If the addict values life, then he or she is not very likely to be infected with HIV or hepatitis C, or HCV. If the drug user is mostly a fatalist, however, his or her actions are likely to result in infection sooner or later. In their research, Peter Meylakhs and his colleagues from the National Development and Research Institute (New York, U.S.) and the Centre for Independent Social Research (St. Petersburg, Russia) studied the lives of people who inject drugs in New York. The duration of their drug use ranged from 8 to 15 years.
In the study, interviews were conducted with 35 drug addicts. Twenty-one participants were negative for both HIV and HCV, 11 had HIV but not HCV, and 3 were positive for both viruses. In addition, seven participants were women and 28 men. Almost half (16) were Hispanic, while 17 were White, and 2 were Black, which may be because of the relatively low prevalence of Black injectors who started injecting since the early 1990s in New York City, the authors say. Their paper, ‘Taking Care of Themselves: How Long-term Injection Drug Users Avoid HIV and Hepatitis C,’ was published in the journal Sociology of Health and Illness, which is among the world's top-ten sociological journals.*
The present pilot study on Russian people who inject drugs in St. Petersburg is a continuation of this project. Preliminary results show that in Russia, people who inject drugs are not as worried about getting infected with HIV as their counterparts in the U.S. They are accordingly are less prone to maintain their health.
The lives of drug users are largely dictated by their dependence. ‘But like everyone else, they fall in love, have families, work, and have hobbies,’ Meylakhs notes. It is specifically those users in particular that more or less successfully carry out social roles not connected with drugs (work, family, relationships with close friends) who are most able to avoid HIV or HCV infection. Aside from obtaining and using drugs, they generally have other aspirations that are based on the values from their own lives. ‘…I can still do normal things… So just because I’m using drugs I don’t consider myself to be dead,’ one informant says.
The majority of informants who avoid using shared syringes describe their lives and behaviour in the context of caring about themselves and the people around them. For them, ‘being normal’ in the eyes of others is important.
One characteristic of uninfected drug users is that they follow a financial strategy. They typically can hold a job, and they keep in touch with relatives, sometimes using their financial support. Overall, Meylakhs says, such informants are carrying out the rather difficult task of combining two lives – a normal, social life, or as much ‘normalcy’ as possible under such conditions, and a life connected with drug dependency.
Drug addicts typically go through periods of varying difficulty in their lives. The researcher separates these periods into stable ones and unstable ones stemming from an array of circumstances, including the loss of a loved one, the loss of a source of income, etc. During such periods, drug users sometimes lose control of the situation and regress into the most critical conditions as concerns a higher risk of infection.
But even in the most difficult situations, uninfected drug users are able to maintain their health. ‘I’d rather sniff. I’d be sick as a dog but still not share [a syringe],’ one respondent comments.
Infected drug users typically lose control entirely and are no longer able to worry about themselves. They also find themselves in periods of complete instability more often, during which infection might occur. ‘I’d use anybody’s syringe... Most of the time, yeah… Like I say, I’d wake up sick… And, and I don’t have the energy to go, go get a syringe and then go to the spot and you know, it’s really bad. The sickness and all that stuff,’ another informant says.
The researcher draws attention to the fact that during stable and unstable periods of their lives, drug addicts find primary support in various aspects of life. In stable times, this is family, work, and a relationship. During critical times, most important are institutional resources that ‘pull’ the drug user out of the abyss. This concerns various support programmes for drug addicts such as rehab, detox, and methadone programmes. ‘These programmes are essentially the drug users’ only way of making it through the tough times,’ Meylakhs notes, stressing the importance of institutional support resources.
Drug users in the U.S. and Russia differ considerably in how they view the threat of contracting HIV. Preliminary results from the pilot study ‘Remaining Uninfected in St. Petersburg’ show that finding addicts who are concerned for their health is much harder to do in St. Petersburg than in New York.
The reason for this, Meylakhs says, might be the fact that when Russian drug users were just starting to inject, AIDS was still a mythical illness spreading somewhere in Africa. Conversely, in the U.S., drug users had already seen how their loved ones and friends were perishing from the deadly illness. This is why Russian drug users, unlike their American counterparts, never had a fear of contracting HIV. And even when cases of HIV infection were registered in Russia, there had not been any instances of people dying from AIDS before medicines were introduced that help the immune system fight HIV infection.
‘We are essentially talking about different generations who encountered HIV at different stages of the epidemic. Equally important is the fact that the range of social roles held by Russian people who inject drugs is notably lower than their American equivalents. The majority of study participants’ lives can be reduced mostly to their drug use,’ Meylakhs adds.
Additionally, unlike in America, Russian drug users are and continue to be in a ‘preventative vacuum’ of sorts. ‘Practically no work has been carried out on the “peer-to-peer” principle, under which more experienced users share advice on how to avoid infection. In fact, there have not been any programmes to lower harm by exchanging dirty syringes for clean ones or offering methadone therapy programmes, which have also been effective at lowering HIV rates among drug addicts,’ Meylakhs notes. To test these hypotheses, more detailed studies need to be carried out, however.
Research results might help save lives and draw attention to HIV prevention among drug users, the researcher adds. A preventative project based on the results of research in New York has already been carried out in America and has proven effective. Given the Russian context, similar programmes might also be applied in Russia, Meylakhs believes.
‘This is not enough, however. In order to reduce the prevalence of HIV among injection drug users, we need to drastically increase the amount of harm reduction programmes. The HIV epidemic, which for now concerns mostly the risk group, has not turned into a “generalised” epidemic that affects everyone. Many experts estimate that Russia is just one step away from this,’ Meylakhs concludes.
*Meylakhs P., Friedman S.R., Mateu-Gelabert P., Sandoval M., Meylakhs N. Taking Care of Themselves: How Long-term Injection Drug Users Avoid HIV and Hepatitis C.