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.

EU-Russia Civil Society Forum Invites Young Professionals to Poland

The EU-Russia Civil Society Forum invites young professionals aged between 25 and 35 from the EU, Russia, and other European states to apply for the Annual “Europe Lab” Forum.

Forum for Young Professionals “Europe Lab” is a unique communication and exchange platform for change makers from all over Europe working in public administration, business, NGOs, universities, think tanks, and other fields of professional engagement.

Main goals of “Europe Lab” are to enable cross-sector cooperation and promote exchange of ideas, develop partner and professional networks, and encourage common cross-border projects and initiatives all over Europe.

The working language of the Forum is English.

“Europe Lab” will take place on 27–30 July 2017 at the European Solidarity Centre in Gdańsk, Poland.

The programme of “Europe Lab” 2017 includes:

Workshops:

  • Freedom and Captivity – Solidarity in the Present and in the Past
  • Climate Change – Where Are You Going?

Innovative Formats:

  • Gdańsk in the Spot – City Development Hackathon
  • 360° Story – Multimedia Telling

Each format will be curated by a coordinator.

The best common projects, whose ideas were elaborated during the Forum, will be granted. The results will be presented at the 8th General Assembly of the EU-Russia Civil Society Forum in 2018.

Finally, “Europe Lab” alumni are invited to join the young professionals’ platform at the EU-Russia Civil Society Forum, to lead and play a role in a number of future initiatives.

Costs for workshops, accommodation, and meals are covered by organisers. Travel costs are borne by participants themselves.

Please submit your application until 1 May 2017 here.

Should you have any questions, don’t hesitate to contact us via e-mail.

Forum for Young Professionals “Europe Lab” is organised by the EU-Russia Civil Society Forum in cooperation with the European Solidarity Centre as well as supported by the European Commission and the Oak Foundation.

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

Reasons for Drug Policy Reform

Michel_Kazatchkine_2012

Text: Michel Kazatchkine, UN secretary general special envoy on HIV/AIDS in Eastern Europe and Central Asia

Why is eastern Europe the only region in the world that still has a growing HIV epidemic? In one of the region’s countries, Russia, more than two thirds of all HIV infections, and 55% of the near 100 000 new infections reported last year, resulted from drug injection.

Some 3.2 million people in eastern Europe inject drugs, and about 1.5 million of them are in Russia. In 2007 the number of newly reported HIV cases among Russian people who inject drugs (12 538) was similar to the number in the rest of eastern Europe (12 026). But since then the numbers have diverged hugely.

Scaling up of harm reduction programmes in several countries coincided with a stabilising of HIV rates—and fewer than 7000 new cases outside Russia in 2014. In Russia, however, where access to sterile needles and syringes is low and opioid substitutes remain illegal and unavailable, the number of people who inject drugs newly infected with HIV climbed to nearly 22 500 in 2014.

Criminalisation of drug use

The reasons for Russia’s high figures include the prohibition and effective criminalisation of drug use, repressive law enforcement, and stigma around drug use. These factors lead people to inject in unsafe conditions for fear of police and arrests and result in needle sharing and overdose.

In 2015, the United Nations’ secretary general, Ban Ki-Moon, called for “careful rebalancing of the international policy on controlled drugs.”

“We must consider alternatives to criminalisation and incarceration of people who use drugs,” he said. “We should increase the focus on public health, prevention, treatment, and care.”

The World Health Organization, the United Nations Office on Drugs and Crime, and UNAIDS jointly recommend a package of harm reduction interventions as best practice to reduce the risk of acquiring, and improve treatment of, HIV, hepatitis, and tuberculosis among people who inject drugs. Such strategies, which do not require prohibition of harmful behaviours, are key to reducing death and disease because drug dependency is characterised by people’s inability to abstain.

Continue reading here.

Nearly two-thirds of European HIV cases are now in Russia

hiv-death-rate-globally

Source: ria.ru

The annual number of new cases of HIV increased by at least 8% in 2015 in the whole of the World Health Organization (WHO) European region, and by 60% in the last decade, according to last month’s annual surveillance report by the European Centre for Disease Control (ECDC) and WHO Europe.

A continued increase in new diagnoses in Russia was responsible for most of the increase. The previous year, as aidsmap.com reported, 60% of European-region new cases were in Russia. In 2015 this increased to 64% of all cases.

