Nikolai
remembers his first fix so well. As the heroin entered his veins
he felt a deep swell of euphoria, one that he would never feel
fully again. At the time he never imagined that one day he’d
crave smack with every bone in his body, “not like real
junkies”.
“At 15 I took my first shot, really for fashion –
it was a cool thing to do. It’s true what they say: ‘one
shot is too much, and a thousand too few’. The memory
of the euphoria you get from the first experience stays with
you forever. The rest of your life is spent chasing that first
feeling – but by the time you understand that you will
never get it again, you are already hooked.”
Now Nikolai has a new fixation – distributing clean needles
and syringes in exchange for dirty ones. “I am a drug-user
to the end of my days now,” says the 25-year-old Red Cross
outreach worker. “But harm reduction is my other addiction.”
In June 2002 he joined a harm reduction project implemented
in Irkutsk, Southern Siberia, run by the local committee of
the Russian Red Cross and funded by the Open Society Institute.
“You need to stay clean in order to share your knowledge,”
says Nikolai, cramming a Red Cross jacket in a huge bag on top
of piles of syringes, needles, condoms, disinfecting tissues
and booklets that form a standard set of distribution materials
of an outreach worker getting ready to go on a “spot”.
Nightmare days
He talks about his nightmare days as a junkie whilst the Red
Cross van is parking beside a scrap-heap, raising clouds of
dust from the dry grey wasteland on the outskirts of the city.
A few shabby houses stand out here and there amid the rubble.
“We still don’t have proper premises for an exchange
point,” he explains. “No one wants drug-users hanging
around, so the wall of that house is our exchange point,”
he adds, pointing at a dirty pink half-ruined building. “Most
of our clients live in this area.”
“Every day I come here and see what I used to be. I have
literally burnt my past – everything – music I listened
to, books I read, clothes I wore, pictures, but I cannot delete
the memory. I have to make the best of it, and reducing harm
is my opportunity to do it. It is my service. When the people
we visit see me clean, knowing that I was on junk for seven
years, they get a glimmer of hope, seeing what is possible,”
he says. Most of Irkutsk’s 14,000 officially registered
intravenous drug-users come from socially vulnerable backgrounds.
The cost of a syringe is only five roubles, or 16 US cents.
But most users, lacking basic information on the dangers of
sharing needles, prefer to spend the five roubles on a pack
of cheap cigarettes or instant noodles.
Nikolai’s parents kicked him out of the family home as
soon as they found out that he was on drugs, worried about the
family’s reputation. For two years he lived in the streets
with his fellow addicts, stealing and swindling for heroin that
could cost up to 100 US dollars per gram. “I had to have
three shots a day. We didn’t even think about HIV or hepatitis,
or any other disease. One syringe for all was fine as long as
it contained junk.”
The devastating spread of HIV continues among Russia’s
intravenous drug-users (IDUs), who account for 82 per cent of
all registered cases, and almost 62 per cent in the Irkutsk
region. The Ministry of Health estimates that there are one
million IDUs in Russia - UNAIDS puts the figure at around 3
million - and while the needle still represents the major threat
of infection, IDUs are forced deeper underground, stigmatised
and deprived of basic human rights. Says Nikolai: “The
problem is that here in Irkutsk you can never talk about it
if you don’t want to become an outcast.”
Limited impact
Although there are now 48 harm reduction programmes across Russia,
run by various non-governmental agencies, including the Red
Cross, so far they have had an extremely limited impact due
to short time frames and their scattered nature.
Despite the fact that the Ministry of Health has accepted WHO-recommended
principles on harm reduction, the value of this activity in
HIV prevention does not sit comfortably in the minds of most
Russians. There is a general perception that such projects promote
drugs.
Nikolai opposes this notion. “There is nothing that could
be ‘promoted’ to our clients. They know it all,
and if someone is going to inject anyway, why not give him a
clean syringe? He will find one anyway, but used and dirty.
And he will get HIV. Then his treatment will cost much more
than a clean syringe.
“Like the author Irvine Welsh once said, I am not this
big reformed ex-junkie voice of experience. I just know that
I exchange some 400 syringes per day, and I would like to think
that by doing it, I save someone’s life.”
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Nikolai
had his first taste of heroin at the age of 15. Now he
is committed to harm reduction (p10808)
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"If
someone is going to inject anyway, why not give him a
clean syringe?" Nikolai says (p10809)
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There
are now 48 harm reduction programmes across Russia. But
they struggle to make an impact in a country with an estimated
3 million injecting drug-users (p10811)
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