Quietly, the number of Russians who have received a positive HIV diagnosis passed the 1m mark in 2016, The New York Times reports.
However, that there is little indication that 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 Moscow-based Federal AIDS Centre, who estimated that at least another 500,000 cases of HIV have gone undiagnosed.
The report says although the label “epidemic” prompts denials from some senior officials, experts on the front lines like Pokrovsky are calling it just that. The overall estimate of victims constitutes about 1% of Russia’s population of 143m, enough to be considered an epidemic, they argued. Beyond that, they said that heterosexual sex would soon top intravenous drug use as the main means of infection.
“This can already be considered a threat to the entire nation,” Pokrovsky said, noting that the caseload is increasing by about 10% 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.
The report says despite the grim milestone, experts do not expect much change in Russia, where victims still face the kind of stigma prevalent in the 1980s in the West and where continuing trench warfare between the Kremlin and independent non-governmental organisations saps collective efforts. In addition, some prominent voices push “family values” as the ideal prevention programme.
The report says 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 V 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.
Anton Krasovsky, a prominent talk show host fired in January 2013 after coming out as gay on air, says he has spent his personal savings building an NGO that tries to bridge that divide. “Since we are not talking about fighting Putin, but fighting a virus, people have to understand that they can fight this virus only if they are on the same side as Putin,” Krasovsky is quoted in the report as saying. “It is impossible to change the situation without coming to some kind of an agreement.”
The report says the president has remained largely silent on HIV. Over all, activists said, the combination of indifference toward victims, government financial austerity, hostility toward 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.
Despite that, the report says both sides in the HIV battle agree that Russia has made some progress. The fact that a national strategy exists – as well as an advertising programme promoting HIV tests backed by Svetlana Medvedeva, the wife of the prime minister – at least implies some high-level interest. But activists and experts always come back to the lack of government support as the root problem.
Under World Health Organisation guidelines, to reduce the spread of the disease, at least 90% of HIV-positive patients should receive antiviral drugs. In Russia, a little more than 37% receive such treatment, 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.
The report says 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, although in some of them, a much higher percentage of the overall population is infected.
The report says most of the $338m 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 programmes a government priority. (The minister is not related to Andrei Skvortsov.) After a deep recession, however, little new money has materialized.
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 the “establishment of 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, the report says. 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 “narco-liberal” scheme. In other countries, methadone programmes are used both 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 is quoted in the report as saying. “If we have traditional values and do nothing, the epidemic will keep spreading.”
Compounding the problems, the federal government has tried to silence organisations that challenged its policies, labelling them “foreign agents” for receiving grants from abroad, forcing some to close. The Andrey Rylkov Foundation for Health and Social Justice, which hands out free needles and condoms in southern Moscow, now has to staple a small label to its plastic bags saying “Foreign Agent” as required by law. Recipients said they could not care less, but it means that the foundation cannot work with government organisations.
“HIV is not a personal problem, it is a social problem, and it should be solved as a social problem,” Elena Plotnikova, who works for the foundation, said as she handed out supplies. “The basic attitude of the government is: You made a bad decision and we are not going to help you.”
The report says NGOs are considered crucial to reaching populations that avoid government contact, including drug addicts, prostitutes and gay men. Help varies widely from city to city. St Petersburg is perhaps the most enlightened, treating all comers to its clinic and sponsoring an advertising campaign.The New York Times report