Healthcare systems in Eastern Europe and Central Asia remain woefully unable to cope with HIV/AIDS as the region’s raging epidemic – the fastest growing in the world – takes on a new dimension, a senior UN official has told IPS.

Until now the Eastern Europe and Central Asia (EECA) epidemic had been driven by injection drug use. But data and anecdotal evidence has shown a strong rise in the spread of the disease through heterosexual transmission as well as via men who have sex with men – potentially throwing up a new set of challenges for governments and healthcare ministers.

But, says the UN Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, Michel Kazatchkine, until a new approach to treating the disease is taken in countries worst affected by it, the response to the epidemic will continue to be poor and largely ineffective."In some countries it will probably take a wave of deaths, or the death of someone famous or a prominent member of the Church for anything to change.”

He told IPS: “HIV/AIDS in Eastern Europe and Central Asia needs to be taken out of the medical ghetto which it is in at the moment.

“Regardless of whether it is driven by heterosexual transmission or drug-injection, I am afraid that until the disease gets visibility and health systems get geared up to take it on, it will not be dealt with properly. In some countries it will probably take a wave of deaths, or the death of someone famous or a prominent member of the Church for anything to change.”

For many years Eastern Europe and Central Asia has had the world’s fastest growing HIV/AIDS epidemic. The estimated number of people with HIV has grown by 140 percent in the past ten years, according to UN figures. Russia has 70 percent of all people living with HIV in the region and together with the Ukraine accounts for 90 percent of the region’s HIV infection cases.

The epidemic remains primarily linked with injection drug use with over 35 percent of case reports in the region associated with drug use.

But in the last five years, there has been a marked increase in heterosexual transmission which now accounts for 30 percent of reported cases, according to Kazatchkine. Much of this is believed to be between male drug users and women.

However, the exposure route of 40 percent of infections in the region is classified as ‘unknown’. It is thought that most of these are among men who have sex with men.

Discrimination, persecution and stigmatisation of homosexuals, drug users and people with HIV/AIDS means that it is impossible to collect accurate data on the spread of the disease.

Gay men are often fearful of admitting to doctors how they became infected and instead say that they contracted it through heterosexual sex. Drug users, who can face long prison sentences in some countries in the region, do the same.

Recent legislation banning the promotion of same sex partnerships and long-standing travel restrictions in some parts of the region for people with HIV have only further marginalised groups in which the disease is spreading rapidly.

This presents a major problem in effectively dealing with the epidemic, say doctors, as it adds to existing barriers to the prevention and treatment of the disease.

Prof. Jens Lundgren of the European Aids Clinical Society (EACS) told IPS:

“What we know is that any policies, anywhere in the world, which are introduced and which marginalise or stigmatise people with HIV are counter-productive to treating the disease.

“A good, rational health policy is one that involves a clear view of a disease’s epidemiology – where, in what communities and how it is being spread.”

This comes on top of what has been repeatedly criticised by international bodies as a continuingly poor healthcare response to the disease in many countries.

Access to anti-retroviral treatment is very low – with as little as eight percent of all those in need of it being able to obtain it in Russia, for example.

Systematic care of those diagnosed with the disease is also inadequate.

“One of the problems in Russia is that there is no integration of a patient with HIV into the primary health care system,” said Kazatchkine. “When someone is diagnosed they are simply referred to a special centre and passed on. It is as if they are something to be got rid of. No one follows up on them and they are essentially forgotten.”

There are fears that news of the changing nature of the epidemic’s spread could be used by some authorities to push their own political agendas on how to deal with the epidemic.

International bodies have urged countries in the region to adopt harm reduction programmes, including needle exchanges and drug substitution therapy, which are recommended best practice in the West as a front-line measure to help prevent the spread of the disease.

While some countries, notably the Ukraine, have had some success in rolling out these programmes and helping bring down new infection rates, others, such as Russia, are apathetic or even hostile to harm reduction.

Drug substitution therapy is illegal in Russia as political and medical authorities refuse to sanction it and there are no state needle exchange programmes.

