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. Last Updated: 07/27/2016

Remember the Living on AIDS Memorial Day

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In the mid-1980s, British AIDS activists urged the public "not to die of ignorance." Today, when the reach of HIV is widening in this country and more and more people are affected, this slogan rings especially true.

On Sunday, people whose relatives and friends have been affected by HIV/AIDS will light candles and release white doves into the sky as part of the 24th annual International AIDS Candlelight Memorial, organized by the Global Health Council.

Despite such events, we have not come to grips with the AIDS epidemic. Ignorance, apathy and intolerance are still steadfast allies of AIDS in this country. We have not confronted the problem head-on as many other civilized countries have. The experience of countries where civilized solutions have been applied to the problem shows that HIV can become an ordinary chronic disease and that the number of new infections can be drastically reduced.

Intravenous drugs users were the first group vulnerable to HIV in Russia. Although 87 percent of all registered HIV cases in this country are still attributable to the use of intravenous drugs, it has become increasingly common for HIV to be transmitted through sexual contact.

As a result, the face of the epidemic is changing as the disease enters the mainstream of society. This process bears out a rather unpopular axiom: When we ignore the problems that afflict an unpopular group such as drug users, these problems eventually begin to afflict everyone else.

Attempts to identify and isolate HIV-positive people have not proven viable. Vulnerable groups still exist and HIV spreads rapidly within them. The effectiveness of efforts to combat AIDS in Russia is directly dependent on our ability to reduce the risk and spread of HIV within vulnerable groups, such as intravenous drug users.

According to data from the World Health Organization, the number of intravenous drug users in Russia in 2005 was somewhere from 1.5 million to 3.5 million. International experts note that it is very difficult to control the spread of HIV when 10 percent to 20 percent of the members of a marginalized social group are infected.

The situation is far worse in some parts of Russia. In Yekaterinburg, 65 percent of all drug users are infected with HIV. In Biisk, a city in the Altai region, 74 percent of all addicts have HIV.

Harm reduction is an efficient, pragmatic and economical approach to this problem. The objective is to reduce the harm that drug use causes to the community and to the drug users themselves. In this case, harm includes the possibility of becoming infected with HIV and a number of measures can be taken to mitigate risks.

These measures include providing counseling services to drug users, distributing free informational leaflets and condoms, exchanging used needles and syringes for sterile ones and providing simplified access to medical and social services. These methods help to connect the marginalized and disenfranchised to medical and social services which, in turn, help to protect overall public health, cut crime, lower the mortality rate and prevent the further spread of HIV.

Current harm reduction programs show that it's better to invest funds in prevention now than to spend more money in the future to treat HIV. Furthermore, according to data from studies conducted in Russia, harm reduction programs are proven to be economically efficient: the average cost associated with HIV prevention comes to $234 per person per year, whereas HIV treatment costs more than $1,500 per person per year.

Substitution therapy also shows great promise for combating HIV/AIDS. In substitution therapy, certain opioids -- a group of natural or synthetic biochemicals that relieve pain in the same way that opiates do -- such as methadone and buprenorphine are used for detoxification and to help reduce addiction.

The World Health Organization and the United Nations have recommended these programs as an efficient method for treating drug addiction and preventing the spread of HIV among drug addicts.

Substitution therapy programs, which have been highly successful in the Americas and Europe, have now been introduced in some former Soviet republics. In Kyrgyzstan, for example, some 100 patients were treated in such a program in 2005. By way of comparison, methadone treatment is prescribed to more than 200,000 people in the United States. The Chinese Ministry of Health reports that newly launched substitution therapy programs have saved $438 million per year.

Medical personnel in these countries view substitution therapy as an efficient support tool, because it motivates drug users to visit doctors. Statistics show that the risk of HIV infection is six times higher among intravenous drug users who do not participate in substitution therapy programs than among those who do.

Substitution therapy is currently illegal in a small number of economically developed countries, including Russia. These programs are strongly opposed by certain government officials and experts at the Health and Social Development Ministry and law enforcement agencies. Their main argument is that from the moral point of view, the state should not provide drugs to users, even for medical purposes.

This kind of reasoning raises a fundamental question, however. Which is more ethical, for medical personnel to continue providing services to drug users who have tried to quit several times with substitution treatment, or for them to ignore these people as their health deteriorates and thousands of lives are lost?

Roughly 80 percent of all HIV-positive people in Russia were infected through drug use and many of them are still addicts. Very few strategies have been developed that motivate this high-risk group to participate in HIV treatment programs. Substitution therapy is one of the most efficient methods. The sooner we begin a public discussion about the benefits of substitution therapy, the sooner we will be able to begin saving lives.

Stigmatizing certain groups as socially unacceptable is a convenient way to separate ourselves from the realities of HIV/AIDS. It creates an overly simplified picture of the world, in which social problems like HIV/AIDS are isolated from day-to-day life. But it does not make the problem of HIV/AIDS disappear. Let's keep this in mind and remember the living on AIDS Memorial Day.

Avet Khachatrian is program director at Transatlantic Partners Against AIDS/Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria in Russia.