International - Russian Federation

Basic Data

(Prevalence of Illicit Drug Use) "The level of drug abuse in the Russian Federation remains high and according to official statistics of the Russian Federal Ministry of Health and Social Development, the number of registered users of illicit drugs is more than half a million (517,389), including 350,267 (67 percent) registered with medical establishments as drug dependants. The majority of registered drug users are opiate abusers and is estimated at over 300,000 people.
"Some Experts from the Ministry of Internal Affairs believe that around 4 million people are using illicit drugs. Some of these experts also believe that most abusers are using opiates, however population data suggests that cannabis is the most prevalent drug. According to the experts’ estimates the number of drug addicts in Russia during the last decade has increased by more than 9 times."

(Prevalence of Cannabis Use) "In keeping with global trends, cannabis abuse still remains the “drug of choice” for the majority of abusers and seizures of cannabis rank first among the total volume of seized illicit drugs in Russia (more than 70 percent).
"Cannabis is abused by many people regardless of their income, education and social standing. Since 2002 the number of Cannabis abusers (19,211) has remained more or less stable and constitutes 22,528 addicts in 2006. There is an increase in the number of cases of cannabis cultivation in domestic green houses.
"The growing abuse of cannabis is at least in part fuelled by publications, films and internet sites which often promote the drug as 'safe' or 'soft'."

(Prevalence of Opioid Use and Related Mortality)
"Revised data for the Russian Federation indicate annual prevalence of the use of opioids to be 2.3 per cent and the annual prevalence of heroin use: 1.4 per cent.⁶¹ Of the 9,263 drug-related deaths reported in 2010, 6,324 were attributed to opioid use."

(Number and Type of Drug Crimes Known to Authorities) "There were more than 240,000 drug crimes (acquisition, sale, manufacture etc.) registered by the Russian law enforcement agencies in 2006 - a 23 percent increase over 2005.
"Most of the crimes were committed in the large cities and industrial centres such as Moscow, St. Petersburg, Krasnodar, Kemerovo, Samara and Rostov. All these regions are located along the major drug trafficking routes.
"The number of crimes classified as “serious”and “extremely serious” has increased by 13 percent (from 134,988 cases in 2005 to 152,824 cases in 2006), although the overall number of drug crimes dropped by 5 percent (from 77 percent in 2005 to 72 percent in 2006). However, the definition of an “extremely serious crime” includes those cases where the offender has been arrested for possession of more than 2.5 grams of heroin.
"A similar trend is observed in drug trafficking cases where the number of these crimes increased by 12 percent in 2006 (100,000 cases in 2005 to 123,000 cases in 2006). However, in the context of all drug crimes, the proportion of drug trafficking cases actually declined by 5 percent (from 63 percent in 2005 to 58 percent in 2006)."

(Homicide Rate) The Russian Federation's homicide rate is 11.2 per 100,000 national population, with a reported 15,954 homicides in 2009.

(Arrests for Drug-Related Crimes) "Eighty-seven thousand people were arrested for drug related crimes in 2006 – an increase of 24 percent over 2005.
"The increase in arrests and the fact that more traffickers are being prosecuted suggests that the Russian law enforcement agencies are becoming more effective. It is certainly the case that they are carrying out more covert operations directed against organized criminal groups and drug trafficking networks."

(General Population, Prison Population, and Incarceration Rate) The Russian Federation's incarceration rate is 629 inmates per 100,000 of national population, with a total prison population 891,738 out of an estimated national population of 141.83 million.

(Transshipment of Afghan Heroin through Russian Federation)) "In 2010 an estimated 25 per cent of the 380 tons of heroin manufactured in Afghanistan -some 90 tons- was trafficked northwards through Central Asia via the Northern route and onward to the Russian Federation. The 90-ton total includes heroin consumed within Central Asia and the Russian Federation, as well as heroin seized by law enforcement or trafficked onward. More than three quarters of this amount are destined for the Russian market, with a small portion (approximately 3-4 tons) continuing to eastern and northern Europe.1 Furthermore, in 2010 between 35 and 40 tons of raw opium were trafficked through northern Afghanistan towards Central Asian markets. The entire 2010 opiate demand of the Northern route is required to transit or be produced in northern Afghanistan."

