Author: Ivan Varentsov, employee at Andrey Rylkov Foundation, Russia
“HIV-positive patients keep complaining about the lack of medicines”; “The Archangelsk HIV Centre to be left without its own office building”; “The number of HIV-positive migrants increased 15 times in the last five years”, “The most common deaths among prisoners in Russian Federation are from HIV”, “HIV dissidents are luring the doubters in their communities.” All these Russian media headlines on HIV were published only during the last several weeks. It seems that the issue with HIV situation has been just recently recognized at the highest state level. It was finally decided to create the state strategy on HIV spread prevention in Russia till 2020. Vice-premier Olga Golodets even made a statement that HIV/AIDS subject is one of the most important in Russia. Although, it still feels like all these statements are just mere words. The situation with the spread of HIV, its prevention and treatment in Russia keeps getting worse. It is especially widespread among such vulnerable groups: injecting drug users, sex workers, men having sex with men, and migrants.
A few weeks ago, the Federal AIDS Centre released the information on HIV situation in the Russian Federation as of 31 December 2016. The total number of registered cases of HIV infection among the Russian Federation citizens has reached 1,114,815 people. There were 870,952 HIV-positive Russian citizens as of the end of the year. Herewith, there were 103,438 new cases of HIV infection registered in 2016 among Russian population (morbidity rate of 70.6 per 100k individuals), which is 5.3% higher than in 2015.
A hundred thousand new cases each year! To compare: a little more than 17,000 cases were registered in Ukraine (morbidity rate of 40 per 100k individuals) in the same year. As for the whole epidemic history, since 1987, there were 300,000 registered cases. If you take Montenegro, for example, where Russians like to go for their vacations, there were only 200 registered cases in 30 years. 100k is a population of Tobolsk or Khanty-Mansiysk.
This situation in Russia has been observed for quite a long time now. The constant increase of new cases in the country has been registered since 1998. In 2011-2016, the annual increase on average was 10%. According to the new UNAIDS report, the number of new registered cases of HIV infection from 2010 to 2016 increased by 75% in the Russian Federation. Russia is the “driving force” of the epidemic in the EECA region – in 2016 it accounted 81% of the new HIV cases. It is important to mention that HIV treatment coverage in the country is little more than 30%. According to the global strategy adopted by World Health Organisation, in HIV health sector on 2016-2021 for the cessation of the HIV epidemic, it is necessary to identify about 90% of possible number of HIV-infected population and to provide no less than 90% of the HIV infected patients with antiretroviral therapy.
Profanation of the fight against HIV
Historically, the main HIV epidemic affected group among the Russian Federation population is injecting drug users (IDUs). By some estimates (UNODC, 2009), the prevalence of HIV among IDUs in Russian Federation is more than 37%. It means that there is a concentrated epidemic among this population group. In the period from 1987 to 2008, there were about 79.78% cases of HIV infection connected to the use of injecting drugs. The sexual transmission has been rapidly growing in numbers in the recent years. In 2016, in 48.7% recorded cases the risk factor was heterosexual transmission. Nevertheless, the injecting way of transmission has been consistently enormous – 48.8% in 2016.
Could there be any better signal to authorities to start taking urgent actions in epidemic spread prevention among this risk group? What are they waiting for? There are several effective programs such as “harm reduction” and substitution therapy, which are scientifically proven ways of HIV prevention worldwide. Moreover, they helped reducing the spread of HIV among IDUs in Ukraine. Nevertheless, the above-mentioned programs are not supported by the state HIV prevention strategy in the Russian Federation.
Different level officials, from “specialists” to ministers, keep making statements about no found evidence for effectiveness of these programs. They also tend to say that methadone therapy is a lie invented by the Western pharmacological companies. Following statements would be questioned in any other country, but Russia. Meanwhile, the social establishments dealing with HIV prophylaxis among IDUs and other social groups are listed as foreign agents. Only in 2016, the Ministry of Justice registered seven such organizations.
The ideology of traditional inaction
It is hard to understand what caused such long-lasting stubbornness of authorities in Russia, and why they refuse to accept effective measures in HIV prevention. Most likely, the reason lies in Russian conservative political outlook. Based on the traditional and social values, politicians do not accept such social groups as drug users and LGBT community. This leads to failures and neglect in observance of consumer rights, including health rights.
The problem is that this attitude is not only perverse and inhumane, but also dangerous to the whole community from the public health perspective. The HIV epidemic is not limited to certain population groups and it is not dying with them, as some may think. It has already surpassed all boundaries. For example, drug user’s sexual partners, on one hand, are very sensitive HIV group, and on the other hand (from the epidemiological point of view), a connecting link between IDUs and the entire population. The number of HIV-positive women is constantly increasing. Therefore, apparently, there will be no changes in the situation with HIV epidemic. Not until we change the ideology.