HIV Prevention
Like we have seen time and time again in our HIV Around the World series, government promises fall short in reality. In 2005, Russia unveiled a plan that would provide prevention services to at least 80 percent of those populations deemed high risk by 2010.Yet, as of 2007, prevention services are falling short of what was promised. International health consultant Cesar Chelala has assessed the prevention services in Russia and has concluded that they are "non-existent". He did note that a program to train medical workers in the science of HIV testing, prevention, and treatment has been launched in hopes of improving HIV prevention education.
Another area of concern is the stigma associated with those infected with HIV. An independent survey done in 2004 found that 70 percent of the Russian population admitted to feelings of fear, anger, and disgust toward HIV infected people. Sadly, that 70 percent included healthcare workers and people who had a family member infected with HIV. Unfortunately, poster and television ad campaigns used to reverse negative attitudes toward those infected with HIV have done little to help.
Russia has instituted "harm reduction" programs. Harm reduction is just what the name implies. They are programs that assume risky behavior will occur so they teach individuals how to reduce the risk of harm from these behaviors.
For instance, abstaining from IV drugs would be the ideal way to decrease HIV by way of sharing needles. But since completely eliminating drug use and needle sharing is not realistic, harm reduction programs education people on how to minimize the risk of harm from IV drug use and needle sharing. Russia has introduced needle exchange programs in an effort to increase the use of sterile needles and syringes, thereby decreasing the incidence of HIV infection.
Another harm reduction program emerging in Russia is encouraging IVDUs to stop using drugs altogether. The oral drug methadone is being substituted for IV drugs in hopes of decreasing their use. Methadone is prescribed in clinics that also provide substance abuse counseling in hopes of treating substance abuse issues all together.
Unfortunately, the number of harm reduction programs is nowhere near enough to meet the demand. This is just one problem. Some local governments within the Russian Federation have criminalized methadone, making it illegal to distribute.
The sad reality is that in these cities, the priority is to arrest and punish drug users, not get them the substance abuse treatment they so badly need. Those harm reduction clinics that do resist government pressure and open their doors are hard-pressed to find customers. Not because there are no drug users but because the drug users are afraid of the government pressure, stigma, and harsh treatment of those found to be using IV drugs or who are infected with HIV.
The State of HIV Treatment & Care in Russia
Russian law guarantees HIV treatment for everyone who needs it. However, the best estimates from independent world health agencies put the number of people who actually receive the treatment they need at about five percent. Few people realize that this figure is much worse than some of the poorest regions in Africa.The Russian Health Ministry has bargained with drug manufacturers, lowering the annual cost of HIV medications from $10,000 per year to about $3000 per year. The Russian government has agreed to better fund treatment efforts by doubling treatment spending to almost $300 million dollars in 2007. Yet the number of people getting their meds is very low.
One reason is the infrastructure of the Russian healthcare system. In order to get government-funded HIV medications, people living with HIV must attend government-funded clinics. These clinics are often in remote places, isolated from the rest of the healthcare system. People also fear going to the clinics because they will be labeled "HIV-infected" and face the resultant prejudices and stigma.
Another reason for the lack of HIV treatment is the poorly educated medical profession. Healthcare workers such as nurses, doctors, and technicians receive very little training with regard to HIV. Outside a few HIV specialty clinics, doctors are not properly educated about HIV testing, prevention and care. Also, many Russian physicians are unwilling or refuse to treat IV drug users because they assume the drug user will not adhere to the HIV medications anyway, wasting the medications on someone who isn’t committed to therapy.
The HIV epidemic is poised to explode in Russia if something isn’t done very soon. Health organizations from around the world are urging the Russian government to place a new priority on slowing the spread of the disease.
Russia need only to look at countries such as Romania, which has been able to get treatment to everyone who needs it while dramatically slowing the spread of HIV, for ideas on how to improve their approach to HIV. Until then, the numbers continue to rise - except population numbers, which continue to fall at an alarming rate.
