Heroin, Russia And Denial

In Russia, A Heroin Glut And Denial  [ 5 January 2011 ]
 By Amie Ferris-Rotman
TVER, RUSSIA
Tue Jan 25, 2011 5:30pm IST
(Reuters) - In her one-room flat, as a small shelf of porcelain cats looks on and the smell of mould hangs in the air, Zoya pulls down the left shoulder of her black blouse and readies herself for her next hit.

A friend and ex-addict uses a lighter to heat a dark, pebble-like lump of Afghan heroin in a tiny glass jar, mixes it with filtered water and injects it into Zoya's shoulder. The 44-year-old widow is a wreck: HIV-positive, overweight and diabetic. After 12 years of dealing and drug abuse, the veins in her forearms and feet are covered in bloody scabs and abscesses, too weak and sore to take fresh injections.

Crimson-dyed hair frames her bloated face, which is made up to match a hot pink manicure. As the syrupy brown mixture enters her system, Zoya's eyes glass over and she ponders her fate and that of her country.

"There are a lot of us. What do they (the government) want to do? Kill us?" she says. "They want to gather us together and drown us? I worry for tomorrow's generation."

If Zoya is anything to go by, today's Russians are hardly flourishing. Russia has one of the world's biggest heroin problems, with up to three million addicts according to local non-governmental organisations. Twenty one percent of the 375 tonnes of heroin produced from Afghanistan's opium fields now finds its way through central Asia into Russia, according to the United Nations. (By contrast, China, with nine times more people, consumes just 13 percent.) The Russian government estimates its citizens bought $17 billion worth of street-traded heroin last year -- about seven billion doses. The addiction kills at least 30,000 Russians a year, which is a third of the world's total heroin-related deaths, adding to pressures on the country's already shrinking population.

So grave is the problem that President Dmitry Medvedev last year branded heroin a threat to national security.

That's one reason why last October, 21 years after the end of the decade-long Soviet war in Afghanistan, Russian troops joined forces with U.S. soldiers for a joint drug raid on four Afghan labs. The operation, which destroyed nearly a tonne of heroin, was hailed a success and the Cold War foes said they would like to see more such operations in Afghanistan, which is responsible for 90 percent of the world's heroin production.

At home, though, Russia has been far less active in tackling the problem. Critics go as far as to accuse Moscow of wilfully neglecting its citizens and thereby fuelling what the World Health Organization says is one of the fastest growing HIV/AIDS epidemics in the world.

Unlike most countries around the world, Russia refuses to finance harm reduction programmes such as needle exchanges, or to legalize methadone. Over the past few months, Moscow has decided to discontinue the work of foreign donors and NGOs with heroin addicts. It even recently blamed foreign groups for worsening the country's HIV epidemic.

Health experts and drug addicts alike point to official inaction as the real culprit. It's as if Moscow has misinterpreted the old U.S. anti-drugs slogan "Just Say No" and turned its back on the crisis. "My government does nothing for me. I am no longer a person in this society," says Zoya, who lives in Tver, a drab city of half a million just off the Moscow-St Petersburg highway, and whose husband, also an addict, died from AIDS several years ago.

Anya Sarang from the Andrey Rylkov Foundation for Health and Social Justice, a small UN-funded Russian organization set up in June 2009, says Russia is failing its people. "For the main groups prone to the disease -- drug users, sex workers, migrants -- there is absolutely nothing for them," says Sarang.

THE PROUD BEAR
Russian officials have a long history of denying crises. From the Soviet government's refusal to help during the famine of the 1920s to its delay in responding to the 1986 Chernobyl nuclear accident, responses from the top have often mixed disregard and cover-up. During last August's heat wave, as peat fires and acrid smoke killed hundreds, officials kept silent on the wider health effects of the smoke for weeks.

One of the reasons for the rush to denial lies in the national psyche. Russia is a deeply patriotic country, with a long history of strong governments far removed from the everyday concerns of ordinary citizens. After the humiliating collapse of the Soviet Union 20 years ago and the calamity and poverty that followed, the strongman rule of Vladimir Putin (former president and current Prime Minister) has allowed the Russian bear to flex its muscles on the international stage again.

But while Moscow crows about hosting such high-profile sporting events as the Winter Olympics and soccer World Cup, it ignores daily reality, says health worker Sarang. "Russia is trying to preserve a certain political image, showing that everything is fine," she says. "This has shown to be nothing more than a lie."

Most Russians see the truth all around them. Zoya's story is repeated so often across the country's nine time zones that the reality is hard to ignore. Even the government estimates there are 1.8 million heroin users; activists and doctors put the number closer to 3 million, and in a study last June, the United Nations put it at 2.34 million or 1.64 percent of Russia's population. That's the world's third highest heroin abuse rate in per capita terms after Afghanistan and Iran. In absolute numbers, the UN says, Russia is number one.

Heroin was virtually unheard-of during the Soviet era, but is now easy to buy in any city in the country. In Tver, a medium-sized city with relatively little industry and few job prospects for the young, the detritus of addiction -- used syringes, needles -- litters the streets. Deals are a regular sight on street corners.

Russia's anti-drugs tsar, Viktor Ivanov, who heads the Federal Drug Control Service -- a powerful government body given to U.S.-style rhetoric about the 'War on Drugs'-- blames the country's porous Central Asian borders for the heroin hunger.

