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MITISCHI, Russia -- In a dingy basement
on an all-but-hidden side street in this industrial Moscow suburb,
Dmitry Blagovo is waging a lonely war against a problem that could
ultimately dwarf all others in post-Soviet Russia: HIV-AIDS. Blagovo, himself a recovering addict, is a combination counselor/therapist/cheerleader/construction foreman as he tries to transform a dilapidated and long-closed pharmacy into an outreach center for drug users. The program he runs, sponsored by the Moscow anti-AIDS group Return to Life, is one of only a handful in Russia to not only go into the streets to offer addicts help, but also to provide clean needles. In a country in which drug treatment and AIDS prevention efforts by the government are virtually non-existent, addicts find people like Blagovo almost too good to be true. ''Drug users in Russia,'' he says, ''have a great deal of difficulty believing that anyone would actually want to do anything good for them.'' Local authorities have gradually accepted Blagovo's efforts but initially were suspect, given the Russian government's policy of treating all drug users as criminals and providing microscopic funding for treatment and education efforts. AIDS experts around the world say that attitude has to change -- and fast -- if Russia is to have a chance of avoiding a full-scale epidemic that could devastate a country still struggling with the seismic economic and social changes forced upon it by the collapse of the Soviet Union. A United Nations report released in February warned that AIDS, fueled by the availability of cheap heroin from nearby Afghanistan, is now spreading faster in the former Soviet Union than anywhere else in the world. The study said one in 100 adults in Russia now have the virus, an infection rate that trails only sub-Saharan Africa and the Caribbean. Spread of the disease could dramatically increase Russia's already alarming population decline and reduce gross domestic product by as much as 1 percentage point a year, a significant hit. Every hour in Russia, five people are infected, according to U.N. figures. ''The warning bells are ringing louder and louder,'' says Flavio Mirella, a Moscow officer for the U.N. Office on Drugs and Crime. ''If there was more outspoken denunciation of this epidemic from the highest levels of government, everything else would follow.'' But thus far, despite the ominous numbers in the U.N. report, there are few signs that the government of President Vladimir Putin is taking the AIDS problem seriously. Russia, which reported just 163 new cases of HIV infection in 1994, had an estimated 1 million people with the virus at the end of 2003 -- a dangerous progression the U.N. report warned could result in 9 million deaths by 2045. Some reasons for the HIV-AIDS explosion, according to U.S. and U.N. experts: * As many as 80% of Russia's HIV-AIDS
cases are drug-related, but Russia still has a tiny federal budget for
drug treatment. It has only 59 government centers for as many as 4
million intravenous drug users. What little treatment there is works
primarily on a medical model that tries to detox the addict but offers
little follow-up or behavioral counseling. Private 12-step recovery
program such as Narcotics Anonymous exist but are not widespread.
* Soviet-era curbs on virtually all controlled substances remain in force, making substitution therapy for addicts almost impossible. Methadone, a heroin substitute widely used to treat addicts in the United States and other countries, is illegal in Russia. * About 20% of Russia's AIDS cases are in prison populations. U.N. experts say that argues strongly against the rigid criminalization of all drug infractions, which puts even more AIDS carriers behind bars. A key theme of the U.N. report is that Russia needs to stop stigmatizing population groups that have high AIDS infection rates, such as drug addicts and commercial sex workers. That just drives those people underground and makes it harder to get control of the AIDS epidemic. Marta Ruedas, deputy director of the regional bureau for Europe and the former Soviet Union for the United Nations Development Program, said in an interview in New York that the study found a ''direct causality between the seriousness of the AIDS crisis and the degree of respect given to human rights.'' Russia's prisons have few AIDS treatment programs except for pilot projects funded by foreign grants.* While Russia's economy has seen solid
growth for the past five years, the country's social service and
medical facilities are in a shambles, stretched thin from dealing with
widespread problems with tuberculosis, venereal disease and alcoholism.