The vast majority of funding for prevention programmes has come from foreign organisations, but some of these have left the country as its regime has become more authoritarian.

Some of the few organisations in Russia offering harm reduction services, such as the Humanitarian Action NGO in St Petersburg, have told IPS of the problems drug users face in accessing harm reduction programmes and of the difficulties they have in providing them, from almost absent funding to hostile police and societal attitudes.

That the disease is being spread more and more by sexual behaviour could provide ammunition to those who argue harm reduction programmes are a waste of resources.

“There are some authorities in the region which take every opportunity to use something that takes attention away from the need for continued harm reduction strategies and programmes and I fear the fact there is a rising heterosexual spread of the disease could be instrumentalised to attack harm reduction programmes among drug users,” Kazatchkine told IPS.

This would further hamper efforts to combat the epidemic as injection drug use is expected to remain the main route of transmission of HIV in the region for some time to come.

“There will continue to be an increase in sexual transmission while the epidemic among drug users will not slow down,” said Kazatchkine.

A “virus” of restrictive abortion legislation is spreading from Eastern Europe, health experts and rights campaigners have said, amid Church pressure and misguided government attempts to stop falling birth rates.

Just weeks ago a new law was introduced in Macedonia tightening up relatively liberal abortion legislation which had been followed for more than 40 years. And last month, Lithuanian lawmakers gave initial approval to some of strictest abortion legislation in the world.

Tighter abortion laws are also being considered in Russia and the Ukraine while the Georgian parliament is expected to debate abortion laws after the country’s Orthodox Church made calls in May for it to be banned.

Critics say that some governments appear to be moving towards introducing total bans on the procedure."Its wider meaning is that it is a step towards more restrictive measures and, ultimately, a ban on abortions.” -- Bojan Jovanovski, executive director of the Health Education and Research Association

Bojan Jovanovski, executive director of the Health Education and Research Association (HERA) in Macedonia, told IPS: “What has happened here is not unique and is happening in a lot of countries, spreading like a virus from Eastern Europe westwards.

“What this law here will do in the short term is it will make it harder for women to get an abortion, because of the bureaucracy and hurdles they will face. This will possibly lead to them undergoing illegal abortions and the problems that brings with it.

“But its wider meaning is that it is a step towards more restrictive measures and, ultimately, a ban on abortions.”

In recent years Eastern Europe has witnessed a push, in many cases driven by socially dominant Churches, to reinforce or tighten abortion legislation and deter access to them.

In strongly Catholic Poland, abortion legislation is among the strictest in the world. Interruptions are legally allowed in only three kinds of cases: rape, incest or if the mother’s health is at risk. But perhaps more importantly, in practice it is virtually unobtainable as many doctors refuse to carry out the procedure.

Women’s rights groups say that virulent pro-life societal attitudes fostered by a Catholic Church whose influence is omnipresent at all levels of society, including in political parties, leads healthcare staff to refuse to help women seeking terminations, even in cases where they have a legal right to them. The doctors cite either their own religious convictions or fear of reprisals as reasons stopping them performing the procedure.

It is estimated that there are up to 200,000 illegal abortions carried out in Poland every year because women cannot access them legally and do not have the money to travel abroad to undergo the procedure in countries where it is legal.

Because of their nature, these illegal abortions are inherently risky. They are almost invariably carried out in unsterile conditions, usually in a room in a flat, by a doctor anxious to get the termination completed for constant fear of being caught and potentially jailed.

No figures of mortality rates or serious health problems resulting from these illegal abortions can be obtained because of their clandestine nature.

However, the World Health Organization (WHO) has stated that even today up to 30 percent of maternal deaths in some countries of Eastern Europe and central Asia are caused by unsafe abortions.

The new Lithuanian law, which is modelled on Poland’s legislation, will also allow terminations only in cases of rape, incest or health complications. Abortion is currently allowed on demand up until 12 weeks. The new legislation must pass further parliamentary approval before it comes into law.

The region’s declining birth rate has been another factor behind the anti-abortion trend at the political level. Many politicians believe that restricting abortion access will help push birth rates up.

But evidence from Poland and other countries around the world suggests otherwise.