The 98,177 diagnoses recorded last year in Russia equate to one HIV diagnosis for every 1493 Russians each year. In comparison, the 55,230 diagnoses recorded in the rest of the WHO region represent one diagnosis for every 13,157 people – one-ninth as many per head.

The number of new HIV diagnoses in Russia has increased 15% in one year, 57% since 2010, and 133% since 2006. Russia admitted this year that more than a million of its citizens have HIV. This is 0.8% of its adult population and is at least the same number as the US in a country with 45% of the US population. At the current rate of increase, this prevalence will double to 1.6% in the next 12 years.

Excluding Russia, 46% of infections in the WHO Europe region were ascribed to heterosexual sex, 26% to sex between men, and 13% to injecting drug use – and less than 1% to mother-to-child transmission. In the last ten years, infections in men who have sex with men (MSM) have increased by 38% and in heterosexuals by 19%, but have fallen in injecting drug users by 38%. In Russia, heterosexual sex is the cause ascribed to half of all recorded cases and a third to injecting drug use.

WESTERN, CENTRAL AND EASTERN EUROPE

In western Europe (which also includes Israel and Greece for WHO’s purposes), and in the European Union (plus Norway, Switzerland and Iceland), the number of new cases of HIV have remained almost static. In western Europe about 30,000 new cases have been reported each year from 2010 to 2014 and in the EU 32,500. An apparent slight decline in 2015 (10% in western Europe and 8% in the EU/EEA) may be due mainly to delays in 2015 reports arriving.

Central Europe – which includes the former communist countries running from Poland down to the Balkans, and also Cyprus and Turkey – remains a low-prevalence area for HIV, but saw a 78% increase in infections from 2010. However, there are signs that a feared acceleration of HIV in these countries may have slowed, with only a 4% increase registered between 2014 and 2015, though this does conceal larger increases in infections in gay men in some countries, including Bulgaria and the Czech Republic. However, many of these countries still have the lowest rate of new infections in Europe, with Macedonia (one infection per 83,000 people last year) and Slovakia (one per 62,500) reporting the lowest rates.

In eastern Europe, which comprises all the former Soviet states (including Lithuania, Latvia and Estonia, which are in the EU) if Russia is excluded, the annual number of new diagnoses has stayed flat or fallen slightly (by 9%) since 2010, though the percentage due to heterosexual sex has more than doubled to 65% of the total and the proportion due to injecting drug use has fallen to 26% of the total. The slight overall fall in eastern Europe conceals big increases in some countries with relatively low HIV prevalence, including Georgia with a 48% increase since 2010, Cyprus with a 95% increase, and Belarus with a 116% increase.

INFECTIONS IN MEN WHO HAVE SEX WITH MEN

In western and central Europe the epidemic is increasingly concentrating in men who have sex with men. In the last ten years, the proportion of infections due to heterosexual sex in western Europe has fallen by 41% and to injecting drugs by 48%, while the proportion due to sex between men has increased by 7%.

The proportion ascribed to sex between men in eastern Europe is still only 4% – but this in fact represents a tenfold increase. In some states such as Belarus and Estonia, infections in MSM were regarded as scarcely existing ten years ago – which means that the 58 cases recorded in Belarus and the 18 in Estonia last year represent proportionally big increases. In Russia sex between men still officially only accounts for a tiny proportion of new HIV cases – 1.5%. However, WHO does not regard Russian data as “consistent” and excludes it from some of its analyses.

The increases in infections in gay men seem to be starting to occur in some countries further east than previously. Georgia, for instance, saw a nearly 50% increase in the annual HIV diagnosis total from 2010 to 2015, a 12-fold increase in gay men, and a threefold increase in MSM from 2014. Belarus saw a 166% increase in HIV cases and a fourfold increase in gay men. Ukraine reports similar increases in gay men against a background of falling diagnoses in other groups. Increases in MSM infections were also reported from the central Asian countries of Kazakhstan and Kyrgyzstan. These increases are from a very low base, though, and may just represent that more men testing HIV-positive are prepared to admit they caught HIV from other men.

OTHER CHANGES IN INDIVIDUAL COUNTRIES

One country that has seen big relative increases in HIV is Turkey. The 2956 cases reported last year represent a 5.5-fold increase over diagnoses in 2010 and a 62% increase in one year. Because Turkey is a populous country (75 million), this still represents a low rate of infection (one per 37,000 head of population per year, less than a third of the UK’s rate), but Turkey may be a country whose HIV epidemic is worth watching.