* Russian government funding to fight AIDS is about $4 million; $3 million of that is allotted for treatment and $1 million for prevention. Given that anti-AIDS drugs cost from $5,000 to $13,000 annually per patient, that budget would pay for medicine for 600 patients per year, at best. AIDS treatment is free in Russia to those who qualify but is strictly limited. In Moscow and St. Petersburg, proof of city residency is required and anyone who shows signs of drug use runs the risk of being arrested. * Putin has said almost nothing about the AIDS problem beyond a phrase in his annual state of the nation address last year. In that speech, in reference to Russia's declining life expectancy, Putin said: ''The spread of so-called new epidemics is aggravating the situation, including drug addiction and AIDS.'' U.S. officials, both here and in Washington, say President Bush raises the issue whenever he meets with Putin. But while diplomats say they see some hopeful signs, they remain uncertain about whether Putin takes the issue seriously. ''Up to now, I am not sure that our president knows enough about HIV-AIDS,'' says Vadim Pokrovsky, Russia's top AIDS researcher. ''There hasn't been a clear speech or phrase that allows us to say that our president understands HIV-AIDS problems. Only a very few times, maybe once or twice, he has mentioned it in his speeches.'' Soft-spoken but internationally recognized for his expertise, Pokrovsky heads the government-funded Russian Federal Aids Center, but he seems almost resigned to continuing bad news for Russia on the HIV-AIDS front. Gennady Onischenko, Russia's chief health officer, agreed to an interview with USA TODAY in Moscow, but canceled it the evening before because of sudden travel plans. Signs of progressThere are more hopeful signs from the international community. The World Bank last year agreed to loan Russia $150 million to fight AIDS and tuberculosis. The Global Fund to Fight AIDS, Tuberculosis and Malaria -- the creation of U.N. Secretary-General Kofi Annan but funded by countries around the world -- has awarded a nearly $90 million grant to five non-governmental organizations in Russia.The Russian government is currently drafting another, even more far-reaching grant proposal for the Global Fund. And the United States, which has provided more than $21 million in AIDS treatment and prevention funds to Russia since 1998, would increase its annual anti-AIDS funding for Russia to more than $8 million under Bush's 2005 budget proposal. The administration gave $6.8 million last year.''It is a significant improvement for prevention,'' Pokrovsky says. ''But of course, it is necessary to get more money and the main source is that state budget. We need to influence our parliament to give us more money.''For that to happen, diplomats and AIDS experts are adopting a two-part strategy. The first is to go directly to Putin in every way possible and try to convince him that, if nothing else, AIDS poses a potentially catastrophic economic risk for a country just beginning to emerge from 70 years of communism. For example, Western investors, a key to Russia's continued economic growth, are sounding alarms. ''It has not yet reached the point of becoming an economic concern, but is on the horizon,'' says Blake Marshall, executive director of the U.S.-Russia Business Council in Washington. ''It's a crisis and it threatens to become a pandemic.'' A U.S. official at the forefront of anti-AIDS efforts here, speaking on condition of anonymity, says he sees growing signs that the Russian government's attitude of ''denial'' about AIDS is waning. ''There are a lot of efforts to get closer to (Putin), to bring this message home,'' says Mirella, the Moscow representative of the U.N. Drug and Crime Office. ''The learning curve is very much increasing in this country. We will have more people on board.'' The second part of the strategy is to continue the momentum being built by foreign donors and through the efforts of average Russians such as Blagovo in Mitischi, a working-class city that seems to attract sex workers and drug merchants. The Return to Life project, which includes nighttime visits to areas frequented by drug addicts with a bus filled with anti-drug literature and clean needles, has been put in place through a partnership between the group, the U.N. Development Program and the Mitischi ministry of health. U.N. officials say local government representatives in Mitischi were unusually open to taking tough measures against AIDS, possibly because of the city's longtime problems with the virus and widespread drug addiction there. Their decision to reach out to addicts in the streets was controversial but has already shown results. ''For a long time we worked and dealt with only those who came for help,'' says Vladislav Kalyagin, Mitischi's head narcologist. ''We were in the office and the door opened and if a person applied, we helped him . . . but we had never dealt with clients in the streets.'' 'Psychology is changing'The new approach initially alarmed the community. ''At first, we had problems,'' says Faina Guskova, an adviser to the Mitischi city administration. ''People were very reluctant to admit us to schools. The topic was forbidden, particularly if it concerned HIV infection. But now, they've become interested in it and the teachers themselves ask us to come. I guess the people's psychology is changing.''Blagova agrees, saying that even the local police now don't interfere with the group's efforts. ''They hassled us for about six months until they figured out we weren't going out into the streets to sell drugs,'' he says. ''After that, they seemed to decide, 'These guys are OK.' '' Health officials around the world hope a similar conversion takes place within the Kremlin. ''The United States made some critical mistakes in our early response to the spread of HIV-AIDS in our own country,'' U.S. Deputy Chief of Mission in Russia John Beyrle told a meeting of the TransAtlantic Partnership Against AIDS in Moscow last month. ''Too many people mistakenly assumed in the United States in the early 1980s that HIV-AIDS only represented a threat to gay men and intravenous drug users, that it wouldn't affect average American families,'' Beyrle said. ''But our sad experience showed that they were wrong. Anyone can contract AIDS. And we are determined to see that our friends and partners in Russia do not make this same mistake.'' Россия начала бороться со СПИДом по-настоящему |
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