Andrey Rylkov Foundation
for Health and Social Justice
Русский

Statement regarding the Implementation of UPR recommendations received and accepted by the Russian Federation during the second UPR cycle, as relevant to the fast growing HIV epidemic combined with multidrug-resistant tuberculosis

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On 11th of April 2018 Anya Sarang, the President of the Andrey Rylkov Foundation for Health and Social Justice, delivered this Statement at the 30th session of the United Nations Human Rights Council Universal Periodic Review Working Group.

The Statement concerned the implementation of UPR recommendations received and accepted by the Russian Federation during the second UPR cycle, as relevant to the fast growing HIV epidemic combined with multidrug-resistant tuberculosis, and was based on the report submitted earlier to the United Nations Human Rights Council Universal Periodic Review Working Group within a Third Universal Periodic Review of the Russian Federation on behalf of the Russian Public Mechanism for Monitoring of Drug Policy Reform.

….

My statement concerns the failure of the government to implement the recommendations given to and accepted by the Russian Federation during the previous UPR cycle. It focuses on the health crisis in Russia, in particular the epidemics of HIV and drug resistant tuberculosis and it will be brief due to time limit. But as you can see from the full report both those epidemics are a direct consequence of the systemic and very serious human rights violations, especially against three key affected populations: people who use drugs, sex workers, and men who have sex with men.

Russia is the third country in the world with fastest growing HIV epidemic after South Africa and Nigeria.[1] Nearly two-thirds of European HIV cases are now in Russia and it is the only European country with a rising rate of new HIV infections.[2] While most of the countries globally have been able to get their epidemics under control and some already strive towards zero new infections and zero AIDS deaths, in Russia, ten people get infected every hour, and in 2017 over 100.000 new cases were registered and almost 32 thousand people died of AIDS.[3],[4]

The main cause of death of people with HIV in Russia is tuberculosis[5]. The number of people with both HIV and TB is growing, in 2017 over 35 thousand patients were registered.[6] According to the World Health Organization, Russia is among top three countries with the largest absolute numbers of drug resistant TB along with China and India, however, compare to these two countries the rate per 100 thousand population is more than 4 to 9 times higher.[7],[8] Russia is also among 4 countries with the lowest treatment success rate among high TB burden countries[9].

Such drastic public health crisis results not from a bad fate but from the government’s total inaction and refusal to provide effective prevention and treatment programs to the most affected populations, particularly to people who inject drugs. According to the last epidemiological studies, HIV prevalence in this group ranges from 48 to 75% in different cities.[10]

People who inject drugs suffer repressions, mass incarceration while also lacking access to effective drug treatment and evidence based HIV and TB services. [11],[12]  As a result of punitive drug policy, prisons are filled with people who use drugs – currently about 25% of all prisoners in Russia are punished for drug offences. And 40% of all women in prisons are there because of drugs.[13] Repressive policing and fear of imprisonment drives people who use drugs away from health services, making them vulnerable to HIV through unsafe injecting and unprotected sex. For people, whose immune system is weakened by drug dependence and HIV, imprisonment often equals death sentence as it can easily lead to TB infection and AIDS death.[14]

However, prisons are often viewed as the only “solution” that the State can offer to people who are dependent on drugs, since evidence based drug treatment and harm reduction programs are not available. The opioid substitution therapy with methadone and buprenorphine is illegal in Russia and effective prevention programs for key populations, such as needle and syringe programs are not provided by the State.

Absence of opioid substitution treatment not only inhibits HIV prevention among people who use drugs, it also leads to low initiation to antiretroviral treatment of HIV and high drop out rate from both HIV and TB treatment for this group. Russia is still reliant on the old Soviet approach of hospitalizing people with TB for long treatment terms of 6 to 18 months and studies suggest that the drop out rate for drug dependent patients reaches 80-100% in some cities. The high failure rates of TB treatment leads to increase of MDR/RR-TB.[15]

Stigma and discrimination against sex workers is the major driver for HIV and sexually transmitted diseases in this group because SWs suffer legal persecution, police harassment, violence from their clients and often from police, and the lack of legal protection. Being legally outcast, sex workers are put in a position when the government stripes them of any legal protection, personal security and dignity. Law enforcement harassment and police raids increase vulnerability of sex workers to HIV. The government does not provide any support to HIV prevention programs among sex workers.

