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Analysis & Opinion
29.10.09 So Much For Preventive Care
By Tom Balmforth

Russia’s campaign against the growing HIV/AIDS epidemic relies too heavily on treating sufferers and lacks effective preventive measures to stop the spread, experts said on October 29 at an international AIDS conference held in Moscow. Out of the million people thought to be living with HIV here in Russia, it is estimated that two thirds were infected through drug use. And although needle sharing continues to be the largest contributor to HIV’s growing presence in Russia, the government has proven unwilling to adopt measures to prevent it further spreading within the drug-injecting community by financing needle exchange programs and drug substitution therapy.

“One of the things that trouble us is the scale and rate of the HIV/AIDS epidemic growth. The data we have seen shows that there’s been about a ten-fold increase over the last ten years. So there’s absolutely no sign of the epidemic slowing in this region,” said Robin Gorna, the Executive Director of International AIDS Society. The three-day conference in Moscow addressed the problem of HIV/AIDS across Eastern Europe and Central Asia, which is the only region where growth actually continues, “compared to every other regions of the world where there are slowing epidemics, plateauing epidemics and even declining epidemics,” said Gorna. “Two thirds of that regional epidemic is in Russia,” she continued. Just over 54,000 HIV-infected Russians were officially registered in 2008, up 20.6 percent from 2007. So far, the first half of 2009 showed a 13 percent year-on-year increase.

There are signs that the Russian government is keen to throw more money at its campaign against the epidemic. “They have given us information today, showing an extremely substantial increase in spending from the domestic budget from nine billion rubles this year to 13.4 billion next year and 19 billion in 2011. This is fantastic, and that expenditure is mirrored by a very strong increase in the number of people on treatment,” said Gorna. But Aleksei Bobrik, the Deputy Director of the Open Health Institute of Russia, was less optimistic. “The problem with Russia is that the funding that goes toward prevention is negligible,” he said.

Although there have been a raft of “needle and syringe” programs in Russia (which eliminate or reduce the risk of contracting HIV for intravenous drug users), they have been exclusively funded by foreign grants which are soon to dry up. Compared to the 75 of these projects in operation at the beginning of 2009, now only 53 remain, and without government funding those will close in the course of 2010. “The Russian government just last year announced its desire to continue these projects and to support HIV prevention among vulnerable groups. Public promises were made by the minister of health, by the chief public health officer and the assistant to the president. Now it is all forgotten,” said Bobrik. “We are concerned about the impact of this on the drug-using population, since that is the main source of infection here,” Gorna said. The demise of these projects is even more alarming in light of a UN report published on October 21, which found that Russia is the biggest target market for heroin.
A Soviet legacy?

Back in the 1970s drug substitution therapies, mostly using morphine, were administered to addicts in the Soviet Union to help rehabilitate them. Since then, however, such therapies have been outlawed, a step that has drawn much criticism from abroad. The most controversial has been Russia’s ban on methadone, a substitute drug for heroin users which is taken orally. “Now it’s more like ideological resistance to the idea of giving a drug to a drug-dependent patient. There is not much scientific evidence behind it. I would compare it to what we had during the Soviet Union. Regardless of the data you provide, even the attempt to question the Soviet economy was not acceptable. The same goes for methadone. It’s just ideological resistance: ‘it’s not ours, it’s promoted by the West,’” said Bobrik.

In an effort to facilitate greater exchange of information between countries of Eastern Europe and Central Asia, this week’s AIDS conference in Moscow is being held almost exclusively in Russian. Gorna was particularly keen that Ukraine’s and Tajikistan’s experience in implementing effective methadone programs would create “some learning across the countries about what works in this region.” “Methadone programs are probably the single most effective intervention to prevent HIV among people who are opiate substance dependent,” she said. But Bobrik was doubtful that a breakthrough was in the offing. “The roots of this problem are in the Soviet legacy, in the infrastructure of the healthcare system, in the mentality of healthcare workers. We don’t have much tradition of these behavioral interventions, changing lifestyle through providing incentives,” he said. On the first day of the conference Gennady Onishchenko, Russia’s chief public health officer, again stated that Russia would not legalize prescription methadone for rehabilitation, the Echo of Moscow radio station reported.

Drug-injecting is the most common form of HIV transmission, but it is still important not to overlook what Gorna called the “sexual dynamic” of the epidemic. Widespread intolerance of homosexuality means that the dangers of HIV for the gay community are not understood, said Gorna. “While it may be legal for men to have sex with men, there is a great deal of stigmatization and prejudice and that leads them to be covert about their behavior, and that takes them away from effective services and interventions,” she said. Evidence also shows that the virus is often being transmitted sexually amongst heterosexuals. While men are five times more likely than women to contract the virus through drug use, women usually contract it during sex, Echo of Moscow quoted Ochishchenko as saying.

Without drug substitution and needle exchange programs, the epidemic will continue to rage amongst drug users. And it is clear that if Russia does not bring its HIV/AIDS epidemic within the drug community under control, it will soon take firm root in the general population.
The source
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