In the EU, Latvia and Estonia had the highest rates. While Estonia’s formely explosive needle-driven epidemic continues to shrink, new HIV cases have increased by 43% since 2010 in Latvia. Notably, Latvia has been till very recently the only WHO Europe country whose national HIV treatment guidelines still recommended treatment should not start till CD4 counts had fallen below 200 cells/mm3.

Western European countries that saw increases in recent years include Malta, where the new HIV diagnosis figures leaped by more than 50% last year and have risen more than fourfold since 2010, though the absolute number of people with HIV in this small island country is still low, at about 300 people in total.

Another country that has seen significant increases since 2010 is Ireland, with a 47% increase relative to 2010 and a 43% increase from 2014 to 2015 – again, mostly in gay men.

The UK still reported by far the largest number of new cases of HIV of any country in western Europe to ECDC – 6078 reported to ECDC last year, way ahead of France, with the second highest number at 3943. However, the annual diagnosis figure has fallen since 2005, as we reported last September, including for the first time a tiny (1%) decrease in diagnoses in gay men. The diagnosis rate per head of population, one per 10,638 people, was second only to Luxembourg’s in western Europe in 2014, but in 2015 was overtaken by Portugal, Ireland and Malta.

One needs to be cautious about saying HIV cases have fallen in specific countries because there is such variation in the number of delayed reports sent to ECDC. However, since 2010 there have been significant falls in HIV diagnoses, exceeding the falls seen in the UK, in France, Spain and Italy.

In France there appears to have been a significant drop of 30% in diagnoses notified between 2014 and 2015, and a 40% drop in gay men. Fewer than 1000 HIV cases were reported in French gay men last year, a third as many as in the UK. In contrast reported diagnoses have risen by 36% in Germany since 2010 (33% in gay men) and this country reported nearly as many new HIV cases as France last year.

eastern-europe-and-c-asia

Source: UNAIDS

MIGRANTS, LATE DIAGNOSES, AND AIDS

Over a quarter (27%) of new diagnoses in the WHO Europe region were in people not born in the country where they were diagnosed. While two-thirds of this 27% represent people from outside Europe, primarily high-prevalence countries, infections in migrants from outside Europe fell by 29% in the last ten years while infections in intra-European migrants increased by 59%.

Nearly half of all new diagnoses (48%) were in people with CD4 counts below 350 cells/mm3. The proportion of these late diagnoses was 55% in heterosexuals and 37% in gay men. It was also 64% in those over 50 years old. Over a quarter (28%) were diagnosed with CD4 counts below 200 cells/mm3, and 12% had an AIDS-related condition at diagnosis.

Regarding diagnoses of AIDS (in both newly-diagnosed people and the already diagnosed), there were 14,579 reported in the WHO European region last year. Diagnosis of any AIDS-related condition was extremely rare in central and western Europe – only one person per half a million head of population in central Europe, and one person per quarter million in western Europe. In contrast one person per 10,000 head of population had an AIDS diagnosis in eastern Europe, including Russia. This means that AIDS diagnoses in eastern Europe were more common than HIV diagnoses in all western European countries bar Ireland, Luxembourg and Malta.

INTERPRETING THE FIGURES

ECDC’s figures always need to be interpreted with caution. Russia, with its huge preponderance of HIV cases, reports a much more limited and more irregular set of figures to ECDC than most other countries. The efficiency of HIV surveillance and the proportion of late reports vary widely from one country to another.

The proportion of people diagnosed also varies widely. If testing rates increase in a country, then it may look as if new infections are increasing when they are not. Some countries, including large western European ones like the UK and Germany, do not collect centralised, verifiable figures for HIV tests. In those that do, testing rates vary hugely. In Kosovo, for instance, just three HIV cases were reported last year – but that is probably because only 1312 tests were conducted, representing 0.07% of the population. In contrast, Russia performed over 28 million tests – meaning it tested more than 20% of its adult population. Generally, HIV testing rates are higher in eastern Europe than they are in central and western Europe. This tends to mean that higher testing rates compensate for lower reporting rates.

It is in central European countries like Poland (0.62% of the adult population tested) and Serbia (0.71%) that low rates of testing imply low rates of diagnosis – meaning that there may be considerably more people with HIV in these countries than appears to be the case.

REFERENCE

The 2015 ECDC/WHO Europe HIV/AIDS Surveillance Report can be downloaded here.

Source: www.aidsmap.com