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East: Experts Argue 'Harm Reduction' More Effective For Prevention Of AIDS

  • Nikola Krastev

The steepest rates of new HIV infection in the world today are found in the states of Eastern Europe and the former Soviet Union. The trend was noted throughout the three days of the United Nations special session on HIV/AIDS held this week. The Open Society Institute -- a U.S.-based civil society group -- hosted a panel discussion on the sidelines of the UN event to draw attention to the problem. A number of world and regional experts emphasized the need to approach drug users -- who make up the majority of the region's HIV-infected -- with humanitarian concern rather than "zero-tolerance" drug laws.

New York, 28 June 2001 (RFE/RL) -- A shared view among the more than 100 experts and activists meeting on the sidelines of this week's UN General Assembly's session on HIV/AIDS was that a major change in public perception is needed before the disease can be effectively confronted in the nations of Eastern Europe and the former Soviet Union.

The experts met on 26 June for a panel discussion organized by the Open Society Institute, a non-governmental network established by U.S. philanthropist George Soros. They agreed major resources are needed to combat HIV/AIDS in a region still struggling with the transition from communism. But most important, they said, is the need for a general understanding among governments that the crisis is global in its dimensions and consequences -- not an isolated epidemic affecting stigmatized segments of society, such as homosexuals, drug abusers, or sex workers.

The damage from the HIV/AIDS proliferation in Eastern Europe and the former Soviet Union is well documented in "Drugs, AIDS and Harm Reduction: How to Slow the HIV Epidemic in Eastern Europe and the Former Soviet Union" -- a report released last week by the Open Society Institute.

The report says that the growing crisis in Eastern Europe and the former Soviet Union -- nearly 700,000 were infected with HIV by the end of last year -- is fueled by the triple epidemics of intravenous drug use, sexually transmitted diseases, and HIV.

The report also finds fault with the "zero-tolerance" policy toward drug users adopted by the Czech Republic, Hungary, Poland, and most recently, Russia.

Paul Farmer is a medical doctor and professor at Harvard Medical School who has studied the outbreak of the disease in the former Soviet Union and took part in this week's panel discussion. He told our correspondent that HIV/AIDS hit particularly hard in the region because it was preceded by a sharp increase in the rates of tuberculosis and syphilis infections.

"[It's a] collision of two major epidemics. One is new, and that's HIV -- new to the region. The other is old but changing, and that's tuberculosis. This has happened elsewhere. It happened in New York in the late [19]80s, it's happening right now in lots of places in sub-Saharan Africa. It happens where I work -- in Haiti -- and also where I worked -- in Russia. So this is the major biological event -- really, [the] bio-social event -- of this century so far, the collision of these two epidemics."

What sets Eastern Europe and the former Soviet Union apart from other heavily HIV/AIDS-affected regions is that intravenous drug use is responsible for the majority of the infections. Experts say up to 80 percent of all cases in Ukraine and Russia, two of the hardest hit countries, are linked to intravenous drug use.

Civil society activists say this trend, combined with tough drug policies and social prejudice against the infected, is hurting prevention efforts. Sergei Kovalev, a member of the Russian Duma and well-known human rights activist, told RFE/RL that the current government in Russia has taken a harsh approach toward drug users.

"The humane motivation to help drug users and those infected with HIV is very low on the government's list of priorities." Farmer says that although governments in Russia, and other countries in Eastern Europe with a "zero- tolerance" policy, are partly to blame for the rapid rise in HIV/AIDS infections, each government should be evaluated individually.

"You've seen radical changes in the political structures of that area [Eastern Europe and Russia], and many of the governments worked with the advice of the so-called Western advisers and people from other transnational agencies. So, I certainly don't think that we can focus on any one particular government. Any government that's passing laws can be evaluated on a case-by-case basis."

The approach backed by the Open Society Institute -- known as "harm reduction" -- is based on the belief that it is more productive to integrate drug users into society than to isolate them. Harm reduction has been practiced for years in Western Europe, North America and Australia, but was met with opposition from the authorities in Eastern Europe and former Soviet Union. Still, some Western non-governmental organizations have helped start -- with mixed results -- harm-reduction programs in a number of Eastern European countries and the former Soviet Union.

One such program, financed by the UN AIDS agency and the Open Society Institute, opened early last year in Bishkek and Osh -- the two largest cities in Kyrgyzstan. Agencies also funded by George Soros have since opened two more centers in Kazakhstan, as well as one in Tajikistan. In these programs, drug addicts exchange used needles and syringes for as many free replacements as they need -- sometimes five or six a day.

The implementation of harm-reduction programs in the West has so far been considered successful. But it is not yet known how effective such programs might be in the countries of the former Soviet Union and Eastern Europe.

Natalia Vasilieva, director of the public health program for the Soros Foundation in Russia, tells RFE/RL that governments in the region have to become more engaged in prevention efforts along with non-governmental groups.

"The government has to initiate more efforts for the introduction of preventive programs because the treatment [is] treatment of something that has [occurred] because of the absence of preventive programs. The main issue for the drug users -- among 85 percent of the newly registered cases [of HIV are in] intravenous drug users -- is that with mutual efforts [by governments and NGOs], a lot can be accomplished through preventive programs."

Meanwhile, in the Baltic states, a Lithuanian health care expert says his country has been more effective than Estonia and Latvia in taking preventive action against the disease. Emilis Subata is the director of the Vilnius Substance Abuse Treatment Center as well as chairman of the Central and Eastern European Harm Reduction Network.

He says: "In comparison to Latvia and Estonia, the HIV/AIDS situation in Lithuania is much better. In the last year the rates of infection in Latvia and Estonia rose sharply. In Estonia one year ago there weren't any registered HIV-positive drug users, now there are more than 1,000. In Lithuania it was possible early to introduce harm reduction programs."

The UN special session on HIV/AIDS concluded on 27 June with a final declaration that outlined targets for halting the spread of the disease. UN officials also expressed optimism about a global fund to help the poorest nations fight the disease. More than $500 million has already been pledged to the fund. It's not yet certain, however, whether some of the struggling former Soviet republics would qualify for assistance from this fund.

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