Wanda Nowicka, a prominent Polish women’s rights campaigner and member of a United Nations taskforce for next year’s International Conference on Population and Development, told IPS: “Since 1993 when Poland introduced its strict abortion legislation the birth rate has fallen. But politicians still follow the populist argument (to limit access to abortion).”

Official government figures show the Polish birth rate has fallen steadily from 1993 to 2012.

Nowicka added: “What happens is that when a woman is unsure about her reproductive choices she decides not to have children.”

Poland’s abortion law served as the model for the new legislation in Lithuania, and it was originally proposed by MPs from the country’s Polish minority. The Church, as in Poland, has a strong influence in society and among politicians and it has for years actively backed a tightening of the country’s abortion legislations.

The law is also expected to have a negative impact on Polish women’s abortion options as many currently cross the northern border to Lithuania for abortions they cannot get in their homeland. This will potentially force even more into undergoing dangerous illegal terminations.

In Macedonia, under the new legislation, official requests for abortions will have to be submitted, women will have to attend counselling, and confirm their partner has been informed of their decision to have an abortion. They will also be banned from having a second abortion within a year of their first.

The government has said that the new law was brought in to strengthen women’s health. But critics contend this, pointing out that it was approved in just two weeks in accelerated parliamentary procedures – effectively preventing any debate about it – and that gynaecologists were not consulted in its drafting.

Jovanovski told IPS: “The law does not meet international human rights nor medical health standards.”

He added: “What’s happened here might be copied by other Balkan countries and in other parts of Eastern Europe and spread. Countries in the West that have long traditions of upholding human rights should be looking at this closely and doing something about it.”

A deeply-engrained culture of graft across Eastern Europe is destroying bonds between politicians and the people as populations lose faith in what they see as a self-serving elite “enriching” themselves at their expense, anti-corruption campaigners have said.

A series of corruption scandals have seen three prime ministers forced out of office in recent months in the region.

While much low-level corruption has been rooted out of society, large-scale corruption connected with politics has actually got worse, experts say.

“The devastating thing is that while Eastern Europe has seen a fall in some of the petty corruption that was a legacy of the communist era when people used bribes to get things because everything was in short supply, ‘grand’ corruption has got worse,” Miklos Marschall, deputy executive director of Transparency International told IPS.

“There is a perception that the new political elite are using the state apparatus to enrich themselves and their circle of friends with massive state resources being channelled where they should not.”

Within the last few months, corruption scandals have forced the Prime Minister in Slovenia out of office and the Bulgarian government to step down.“There is a perception that the new political elite are using the state apparatus to enrich themselves and their circle of friends..."

And just last week Czech Prime Minister Petr Necas was forced to step down after a massive police raid on the government headquarters and the arrest of eight high-ranking civil servants and politicians. Millions of euros in cash and dozens of kilos of gold were seized by hundreds of law enforcement officers.

Corruption and bribery continue to claim the scalps of junior ministers and senior civil servants in other countries while scandals connected with controversial processes for obtaining multi-million or multi-billion euro funding streams or public procurements occur with almost monotonous regularity.

The situation has become so bad there is a widespread perception among people in the region that most public officials are corrupt.

“This is of course not true, not all of them are, but this is the perception that has been created,” said Marschall.

Experts say that this lack of trust creates an opportunity for populist politicians to come to power on the back of false pledges to deal with corruption. This in turn stifles the passage of much-needed reforms to improve the situation, entrenches the culture of graft at the highest levels and further severs any positive links between the population and a country’s leaders.

“It’s a vicious cycle,” says Marschall.

But this perception is not limited to just the electorate. Corrupt governments are seen as a risk for foreign investors who are vital to developing the economies, and through that the living standards, of countries in an already poor region.

Speaking at a conference in Paris last week, Suma Chakrabarti, president of the European Bank for Reconstruction and Development (EBRD), which has engaged countries such as the Ukraine on programmes and measures to reduce corruption, warned of its effects on Eastern Europe’s economies and people.

