Sex and drugs and Russian roulette

[Avnish Jolly]

Sex and drugs and Russian roulette
http://www.guardian.co.uk/global-development/2010/sep/14/mdg6-hiv-aids-russia

HIV and Aids have gripped Russia's drug users and sex workers and
transmission rates are spiralling. What next for the hidden epidemic?

Tom Parfitt guardian.co.uk, Tuesday 14 September 2010 07.45 BST
Article history
Alexei Kropinov, deputy chairman of the Russian Union For People
Living With HIV. By Tom Parfitt Photograph: Tom Parfitt/The Guardian

Alexei Kropinov thinks it was probably the sex.

Millennium development goal 6: Combat HIV/Aids, malaria and other
diseases
What is the goal? To halt and begin to reverse the spread of HIV/Aids,
malaria and other major diseases, and to ensure universal access to
treatment for HIV/Aids. Progress so far Progress on this goal has been
slow and mixed. Overall, 26% of countries have seen infection rates
drop, while 41% have recorded no change. Sub-Saharan Africa has the
highest HIV infection rates in the world, but, says the ODI, of the 27
countries that have reduced rates, 21 are found in the region. Rates
have increased in Russia. Honduras is the only Latin American country
to have reduced infections. Almost 85% of countries have increased the
proportion of people with access to treatment, but the rate of
infection is outstripping supply. Progress has been made on reducing
malaria. Likely to be met? Targets for HIV infection rates and
treatment won't be met, although there are indications the latter
could be reached by 2020. The target on malaria could be reached with
more funding. "I messed around with heroin for three years but I
didn't share needles with anyone," he recalls. "As for girls, back
then it was a different one every week. We never used contraception.
What for? I thought, 'She's got nice hair, clean skin, she's healthy,
right?'"

Now 34, Kropinov, a tall, handsome man with a sculpted face, is one of
an estimated 1 million people in Russia infected with HIV.

His story of survival is a triumph of will power rather than heroic
intervention by outside forces. For while the country has resources
and hi-tech equipment for tackling Aids, critics say a series of
strategic mistakes has led to an explosion of the disease in Russia.

Eastern Europe and Central Asia have the fastest growth rate of HIV in
the world and Russia accounts for between 60% and 70% of the epidemic.
While India and some Africa countries have the largest populations of
people living with HIV, the amount of new infections in these places
each year has stabilised or dropped. By contrast, the epidemic in
Russia peaked in 2001, dipped, and has risen steadily since 2004. Last
year there were 58,448 new cases of infection, up 8% on 2008. Early
figures for this year show no halt in the increase.

The millennium development goals laid out in 2000 called for universal
treatment for people with HIV/AIDS by 2010 for all those who need it,
and a reversing of the spread of the disease by 2015.

But, says Joost van der Meer, executive director of AIDS Foundation
East West, a Dutch NGO, "Russia is totally failing to meet the MDGs.
Bringing the epidemic to a halt is still a distant dream, and
reversing the spread of HIV is… well, perhaps more realistic for the
next millennium if things continue as they are."

Experts believe the sharp growth rate in infection has concrete
origins. About two-thirds of people get HIV via injecting drug use –
sharing dirty needles – but harm reduction measures, such as
organising needle exchanges, are left to NGOs, whose coverage is
patchy at best. Opiate substitution treatment to wean people off
heroin, using substitutes such as methadone – recommended by the WHO –
is illegal in Russia. And high-risk groups like migrants, prisoners
and sex workers are widely ignored by government programmes. Outreach
– attempts to bring people like heroin users who are afraid of
authorities into health facilities – is practically non-existent.

Kropinov only found out he had HIV when he decided to give up the
family construction business in the Kaluga region, in western Russia,
and applied to become a policeman. "They sent some blood samples to
the local Aids centre. When the third one in a row came back positive,
I said: 'Listen, doc, I'll give you money, just write that I'm clean.'
I thought I could buy my health."

For a while it seemed he would go off the rails. He drank solidly for
a fortnight. He sank into depression. Yet, eight years on, Kropinov
has clawed back a stable life. He is a successful businessman, a
husband and the father of a healthy four-year-old girl. It began when
he set up an organisation called We Shall Live! for people infected
with HIV in Kaluga, through which he met his wife, Vika. Today he is
the deputy head of a countrywide union of such groups, and is based in
Moscow.

NGOs – largely funded by international donors like the Global Fund to
Fight Aids, Tuberculosis and Malaria – have plugged enormous gaps.
State health services have strengths: Regional Aids centres provide
high quality HIV testing, mother-to-child transmission of HIV is
efficiently prevented, and blood quality is good. Yet state provision
is heavily weighted towards medical care.

Drug addicts undergo detox at "narcological clinics" but up to 90%
slip back into dependency. "We all know physical addiction can be
overcome, it's psychological addiction that's harder to break," says
Pavel Aksenov of Esvero, a network of organisations that aims to cut
HIV-risk behaviour among injecting drug users. "In Russia there's no
network of social services to make sure people don't relapse once
they're clean." Esvero meets the need by providing "client managers"
who advise on counselling and rehabilitation.

Russia has not ignored HIV. In 2007, the then president, Vladimir
Putin, announced the federal HIV/Aids budget was being increased to
$445m (£286m) - a 57-fold increase on the allocation for 2005.

Yet the emphasis is on paying for treatment and "propaganda of
healthy lifestyles". Denis Broun, the Moscow-based director of UNAIDS
for Europe and Central Asia, says the priorities are wrong.

The lack of prevention measures targeting high-risk groups is the
biggest problem. No money was allocated for it in the federal budget
this year. Zero." HIV prevalence among injecting drug users in western
countries is 1 or 2%, but lack of outreach work, he says, and the
absence of opiate substitution and other harm reduction measures mean
the figure is 16% in Russia – rising to 60% in hotspots such as St
Petersburg.

"Also, what we see now more and more is an increase in sexual
transmission of HIV, mostly among the wives and partners of drug
users," says Broun. That brings a growing threat of the epidemic
crossing into the general population, where it will be impossible to
contain. Advice on condoms for sex workers has been dramatically
reduced.

Meanwhile, the goal of providing universal treatment by this year is
unfulfilled. While the government plans to ensure 70,000 people with
HIV get antiretrovirals this year, the UN estimates that could be less
than a quarter of the number requiring treatment.

Distribution of the medicines has been plagued by glitches, leaving
many patients without their drugs. "Our newsletters are full of people
from different regions trying to exchange supplies," says Aksenov. "If
you stop taking antiretrovirals for just a few days then resistance
can build up and they become redundant. We are talking about lives at
risk."