Text: Helena Cazaerck
“The choice between a HIV-infected needle and no needle is easily made. It is hard to understand for most people but I have experienced it myself”, says Ezhi while she is handing out syringes in the gloomy streets of Marino, Moscow. One day Ezhi needed a shot of heroin, so she bought the drug from her dealer that time, who is HIV-positive. He had no other needles but his own, therefor Ezhi went to the pharmacy to buy a clean one.
“I had money, but the druggist saw that I was a drug user and refused to sell it to me. It is a policy of some pharmacies. This situation, to put it mildly, is unpleasant. It’s good that I still had my own used syringe. Because in the other scenario, I would probably have used the syringe of the HIV-infected dealer, she says.
HIV in Russia is growing at about 10 percent per year. In 2016 the number of HIV cases climbed up to one million in total. That means Russia registered 275 new HIV cases every day. It is the largest H.I.V. epidemic in Europe and among the highest rates of infection globally. An estimated half of HIV infections were contracted through intravenous drug use. And yet, it seems that the Russian government is not prepared to deal with heroin dependency in an effective way. Harm reduction programs do not find government support, Methadone substitution therapy is banned and being addicted to drugs is a criminal offence.
“Most people think we are animals. They do not see an addiction as a clinical condition but they believe that we are bad people, criminals, who deserve to suffer.” (c) Helena Cazaerck
Ezhi has been a social worker for the Andrey Rylkov foundation for five years. The organisation advocates for drug reform in order to combat the spread of HIV and to give drug users a more human life. Besides that, Ezhi and her colleagues form a mobile activist group that organises nightly outreach projects in the Moscow area during which they dispense condoms, syringes and quick tests for HIV infection. There are 20 people working for Andrey Rylkov, 10 of them go on outreaches. Usually in pairs. “We hand out about 500 syringes every night, that gives you an idea of how many people are using heroin here.”
After the collapse of the USSR in 1991, Russia went to a period full of crisis, often described as the wild 90’s. With the fall of communism, new freedoms of cross-border trade and travel led to an explosion in drug use and trafficking. The Afghan opium trade, which involves over 90 percent of the world’s heroin, made Russia the world’s largest heroin consumer. According to the U.S. International Narcotics Control Strategy Report the number of addicts in the first 18 years of post-Soviet Russia has increased nine times.
The rejection of Communism had left over a huge ideological gap which is nowadays filled with more traditional Russian values. This mix of nationalism, mostly with an anti-Western taste, and conservative interpretations of Orthodox Christianity leads according to the Global Drug Policy Observatory to Russia’s frigid drug policy. The Kremlin’s fear of further contamination from the West’s liberal values is seen a barrier for adopting more liberal drug laws which would boost preventive measures among vulnerable groups, like drug users.
“As a drug user you cannot cross the street safely. Russian drug legislation makes it possible to arrest someone who has taken drugs for up to 15 days. That is why a lot of drug users are so scared.” (c) Helena Cazaerck
“Russia wants to be strong and powerful, drug users or an HIV epidemic do not suit that image and therefore seem to be ignored for the sake of the ideal. There is an enormous stigma”, says Ezhi. “Most people think we are animals. They think we are spoiled. They do not see an addiction as a clinical condition but they believe that we are bad people, criminals, who deserve to suffer.”
The Russian government seems to hope it can legally combat drug use and therefore reduce the spread of HIV/AIDS. Yet, experience of other countries shows that while governments are taking steps to combat drug use, drug users should also receive relevant medical help. Something that is still lacking in the today state’s strategy.
“As a drug user you cannot cross the street safely. Russian drug legislation makes it possible to arrest someone who has taken drugs for up to 15 days. When you have a small amount of drugs with you, you can be sent to prison for 3-8 years, says Moscow based Human Rights lawyer Anna Kinchevskaya. According to The Global Fund Russia manager, Sandra Irbe, there is a massive incarceration of drug users, which results in more than 70% of the inmates being drug users. Very often young people, of whom their entire life will be affected from that. “Russia needs to understand prison is not an alternative to drug use. Appropriate drug addiction treatment, psychosocial accompaniment, reintegration into society are alternatives to drug addiction”, she says.
