Features of Conducting Harm Reduction Programs for Intravenous Drug Users in Central Asia
Igor Vassilenko, IHRD Technical Advisor for Central Asia

Before the 1990’s drug abuse in Central Asia existed among several population groups but wasn’t as wide spread as it is now. Homemade drugs like marijuana and opium were used by marginalized populations. Today, the illegal drug trade is so pervasive that more and more youth are starting to use drugs. The paradox is that the new market economy helped the young generation choose this new lifestyle, this new way of thinking, and, unfortunately, this new way of relaxation. It is certain that the drug expansion that started in the 1990’s and is ongoing assists with this.

Why does this happen? Central Asia has many territories where narcotic plants grow. There are regions near the mountains of Kirgizstan, Tajikistan and Kazakhstan with wild growing opium poppy and ephedra; and located in Central Asia is Chew valley where potent cannabis grows, which is the source for preparing marijuana and hash. One of the main reasons for drug expansion is Central Asian countries share boarders with countries that are home to the drug cartel "Golden Crescent" (Afghanistan, Pakistan, and Iran).

Central Asia has become a new drug market. The price of drugs in this region is constantly dropping; thus, more and more drugs are available. In the mid 1990’s a gram of heroin cost approximately $200; it now costs $50 – $90. But the drug trade is still profitable. For example, a kilogram of opium in Afghanistan costs approximately $50, in Tajikistan – approximately $200, in Kirgizstan – approximately $1000, in Kazakhstan - $3000 to $4000, and in Russia the price can be as high as $10000. The illegal trade of different drugs can include 10’s of tons. Additionally, there are cases of merging drug businesses and law representatives which is a great problem and makes resisting the drug market quite difficult. Therefore, drugs have penetrated people’s lives in Central Asian countries and with them has come HIV, to be discussed later.

Various types of drugs are found in these countries. First about marijuana and hash. The attitude regarding these drugs in the east was always tolerant and in many regions the use of these drugs was a matter of culture, stemming from ancient times. People used them for treatments, cooking, and as substitutes for alcohol in countries where it was forbidden. Using drugs in such ways wasn’t destructive and many people from Central Asia are less affected by tetracannabiol than people from Europe or America. But now that marijuana and hash is prevalent among youth it becomes dangerous as for many it is a step to using harder drugs such as opium, heroin, and amphetamines. (Research shows that in several institutions approximately 43% of youth aged 14 – 17 have used marijuana at least once.)

About opium. At the end of the 1980’s, beginning of the 1990’s, it became more common for this type of drug to be homemade. This type of drug is prepared at home and used in changeable groups of 2-5 people. Joint preparation and use with shared kits facilitates the spread of infections such as hepatitis and HIV/AIDS among drug users.

Heroin – has been dominating the market for the last 2-3 years, replacing other drugs. Drug users at first sniff it and within two to three months as the dosage increases many drug users start injecting it. Heroin, as well as opium, is used by groups of people with shared kits, which also facilitates the transmission of HIV and hepatitis C. With the spread of heroin use one more problem has appeared – overdoses. For example, at the present moment in Kirgizstan overdosing is the most wide-spread risk of drug use. In the city of Bishkek approximately 12 cases of overdoses are registered every week, a third of which are fatal.

Finally, amphetamine. It is prepared at home from ephedra or other medicines that are sold in pharmacies. In addition to the high potency of this drug, there is one more risk associated with its use. It is used by groups of 5-10 people, it stimulates sexual arousal and users simultaneously become more careless. All these things lead to dangerous sexual behavior and the spread of STDs, and the spread of diseases transmitted intravenously.

All of the above mentioned factors led to a 10-fold increase of drug use in the mid-1990’s in Central Asia. As the governments of these countries were concerned, they adopted various laws and programs regarding drug abuse and HIV/AIDS.

The treatment of drug addiction in governmental and private clinics can be considered successful, especially when we speak about detoxification and symptom therapy. Treatment is available for all strata of the community as the payment for it is $50 - $500 in governmental clinics and $1000 – $3000 in private clinics. Minors are treated free-of-charge. Unfortunately, with all the effective first steps of therapy, the absence of rehabilitation programs greatly lessens the outcome of treatment. For the past two years Central Asia has been addressing the issue of creating sufficient numbers of rehabilitation centers and at the present moment new rehabilitation centers are being established in Kazakhstan and other regions.

