ Around 75% of males and 54 % of female who have both HIV and TB acquired HIV through injecting drug use

Best practice harm reduction
‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Needle and syringe programmes (NSPs) Opioid substitution therapy (OST) and other drug dependence treatment HIV testing and counseling (T&C) Antiretroviral therapy (ART) Prevention and treatment of sexually transmitted infections (STIs) Condom programmes for IDUs and their sexual partners Targeted information, education and communication (IEC) for IDUs and their sexual partners Vaccination, diagnosis and treatment of viral hepatitis Prevention, diagnosis and treatment of tuberculosis (TB).

the government inhibits effective interventions
‡ Russian government does not provide specific targeted evidence based programs recommended by the UN:
± Needle and syringe programs operate but
‡ no adequate coverage (coverage estimated at 2%, recommended

‡ not funded by the government ‡ ambiguous legal framework puts implementers at risk

± Opiate substitution programs legally banned ± Articulated opposition to both on behalf of Ministry of Health, Federal drug control service, INCB officials (Russia rep) ± Political resistance on the international level (CND, PCB UNAIDS)

drug treatment - accessibility
‡ state system offers only detox ‡ only the state can offer detox ‡ few state rehabs, also paid, not anonymous, and many closing due to OHI ‡ no free, anonymous treatment available ‡ only possible with registration as a drug user constraints on civil rights (job, driving license, childcare)

drug treatment - quality
‡ outdated standards, using substances prohibited in international practice (such as strong neuroleptics) ‡ official statistics of state centers: 8.6% remain drug free within a year. On average a drug dependent person has from 5 to 6 hospitalizations ‡ private drug treatment lack of quality standards, wicked practices
± ± ± ± Eg ³Spanking therapy´ handcuffing hypnotherapies (³coding´). etc

government approach: repression and criminalization

policing drug users: violations normalized and routine Well at the Ditch [drug selling
I drugs on village] they plant m very afraid. Really. They someone every beat me soarresting Unjustified day Well, they random strongly! One time have to justify their salaries, and badly, planted they beat me so therefore they arrest. Drugs planted Subbotnik is on the that I was so shit a new[drugs], kind of thing, they star this so Planting shoulder-straps scared that for two weeks I was evidence itsa girl out from the car by their job. can just pull afraid do. [Male, Everybody has a job toto even thinkbut how it her hair, and not only one girl, about 23, Barnaul] many sit there, put her in their Extortion ever [Female, 23, Moscow]

I had one tiny needle prick mark, and my friend had the same. And right beside the metro they, immediately: Young people, present your veins . So without checking documents or anything, just present your veins . And then Let s walk behind the kiosk for personal search . [Male, 21, Moscow]

car and take away, fuck her for free in whatever way they like. I was coming back from the University, and I They can even beat her, in this or When I dropped by a pharmacy to buy syringes.that way, and also Physical violence walked out to the street I was surrounded by a do their raid on prostitutes. [Female, and torture crowd, maybe six people, police. They checked 17, Barnaul]
my documents, they checked my purse, put a gram of heroin into it. And consequently, I gave them almost a thousand dollars, just not to get it [the case] on paper. [Female, 22, Moscow]


‡ ‡ ‡ ‡ ‡ ‡ ‡

³Fear. Fear ± this is the very Reduced reason«And not only fear main hygiene; urgency of injecting Increased risks of sharing to be caught, but fear that you Pharmacy patrolling will be caught and you wont get NSP interference fixed. an IDU identifier Syringe asSo on top of being pressured NSP Refusal to come toand robbed [by Taking away and/or breaking syringes sick« police], you will also be - in ourthat¶s why you will use available were generally And study while syringes sharing in last 4 weeks: from pharmacies 22% reported whatever syringe is quickly `available«´

fear and terror = risks

criminalization of drug users
‡ possession of small amounts: different by law and in practice ‡ police arrests quotas ‡ faults in investigation and courts on drug cases:
± majority of cases not thoroughly reviewed, based on false evidence, provocation (4 cases in ECHR)
± Courts as ³notary¶s offices for prosecutors accusations´

