Addicts talk of their rare encounters with methadone users with a sense of wonder and even magic. “All of us know about this drug methadone and all of us want it. People come through who have done it and we can instantly see how much brighter and better they live,” says Tver addict Valera in jittery sentences, high after shooting up twice by midday, in an interview in the back of his tobacco-stained car.

But Moscow won’t be swayed. “The medicine has become more dangerous than the illness. It would be replacing one evil with another,” said the anti-drugs baron Ivanov. “And why on earth would we do that?” Gennady Onischenko, the country’s top doctor, repeatedly dismisses methadone as “still a narcotic”.

In a major government anti-drug strategy launched last June, there was no mention of substitution therapy, even though Moscow says it is now focused on reducing the demand for drugs. That means that Russia’s measly four federal and 77 regional rehabilitation centers will continue to treat addicts with psychotherapy, counseling or simple painkillers.

CHAINED TO BED FRAMES

The vacuum created by the lack of effective substitution therapies was highlighted in an incident last October in the Ural Mountains town of Nizhny Tagil. Anti-drugs activist Yegor Bychkov, 23, was sentenced to three and a half years in prison for kidnapping drug addicts. Bychkov said he had received permission from the addicts’ parents to forcibly take their sons and chain them to steel bed frames while they underwent a painful detox.

Anti-drugs chief Ivanov praised Bychkov, saying he had acted in good will; the head of the parliamentary health committee Olga Borzova said the state was to blame for his arrest as he had become desperate.

The Russian Orthodox Church also weighed in. Though its official stance is against sex education and it regards heroin use as a sin, it has set up its own rehabilitation centers which offer religious guidance. The Church also holds regular discussions with the UN over the HIV/AIDS crisis.

Unfortunately, those sorts of initiatives may be risky. Almost two years ago, the General Prosecutor’s Office was ordered by Russia’s Security Council to beef up prosecutorial measures against non-governmental organizations which advocate substitution therapy. Since then, activists distributing free needles have been detained on charges of aiding illegal drug use.

“Russian government officials consistently promote falsehoods about harm reduction, and deter those who speak in favor of them,” the IHRA’s Rick Lines says. “Speaking honestly about the vast body of evidence supporting the effectiveness of methadone is a dangerous thing to do (in Russia).”

That may be why relations between the UN’s Global Fund to Fight AIDS, Tuberculosis and Malaria - which has been pushing for methadone legalization - and Russia’s health ministry ruptured at the end of last year. The Global Fund provides the most finance for HIV/AIDS prevention in Russia and granted $351 million to Russia for 2004-11. Now $16 million of that allocation remains, and is at risk of being cut this year.

Worse, say global health experts and local NGOs, is the health ministry’s decision to scrap the Global Fund’s needle distribution, HIV awareness and medication programs. “They proved ineffective and we shall not continue them after 2011,” said Alexander Vlasov, the ministry’s spokesman.

In October, the health ministry directly accused the Global Fund of making the HIV epidemic worse. “In the regions where these (Global Fund needle) programs were operating, the spread of HIV infection increased three-fold,” minister Tatyana Golikova told a narcology conference.

The Fund says it is keeping up a dialogue with the Health Ministry. But global health experts warn that the decision to end the Global Fund’s work in Russia will be catastrophic. “Russia will fall behind and lose the achievements made so far,” warned IAS president Katabira. “We will not be able to recover the situation.”

(Additional reporting by Ee Lyn Tan in Beijing, Maria Stromova in Moscow and Roman Kozhevnikov in Dushanbe; editing by Simon Robinson and Sara Ledwith)

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By Amie Ferris-Rotman

TVER, RUSSIA