Russia has one of the fastest growing HIV rates in the world but as Victoria MacDonald reports, its reluctance to use harm reduction programmes among addicts is fuelling the spread of the disease.
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Russia is facing international condemnation for its failure to deal with its catastrophic drugs problem which is in turn fuelling an epidemic of HIV and Aids.
Ahead of thus Sunday's International Aids Conference in Washington, a briefing paper has been released to show that Russia and the Ukraine have the fastest growing HIV rates in the world. The figures are stark: in the Russian federation, more than one third (37per cent) of the country's 1.8m injecting drug users have HIV.
In 2010 injecting drug users accounted for 78 per cent of all HIV cases. A decade ago 100,000 people were HIV positive in Russia. Now it is over one million.
According to an International Aids Society report, the standards of drug treatment are outdated and do not conform to recognised standards.
Indeed, the UN, the World Health Organisation, the European council, 60 countries, including all of Europe, recognise methadone replacement and needle exchange programmes as the best method of harm reduction - the optimum way of preventing death and the spread of disease. Both are banned in Russia.
So people are dying from drugs and Aids. It is no longer just about heroin either. That has been harder to get lately following crackdowns by the police and since the trail from Afghanistan diverted down through Africa.
Instead there in a new, even more frightening drug around. Called krokodil, or desamorphine, it is a combination of pharmaceutical opiate-based drugs, iodine, petrol and hydrochloric acid, mixed up on the stove at home and injected.
It is a drug so toxic that it hardens the skin, turning it irreparably scaly - thus the name. Then it rots the flesh, damages the brain and finally kills its users usually within about two years.
'I want a normal life'
We met Katya (not her real name) at the home she shares with her sister and her elderly parents. Both women are addicted to krokodil and both have HIV. When you sit in their tiny bedroom, wallpapered to look like a starry night, you can smell them. They ooze the chemicals they inject three, four, five times a day. We had been warned that if we went into a room where it was being cooked we would likely have to throw away our clothes. It permeates everything.
Katya, aged 37, wants to be free of the addiction because, she said, she will either die or end up in prison. "I want to get married and have a baby and have a normal life," she said. A refrain we heard many times as we spoke to addicts.
But there is little to help them. With the ban on methadone, state sponsored clinics are able to do little except detox them rapidly, give them vitamin injections, and within a week, send them back out again. This cost money, too, which few can afford.
This gap has left room for the growth of organisations with unorthodox ideas on how to deal with addicts, ranging from the lock-em-up to the make them pray varieties.
I want to get married and have a baby and have a normal life. Katya, addict
One such group, City Without Drugs, has been going for 12 years, run by a self-styled crusader Yevgeny Roizman. He and his band of young men organise raids on what they describe as drug dealers, but who are usually little more than addicts cooking up in their kitchens.
He also runs rehab units where desperate parents bring their offspring, often locked in the boots of cars or tied to the backseats to stop them escaping.
We were given access to the women's unit about an hour outside the city which was being expanded to deal with the increasing numbers. About 40 women ranging in age from 14 to their early 30s, were locked inside, with little to do but watch tv or read.
We were even shown (though it was by mistake) the room they call the quarantine. Here, bunk beds were crammed in. A double locked door opening on to a double locked grille. When she arrives the young woman is locked in here for 28 days. Enough time, Roizman says, to give them time to think. They are allowed out only for meals of porridge, onion and garlic and to go to the toilet.
Still, this is an improvement. They used to be handcuffed to the beds, but a court case out a stop to that. Rumour had it they also had to go to the toilet in a bucket. Certainly that is what one former inmate told us but we were not able to verify that.
What we did learn was that in the week we visited one of the women was taken ill but was not given treatment in time. She later died in intensive care. Two days after we had been there the police raided the unit and some of the girls escaped.
Yet while the authorities may not like Roizman's approach to the drugs crisis, nobody has attempted to stop him. He has support, too, from parents who see their children self-destructing and, for the lack of an alternative, they embrace him.
Aids 'biggest myth of the 20th century'
For those who feel queasy at this approach, there is always the church-backed units. When we asked the Orthodox Church if we could see how they are dealing with the issue, they directed us to a unit in the Ural mountains run by a psychologist and narcologist, Vyacheslav Borovskikh.
The unit is in a former kindergarten next to an Orthodox Church. About 30 men at a time live and pray here.
Borovskikh claims an 80 per cent success rate but this has never been verified. Based on orthodox idea of human man. Drug addiction is a problem of the soul and it is the soul that should be cured and not the body. People should put their inner lives in order and speak to god every day in church. Local bodies respect that.
Yet this is also a man who is part of a growing band of Aids dissidents. He told Channel 4 News that Aids "is the biggest myth of the 20th century". He also said anti retrovirals are poison and kill those who take them.
For those trying to stop the spread of Aids, this is one more battle to fight. Not only do they have to deal with the ban on methadone and needle exchange programmes, but in some cities even sex education is banned so they cannot discuss safe sex.
This means that where previously HIV was largely contained to injecting drug users, it is now spreading to the general population.
Yet the government refuses to acknowledge evidence from other countries where they have begun a successful fight back against the virus. The result is that people are dying.
17 August 2011
01 December 2011