Geneva, 9 April 1999 (RFE/RL) -- It usually takes years for a person infected with HIV --the virus that causes AIDS-- to show clear signs of the illness. But it only takes minutes --often from a quick dose of contaminated narcotics or a dirty syringe -- to become infected.
That stark reality is the driving force behind current harm-reduction efforts in Central Asia, Russia and Eastern Europe, where intravenous opiate use is on the rise. In the newly independent states of the former Soviet Union, official statistics show the number of intravenous drug users in the region is doubling every one to two-and-a -half years.
Along with that increase has come a rapid increase in the number of cases of HIV infection. Statistics show a six-fold increase in HIV since 1994.
Chris Fitch, an outreach worker with the Center for Research into Drugs and Health Behavior at London's Imperial College, says kitchen-based or homemade injectable drugs are not a new phenomenon. What is new, according to Fitch, are changes in the distribution and availability of the drugs.
"The Asian drugs industry has been traditionally dominated by the Golden Crescent of Afghanistan and Pakistan and the Golden Triangle of Burma, Laos and Thailand. But it has been suggested that there is a new area for the production of heroin, which is going through Russia into Western Europe and being used domestically in Russia. And it's been estimated that by 1995, Kyrgyzstan was exporting more narcotics than either Myanmar, Burma or Thailand. So there's been documented growth in the region."
Fitch said users in the Russian Federation, Central Asia and Eastern Europe favor "chorney" (or "black heroin"), which is often ritualistically mixed with users' blood, or, a liquid amphetamine. He said such drug use occurs mostly in groups of six to eight, with the drugs prepared in a kitchen and the actual injecting taking place some 20 minutes later, either in a living room, bedroom or toilet.
According to Fitch, who has observed the process at close hand from Moscow to Almaty to Minsk, the lure is a $2 high that can often last up to 24 hours.
Researcher Jean-Paul Grund of the Chemical Dependency Institute of New York's Beth Israel Medical Center warns there are inherent risks of HIV infection at the stage when users are preparing to inject the drugs, particularly drugs mixed with human blood.
Grund said the biggest risk for the spread of HIV comes from a practice called front-loading. Here is how he described the practice to harm-reduction counselors at the 10th annual International Conference on the Reduction of Drug-Related Harm in Geneva, where he was honored recently for his harm-prevention efforts.
"They draw it into a large syringe -- often a five- or 10-milliliter syringe. I saw this in the Netherlands and many places since. They then front-load by squirting it from the big syringe --and dividing it (the drugs) across a number of other syringes by sticking the needle of the donor syringe into the front receptor syringes. This has been shown in a number of studies to be a clear risk for HIV transmission."
Grund notes that, in addition to HIV, intravenous drug users also face the risk of contracting hepatitis C, severe abscesses at the site of the injections, hair and tooth loss, as well as the chance of a potentially lethal overdose.
Last year, harm-reduction workers --with technical assistance from UNAIDS, a United Nations AIDS agency; the World Health Organization; and the UN Drugs Control Program-- undertook a rapid assessment and response program on HIV infection among intravenous drug users in five cities in Central Asia.
International teams of researchers and professionals conducted assessments in Tashkent in Uzbekistan, Osh and Bishkek in Kyrgyzstan, and Shymkent and Almaty in Kazakhstan.
Wouter de Jong of the Netherlands took part in the assessment, which found in all five cities a high and steadily growing prevalence of drug use, in particular the injection of homemade opiates. De Jong said that, so far, the prevalence of HIV is very low in the five Central Asian cities. But he said limited outbreaks of HIV have occurred, most notably in the Karaganda region in Kazakhstan.
In response, de Jong said, local and national authorities across the region decided to develop HIV prevention programs in four of the five Central Asian cities.
"In each city, agreement was made that there will be an outreach intervention aimed at 300 IDUs [intravenous drug users}, which will provide needle-exchange, condoms, information and counseling and rehabilitation services. Added to that, in the city of Bishkek, an experimental methadone treatment program will be started for 50 injecting drug users."
De Jong said Almaty is still in the process of negotiating the formulation of a rapid assessment and response program.
(This is the third in a series of features by Lisa McAdams focusing on the global fight against drug-related medical harm. McAdams attended a harm-reduction conference late last month in Geneva. In the fourth of the series our correspondent takes a look at other countries forced to initiate rapid assessment and response programs-- notably Romania and the Czech Republic -- and the lessons they have learned.)