HIV cases surpass 1 million in Russia
QUIETLY, the number of Russians who have received a positive HIV diagnosis passed the 1 million mark this year. There is, however, little indication the government will commit adequate resources to stem the acceleration of the virus from high-risk groups into the general population.
About 850,000 Russians carry HIV and an additional 220,000 have died since the late 1980s, said Vadim Pokrovsky, the longtime head of the Moscowbased Federal AIDS Center, who estimated that at least another 500,000 cases of HIV have gone undiagnosed.
Although the label “epidemic” prompts denials from some senior officials, experts on the frontlines like Pokrovsky are calling it just that. The overall estimate of victims constitutes about 1 percent of Russia’s population of 143 million, enough to be considered an epidemic, they argued.
“This can already be considered a threat to the entire nation,” Pokrovsky said, noting that the caseload is increasing by about 10 percent a year. In 2016, 100,000 new infections are anticipated, about 275 daily. It is the largest HIV epidemic in Europe and among the highest rates of infection globally.
Despite this, experts do not expect much change in Russia, where victims still face the kind of stigma prevalent in the 1980s in the West. In addition, some prominent voices push “family values” as the ideal prevention programme.
In many ways, Russia’s fight against HIV is a case study in the constant tension between civil society and a Kremlin under President Vladimir Putin – public activity outside government control is considered inherently suspect.
Tensions heightened this year after the Justice Ministry blackballed a number of bantam NGOs involved in combating HIV/AIDS as “foreign agents” because they received grants from abroad.
The president has remained largely silent on HIV. Overall, activists said, the combination of indifference towards victims, government financial austerity, hostility towards foreign funds and a powerful camp of AIDS deniers all amounts to the lack of a coherent national effort.
Experts criticised a new, rather vague Russian government strategy on fighting HIV that was released in October for lacking a plan of execution or any new money.
HIV warrior
In St Petersburg, one married couple, Dr Tatiana N Vinogradova and Andrei Skvortsov, straddle the government-NGO divide on the issue.
Vinogradova is a thirdgeneration HIV warrior. Her grandmother, an infectiousdiseases specialist, treated one of the first patients in St Petersburg in the late 1980s and pushed the city to establish an AIDS centre. Vinogradova’s mother ran it, and she herself is now its deputy head of scientific research.
Skvortsov, wiry, scrappy and HIV positive – a reformed drug addict and ex-convict – runs a small NGO called Patients in Control. It was founded in 2010 to try to cajole, pressure and embarrass both federal and local governments into providing government-guaranteed treatment.
At the St Petersburg AIDS Center, Vinogradova, 41, has seen the prevalence among drug addicts shrink while cases among heterosexual couples soar.
“Calling it an epidemic would be akin to admitting that the government let the problem get out of control over the past 30 years,” she said, explaining why the government avoids the term. But she uses the national strategy and any official statements she can find to try to wring more money out of politicians. “This is Russia, so everything has to be top down to get anything done.”
The couple has tried to use their marriage to help break the stigma that the disease is an untreatable plague limited to drug addicts, homosexuals or others likely to die anyway.
“I watch people jump back a metre when he says he is living with HIV,” Vinogradova said, with older medical professionals particularly still fearful despite the raft of evidence that anyone taking antiviral drugs is not infectious.
“Now whenever I hear about HIV discrimination, I take it as a personal offence.”
Activists and experts always come back to the lack of government support as the root problem. Under World Health Organization guidelines, to reduce the spread of the disease, at least 90 percent of HIV-positive patients should receive antiviral drugs.
Little more than 37 percent receive such treatment in Russia, according to government statistics. “The prevention programs are not working, the coverage is not sufficient to break the curve,” said Vinay P Saldanha, the UNAIDS regional director for Eastern Europe and Central Asia.
Russia is among five countries that account for almost half the new infections globally – the others are South Africa, Nigeria, India and Uganda, according to UNAIDS figures, although in some of them, a much higher percentage of the overall population is infected.
Most of the $338 million annual Russian federal HIV budget is spent on medicine, and almost nothing goes to preventive education. Veronika Skvortsova, the health minister, has repeatedly called expanding treatment programs a government priority. (The minister is not related to Andrei Skvortsov.) After a deep recession, however, little new money has materialised.
At the same time, the Russian Orthodox Church and some politicians promote “conservative values” as the best way to combat HIV.
Patriarch Kirill called for “moral education”, stressing that “family values, ideals of chastity and marital fidelity” should be at the forefront of curbing the virus.
Both the government and the church staunchly oppose sex education for children. One senior government official stated that classical literature was the best teacher.
The state also adamantly opposes methadone for drug addicts, sometimes denigrated as a “narcoliberal” scheme. In other countries, methadone programs are used to treat and to monitor patients infected by intravenous needles.
The emphasis on traditional values dismays those fighting the disease. “Traditional values just means leaving everything as it is,” Pokrovsky said.
“If we have traditional values and do nothing, the epidemic will keep spreading.”