Harsh treatment

Harsh treatment
By Daniel Wolfe
Copyright by The International Herald Tribune
Published: December 27, 2006


NEW YORK: On Dec. 8, 43 HIV-positive women were killed by a fire in a locked Moscow hospital ward, where they were supposedly being treated for drug addiction. Two nurses also perished. Until governments in Asia and the former Soviet Union stop punishing drug users in the name of treatment, such tragedies are bound to be repeated, and efforts to control both addiction and AIDS will continue to fall tragically short.

In Russia, the locked ward is a legacy of the Soviet era, where medical specialists (or "narcologists") subjected alcoholics and drug addicts to hypnosis, aversion therapy and, when deemed necessary, forced labor.

State power to enact compulsory treatment largely collapsed with the Soviet Union, but in many former Soviet republics the bars on the windows and fire escapes of drug treatment facilities remain in place. So does the attitude that drug users are best treated like drugs — as something to be controlled and contained for the good of society.

Many Russian narcologists offer drug users little more than extreme sedation to mitigate withdrawal from heroin. Drug users' names are added to government registries. Psychological support is minimal or nonexistent. Prescription of the oral medications most effective in reducing heroin injection and HIV risk, such as methadone or buprenorphine, is illegal.

China, spurred by the spread of HIV among injecting drug users, has won well-deserved praise for new programs prescribing methadone to heroin addicts. Less attention, however, has been given to the fact that most Chinese methadone patients receive medication only after spending two terms in compulsory detoxification centers run by the Public Security Bureau, where they are offered such measures as 12 hours of daily, unpaid labor, therapy with electric shocks, and sessions where they chant such slogans as "drugs are bad, I am bad."

In Southeast Asia, drug users are also forced into overcrowded facilities where conditions more closely resemble prisons than treatment centers. Some 35,000 Vietnamese are now detained in rehabilitation centers in Ho Chi Minh City alone.

In Malaysia, an estimated 5,000 drug users are in compulsory rehabilitation centers where they are subjected to boot-camp style drills, and locked at night into barred cells where as many as 40 patients sleep on the floor.

Experts estimate that from 90 percent to 100 percent of drug users subjected to coercive internment in the former Soviet Union and Southeast Asia return to illicit drug use. Bizarrely, this finding has sparked some governments to increase the length of internment rather than to re-examine their approach. In Ho Chi Minh City, detention reportedly can last four years or more.

The cost of these failed approaches can be measured not only in terms of unchecked drug dependence, but also in new HIV infections. In China, Russia, Malaysia and Vietnam, the largest share of all HIV cases are due to injecting drug use.

Outside Africa, the UN now estimates, nearly one in three infections is the result of contaminated needles. For the hundreds of thousands of drug users who are HIV-positive and unlucky enough to find themselves in punitive clinical settings, the problem of ineffective drug treatment is usually compounded by the absence of any HIV treatment at all. Sterile syringes and condoms are also unavailable, even though reports of drug use and sex in compulsory treatment settings are common.

The tragedy in Russia should move national governments and the United Nations to increase monitoring of what for too long has passed for drug treatment, and to speak out against abuses committed in the name of health. Otherwise, we leave millions of drug users in Asia and the former Soviet Union like those young, HIV-positive women: trapped, screaming and with no one to help.

Daniel Wolfe is deputy director of the International Harm Reduction Development Program of the Open Society Institute.