needle exchange

NY times 2009 - Russia needs needle exchange more than any other country: its H.I.V. epidemic is large, one of the fastest-growing in the world, and perhaps the most dominated by injecting drug use. Yet the needle-exchange efforts that do exist are scarce, small and under siege. I traveled there recently to see what lessons they hold. At 9 p.m. on a May night, in a tough neighborhood in Moscow’s north, I joined two young men as they climbed the stairs from the Metro. Arseniy and David were in their late 20s, wearing jeans and baseball caps. They had arrived to give out clean needles and promote harm reduction — but theirs was a guerrilla effort.

Needle exchange is legal in Russia — sort of. It must follow federal regulations. The catch is that these regulations don’t exist: the Federal Drug Control Service, whose top officials have called needle exchange “nothing more than open propaganda for drugs,” has been sitting on them for five years. As a result, no new harm-reduction programs have started during that time. Old ones continue where local authorities tolerate them, but Moscow’s government disapproves of needle exchange. So like their clients, Arseniy and David avoid the police. One of their clients was Masha, who, like every other drug user I interviewed, talked about police extortion. It is every addict’s main fear, but avoiding police shakedowns means only more dangerous injecting: if you fear being caught walking around with a needle, you use the community needle your dealer provides.

Arseniy told me that he started doing harm reduction as a volunteer with an organization working with the homeless. “Most of my clients used drugs, and I understood we couldn’t do anything without needle exchange,” he said. So the workers began buying needles with their own money and giving them out. Now he, David and another pair of outreach workers get financing from another Russian group. The city of Moscow, then, has only a handful of people doing needle exchange. An extremely conservative estimate of Moscow’s drug injectors puts the number at 240,000.

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