Andrey Rylkov Foundation
for Health and Social Justice
Русский

Immune to reason

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The front line in the fight against Europe’s fastest-growing HIV epidemic runs through a dark blue bus parked on the outskirts of St Petersburg. Two friends enter late one September evening to collect clean needles and condoms, and duck into a side cabin for an HIV test with a nurse from Humanitarian Actions, a local NGO. “You barely feel it, don’t be afraid,” one says. Several minutes pass with bated breath. Then the results appear: all clear.

In most of the world the threat of HIV/AIDS has receded. The exceptions are eastern Europe and Central Asia. In Russia, which accounts for more than 80% of new infections in the region, 51,000 people were diagnosed in the first five months of this year. In January registered HIV cases there topped one million. Vadim Pokrovsky of Russia’s Federal AIDS Centre reckons the true figure may be 1.4m-1.5m, about 1% of the population; he warns there could be 3m by 2020. In some African countries prevalence can reach 19%, but the epidemic is slowing. In Russia, the infection rate is “getting worse, and at a very fast pace”, says Vinay Saldanha, UNAIDS’ director for eastern Europe and Central Asia.

The Soviet Union began reporting HIV in 1987, and the virus took off in Russia in the early 2000s, mostly among intravenous (IV) drug users. Dirty needles remain the primary means of infection. But with more new transmissions through heterosexual sex, doctors warn that HIV may threaten the general population. Bad policies and neglect have fed the epidemic. Russia has eschewed the kind of sex-education and drug policies that have been shown to work elsewhere. Vladimir Putin’s government keeps getting more prudish. “Russia is always taking its own path,” says Sergei Dugin, director of Humanitarian Actions. “I would be happy about that, but it’s going in the wrong direction.”

Harsh anti-drug laws keep users in the shadows. Methadone and other forms of non-injected opioid substitution therapy (OST) are illegal; in other post-Soviet states, such as Ukraine, they are legal. (After Russia annexed Crimea in 2014, 800 patients found themselves cut off. The UN believes some 10% have died, “mostly of overdose or suicide”.) The World Health Organisation calls methadone “the most promising method of reducing drug dependence”, and HIV-positive addicts who receive OST are 54% more likely to get the antiretroviral (ARV) drugs they need to stay healthy, according to studies.

Russia’s foreign minister has derided OST as a “narcoliberal” idea. The country’s chief narcologist compares methadone to “treating a vodka-drinking alcoholic with cognac”. (Three activists have challenged the methadone ban in the European Court of Human Rights.) Harm-reduction programmes such as needle exchanges, while not illegal, receive little government support. As for sex education, Russia’s former children’s rights ombudsman declared that the best lessons lie in classic Russian literature. (Presumably he did not mean for disappointed lovers to throw themselves under trains.) The new ombudsman, the wife of an Orthodox priest, belongs to a social-media group called “HIV/AIDS is the Biggest Hoax of the 20th Century”.

economist-chartSkimpy funding has left gaps in treatment. Fewer than 25% of Russia’s HIV-positive patients receive ARV drugs, well below the global average of 46%. Costs are high, in part because drug procurement has been left to the 85 individual regions: the cheapest ARV treatments in Russia cost several times more than in Brazil or India. Patients who do not get medication are more likely to die of AIDS—and more likely to spread the virus. (ARV drugs suppress viral load and make patients less infectious.)

Stigmatisation compounds the challenge. When Alexander, an HIV-positive drug user in Moscow, received his diagnosis, he says he “didn’t leave the house for a month and a half”. His mother gave him a separate cup and washed the shower after he used it, unaware of how HIV actually spreads. Drug users fear criminal repercussions if they seek help. And Russia’s “anti-gay propaganda” laws make it harder for gay-friendly charities to operate.

Virulent prejudice

Independent NGOs, many staffed by HIV-positive people, play a crucial role in reaching vulnerable groups. But Russia’s “foreign agents” legislation, which places bureaucratic restrictions around groups that accept foreign money, has made funding difficult. Several HIV and drug-policy advocacy groups have been labelled foreign agents this year, including the Andrey Ryklov Foundation, the only group offering free needle exchanges in Moscow.

As the number of HIV cases grows, the government has been forced to address the problem. In October 2015 the prime minister, Dmitry Medvedev, held a meeting on AIDS. Russia’s health minister, Veronika Skvortsova, promised an extra 20 billion roubles ($315m) in AIDS funding in 2016. A new federal HIV strategy is expected within weeks. The government plans to centralise ARV procurement beginning in 2017, which ought to reduce costs.

Some regions have made progress through co-operation between doctors, patients and activists. In St Petersburg, where the number of new cases is slowing, the city’s chief AIDS doctor, Denis Gusev, has worked with activists and opened a “prophylactic point” in the city’s AIDS Centre offering needle exchanges. An advertising campaign encouraging testing has brought more traffic to the AIDS Centre’s hotline and website. But without action at a higher political level, there will only be “islands of good practice, but never a good national response”, says Anne Aslett, director of the Elton John AIDS Foundation.

Russia’s economic crisis has slashed health-care budgets, and more money for AIDS seems unlikely. Even this year’s promised extra federal funds have yet to materialise, says Mr Pokrovsky. Officials, he adds, must abandon the old saying that “what’s good for the German is death for the Russian.” Germany’s population is a bit over half the size of Russia’s, and it has one 25th the number of new HIV cases. “Narcoliberal” ideas save lives.

Source: www.economist.com



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