Reduced harm

Often street social workers of the Andrei Shkov Foundation are found with misunderstanding, and sometimes aggression from citizens in relation to their work. Recently, when one of our social workers stood at the pharmacy and distributed ointments, bandages, packaging with clean syringes, Nalaksson, HIV information on the prevention of HIV and other materials that we usually give out during street social work, a man came up to him and began to insult, calling a drug addict and an accomplice of drug addiction - for the distribution of sterile syllables. It was not possible to calm the displeased in any way, I had to call the police, who took both to the department. Upon learning what was the matter, the police indignant released, and the social worker began to be accused of aiding drug addiction. It’s good that in the end everything managed to resolve.

For most fellow citizens, the very desire to help consumers of drugs, to reduce the possible damage associated with use, without forcing them to stop using drugs here and is something unnatural and is considered as a connivance of drug use. And to give a drug addict a sterile syringe or some other tools for safe injections is generally a crime.

At the same time, drug addicts in Russia are not very powerful-unlike alcoholics, who, in general, are also drug addicts, but they are usually condescending to them in society, apparently brought up by folk traditions and due to the legalism of alcohol. In 2010, in Nizhny Tagil, the head of the local branch of the city of "City without drugs" Yegor Bychkov was judged - for abduction, torture under the guise of treatment and the retention of drug addicts without their consent. Many journalists, human rights activists, musicians and bloggers spoke in defense of Bychkov. A survey of the Echo of Moscow radio station (the audience of which is believed to be mainly the intelligentsia) showed that more than 90% of its participants are supported by the “treatment” methods used by bull.

This position of the majority of the population, in principle, correlates with the general Russian practice of zero tolerance to the use of drugs (recall at least the story with an attempt to introduce mythical "zero ppm"), which in fact expressed in the complete impatience of the state to people who use drugs (and this, according to the Federal Drug Control Service, almost one percentage of total Russian population).

Despite all the difficulties and barriers, we continue to go to the streets of Moscow daily and work with drug consumers on the principle of reducing harm

Programs for the prevention of HIV infection and other negative consequences from the use of injection drugs (the so-called damage to harm), which include the distribution of needles and syringes, have been successfully used for several decades in most Western countries (and not only Western ones). It is thanks to such programs in these countries that injecting drugs are not the main one affected by the HIV group. The term “reduction in harm” in this case applies to politics and programs that have the main goal to reduce the negative consequences from the use of psychoactive substances, without a prerequisite for reducing the level of drug use. Within the framework of this approach, the simple fact is recognized that only very few drug consumers are ready and have the necessary resources for immediate refusal of use. The rest, by virtue of their drug addiction (which is a disease, both according to the classification of WHO and the Russian Ministry of Health), cannot yet do this. Therefore, in working with this social group, it is necessary to reduce harm that be accompanied in order to be able to focus on the solution of the problem of consumption in the future. At the same time, the very concept of reducing harm caused by behavior has long and successfully used in many areas of our daily life: from helmets and other protection elements when driving on a bicycle and motorcycle to belts and airbags in the car. But it is the use of this approach in the context of drug use that causes the hostility of Russian society.

Here is an example of Australia, which is one of the most progressive countries of the world in terms of implementing a program to reduce harm from drug use. The first programs for reducing harm in Australia began to work in 1987, and since 1989 such programs have become an obligatory component of the National HIV prevention strategy. Today, more than 3,000 state programs for the exchange of needles and syringes operate in this country. The reason is simple - in addition to the humanistic aspect of this approach to HIV prevention among drug consumers and effectiveness in terms of influence on the epidemic, the state was evaluated by economic benefit. In the 1990s, the state invested in the operation of needles and syringes in Australia 130 million US dollars. As a result, according to estimates, approximately 25 thousand cases of HIV infection and more than 20 thousand cases of hepatitis C were prevented this allowed Australian healthcare to save from 2.4 to 7.7 billion dollars to treat these people, and the prevalence of HIV among drug consumers in Australia today less than 3%.

Another example is the UK. In the early 1980s, injecting drugs in the UK were considered almost the most affected by the HIV epidemic. In 1986, the country's reduction programs began to work throughout the country: drug consumers gained access to clean needles and syringes, information and medical and social support. By 1996, the prevalence of HIV in this group decreased ten times, to 0.6%. In recent years, the situation with the prevalence of HIV in this group is more or less stable: in 2008, only 166 cases of HIV transfer were registered with parenterally, and in 2009-109.

But for comparison, Russian data. To begin with, in Russia, according to FSKN for 2010, there are about five million consumers of illegal drugs. Of these, 1.7 million are consumers of opiates. Due to the conservative and discriminatory state drug policy, as well as due to the lack of state programs for the prevention of HIV among not only drug consumers, but also other groups of HIV-vulnerable to HIV groups, more than 830 thousand cases of HIV infection are officially registered (respectively, the real number of infected can be three times more, according to the principle of iceberg). About 200 new cases of HIV are recorded every day, the prevalence of HIV among injecting drugs is, according to estimates, from 18 to 31%. According to Yunaids, our region (Eastern Europe and Central Asia) is the only world in which the HIV epidemic continues to gain pace. At the same time, 85% of HIV-positive people in the region live in Russia and Ukraine. But if in Ukraine, according to the report of the WHO regional bureau, for the first time in recent years, there has been a decrease in the prevalence of HIV among consumers of injection drugs (and again - thanks to the programs for reducing harm), then this cannot be said about Russia.

That is why, despite all the difficulties and barriers, we continue to go to the streets of Moscow daily and work with drug consumers on the principle of reducing harm. When we started this project, many claimed: it is impossible to conduct needles and syringes in Moscow - the government does not support. But it turned out that nothing is impossible, you just want to want to do it. Sincerely believe in your strength and that a decrease in harm is not just the distribution of syringes and the prevention of HIV and overdose, but, first of all, building relationships with our participants in respect, attention and mutual assistance. It is such relationships that give hope and strength to us and those to whom we want to help.

Ivan Varentsov - participant in the Andrei Shkov Foundation