Stigma and discrimination is a major driver for HIV among gay and other men who have sex with men as well as trans* people due to the fact that the state-sponsored anti-gay propaganda laws drive them out of HIV prevention and treatment services. These laws fuel violence against LGBT and MSM and prevent distribution of HIV prevention information. The government does not provide any support to HIV prevention programs among gay and other men who have sex with men and trans* people.

I conclude with the following recommendations for the Russian Federation during the third UPR cycle:

  • Provide clear legal grounds and other support to WHO-recommended measures for HIV prevention and treatment among people who inject drugs, in particular the opioid substitution therapy with methadone and buprenorphine, as well as needle and syringe, and overdose prevention programs.
  • Address the structural vulnerability of people who inject drugs to HIV and depenalize drug use, by repealing administrative and criminal punishment for drug use, possession for personal use, and micro-trafficking.
  • Address the vulnerability of sex workers to HIV and depenalize sex workers by repealing administrative and criminal punishment for voluntary adult sex-work and its management, and establish HIV and other health services for sex workers.
  • Address the vulnerability of gay and other men who have sex with men and transgender persons to HIV and provide them with necessary protection against discrimination and violence, in particular through the adoption of anti-discrimination legislation and the revision of the existing discriminatory laws that prohibit information related to “non-traditional sexual relations”.
  • Provide support for science-based and human rights oriented HIV prevention, treatment and care services for men who have men and transgender persons.

Download the slides presented along with the Statement

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[1] To stop the epidemics we need political will. Interview with Michel Sidibe. 01.12.2017. Kommersant. https://www.kommersant.ru/doc/3481934?query=%D1%81%D0%BF%D0%B8%D0%B4

[2] Gus Cairns. Epidemiology. NAM. 9 January 2017. http://www.aidsmap.com/Nearly-two-thirds-of-European-HIV-cases-are-now-in-Russia/page/3109895/ (Accessed October 4, 2017)

[3] UNAIDS (2017) UNAIDS 2017 reference. http://www.unaids.org/sites/default/files/media_asset/20170720_Data_book_2017_en.pdf

[4] Federal AIDS Center (2018) HIV-infection in the Russian Federation in 2017.

[5] Ibid.

[6] Epidemiological TB situation in Russia in 2015. Central Scientific-Research Institute of the Administration and Informatization of Public Health. The Ministry of Health of the Russian Federation. 2016.  http://mednet.ru/images/stories/files/CMT/2016tb.pdf (Accessed 4 October 2017)

[7] In Russia the rate is 42 cases of MDR/RR-TB per 100,000 population compare to India with 9.9 and China with 5.1 cases per 100.000 population

[8] WHO Global tuberculosis report 2016. Fig 3.20 http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf?ua=1 (Accessed 4 October 2015)

[9] WHO Global tuberculosis report 2017. Fig 4.22 http://www.who.int/tb/publications/global_report/MainText_13Nov2017.pdf?ua=1 (Accessed 20 March 2018)

[10] Федеральная Служба по Надзору в сфере защиты прав потребителей и благополучия человека.  Федеральное бюджетное учреждение науки Центральный Научно-Исследовательский Институт Эпидемиологии» Роспотребнадзора (2017). Аналитическая записка. Результаты био-поведенческого исследования по ВИЧинфекции среди групп населения повышенного поведенческого риска (ПИН,_ МСМ, КСР), проведенного  в 2017 году в 7крупных городах Российской Федерации

[11] Sarang, A et al. “Prisons As A Source Of Tuberculosis In Russia”. International Journal of Prisoner Health 12.1 (2016): 45-56. Web. http://www.ncbi.nlm.nih.gov/pubmed/26933992

[12] Golichenko M and Sarang A. Atmospheric Pressure: Russian drug policy as a driver for violations of the UN Convention against Torture and the International Covenant on Economic, Social and Cultural Rights. Journal Health and Human Rights special issue on Framework Convention on Health and Human Rights. June 2013

[13] Statistics of Penitentiary Service of the Russian Federation as of the end of 2016. www.fsin.su

[14] Sarang, A et al. “Prisons As A Source Of Tuberculosis In Russia”. International Journal of Prisoner Health 12.1 (2016): 45-56. Web. http://www.ncbi.nlm.nih.gov/pubmed/26933992

[15] The New Profile of Drug-Resistant Tuberculosis in Russia. A Global and Local Perspective

Summary of a Joint Workshop. Institute of Medicine (US) Forum on Drug Discovery, Development, and Translation; Russian Academy of Medical Science. Washington (DC): National Academies Press (US); 2011. Figure 7-1. Online: https://www.ncbi.nlm.nih.gov/books/NBK62461/



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