Explosion in the East
by Alexandre Smirnov

More than half of the people infected with AIDS in Russia are injecting drug users. The emergency measures taken by associations and NGOs in collaboration with international organizations to provide medical assistance and sterile equipment aroused some public hostility at first. However, mentalities have been changing and greater awareness has been developing during the last few years.

The first case of HIV to occur in Russia was recorded in 1987: officially, it involved a homosexual male who had just returned from a trip to Africa. Up to 1995, only 1000 new cases were reported annually, and these were contracted via either the sexual pathway or blood transfusion. There were only two recorded cases where the infection was thought to have been due to intravenous drug injection. In 1996, however, a HIV epidemic took hold among the drug injecters. In 1999, 14980 new cases of AIDS were recorded, which brought the official number of cases to 25,842, and 15,000 of these were officially said to have been contracted via intravenous drug use. In April 2001, the government epidemiological watch department estimated that there were as many as 102,000 people suffering from HIV, and that half of them were intravenous drug users (IDU)!
As far as the history of drug dependence in Russia is concerned, opium* was mentioned by Gogol in 1835, and many members of the more privileged classes were consumers in the mid-19th Century. In 1927, Mikhail Boulgakov wrote "Morphine", the story of a young doctor-turned morphine addict attempting to kick the drug by using cocaine* as a substitute. In 1934, the review "Russia Illustrated" published an article entitled "A Love Story with Cocaine", containing the confessions of a Russian cocaine addict. Many contemporary authors have referred to drugs, including Bayan Shirianov, with his tales based on the lives of Vint* users (Vint is an intravenous amphetamine similar to Pervitine*).

The opening of the frontiers made drug trafficking easier.
In the mid 50s, an opium trade developed in the USSR along similar lines to that existing in the Central Asian Republics and Afghanistan, where the use of this narcotic plant has cultural roots. During the 60s, cannabis* plantations were set up in the Krasnodar and Stavropol regions, and during the 70s, the use of narcotics became quite a common habit, although it was not perceived as such by the great majority of the population. Nor was there any official recognition that a narcotics dependency problem had arisen. Apart from alcoholism*, the official 1971 psychiatric handbook mentions only addiction to morphine and cocaine*, although it adds that "in practice, problems of this kind are hardly ever encountered".

Toward the end of the 80s, a drugs revolution took place, in parallel with the Perestroika and Glasnost reforms initiated by Mikhail Gorbachev. The collapse of the Soviet Union in 1991 made it possible to obtain information about the consumption of drugs in the West, which had previously been kept more or less secret. From 1987 to 1994, an additional factor came into play, namely the national anti-alcoholism campaign initiated by Gorbachev, which was most energetically implemented. The restrictions on alcohol led many people, especially among the young, to look for "alternative highs" and they began experimenting with all kinds of substances affecting the sensory system. The tendency for frontier controls to become more relaxed also facilitated drug trafficking.

The first intravenous drug to enjoy enormous popularity in Russia was Vint, a "kitchen sink" version of Pervitine. The consumption of this drug rocketed at the beginning of the 90s after first appearing in Leningrad in 198586. The use of Vint was surrounded by a number of ritual procedures. First the ingredients had to be collected, then a "master chef" had to be sought out, as the preparation process is dangerous and complex. The drug was then injected, usually in a collective context involving the use of a single syringe.

The main foci of the virus were Ukraine, Byelorussia and Moldavia, but it was in Russia that the disease propagated most quickly.

At about the same time Ketamine*, which is also known as Kalipsol*, appeared on the market. This intramuscularly injected anaesthetic, which was less popular than Vint, is also a potent hallucinogen. A new sub-culture based on its consumption developed in Russia, Ukraine, Byelorussia and Moldavia. Here again, the drug was usually injected collectively using a single syringe. Although this substance has been classified as "narcotic and psychotropic" it was not on the official drug list used by the police and was therefore easy to procure.

However the real shock occurred in 1994, when Russia stopped being simply a point of transit on the heroin trade routes, and also began to join in the production and consumption processes. At the same time, the so-called magic mushrooms were all the rage and cocaine, which had been out of fashion since the 1920's, made a comeback, selling at extremely high prices. Ecstasy*, LSD* and various amphetamines* gradually replaced Vint. In the cities, it was also possible to acquire mescaline and DMT*. And with the increasing demand for heroin, which was subsequently to become the most popular intravenous drug in Russia, HIV began to spread like wildfire.

Ukraine, Byelorussia and Moldavia were the countries most severely affected by the virus in the Community of Independent States (CIS). However, it was in Russia itself that the highest rates of infection were recorded. The rapid spread of HIV to all the regions was due to unhygienic methods of drug consumption, the hardline position adopted by the forces of law and order and the fact that heroin was fairly cheap. To illustrate the latter point, in Kaliningrad, a packet of cigarettes cost 20 roubles and a decent dinner 130 roubles but a tshek (a "wrap" of up to half a gramme of heroin) cost 100 roubles. In 1997, the first prophylactic measures targeting HIV among the IDUs were launched. From 1998 to 2000, the Ministry of Health in collaboration with the Netherlands branch of Medecins Sans Frontieres conducted a nation-wide harm reduction programme, the results of which were positive, according to the Federation's Chief Medical Advisor in 1999.

Up to 1998, the federal Law on narcotic and psychotropic substances was fairly open-minded and made the distinction between the dealer and the consumer: only the former faced the risk of prosecution. This distinction was accompanied by a complex set of "tariffs" established by the Standing Committee on Drug Control (PKKN) which listed offences and the corresponding penalties. Edward Babayan, its director at the time, was unbendingly in favour of making drug consumption an offence, and strongly opposed any measures in the opposite direction. In 1998, a new, more repressive law came into force, which decreed that a "large quantity of heroin" was defined as any amount exceeding 0.0058 (which is much less than the standard tshek of 0.58), and that its possession could entail a prison sentence of between 7 and 15 years (paragraph 4 of article 228 of the Penal Code).