(Transshipping and Seizures in Central Asia) "In Central Asia, traffickers have access to a well-developed road and rail network. Around 70-75 per cent of opiates are transported by truck or another vehicle across Central Asia through Kazakhstan to major cities in south-western Russia and western Siberia.¹⁰⁸ Trains and planes usually account for approximately 15-25 per cent of trafficking. Seizures on trains have been on the rise as of 2011, particularly in Uzbekistan. Based on available data for Central Asia and Russia, in 2011 the average size of heroin seizures on trains was 6 kg, out of a reported 55 seizures (at the time of this writing). Shipments can, however, be much larger, as shown by two heroin seizures of 191 kg and 118 kg made in 2010 in the Russian Federation and Tajikistan, respectively."

(Total Drugs Seized in Russia, 2010) "The total amount of narcotics seized from illegal circulation by all law enforcement agencies in 2010 was 41 (metric) tons, 245.8 kilograms (an 8.8 percent decrease in comparison to the previous year). Total seizures of illegal narcotics in the first nine months of 2011 by type of substance were as follows: heroin, 1 ton, 637.3 kilograms; cannabis, 19 tons, 659.5 kilograms; hashish, 1 ton, 922.5 kilograms; cocaine, 188.1 kilograms; and synthetic narcotic substances, 533.6 kilograms."

("The Silk Route" and Smuggling to and Through Russia) "While check points staffed with border guards, police and customs officers operate at official entry points at the Kazakh-Russia border, the length of the border and the limited number of law enforcement agents available does not allow for an effective control over the numerous illegal entry points and makes the Kazakh-Russia border porous. This situation is fully exploited by the drug traffickers whose activities are often facilitated by corrupt officials, many of whom are law enforcement agents.
"Recently, drug traffickers have adopted more sophisticated methods of concealment: sliding double walls in containers and trucks, as well as false floors and roofs in trucks. These false compartments which are often operated by remote control are installed by specialist vehicle repairers.
"It is also worth noting that after the withdrawal of the Russian Border Guards from Tajikistan in 2005, the seizures of opiates have dramatically decreased in all Central Asian States.
"Given the huge increase in opium production in Afghanistan, the so-called Silk Route is becoming more and more attractive for the drug traffickers.
"Major heroin trafficking routes from Central Asia lead to Moscow, St. Petersburg, Saratov, Yekaterinburg, as well as the other large cities of Volga Region and Siberia. These locations are not only destination points but also serve as a transhipment point for further shipments to other destinations in Russia and in Europe."

(Illicit Cannabis Market) "The widespread trafficking of cannabis continues unabated. The trafficking is fuelled by the fact that cannabis grows wild in a number of regions in Russia and so is readily available. Indeed, the Russian Federation and neighbouring Kazakhstan contain the world’s largest areas of wild cannabis and the Russian authorities estimate that production of wild cannabis in Russia is around one million (1,000,000) hectares. Depending on the climate conditions, one hectare of cannabis may produce up to 1 million seeds with 5-8 years of reproduction cycle. The THC content of cannabis differs in different regions but tends not to exceed 5 percent. Since 1992, cannabis seizures steadily increased 8 times and reached 89.7 tons in 2004. However, seizures sharply decreased almost threefold in 2005 (30.6 tons) and continued to decrease in 2006 (23.7 tons)."

(Heroin and Opium Seizures Along Tajik- and Kazakh-Russia Border) "One of the major concerns is the continuing deterioration of security on the Tajik-Afghan border following the withdrawal of the Russian border guards from the region. The situation on the Russian-Kazakh border also gives rise to concern given the fact that the major trafficking routes of Afghan heroin go through the Russian-Kazakh border - and the number of border guards is insufficient to counter the activities of such traffickers."
"The proportion of heroin and opium seizures has increased every year since 1999 and seizures of these two drugs increased from 38 percent in 2005 to 67 percent in 2006. At the same time, the number of significant heroin and opium seizures (according to UNODC classification) has also increased."