Along with the drug use outbreak was the start of an HIV epidemic. Kazakhstan became a vulnerable region. Within 2-3 years an HIV outbreak occurred in central Kazakhstan, in the city of Temirtau. The number of HIV infections increased 10-fold, from 25-30 to 900. 83% of those who were infected are intravenous drug users. In other Central Asian countries the HIV situation is more or less quiet but HIV is still spreading in the drug community, which is the cause of great concern. At the present moment there are 5 HIV cases in Tajikistan, 53 – in Kirgizstan, and 1337 – in Kazakhstan.

During the HIV outbreak, Central Asian governments turned to the United Nations for help; UNAIDS conducted a rapid assessment of the situation in targeted cities and financed several harm reduction projects. In 1999 the Open Society Institute (OSI) and the International Harm Reduction Development (IHRD) program also started a harm reduction program and supported several projects in Central Asia. Currently there are 12 projects in this region (6 in Kazakhstan, 3 in Kirgizstan, and 3 in Tajikistan).

Conducting a harm reduction program in Central Asia has several features of both general and more specific natures, which depend on various factors. All these features can be divided into several groups.

First: Imperfect legislation for conducting harm reduction projects. In many Asian countries governments adopted AIDS prevention laws such as the governmental decree "About Programs for Preventing and Fighting AIDS." However, legislation for conducting harm reduction projects which identify their status and possible financing was absent until the start of this year. Therefore, organizations that run harm reduction projects have had to lobby for local decrees that make these projects legal. This is not easy as authorities are often cautious about and sometimes negative towards harm reduction projects, especially when these projects are proposed and implemented by non-governmental organizations (NGOs). The exception is found in cities where the threat of an HIV epidemic is imminent or the reputation of the NGO allows it to successfully lobby for the program. At the start of 2001, due to the success and achievements of some harm reduction projects, the governments of some countries adopted different laws in which harm reduction strategies are newly mentioned.

Second: Negative community attitudes towards needle-exchange programs. This can often be explained by culture, ways of thinking, and negative attitudes regarding drug use and drug users, as well as the lack of knowledge about the effectiveness of harm reduction projects. It is possible to overcome these obstacles with the help of gradual work with the community via good public relations. The effectiveness of harm reduction projects depends on forming tolerant community attitudes towards drug users. This is most important at the beginning of project development and success greatly depends on it.

Third: Unconvinced drug users. Drug users often can’t even fathom this approach to the problems of drug use and AIDS. There is no harm reduction practice in many Central Asian cities; therefore, drug users are often wary of intervention within their community. Sometimes project organizers repel drug users due to their lack of knowledge about the peculiarities of the behavior of drug users. To overcome these difficulties it is necessary to attract volunteers from the drug using community who know all the nuances which should be considered. Additionally, our experience showed the necessity of regular trainings for volunteers who participate in outreach work. One feature of harm reduction in Central Asia is the intense role of outreach work, important because the specifics of drug use in these countries differs from European countries – many drug users prepare and use drugs at home and with a group.

As already stated, OSI and IHRD currently support 12 harm reduction projects. Half of the projects have worked for 1-2 years and have had certain successes. In six cities in Central Asia, harm reduction projects achieved great results: regularly occurring needle-exchanges, distribution of necessary harm reduction supplies, counseling and medical aid to drug users, HIV testing, and systematic work with communities to form more tolerant attitudes towards drug users. In whole there are 4000 to 5000 drug users involved in these projects. A number of projects started working last year and they are very active. For now, we have Central Asian networking which assists the projects to exchange experience and be united in resisting the HIV epidemic in Central Asia. In the future, when we connect Central Asian networking with European networking, the harm reduction program will have a greater effect. This will certainly provide the opportunity to exchange experience and information as well as to coordinate efforts of all countries in Eurasia in preventing an HIV/AIDS epidemic.

OSI and IHRD international support to Central Asian projects is quite meaningful as it allows not only the implementation of projects but the opportunity to demonstrate to governments the effectiveness of such an approach in preventing the spread of HIV. This has led to the gradual financing of such projects by local administrations in some cities and we can assume that in the future harm reduction projects will be entirely financed by governmental budgets of Central Asian countries.

Email this article
Posted March 1, 2001 © Eurasianet
http://www.eurasianet.org

	The Central Eurasia Project aims, through its website, meetings, papers, and grants, to foster a more informed debate about the social, political and economic developments of the Caucasus and Central Asia. It is a program of the Open Society Institute-New York. The Open Society Institute-New York is a private operating and grantmaking foundation that promotes the development of open societies around the world by supporting educational, social, and legal reform, and by encouraging alternative approaches to complex and controversial issues. The views expressed in this publication do not necessarily represent the position of the Open Society Institute and are the sole responsibility of the author or authors.