MOSCOW - AIDS experts urged Russian officials on Wednesday to scrap their abstinence-based strategy for curbing the spread of HIV, saying the country's fast-growing epidemic could be entering a dangerous new phase.
AIDS specialists meeting here urged Russia to adopt successful strategies such as needle exchange programs and heroin substitutes such as methadone for drug addicts.
The calls came in the face of a doubling in the number of HIV infections in Russia in the past eight years and despite evidence that in this region the virus is increasingly spread by heterosexual sex.
The rapid growth of the epidemic in Russia is in contrast to sub-Saharan Africa and South and Southeast Asia, where prevalence of the virus fell during the same eight-year period, according to UNAIDS, the United Nations AIDS agency.
Russia's chief public health officer, Gennady Onishchenko, told a regional AIDS conference Wednesday that Russia is "emphatically against" the use of drug replacement therapy. Meanwhile, he criticized needle exchanges, saying such programs may promote illicit drug sales and HIV transmission.
Robin Gorna, executive director of the International AIDS Society, a group representing health professionals involved in prevention and treatment of the illness, said the only needle exchange programs in Russia are some 75 funded primarily by foreign donors, 22 of which shut down in August after their grants ran out.
AIDS experts said the regions where those programs have operated in recent years have seen slower transmission rates than the rest of Russia.
Michel D. Kazatchkine, executive director of the Global Fund to Fight AIDS, TB and Malaria, told reporters at a news conference that he hoped the Russian government would pick up where the Global Fund left off and keep the programs going.
But Onishchenko, speaking at the same news conference, did not say whether the Russian government would do so.
UNAIDS executive director Michel Sidibe said methadone has proven effective elsewhere and that, despite progress, Russia still faces a growing epidemic. "It's very dangerous," Sidibe said. "We are seeing a huge increase in heterosexual transmission."
What started as an epidemic among male injection drug users in the late 1990s has gradually moved into the communities of sex workers. By 2007 about 44 per cent of new infections in Russia were among women, according to UNAIDS, raising fears it could move into the general population.
Onishchenko blamed the increase in HIV infections to the surge in Afghan poppy production over the past decade, a trend that has flooded the former Soviet Union with heroin.
AIDS activists say that another major factor is widespread stigmatization and discrimination, which drives many people with HIV to avoid testing and treatment. While the UN estimates Russia has 1.1 million people with HIV, the government says it has registered just half that number - a total of 501,000 cases.
The disagreement isn't limited to the count of total cases.
Kazatchkine of the Global Fund said Wednesday that only 23 per cent of Russians who should be receiving anti-retroviral therapy for HIV are getting it. He said most nations are providing such therapy to 35 to 40 per cent of those infected.
Onishchenko called this "strange data," saying that everyone who needs it is getting the drug regimen, except for injection drug users who walk away from the program. "They are receiving treatment unless they escape treatment," he asserted.
Though Russia has adopted federal laws forbidding discrimination against HIV-positive individuals, widespread stigmatization continues, according to a December 2008 United Nations report on AIDS in Russia, Eastern Europe and the former Soviet Union.
People living in the region are routinely asked to provide health certificates that reveal their HIV status, the report found. Hospital workers often casually identify HIV-positive patients to bystanders and co-workers, UN researchers said, and hospitals frequently segregate HIV-positive patients, treat them with scorn or charge them extra, hidden fees.
HIV-positive children face discrimination at school, including forced disclosure of their status and segregation from other students, while in the labour sector, many employers are wary of hiring HIV-positive individuals.
Russia has increased spending on AIDS programs by 33 times since 2006, making it a central part of an ambitious new national health care strategy. It has expanded drug treatment dramatically for AIDS sufferers and is among the leaders in reducing the incidence of transmission of the disease between mothers and their babies.
But many Russian officials view so-called "harm reduction" efforts as encouraging criminal or shameful behaviour, and the government has chosen to promote a just-say-no approach to the epidemic that urges people to adopt healthier lifestyles.
That isn't good enough, a number of foreign experts say.
"International studies show that an abstinence-based message on drug use or sex simply doesn't work," said Gorna of the International AIDS Society. In Russia, she said, "it does appear that ideology is getting in the way of public health care policy."
