CT: How much sympathy is there among the general population in Russia for those who are HIV positive, particularly where they have been infected through drug addiction? Are you aware of any cynicism, that says 'they only have themselves to blame'?

Kostya: There is no sympathy for drug users in Russia (he laughs when I ask him the question) because drug addiction can lead people to a life of crime. As for people living with HIV, the Russian culture is highly superstitious, so there is a lot of fear about the unknown, and HIV has been one of these unknowns. Its still is for some people. The attitude towards people living with HIV is changing, because there is more public awareness now, including from the Government. So the situation for people living with HIV is improving.

As for whether people think drug addicts only have themselves to blame, absolutely, yes people do think that. Even among health care workers and doctors. I have heard this many times, even at the AIDS centres (specialist clinics for people affected by HIV and AIDS).


CT: What do you think is driving people to drug addiction in Russia?

Kostya: The reasons are many, but I think for most people who come to our rehab centre, it started with curiosity. They met people who had already tried drugs and they wanted to fit in. For a lot of girls, they are introduced by their boyfriends. Unfortunately, heroin is readily available today because of the drug trafficking route from Afghanistan. Even in prison.

CT: Are drug users who share needles and syringes aware of the risk they expose themselves to? How much is there in the way of support to help drug users look after themselves and kick the habit?

Kostya: Yes, they largely know the risks. When you an addict you are largely negligent about your health, despite knowing the risks. All you care about is finding the next hit. More rehab services are definitely needed. There are an estimated 800 rehab centres run by Christian organisations in Russia, ranging from treating 10 people to 150 people. The Salvation Centre see about 80 people at a time.

According to the Russian Government there are only three government run rehab centres in the whole of Russia. The Government estimates that there are 500,000 drug users in Russia. But unofficial estimates place it between three and six million out of a population of 140 million.

Galia: Because of the massive gap in care for addicts in Russia, former addicts, like Kostya, are plugging a gap. But right across the country, this work needs to be scaled up, both in terms of quantity and quality. Kostya’s centre, The Salvation Centre, has been very proactive with the local authorities to standardise the level of care in rehab centres and are one of the first centres to be assessed.

CT: Can you describe the reality for a drug addict who is also HIV positive in Russia. In what way does being HIV positive add to the difficulties of someone who is drug addicted in Russia?

Kostya: For those living with HIV and addiction, if you find out about your HIV status and you want to receive ARVs, you have to go to the local AIDS centre, who will ask how you have contracted HIV. When you say it was through drug use, it goes down on your medical records – both that you are positive and that you contracted it by using drugs. You have to show these medical records to many people in Russia. For example, if you want to get a drivers license or a job. So everyone knows your status and your past life. Some officials overlook this if you give them a bribe. Others turn you away.

(Kostya is not HIV positive but spoke a little of his experience whilst on drugs) When I think back to my time on drugs, I think about it as life in hell. Drugs were my lifeline because I couldn’t eat, sleep or even use the toilet if I didn’t inject. In the beginning there was the feeling of euphoria, the high. I thought I could control it. But there is no single drug user who can control the drug. [I think there are evil spirits in drug use. It’s a spiritual warfare that you can’t control on your own.] So the drug finally gained complete control over me.

The worst part is that a person under the influence can do things that he would never otherwise do. He steals because he needs money, he lies to his family and friends. That’s what the drugs do. Its scary. You face that every day. In the morning your first thought is where do I get the first dose? During the daytime you look for a fix, you inject in the evening and then you fall asleep and you also prepare a dose for the morning. That’s what my life was like. I am so happy I am alive now and I free.

CT: The Russian government is taking a hard line by criminalising drug addiction. What is the alternative?

Galia: Drug addiction is not a crime, it’s a disease. The addiction breeds crime. So if you treat the addiction to drugs, you are treating the cause of the crime. The scientific community clearly advise that needle and syringe programmes and substitution therapy (such as methadone) – which are proven and cost effective - will lower HIV rates without increasing drug use.

Kostya: If you lessen the criminalisation surrounding addicts then more people will come forward for help and support for their addiction. And then we can help them find out their HIV status and if positive, get access to the treatment and support that’s needed.

CT: What do you see the role of the church being in terms of supporting HIV sufferers and drug addicts, and influencing the position of the Russian government?

Kostya: In the beginning, when society denied addicts existed in Russia, the church welcomed them, helped them overcome their addiction. I am living proof that this works. For me, the role of the church is illustrated in the name of our centre, the Salvation Centre, which started over 12 years ago. The role of the church is to reach out to the outcasts of society, to show compassion by helping them. But this is not happening with all churches.