In Response to ‘Is Russia’s HIV/AIDS problem worse than Africa’s?’

September 17, 2010

Posted by Slava Kushakov

Alliance Regional Representative: Eastern Europe & Central Asia

Russian influence over Ukraine’s economic, cultural, and political life is difficult to overestimate. Difficult… but not impossible…

The recent Foreign Policy article posted by Elizabeth Dickinson on 8 September conflates Russia’s appalling track record on HIV with Ukraine’s and that of the whole of Eastern Europe and the Central Asia region.

All the data and quotes included in the article relate specifically to Russian Federation or its specific parts, and the mentioning of Ukraine at the beginning of the article seems to be an unfortunate misprint.  

Russia is indeed pushing Ukraine to revert to the archaic responses to HIV and drug use still widely practiced in Russia. The Ukrainian law enforcement structures are particularly susceptible to the ‘progressive’ practice of the old good neighbor, and with the recent warming of the relationship between the two countries this is increasingly felt by HIV/AIDS practitioners. The Russian supply of ‘best practice’ includes coercive drug policies and barbarous drug treatment, unfocused HIV prevention interventions targeting everyone but the most vulnerable and affected populations, denial and artificial obstacles to evidence based HIV prevention approaches including needle exchange programmes and substitution maintenance treatment of drug dependency. The latter has been long considered in the developed world (more recently including the US where the treatment is called MAT – medication assisted treatment) to be the most effective treatment of opiate dependency as well as one of the most effective prevention interventions targeting drug users. In Russia MAT is illegal, but in Ukraine over 5,000 people receive this therapy, which is also vital in ensuring access of people with drug problems to life saving AIDS treatment.    

The Russian handling of the drug problem, inherited from the Soviet times, continues to inspire the relapse of Ukrainian law enforcement into the outdated and counterproductive models of work. The recent imprisonment of one of the leading clinicians who significantly contributed to the development of MAT in Odessa, as well as the recent letter prepared by the internal security department of Ukrainian Ministry of interiors demanding that international organizations withdraw their support of MAT in Ukraine, are believed to relate to such inspirations.

At the same time since the mid 90’s Ukrainian response to HIV was becoming more and more dramatically different from that of Russia. The National Law on AIDS and the national AIDS Programme include most of the evidence based interventions required to contain the epidemic. Thanks to the OSI, USAID, Global Fund and a range of other donors the Ukrainian response has a significant focus on populations that remain the most significant to the epidemic dynamics including injecting drug users (IDUs), sex workers, men having sex with men, prisoners and vulnerable youth.              

One of the factors that protected the Ukrainian response from Russian influence was the unprecedented involvement of the non-governmental sector and the affected communities. HIV prevention in particular has been developed almost exclusively by non-governmental organisations. Major programmes funded by the Global Fund, US government and others are also implemented by NGOs. Ukraine has the most organized and outspoken network of people living with HIV in the region. The All-Ukrainian PLHA Network is represented in the National AIDS Committee and other national and provincial level structures designing HIV/AIDS programmes. The Network is also a co-manager (together with the International HIV/AIDS Alliance in Ukraine) of the large scale $100M programme supported by the Global Fund.  It was the Fund’s earlier investment that led to the break-through in AIDS treatment and which has also been managed by the Alliance in close partnership with the Network and the National AIDS Centre (a structure of the Ministry of Health).

Deployment of evidence based HIV prevention and care approaches is associated with the recent signs of improvement in Ukraine’s epidemiological situation. “After 10 years of significant growth, the amount of new officially recorded HIV cases slowly but constantly goes down. These decreases have more than doubled among IDUs with a recent history of drug injections”[1]: results of sentinel surveillance in 8 Ukrainian cities demonstrate a decrease in HIV prevalence among recently initiated drug users from 29.9% in 2004 to 17.7% in 2006 and further to 11.2% in 2008. Although from 2008 transmission of HIV through injecting ceases to be the main route of HIV transmission in Ukraine, the observed increase in sexual transmission is closely related to sexual behaviour of IDUs and their sexual partners. IDUs remain the most significant population in the further development of the HIV epidemic.

Stressing the similarities between Russia, Ukraine, and other countries of the region does not seem to be particularly productive. The differences are significant both in the responses to HIV and in the actual contexts and drivers of the epidemic. Even the illicit drug supply reduction measures required in Ukraine are different from those in Russia and have nothing to do with the Russian interests in Afghanistan, as the bulk of the drugs injected by Ukrainians is produced locally and from local raw material. In the interest of improved responses to HIV, highlighting the differences in order to be able to differentiate between failures and successes so that this learning could be disseminated across the region appears to be more productive. Russia has a lot to learn, not just from Nigeria and China, but also from its immediate neighbours.

Ukraine in turn needs protection of its responses to HIV from the Russian influence and requires a lot of support from the international community rather than being thrown into one basket with Russia.

[1] Yves Souteyrand, Strategic Information Coordinator in the WHO HIV Department speaking at the opening of the 18th International AIDS Conference in Vienna.

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