(Amphetamine-Type Stimulants (ATS) and Other Synthetic Drugs) "The illicit manufacturing of synthetic drugs remains one of the major concerns. A thriving chemical industry, often lacking sufficient regulatory control, means that precursor chemicals are easily obtained by Russian criminals and are used in the production of synthetic drugs for both the domestic and foreign markets. The current trend seems to be that precursors used in the production of ATS are trafficked to European countries whilst precursors used in the production of heroin, are trafficked to Asia.
"In terms of domestic production, so-called “kitchen labs”, still prevail. The majority of these laboratories produce relatively small amounts of pervitine (ATS) for local consumption. This drug is widely abused and in terms of injecting users, is second only to heroin and other opiates.
"In 2006, there were 1,486 registered cases of illicit production of drugs (+14 percent compared to 2005). The main types of drugs illicitly produced in clandestine labs are amphetamines, methamphetamines, 3-methylfentanyl, and phencyclidine. It is rather reassuring to report that there are very few cases when illicit synthetic drugs were produced in laboratories at industrial facilities and most of the clandestine laboratories are either the “kitchen labs”, described above, or otherwise small scale, rudimentary enterprises."

(Crime and Drug Use) "The growing number of young people abusing drugs is a serious concern. Worryingly, the overwhelming majority of drug addicts are between 18 – 30 years old. Many of them are unemployed, have a chronic history of offending and commit a large number of crimes to finance their addiction. As is the case in many other countries, the so-called ‘dark figure’ of crime – the mismatch between crime estimates produced by victimization surveys and those recorded by the police - is a well-known concept in Russia and most commentators agree that a relatively small number of opiate addicts are responsible for a staggering amount of acquisitive and violent crime. In this context it is worth noting that the Russian police registered around 12,000 crimes (of which 63 percent were rated as serious or extremely serious) which had been committed by offenders whilst they were suffering drug intoxication.
"The increase in drug abuse amongst otherwise law-abiding people, particularly adolescents, is causing a good deal of concern. Over the last few years, more and more young people have become ensnared in the cycle of drug abuse and crime. In 2006, more than 3,000 adolescents committed drug related crimes. Of these, some 845 cases involved the distribution of drugs. Young people’s increasing willingness to abuse drugs which too often leads to addiction, prostitution and homelessness, poses a real threat to community safety."

(HIV Transmission and IDUs) "The epidemic disproportionately affects IDUs who comprise 87% of the cumulative number of registered HIV cases, however, with the epidemic becoming more mature, the infection tendency away from IDUs to heterosexual is also increasing with 68% of newly registered cases by the end of 2004 corresponding to IDU and 30% to heterosexuals (In the previous year heterosexual transmission accounted for 23.4% of new infections). The interpretation of the tendency towards less new infections diagnosed is not an indication of a slowing of the epidemic but rather reflective of the changes in HIV testing policy, the smaller number of tests performed in population groups with high-risk behaviors and also a shortage of test kits."

(Growth in Heroin Use from 1990-2004) "There is no doubt that drug use and heroin use particularly have risen meteorically in Russia since 1990. Mikhailov said the total number of drug users had risen 900 percent in the decade ending in early 2004. A Max Planck Institute study of the drug trade in Russia concluded that drug-related crimes increased twelve-fold from 1990 to 1999. Many analysts have traced the dramatic rise in use of injected heroin since the fall of the Soviet Union to economic collapse and attendant rises in unemployment, poverty and desperation and to increased availability of cheap heroin trafficked through central Asia and across the former Soviet states. Some observers have suggested that the aftermath of the events of September 11, 2001 in Afghanistan and central Asia has done nothing to stem the flow of heroin through the region and may even exacerbate it in the long run. Mikhailov of the SDCC has told the press on numerous occasions that the United States military intervention in Afghanistan has contributed to heroin consumption in Russia because the Taliban had been able to suppress opium production before they were overthrown. In 2003, Victor Cherkesov, head of the SDCC, said the drug trade in Russia was valued at about U.S. $8 billion a year."

