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Contributions from
the Column
Focus
Combating HIV/AIDS – the German input
US study warns of dramatic rise in the HIV infection rate
People living with HIV as target group counsellors in Argentina
Empowerment of girls in Africa
Russia's underrated epidemic
Big sales, little education
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Work on the development of vaccines
02/2003
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Drug use drives increase in HIV infections
Russia's underrated epidemic
Tatjana Bateneva and Torsten Brezina
According to international estimates, almost one million people in Russia are now living with HIV. The number of cases is growing dramatically. Earlier, HIV was most prevalent among homosexual men and drug users. But infections transmitted by heterosexual intercourse are also rising. Only now, however, is the government beginning to spend more money on prevention measures.
As of October 1, 2002, a total of 215,304 people in the Russian Federation were officially registered as living with HIV . International organisations such as UNAIDS and the WHO estimate that the true number of infections is four times greater, meaning that almost 900,000 people in Russia have HIV. The explosive increase in infections since the end of the 1990s is especially worrying. In 1998, a total of 10,993 people were officially registered as HIV cases. In 2001, the number of new infections alone totalled 83,000. As a whole, the number of registered HIV cases has risen by 20 times since 1998. Russia has the highest increase rate worldwide.
Drugs and the risk of AIDS
The main risk group are drug addicts. The majority of infections in Russia, totalling more than 80 per cent, are transmitted by injecting drug use (IDU). That is a top value; according to the UN, the global prevalence rate among such groups is only 5-10 per cent.
The spread of the HIV virus in Russia is not limited to big cities and central regions. A typical example of cases outside major urban areas is the village of Kamysjak of 8,000 inhabitants on the Lower Volga, far from cities and the country's major roads. In 1999, 30 new HIV cases were registered there within only a few weeks, all involving young people aged 15 to 27. They had taken up drug use together, injected themselves regularly as a group, and often shared a needle or a prepared substance.
The first official HIV case in Russia, a Soviet development aid worker who had spent many years in Southern Africa, was registered in 1987. Russian and international specialists warned at the time that widespread education work, especially among young high-risk groups, was urgently needed. A law on the rights of people living with HIV was passed and a network of state centres for preventing and combating AIDS was set up. There are now such centres in every region and all big cities. But due to a lack of money they restrict their work almost solely to registering and caring for people already infected with HIV.
Social change
The radical processes of social change triggered by perestroika were and still are marked by a rapid growth in drugs use. Due to the partial withdrawal of the state from its responsibility for education and healthcare, the break-up of family ties and a general ideological crisis, the general conditions for healthy behaviour by the people were decisively worsened. Against this background, children and teenagers are a particularly endangered group. Often, they are unable to cope with difficult situations in life. In addition, they lack role models or their parents have no ideas about their upbringing on which the young people could orient themselves amid new problems. These conditions are the breeding ground for continually growing consumption of drugs and alcohol among young people. And the use of drug injection needles by several persons increases the risk of infection with viruses.
Whereas the first wave of HIV infections paved its way mainly in the homosexual milieu and in hospitals (via blood transfusions), the second strong wave is linked with an extreme increase in drugs use. This wave is now being overlaid by a third. The number of new infections transmitted by heterosexual intercourse is growing steadily. However, in the social debate the subject of AIDS is still seen largely as a problem of marginal groups. Most people do not recognise that AIDS and dealing with it will increasingly become part of daily life.
Signs of a new policy
There are now initial signs of change. For 2002 the state programme of measures to combat the spread of AIDS (ANTI-HIV/AIDS) was for the first time fully financed with 183 million rouble (about 6 million euros). In earlier years, at best only 10 per cent of the funds applied for were approved. In addition, Russian President Vladimir Putin has created with much media coverage a financially well-equipped 'President Programme' to promote mass sports for children and teenagers aimed at general good health.
But concrete work in Russia on preventing HIV is now done mainly by NGOs. Promoted by international organisations such as UNICEF and Doctors Without Borders, they realise projects to improve the knowledge of children and teenagers about HIV/AIDS and measures to prevent infection. That includes education campaigns, the training of 'peer educators', distribution of print and video material on AIDS and drugs, and staging concerts and sports actions. The range of the measures is good in qualitative terms, but completely insufficient in quantity.
In Kamysjak, experts from the regional AIDS centre are currently implementing a 'harm reduction' programme. One of the programme's simplest but most effective measures was exchanging used drug injection needles for new, sterile ones. A mobile needle exchange centre visited the village. The action was run mainly by volunteers from the non-profit fund "We Young People" of the Astrakhan youth newspaper of the same name. They included many people who themselves are affected.
The trend to changing from being a passive victim of HIV infection to becoming an active fighter against negative social situations can now be seen more and more in Russia. The political acceptance of such activists is so far low. Politicians cannot win votes with issues such as HIV/AIDS and drugs. But if the present scale of the epidemic should grow further (and that must be expected), it cannot be excluded that a movement of people living with HIV will arise. Its leader would represent the interests of the infected and their families. The almost one million HIV-positive people in Russia are already a real force who can defend their own rights.
Tatjana Bateneva is a correspondent of the Russian newspaper Isvestia and specialises in reporting on the spread of HIV/AIDS.
Torsten Brezina is a GTZ foreign staff member in Moscow and responsible for, among other things, projects to promote the health of young people in Russia. bamos@com2com.ru
1) Statement by the Ministry of Health of the Russian Federation, 16.10.2002
2) UNAIDS: Report on the global HIV/AIDS epidemic, Geneva 2002.
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