The directors of the Fight against the Trade in Illegal Drugs (OuBNON), the main organ of drug repression headed by Lieutenant General Aleksandr Seergev, declared a "war on drugs". The seizure and destruction of drugs was regularly televised in broadcasts arranged by the Interior Ministry. Meanwhile, the statistics from OuBNON all pointed to growing criminal involvement in the drug market.

Many began calling for a change in the law and for the provision of "an alternative to prison for users instead of article 228". The changes in the penal code proposed were rejected in the Duma by only 25 votes.

Given the highly repressive legislative setting, drug addicts are not in a hurry to declare themselves.

During the last two years, the Ministry of Health has made a change of approach. The former director of the government's HIV prevention programme, Mikhail Narkevitch, announced in 2000 that "repressive measures will do nothing to halt the epidemic". Narkevitch encouraged the harm reduction efforts of NGOs targeting IDUs. His successor, Aleksandr Gooliousov has been pursuing a similar policy. The psychiatrist Vladimir Egorov, official advisor to the Ministry of Health on drug related matters, has himself undergone quite a change of standpoint, moving from 1 absolute refusal to collaborate with harm reduction projects, to a recent declaration of "perfect mutual understanding". Even the Principal Medical Advisor to the Ministry of Health, G.Onishenko, incidentally reputed to be incorruptible, has become a proponent of a more open-minded approach to drug users. V.Pokrovski, a leading intellectual figure, has been loudly predicting a global epidemic for 2008, and like many experts, substantially revising the official figures giving the number of persons currently infected, since in the context of a repressive legislation, drug addicts are in no hurry to appear on the official registers. They probably number 1.5 million rather than the 209,000 officially recorded.

Since the end of the 90s, a few NGOs have been extremely active. Médecins Sans Frontieres- Netherlands has been directing outreach projects in partnership with 40 regional groups. As many as 34 harm reduction programmes financed by the Oktrytoe Obshestvo institute, a branch of the George Soros fund, are also sponsoring outreach projects as well as syringe exchange programmes and information campaigns run in partnership with MSF. Meanwhile, UNAIDS, together with the Ministry of Health, is supporting 17 projects across the country. One of the peculiarities of the Russian situation is the fact that most of the funding for these projects comes from abroad, and that all these associations are interlinked. One should however also mention the Russian association Spid Infosviaz, which publishes a specialised review intended for the organisations working in the field of HIV. A large-scale project is also managed by DFID, a financing body linked to the British government. However, in recent times, in some regions and Republics such as Tartarstan and Sakha-Yakoutia, a transition to the self-financing of these programmes is occurring.

A tendency to adopt a more flexible, more humane approach can now be observed.

In St Petersburg, three specially converted buses cruise the streets offering syringe exchange facilities. In Moscow, independent harm reduction projects have been launched, but there is no point in looking for facilities for syringe exchange, which has been prohibited by the municipal authorities. In March 2000, an organisation called Kolodets appeared in the capital. This is an organisation founded by the drug users themselves, and its emblem is a symbol representing a bonfire of used syringes. In a television interview, the members of the local Militia expressed their approval of the aims and activities of organisation. The Moscow region, which is an autonomous member of the Russian Federation, seems to be about to adopt an attitude which would make it possible to set up syringe exchange facilities.

In conclusion, attitudes towards drug use and the spread of HIV in Russia have evolved conspicuously. Although the war on drugs and their users is still going on, medical circles are adopting more flexible attitudes and an increasingly humane approach. At this very moment, there is an ongoing debate as to the relevance of introducing experimental substitution programmes in Russia, mainly based on the use of methadone*. A loan from the World Bank is also awaited and a substantial part of this money will go towards funding specific aspects of HIV prevention among IDUs.

A GALOPING INCREASE IN DRUG ADDICTION

According to the figures given by the Russian Ministry of the Interior, there are more than three million drug abusers in the country, and less than 10% of them have been registered. One person out of every five, making 30 million individuals in all, is thought to have a connection of some kind with drugs. What makes the situation even more alarming is the fact that an increasingly young population is becoming involved in drug abuse. 60% of the drug consumers are between 18 and 20 years of age and 20% of them are frequenting educational establishments. According to the Ministry of Health, the first contact with drugs was occurring until quite recently at the age of 15 to 17 years, but it is now tending to occur between the age of 11 and 17 years. The results of a survey carried out in autumn 1998 on secondary school pupils in Moscow and Saint Petersburg indicated that 70% of all the consumers of illicit substances had tried these substances for the first time either at school or when attending night-clubs. According to the National customs committee, the structure of the market changed considerably in 1999. The statistics show that dried poppies (which are used to make home-made heroin), hashish and marijuana are tending to be replaced nowadays by brown sugar (a type of heroin) and sometimes by China white (another type of heroin), as well as by synthetic drugs. In parallel, drug abuse has become the main cause of contamination with AIDS. In approximately 90% of all the cases of AIDS recorded in 1997-1998, needle-sharing among drug injecters was responsible for the transmission of the disease. The towns where this situation has developed most alarmingly in this respect are Moscow and the surrounding area, Kaliningrad, Saint Petersburg and Krasnodar.
Source : Geopolitical Drugs Watch.

1 .Fonds Soros :

2•DFID : Departement for International Development :

Source: PEDDRO december 2001