Russia’s Cold Turkey Drug Treatment Fails to Stem HIV

Yekaterinburg, the Siberian city where drug users used to be handcuffed to their beds to help them quit, exemplifies Russia’s efforts to stamp out the habit in a nation that has the most HIV-infected addicts.

The practice was stopped by local police in 2005, though going cold turkey still prevails, said Kiril Petrov, a coordinator with City Without Drugs, the organization whose centers used handcuffing but have abandoned that method. Users are expected to quit without the aid of addiction-easing medicines such as methadone, which is banned in Russia.

While its neighbors China and Ukraine are seeing the benefits of methadone and other ways of preventing HIV transmission such as clean needles, Russia is instead fighting drugs and the virus with a patchwork of home-grown strategies that emphasize willpower, personal discipline and healthy lifestyles. The approach reflects a culture that idolizes strong men such as President Vladimir Putin and is common in Russia, with hundreds of similar centers around the country, said Sasha Lesnevskiy, a psychologist at an HIV clinic in Yekaterinburg.

“It’s a kind of military idealism,” Lesnevskiy said. “I don’t understand as a psychologist why a person who comes out of one of these rehabilitation centers would quit drugs.”

There’s been a 10-fold drop in drug-related deaths since City Without Drugs started, Yevgeny Roizman, the group’s founder, said in a telephone interview.

Cheap Heroin

Still, the cold-turkey push isn’t stemming HIV: as of Dec. 25, the Sverdlovsk region, of which Yekaterinburg, with 1.4 million people, is the capital, had 1,494 cases of HIV per 100,000 people, the third-highest rate in Russia and twice the national average, according to the region’s state-run Center for Prevention of AIDS and Infectious Diseases. Almost 66,000 people have been infected with HIV in Sverdlovsk, making it the region with the most cumulative infections.

The City Without Drugs concept remains popular in Yekaterinburg. In September, Roizman was elected mayor of Russia’s fourth-biggest city in a surprise victory over a candidate from Putin’s United Russia Party.

City Without Drugs was started during the 1990s, when cheap, high-quality heroin flooded into Yekaterinburg from Afghanistan following the collapse of the Soviet Union.

“It was cheaper than vodka,” Petrov said. “It was even sold to school children.”

Handcuffs Helped

Petrov said he’s living proof the approach works. The enforced cold-turkey method -- Petrov was handcuffed -- helped him break his heroin habit and realize he didn’t need drugs.

“We have to put a drug user in such a condition where he has no access to drugs, and he himself can see that he can live and survive without drugs,” he said. “In the future, he himself has to decide whether he needs drugs or not. There is no other solution.”

About 5,000 people have been through the group’s centers, Petrov said, though the organization doesn’t keep figures on how many have remained drug-free.

No one is forced to stay, though drug users who try to leave will be urged to complete the process, Petrov said. A qualified psychologist helps the addicts, he said. Patients are asked to pay 8,000 rubles ($240) a month to cover the cost of food. Those who can’t pay are still accepted, he said.

Quarantine Room

At one of the group’s centers on the city’s outskirts, a locked iron gate, a security guard and a dog help ensure no one gets in or out unnoticed. The slogan “Strength in Truth” is stenciled in blue and red letters above the door of a run-down house. Addicts in the initial stages of recovery spend three weeks in a so-called quarantine room jammed with bunk beds and are under constant video surveillance.

Osman Osmanov, 40, said he checked in to break a three-year habit of injecting heroin as many as 10 times a day.

“When I saw the room with the bars on the windows it gave me adrenaline to overcome this,” Osmanov said. “This center is the only thing that helped me get out of the swamp. I was at other centers but they were hopeless.”

While the program may help a few patients, Lesnevskiy said he refers drug users to centers operated by churches, Narcotics Anonymous, or a newly-opened state-run center.

Pavel Shalginsky, a 32-year-old drug user, said he declined an opportunity to attend a City Without Drugs center.

“I said I’d rather go to prison,” Shalginsky said.

Infections Rise

Roizman rejects such criticisms.

“I’m not interested in these talks,” he said. “I gave my blood and my soul. I invested my money and 15 years of my life in this.”

Meanwhile, new HIV infections in Russia jumped 13 percent to 70,453 in 2012. Vadim Pokrovsky, director of the country’s Federal AIDS Center in Moscow, said he “can’t find a sane explanation” for why his superiors in the Kremlin continue to prohibit methadone.

“The people who are prevailing now are the supporters of force used in order to combat drug use,” Pokrovsky said. “The question of how to stop the epidemic of HIV among drug users is still not solved.”

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