AIDS and Russia: a health catastrophe

On this trip they were to meet with members of the Russian association FrontAids, of which members had come to Paris in March 2005, and their mission was to collect information on the Russian situation concerning HIV/AIDS and relay this information to France and other western European countries.

At the same time they took advantage of the situation to bring information and expertise to their Russian counterparts. Upon arrival they noticed immediately how desperate the situation was for those being cared for with HIV/AIDS, at both a social and health level. This being even with the valiant and appraisable efforts of some associations, government bodies and doctors.

The following examples make it possible to demonstrate these remarks (the information in this article are taken from reports by the NGO Human Rights Watch, UNAIDS and the United Nations Development program, as well as information provided by Russian Associations and members of its medical team).

Screening Practices
Russian law calls for obligatory blood screening for blood donors, health professionals who in their work are particularly exposed to infection and for people who care for patients with illnesses that share the same form of transmission as HIV (hepatitis, STIs, etc.).

This is often done without the person’s consent. Therefore, it isn’t rare that a test is done in a pregnant woman or a person in the hospital being treated for hepatitis. In fact, one of the members of the Russian association informed us that that was how his blood was tested for HIV for the first time while he was in the hospital.

Screening is still obligatory upon entering prison. In the absence of any follow-up, this one-time test can result in many ”false negatives“. They are not very accurate, and also create ”false positives“. The association IMENA+ has informed us of one prisoner who has tested positive every time he has entered prison, yet upon exiting and being retested it has always turned up negative.

Epidemiology
The epidemiological information in Russia can not be taken as absolutely accurate, as it needs to be judged against the screening practices of the country. There is no free and anonymous screening set up by the government. Only a few associations offer free and anonymous testing, this makes the access to testing difficult if not impossible for many. A more concrete example is that of Saint Petersburg, where there are only two associations which offer free and anonymous tests in both the city center and its suburbs.

An UNAIDS report confirms that in Russia, as well as many countries of central and eastern Europe, the growth of the epidemic is astounding. Between 1995 and 2001, the number of new infection doubled every 6 to 12 months.

According to, Vladim Pokrovsky, head of the federal AIDS service, interviewed by Human Rights Watch in February 2004, the estimation of people infected with HIV in Russia is between 800,000 and 1.2 million. The annual UNAIDS report of 2003, stated 1.5 million HIV+ people. In 2002 the CIA estimated that 2 million Russians were HIV+ and that the number could grow to 8 million by 2010. The Russian government says that the number could raise to 5 million by the year 2007.

Considering these numbers, Russia has to face up. The extremely repressive government policies may only worsen the situation. In 2002, according to the state, 93% of the new infection happened through unsafe drug users. The same year, only 12% of the new infection came through sexual intercourse; in 2003 the percentage went up to 17.5%. The numbers indicate that maybe injection transmission has reached a ”peak level“ and that sexual transmission may become more important. Looking at the low, or nonexistent, level of prevention information it is possible that AIDS will continue to grow for years to come in Russia.

With the rapid growth of AIDS in Russia, the life expectancy of the Russian population has gone below 60 years. However, it is difficult to link this decrease to AIDS for in the official statistics AIDS is not listed as a cause of death. Opportunistic infections are listed, but apparently have no link to AIDS. The most common is tuberculosis and would kill 30,000 people every year. Another damaging fact is that there is no coordination between the health services specified for tuberculosis or AIDS. Therefore, a tuberculosis patient will be put in a special program where he will receive nothing, not even a stretcher. One cannot even dream of anti-HIV drugs or palliative care. When it comes to antibiotics they are not adapted to multi-resistances.

The Situation in Prison
In prison, the rate of HIV+ inmates went from 1 in 1000 in 1996 to 42.1 per 1000 in 2003. 34,000 people are HIV+ and incarcerated, which represents, according to official statistics, more than 15% of the HIV+ population in Russia. No treatments or medical care is available, and the obligatory screening upon entry in prison is based on tests of bad quality.

In 2001, a federal directive officially ordered end of separation of HIV+ and HIV- inmates. Yet according to two older inmates that we met, it continues in practice in many Russian centers such as the detention center n°7 or Kristen prison in Saint Petersburg. When the segregation is not done by the administration it is the prisoners themselves who carry it out in a volunteer fashion.

Discrimination of HIV+ people
The knowledge that people possess on HIV/AIDS is extremely low. For instance taped interviews with people done in the street by the group Delo showed that many would not shake hands with or drink out of the same glass as an HIV+ person.

In 2001, a poll done in Saint Petersburg showed that one third of the people interviewed believed that the condom was not viable, 48% believed that HIV could be passed through kissing, 30% through sharing a cigarette and 56% by an insect bite. Another poll showed that 40% believed that a HIV+ teacher shouldn’t teach.

This is due to a lack in informational and preventive campaigns. In 2004 the budget for prevention by the federal government was less than a million euros (compared to almost 25 million euros in France for prevention campaigns, informational brochures, a hot line on AIDS, etc.).

Discrimination is present in almost all levels of society. A poll done with 470 HIV+ people revealed that 10% of them had been fired from their jobs when their positive status became known, more than half had been forced to sign documents for the police stating their HIV+ state. 44% revealed that they had been pressured by medical personal to tell details about their sexual activity or give information on other drug users that they know.

New-born babies of HIV+ mothers are marked with a red ribbon on their hand, which is also included in the medical report needed to enter a daycare. All children who are born from a HIV+ mother are systematically refused entrance into a daycare.

This in turn makes it impossible for the mother to work.

Access to Treatments
To hope to have access to treatments against HIV, it is necessary to register with the city’s health services; this comes with all the negative consequence to confidentiality of the person’s status. In Saint Petersburg the access to treatment is extremely limited. In 2004, funds allowed only 500 people to have access to treatment.

This same year, the International Fund for the Fight Against AIDS financed the treatment of 400 other people to bring the total to 900 patients.

Selection committees for the institutions choose whom they decided to be ”justified“ patients for access to treatment. According to, Nicolaï Panchenko, director of the Society of People Living with HIV, who had the sadness to witness one of these committees. Although the standards set by the WHO are respected, there is the problem that before the selection is made all those considered unworthy are discarded from the process: drug users, alcoholics, homeless, etc. Children are given full access to treatment when they are in need. For the others, between the lack of financing and the open discrimination, there are few places available for them to receive antiretroviral treatment.

The only solution for these people is to pay for the treatment themselves, but most can not afford to pay 12,000 dollars a year. Here again we see why the need for access to generics is so crucial in the fight against AIDS. For four years the Russian government has been promising to make generic drugs available. The local industry is more than ready to comply and even some laboratories are currently prepared. Yet the non-existent will of the government to lower the price to 7,000 euros a year has stalled the entire process. After four years how many people have died in Russia? The authors of this article would like to thank in particular all the associations and collaborators, without them this article would have never been written (hoping we have not forgotten anyone) : FrontAids (Daniel, Sacha, Andreï, Nixon, Anna, Anja and others), the Society of People Living with HIV (Nicolaï and others), Humanitarian Action (Anja and company) and IMENA+ (Tatiana and others), Russian Harm Reduction Network (Pavel, Vitaly, Dacha and the rest), the Community of people living with aids (Dima, Micha, Shona and others), Aids Foundation Est West and the Dr. Vladimir Musatov.

Also the readers are invited to visit the following web page in order to read more on this mission to Russia: www.actupparis.org/article1960.html

Hugues Fischer

EATN - European AIDS Treatment News, Volume 15, I – Spring 2006

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