Beyond Resistance: Drugs, HIV and the Civil Society in Russia

The speech given by Anya Sarang, the President of the Andrey Rylkov Foundation, at the side event Reducing the harms of drug control in Eastern Europe and Central Asia which took place during the 60th annual meeting of the Commission on Narcotic Drugs on 17 March 2017 in Vienna. 

In 2016 the UNAIDS reported that the HIV epidemic has been taken under control in most countries of the world. The countries of Eastern and Southern Africa have reached a 4% decline in new adult HIV infections, the rates of which were also relatively static in Latin America and the Caribbean, Western and Central Europe, North America and the Middle East and North Africa. At the same time, the annual numbers of new HIV infections in Eastern Europe and Central Asia increased by 57% with Russia responsible for 80% of the new cases. There are only a few countries in the world where HIV keeps rising, and Russia has the fastest rate. According to the Federal AIDS Centre, around 300 people get infected, and 60 people die of AIDS every day. As of August 2016, the number of registered HIV cases was 1,060,000 while the estimates go beyond 3 million. And according to the Ministry of Health, only 28% of patients in need receive antiretroviral therapy.

The main group affected by the HIV in the country is people who inject drugs (PWID). From 1987 to 2008 about 80% of HIV infections were related to unsterile injections and still in 2015 almost 55% of the new cases are among drug users.  Since the beginning of the epidemic, over 200,000 people with HIV have died, the primary cause of death being co-infection with tuberculosis. According to WHO, Russia is among top countries with the highest burden of TB including its multidrug-resistant forms.  Another deadly co-infection is hepatitis C: its prevalence among people who use drugs reaches 90% in some cities. And drug users are entirely excluded from any treatment programs.

The reason for such a dramatic dynamic in public health is the Russian government’s failure to address the HIV epidemic, especially among the people most affected. The Russian government is notoriously negligent to the issue of HIV, vigorously adherent to the most repressive and senseless drug policies and openly resistant to evidence-based internationally recommended harm reduction programs and opioid substitution treatment with methadone and buprenorphine. The government not only fails to provide the financial support to these programs, it explicitly opposes them in the State strategies, such as the National drug strategy. At the same time in the past several years, the international support to HIV prevention has also dramatically shrunk. Due to the aggressive line of the Russian government towards the international aid and unkept promises to allocate own resources towards the epidemic, most international donors have left the country. That resulted in 90% decrease in the coverage of needle and syringe programs. Back in 2009, we had 75 harm reduction projects reaching out to 135.000 clients, and in 2016 there are only 16 projects to reach out to 13.800 individuals which is less that half percent of the estimated number of people who inject drugs. These few remaining projects are supported by the Global Fund to Fight AIDS, tuberculosis, and malaria, but even this symbolic support expires by the end of this year, and there are no new sources on the horizon.

To make the situation even more tragically absurd, in 2016 the Russian government started to attack non-governmental organizations that provide prevention services to people who use drugs and to LGBT. In one year alone, eight AIDS organizations were registered as “Foreign Agents” based on the fact that they receive funding from the Global Fund. Inclusion into the list means four times more reporting, expenses for administrative work and increased risks of fines and administrative charges. It also means that the organizations will not be able to receive any money that comes from the governmental sources.

All of the above has created the situation when the AIDS Service NGOs are blocked from the potential governmental funding while at the same time, most international donors have terminated their support to the Russian NGOs. Some donors, including USAID and several UN agencies, had to cease their operations in Russia due to the government pressure, a supporter of advocacy and human rights initiatives in the area of public health, the Open Society Foundations have been blacklisted by the authorities. But many potential donors also believe that a) situation in Russia is hopeless, and there is no way to improve and b) that their support may exacerbate the risks for the NGOs. Our organization believes that its necessary to provide more truthful information to the international partners about the situation in Russia and possibilities to express support and solidarity.

