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II. RECOMMENDATIONS

For the government of the Russian Federation

The government of the Russian Federation has a limited window of opportunity to address its fast growing AIDS epidemic. It should take urgent action in the following areas.

On HIV/AIDS

• End discrimination in the application of antiretroviral treatment programs for persons with AIDS. Respect the recommendation of the Russian Federal AIDS Center that active drug users should be included in antiretroviral treatment programs.
• Respect the rights of people in Russia to be well informed on HIV/AIDS, including the facts of HIV transmission and the importance of reducing stigma related to HIV/AIDS. Establish large-scale, sufficiently resourced information campaigns based on lessons from programs established in other countries over the last twenty years, including programs tailored to the needs of vulnerable persons such as drug users and their sexual partners, street children, and workers in the sex trade. Design and implement programs suitable for school children, members of the armed forces, and any other large population that is reachable through state institutions. Make use of peer education among young people, drug users, sex workers and others at risk, building on the lessons of other countries.
• Expedite the process of registration of generic antiretroviral drugs and ensure widespread information for the population about the availability of generic drugs through government programs and private sources.
• Follow the example of nearly every other U.N. member state by establishing an interministerial body to coordinate the national HIV/AIDS response that would include, at a minimum, representatives of the Ministry of Health and Social Development, Ministry of Economic Development and Trade, Ministry of Education and Science, and Ministry of Culture and Mass Communications. This body should have budgetary resources independent of the participating ministries, and participating ministries should be represented by high-level staff.

On narcotic drugs and drug users

• Do not inhibit the operation of syringe exchange and other harm reduction services by governmental or nongovernmental bodies. In particular, allow drug users to utilize syringe exchange services without requiring that they be identified by name or that their names be recorded. Increase the availability of harm reduction services, including syringe exchange, in recognition of their importance for HIV prevention.
• Reject the suggestion of the State Drug Control Committee mandating prison sentences for possession of extremely small amounts of narcotics, which would exacerbate the problem of HIV/AIDS among drug users. . Establish standards in line with the spirit of the State Duma’s December 2003 reform.
• Do not prohibit the participation of drug users and former drug users in outreach, education and harm reduction programs for drug users.
• Repeal the ban on use of methadone in replacement or substitution therapy² for opiate addiction and make replacement therapy a central element of HIV prevention for opiate users.
• Establish services for the humane treatment of narcotics addiction, including in prisons, according to international standards, which would include the use of opioid substitutes such as methadone or buprenorphine.

In law enforcement

• Discontinue the practice of police harassment, arrest and detention of drug users because of possession of syringes, which is not justified under either Russian law or international guidelines. Discontinue harassment of people based on the visibility of traces of injection on their arms. End other arbitrary detention of drug users, and ensure their right to due process.
• Abolish the use of arrest or detention quotas by police, which encourages arbitrary arrest and detention Detention should be premised on the state’s demonstration of one or more of these conditions. The state should prosecute to the fullest extent of the law those law enforcement agents responsible for arbitrary arrest, extortion, mistreatment and abuse of office.
• Establish and maintain a program of training for police at all levels on HIV/AIDS, the importance of harm reduction services, and related human rights issues. Make collaboration with public health officials on HIV prevention a criterion for promotion for police officials.
• Discontinue the practice of segregation of HIV-positive inmates in Russian correctional facilities. Take measures to respect the principle that the level of health services in prisons, including HIV prevention and AIDS care, should reflect the level offered to the general public. Provide condoms to inmates as well as bleach or another disinfectant for sterilization of syringes. Ensure nondiscrimination against drug users and people with HIV/AIDS in access to health, information, education and other services in Russian prisons.
• Discontinue the practice of mandatory testing of inmates for HIV. Establish a system for detainees of voluntary and confidential HIV testing with informed consent and appropriate counseling.

For international donors and multilateral agencies

• Support measures in Russia that contribute to a public health approach to HIV prevention for drug users, particularly the strengthening of syringe exchange and other harm reduction services. Encourage the Russian Federation to revise its drug laws to provide alternatives to incarceration for individual possession of tiny amounts of narcotics. Urge the Russian Federation to authorize the use of methadone and other widely used substitution therapies for heroin addicts.
• Urge the Russian Federation to establish a reliable system of nationwide sentinel surveillance of the prevalence of HIV. Provide technical support to ensure not only the scientific soundness of this exercise but also that it ensures the confidentiality of the results of HIV tests taken for surveillance purposes.