Plenary preview: HIV, drug policy and human rights the case of Russia

1. Plenary preview: HIV, drug policy and human rights the case of Russia anya sarang, andrey rylkov foundation for health and social justice

2. themes of this conference • Drug policy • Human rights • Harm reduction HOW DO THEY RELATE TO HIV? LETS LOOK AT THE CASE OF RUSSIA!

3. background • estimated number of drug users 5 millions • estimated number of opiates users over 1.6 million • 550 thousand officially registered DUs. 71% of them IDUs • 504,537 PLWHA officially registered as of end 2008 • average HIV prevalence in IDUs - 37.2%, reaching 75% in some cities • in 1987-2008 about 80% of HIV infections related to IDU • About 11% of all PLWHs are in prison settings.

4. background 2 • Hep C prevalence in IDUs reaches 90% in some cities • More than 105,000 new cases of active TB were detected in 2009. In 2008 more than 16,000 people had both TB and HIV (18% growth compare to 2007). • TB is the leading cause of death (62%) among PLWHs • Around 75% of males and 54 % of female who have both HIV and TB acquired HIV through injecting drug use

5. Best practice harm reduction • Needle and syringe programmes (NSPs) • Opioid substitution therapy (OST) and other drug dependence treatment • HIV testing and counseling (T&C) • Antiretroviral therapy (ART) • Prevention and treatment of sexually transmitted infections (STIs) • Condom programmes for IDUs and their sexual partners • Targeted information, education and communication (IEC) for IDUs and their sexual partners • Vaccination, diagnosis and treatment of viral hepatitis • Prevention, diagnosis and treatment of tuberculosis (TB).

6. the government inhibits effective interventions • Russian government does not provide specific targeted evidence based programs recommended by the UN: • Needle and syringe programs operate but • no adequate coverage (coverage estimated at 2%, recommended 60%) • not funded by the government • ambiguous legal framework puts implementers at risk • Opiate substitution programs legally banned • Articulated opposition to both on behalf of Ministry of Health, Federal drug control service, INCB officials (Russia rep) • Political resistance on the international level (CND, PCB UNAIDS)

7. drug treatment - accessibility • state system offers only detox • only the state can offer detox • few state rehabs, also paid, not anonymous, and many closing due to OHI • no free, anonymous treatment available • only possible with registration as a drug user constraints on civil rights (job, driving license, childcare)

8. drug treatment - quality • outdated standards, using substances prohibited in international practice (such as strong neuroleptics) • official statistics of state centers: 8.6% remain drug free within a year. On average a drug dependent person has from 5 to 6 hospitalizations • private drug treatment lack of quality standards, wicked practices • Eg “Spanking therapy” • handcuffing • hypnotherapies (“coding”). • etc

9. government approach: repression and criminalization

10. Well at the Ditch [drug selling village] they plant drugs on someone every day… Well, they have to justify their salaries, and therefore they arrest. Drugs planted – a new star on the shoulder-straps… its their job. Everybody has a job to do. [Male, 23, Barnaul] I had one tiny needle prick mark, and my friend had the same. And right beside the metro they, immediately: “Young people, present your veins”. So without checking documents or anything, just “present your veins”. And then “Let’s walk behind the kiosk for personal search”. [Male, 21, Moscow] policing drug users: violations normalized and routine “I’m very afraid. Really. They beat me so strongly! One time they beat me so badly, planted [drugs], so that I was so shit scared that for two weeks I was afraid to even think about it” [Female, 23, Moscow] Subbotnik is this kind of thing, they can just pull a girl out from the car by her hair, and not only one girl, but how ever many sit there, put her in their car and take away, fuck her for free in whatever way they like. They can even beat her, in this or that way, and also do their raid on prostitutes. [Female, 17, Barnaul] • Planting evidence Extortion I was coming back from the University, and I dropped by a pharmacy to buy syringes. When I walked out to the street I was surrounded by a crowd, maybe six people, police. They checked my documents, they checked my purse, put a gram of heroin into it. And consequently, I gave them almost a thousand dollars, just not to get it [the case] on paper. [Female, 22, Moscow] Physical violence and torture rape Unjustified random arresting

