While the attitude of the Swedish government towards harm reduction programs is currently perceived as negative ⁹, and restricts the possibility for governmental funding within Sweden, there is considerable scope and need for a Infectious Diseases Program.

From the available data and even utilising the most conservative drug use estimates available, it appears as though St.Petersburg is at the entry point of an unprecedented HIV epidemic by Eastern or Western European standards. This situation must be closely monitored for it has the potential to pose one of the most serious environmental and human welfare risks in the Baltic region. If the multi-location micro-surveys conducted by Médecins du Monde France prove to be an indicator of a general trend, then the HIV epidemic represents a human catastrophe for Russia, but a national security threat to the Baltic states and Sweden itself.

This assessment report recommends that Médecins du Monde Sweden in collaboration with the leading infectious diseases research unit in Sweden, the Karolinska Institute (KI) establish a monitoring service to monitor and track the emergence of the possible HIV epidemic in St Petersburg. Given the close relationship between KI and Médecins du Monde Sweden, this report recommends the establishment of a working relationship between KI with field implementation and liasion by Médecins du Monde Sweden on the one hand, and Médecins du Monde France and the Doctors New Initiative on the other. This relationship would facilitate closer links between the research institutions and field NGOs in the countries concerned in order to facilitate the knowledge transfer process at a research and institutional level and awareness, prevention and harm reduction campaigns on the streets and in the media.

Activities regarding the founding of self-support groups to encourage sustainability and local capacity building should also be actively encouraged by Médecins du Monde Sweden in cooperation with local partners. While impetus and initiative for self-support groups must come from people living with HIV and trying to stop taking heroin themselves, there is no reason why Médecins du Monde Sweden cannot facilitate this local support process by providing space within which the activities of these extremely vital groupings can take place.

Action: Médecins du Monde Sweden in conjunction with KI should form a working group to assess possibilities and implement concrete measures in the aforementioned directions.

9. The Swedish government tends to prefer "Prevention" programs over harm reduction. While some label this policy as "repressive" it is clearly to late to effect a comprehensive prevention program given the prevalence of heroin use existing within the city and the lack of adequate law enforcement mechanisms and sea borders to halt the "market forces" which stimulate importation.