2. Heroin, health and HIV: An international development perspective 4 th March 2011 www.abdn.ac.uk/sustainable-international-development

3. Overview Why an international development perspective? – From Aberdeen to Afghanistan – Failed reconstruction & over-reliance on cash crops – Governance, poverty & youth unemployment – Health consequences – HIV

4. Photo MST programme King Street

5. Injecting drugs in Aberdeen AreaEstimated numberEstimated prevalence Aberdeen shire6830.43% Aberdeen2,2461.56% Mainland Scotland23,9330.71% 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

6. Britain – Afghanistan links 1 st March 2011 David Cameron and Hamid Karzai held talks on Afghanistan's future

7. 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

8. 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.

9. Opium plantation

10. Opium pod, powdered heroin, heroin block

11. Injecting drugs inside the ruined cultural palace, Kabul

12. Inside the morgue, Kabul – injecting drug user who had overdosed

13. Bags of heroin – ready to export

15. Governance and crime Drug trafficking linked with people trafficking and sex trafficking Porous borders Increasing inequalities and poverty

16. Youth Youth unemployment about 20% for CEE/CIS...boredom Adolescence...experimentation

17. Displaced male youth in Georgia – bored and unemployed

18. Evidence of Common Roots* Risk & Protective factors for adolescents Early SexSubstance Use Depression A positive relationship with parents A positive relationship with adults in the community Engaging in other risky behaviours Conflict in the family A positive school environment Friends who are negative role models Having spiritual beliefs *”Broadening the Horizon” Evidence from 52 countries Protective factor Risk factor

19. Numbers of injecting drug users

20. % of IDUs per population

21. 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

22. 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

23. HIV due to injecting drugs

25. 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

26. The Problem: Use / injecting of heroin driving HIV epidemic The Intervention: Program targeting pre-injectors to reduce transition to heroin use / injecting

27. Not only HIV... Hepatitis Drug dependency in children Linkages between sexual and injecting drug transmission Problems with rehabilitation

28. 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

29. MDG 6 – Halt and reverse the spread of HIV

30. Conclusion Need to invest in economic, social and environmental development i.e. sustainable international development