(Corrects a story that ran Dec. 21, 2011, changing wording in
paragraph 24 to expand detail on how Russia tackles AIDS)
* This updates a Special Report on HIV in Russia
* For a PDF of that report: link.reuters.com/naq67r
By Amie Ferris-Rotman
MOSCOW, Dec 21 In 2010, President Dmitry
Medvedev said heroin was a threat to Russia's national security.
This year, Russia pledged to finance programmes to reduce the
harm done by drug use, including an HIV crisis that is one of
the most severe in the world.
But even though the number of new HIV infections in Russia
jumped 10 percent over 2011, health workers and global HIV
authorities say Moscow has not honoured that promise. This is
not due to a lack of cash - Russia is doubling its budget for
HIV in 2012 from 2010 levels. At issue is how it will use the
From next year, no money will go to such internationally
recognised efforts as needle exchanges. None has ever gone to
heroin substitution: the Russian authorities oppose it. Moscow
doesn't believe these approaches help slow the spread of
"Working on drug dependency is more effective than needle
exchange and methadone programmes," said Alexei Mazus, who heads
the Moscow Centre for HIV/AIDS Prevention, one of around 100
such venues across the country run by the health ministry.
In areas where needle exchanges have taken place, he said
the health ministry had seen new HIV cases increase, not fall.
Russia's health ministry said last year it had evidence that
HIV rates have tripled in areas where foreign-run needle
exchange programmes were running.
The United Nations says so-called "harm reduction"
programmes - needle exchanges, and using methadone as a
substitute for heroin - are effective in slowing the spread of
HIV. Methadone reduces the risk of infection by dirty needles
because it can be swallowed, rather than injected.
A major WHO study found HIV rates fell more than 18 percent
in cities with needle exchanges, while they rose 8 percent in
areas that did not have them. The British and U.S. governments
both approved needle exchanges in recent drug policies drafted
to combat HIV. But in Russia's drug strategy for 2010-20, heroin
substitutes are banned.
Projects such as giving drug users and sex workers clean
needles, HIV awareness training and medication have been funded
by the United Nations in Russia for the last seven years. Next
year that funding comes to an end and with it, so will most of
Some health workers and global HIV authorities are angered
and baffled by Russia's approach, which they say will only
aggravate the problem.
"When a few programmes were funded and running it was then
difficult to see how things could get worse. Now we know," Damon
Barrett, a senior human rights analyst at Harm Reduction
International in London, told Reuters.
Separated from world no. 1 opium producer Afghanistan by
former Soviet Central Asia, whose borders are porous, Russia has
more heroin users than any other country. Moscow puts the total
at two million, although the United Nations says there are half
a million more, and local non-governmental organizations (NGOs)
say there could be as many as three million.
This year, Russian health officials estimate 62,000 people
were newly infected with HIV, a 10 percent increase on 2010 and
the upper limit of a prediction made last year by the
International AIDS Society. Officially, Russia has had almost
637,000 cases, including over 100,000 deaths in the year to
The UN puts the number of people living with HIV today in
Russia at over a million.
Since 2004, NGOs in Russia have received a grant from the
UN's Global Fund to Fight AIDS, Tuberculosis and Malaria. The
Fund says the $351 million it has provided has reached half a
million Russians. It has supported over 70 harm reduction
programmes across the country. The 20 or so that remain will
stop receiving UN money at the end of this month.
This is for two reasons, says Nicolas Cantau, fund portfolio
manager for Russia at the Global Fund. First, Russia has become
richer, and the Fund's resources can be given to impoverished
countries. For rich countries to be eligible for Global Fund
resources, 10 percent of the population must be infected: South
Africa is the only country in the Group of 20 richest nations to
Russia has been a donor as well as a recipient, and has
given the Fund $265 million up to date. But the Fund now wants
something in return: It says Russia should begin financing its
own harm reduction programmes.
At a United Nations meeting in New York in June, Russia
pledged to do just that from this year. Its deputy health
minister Veronika Skvortsova said Moscow also gave "general
support" to a declaration for "Zero new infections, zero
discrimination, and zero AIDS-related deaths".
A spokesman for the health ministry said Russia has put
aside money for free HIV testing, for the first time ever. But
he declined to comment in detail on why harm reduction
programmes have yet to materialise. "They are not considered
useful in fighting this disease," he said.
Some health workers are incensed.
"As it turns out, they were tricking us," said Anya Sarang,
who heads the Andrey Rylkov Foundation for Health and Social
Justice, a small Russian NGO. "Now we are in the final month of
the year. Have they actually done anything? No," Sarang said.
The Global Fund's Cantau is dismayed. "All the things that
we have done will be lost without further funding," he says. "It
PREVENTION BY COUNSEL
Russia has put aside around $600 million for HIV in 2012 -
double what it had in 2010 - but only 3 percent of this will go
towards prevention. Some money will go to HIV tests, and Moscow
says it also provides free anti-retroviral drugs for all
sufferers of the disease, although the UN says only a quarter of
those in need actually receive them.
No funds will go to needle exchanges. Instead, Russia's
HIV/AIDS Prevention Centres will try to prevent HIV with
anti-drug adverts, and treat HIV with psychological counselling,
as well as various other methods.
Mazus, the head of the Moscow Centre, said HIV sufferers
need to grieve through counselling, which will also prevent them
from passing on the disease to others.
"HIV is a behavioural disease. It's not being transferred in
everyday life. It is not dangerous," he told Reuters.
Such views are scorned by foreign health bodies.
Instead of making good its June promise, Russia has "ramped
up repressive measures known to fuel HIV", said Harm Reduction
International's Barrett. He pointed to the ban on opiate
Concerns have spread beyond health workers. On World AIDS
Day, Dec. 1, a drug-users' network organised protests at 12
Russian embassies from New York to Stockholm to Canberra.
Hundreds of protesters rallied and held candles, some
holding signs accusing the state of murder for its refusal to
legalise methadone, while others held large red banners heaping
shame on Russia.
The protests' coordinator, Erin O'Mara, also editor of
"Black Poppy", a British magazine for drug users, said "the
spotlight was on Russia and its shameful lack of response and
indeed inappropriately aggressive, state-sponsored aggression
towards... people who use drugs".
In Moscow, protesters played funeral music and held up
coffins as they paraded past the health ministry. The ministry
Some foreign health workers in Russia fear its endemic
corruption could make it hard for them to access what funds are
available for HIV prevention.
"It will be very tough to find money. We fear that the
state's funding for HIV will be pre-awarded," said Yelena
Agapova, from the AIDS Foundation East-West (AFEW), a Dutch
organisation set up in Russia 10 years ago.
Like dozens of NGOs in Russia combating HIV, her
organisation has received the bulk of its support from the
Global Fund. It runs mother-to-child HIV [20111221 145945 GMT]
prevention programmes, prison HIV prevention and safe sex
Though its Moscow office will stay in place with a skeletal
staff, it says it will "significantly" downsize its projects
from next year. Only a handful of similar organisations will
continue working once flows from the Global Fund stop over
coming weeks. They will be financed from Western awards and
George Soros' Open Society Foundation.
Harm Reduction International's Barrett says the impact will
be catastrophic: "It is a human disaster that Russian
authorities are willing to watch unfold," he said.
(Additional reporting by Catherine Koppel; Editing by Sara