He said: “Corruption squanders talent and precious resources. It means a much higher cost of doing business, and, at the same time, greater uncertainty as regards the outcome of the investment… purely and simply it scares most investors away.”

Economic experts say that Russia, whose own National Anti-Corruption Committee estimates that graft accounts for 300 billion dollars a year and that the average bribe is 10,000 dollars a year, is struggling because of endemic corruption to gain the foreign investors it needs as its energy wealth fades.

Transparency International’s corruption perceptions index for 2012 ranked Russia 133 out of 176 countries while in the World Bank’s Doing Business Survey, the country came 112th out of 185 for “ease of doing business”.

The arrests in the Czech Republic have been praised by anti-corruption campaigners as a welcome sign that graft is being tackled.

But the need for law enforcement bodies in other parts of the region to follow the lead of their Czech counterparts is evident, they say.

Radim Bures of Transparency International in the Czech Republic told IPS: “This kind of action (against politicians) is needed in other countries in Eastern Europe. It sends out a strong message that corruption will not be tolerated and that politicians cannot, and should not think they can, act above the law.”

Monday’s resignation of Czech Prime Minister Petr Necas over a massive corruption scandal may well mark a new era of judicial independence in the Czech Republic and possibly the whole post-communist region.

The Prime Minister’s chief of office Jana Nagyova, a regular in the tabloids and allegedly his lover, has been arrested and stands accused of illegal spying and bribing of MPs.

Two military intelligence officers and two former members of parliament face similar charges. Necas himself denies any wrongdoing.

The government, composed of a coalition of right-wing liberal and conservative parties, is resisting opposition calls for a fresh election, hoping to weather the storm with a mere government reshuffle.

Necas, who is intent on leaving politics following last week’s events, tendered his resignation to the President on Monday. He will remain in his post until a new prime minister is appointed.

“This is a good sign of some judicial independence in governance structures,” Petr Lebeda, director of the independent think-tank Glopolis told IPS.

“It could be encouraging for judicial systems in other countries. A message has been sent that there is no such thing as impunity for politicians and high public officials, that anybody who does something illegal can be sued for his crimes.”

Indeed, news of the corruption scandal and the subsequent resignation have sent shockwaves across Central and Eastern Europe, with the media following developments closely.

In the face of weak institutions, the region’s media and particularly investigative journalists have played a crucial role in uncovering corruption scandals and in pushing authorities to act, as is frequently recognised by international anti-corruption organisations such as Transparency International (TI).

Slovakia is witnessing the re-emergence of a public debate on the lack of independence of prosecuting and judicial bodies as well as on politicians’ lack of will to tackle corruption systematically.

In a statement published last year, Transparency International singled out the Czech Republic and Slovakia as home to particularly weak prosecuting bodies, describing them as “vulnerable to direct political influence because of their strictly hierarchical and non-transparent organisational structures.”

In one comment published by leading Slovak daily Sme, commentator Roman Pataj accused the government of “occupying key posts in the Slovak judiciary” and termed its policies in this field as “non-transparent” and “disastrous”.

There were similar reactions in Hungary, where also politicians could be heard: Gergely Karacsony, leader of the opposition party Dialogue for Hungary, reacted by making fresh calls for an investigation into a recent tobacco retail tender which controversially benefited government supporters and their relatives.

Karacsony lashed out at the country’s state prosecutor, calling on him to follow the Czech example while criticising his inactivity: “He lacks the expertise and the courage to step up,” he said, accusing him of protecting government “mafias”.

The Czech scandal has reverberated because it is inserted in a region that faces very similar challenges. The most frequently corruption-related malaise in the region involves unlawful party financing, manipulation of state institutions by political and economic interest groups, murky ties between the business and political classes, and weak prosecuting bodies.

There is also a clear East/West divide: TI’s corruption perception index shows Central and Eastern Europe lagging behind all of Western Europe with the exception of Italy. Among post-communist countries, only Estonia fares well in the index.

Hence the fall of the Czech leader caught many by surprise, not because of the high-level corruption, but due to the fact that authorities acted: “Justice only worked at the lowest levels, once it reached the top levels it would never lead to the courts,” Lebeda said.

