Although the label “epidemic” prompts denials from some senior officials, experts on the front lines are calling it just that. Those experts don’t foresee change, either, as moral disapproval, political battles and an economic recession combine to stall national action.
ST. PETERSBURG, Russia — Quietly, earlier this year, the number of Russians who have received a positive HIV diagnosis passed the 1 million mark, with little indication that the government will commit adequate resources to stem the acceleration of the virus from high-risk groups into the general population.
About 850,000 Russians carry HIV and an additional 220,000 have died since the late 1980s, said Vadim Pokrovsky, the longtime head of the Moscow-based Federal AIDS Center, who estimated that at least another 500,000 cases of HIV have gone undiagnosed.
Although the label “epidemic” prompts denials from some senior officials, experts on the front lines like Pokrovsky are calling it just that. The number of victims constitutes about 1 percent of Russia’s population of 143 million, enough to be considered an epidemic, they argued. Beyond that, they said that heterosexual sex would soon top intravenous drug use as the main means of infection.
“This can already be considered a threat to the entire nation,” Pokrovsky said, noting that the caseload is increasing by about 10 percent a year. In 2016, 100,000 new infections are anticipated, about 275 daily. It is the largest HIV epidemic in Europe and among the highest rates of infection globally.
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Despite the grim milestone, experts do not expect much change in Russia, where victims still face the kind of stigma prevalent in the 1980s in the West and where continuing trench warfare between the Kremlin and independent nongovernmental organizations saps collective efforts. In addition, some prominent voices push “family values” as the ideal prevention program.
Tensions heightened this year after the Justice Ministry blackballed a number of bantam NGOs involved in combating HIV/AIDS as “foreign agents” because they received grants from abroad.
President Vladimir Putin has remained largely silent on HIV. Overall, activists said, the combination of indifference toward victims, government financial austerity, hostility toward foreign funds and a powerful camp of AIDS deniers all amounts to the lack of a coherent national effort.
Experts criticized a new, rather vague Russian government strategy on fighting HIV that was released in October for lacking a plan of execution or any new money.
Despite that, both sides in the HIV battle agree that Russia has made some progress. The fact that a national strategy exists — as well as an advertising program promoting HIV tests backed by Svetlana Medvedeva, the wife of the prime minister — at least implies some high-level interest.
Under World Health Organization guidelines, to reduce the spread of the disease, at least 90 percent of HIV-positive patients should receive antiviral drugs.
In Russia, a little more than 37 percent receive such treatment, according to government statistics.
“The prevention programs are not working, the coverage is not sufficient to break the curve,” said Vinay P. Saldanha, the UNAIDS regional director for Eastern Europe and Central Asia.
Russia is among five countries that account for almost half the new infections globally; the others are South Africa, Nigeria, India and Uganda, according to UNAIDS figures, although in some of them, a much higher percentage of the overall population is infected.
Most of the $338 million annual Russian federal HIV budget is spent on medicine, and almost nothing goes to preventive education. Veronika Skvortsova, the health minister, has repeatedly called expanding treatment programs a government priority. After a deep recession, however, little new money has materialized.
At the same time, the Russian Orthodox Church and some politicians promote “conservative values” as the best way to combat HIV.
Patriarch Kirill called for “moral education,” stressing that the “establishment of family values, ideals of chastity and marital fidelity” should be at the forefront of curbing the virus.
Both the government and the church staunchly oppose sex education for children.
The state also adamantly opposes methadone for drug addicts, sometimes denigrated as a “narcoliberal” scheme. In other countries, methadone programs are used both to treat and to monitor patients infected by the sharing of intravenous needles.
Compounding the problems, the federal government has tried to silence organizations that challenged its policies, labeling them “foreign agents” for receiving grants from abroad, forcing some to close.
The Andrey Rylkov Foundation for Health and Social Justice, which hands out free needles and condoms in Moscow, now has to staple a small label to its bags saying “Foreign Agent,” as required by law. Recipients said they could not care less, but it means that the foundation cannot work with government organizations.