11. fear and terror = risks “Fear. Fear – this is the very main reason…And not only fear to be caught, but fear that you will be caught and you wont get fixed. So on top of being pressured and robbed [by police], you will also be sick… And that’s why you will use whatever syringe is quickly `available…” • Reduced hygiene; urgency of injecting • Increased risks of sharing • Pharmacy patrolling • NSP interference • Syringe as an IDU identifier • Refusal to come to NSP • Taking away and/or breaking syringes - in our study while syringes were generally available from pharmacies 22% reported sharing in last 4 weeks:

12. criminalization of drug users • possession of small amounts: different by law and in practice • police arrests quotas • faults in investigation and courts on drug cases: • majority of cases not thoroughly reviewed, based on false evidence, provocation (4 cases in ECHR) • Courts as “notary’s offices for prosecutors accusations” • high rate of incarceration sentencing • no alternatives to sentencing (treatment)

13. prisons Drugs were around but you see a syringe is a forbidden thing... With drugs it is possible to hide them somehow, somewhere, but well, how do you hide a syringe? So, if someone somehow got hold of a syringe—maybe they brought it in or stole it from the medical centre—then it was just superachievement. Then that syringe would do the rounds and rounds and rounds of the whole camp. And then you get loads of syphilis, AIDS and . . . Someone would shoot up once and then in the course of the next 2 months about 20 people would be in the isolation ward with viral hepatitis. (Barnaul, male, 18) • 2 highest rate of incarceration (~1 mln) • Over 55% male IDUs report prisons experience • Over 50% inmates on drug related charges (st pete, • Prisons as structural factors of HIV/TB transmission: • Drugs are available (study of 7 prisons demonstrates 43% injected in prison, others confirm) • Needles, drug treatment, and prevention not available • HIV explosions in prisons (eg Tatarstan) • HIV treatment either inaccessible or intermittent • General conditions unhealthy and humiliating

14. access to health I was in such pain. they thought I was a junkie. I never knew of pain like that before… but they don’t care – “You’re in withdrawal! Go to narcology, we don’t treat people like you”. They give some kind of shit like baralgin, and only if you really yell at them. If there is a Hell on Earth for HIVs, its here, in the 2nd city hospital of Kaliningrad… I want to be one of the society, im just like them, but no, if you’re HIV they just let you die like a bitch, like an animal. But I so want to live! im only 35! But they wouldn’t let me. Only suffering and pain and hopelessness – and no help. I’m for euthanasia, its better to die than to tolerate this fascism on behalf of health [system]. They care about kitties on the streets, but if a man dies – who cares. Fucking humanists. Lesha Gorev, 35 yo, Kaliningrad, died of AIDS-associated lymphoma in Jan, 2009 • Discrimination of drug users in general practice • HIV treatment: • Over 60% PLHIV – IDUs • Less than 20% people receiving HIV tx. • Discrimination in enrollment, underdeveloped support structures, problems with supporting adherence • Access to hepatitis C treatment: not available for injectors • TB treatment: system of out patient treatment (DOTs) doesn’t exist, in-patient treatment impossible for drug users (no OST!) • Palliative care: opioid analgesics are generally little accessible (INCB, 2008) even less so for IDUs and former IDUs

15. education and information • Initiatives on drug testing in Universities (supported by municipal authorities and Deans) • Case in Kazan • Law on Propaganda and article 46 of Federal Law on Drugs: • Prohibits distribution of information, including drug counseling, HIV prevention • Prohibits scientific debate on substitution treatment • FDCS issued recommendations to take out of circulation certain books and punish publishers

16. some action • Advocacy on int level • Work with CESCR • Complaints to the Special Rappourteaur on the Right to Health • European Court on Human Rights • Advocacy on local level, working with communities • Press conferences • Action and public sensibilization (Togliatti and N.Chelny) • Official requests to ministries etc. • Working with local and national press • Working group on OST advocacy • Documenting • Case documenting • General reports • Focused research

17. Kostya Proletarsky www.rylkov-fond.ru

18. Vienna – home to the international drug policies Russian diplomat Yuri Fedotov appointed as head of UNODC – UNAIDS family leading agency on HIV prevention in drug users and prisoners.

19. HIV, drug policy and harm reduction • HIV prevention and treatment cannot be effective in contexts where human rights and dignity are neglected • HIV prevention and treatment cannot be effective in the context of drug policy built on fear and terror • HIV prevention and treatment are developed, well studied and not expensive, but we have to fight.

20. This conference can and should become an important step in Understanding harms of current drug policies Challenging these harms Ending the terror of drug war! Making best practice effective HIV prevention and treatment available to all!