While prosecutions of high level officials are not unseen in the region, they are usually reserved for opposition politicians, and convictions are rare.

What makes the Czech Republic different from the rest of the region is the fresh “emancipation of the office of public prosecutor and consequently anti-corruption police,” Ondrej Cisar, a political scientist at the Czech Academy of Sciences told IPS.

“Making a sort of sweeping analogy, one can say that we are going through a prosecutors’ revolution, similar to the judges’ revolution in Italy in the beginning of the 1990s,” Cisar added.

Ironically, Necas himself may be responsible for his own fate, as he ended an old habit – not just in the Czech Republic but in all of post-communist Europe and beyond – of placing political appointees to judicial posts.

Following years of media criticism of various governments over the prevalence of an alleged ‘justice mafia’ that protected high-profile politicians from prosecution, Necas named Pavel Zeman as chief prosecutor in 2010.

Zeman, perceived as an independent, played a key role in strengthening the independence of various prosecution and judicial bodies as well as in starting a wave of prosecutions that reached its climax last week.

This process was one that the “government probably did not actively support, but also did not block,” Lebeda told IPS. The weakness of the coalition government may thus have been a blessing in disguise, preventing any particular political force from asserting its authority over the judiciary.

An orphanage in Ruse in Bulgaria that the government wants to close down next year. Credit: Hope And Homes for Children.

By Pavol Stracansky
SOFIA, Bulgaria, Dec 2 2012 (IPS)

Governments in Eastern Europe and Central Asia are being urged to end the institutionalisation of babies as more than 15,000 children a year in the region continue to be subjected to a practice experts say often leaves them physically and mentally scarred for life.

At a UNICEF conference in the Bulgarian capital Sofia last week, representatives from 20 governments across the region heard that every hour on average two young children, mostly babies, are separated from their parents and sent into institutional care.

And, despite concrete reforms in some states, and with institutionalisation on the rise in more than half the countries in the region, more work needs to be done to ensure childcare across the entire region is radically overhauled, UNICEF and other groups say.

Jean Claude Legrand, regional advisor on child protection at the UNICEF regional office for Central and Eastern Europe and CIS (Commonwealth of Independent States), told IPS: “Childcare in the region needs to be de-institutionalised and there needs to be a change of attitude towards what can be best done for children.”

A relic of communism, child institutionalisation remains common across the former Eastern bloc.

A report presented at the conference in Sofia showed that more than a million children in the region are separated from their families and more than 600,000, including at least 31,000 aged three or under, are in state-run facilities.

Eastern Europe and Central Asia has the highest rate of institutionalisation in the world.

Many families who feel they cannot support a child, often for financial reasons, turn them over to state-run orphanages. Support services for parents considering abandoning children are often weak, and in some cases non-existent.

This leaves some feeling that they have no choice but to abandon their child to an institution, especially if the child is disabled.

But while orphanages across the region do provide basic care, campaigners for de-institutionalisation point to studies showing that putting children in institutions, especially when very young, can result in severe developmental problems.

Among these are brain and other physical growth deficiencies, cognitive problems and delays in the development of speech and language skills believed to be caused by a lack of stimulus and affection in institutions.

This, however, is not universally acknowledged or even known about in some parts of the region, and many people working in or in charge of childcare continue to see institutionalisation as a benefit for some children.

Beth Maughan of UK-based charity Hope and Homes for Children which works in Eastern Europe helping governments deinstitutionalise childcare, told IPS: “Among people working at or running, institutions, there is often a lack of information on the effects that institutionalisation has on children under three.”

Other studies have also shown that it costs as much as six times more to house a child in an institution as to provide social services to vulnerable families, is three times more expensive than professional foster care and twice as expensive as placing them in a small family home.

But despite the proven negative effects on young children put in care and the potential economic savings of deinstitutionalisation, moving away from institutionalisation remains a challenge in many countries in the region.

Often state services are not linked, and different stages of childcare responsibility can fall under different ministries, leading to a lack of a uniform strategy for any childcare reform.

Such reform is also often low priority for governments.

