Monday, January 16, 2017

The Russian HIV/AIDS Epidemic

"Most government-funded services are only in detoxification, allowing people to briefly withdraw from their addiction and then to return to their life situation. Private rehabilitation services have grown, where people can go after detoxification, but mostly you can only use them if you have money. If you don’t have money, there are still basically no options."
Anya Sarang, president, Andrey Rylkov Foundation,  Russian nongovernmental organization (NGO)

"Intravenous drug users make up most of my patients. To treat them — and for their HIV, for the tuberculosis that usually comes with it — they need to take pills every day."
"The only reliable way to bring them in is with OST. Without it, patients only come when they are feeling deathly ill and leave as soon as they can get their next fix."
Russian (anonymous) lung disease specialist

In Russia, just as there are no gays, despite the presence of gay clubs and the official proscription against gays flaunting a lifestyle that could 'infect' impressionable young people as the government seems to put it, there are also no HIV-infected citizens of the country. At least no HIV crisis that would require government to put its mind to instituting protocols that would have the effect of viewing the situation as one requiring intervention that would begin to halt the rise of those infections.

Since there are no gays, it makes sense that there are no HIV infections. Except for the fact that it is no longer just the gay community that is haunted by HIV/AIDS but a growing contingent of the heterosexual community. Russia, like most other countries, has a problem not only with alcohol consumption, but with heroin and other injectable drugs as well. Trafficking of drugs from Afghanistan through Central Asia and into Russia has helped drive infection rates.

The trafficking of drugs represents a multi-billion illegal business, profitable for traffickers and impossible to put a stop to. There are many elements of involvement, and corruption reigns supreme when such profits are involved. And where there is rampant drug use, there invariably also is infection. According to the Russian Federal AIDS Center, intravenous drug use resulted in 58 percent of HIV infections; the remainder from transmission through sexual encounters.

Volunteers for the Andrey Rylkov Foundation must attach the label “foreign agent” to the plastic bags they distribute. Credit Max Avdeev for The New York Times
Volunteers for the Andrey Rylkov Foundation must attach the label “foreign agent” to the plastic bags they distribute. Credit Max Avdeev for The New York Times

However, since Russia has no gay problem and no HIV problem, opioid substitution therapy (OST) is also not present as a proven harm-reduction response to what Russia claims may be a growing problem elsewhere but not in Russia. OST reduces HIV transmission by replacing intravenous drug use with oral medication that is opioid-based but does not induce a high, through the use of methadone or buprenorphine. Taking away the use of needles reduces risk. 

But Russian authorities see the situation of OST as authorizing simply another form of drug addiction. Now, the number of Russians with HIV surpassed one million a year ago. HIV afflicts about 850,000 Russians, with another 220,000 who have died in the last thirty years. As well, estimates Vadim Pokrovsky, head of the Moscow-based Federal AIDS Center, there is at least another half-million Russians whose HIV condition has gone undiagnosed.

Those with HIV/AIDS represent about one percent of the 143 million population of the country, with heterosexual sex poised to leap over intravenous drug use as the main infection vector. "This can be considered a threat to the entire nation", observed Mr. Pokrovsky. Russia's HIV demographic now represents the largest such epidemic in Europe, as well as being among the highest infection rates globally.

Volunteers from the Andrey Rylkov Foundation distributing free needles, condoms and other supplies from a truck in Moscow. Credit Max Avdeev for The New York Times
Volunteers from the Andrey Rylkov Foundation distributing free needles, condoms and other supplies from a truck in Moscow. Credit Max Avdeev for The New York Times

"Family values" put forward as a  solution to just about everything will not rescue Russia from its current and growing HIV epidemic. But there is an actual national strategy along with an advertising program to promote testing for HIV, a movement supported by Svetlana Medvedeva, wife of the prime minister.

The World Health Organization guidelines meant to reduce HIV from spreading posits that at minimum 90 percent of HIV-positive patients receive anti-viral drugs. Just in excess of 37 percent of Russian HIV patients receive anti-viral treatment. Russia has the distinction of being among five countries accounting for nearly fifty percent of new infections globally, keeping company with South Africa, Nigeria, India and Uganda.

If an HIV-sufferer lives in St. Petersburg the story is that all comers to its clinic are treated at the St.Petersburg AIDS clinic. There, Dr. Tatiana V. Vinogradova who works at the clinic has noted the shrinkage of drug addicts among the clinic's patients, at the same time seeing cases of HIV/AIDS steadily increasing among heterosexual couples.

Dr. Vinogradova's husband is Andrei Skvortsov, a reformed drug addict who operates a small NGO called Patients in Control, and is himself HIV-positive. "I watch people jump back a meter when he says he is living with HIV", says Dr. Vinogradova. "Now whenever I hear about HIV discrimination, I take it as a personal offense", she says.

She and her husband are featured in an advertising poster, standing together, looking into one another's eyes with the caption: "I know that there are no barriers to my love".

Dr. Tatiana N. Vinogradova and Andrei Skvortsov, who is H.I.V. positive, have used their marriage to help break the image of H.I.V. as untreatable. Credit Max Avdeev for The New York Times
Dr. Tatiana N. Vinogradova and Andrei Skvortsov, who is H.I.V. positive, have used their marriage to help break the image of H.I.V. as untreatable. Credit Max Avdeev for The New York Times

Labels: , , , ,

Links to this post:

Create a Link

<< Home

Follow @rheytah Tweet