Alexey Kurmanaevsky has been clean for 20 months. It’s not the longest period the 25-year-old from Kazan, Russia, has been off drugs like heroin, but with his family’s help, the social worker turned lawyer and activist is doing reasonably well. Sadly, however, Kurmanaevsky will always carry a reminder that he was once part of a community plagued by addiction, and dirty needles.
In 2001, Kurmanaevsky was diagnosed with HIV — one victim of a worsening epidemic.
This number, says Vinay Saldanha, UNAIDS’ regional director for Eastern Europe and Central Asia, is the culmination of figures collected since 1987. More than 200,000 Russian citizens diagnosed with HIV have already died, and the Ministry of Health tells OZY there are 742,631 Russians who are HIV positive, with many more who have never been tested. As Saldanha points out, on a global scale almost half of those who are positive are “living with HIV, perhaps even transmitting HIV, but are unaware of their HIV status.”
Major epidemics elsewhere — Zimbabwe, Kenya, Zambia, South Africa, Brazil, India, China — have seen significant improvements as the result of “intensive and successful HIV prevention programs” being put in place, Saldanha says. In Russia, however, the numbers have increased by roughly 10 percent annually since 2006, according to the ministry. This, Saldanha says, means “that either the prevention programs don’t exist, or … they don’t have the coverage and intensity needed.” Even more frightening, Russian Health Minister Veronika Skvortsova has reportedly predicted that if the epidemic isn’t brought under control, the number of those diagnosed in Russia could increase by 250 percent by 2020.
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So what is working? A Russian federal program provides HIV testing and surveillance, treatment of roughly 200,000 people — only 25 percent of those with HIV — and awareness campaigns. The Russian Federation has also successfully lowered the rate of transmission from mothers to children. Saldanha says he’s encouraged by signs that Russia is making a new federal HIV strategy a priority, with demands in place for a new policy by this spring, which the ministry says will include a comprehensive effort to reduce HIV infections and AIDS mortalities. Saldanha is hoping to also see a fast-tracked implementation of a widespread “Test & Treat” program, ensuring all Russian HIV-positive patients begin receiving immediate treatment, and a ramping up of needle exchange programs and other harm-reduction measures for drug users.
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There’s a funding gap for better outreach and treatment, but there’s also a programmatic gap for evidence-based prevention programs highly recommended by the United Nations. Opioid substitution therapy — namely, methadone — is illegal in Russia, despite evidence that it works to treat and prevent the spread of HIV. Liquid or tablet-based methadone eliminates the risk of drug users injecting blood-borne viruses into their systems. For those who are already HIV positive, OST helps them better manage their lives and stay on anti-retroviral treatment, which drastically reduces the risk of them passing the virus to sex partners.
“If I had to pick one thing [for Russia to adopt], it would be substitution treatment,” says activist Anya Sarang, president of the Andrey Rylkov Foundation for Health and Social Justice. Kurmanaevsky is also a proponent of OST, and he’s taking his case for it, and against Russia (alongside two other plaintiffs), to the European Court of Human Rights this year. Kurmanaevsky fears it won’t make much difference, but some are hopeful the court will demand Russia implement OST programs.
Saldanha, for one, remains upbeat. He’d like to see more money, more doctors and a better pill regimen (one pill, not six or nine), and he hopes to help win federal authorities over to the U.N.’s way of thinking with regard to evidence-based programs.
