On the third Sunday of May we remembered people who had died of AIDS. But it would be right to not only remember those who left us, but also to think of what we can do to stop these deaths: to help those not living with HIV protect themselves from the virus and to increase access to testing, access to treatment and healthcare services for people living with HIV.
For drug users, AIDS-related deaths are an everyday reality. People who use drugs are the force that drives the HIV epidemic in the countries of Eastern Europe and Central Asia. They comprise over 50% of all people living with HIV, while few of them have access to treatment. In many countries of our region, even if antiretroviral drugs are purchased and distributed on time, this does not mean that people who use drugs will be able to start treatment.
There are many factors for why people who use drugs are not able to start or continue treatment and, therefore, to save their lives.
One of the most important factors is that people who use drugs often learn about their HIV status too late. If a country does not have harm reduction services, then it also lacks access to HIV testing for people who use drugs. Access to “drop-in programs” is constrained for many reasons (including inconvenient schedule, stigmatization by doctors, anonymous testing is fee-based and long wait for test results). In the framework of harm reduction programs, these services are much more accessible, and many countries offer rapid tests as part of their outreach programs.
Another problem is that many doctors in EECA do not administer therapy to people who use drugs because they consider them unreliable patients. However, this lack of reliability is related to lifestyle of people who use drugs and can be corrected with the help of case management, which can only be implemented as part of harm reduction programs. If a country provides access to opioid substitution therapy, people who use drugs can adhere to ART and restore their health.
Repressive drug policies are a source of fear of any official bodies, including healthcare facilities. In countries such as Russia and Ukraine, fear of police often prevents people who use drugs from purchasing clean syringes at pharmacies. When people who use drugs are searched, the presence of a clean syringe can justify detention. In a clear example of the connection between repressive drug policies and HIV, when Portugal decriminalized drug use the rate of HIV-related deaths in that country fell by 13% in five years.
In many countries, access to OST and other programs in detention is impossible, and access to ART in detention is severely constrained. Moldova is the only Eastern European country that has a needle and syringe exchange program in prisons.
In absence of harm reduction, with its components such as outreach programs, OST, case management and access to rapid testing, without overcoming health workers’ stigma towards people who use drugs, even access to modern drugs cannot save vulnerable people’s lives.
It hurts to mourn people who died of AIDS, and we are tired of being afraid of losing lives. That is why the Eurasian Harm Reduction Network advocates for sustainable funding of a comprehensive package of HIV services for people who use drugs. And we believe that our efforts will lead to a reduction in AIDS-related deaths.