Health Special

AIDS in Russia

AIDS is a word that we Westerners have largely grown bored of. Amidst reports that the number of HIV-infected people in our countries has stabilised, or is even falling, we have convinced ourselves that the problem is over. But what about Russia? We hear all sorts of stories about a very alarming situation in terms of the numbers of people HIV-infected. But what is the official view and how does the attitude to treating people differ from that in our own societies? PASSPORT talks to Deputy Health Minister, Veronika Skvortsova

Deputy Minister, the western press has reported that AIDS is rampant in Russia. The New York Times, the BBC and other western news agencies have reported over the past few years that the AIDS epidemic is out of control in Russia. What is the actual situation here?

First of all, I’d like to say how we get our figures. Between 22 and 25 million people a year are tested for HIV positive, which is about 16% of the population. HIV positive tests are taken by pregnant women, registered addicts, blood donors and many other groups on a compulsory basis. Other groups, such as people working in the sex industry are tested on a voluntary basis. So we actually have a pretty clear idea about what is happening. There was a large increase in the number of infected people from 2005 to 2008, but after that the growth rate has tailed off, and there was a zero growth in the total number of infected people between 2009 and 2010.

The Times reported that at least 60% of new cases were spread by intravenous drug use, and a good portion of the rest of the new cases were the result of sex with drug addicts. Are drug addicts still the main vehicles for the spreading of AIDS in Russia?

Yes of course drug addiction and drug addicts are the main reason that AIDS is being spread in Russia. This is a very tough problem for our country, and has been for some decades now, ever since the time of the hippies. In June 2010 President Medvedev set out the official anti-drugs strategy up until 2020. The strategy involves coordinating the work of whole range of government bodies: the police, the ministries of health and social development, education, sports and tourism, voluntary organisations. It is also important to work with international organisations which are working to cut down drug trafficking and cooperate on curtailing the drug industry internationally. I am the chairwomen of a Russia-USA committee, and I can tell you that there are many similar problems in these two countries. In Russia we are adopting a holistic attempt to come to grips with the problem. Cutting down on demand is as crucial as cutting supply.

Is such wide-scale cooperation between government departments possible?

It is already taking place.

A simple thing like making sure that syringes are freely available to drug addicts seems to have turned around the problem in many some Western countries. But in Russia, drug addicts are marginalized and do not feel confident talking to the authorities about their problems. The attitude seems to be that they are sick, but also that they are weak and guilty of letting society down. Should this attitude be changed, and if so, how?

The results of the programme of supplying free disposable syringes, in those parts of the country where the programme was introduced, turned out to be negative. The level of HIV infection actually grew, dramatically. Obtaining disposable syringes in Russia actually isn’t a problem at all, syringes and needles can be bought in any chemist very cheaply with no questions asked. Our experience shows that supplying syringes is actually indirect way of showing society’s approval of drug using. Traditionally, Russians treat drug users as sick people, and are not too inclined to suddenly show their approval of their activities by offering them free syringes and so on.

In other countries, methadone and buprenorphine have long been recognised as “substitute” maintenance drugs to treat addicts. But in Russia there seems to be an ideological opposition to the use of these substances. What is the current situation, is Russia running an effective anti-drugs campaign?

Addiction is a requirement of the human brain, people show addiction to many things right from childhood, for example to computer games. However physical dependence on drugs leads to disintegration in both a mental and physical way, and the effect snowballs. How did it all start? Originally, there was opium, then in the middle of the 19th century morphine was created as a derivative of opium, then a little later, in 1874, a stronger drug, heroin, was created from morphine. Methadone and buprenorphine are both synthetic opiate substances created in the 20th century, containing derivations of heroin. In our opinion it is counter-productive to cure addicts by giving them more opium- related drugs. The overwhelming majority of our specialists do not agree that you can cure addiction by using these drugs.

In Russia, we see that there is more drug taking where there is more drug dealing. There is a direct correlation between supply and demand. At the same time, the more we cut demand, the less trafficking goes on. So it comes back to creating the basis for a healthy way of life, from a very early age onwards. Our programme includes both medical and non-medical methods, and has three aspects: primary care which covers social aspects. For example, free psychological testing for children and special treatment where necessary. I cannot emphasise the importance of the family enough, the importance of having both a mother and a father around. For children from broken homes, it is vital that they find role-models for themselves. It might be a teacher or a trainer. It is really important to build up the emotional strength of children so they can withstand the onslaught of drugs. Secondary care is concentrated on people who use drugs from time to time, and the third kind of care concentrates on the treatment and rehabilitation of drug addicts. This involves detoxification, easing the psychological and physical dependence on drugs, rebuilding psychologically damaged personalities and so on. This is not so different from what goes in European and American rehab centres. To do this, we consider it vital to carry out pathological treatment involving complete denial of any narcotic substances. We do use special medicines to help us in this, but not methodone or buprenorphine.

That sounds very good, but it also sounds rather Soviet, as if you are going back to strict disciplinarian methods in the schools. Do they work in today’s world?

We don’t want to return to the Soviet school system, because it was not all good. In particular, it did not provide for enough development of the individual. But we do want to protect our children and provide them with all the opportunities they need to realise their talents. Together with the ministry of education we are already starting to implement special social programmes in some schools. Also vital is to increase extra-curricular activities to help character development. We are finding that this kind of approach is really effective. Over the last 10 years the number of infected 15-20 year olds has decreased 11.2 times, to only 2.2 % of the total HIV infected population.

“Our experience shows that supplying syringes is actually indirect way of showing society’s approval of drug using. Traditionally, Russians treat drug users as sick people, and are not too inclined to suddenly show their approval of their activities by offering them free syringes and so on.“

But drug takers are not just school children, the majority are already adults. In 2010 we started to set up Health Centres where anybody can come in off the street and have free blood, cardiac and other scans. These are paid for by the compulsory medical programme. In parallel, we are developing secondary care programmes, for example providing information and medical care for people working in sex industry are incredibly important. The circles of people we are talking about are fairly closed, they aren’t exactly disposed to sharing their secrets with anybody, so the people who implement these programmes, have to be incredibly tactful, otherwise they will never gain addicts’ emotional trust. And it is vital that our government creates the necessary infrastructure so that health centres and labs for anonymous HIV testing appear in every corner of the country. Of course with a country this large, in a country with 83 different regions, there has to be some flexibility in the way policies are implemented according to the local environment. Yes, we do have a programme and it is working.