Attitudes have proved slow to change. The belief that it is better to grow up in an orphanage than in a poverty-stricken family – thinking which has been prevalent since communist times – remains deeply entrenched in some communities. In some cases, parents who were themselves institutionalised see it as the best option for children of their own.

Ignorance among those involved in childcare and social stigma also means that children with disabilities, ethnic minorities and infants born to HIV positive women are at high risk of being institutionalised. It is not uncommon for mothers to be actively encouraged to give up their babies at birth.

The subsequent predominance of institutionalisation and prevailing attitudes have suppressed the development of alternative care options for abandoned children, such as foster care and small home facilities, as well as support networks to prevent abandonment in the first place.

This, those working in the field say, has only encouraged more child institutionalisation.

Maughan told IPS: “The fact that institutions exist encourages them to be used. In a borderline case where there might be some concern over a child, decisions may be made to simply put them in an institution rather than making a lot of effort to analyse whether this is actually necessary.

“We know from our own experience this happens. But if there is no institution, more is likely to be done to determine whether a child should be left with its family.”

However, despite the apparently considerable barriers to deinstitutionalisation, campaigners remain optimistic that the placement of under-threes in orphanages in the region can be stopped before the end of the decade.

Some countries have recently made significant advances in reforming their childcare systems. Romania, Serbia and Croatia have introduced legislation to ban the placing of children under the age of three in institutions while Bulgaria has already started closing down some of its orphanages.

Other countries have also pledged to take concrete steps to reform their childcare systems and move towards ending institutionalisation of infants.

“Some countries have made incredible progress on de-institutionalisation in recent years,” UNICEF’s Legrand told IPS.

“What we want to see, by 2020, is laws, mechanisms and services in place for ensuring that all children below three years can live in a family environment.

“Hopefully, getting results on (deinstitutionalisation) of children below the age of three will gradually close the flow (of children into orphanages) and stop as many children being put in institutions as there are today.” (ends)

When the Global Commission on Drug Policy, which advocates an end to what it says has been a failed ‘war on drugs’, held its latest working meeting in Warsaw last month, the choice of venue was apt.

Eastern Europe, with the notable exception of the Czech Republic where possession of some drugs was decriminalised in 2010, has some of Europe’s strictest drugs legislation. It also has some of the world’s worst drugs-related problems.

And the two are inexorably linked, according to the Global Commission.

“We wanted to highlight the problems Eastern Europe faces with repressive drugs policy and its links to very serious problems in the region,” Ruth Dreifuss, former Swiss president and a member of the Commission, told IPS.

Under communism, Eastern bloc countries’ legislation on drugs was typically repressive. But since the communist regimes fell, policy has been slow to change in the region and, in some countries, remains as repressive as it was just over 20 years ago.

Stiff jail sentences are not uncommon for possession of even small amounts of cannabis, and prosecutions are often fervently pursued with the full force of local legal systems.

In Russia, widely seen as having the most repressive drug laws in Europe, possession of any amount of drugs – even the residue in a used syringe – is likely to result in a lengthy jail sentence, sometimes up to eight years.

Drug users’ access to harm reduction programmes, including opiate substitution therapy (OST) – a treatment for drug users in which methadone or buprenorphine are provided to heroin users and which is standard practice in much of the rest of the world – and needle exchanges, is often officially, or unofficially, absent or restricted.

The result of these laws has been, campaigners for more liberal drugs laws say, not just the development of deadly epidemics, but a failure to reduce the numbers of drug users.

According to the World Health Organisation (WHO), Eastern Europe and Central Asia (EECA) have the world’s fastest-growing HIV epidemic. Injection drug use has been identified as fuelling the epidemic – accounting for up to 70 percent of new infections, according to the WHO.

Addicts admit to being afraid to get treatment for fear of criminal prosecution, and some say they would rather risk getting HIV than going to a needle exchange centre.

Hepatitis C is another chronic problem in the region, where, like HIV, it is largely spread through injection drug use. According to the Open Society Foundation, in some cities in Poland, Hepatitis C infection rates among injection drug users are above 80 percent.

