Heroin, health and HIV: An international
development perspective
4th March 2011
www.abdn.ac.uk/sustainable-international-development
Overview
• Why an international development
perspective?
– From Aberdeen to Afghanistan
– Failed reconstruction & over-reliance on
cash crops
– Governance, poverty & youth
unemployment
– Health consequences
– HIV
• Photo MST programme King Street
Injecting drugs in Aberdeen
Area
Estimated number
Estimated prevalence
Aberdeen shire
683
0.43%
Aberdeen
2,246
1.56%
Mainland Scotland
23,933
0.71%
• Aberdeen city has the second highest rate of injecting
drug use in Scotland
• 27 drug related deaths were recorded in Aberdeen city in
2008 – cause of most deaths were heroin/morphine,
benzodiazepine and alcohol
Britain – Afghanistan links
1st March 2011 David Cameron and Hamid Karzai held talks on Afghanistan's future
Big changes to Britain's
foreign aid programme
• Funds cut to 16 countries
•
Angola, Bosnia i Herzegovina, Cambodia,
•
Kosovo, Vietnam no more UK aid
•
Aid to Russia and China cut by millions £ pa
Freezing funding for India
Afghanistan, Somalia, Zimbabwe
2001 Fall of the Taliban
• Aid pledges made not fully met
• Result – re-introduction of opium poppy
plantations
• Drug production in Afghanistan increased
almost tenfold since the U.S.-led invasion
toppled the Taliban in 2001.
Opium plantation
Opium pod, powdered heroin, heroin block
Injecting drugs inside the ruined cultural palace, Kabul
Inside the morgue, Kabul – injecting drug user who had overdosed
Bags of heroin – ready to export
Governance and crime
• Drug trafficking linked with people
trafficking and sex trafficking
• Porous borders
• Increasing inequalities and poverty
Youth
• Youth unemployment about 20% for
CEE/CIS...boredom
• Adolescence
...experimentation
Displaced male youth in Georgia – bored and unemployed
Evidence of Common Roots*
Risk & Protective factors for
adolescents
Early Sex
Substance
Use
Depression
A positive relationship with parents
Conflict in the family
A positive school environment
Friends who are negative role models
A positive relationship with adults in the
community
Having spiritual beliefs
Engaging in other risky behaviours
*”Broadening the Horizon” Evidence from 52 countries
Protective
factor
Risk factor
Numbers of injecting drug users
2,000,000
1,800,000
1,600,000
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
Russia
Ukraine
Georgia
No. of IDUs estimated
Kazakhstan
No of IDUs registered
Kyrgystan
Tajikistan
% of IDUs per population
% of IDUs per population
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
Russia
Ukraine
Georgia
Kazakhstan
% of IDUs per population
Kyrgystan
Tajikistan
Russia
• At least 30,000 people die in Russia every year
from heroin, 90% of it smuggled in from
Afghanistan.
• Russia and the European Union are working
hard to develop a 5 year plan to tackle the
Afghan drug trade.
• Viktor Ivanov Director of Russia's Federal Service for
the Control of Narcotics 21/02/2011
HIV
• HIV epidemic is disproportionately affecting
Eastern Europe
• About 80 percent of the more than 100,000
new HIV infections were reported in Europe
in 2008
• Ukraine the fastest growing HIV epidemic in
the world
HIV due to injecting drugs
% of cumulative HIV cases caused by IDU
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Russia
Ukraine
Georgia
Kazakhstan
% of cumulative HIV cases caused by IDU
Kyrgystan
Tajikistan
Adult HIV Prevalence among IDU
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Russia
Ukraine
Russia
Georgia
Ukraine
Georgia
Kazakhstan
Kazakhstan
Kyrgystan
Kyrgystan
Tajikistan
Tajikistan
Age of first injecting decreasing
• In Kazakhstan, 54% of IDUs under age 25.
• Adolescent IDUs (< 19 years): St. Petersburg,
Russia, almost 1/3 IDUs, Ukraine, 20% &
Armenia 13%.
• Young IDUs first injecting:
– Albania the median age of first injection 16 years
– Romania 76%
& 67%
started injecting
before age 18
– Ukraine average age of first injection 14.4 years
– Serbia 20% of all IDUs started injecting before 18
The Problem:
The Intervention:
Use / injecting of heroin driving HIV
epidemic
Program targeting pre-injectors to
reduce transition to heroin use /
injecting
Not only HIV...
• Hepatitis
• Drug dependency in children
• Linkages between sexual and injecting drug
transmission
• Problems with rehabilitation
Conclusion
• Lack of support for international
development has devastating
consequences not only for the
country concerned, but for a wide
range of other countries and cities
close to home.
• Failure to meet MDG 6 to reduce HIV
infection
MDG 6 – Halt and reverse the
spread of HIV
Conclusion
• Need to invest in economic, social
and environmental development
i.e. sustainable international
development