Our team works since 2009 providing daily health services on the streets of Moscow to people who use drugs. We do outreach work to sites where drug users get together, where we give our HIV prevention materials: sterile needles and syringes, condoms, rapid tests for HIV and Hep C, peer counseling, and support as well as referral to various health institutions. We see from 10 to 30 people daily, and last year alone almost three thousand people contacted our small service. We carried out more than 300 consultations on HIV and hepatitis, and in the last three years, we received reports of 735 lives saved with Naloxone we provide to the clients to prevent deaths from overdoses. We also run a street lawyers project, helping drug users to stand for their rights and dignity, providing them with legal skills and empowerment to represent their interests in courts and state institutions. We have a team of 4 lawyers and around 20 social workers and volunteers. We also provide secretarial support to the Forum of people who use drugs in Russia and facilitate documentation and submission of reports on human rights abuse to the state parties as well as the international human rights bodies. Several strategic litigation cases that came out of the Forum’s work aim to improve the legal context in Russia with regards to access to health and justice, including a case currently under review by the European Court of Human Rights on lifting the ban on opioid substitution therapy in Russia and in Crimea.

In 2016 our organization has been registered as a Foreign Agent, and we were subjected to a fine for not volunteering ourselves into the registry. There was some skepticism concerning our ability to continue the work with this status, but we didn’t want to lose our services because of the bureaucratic inadequacy of the Ministry of Justice. We have challenged their decision in court which surprisingly supported us by finding the Ministry’s decision illegal and lifting the fine. We are still listed as a Foreign Agent, but we also fight this decision by the legal means including, if necessary in the European Court of Human Rights. With the help of our partners and supporters, we have generated a fiscal security fund to sustain our work in case of financial sanctions on behalf of the Ministry. We have also received a lot of support for our cause from the mass media and the general public, including the recently started parliamentary debates on the inadequacy of application of the Foreign Agents law to the AIDS prevention NGOs.

Our experience and the experience of like-minded organizations demonstrate that it is still possible to provide AIDS and drug services in Russia, even in the context of political suppression of the NGO work. The only and the most important condition is the commitment to the protection of rights and health of our community. We are learning by doing and hope to develop creative approaches and a practical model of operations for organizations or groups who find themselves in similar politically restricted circumstances not only in Russia but other countries of our region.

We believe that the western NGOs and governmental organizations should not ‘give up on Russia.’ In fact, now more than ever we need the support and solidarity to continue our work and keep saving lives, health, and dignity, despite the political oppression.

Side Event: Addressing and Reversing the Harms of Drug Control in Eastern Europe and Central Asia

Side Event ‘Addressing and Reversing the Harms of Drug Control in Eastern Europe and Central Asia’ was organised by AFEW International, the Canadian HIV/AIDS Legal Network, the Andrey Rylkov Foundation for Health and Social Justice, and the International Drug Policy Consortium during the 60th Commission on Narcotic Drugs in Vienna in March 2017.

Richard Elliot (Canadian HIV/AIDS Legal Network): To provide a public health overview. Punitive approaches to drug control in the region are rife. But also resources and energy are devoted to law enforcement, rather than public health. Unbalanced situation. In many countries, criminal provisions impose liability for possession for personal use. Even if there’s no criminal sanction, the administrative penalty is used as a platform for rights abuses. Illegal searches, arbitrary detention. In terms of procedural rights, repeated instances of improper procedures in terms of handling of evidence, inaccurate investigation, inflation of quantities of possession, coercion through violence, fostering/inducing withdrawal to extract confessions. There is a general failure to consider someone’s drug dependence when deciding how to apply the law. The right to health is widely affected. There’s a cruel irony in the fact that the criminalisation of people who use drugs is coupled with lack of access to treatment for dependence. Criminalisation pushes people away from services, which are scarce themselves (OST, ART, NSP) or completely absent. There is a case on Russia’s denial to provide OST before CEDH. This denial violates the provisions on torture, privacy and discrimination of the European Convention on Human Rights. Both the ECOSOC and HRC have expressed concern about Russia’s refusal to offer OST. In prison settings, the situation is even more acute. In some countries, bureaucracies also create barriers to access. Ex.the confluence of multiple health conditions is something that sometimes public health systems in the region are incapable of handling. Beyond this, there’s an issue of access to opiate pain medication. Also, women are disproportionately affected by these policies. For instance, even if WHO guidelines have established OST during pregnancy is viable and advisable, many countries prohibit it; adding gender discrimination to the list of abuses in the name of punitive drug control.  The right to privacy of people who use drugs is also consistently violated, including the release of medical records to the public. What to do? Abolish all criminal and administrative liabilities for possession for personal use of illicit substances. Improve access to legal aid services. Work with law enforcement to reduce punitive and torturous practices. Stronger legal foundation that facilitates access to harm reduction and treatment service. Increase funding. In many domestic legal orders, the constitution stipulates human rights protection; they should be expanded to people who use drugs.

