Harm Reduction in Georgia

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The Price of Zero
Drug Policies in Former Soviet Republics, Like Georgia, Are Spiking HIV and HCV Rates
by Larry Buhl
georgia

Georgia is facing the same problem as other Soviet republics: a surging rate of HIV and hepatitis C (HCV). Harm reduction advocates and NGOs have concluded that these surges have been exacerbated by government policies on illegal narcotics.

Russia, Georgia, and the Ukraine have very strict drug laws that mandate prosecution and punishment of users, instead of treatment or prevention. But Georgia has been particularly fierce in criminalizing drug use and “hunting” IV drug users.

To make matters worse, a lack of emphasis on treatment and education means people are unreachable by HIV prevention/harm reduction programs, according to Maka Gogia, Program Director for the Georgian Harm Reduction Network (GHRN), a group of non-governmental organizations that advocate the use of public-health policies to reduce drug abuse. “What contributes to the rise in blood-borne infections like hep C and HIV are harsh drug laws combined with the lack of free treatment programs,” Gogia tells A&U.

The GHRN estimates 45,000 drug addicts in the country. But there is only one detoxification center for all of them—a one-month free program located in the capital, Tbilisi, that can accept only two dozen people at a time. A methadone-substitution therapy program can accommodate 1,300 patients in eight towns across the nation. Beyond that, nothing.

“When you want to register for a treatment program, you must stay on a waiting list until someone leaves the program,” Gogia tells A&U. “During that time the police have a record of you being on that wait list, and that causes people to not sign up.”

While the government of Georgia has little money to invest in drug treatment and education, it is reaping a small fortune from cracking down on users. First-time offenders who use a narcotic without a doctor’s prescription can face a fine of 500 lari (US$280). That’s nearly half of the average per-capita monthly income in Georgia. On the second offense within the same year, the fine is 2,000 lari, (US$1,125) or one year in jail.

In 2007, the latest year for which data is available, drug fines brought in 30 million lari ($16.9 million) to the government of Georgia, according to a report by the Beckley Foundation Drug Policy Programme, a United Kingdom-based research center.

The crackdown started in 2006 when a “zero tolerance” policy on drug use was introduced by former President Mikheil Saakashvili. That policy shifted prosecution from drug traffickers to users, and no distinction is made between possession of drugs for personal use and for trafficking.

Proponents of Georgia’s zero-tolerance drug policy point to the drastic reduction in imports of heroin and opium. But it hasn’t stopped IV drug use. In fact, Georgia has the fifth highest rate of injecting drug use in the world, just behind Azerbaijan, Seychelles, the Russian Federation, and Estonia, according to the UN World Drug Report 2013.

With heroin and opium in short supply, Georgians who want a quick high are mixing cocktails called Krokodil, using readily available ingredients like gasoline, drain cleaner and cough syrup. Not only is this home brew highly toxic, it has made drugstores the new locus for cops to crack down on users.

“Very often you will see police standing outside the drug store looking for someone who ‘looks like’ an addict who has purchased these ingredients and shake them down for money,” says Paata Sabelshvili, a programs manager at GHRN. “This is how the government collects money. Drug users are more numerous, so the government will do the plea bargaining agreement with them. The government doesn’t count those users as human beings. It will lock them up, sell their houses and let them die in prison.”

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Anecdotally police also have been known to take otherwise law-abiding people off the streets for random drug testing by urinalysis.

Sabelshvili says these policies drive drug-dependent people underground where they dramatically increase their risk of contracting HIV, HCV and tuberculosis.

“The rate of HIV in Georgia is still low, but it is increasing every year,” Sabelshvili says. “Now we see an increasing rate of HIV in the heterosexual population, and women who contract HIV now are mostly sex partners of injection drug uers. This is because Georgia has the most repressive drug policies in the world.”

Sabelshvili notes that they cannot collect used needles for a needle exchange program as many other countries conduct, because anyone caught with a syringe containing even a trace amount of an illegal substance risks jail time of up to fourteen years and huge fines. “All we can do is needle and syringe distribution,” he says.

A recent report on drug policy in Russia to the UN Committee against torture, by the Andrey Rylkov Foundation for Health and Social Justice in Moscow, underscores links between the harsh drug policies, lack of treatment for IV drug users and the rise in HIV and HCV, not just in Georgia but also in countries throughout the region, including Russia, Estonia, and Ukraine.

“Recent research showed that most (78%) patients with HIV/TB co-infection are drug dependent people,” the report states. In some cities in Russia, up to ninety percent of injecting drug users are infected with hepatitis C, it concludes.

A few in the Georgian government have taken notice of these disturbing trends. In December 2013 an intra-ministerial council chaired by Justice Minister Tsulukiani proposed increased funding for prevention and treatment and public information, and making the use of illegal drugs an administrative, rather than a criminal offense. Last November, at the signing of the EU’s Vilnius agreement on cooperative measures, Georgian Justice Minister Tea Tsulukiani pledged to “reallocate resources from the ineffective prosecution and punishment of drug users to effective prevention and treatment.”

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Until legislation is passed, these recommendations for reform will remain on paper. The nation is scheduled to sign an agreement on closer long-term ties with the European Union on June 27. That signing is considered to be a big step toward eventual membership, but the EU has been silent on Georgia’s drug policies, and there is no telling when or if the nation will be invited to join the union.

For now, activists, like those in the GHRN, and their regional representatives will continue pushing the government to change, through petitions and protests against the drug policies.

In October of 2013 Gogia and her colleagues created a network of People Who use Drugs in Georgia (called GeNPUD) under the framework of the Global Fund Harm Reduction program. The network has created its statute, internal regulation, strategy, and annual work plans for the long and short term, she says.

“Our goals are first, change the drug laws, second, make the government increase funding for methadone programs, and third, promote the construction of rehab centers.” Gogia points to a large proposed rehab center in Tbilisi that the government has not yet built.

“People need to understand the growing number of people with HIV and hepatitis C here is not just a problem for drug users,” says Gogia. “It is a problem for the public health.”

Journalist and novelist Larry Buhl writes A&U’s monthly Hep Talk column.