‡ high rate of incarceration sentencing ‡ no alternatives to sentencing (treatment)

Drugs wererate of incarceration (~1syringe is a ‡ 2 highest around but you see a mln) forbidden thing... IDUs report prisons experience ‡ Over 55% male With drugs it is possible to hide them somehow, somewhere, drugwell, how do you hide a ‡ Over 50% inmates on but related charges (st pete, syringe? So, structural factors of HIV/TB transmission: ‡ Prisons as if someone somehow got hold of a syringe²maybe they broughtprisons demonstrates 43% injected ± Drugs are available (study of 7 it in or stole it from in prison, otherscentre²then it was just the medical confirm) ± Needles, drug treatment, that syringe would do superachievement. Then and prevention not available ± HIV explosions in prisons (eg Tatarstan) the± HIV treatmentrounds and rounds of the whole rounds and either inaccessible or intermittent camp. And then you unhealthy and humiliating AIDS ± General conditions get loads of syphilis, and . . . Someone would shoot up once and then in the course of the next 2 months about 20 people would be in the isolation ward with viral hepatitis.
(Barnaul, male, 18)

access to health
I was in such pain. they thought I was a junkie. I never knew of ‡ Discrimination of drug users in general practicein pain like that before« but they don¶t care ± ³You¶re ‡ HIV treatment: narcology, we don¶t treat people like you´. withdrawal! Go to ± Over 60% PLHIV of shit They give some kind ± IDUs like baralgin, and only if you really yell ± Less than there is a Hell on Earth tx. HIVs, its here, in the at them. If 20% people receiving HIV for ± Discrimination in enrollment, underdeveloped support structures, nd city hospital of Kaliningrad« I want to be one of the society, 2 problems with supporting adherence im just like them, but no, treatment: not available for ‡ Access to hepatitis C if you¶re HIV they just let you die like a bitch, like an animal. But I so want to live! im only 35! But they injectors wouldn¶t let me. Only suffering and pain and hopelessness ‡ TB treatment: system of out patient treatment (DOTs) ± doesn¶t exist, in-patient treatment impossible for drug and no help. I¶m for euthanasia, its better to die than to tolerate users (no OST!) this fascism on behalf of health [system]. They care about ‡ Palliative care: opioid if a man dies ± who cares. little kitties on the streets, but analgesics are generally Fucking accessible humanists. (INCB, 2008) even less so for IDUs and former IDUs
Lesha Gorev, 35 yo, Kaliningrad, died of AIDS-associated lymphoma in Jan, 2009

education and information
‡ Initiatives on drug testing in Universities (supported by municipal authorities and Deans)
± Case in Kazan

‡ Law on Propaganda and article 46 of Federal Law on Drugs:
‡ Prohibits distribution of information, including drug counseling, HIV prevention ‡ Prohibits scientific debate on substitution treatment ‡ FDCS issued recommendations to take out of circulation certain books and punish publishers

some action
‡ Advocacy on int level
± Work with CESCR ± Complaints to the Special Rappourteaur on the Right to Health ± European Court on Human Rights

‡ Advocacy on local level, working with communities
± ± ± ± ± Press conferences Action and public sensibilization (Togliatti and N.Chelny) Official requests to ministries etc. Working with local and national press Working group on OST advocacy

‡ Documenting
± Case documenting ± General reports ± Focused research

Kostya Proletarsky

Vienna ± home to the international drug policies
Russian diplomat Yuri Fedotov appointed as head of UNODC ± UNAIDS family leading agency on HIV prevention in drug users and prisoners.

HIV, drug policy and harm reduction
‡ HIV prevention and treatment cannot be effective in contexts where human rights and dignity are neglected ‡ HIV prevention and treatment cannot be effective in the context of drug policy built on fear and terror ‡ HIV prevention and treatment are developed, well studied and not expensive, but we have to fight.

This conference can and should become an important step in
Understanding harms of current drug policies Challenging these harms Ending the terror of drug war! Making best practice effective HIV prevention and treatment available to all!