In the Newly Independent States in Eastern Europe (NIS) a rapid spread of drug use and drug injecting has occurred since 1990, paralleled by major social dislocation and change. Shifts to private economic production have occurred in the context of sharp declines in gross domestic product and have led to dramatic unemployment, increased income differentials and poverty, and the rapid expansion of criminal economies. Further suggestions of the link between social conditions and ill-health are indicated by the parallel increases in alcohol consumption and morbidity (Rhodes et al. 1999). Since this time there is overwhelming evidence confirms that there has been a massive increase in the trafficking, production and distribution of injectable drugs.

Changes in drug supply, including price and availability, linked to changing international patterns of drug production and trafficking, itself linked to the opening up of borders between Eastern and Western Europe, lead to an increase in drug use. Evidence also suggests that rising drug consumption is also manifesting itself as an increase in drug injecting and the sharing of injection equipment.

According to recent estimates there are currently between 2.3 and 4 million injecting drug users in the region and the number of users is growing. These trends are exacerbating a range of devastating drug-related harms such as HIV/AIDS (Rhodes et al. 1999).

Unauthorized possession of needles and syringes is illegal in many countries in the region. Lack of access to clean injection equipment therefore forces many users to share, which puts them at risk of contracting HIV. Many users of illegal drugs refuse to visit health care professionals for fear of contact with state agencies or the police. Consequently, they lack knowledge about the health risks of injecting drug use in general, and their own health situation in particular. In many countries, deteriorating health care systems struggle to provide the public with even the most basic information on HIV/AIDS. Bearing a double stigma, HIV-positive drug injectors face even more discrimination in accessing treatment and care.

Poland

From 1985 to 31 July 1996 there were 4166 reported cases of HIV infection in Poland, at least 2802 of these were illicit drug users. A study of injecting drug users (IDU) attending two detoxification centres in Warsaw found 46% to be infected with HIV (Rhodes 1999).

Belarus

Belarus has had a sharp increase in registered cases of HIV infection since June 1996, mostly among injecting drug users, particularly in Svetlogorsk. According to the police in Svetlogorsk, most young people below the age of 17 years have experimented with drug injecting. It is estimated that 4,000 -7,000 injecting drug users live in Svetlogorsk. Before June 1996 nearly all HIV test results from Svetlogorsk were negative. In June of the same year, 6 of 33 (18%) IDU-tested HIV-positive. In July 173 of 333 (50%) tested HIV-positive. By October 482 cases of HIV infection were registered, mostly among IDU. These figures indicate an extremely rapid spread of HIV (Rhodes 1999).

Ukraine

There was estimated to be about 500,000 drug users in the Ukraine in 1998, 30,000 of these are thought to be in the Odessa region. New HIV infections are being detected in this region at the rate of about 500 per month, according to UN sources (Rhodes 1999).

The opening up of the countries of Eastern Europe and the Russian Federation to the West offers opportunities for such countries to learn from and participate in the debates and research which have shaped drug policy-making and programming in Western Europe, North America, Australia and, increasingly, parts of Asia. However, these cannot merely be replicated as that would be to ignore the particularities of history, culture and society as well as the characteristics of drug use and drug users in countries of the region.

In Poland, the Ukraine and Belarus there is now a growing understanding amongst academics and policy makers of the implications of the emerging twin epidemics of injecting drug use and HIV infection. Experience in other parts of the world has demonstrated that injecting drug use practices are both locally specific and very diverse. Yet there remains both a lack of basic information regarding injecting drug use practices, and a need to develop local capacity to collect and analyse such data.

There is a need for basic information on the context in which drug injecting takes place. This includes such information as what are the social profiles of those involved, what is the nature of the sub-culture and norms surrounding drug injecting, where does injecting take place and what health or other services are accessible and trusted.

Developments in democracy and governance in the region may make such a process particularly appropriate and timely for those countries as it can build on existing efforts to increase institutional capacity, decentralize decision-making, democratize political systems and promote citizen and community participation. Such a development framework also allows the conceptual focus to widen beyond the individual to an understanding that HIV infection is as much to do with the social contexts as it is with an individual's behaviour. Work on injecting drug use and HIV must be placed in the contexts of poverty, gender, social disaffection and hypocrisy (Rhodes 1999).

References

Burrows D. Starting and managing needle and syringe exchange programs: a guide for Central and Eastern Europe and the newly independent states of the former Soviet Union. International Harm Reduction Development, 2000.

Rhodes T et al. Drug injecting, rapid HIV spread and the risk environment: implications for assessment and response. AIDS 13 Supp A S259-270, 1999.