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Russia’s ban on methadone for drug users in Crimea will worsen the HIV/AIDS epidemic and risk public health

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3118 (Published 08 May 2014) Cite this as: BMJ 2014;348:g3118
  1. Michel Kazatchkine, UN Secretary General’s Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, International AIDS Society, Avenue de France, 23, 1202 Geneva, Switzerland
  1. contact{at}michelkazatchkine.com

Injecting drug use drives the huge HIV/AIDS epidemic in the region, but Russian law does not permit the substitution treatment that is shown to help. The end of its provision on 1 May will have huge repercussions, says Michel Kazatchkine

Ten years ago 170 000 people in the Russian Federation had HIV.1 The estimated number is now 1.2 million.2 More than 2% of men aged 30-35 are infected, says Vadim Pokrovsky, the head of the Russian Federal AIDS Centre. Russia now accounts for over 55% of all new HIV infections reported in the European region.3

This epidemic was mainly caused by injecting drug use, but it is now spreading to the general community. And it could have been avoided if Russia had implemented large scale harm reduction programmes including opioid substitution therapy (OST).

Treatment with methadone or buprenorphine and the provision of clean needles have saved the lives of millions of injecting drug users worldwide in the past 30 years of the HIV/AIDS epidemic.4

Drug injectors in Ukraine have had access to harm reduction, including OST, for 10 years, and nearly 9000 clients were reported as of March 2014.5 Such programmes had begun to reverse Ukraine’s growing HIV/AIDS epidemic.6

The Ukrainian Center for Disease Control said that in 2013 some 8000 people in Crimea were infected with HIV. OST has helped to manage the epidemic in Crimea, but after Russia’s recent annexation of the peninsula it announced a ban on the supply of such drugs to the region. This will bring unnecessary suffering to the people of Crimea and is a blatant example of health policy being hijacked for political ends rather than being led by evidence.

Russia’s federal law on narcotic and psychotropic substances, introduced in 1997, prevents the medical use of methadone, and …

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