Antonio Maria Costa
Executive Director
United Nations Office on Drugs and Crime
Moscow
1 April 2005
Thank you and welcome. I have enjoyed a special vantage point from which to view the problem of HIV/AIDS - I am both the Chair of the CCO, and Executive Director of UNODC.
But the news is not good, from any perspective. There are an estimated 13.2 million injecting drug users (IDUs) worldwide, and nearly one-third live in CIS countries. HIV is infiltrating the general population, and the epidemic shows no sign of slowing. This raises important questions: are our drug control policies working? What role do treatment and prevention programs play in this control strategy? Are drug control programs antithetical to HIV treatment and prevention - or is there enough room in our portfolios for both?
Let me start with the global drug situation: on the supply side, the picture is a positive one. Drug cultivation is down across the world: in Afghanistan, Myanmar, Laos - the Golden Triangle - poppy production is declining. Coca cultivation is down in the Andean regions. There are even signals that less cannabis is coming out of Morocco. All of this is happening for different reasons - eradication, market adjustments, and a sense that governments are getting tough.
On the demand side, the news is not as good. In Eastern Europe, the CIS countries, and Russia especially, the market for drugs remains strong. Heroin continues to flood the region - the result of boom crops in Afghanistan over the past two or three years - and cocaine and synthetic drugs are gaining ground. More drugs translate into more drug users, more injecting drug users, and in a commensurate increase in HIV/AIDS.
A steady supply of heroin and a robust market demands a strong response on multiple fronts - which I do not see yet, at least not in all countries. Prevention and treatment must be available to high-risk groups, as well as to injecting drug users already living with the disease.
We cannot deny addicts the genuine opportunity to remain HIV negative. Greater attention and more resources should be invested in drug control programmes intended to check the spread of blood-borne diseases. But these initiatives cannot be ends in themselves; they must be parts of larger, more comprehensive efforts to reduce and eliminate drug use altogether. UNODC unequivocally rejects any initiative, as well intentioned as it may be, that facilitates drug abuse.
In other words, we reject the �false dichotomy� that
Governments can, and must ensure both drug control and HIV prevention. UNODC�s position in this matter remains closely aligned to direction provided by the International Narcotics Control Board (INCB): � . . . governments need to adopt measures that may decrease the sharing of needles among injecting drug users in order to limit the spread of HIV/AIDS. At the same time . . . prophylactic measures should not promote and/or facilitate drug abuse.�
CND resolution 46/2 of April 2003 calls on � . . . all States to strengthen efforts to reduce the demand for illicit drugs, taking into account . . . the drug related spread of HIV infection.� This means it is the responsibility of Member States to construct programmes that address the threat of HIV/AIDS.
UNODC and INCB can point you in the right direction, but each Member State has to design the actual avenues, or HIV prevention and treatment programmes, you believe suit your needs.
UNODC is extremely concerned about the plight of people living with HIV and AIDS, about the social impact of the disease, and about stigma and discrimination. We want States to respond to this threat. We expect action.
The UNODC mandate does not impose specific prevention and treatment plans on Member States. UNODC�s responsibility is to reflect the consensus among Member States. Operationally, States construct the blueprints, and when it is time to put them into action, UNODC has a role to play.
Our goal is to draw the attention of Member States to a looming crisis, to prod governments into action, and to offer technical assistance and support. I urge CIS countries to commit now, in concrete ways, to 1) preserving the lives of health of your citizens; 2) to protecting economic development; 3) to reducing drug abuse, and 4) to ensuring national stability. HIV/AIDS is a threat to all four, and its impact is already taking a toll.
By the end of the year 2000, HIV had spread to 82 out of 89 regions across the Russian Federation. Epidemics had erupted in 30 cities. Today, estimates suggest about a million people are living with HIV in Russia. Young people are hit hardest in CIS countries. In Eastern Europe, 8 out of 10 people infected by the virus are under thirty - 70 percent are young men. These young people cannot be replaced - their potential contribution to society, and to our economy is forever lost.
Children are orphaned by HIV/AIDS. Abandoned and vulnerable, they can become prey for human traffickers. The epidemic creates orphans in other ways: children who are HIV-positive are often abandoned by mothers who passed the disease to them at birth. Many of these women are injecting drug users themselves. Others were infected by sexual partners. But the results are the same: orphanages overflowing with children whose lives have already been damaged, irrevocably, by HIV/AIDS.