(Prevalence of HIV Related to IDU) "The Russian Federation borders on a generalised epidemic with a population prevalence of 1.0% (95% CI 0.9% to 1.2%).² Official registration data from 2010 indicated over 38 000 prevalent cases in Moscow,³ the largest city of the Federation and the political and economic hub. The continued rise of HIV parallels the increase in sexually transmitted infections (STIs), most notably syphilis and Chlamydia, in the years following the fall of the Soviet Union,^{4 5} which subsequently stabilised to approximately 78.5 and 100.8 per 100 000, respectively, by 2004.⁶
"Russia’s epidemic is largely concentrated among vulnerable populations.2 7 Injection drug use (IDU), responsible for over half of all new infections, has been considered the primary driver.8 Sexual transmission is increasingly common and contributes approximately one-third of new HIV cases.^{8 9}

(Availability of Naltrexone in Russian Federation) "In Russia, substitution therapy is forbidden by law, and naltrexone is the only available pharmacotherapy for heroin dependence. Due to the lack of alternatives to naltrexone and stronger family control of compliance (adherence), naltrexone is more effective for relapse prevention and abstinence stabilization in Russia than in Western countries. Long-acting, sustained-release formulations (injectable and implantable) seem particularly effective compared with oral formulations."

(Limited Availability of Treatment) "Most drug replacement therapies, such as methadone, are illegal in Russia, although a few new models of cognitive therapy which expand the breadth of substance abuse programs and rehabilitation are being implemented in treatment centers in St. Petersburg and Orenburg. A new medication-assisted therapy study, supported by USAID and the Russian government, is expected soon concerning the use of Naltrexone. In addition, the Russian Orthodox Church has established approximately 40 faith-based rehabilitation centers."

(Arrest Risk for Casual Use) "This was a couple of years after Russia had toughened its drug laws, lowering the minimum punishable dose to such a level that virtually any user could land behind bars. By 2004, the Justice Ministry estimated that 300,000 people were serving drug-related sentences in Russian prisons.
"That year the government -- responding in part to pressure from the Justice Ministry, which was fighting prison overpopulation -- raised the minimum punishable doses of illegal drugs, essentially ensuring that users who had no intent to sell would not be arrested. The police were incensed, arguing that some dealers took to carrying amounts just below the punishable level -- but still sufficient to satisfy between one and nine users. In other words, the police complained, they were being prevented from arresting users and small-time dealers and forced to focus on real drug dealers, whom they didn't want to touch with a 10-foot pole.
"The more-liberal policy lasted less than two years. The minimum punishable dose has been lowered again -- in most cases, by more than 50 percent. The dose is not quite as low as pre-2004 levels, but still low enough to put even casual users at risk."

(Value of Heroin Trade) "It is important to note that profits made from trafficking Afghan opiates into Central Asia (USD 344 million) in 2010 are dwarfed by the net profit pocketed by criminals trafficking onwards to the Russian Federation, which was around US$ 1.4 billion in 2010. This calculation does not include other drugs such as those of the cannabis group, which are also trafficked through the region.
"The mark-up on heroin brought into Central Asia and sold in the Russian Federation is as much as 600 per cent. As shown in the figure below, as prices increase purity decreases; this is explained by the growing distance from the source and by the practise of cutting the heroin with adulterants. This means that 1 kg of heroin at 70 per cent purity can become 2 kg at 35 per cent purity. This inversely proportional relationship between price increase and decrease in quality translates into greater profits for traffickers."

Laws & Policies

"In June 2012, the government launched the “State Counternarcotics Strategy until 2020” that calls all agencies and all levels of government to join in the fight against illicit drugs. The Strategy urges improvements in supply and demand reduction, and outlines new legislation aimed at deterring drug trafficking. An important development in implementing the Strategy in 2012 was the signing in March by then-President Medvedev of a law stipulating life sentences for trafficking large quantities of drugs. Previously, the maximum sentence was 20 years. The law also allows for the confiscation of property and money obtained by drug dealing."

(Deficiencies in Demand Reduction and Treatment Services) "The Russian government addresses demand reduction and drug abuse prevention in the State Counternarcotics Strategy. The Strategy outlines ongoing deficiencies in the demand reduction system, including insufficient medical treatment and social rehabilitation services, a shortage of specialized workers (doctors and social workers) and a shortage of centers serving drug abusers. At present, there exist only four state-run and 70 non-governmental organization (NGO) centers for rehabilitation of drug addicts. The few government-supported drug addiction treatment programs that do exist are generally ineffective, with high rates of recidivism. Most drug replacement therapies, such as methadone, are illegal in Russia, although treatment centers in St. Petersburg and Orenburg are implementing a few new models of cognitive therapy which expand the breadth of substance abuse programs and rehabilitation. A new medication-assisted therapy study on Naltrexone abuse, supported by the United States and Russian governments, is ready for publication. The Russian Orthodox Church continues to operate approximately 40 faith-based rehabilitation centers."

