Partnership to fight HIV/AIDS in Europe and Central Asia
Ministerial Conference, Dublin, 23-24 February 2004
Antonio Maria Costa
Executive Director
United Nations Office on Drugs and Crime
Excellencies, Ladies and Gentlemen,
Eastern Europe, Russia and Central Asia are strong evidence of the relation between the HIV/AIDS infection on the one hand, and drug addiction, human trafficking, crime and punishment on the other. Paraphrasing the tough jargon of the military, one could say that in these regions HIV/AIDS is a collateral damage of uncivil behaviour.
The problem, of recent origins, started at the turn of the 90s when a dozen or so newly independent states emerged from the collapsed Soviet Union. During the transition that followed, great many government institutions stopped functioning, including drug control, crime prevention, justice and health care sectors. Suddenly, countries until then closed to foreign influence and inward-looking had to cope with open borders, free movement of behaviours, people and goods. They were unprepared to patrol what was getting in and out of the country.
To render things worse, during the economic and social upheavals that followed, crime syndicates penetrated important segments of society, even of governments: bribery and corruption, already quite widely spread in the pre-independence period, reached further into society. As the region faced a sudden influx of illicit drugs, open prostitution, and large-scale trafficking of their beautiful people, the prison population swelled, at times spilling into the (former) Gulag archipelago. No health assistance was made available.
(a.) Intravenous Drug Use (IDU),
Over time this led to a dramatic rise in the intravenous drug use (IDU) accompanied, not surprisingly, by an equally dramatic rise of the HIV infection. Today we estimate that approximately 20% (or 2.3 million) of the worlds 12.5 million injecting drug users live in Eastern Europe, Russia and Central Asia.
In the same regions, between 1.2 and 1.8 million people have contracted HIV/AIDS. In 2003 alone between 120,000 to 180,000 people were newly infected, most of them below 30 years of age. If this 10% annual growth rate of the HIV infection among the cohorts of drug users is sustained over time, it will inevitably spill into the population at large imparting further momentum to the pandemic. The region is thus facing the most alarming public health problem in many generations.
(b.) Trafficking of Humans
Organised crime traffics in illicit drugs. Criminals also fill containers, ships and tractor-trailers with smuggled migrants and enslaved human beings. Around the world over one million people are estimated to be victim of human trafficking. These men, women and children lured at first, and then coerced into sex work, paedophilia and child exploitation -- once discovered by the host country are generally treated as clandestine. So they have no rights. They are not protected from violence, exploitation or health infections. They have no access to support and care.
The most typical, and painful example I can provide concern young girls, forced into prostitution at a very young teen age and soon (at age 14 or 16) infected with HIV. What future do they have once released, as useless in the brothel profession? How not to realize that they become an even more serious health threat, back in their villages?
(c.) The tragedy of prisons
Experience shows that before adequate policies are put in place to deal with HIV/AIDS, countries often react with inept measures. First, denial prevails: the problem of HIV/AIDS is simply ignored. Countries then estimate the citizens infected with the virus, downplaying the findings: inertia prevails. Finally, in desperation, countries put drug users into prison or round up illegal sex workers.
Fear drives people underground. Drug users go into hiding: when discovered they are jailed. Largely the same happens to HIV positive people, considered the results of despicable behaviours. In overcrowded prisons inmates share drugs, needles and sex.
If you want a vivid example of how prisons become breeding ground for HIV/AIDS, think of the insane business I have witnessed by an enterprising inmate in a distant detention centre across the Caspian Sea. Having manufactured a primitive syringe with an elongated plastic pen and a rubber end, this fellow would rent it out to fellow inmates at 1c (one cent) per shot -- netting about 3$/day. Think of the 300 IDU made in a single day, with the same rudimentary tool occasionally washed with an inmates own blood.
Breaking the barriers
This Conferences call to break the barriers is telling us to address the problem with common sense and scientific evidence, in partnership with all in society.
We know what to do. We need to provide injecting drug users and sex workers with appropriate services, outreach activities, information, counselling and HIV testing, and the means for protection from infection. At the moment in region only less than 5% of injecting drug users are reached with such services.
We do not have much time at our disposal. Unless the right decisions are taken right now Eastern Europe, Russia and Central Asia risk an HIV/AIDS pandemic even more serious than Africas.
Ladies and gentlemen, the United Nations Office on Drugs and Crime (UNODC) has no public health mandate and we do not look for one. We have been drawn into HIV/AIDS prevention by the desire to eradicate some of the infections roots causes. I have focussed on three areas: drug injection, trafficking of people and the criminal justice system, areas where the UNODC expertise goes back a quarter century. With your encouragement and in partnership we shall persevere in our efforts.
I thank you for your attention.