HIV Treatment Programs Fail Drug Users in Asia and the Former Soviet Union, Experts Warn

TORONTO—Countries facing HIV epidemics among injecting drug users routinely exclude them from HIV treatment, leaving millions vulnerable to disease and potentially fueling the world's fastest-growing HIV/AIDS epidemics, experts at the XVI International AIDS Conference warned today. The consequences may be particularly severe in Russia, China, and other countries of Asia, Eastern Europe, and Central Asia where injecting drug users account for the largest share of those diagnosed with HIV.

“Outside of Africa, nearly one in three HIV infections comes from injecting drugs with contaminated equipment, yet in many countries drug users are not able to access HIV treatment,” said Dr. Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).  “Some 20 years of research and experience confirm that HIV epidemics among injecting drug users can be prevented, stabilized, and even reversed using a comprehensive package of HIV treatment and prevention activities. We need to build on what we know works, and rapidly increase both treatment and prevention services for drug users.”

Data from 46 countries shows that at the end of 2004, only 36,000 former or current injecting drug users were receiving antiretroviral treatment. Of these, 30,000 were in Brazil. In Eastern Europe and Central Asia, injecting drug users account for more than 70 percent of HIV cases but represent only 24 percent of people receiving antiretroviral treatment.

Kasia Malinowska-Sempruch of the Open Society Institute, which has supported programs to make sterile injection equipment and antiretroviral treatment accessible to drug users in Eastern Europe and Central Asia, said that government failure to engage drug users in health care was likely to fuel further infections. “Governments tell drug users to act responsibly and not to infect others, but the clinics shut the doors in the faces of those seeking to take care of themselves,” she said. “The message sent is that some people with HIV are good and pure, and others deserve to die.”

In Russia, where UNAIDS estimates that as many as 940,000 have become infected with HIV and where about 80 percent of those infected have a history of injection drug use, stigma is particularly severe.

"Doctors used to tell drug users that they were ‘socially unproductive’ and not eligible for treatment," said Alexandra Volgina, a peer counselor and former drug user from St. Petersburg who for a year wore a mask when speaking publicly about her HIV infection, for fear of discrimination. "Now people say they are committed to including drug users, but they provide none of the tools, such as substitution treatment, that are needed to make it work. Physicians say drug users fail on treatment, but it seems that the treatment system is really failing us."

In many Asian countries, including China, Malaysia, and Indonesia, injecting drug users make up the largest share of HIV infections. There, too, those with a history of drug use are the minority of those receiving HIV treatment.

“In Malaysia, there are 15,000 drug users interned in rehabilitation centers, including a significant proportion who are HIV-positive,” said Dr. Adeeba Kamarulzaman, President of the Malaysian AIDS Council. “Currently ARV and substitution therapy is only available in one of these rehabilitation centers, with only a small number of HIV-positive injecting drug users receiving this treatment.” Dr. Kamarulzaman noted that despite recent efforts to increase access to ARV in Malaysia, where more than 75 percent of all HIV infections are estimated to be among injecting drug users, only 12 percent of those receiving ARV are drug users.

The International Harm Reduction Development Program (IHRD) of the Open Society Institute released a book-length, peer-reviewed study here, Delivering HIV Care and Treatment to People Who Use Drugs, detailing successful efforts to offer drug users treatment for HIV, tuberculosis or hepatitis C, and raising questions about the widespread failure to reach patients in need.

“The assertion that drug users cannot comply with treatment tells us more about the inflexibility of health care providers than it does about medical facts,” said French HIV/AIDS Ambassador Michel Kazatchkine, an author of the volume’s foreword and a physician whose clinic in Paris has provided care to drug users with HIV. “It is a physician’s responsibility to create circumstances in which patients are likely to succeed. The marginalization and discrimination faced by drug users are having terrible consequences.”

The International Harm Reduction Development Program (IHRD) works to reduce HIV and other harms related to injecting drug use, and to press for policies that reduce stigmatization of illicit drug users and protect their human rights.  IHRD, which has supported more than 200 programs in Central and Eastern Europe, the former Soviet Union, and Asia, bases its activities on the philosophy that people unable or unwilling to abstain from drug use can make positive changes to protect their health and the health of others. Since 2001, IHRD has prioritized advocacy to expand availability of needle exchange, opiate substitution treatment, and treatment for HIV; to reform discriminatory policies and practices; and to increase the political participation of people who use drugs and those living with HIV.

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