Drug policies help keep HIV rates low in Central Europe (Feature)

By Katerina Zachovalova Jul 19, 2010, 3:06 GMT

Prague - For Pepino, a 44-year-old Czech drug addict, needle exchanges are a routine affair. He started doing it in 1986, three years before the Velvet Revolution ended Communist rule and opened his country to visitors from around the world.

On a recent afternoon, Pepino, who did not want to give his last name, arrived at a Prague outreach centre to swap a batch of dirty syringes for new ones. The skinny, grey-haired man - tattooed and with a wisp of a goatee - has been using drugs for 28 years.

'I don't want to use dirty needles. I don't want to catch something,' he said. 'I am not worried about myself, but I have family and I do not want to jeopardize them.'

While there is not enough scientific evidence, experts and activists believe that needle exchanges and other so-called harm- reduction services have led to low HIV infection rates in some former Communist countries in Central Europe and the western Balkans.

A declaration by doctors and scientists, which coincides with the 18th International AIDS Conference taking place in Vienna, calls for decriminalization of drug use, arguing that harsh policies are partly responsible for the spread of the AIDS virus among intravenous drug users.

The Iron Curtain protected the former Eastern bloc from the global HIV/AIDS epidemic in 1980s. When Communist rule ended in 1989, freedom came along with the illegal drug trade and the deadly virus.

Instead of driving intravenous drug users like Pepino into the hiding, some ex-Communist countries rushed to open Western-style services that allowed addicts to use drugs safely in a bid to protect public health.

'We accepted the reality. The drugs are here whether we like it or not,' said Jiri Presl, a veteran Czech expert on drug addiction prevention and treatment.

'We began exchanging needles and syringes in 1986,' he said. 'Ukraine accepted a repressive approach, and as a result they have an epidemic level of HIV.'

The Czech Republic, a country of 10.5 million, had 1,425 known cases of HIV as of May 31, including fewer than 100 cases of injection drug use transmissions, official data say, while Croatia and Slovenia, which also introduced harm-reduction methods early on, have fewer than 500 known infections.

Ukraine's rate, 1.6 per cent at some 440,000 known HIV cases in 2007, is the highest in Europe.

Presl co-founded Drop In, a Prague-based group that began exchanging needles in a downtown alleyway in 1992, the year illicit drugs swamped the then Czechoslovakia.

Nearly two decades later, there are 100 publicly-funded harm- reduction programmes across the country, syringes are available over- the-counter at pharmacies. That treatment is now available has played a role in keeping the epidemic at bay, as those undergoing treatment are less infectious.

This approach is rare in many other former Soviet states, where the HIV epidemic has surged in recent years.

Yet harm reduction alone cannot be credited for the region's low infection rates, which some fear may underestimate the extent of the problem.

Activists and experts suggest that the infection levels may be far greater than known, since many in the region have not been tested for the disease.

Safe sex is far from a widespread practice in a region that prides itself on low HIV infection rates.

While Czechs use condoms more often than they did 20 years ago, 45 per cent of men and 49 per cent of women admitted to have had unprotected sex, a Charles University survey found in 2008.

Experts warn that the low-rate countries should not become complacent.

While the spread of HIV among intravenous drug users appears to have been contained, the infection has been on the rise in gay communities in the region.

Moreover, outreach centres like Drop In have never been popular with the public. Their existence is often due to the work of activists rather than politicians.

The Czech capital has been an exemplar of harm reduction, but the anticipated departure of the city's longtime mayor, Pavel Bem, later this year may change things.

Bem, a psychiatrist who treated drug addicts before entering politics, has been a patron of harm reduction programmes. But he recently failed to prevent Sananim, another Prague needle exchange group, from facing the second eviction this year.

'The Czech Republic belongs to a few places where the rational, pragmatic and apolitical approach has worked,' Presl said.

His colleagues fear that may not last much longer.