Another lethal disease, tuberculosis, is also a major health concern, particularly in former Soviet countries. It is rife in overcrowded prisons, where many drug users end up as a result of local punitive drug policies.

UNAIDS officials have said that the HIV/AIDS epidemic in the region could be effectively eradicated through the use of harm prevention programmes. And according to published medical studies by western experts, harm reduction programmes have been shown to reduce the risk of Hepatitis C infections in injection drug users by up to 75 percent.

Campaigners also claim that incarcerating people found in possession of tiny amounts of drugs in overcrowded, underfunded prisons which are hotbeds of disease only encourages the further spread of tuberculosis and underlines the flawed philosophy behind punitive drug laws as a means of tackling drug abuse.

Dasha Ocheret of the Eurasian Harm Reduction Network, who has spent years working with drug addicts in Eastern Europe, told IPS: “I’ve lost several friends because they were jailed for drug possession and then died soon after their release because of a tuberculosis infection.

“And out of hundreds of drug users from Russia that I know, not one of them stopped using drugs because they were sent to prison or because of the threat of a prison sentence.”

Governments in Eastern Europe defend their countries’ strict drugs laws by saying they act as a deterrent to drug users and reduce demand for narcotics while at the same time helping bring about the arrest of drug dealers.

But the Global Commission and other similar organisations argue that evidence from decades of trying to tackle drugs problems with repressive measures shows that such policies are costly and completely ineffective.

Alexander Kwasniewski was president of Poland in 2000 when he signed into law some of the harshest anti-drugs legislation in Europe, including three-year prison sentences for possession of even the tiniest amount of drugs.

Now a member of the Global Commission, Kwasniewski says the law was a mistake and is vigorously encouraging governments to rethink their drugs policies.

At its meeting in Warsaw, the Global Commission repeated its calls for governments to abandon their failed ‘war on drugs’ based on prohibition and criminalisation. It said that billions of dollars had been wasted and lives and societies destroyed with no tangible results.

Instead, it has urged governments to focus on prevention and treatment programmes and looking at drug addicts as people in need of help, not criminals in need of incarceration.

It also called on governments to experiment with legal regulation of drugs as had been done for alcohol and tobacco.

Supporters say that similar moves in other countries do not bear out fears that they would automatically lead to greater drugs problems.

“On the contrary,” Kasia Malinowska-Sempruch, director of the Open Society Foundation’s global drug policy programme, told IPS, “looking at countries that have experimented with alternative approaches to drug policy we see that, in the Netherlands, for example, there is a lower rate of drug use by the Dutch than in all neighbouring countries.

“In Portugal, there has been a slight reduction in use among young people, while in Switzerland, people on drug substitution treatment reduce their use of heroin over time.”

Global Commission member Dreifuss told IPS: “Making a change on drugs laws requires public debate and debate on this in Eastern Europe needs to be encouraged. As we have seen in other states, such as my own country Switzerland, making this change may be a long process, but it will only come after debate.” (ends)

Patients attending Opiate Substitution Therapy at a clinic in the eastern Ukrainian region of Dnipropetrovsk. Credit: International HIV/AIDS Alliance in Ukraine.

By Pavol Stracansky
KIEV, Sep 3 2012 (IPS)

Despite pledges from governments across Eastern Europe and Central Asia to fight HIV/AIDS – one of the eight Millennium Development Goals – the region has the world’s fastest-growing HIV epidemic.

Punitive drug policies, discrimination and problems with access to medicines and important therapy are all driving an epidemic which is unlikely to be contained, world experts say, until governments in countries with the worst problems change key policies and approaches to the disease.

Daniel Wolfe, director of the International Harm Reduction Development Programme at the Open Society Foundations, told IPS: “In most post-Soviet countries, where HIV remains concentrated among injecting drug users, harsh policies and discrimination in healthcare settings continue to cripple the AIDS response.”

Figures showing the extent of the region’s problems with the disease make grim reading. According to the World Health Organisation (WHO), while HIV infection rates are actually falling globally, Eastern Europe and Central Asia (EECA) is seeing the reverse.

