Eastern Europe’s Ostrich Policy on HIV

CARDIFF, CALIFORNIA – Russia and Ukraine account for roughly 90% of the 1.5 million people estimated to be infected with HIV in Central and Eastern Europe. On a recent trip to these countries, and despite repeated requests, no politician or public-health official in either country would meet with me. None returned the phone calls, faxes, or e-mails that I sent after I returned home.

Both countries have epidemics driven by injecting drug users (IDUs) who share needles and syringes, the most efficient way to transmit HIV. Yet proven methods exist to slow the spread of HIV by IDUs.

If IDUs inject heroin or related opiates – as is primarily the case in Eastern Europe – establishing opiate substitution programs with methadone or buprenorphine can dramatically slow HIV transmission. The success of such programs also depends on establishing needle/syringe exchanges at convenient locations, both to provide clean equipment and to draw users into the healthcare system. As the third leg of the stool, IDUs need counseling.

This trio of policies forms the foundation of what’s known among health-care professionals as the “harm-reduction package.” Russia and Ukraine, however, spend no money on harm reduction.