Russia should increase HIV prevention efforts targeted at IDUs, UNAIDS Executive Director Piot says

May 6 2008

Russia should increase efforts to address HIV/AIDS among injection drug users to slow the spread of the disease, UNAIDS Executive Director Peter Piot said on Saturday during a conference on HIV/AIDS in the former Soviet Union, Reuters reports. According to Reuters, the former Soviet Union has the third-highest number of people living with HIV/AIDS worldwide.

IDUs account for about 80% of people living with HIV/AIDS in the region, and about one-third of IDUs in Uzbekistan are HIV-positive, Reuters reports. The region has "ploughed millions of dollars" into HIV prevention and treatment programs, and the number of new annual HIV cases decreased from 210,000 in 2001 to 150,000 in 2007. However, there has been a 150% increase since 2001 in the number of people living with the virus in the region to about 1.6 million.

Russia has not invested in methadone clinics or needle-exchange programs to help slow the spread of HIV among IDUs, according to Reuters. In addition, HIV-associated stigma is still widespread in the country. Piot said that the "big difference" between HIV epidemics in the former Soviet Union and other regions is that injection drug use is "so widespread" in former Soviet countries "compared to other countries in the world." Piot added that although the region is "on the right path, the right trajectory," it "is at a critical point," and "some difficult decisions have to be made."

At the conference, Piot also noted an increase in the number of women living with HIV/AIDS who are not IDUs or commercial sex workers -- a group previously considered less vulnerable to HIV. Women accounted for about 40% of new cases in Russia and Ukraine in 2007, nearly double the percentage in 2000, Piot said. "The question for me is: Is this the beginning of the generalization of HIV, is HIV getting out of the classic high-risk groups?" Piot asked (Kilner, Reuters, 5/3).

Russia Not Prepared To Implement Drug-Substitution Programs, Health Official Says

In related news, Gennady Onishchenko, Russia's chief public health officer, on Monday said that the country is "not ready" to implement some HIV-prevention measures related to drug use. According to Onishchenko, regulations are not sufficient enough for some initiatives, such as methadone replacement therapy for heroin users, to run properly. He added that he is "not convinced" about the efficacy of substitution therapy, which is illegal in Russia under current regulations. Even if such programs were effective, the clinics would "turn into shops for drugs" because of inadequate law enforcement, Onishchenko said.

However, Craig McClure, executive director of the International AIDS Society, said that there is much scientific evidence that supports the effectiveness of substitution programs. He added that such programs "could have a dramatic impact if implemented properly." In addition, Michel Kazatchkine -- executive director of the Global Fund To Fight AIDS, Tuberculosis and Malaria -- said that substitution therapy is a serious matter and should not become a political issue. "You have countries that are moving in the right direction ... and others that do not move," he said, adding, "Russia is like an isolated island. Where [injection] drug use drives over 60% of the epidemic, you cannot afford not to have a comprehensive approach."

Some advocates also said that Onishchenko's comments reflect the attitudes of the Russian government and overall population. According to Kazatchkine, few members of the country's national legislature or dominant political party support substitution programs. He added that the Moscow government is conservative in its methods of addressing HIV/AIDS. "There is a basic lack of political support," Kazatchkine said. In addition, there is widespread stigma and discrimination against IDUs, according to Onishchenko.

However, some advocates and officials say there has been some progress in Russia. Myths about HIV/AIDS are being addressed through measures such as television advertisements, McClure said. In addition, Russia has pledged about 9.3 billion rubles, or $392 million, for HIV/AIDS efforts in 2009 -- more than 20 times the amount spent in 2005. "The money is enough," Kazatchkine said, adding that the "question is whether the money is spent on the right things" (Nowak, AP/Google.com, 5/5).