Anya Sarang (Andrey Rylkov Foundation): Russia is probably the epicentre of abysmal drug policy that fuels AIDS epidemic in our region. The HIV epidemic is progressively under control according to WHO. Relatively static numbers for new infections in most regions of the world. But new HIV infections are sharply increasing in our region. Russia has the fastest growing HIV epidemic in the world. The Federal AIDS Centre in Russia reports every day 300 people get infected with HIV. Everyday 60 people die of AIDS in Russia.  Estimates 3m infected. Official numbers suggest less than 1/3 have access to ART. 10 years ago, 80% of cases were related to injecting drug users. It’s still 55%.  The primary cause of death related to AIDS is tuberculosis. One of the few countries where tuberculosis is still a major killer for people with HIV. Hepatitis also a significant co-morbitidy that adds to the burden of disease. Russia is openly resistant to evidence-based internationally-recommended practices, programmes and treatment. Not only does the government refuses to finance these, it opposes them. The national strategy describes NSP as a threat to the counter-drug strategy. Most international donors left the country. 90% decrease of harm reduction programmes in Russia as a result. From 104 programmes to 16. There is no new sources of support on the horizon. During the 2016, 8 organisations have been included in the list of “foreign agents”, including ours, because we receive foreign funding. It means the organisations cannot receive any money from governmental sources. It is necessary to provide more truthful information to the international community and donors.  We provide support for drug users through outreach services, provide sterile needles and syringes, peer counselling and support, referral to health services. Almost 3000 benefited from our services. 736 lives saved as a result of naloxone distribution. The Street Lawyers programme documents human rights abuses and provides support to access legal services. Strategic litigation cases. The experience of the Foundation and like-minded organisations demonstrate it is still possible to provide services. We are committed to the protection of the rights of our community.

Victor Sannes (Ministry of Health and Social Welfare of the Netherlands): We value a balanced approach between public health and law enforcement efforts. We’ve come to realise there has been a disproportionate accent on the law enforcement aspect. It’s not about choosing between approaches, but combining them. There’s no “one size fits all solution”. A public health approach requires the deployment of a wide range of initiatives: prevention efforts to avoid or delay uptake as much as possible, risk and harm reduction interventions, etc. The basis of this policy lies in the law enforcement policy. The police were fed up in the 1970s, as the country dealt with street heroin use and related challenges. The Dutch government implemented comprehensive harm reduction interventions. And these policies are implemented with the collaboration between institutions and agencies, as well as people who use drugs, is fluid.


Question 1: What can the international community do to improve the quality of life of people who use drugs in Russia?
Anya Sarang:
 We sometimes have a feeling of isolation. Donors say we cannot do anything. It is important to remind GF donors and board, as well as other donors, that there’s still a need and good work being done on the ground. WE have evidence about our direct impact on people’s lives through our distribution of condoms and naloxone.
Richard Elliot: Important to use international mechanisms to keep attention on this situation. Monitoring state compliance with human rights, etc. At CND, underscore slow-motion genocide of people who inject and use drugs. Denying OST despite the evidence of the death that this produces is on a par with extrajudicial executions and the death penalty.

