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The purpose of this paper is to analyze poor management of tuberculosis (TB) prevention and treatment and explore parameters and causes of this problem drawing on qualitative interviews with former prisoners and medical specialists in Kaliningrad Oblast in Russia.

The authors undertook a qualitative study, to explore access to HIV and TB treatment for people who inject drugs in Kaliningrad. The authors interviewed (outside of prisons) 15 patients and eight health specialists using a semi-structured guide. The authors analyzed the accounts thematically and health consequences of imprisonment emerged as a major theme.

Prisons are overcrowded and lack basic hygiene and infection control. Demand for medical services outstrip supply, HIV and TB prevention lacking, HIV and TB treatment is patchy, with no second-line drugs available for resistant forms. The prison conditions are generally degrading and unhealthy and many respondents perceived surviving prisons as a miracle. Cooperation with medical services in the community is poor.

The authors used qualitative research methods, which do not rely on a representative sample. However, many of the structural barriers preventing effective TB treatment and prevention highlighted in this paper have been noted elsewhere, suggesting that findings are likely to reflect conditions elsewhere in Russia. The authors tried to include all possible points of view, as of the medical staff and the patients. However, due to resistance of the officials the authors were unable to conduct interviews with employees of the FCS. Since all the interviews are recalling past experience, the situation may have changed. This does not undermine importance of the findings, as they shed light on particular treatment experiences, and development of prison health system.

The paper contributes to the literature on prisons as a contributor to TB epidemic, including drug resistant forms. An urgent penitentiary reform in Russia should focus on HIV and TB prevention, case detection, availability of medications and effective treatments. Key to decreasing prison population and improving health is political reform aimed at introduction of effective drug treatment, de-penalization and de-criminalization of drug users and application of alternatives to incarceration.

The United Nations General Assembly Special Session on drugs has provided countries with internationally agreed recommendations to adapt their drug policies for more efficiency and better outcomes. This chapter focusses on the Russian Federation’s role in international drug policy, through an analysis of its national approaches and their design, as well as on its diplomatic efforts at the bilateral and multilateral levels to oppose drug policy reform. A systematic review of peer-reviewed, grey literature, policy documents, UN reports and news reports on the country’s response to drugs internally and externally was conducted between September and December 2017. Despite its efforts to oppose drug policy reform and the prioritisation of public health, the Russian Federation faces major epidemics of imprisonment and HIV. Internationally, while it has not been successful in addressing the ongoing reforms in Europe and the Americas, it has been effective in preserving its international priorities by opposing harm reduction and maintaining the prohibition paradigm at the multilateral level.

The negotiations leading to the UN Special Session (UN General Assembly Special Session on drugs (UNGASS)) on drugs have highlighted the lack of consensus among the global players, with some strengthening the prohibitionist approach and others seeking policy reforms. The purpose of this paper is to focus on the Russian Federation’s national policies and diplomatic activism to influence the outcome of the negotiations at the multilateral level.

A systematic review of the federal legislation on drug control and the legislation on HIV/AIDS has been undertaking in October 2016. Peer-reviewed, grey literature, policy documents, UN reports and news reports were used to gather information on the country’s response to drugs internally and externally.

Despite its limited regional influence on harm reduction and declining financial power, the Russian Federation has been successful in preserving its international priorities by opposing harm reduction and maintaining the prohibition paradigm in the UNGASS outcome.

Every effort was made to identify valid sources of information on the levers of influence of the Russian Federation. Little data were available on the real outcome of the efforts deployed in influencing the BRICS and other regional and international assemblies.

This paper presents an overview of the national policies of the Russian Federation, a global player, and provides a better understanding of how the national approach to illicit drugs and their perception influences its international position. It analyses the geographic, economic and diplomatic sphere of influence of the country in drug policies, and provides explanations on the successes and shortcomings of the Russian influence at the multilateral discussions on drugs.