Drawing by Natalia Mikhailenko . Click to enlarge the image.
The HIV epidemic is one of the most pressing public health problems in Russia today. According to the latest UNAIDS global report, Eastern Europe and Central Asia are the only regions in the world where HIV is spreading at a growing rate.
The worst situation is in Russia — home to 70 percent of all people living with HIV in the region. Russia and Ukraine combined account for 90 percent of HIV infection cases.
The number of people living with HIV in Russia continues to rise, with 704,000 cases of HIV infection registered by the Federal AIDS Prevention and Treatment Center as of November 2012. The actual number of people living with HIV in Russia may be at least twice as high.
- The estimated number of illegal drug users in Russia is 5 million
- Illegal opiates are used by an estimated 1.6 million people
- As of late 2009, there were more than 555,000 officially registered drug users, of whom 70 percent used injections
- An average 37.2 percent of intravenous drug users live with HIV and, in some regions, the figure is as high as 75 percent
For more than 10 years, the main cause of HIV transmission has been the use of non-sterile syringes for the intravenous injection of drugs. As of the end of 2012, more than half (57.6 percent) of all new infections were caused by intravenous injections. However, since 2002, the epidemic has spilled beyond the vulnerable groups and sexual transmission has been gathering momentum.
Gennady Onishchenko, the head of the federal service on consumer rights protection and human well-being surveillance (Rospotrebnadzor), says: “The majority of HIV infection prevention in the most vulnerable groups that were being successfully implemented in the previous years have practically been curtailed, and preventative measures among the general population and based exclusively on encouraging a healthy lifestyle have little effect on the said population groups.”
Put simply, Russia does not spend a single ruble to finance HIV prevention among drug users. Formerly, these programs were financed by international donors — most of whom have left Russia due to recent political trends.
In 2011, the 85-million-ruble ($2.5 million) preventative campaign among vulnerable groups — including drug addicts — lasted only 39 days. Its practical effect is not known. However, at the request of the human rights group AGORA, the Prosecutor General’s Office has sent materials to the Investigative Committee with the intention of opening criminal proceedings.
Today, the campaign against the HIV epidemic in Russia is using ineffectual preventative measures and programs, promoting a healthy lifestyle against the background of repressions against drug users and a general atmosphere of intolerance toward them.
Meanwhile, global experience shows that the prevalence of HIV in that group has been reduced due to the use of scientifically grounded preventive programs—for example, the program for exchanging needles and syringes, opioid replacement therapy (ORT), and a departure from repressive policies.
In particular, ORT is successfully used in more than 60 countries. Methadone programs are being implemented in all CIS countries, with the exception of Russia, Uzbekistan and Turkmenistan. In Russia, the use of methadone for medicinal purposes is banned, and there are no replacement therapy programs.
HIV testing in Russia is another problem. The crux of the problem is that Russia spends huge amounts on tests, but it tests indiscriminately — mainly elderly women when they are hospitalized, and not members of vulnerable groups.
In 2011, out of the 24 million HIV tests in Russia, members of vulnerable groups such as drug users and homosexuals accounted for less than one percent. Indeed, the number of people tested in 2011 dropped in comparison with 2010, with the most vulnerable groups accounting for the biggest drop (homosexuals and bisexuals by 35.9 percent, and “people sick with drug addiction” by 10.2 percent).
In this context, one should note Rospotrebnadzor’s recent initiative for organizing the first nationwide study of the prevalence of HIV among “men practicing sex with men” and women engaged in prostitution.
Large-scale programs studying the prevalence of HIV among gays have been successfully implemented in other countries. The initiative is very important in Russia: It would provide authentic data on the spread of HIV among high-risk groups, which could be grounds for government allocation of money for scientifically valid HIV prevention programs among these groups.
However, because Russia pursues a conservative policy with regard to sexual minorities and a repressive policy with regard to drug users, there are fears about the consequences of people coming out and disclosing their sexual orientation and status.
In addition, another result of the study would be a large number of newly revealed HIV-positive cases. This, in turn, raises the issue of quality counseling before and after tests and, most importantly, availability of antiretroviral therapy for those who need treatment.
Ivan Varentsov is an expert on public health with the Andrey Rylkov Foundation.
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