A head-in-the-sand approach shows an appalling disregard for an unfolding human tragedy, write Cristina Galvin and Murray Feshbach.
The burgeoning epidemic of HIV/AIDS in Russia received little attention at the recent 15th International AIDS Conference in Bangkok, which almost exclusively focused on Africa, Asia and the Caribbean. Yet, since the early 1990s, Russia has seen a substantial increase in HIV infection, with rates now among the highest in the world.
While official statistics (Jan 2004) put the figure at 265,296, the actual numbers living with HIV/AIDS is estimated to be three to five times higher. Prof Vadim Pokrovskiy, head of the Federal AIDS Centre in Moscow, believes the real number exceeds 780,000, which suggests a per-capita total surpassing that of the US.
An age breakdown reveals disturbing trends. Eighty per cent of officially identified cases involve young people aged from 15-29 years, with up to 8 per cent infected in some regions. Although intravenous drug use has been the primary mode of transmission, in recent months there has been a significant rise in heterosexual transmission of HIV - from 3 per cent of all cases in 1996 to 17.6 per cent in 2003.
Incidence of STIs (sexually transmitted infections) remains high among younger age groups, and since the presence of such infections increases the risk of HIV transmission by three to five times, there could be serious consequences for the health of future generations. Given that HIV is a debilitating and incurable virus, disproportionately affecting cohorts of working age, the costs to society in social and economic terms alone will be substantial.
According to UNAIDS (Joint United Nations Programme on HIV/AIDS), the crisis will lead to an acceleration in population decline and a four-year drop of life expectancy for Russian men by 2015.
President Putin plans to double Russia's GDP by 2010. However, as a recent World Bank report warns, without a scaled-up response to the crisis, premature morbidity and mortality, due to HIV/AIDS among adults of working age, could reduce annual GDP growth by up to 4.15 per cent by 2010 and 10.5 per cent by 2020.
In the absence of drug discounts, Russia will need to spend up to $500 million on treatment alone if it is to cope with the problem of HIV. While Ukraine successfully negotiated price reductions for generic drugs, the Russian government has been slow to follow suit. According to Prof Pokrovskiy, treatment for HIV costs a minimum of $700 a month - $9,000 a patient a year - posing a significant burden on an already overtaxed health system. Under the current budget, only 1,200-1,500 patients can access treatment, a small fraction of the estimated 50,000 who require it.
Russia is not alone in its reluctance to acknowledge the problem of HIV/AIDS. Many countries have waited until large numbers of people started to die before taking action. Such denial is obviously dangerous. Firstly, it ignores the serious "undercount" of AIDS deaths in official statistics.
Because the WHO international AIDS classification system is rarely employed in Russia, and HIV-related deaths are registered only under specific opportunistic infections, the actual total is invariably much higher than records show.
Secondly, HIV has a long period of latency. While death rates may appear "low" now, growing HIV incidence means an increase in the number of deaths soon.
Many analysts believe that Russia stands now where South Africa did 12 years ago and that without intervention, the number of people infected could rise to anywhere between 5.4 million and 14.5 million (or 2 per cent and 10 per cent of the population), with an average of 200,000 deaths a year beginning in 2010.
As in the West, stigma also has hampered intervention. While recent reforms to repressive drugs legislation are to be welcomed, it will take much more to change entrenched intolerance towards drug users, sex workers and other supposedly "marginalised" and scapegoated groups.
The institutionalised attitude that HIV is a problem of "deviant" expendable groups, "people who do not wish to live anyway" as one health minister recently put it, suggests that until the "right" kind of people start dying, the government will not take notice.
Research shows, however, that drug use is far from being a marginalised activity and that intravenous drug users and sex workers are not an identifiable "group".
The UN Office for Drug Control estimates that 2-3 per cent of the Russian population aged 15-64 uses drugs and that 2 per cent of this total, or about 1.5 million people, are classified as "addicts", with the majority injecting heroin. This does not constitute a marginalised group.
There is, therefore, no justification for the absence of high-level political commitment to tackle the crisis of HIV/AIDS in Russia. When set against vast gold and foreign currency reserves of $88 billion, the doubling of the federal AIDS programme budget this year from $4 million to $8 million can only be described as derisory.
If the government made a decision, as Brazil has, to direct even $1 billion to the HIV/AIDS programme, the epidemic could be halted. In Brazil rates of new infection are now declining. The comparison is pertinent as both countries have essentially the same standard of living, the same GDP and the same sized population.
The many AIDS prevention and harm-reduction projects operating in Russia exemplify what can be done, and can be used as an effective tool to lobby government for increased support. However, the current budget will not influence the course of the epidemic. Without an immediate, accelerated and significantly scaled-up response by government and other agencies, AIDS risks undermining, and even reversing, Russia's prospects for economic growth and human development.
According to a recent UN report, if current predictions on the detrimental impact of HIV/AIDS for Russia's economic growth materialise, in 20 years Russia could "lag further behind the most developed countries, including neighbouring China and even India". Russia's epidemic represents a public health crisis of unparalleled proportions, with the potential to undermine development, social cohesion, political stability and national security across the region.
The head-in-the-sand approach within Russia itself and at the Bangkok conference, is deplorable and represents an appalling disregard for the human tragedy unfolding in the country.
Cristina Galvin and Dr Murray Feshbach work with the USAID Research Project HIV/AIDS Russia/Ukraine. (The views expressed do not necessarily represent those of USAID)