The WHO says that there were 170,000 new HIV infections in the region in 2011. New infections have risen 22 percent in the EECA since 2005, and there is no sign of a slowdown.

Injection drug use has been identified as fuelling the epidemic – accounting for up to 70 percent of new infections, according to the WHO.

Activists say the key to tackling the epidemic lies first and foremost in combating the injecting drug use problem, but that official and unofficial stances towards drugs and their users are stopping the problem being effectively tackled, or are even making it worse.

Dasha Ocheret of the Eurasian Harm Reduction Network, told IPS: “Punitive drug policies have to be stopped. People are afraid to get treatment for fear of criminal prosecution or problems with the police in other forms and there are situations where people would rather risk getting HIV than go somewhere like a needle exchange centre.”

Russia and the Ukraine are widely seen as facing the greatest problems, with official policies in the former being blamed for hindering the fight against HIV/AIDS in other countries in the region too.

Opiate-substitution therapy (OST), a treatment for drug users in which methadone or buprenorphine are provided to heroin users, which is standard practice in much of the rest of the world, is banned by law in Russia. Public promotion of its use is punishable by jail.

Critics of methadone treatment in Russia argue that it keeps patients in addiction, while others claim western countries want the treatment offered in Russia for commercial gain. They also warn that methadone would probably end up being sold on the black market, sparking another drug problem.

But with Russia emerging in recent years as a major donor in the EECA region, it is also exporting its policies, including on OST, along with its money, and there are fears this could lead to OST programmes being shelved or restricted in other states.

“Russia is a serious regional player and its policy on drugs, like its policies on other drugs, influence policies in other countries in the region,” said Ocheret.

UNAIDS officials have publicly said that the spread of HIV among injecting drug users could be largely stopped if OST, combined with needle exchange programmes, were offered.

This is a view backed up by groups such as Harm Reduction International, which told IPS that huge differences – up to 30 percent – in prevalence rates of HIV among injecting drug users in western countries and Russia is down to the provision of OST and needle exchange programmes.

But even in EECA countries where needle exchange and OST schemes are on offer, there are often serious problems with access to them.

In many EECA countries government officials continue to question their effectiveness and refuse to support them financially, leaving programmes relying on donor support.

This can limit the coverage, scale and subsequent effectiveness of such programmes, and, because such funding is rarely indefinite, creates fear among those on them that their access to OST could be suddenly cut off if a programme closes.

But a greater problem is the active persecution of those trying to access schemes.

Many drug users across the region, where lengthy jail sentences for possession of even the tiniest amounts of drugs – for instance the residue in a used syringe handed in at a needle exchange centre – are the norm, have reported being beaten, tortured, blackmailed or even falsely imprisoned by police.

A spokesman for the International HIV/AIDS Alliance in Ukraine, where OST and needle exchange schemes ostensibly have government backing, told IPS: “Physical and other intimidation towards drug users is routine police practice.

“Drug users, sex workers, and service providers have spoken of how police have extorted money and information from drug users through severe beatings, electric shocks, partial suffocation with gas masks, and threats of rape.

“They have also reported that police planted drugs in their homes or on their persons, and used this as evidence to arrest or abuse them.”

Discrimination of drug users also extends to the provision of antiretroviral (ARV) drugs.

The International HIV/AIDS Alliance in Ukraine told IPS that denying drug users ARV drugs was a “common problem”, although there is no way of officially proving it.

The Eurasian Harm Reduction Network also told IPS similar incidents had been reported in Russia.

The WHO estimates that only 23 percent of people who are eligible for HIV drugs in the EECA actually receive them. The figure in sub-Saharan Africa is more than double that.

Local groups working to combat the disease say until Western healthcare approaches to HIV/AIDS treatment and prevention are adopted, the region is unlikely to get the epidemic under control.

Ocheret told IPS: “Countries like Poland, for instance, introduced western healthcare practices on HIV/AIDS, including OST, in the 1990s when it had a difficult problem with HIV/AIDS and by doing so managed to get the problem under control.

“In many EECA countries these programmes remain in perpetual ‘pilot’ stages and have never developed further.”