People who inject drugs—risk environment

People who inject drugs—risk environment

Sarang and colleagues undertook qualitative interviews with 209 persons who inject drugs (primarily heroin) in three Russian cities: Moscow, Barnaul, and Volgograd. They explored the accounts of persons who inject drugs about HIV and health risk. Policing practices and how these violate health and self, emerged as a primary theme. Findings show that policing practices violate health and rights directly, but also indirectly, through the reproduction of social suffering. Extrajudicial policing practices produce fear and terror in the day-to-day lives of drug injectors, and ranged from the mundane (arrest without legal justification; the planting of evidence to expedite arrest or detainment; and the extortion of money or drugs for police gain) to the extreme (physical violence as a means of facilitating "confession" and as an act of "moral" punishment without legal cause or rationale; the use of methods of "torture"; and rape). They identify the concept of police bespredel-living with the sense that there are "no limits" to police power-as a key to perpetuating fear and terror, internalized stigma, and a sense of fatalist risk acceptance. Police besprediel is analyzed as a form of structural violence, contributing to "oppression illness." Yet, the authors also identify cases of resistance to such oppression, characterized by strategies to preserve dignity and hope. They identify hope for change as a resource of risk reduction as well as escape, if only temporarily, from the pervasiveness of social suffering. Future drug use(r)-related policies, and the state responses they sponsor, should set out to promote public health while protecting human rights, hope, and dignity.

Reading this article you will learn more than you may have wanted to know about policing practices in these three Russian cities and, in particular, about police bespredel, no limits or restrictions on police power. Being a drug user is not against the law in Russia, while possession and transport are, so planting evidence creates opportunities for arrests. Formal arrest quotas encourage this behaviour and ‘police taxes’, routine extortion of small amounts of money, provide police officers with supplemental income. Coerced provision of sexual services without payment to police is referred to as subbotnik, a term used for semi-volunteer work without payment on non-working days for the benefit of the State. The impact of the policing risk environment described here on HIV risk is both direct (unsafe needle-syringe practices and sex) and indirect through the loss of hope, dignity, self-esteem, and any sense of agency. To learn more about what should be done to address the risk environment and decriminalise drug users, read The Vienna Declaration http://www.viennadeclaration.com/. More than 15,000 scientists and others have signed on so far to its call for evidence-informed, human-rights-based drug policies.