"Unfortunately, in 1991 we suddenly found ourselves without borders," Ivanov told reporters in December, referring to the collapse of the Soviet Union.

Ex-Soviet Tajikistan, which borders Afghanistan and is one of the world's poorest countries, has long been a haven for drug smuggling out of Afghanistan, where the Tajiks have ethnic ties. From there the heroin flows through Kyrgyzstan and Kazakhstan and into Russia.

INTERTWINED WITH AIDS
The drug problem has now become an AIDS problem. Officially, Russia has 520,000 registered HIV-positive people. The UN and local NGOs say there are probably closer to a million, maybe even more. HIV/AIDS has spread rapidly over the past decade, especially among drug users who regularly share dirty needles. The government estimates around a third of all drug users in Russia are HIV-positive; and international and Russian health experts worry the disease is beginning to spread to the general population through heterosexual sex.

The biggest problem, say health experts, is the government's refusal to address Russia's drug addiction. The lack of official intervention is remarkable. There are currently just 70 needle exchange and distribution programmes in Russia, reaching a mere 7 percent of heroin addicts according to the London-based International Harm Reduction Association (IHRA). In terms of needle exchanges, "Russia is not even scratching the surface," says Rick Lines, executive director of the IHRA.

All the programmes are run with foreign funding. Government support: nil. It's not as if the government is powerless. In the one area of the HIV/AIDS epidemic where it is active -- mother-to-child transmission -- it has reduced transmission rates to almost zero.

HIGHWAY AIDS TEST
In the face of government inaction, grassroots groups have mushroomed across the country.

Outside Tver, Yuri Surin parks his beat-up black Toyota at a truck stop along the Moscow-Saint Petersburg highway every night. There, between 7 pm and 4 am, he surreptitiously doles out clean needles and condoms to prostitutes, many of whom work to support their drug addictions. "If I were not here, where would these girls go? Who would help them? No one," Surin says as a trio of prostitutes in knee-high boots and bomber jackets approaches the car.

Surin's organization, We And AIDS, consists of himself, a second outreach worker and a driver. The supplies he hands out every night and the kits he uses to test women come, he says, from sympathetic doctors and western groups who want to help.

On a cold night in November, 20-year-old prostitute Olga slips into Surin's car for an AIDS test. Surin rubs a two-inch indicator on her gums and inserts it into a small plastic tray while Olga nervously smokes a cigarette and shakes her black-bobbed head from side to side in anger at her fate, her gold leaf-shaped earrings swaying.

After studying the result -- negative -- the prostitute flings the indicator out of the car window and then hops across the gravel into a truck cabin where customers -- two large middle-aged truckers -- are waiting.

DEEMED SUFFICIENT
The Health Ministry says it spent 10 billion roubles ($320.5 million) on HIV/AIDS testing and treatment -- mostly antiretroviral drugs -- in 2010. But activists and health experts say this amount compares badly with other countries in the G20 and sufferers are routinely ignored.

In a 2010 report, the World Health Organization said just a fifth of Russians who needed AIDS drugs were receiving them. South Africa, which has the biggest HIV-positive population in the world -- and whose government until recently was criticized as being in denial on AIDS -- gives AIDS drugs at almost twice that rate.

"Appeals, trials and public action -- nothing works," says Alexandra Volgina, head of the Candle Foundation for HIV-positive people, a non-governmental organization in Saint Petersburg.

When asked why so many sick Russians lack access to AIDS drugs, the health ministry's spokesman responds: "The amount spent was deemed sufficient."

POPULATION PROBLEMS
Russians usually blame alcohol for their health problems. Official data shows the average Russian drinks 18 litres (38 pints) of pure alcohol every year, compared with 14 litres in France and eight in the United States.

Official campaigns against drinking have been pursued sporadically since Tsarist times, usually with little success. In September last year Russia banned night-time sales of heavy alcohol, following on from a proposal to double the minimum price of vodka over the next two years in an effort to curb drinking.

"They (the government) are nicer to alcoholics than they are to us," says 32-year-old heroin addict and Tver resident Valera, whose scaly hands and face are covered in bright pink scabs from a decade of use. Like many drug addicts, Valera does not work and refuses to say how he funds his $300-a-day habit.

The Geneva-based International whose scaly hands and face are covered in bright pink scabs from a decade of use. Like many drug addicts, Valera does not work and refuses to say how he funds his $300-a-day habit.

The Geneva-based International Aids Society Aids Society (IAS) warns that if Moscow continues to take no measures, the number of new HIV infections in Russia is likely to grow by 5-10 percent a year, pushing the problem to "an endemic level", according to IAS president Elly Katabira: the rate will stay constant even without any additional infections from outside the country.

That would hit Russia's already dwindling population -- recently called a "demographic crisis" by President Medvedev. Heavy smoking, alcoholism, pollution, poverty, low birth rates in the years after the fall of Communism, as well as HIV/AIDS underpin UN projections that the population will shrink to 116 million by 2050 from 142 million now. Moscow -- which now gives money to mothers bearing two or more children - targets a population of around 145 million by 2025, but concedes that it could fall to as low as 127 million by 2031.