We report on the first two years of operation of the Yaroslavl, Russia harm
reduction project for injection drug users (IDUs). From October 1996 to Se
ptember 1998, the project was one of 13 projects in central and eastern Eur
ope that comprised the international Harm Reduction Development Program, fu
nded by the Open Society institute in New York City and the city and provin
ce of Yaroslavl. The project is modeled after and received technical suppor
t from the Eastern Connecticut Health Outreach project of the University of
Connecticut, which was funded by the National institute on Drug Abuse. The
Yaroslavl project consists of two interrelated programs: a peer-driven out
reach intervention that offers active drug users modest rewards for educati
ng their peers in the community and recruiting them to a storefront for fur
ther education, interviews, free HIV, STD, and hepatitis B and C test couns
eling; and a needle exchange where IDUs can return used syringes for new on
es and also receive other harm reduction materials such as condoms. We repo
rt on the development and implementation of the project and on in-depth int
erviews with 484 IDUs recruited to the project, 161 first follow-up intervi
ews, 86-second follow-up interviews, and 35 third follow-up interviews. The
se interviews are based on clients' drug use and sexual risk behaviors, kno
wledge of HIV and other drug-related harms, and the Yaroslavl drug scene. W
e conclude with a discussion of the operational and political obstacles tha
t the Yaroslavl project faces as those factors bear on the future of harm r
eduction programs in Russia.