The New York Times

October, Monday 16, 2000

BISHKEK JOURNAL

Heroin and Needles: A Post-Soviet Ray of Hope

By DOUGLAS FRANTZ

BISHKEK, Kyrgyzstan, Oct. 15 - Sveta stretched across the couch in the cramped apartment with lace curtains, tilted her head back and slowly massaged her bare neck. With the tenderness of a lover and the expertise of a long-time practitioner, Aleksandr located the vein, slipped the needle into her neck and sent the heroin on its way.

The drug turned Sveta's eyes bright and her slightly crooked smile was pretty. Aleksandr took her place on the couch, tugging his right sleeve up to expose his under arm. Sveta thumped hard on his skin, found a reluctant vein and injected the heroin. A third person, Yuri, sat in a chair, silent and staring, transported to his own world by the drug they had just mixed in a small pink plastic bowl.

Pulling back a curtain, Sveta dropped the needles and syringes into two separate plastic containers. In a few days, they would be taken to a clinic and traded for new ones, courtesy of a groundbreaking - and possibly lifesaving - needle exchange program in the capital of this small, remote country.

Bishkek, capital of Kyrgyzstan, seems an unlikely spot for heroin addicts, let alone something as reformist as a needle exchange. This country of 4.5 million is largely mountainous, and through decades of Soviet domination retained many of its nomadic traditions and tightly knit communities.

But heroin addiction has arrived all across Central Asia, the sad if predictable byproduct of the transformation - after the end of more rigid Communist control - of the ancient Great Silk Road into a major conduit for drug traffickers. United Nations experts estimate that 80 percent of Europe's heroin originates in Afghanistan and Pakistan. The principal route to market winds through the mountains and steppes of three former Soviet republics, Kazakhstan, Kyrgyzstan and Tajikistan.

The influx of drug trafficking has strained the limited resources of the police, increased corruption and helped finance Islamic militants trying to destabilize the region. The new availability of heroin also expanded the number of addicts.

Heroin is cheap, plentiful and powerful. An average dose, about a tenth of a gram, costs $2 in Bishkek, half that in Osh, the major city in southern Kyrgyzstan where the supply is greater, and 50 cents in Tajikistan. In those poor Soviet republics, where average income rarely tops $600 a year, it has replaced its weaker cousin, opium, as the drug of choice. And it is far more addictive.

"Five years ago, we didn't see heroin," said Col. Zhanybek S. Bakiyev, the top drug enforcement officer with the Kyrgyzstan Ministry of Internal Affairs. "Now we are concerned that our people consume heroin in greater quantities."

The number of intravenous drug users in Kyrgyzstan has increased fourfold in the last decade. Yet police and drug experts believe that the number is still small enough to avoid an epidemic. Tough enforcement is one means. But the police are also supporting an attempt to reduce the harm to addicts through needle-exchange programs.

"This is the moment when we should act," said Yuri Misnikov, an official with the United Nations Development Program in Bishkek.

The first needle exchanges opened last February in Bishkek and Osh. They are financed by the United Nations program and the Open Society Institute, part of the New York-based Soros Foundation. They were the first needle-exchange programs in Central Asia, though the Soros group has since opened two centers in Kazakhstan and plans one in Tajikistan soon.

The idea is simple and common in Europe and the United States. Addicts swap used needles and syringes for as many new ones as they need, usually five or six a day. Discarding used needles and not sharing them reduces the spread of the AIDS virus and diseases like hepatitis. At the exchanges, the addicts also get free medical care and blood tests.

Estebesova Batma, a psychiatrist who coordinates the program, said she expected 10 or 15 new clients a month when the two exchange offices opened here. Within weeks, more than 500 addicts were taking part and new clients were turned away because the program was running out of needles. About 180 people show up monthly at the Osh center.

The need was demonstrated by a survey of 100 clients in March. Ninety-six said they shared needles and 35 reported using the same syringe more than 20 times. One addict exchanged a syringe that had dangled from his belt on a key chain. Others turned in syringes used so often that the gauge marks had worn off and been replaced with notches to determine how much heroin to load in. One in five used tap water to wash needles and syringes before the next use and half did not know they could be infected by a needle.

The number of drug-related AIDS cases is surprisingly low. When the police announced two weeks ago that a heroin user who had been jailed had tested positive for AIDS, it was the first publicized case of a drug user contracting the disease in Bishkek, a city of about 650,000 residents, though experts say there are several others.

In addition, a study by the United Nations and the Soros Foundation found that between 11 percent and 18 percent of intravenous drug users in Bishkek are infected with H.I.V. and between 32 percent and 49 percent in Osh, where there are fewer education programs.

The news of the first drug-related AIDS case sent a chill through the drug-addict population. Two dozen friends of the jailed addict showed up the next day at Dr. Batma's two offices, asking for blood tests.

Among them were Sveta, Aleksandr and Yuri. All three are longtime drug users who switched from opium to heroin within the last three years. They agreed to be interviewed and photographed in Aleksandr's apartment as long as their last names were not used.

The apartment was on the second floor of a rundown building on the outskirts of Bishkek. Inside the paint was peeling and plumbing was exposed, but Aleksandr's wife, Olga, does not use drugs and tries to keep the place neat and clean for the sake of their two children.

Sveta, 35, said she started using drugs when she was 17. She said she stopped four times while using opium, once for three months. But she cannot stop using heroin.

"We are scared to quit because we know that this withdrawal is waiting for us," she said, gesturing to her friends, too. "I would like to quit. I'm trying to reduce my use."

Aleksandr, who once made a good living as a driver despite his opium habit, has been unable to work since becoming addicted to heroin three years ago. He said he wants desperately to quit and emigrate to Germany with his family to start a new life, but he cannot leave his heroin.

Despite the expressed desires to quit, the apartment crackled with anticipation as drug paraphernalia and a foil-wrapped packet of heroin are pulled out. They mixed the heroin in a plastic cup with boiled water and a powdered antihistamine that enhances the effect, and drew it equally into three syringes.

Aleksandr's 14-year-old daughter lingered in the hallway, ignoring the all-too-common scene. The two bottles into which Sveta deposits the used needles and syringes sat beside a bag filled with 30 or more new replacements.

Back at the clinic, Dr. Batma said exchanging needles is not enough. Heroin cannot be overcome without an extensive rehabilitation program. But there are none in Kyrgyzstan, where half the population lives below the poverty line and the national annual budget is only $300 million.