Ezhi is standing underneath a tree in front of a pharmacy. Despite it is freezing, she looks strong, comfortable and ready to actually do something about Russia’s HIV problem, street by street. “I wish I could leave Russia, to give my children a better future. But I can’t, I am stuck. I am stuck because I can’t just close my eyes, I want to change something.”
From a distance Ezhi recognises Gaidar. They greet each other very amicably and Ezhi gives him fifty or more syringes. Gaidar is regular ‘customer’. He distributes the syringes to those who are unable to get it themselves. “There is a pregnant girl living in the neighbourhood and it is hard for her to come to the outreach because she is scared to be caught by the police. It still happens today but it has been worse in the past”, he explains. “In the nineties it was impossible to go to a pharmacy to buy syringes without being caught. The police was waiting for us. They were on the lookout, every night. We knew it. So it was a common practice to use one syringe for sometimes five people. Rather that than a life in prison.”
For a Russian drug addict, prison sentence often equals death sentence. People with HIV or AIDS who acquire tuberculosis in jail, have only a small chance to survive. “I have lost almost all my friends, they have all died,” Ezhi says. She is thirty two now. “I only have two old friends left. One just got out of prison two weeks ago. He is HIV- positive and is struggling with his health.”
Ezhi’s friend is not receiving HIV treatment. The AIDS center where people can get treatment do not take the lifestyle of people with a heroin dependency into account. “When you are addicted to heroin, you first have to get a shot in order to do anything else. Finding drugs can sometimes take a while and by the time you get to the center, it is closed.” Another problem is that very often the condition for receiving treatment is abstinence from drug use. Due to the absence of rehabilitation programs or substitution treatment, this is almost impossible for most drug users. Where the HIV infection percentage of drug users is high, the mortality rate is so too.
A man takes about 50 condoms with him. He didn’t take any syringes. “I am trying to replace the heroin with sex, you see. I just love girls” (laughs). (c) Helena Cazaerck
The criminalization and the stigma around drug use leads to pushing drug users underground, making it difficult for them to access health care that is addressing their particular needs. “Heroin users have complex problems and without help, a lot of them don’t see a way out anymore, with depression and more drug use as a result. Most drug users are afraid. To reach them the government should support social non-governmental organizations, like ARF, which offer a client oriented approach, different for every person, instead of a formal approach”, says Ezhi. But they don’t. The government doesn’t support ARF’s activity. Instead the organisation is stamped as a foreign agent. A half legal organisation not worth trusting.
Besides that it is difficult for drug users to access health care there are also sever cases of discrimination in the medical sphere. About a year ago Svetlana, drug user and mother of two children, had had a trophic ulcer on her ankle. She visited a therapist who referred her to a surgeon in the polyclinic in Moscow but was refused treatment because she has HIV. “The surgeon asked me if I had a chronic disease. I told him I have HIV after which he immediately send me away. He wouldn’t even look at it.” People who use drugs therefore rarely go to doctors, explains Ezhi. “In practise they do not have access to it. When you feel the constant fear of being arrested and a doctor refuses to help and you, it is not like you will ever go back. You will cope with your problem somehow yourself.”
Every month ARF creates a magazine by and for drug users with legal information, poems and drawings. (c) Helena Cazaerck
Many of the drug users that pass by to get syringes seem to have the feeling that the government is ignoring the problem of the growing number of HIV patients among drug users in the hope the two problems will solve each other. “I can only guess why this problem is kept silent at state level. We have an official policy on the absolute non-acceptance of drug use. The state chooses for punishment instead of support and keeps promoting this mindset even if it is clear that it is not working. Perhaps they find it hard to recognize that they have made a mistake”, says Anna Kinchevskaya. Russia’s Federal AIDS Centre has warned that if nothing changes, more than 2 million people will be diagnosed with HIV by 2020.
Source: www.euroviews.eu