(Russian Federal Drug Law Enforcement Agencies) "Four federal agencies in Russia conduct investigations of drug trafficking: FSKN, the Ministry of Internal Affairs (MVD), the Federal Security Service (FSB) and the Federal Customs Service (FTS). The FSKN is the primary drug enforcement agency and has an authorized staffing level of 40,000 employees, with branch offices in every region of Russia."

(Law Enforcement and National Drug Policy) "The drug enforcement agencies are supported in their functions by strong drug control laws and high-level Governmental attention. While recent years have seen some increase in the resources devoted to the prevention of drug abuse and to the care for drug users, the major emphasis in the Government's policy is clearly targeted on addressing the problem of drug trafficking and production.
"Some outside observers believe that this heavy emphasis on law enforcement sometimes hampers efforts to address the problems of drug abuse, particularly among the youth. For one thing, there is some evidence that many drug users are sent to prison for drug trafficking, although they are arrested with small quantities of drugs in their possession. Since 1997, with the introduction of a new Criminal Code, the possession of a "small amount of narcotics" is not considered a criminal offence, but an administrative infraction. However, the definitions of what constitutes a "small amount" of the various drugs are established at extremely low levels. In the case of heroin, there is no quantity that can be considered a "small amount" and, thus, the possession of any quantity of that drug can be prosecuted as drug trafficking. This phenomenon, coupled with the fact that there are no juvenile courts in Russia, has resulted in the incarceration of many young drug users in adult prisons where there are few, if any, drug treatment programmes, and where they may be exposed to risks of violence, and of infection with tuberculosis and HIV/AIDS."

(Russian Juvenile Justice System) "The system of penalties for juveniles facing criminal charges in Russia is based on suspended sentences or detention in educational correctional facilities, which house young offenders aged up to 21 years. The average sentence is four years. Only one quarter of adult recidivists considered a high-risk to society are said to have been admitted to a VK [educational correctional facilities] as juveniles."

(Opioid Substitution Treatment Illegal in Russia) "Substitution (or replacement) therapy such as methadone maintenance therapy, which has been widely credited with controlling HIV transmission among injection drug users in many countries, is illegal in Russia, and the 2003 amendments to the drug law did not change this. Methadone is classified as "illicit" by the terms of the three United Nations conventions on drug control, though most countries that are signatories to the conventions have methadone programs that are successful in substituting injected heroin with noninjected methadone. In this case, neither the SDCC [State Drug Control Committee] nor the Ministry of Health seems necessarily disposed to review the status quo. Dr. Golyusov of the Ministry of Health said that he is concerned by first-hand accounts from drug users that methadone is more addictive or "harder to get off" than heroin and that other countries' experiences have been "contradictory.""

(Russian Anti-Trafficking Legislation) "Russia has a legislative and financial monitoring structure that facilitates the tracking, seizure, and forfeiture of all criminal proceeds. Russian legislation provides for investigative techniques such as wiretapping, search, seizure and the compulsory production of documents. Legislation passed in 2004, entitled: "On Protection of Victims, Witnesses and Other Participants in Criminal Proceedings" extends legal protection to all parties involved in a criminal trial. Prosecutors or investigators may recommend that a judge implement witness protection measures if they learn of a threat to the life or property of a participant in a trial."

(Harm Reduction in Prisons) "Because of drug laws that have historically criminalized the possession of very small amounts of narcotics, drug users in Russia face a high probability of spending time in prison or pretrial detention at some time in their lives. Injection drug use is widespread in prisons. But basic HIV prevention measures, including condoms and materials for sterilization of syringes, are largely lacking in Russian correctional facilities, making prisons across the country high-risk environments for AIDS. The vast numbers of prisoners released every year thus represent a public health challenge for the general population. Both in and outside of prison, the virtual absence of humane services to treat drug addiction and the illegality in Russia of methadone and other drugs used elsewhere to treat heroin addiction further compromise HIV prevention among drug users."

