WE CAN FIGHT AIDS, BUT WE MUST DO IT NOW

In response to "The Siberian Side of AIDS," April 29.

Editor,

In addition to the outbreak in Irkutsk - as described in the
aforementioned article - HIV/AIDS has now reached epidemic levels in
many regions of Russia. And the outbreak is fueled almost entirely by
drug use. What can be done?

Providing drug users with clean needles through syringe exchange
programs dramatically decreases the spread of HIV and other
blood-borne illnesses. Offering drug users methadone treatment is also
an effective strategy.

In 1998, the Open Society Institute together with MSF-Holland,
MDM-France and the Health Ministry began a partnership to develop
needle exchange programs. Over 190 participants from more than 60
cities received training, and now there are 29 programs operating
throughout the country.

The programs provide drug users with the necessary tools and
information to reduce drug-related harm. Concerns have been expressed
that these activities increase drug use, but ample research shows
these fears to be unfounded. For many drug users, harm reduction
programs are an important first step toward improved health behavior
and the only way to prevent the spread of HIV.

There is now a small window of opportunity to act before the HIV
epidemic in Russia outpaces the capacity to control it. But the
projects OSI currently help are not enough to halt the region's tide
of HIV infections.

To do so, more national decision-makers, foreign aid agencies, and
non-governmental organizations must provide financial and policy
support for pragmatic harm reduction strategies. The discussions for a
World Bank loan in the area of HIV/AIDS is a crucial beginning, but
dealing effectively with the epidemic requires significant regional,
federal and international commitment.

We have the capability: Needle exchanges and methadone therapy are
effective public health interventions. What we don't have is time.

Nina Schwalbe,
Program Director,
Public Health Program,
Open Society Institute,
Assistance Foundation,
Moscow