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Why Russian Heroin Users Are in Agony

Russia is grappling with one of the most devastating and fastest growing HIV epidemics in the world. In January, Vadim Pokrovsky, the head of the nation's research center for AIDS prevention stated that 1 million Russian citizens were registered as being infected with the HIV virus and an estimated 3 million people in Russia will be infected with HIV by 2020.

Earlier this November, Yekaterinburg's health department officials announced that the Russian capital city of the Sverdlovsk Region has been hit by an HIV epidemic, with 1 out of every 50 people being a carrier of the HIV virus and 774 of these carriers being children, 343 of whom have already been diagnosed with the virus. The city of Yekaterinburg has recorded nearly 27,000 HIV infection cases, out of which 52% were caused by intravenous drug use.

Anya Sarang, director of Andrey Rylkov Foundation for Health and Social Justice, the only group that offers free needle exchange in Moscow, claims that both the public and the government fail miserably at handling opioid use disorders in an ethical, humane and effective manner. The country has the largest population of injecting drug users in the world and more than a third are infected with the HIV virus. But despite these devastating data, there are only 4 state-run and 70 NGO centers for rehabilitation of drug users in the Russian Federation and the few existing drug dependency treatment programs are generally ineffective, with high rates of recidivism, given the resource-poor settings.

Even worse, most drug replacement therapy such as methadone therapy are still illegal in Russia and harm reduction services are virtually non-existent. The Andrey Rylkov Foundation, whose mission is to develop and promote humane drug policy is one of the few groups in Russia that advocate for the legalization of methadone therapy. Evan Wood, the founder of the International Center for Science in Drug Policy, has referred to the nation's repudiation of drug substitution therapies as a case of ideology triumphing over evidence and more importantly, at great cost to public health.

Per the WHO, the effectiveness of opioid substitution therapy in reducing illicit opioid use, overdose deaths, criminal activity and HIV risk behavior is already recognized in developed countries. Globally, it's estimated that only 8% of injecting drug users currently receive methadone or buprenorphine therapy, with less than 3% in India and China and none in Russia, because the Russian government wants nothing to do with this "narco-liberal" idea stemming from the West.

In Russia, the future of people who are suffering from an opioid use disorder looks heartbreakingly grim. This is due not only to the authorities' ridiculously stubborn refusal to acknowledge the evidence for the effectiveness of opioid substitution therapy and thus provide them with legal, adequate medication-assisted treatment but also to the rampant stigmatization of these chronically ill people viciously referred to as " anti-social elements" by the Russian authorities.

Because the Russian government and Kremlin-created institutions such as the Russian Institute for Strategic Research ( RISI) continue to fuel the stigma associated with opioid dependency, the general public is still misinformed about the pathological nature of opioid addiction. In May, last year, RISI presented a report on the HIV epidemic claiming that HIV is a Western moral issue, not a Russian disease and the best "form" of protection against STDs is the monogamous heterosexual family.

Per several reports by the Andrey Rylkov Foundation, many Russian doctors refuse to treat HIV-infected patients who use heroin because they wrongly believe that these patients will not be able to follow their treatment. In fact, as emphasized in the WHO report, opioid substitution therapy for HIV positive people with an opioid use disorder improves adherence to antiretroviral therapy by 54%.

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