(Human Rights, Public Health, and Syringe Access) "State action that impedes people from protecting themselves from a deadly epidemic is blatant interference with the right of Russians to the highest obtainable standard of health. There is no dispute as to the effectiveness of sterile syringes for preventing HIV, hepatitis C and other blood-borne infections. Public health experts are virtually unanimous in the view that providing access to sterile syringes neither encourages drug use nor dissuades drug users from entering drug treatment programs. In reality, the near absence of humane treatment programs for drug addiction in Russia and the very nature of drug use guarantee that there will always be people who either cannot or will not stop using drugs. Impeding this population from obtaining or using sterile syringes amounts to prescribing death as a punishment for illicit drug use."

(Funding Shortfalls Hamper Treatment Assistance for Drug Users) "While provisions of the Federal Drug law guarantee state assistance to drug addicts, in fact, budgetary restraints have severely limited the capacity of state institutions to provide even a minimum level of support for drug users. Although the state drug-treatment centres are under the guidance of the Ministry of Health, they are, in fact, financed by the various administrative entities of the Federation. Since most of the oblasts and republics have severe financial restraints, in most cases, the drug-treatment centres have not been able to cope with the sudden expansion in the number of drug users requiring assistance. They lack the financial, material and staff resources to carry out the tasks, which are assigned to them by law. There are a few private treatment centres in some of the major cities, but only the wealthy can make use of their facilities. This general lack of treatment and rehabilitation facilities and activities for drug users are some of the reasons why the country has been facing extreme difficulties in attempting to address the very serious problem of HIV/AIDS infection among injecting drug users."

Research on HIV and IDU in Russia

(Police Harassment and IDU) "Researchers have found that police harassment is one of the most important factors that exacerbate risky behavior among drug users in Russia. In a 2002 study of drug use in five Russian cities, 44 percent of drug users said they had been stopped by the police in the month prior to being interviewed, and two third of these said that their injecting equipment had been confiscated by the police. Over 40 percent added that they rarely carried syringes for fear of encountering the police with them. In the Togliatti study, Rhodes and colleagues found that fear of being arrested or detained by the police was the most important factor behind the decision of drug users not to carry syringes, which in turn was an important determinant of sharing syringes during injection. This study concluded that drug users who had been arrested or detained by the police for drug-related offenses were over four times more likely than other users to have shared syringes in the previous four weeks. Drug users who feared the police in Togliatti tended to avoid not only syringe exchange services but also drug stores that sold syringes because police frequently targeted people buying syringes at such locations, a result also highlighted in a 2003 study of drug users in Moscow."

(Street-Level Policing and High Risk Drug Using Behavior) "Street-level policing practices in Russia have been found to fuel a pervasive sense of risk, and fear of arrest, fine or detainment, among IDUs, which in turn is linked to their reluctance to carry needles and syringes, thereby increasing the chances of high risk syringe sharing at the point of drug sale (Rhodes et al., 2003). Police agencies themselves emphasise a rationale of intense surveillance of drug users, enforced through a combination of extremely restrictive criminal articles on possession and the use of administrative codes unrelated to drug use (Rhodes et al., 2003, 2006). Moreover, civil society responses to HIV prevention, treatment and care for IDUs remain weak, as does public health policy and infrastructure, which depends heavily upon international donation (Sarang et al., 2007; Wolfe, 2007). Officials and health professionals give very weak endorsement to concepts such as ‘harm reduction’, which are still characterised by some as a corrupting influence of the West, and instead defer to normative social constructions of drugs users as unproductive, dangerous, and criminal (Tkathchenko-Schmidt et al., 2008; Elovich and Drucker, 2008; Wolfe, 2007)."

(Policing Practices Violate Health and Rights) "In the three Russian cities participating in this study, we found policing practices targeting injecting drug users (IDUs) to violate health, as well as individual rights. The brutality of police practices violate health directly, but also indirectly through the reproduction of day-to-day social suffering, which in turn can be internalized as self-blame, lack of self-worth, and fatalism regarding risk. These findings illustrate how law enforcement practices, particularly extrajudicial practices, generate an atmosphere of fear and terror, which shapes everyday practices of risk avoidance and survival among IDUs. Policing practices contribute to the reproduction and experience of stigma, and linked to this, a sense of fatalistic acceptance of risk, which may become crucial in shaping health behaviour, including HIV prevention. Yet we also identify nonconforming cases of resistance to such oppression, characterised by strategies to preserve dignity and hope. This leads us to consider how hope for change provides an important resource of risk reduction as well as escape, if only temporarily, from the pervasiveness of social suffering."