Comment by the Russian representative:

1) The first question should be “what is prohibited and allowed in Russia”? We cannot allow for activities that are not legal in our country. Last year Russia adopted a new national strategy on combating HIV/AIDS epidemic. We hosted Michel Kazatchkine, to visit some cities in Russia. He decided which cities to visit. He examined the new strategy. His opinion is that the situation improved. He will visit Russia again in a couple of years and compare. We are open for discussion on this particular issue.
2) If some activities are prohibited, we do not allow civil society representatives to continue these activities. Each and every country does the same. There is a huge scope of activities with regards to UNODC/WHO HIV Unit Technical Guide that Russia implements. OST is prohibited. We don’t treat drug users with another substance containing drugs. But we use naltrexone, an opioid antagonist, which blocks receptors. It’s a medication, not a drug.
3) We provide people with a whole range of measures on demand reduction and they work.

Richard Elliot
– If you withhold treatment that is evidence-based, and this leads to the death of hundreds of thousands…I think it’s not a mischaracterisation, to say it’s akin to genocide.

Source: CND Blog

Andrey Rylkov Foundation Presents a Shadow Report to the Review of the Periodic Report of the Russian Federation

logoOn 17th of January, 2017, the Shadow Report in relation to the review of the 6th Periodic Report of the Russian Federation (E/C.12/RUS/6) was submitted on behalf of the Russian Public Mechanism for Monitoring of Drug Policy Reform to the Committee on Economic, Social and Cultural Rights (CESCR).

The report was drafted by the Andrey Rylkov Foundation for Social Justice and Health (ARF) with technical assistance of the Canadian HIV/AIDS Legal Network (CALN).

The report informs the CESCR about the next serious violations of Articles 3 and 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR):

  • The Russian Federation did not fulfill CESCR recommendations given in paragraph 29 of June, 2011 Concluding Observations; Russian authorities retaliated against civil society organization which called upon them to fulfill these recommendations. As a result, HIV epidemic in Russia continues growing. Nearly two-thirds of European HIV cases are now in Russia. Up to 1.8 million of people who inject drugs remain a group of people most vulnerable to HIV, Hepatitis C, Tuberculosis (TB), and lethal drug overdoses. Moreover, Russian authorities obstruct the activities of HIV and harm reduction service providing non-governmental organizations by labeling them “foreign agents”, which bares significant humiliating connotation in Russia.
  • The Government of the Russian Federation does not ensure gender sensitive medical and social care for women who use drugs, including women living with drug dependency and drug dependent women with children.

Particularly the report provides the Committee with the information regarding:

  • The ignoration by Russian authorities of the CESCR recommendation to apply human rights-based approach to drug users;
  • The persecution by Russian state authorities of the civil society activists for promoting CESCR recommendations;
  • The termination of OST program in Crimea;
  • The ongoing litigation challenging the legal ban on OST in the European Court of Human Rights;
  • The lack of access to OST for pregnant women who use drugs and the lack of HIV prevention and social support for women who use drugs;
  • The Russian Government not providing any political, financial, or legal support to needle and syringe, and overdose prevention programs.

Earlier in 2010 ARF with support of CALN have already submitted the report to the CESCR on implementation by the Russian Federation of article 12 of the International Covenant on Economic, Social and Cultural Rights in relation to access of people who inject drugs to drug treatment and HIV prevention, care and treatment programs which led to the inclusion into the Concluding Observations of the Committee on Economic, Social and Cultural Rights on Russian Federation of the recommendation to the State party “to provide clear legal grounds and other support for the internationally recognized measures for HIV prevention among injecting drug users, in particular the opioid substitution therapy (OST) with use of methadone and buprenorphine, as well as needle and syringe programs and overdose prevention programs”.

The Russian Public Mechanism for Monitoring of Drug Policy Reform (Mechanism) is a consortium of more than 70 civil society activists, legal and medical professionals, which are committed to improve drug policy in Russia through legal and policy analysis, information sharing, and strategic litigation. From 2009 the Andrey Rylkov Foundation for Health and Social Justice (ARF) serves as a Secretariat for the Mechanism.

Source: Andrey Rylkov Foundation for Health and Social Justice