#17 - JRL 7237
The Economist (UK)
June 21-27, 2003
AIDS in Russia
Saying versus doing
Russia is running out of time to curb AIDS before it devastates the country
HE FLICKED out the word as if expelling a tiny, irritating hair, so unobtrusively that many listeners did not hear it. Nonetheless, Vladimir Putin is the first Russian president to mention AIDS in a state-of-the-nation speech.
Mr Putin has talked about AIDS (SPID, in Russian) before, but his speech last month gave campaigners hope that he is now taking it seriously. A conference held in Moscow the same week (with a second meeting this week in Washington) organised by the EastWest Institute, an American think-tank, brought Russian and foreign AIDS campaigners, officials and some MPs together for the first time--another good sign. Mikhail Margelov, a senator close to Mr Putin, compared the threat of AIDS to that of terrorism. Unfortunately, it still seems to be one of the government's lowest priorities.
Russia's epidemic is still young. In most countries, HIV, the virus that causes AIDS, is usually contracted through sex. But in Russia, its first rise was among needle-sharing drug-takers. The question is how far it has spread, through sex, to the population at large.
The statistics are not much help. There were 237,000 registered cases by the end of March; the true number could be four to six times higher, or up to 1% of the population. But in the past two years the rate of new registered cases has dropped (see chart). Explanations vary: that drug control is working, that education among drug-takers is working, that the heroin supply has fallen, that heroin is now purified before it comes into Russia so that addicts meet for communal cook-up sessions less often, or simply that HIV is beginning to saturate the drug-taking population.
The authorities treat AIDS as mostly a drug-takers' problem, but addicts presumably sometimes have sex with non-takers, especially if they pay for their drugs through prostitution. Most testing, however, is still done on groups at risk from dirty needles, such as hospital workers, prisoners and conscripts (and only when they go into the army or jail, not when they leave). Only 7% of tests are voluntary.
Almost all those who test positive and think they know how they got the virus say it was from a needle. But 40% say they do not know how they caught it. Among the untested it could already be spreading, mostly through sex, between people who never suspect they may be at risk.
This year's federal budget for fighting AIDS was a paltry 122m roubles ($3.7m), even less than last year's. Just 25m goes on prevention and education, according to Vadim Pokrovsky, the director of the partly state-financed Federal AIDS Centre. Local governments, he estimates, spend another 500m roubles. Even so, that means a national total of only $22m a year. Russia gets nearly as much from America and Britain for (mostly non-governmental) AIDS projects. The health ministry's anti-AIDS unit boasts a full-time staff of three, at a time when high oil prices have given the treasury a reserve of more than $7.5 billion.
There is other money available, but the government seems reluctant to take it. A World Bank loan to fight AIDS and tuberculosis, worth $150m over five years, was agreed on in April but only after four years of squabbling about how to spend it. Russia has not tapped into the UN's one-year-old Global Fund, which has given some $1 billion for fighting AIDS around the world, because the government has not managed to set up the "country co-ordinating mechanism" required to submit applications. This is not unduly difficult; Kirgizstan, Armenia and Togo have all managed it. Nor has Russia started negotiating with drug firms for cheap anti-retroviral drugs. Its neighbour, Ukraine, has done so, and so pays several times less for them.
Russia's parliament passed a law to fight AIDS back in 1995, but it is poorly enforced, and other laws work against AIDS prevention. One, for example, allows the police to close down needle-exchange programmes. Another outlaws substitution treatment (eg, replacing heroin with methadone). Another, which criminalises the witting spread of disease, means that people who know they are HIV-positive can be prosecuted for having sex, even with a condom. That, says Alexander Barannikov, a member of parliament, who is trying to have the law changed, puts people off being tested.
So far, AIDS has killed relatively few, a little over 3,000. But unless the government works a lot harder at prevention, that total will swell. A World Bank study predicts that by 2020 up to 10% of an already shrinking population could have the virus--and, long before that, the cost of treating the sick could all but devour the government budget.