We met some of these children yesterday, in a facility not far from this hotel. They were beautiful � and living lives that were �normal� in every way but one. One of my colleagues characterized them as �social orphans,� hundreds of thousands of childen penalized not by the absence of living parents, but by society�s lack of concern. They are written off, marginalized, and their needs are far down the list of priorities. Russia has been home to social orphans before, after the Revolution, and after World War II, and the problem today is as compelling as it was on those occasions.
We talk a lot about competition for resources. But at some point, sooner or later, when AIDS burns through the population at large, the question is going to be �Why didn�t governments act sooner?� Waiting isn�t going to save money. And it certainly isn�t going to save lives.
In some cultures, it may be difficult to summon up compassion for injecting drug users or sex workers living with HIV or AIDS. Some people may not be comfortable with their lifestyles, but we must embrace their humanity; we have to accept the fact that these individuals are, in fact, vectors for a deadly disease. We need to intervene - to stand between this disease and untold numbers of potential victims.
Drug dependence treatment, and basic drug prevention are cost-effective. Antiretroviral treatment is critical. And programs designed to prevent mother-to-child transmission are at the top of the list.
We also need to ensure linkages between HIV prevention and treatment programs: the sooner we know someone is HIV-positive, the sooner we can get him or her into treatment and make sure no one else is infected.
HIV/AIDS is a problem in prisons, where great numbers of inmates continue to inject drugs, and to spread the virus. It was Dostoevsky, of course, who said that the degree of civilization in society can be judged by entering its prisons. He was a wise man. What would he say on entering our prisons today?
Rape, violence, corruption, overcrowding, and poor prison management all conspire to make the situation appear hopeless. The prospect of controlling HIV/AIDS in this environment is daunting.
I cannot forget visiting a prison where I met an inmate who made a significant amount of money �renting out� a crude syringe he had fashioned out of a ballpoint pen. This fellow charged inmates 1 cent to use this syringe one time, and he told me he was making $3 a day from 300 injections. He didn�t clean the syringe much, but when he did, he used the blood of another inmate to wash the utensil out. This is the reality inside our prisons.
The presence of drugs and HIV/AIDS in prisons presents two distinct dilemmas: first, drugs in prison represent a failure of security and an affront to the rule of law.
When drug traffickers can operate inside government facilities, something is wrong -- collusion between criminal gangs or trafficking organizations, and prison officials.
This calls for a strong response from enforcement authorities as well as anti-crime and anti-corruption agencies. UNODC can help in this regard.
The second problem turns on drug use among prison populations, and the consequent transmission of HIV/AIDS from prisoner to prisoner, and, after inmates are released, from prisoners to uninfected partners.
Recidivism among prisoners is high: 70 percent of prisoners are re-incarcerated within 6 months; 90 percent within a year. Turnover rates in prisons are also high. This means that two population streams flow into and out of prisons on a regular basis: new inmates who may not yet be carriers of HIV/AIDS, and HIV-positive offenders already suffering from AIDS, who leave prison, spread the disease outward, to non-infected persons, and then return to prison.
The result is that, within the prison population, the disease grows with extraordinary speed and intensity, outpacing anything you see in the general population.
There�s a great deal we can do right away. Some people think prison authorities should fix the problem. But they cannot do it alone. They have to work with other government entities, health and justice agencies in particular.
Common sense has to guide us. We cannot allow discrimination and stigma to stand between us and a solution. Injecting drug users in prison must have access to the same care offered to people on the outside:
It is important to remember that, even among prison populations, there are success stories. Since 2003, UNODC has worked with regional authorities across the Russian Federation to develop HIV prevention and treatment programs for former inmates.
The result? The creation of special Social Bureaus - networks of service providers including psychologists, social workers, and other trained professionals. They start working with inmates months before their release, counselling them about HIV
HIV/AIDS and drug abuse, and providing information about the assistance programs offered by the Social Bureaus.
In one region where these Social Bureaus are up and running, we saw real results: former inmates who took advantage of these services were able to beat the odds - after 12 months, not one had been returned to prison.
No one agency or organization working alone can hope to remedy the problem of HIV/AIDS in prisons, or to control the spread of this disease once it moves beyond the prison walls. But together we can make a difference, by building comprehensive service initiatives that work before inmates are released and after they re-enter the general population. These men and women need economic opportunities, health and social services, outreach from law enforcement agencies and courts, and most of all, they need another chance from people willing to invest time, money, and political capital in this effort - and that, my friends, means all of us.
Thank you.