(HIV and IDUs in Russia and Central Asia) "In terms of absolute numbers, the Russian Federation is particularly affected with its 1.5 million addict population. The hugely damaging threat of HIV/AIDS is directly related to heroin injection. To date, there are over a quarter of a million registered HIV cases (although the number of unregistered cases is estimated to be much higher than this) in the Russian Federation. Of these, over 80% are intravenous drug users. In the CARs, nearly 15 years of continuous heroin transit has created a local market of 282,000 heroin users, consuming approximately 11 mt of heroin annually. Local opium consumption is estimated at approximately 34 mt (although demand in Turkmenistan may be underestimated). This puts some Central Asian states on par with countries with the highest global opiate abuse prevalence."

(Russian Federation Policy Toward HIV and IDU) "The Russian Federation is facing a deadly epidemic of acquired immune deficiency syndrome (AIDS). It is driven in part by abuses of the human rights of those most at risk to get the disease and of the over 1 million Russians already living with the human immunodeficiency virus (HIV). The principal means of HIV transmission in Russia has been and remains injection drug use. But the Russian state has done little to support low-cost measures that would enable drug users to realize their right to be protected from this incurable disease. Instead, Russia has been a model of repression of drug users and stigmatization of HIV-positive people, putting the country squarely on the path of very high AIDS mortality and continued abuse of people affected by HIV/AIDS."

(Prevalence of IDUs and HIV/AIDS) "There is some controversy over the number of narcotic drug users in Russia. Dr. Vadim Pokrovsky of the Federal AIDS Center said that estimates of the number of active drug users in Russia in February 2004 ranged from 1 to 4 million, and he believed the high end of that range reflected the reality. On February 20, 2004, Alexander Mikhailov, the deputy director of the State Drug Control Committee (SDCC), a federal body, was cited in Pravda as saying that Russia had over 4 million drug users, and that the "gloomy prediction" of his office was that Russia could have over 35 million drug users by 2014. In early January 2004, the executive secretary of the Commonwealth of Independent States, which includes twelve former Soviet states, predicted that in 2010 the twelve countries would have 25 million drug users of whom 10 million would be living with HIV/AIDS, the vast majority in Russia."

(HIV Transmission and IDUs) "In 2002, an estimated 93 percent of persons registered by the government as HIV positive since the beginning of the epidemic were injection drug users. In contrast, in 2002 an estimated 12 percent of new HIV transmission was sexual -- that figure climbed to 17.5 percent in the first half of 2003 -- indicating the foothold that the epidemic is gaining in the general population. The European Centre for the Epidemiological Monitoring of AIDS (EuroHIV), a center affiliated with the World Health Organization, noted that HIV prevalence may have 'reached saturation levels in at least some of the currently affected drug user populations' in eastern Europe, including in Russia, but cautioned against complacency 'as new outbreaks could still emerge among injection drug users…, particularly within the vast expanse of the Russian Federation.' Rhodes and colleagues in a February 2004 article echo this conclusion, noting evidence of recent examples of severe HIV outbreaks among drug users in Russia."

(HIV Prevalence in Prisons) "Being in prison or other state detention is an important risk factor for HIV in Russia. A very high percentage of drug users in the FSU [former Soviet Union] find themselves in state custody at some time in their lives. Injection drug use is reportedly widespread in Russian prisons, and HIV prevention services such as provision of sterile syringes, disinfectant materials for syringes and condoms are virtually absent. Official statistics indicate that from 1996 to 2003, HIV prevalence in Russian prisons rose more than thirty-fold from less than one per 1,000 inmates to 42.1 per 1,000 inmates. According to a 2002 report, about 34,000 HIV-positive persons—over 15 percent of the persons officially counted as HIV-positive in the country—were in state custody, of which the large majority found out about their HIV status in prison. The Kresty pretrial detention facility in Saint Petersburg was reported in 2002 to have about 1,000 HIV-positive persons among its 7,800 inmates. Some 300,000 prisoners are released each year from penal institutions in Russia, representing an important public health challenge."