Geneva, 9 April 1999 (RFE/RL) -- An estimated 30 million people worldwide are infected with HIV, the virus that causes AIDS (Acquired Immunity Deficiency Syndrome). By far the worst affected country in Eastern Europe is Ukraine, where some 24,000 new cases of HIV were recorded last year alone.
At least 50 percent of the new infections have occurred among intravenous drug users --known as IUD's-- who favor a potent mix of home-cooked amphetamines. One of the most common ways that HIV is spread is through the reuse of contaminated needles. Recent statistics show there is also a growing rise in the number of sexually transmitted AIDS cases in Ukraine.
In response, the government in Kyiv has begun rapidly instituting a number of programs aimed at reducing drug-related harm, the first of which was established in the city of Odessa three years ago.
One of the founders of the effort is Dr. Lidia Andrushchak, a project officer with UNAIDS, a United Nations AIDS agency, in Kyiv. She says the programs target people aged 10 to 24 who account for more than half of all new cases of HIV infection. She spoke with other project officers and harm reduction peers at the 10th annual International Conference on the Reduction of Drug Related Harm held late last month in Geneva, Switzerland.
Despite some initial successes, Andrushchak says the programs --which focus on local-level advocacy and needle exchange-- are still facing some formidable obstacles. She listed them:
"Disbanding of the National AIDS committee --the national coordination body; a lack of acceptance of harm-reduction strategies, not only among the general public but among specialists; a belief that [mandatory] HIV testing of drug users maintains prevention and limits outbreaks to drug users and will pose no threat to society; and a lack of advocacy within the administration to raise awareness of the social and economic consequences of AIDS, resulting in a misunderstanding of harm-reduction strategy and priority over restrictive actions."
Russia, new to harm-reduction theory, is encountering similar problems. The country is on the brink of what many predict will be an explosive AIDS epidemic. Russia's health system is in a state of collapse, and sexually transmitted diseases are on the rise in the country. In Russia, the drug of choice is heroin, which sells for little more than the cost of an ice-cream sandwich. The method of use, as in Ukraine, is largely by injection.
Dimitri Ostrovski is the director of a program on HIV prevention for drug addicts in Saint Petersburg, where there are an estimated 70,000 drug users. He works in association with Medecins du Monde (Doctors of the World) and with George Soros' Open Society Institute. Speaking through a translator, Ostrovski detailed for journalists the emergence of the heroin epidemic in Russia and a rapid rise in incidents of HIV transmission this past year. He suggested that there is an underlying story behind the figures:
"The special thing about the situation [in] 1998 is that it was the time when the economic crisis in Russia emerged and also at the same time when the new law on drugs was adopted, which sort of criminalized drug users. Because even before the law, there had been a huge barrier between drug users and specialists. But after the law, the fence got even higher, after which the flow of drug users to medical specialists decreased. In the same year, 1998, the mortality of drug users also grew."
Ostrovski quoted Ministry of Health statistics which predict that, by the turn of the century, there will be 800,000 people across Russia who will test positive for HIV. He adds that in the country today there are only a handful of needle-exchange programs, no methadone clinics, and no central state agency charged with gathering or analyzing information on the drug problem.
Currently, Russia's western outpost of Kaliningrad is experiencing what many experts say could very well be the world's fastest-moving epidemic of AIDS infection, much like the quick spreads seen earlier in Ukraine and in Belarus.
Contaminated needles have always been the most efficient way to spread the AIDS virus. Experts say that the way drugs are prepared in Kaliningrad --often mixed with the users' own blood-- has so increased this 'efficiency' that the study of its effects now amounts to what they suggest is a grim scientific specialty.
(This is the second in a series of features focusing on the global fight against drug-related medical harm. Lisa McAdams attended a harm-reduction conference late last month in Geneva. In the third in the series our correspondent further examines the growing use of injectable opiates, with particular emphasis on Eastern Europe and Central Asia.)