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Thanks to pressure from advocacy groups and Russia's foreign partners, this is changing. Russia is allocating $1 billion to AIDS treatment and prevention over the next five years -- a vast increase. Top officials, including President Vladimir Putin, have begun to say the word "AIDS" in public.
This has happened none too soon. With about 1 million people with HIV, Russia has the largest AIDS epidemic in Europe and one of the fastest-growing in the world. So far, Russia has addressed that through what has amounted to police tactics: mandatory testing, heavily censored prevention programs, and woefully inadequate treatment.
AIDS activists decided to stage a demonstration thanking the president for his newfound commitment. The same people who chained themselves to government buildings to demand access to treatment were now going to come out with banners that said, "Thank you, Mr. President." They were going to hold the rally on World AIDS Day. It was banned.
The rally was probably banned because the Moscow city government has banned all public demonstrations in the week leading up Sunday's City Duma elections. The ban is not only blatantly unconstitutional but also highly symbolic: It stands to reason that in today's Russia people would be prevented from expressing their opinions publicly before expressing their opinions in the voting booth. And the ban on the rally is doubly symbolic.
The point of the rally, as the organizers had planned it, was not only to thank the president: It was also to show him, and the media, that AIDS activists were watching. The message was: We will do everything to ensure that the $1 billion does not settle in the pockets of corrupt ministry officials, does not turn into kickbacks paid by drug or distribution companies and, generally, does get spent efficiently. In other words, the AIDS activists wanted to pledge to do what civil society does: make sure the government does its job.
The existing Russian system of AIDS centers is not designed to address the epidemic efficiently. Its focus tends to be on two things: compulsory testing, which international health authorities have deemed virtually useless, and selective treatment. In the roughly nine years since effective HIV treatments first became available, AIDS centers have designed elaborate systems for keeping people out. They refuse to treat anyone who may be unable to stick to a strict medicine regimen -- and that generally includes current as well as former drug users.
If the money materializes, the AIDS centers might have to seek out people to treat. Then they would have to do something they have never done: ensure that people adhere to a course of treatment even if they are not well equipped to do so. The risk is huge: If a person with HIV stops taking his medicine, the virus will likely mutate into a form resistant to current treatments. Then this person may pass the resistant form of the virus to others. The number of infections that are resistant to all current therapies is growing at a shocking rate in Russia. Some estimates place it at 25 percent of all new infections.
AIDS activist organizations would be a perfect asset for state AIDS centers in their efforts to develop a new approach to the epidemic. But then they would have to be allowed to perform their civil-society function. That seems an unlikely prospect in Russia today.
Masha Gessen is a contributing editor of Bolshoi Gorod.
