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Stopping the HIV Epidemic

The Russian government put itself in the spotlight of the international health community by organizing a high-level forum in Moscow two weeks ago on halting the spread of infectious diseases such as HIV. A goal agreed upon by all member states of the United Nations strives to halt and reverse the spread of infectious diseases, among which are HIV and AIDS, by 2015. Russia positioned itself at that conference as a leader in the battle against HIV.

Indeed, Russia has some things to boast of: Transmission of HIV from mother to child during pregnancy is almost eliminated, and many more Russians with AIDS are receiving medication against their disease than ever before. But HIV in Russia is growing because the government has not addressed HIV transmission in the group where it matters most: intravenous drug users. Nearly 80 percent of people with HIV in Russia got their infection through drug use, and new cases continue to occur among the country’s 1.8 million drug users.

There are evidence-based interventions that many countries have adopted and that lead to demonstrably lower HIV transmission, based on reducing the harm that drug use brings about, including the spread of HIV by contaminated injections. It is important to exchange used needles and syringes for clean ones among users that cannot or will not kick the habit, and it is equally important that those users who want to get clean are admitted to high-quality rehabilitation programs.

True, needle exchange does not cure opiate addiction, as some of our Russian critics argue. But we treat diabetes with insulin and are perfectly happy with this noncurative approach that hugely improves the quality of life of diabetics.

The scientific evidence that this approach works against the spread of HIV has been around for years. Methadone programs prevent new HIV infections, and they also help reduce petty crime, while fears that needle exchanges spread injection drug use have proved unfounded. But Russia has largely ignored these facts, much to the frustration of international organizations including the UN and much to the disappointment of nongovernmental organizations and local authorities in Russia that are dealing with a huge drug and HIV problem on the ground.

The Russian government is clearly shooting itself in the foot. The UN estimates that about 1 percent of adult Russians are HIV positive, while the population continues to decline. Brazil has made different choices. With similar expenditure on HIV as Russia, Brazil has managed to turn the tide and enjoys impressively declining rates of HIV among drug users.

So why does Russia ignore all the evidence and international pressure to step up its commitment to make sure the spread of HIV in the country is halted by 2015?

The U.S. battle against HIV may offer some good lessons. Under the administration of President George W. Bush, it made life for drug users difficult and blocked needle exchange among drug users. But when President Barack Obama took office, this changed.

It is not that Russia lacks supporters and leaders in the field of HIV prevention. Civil society leaders have spoken out over the last few years, television journalists such as Vladimir Pozner have played a pivotal role in bringing the issue to the attention of the public, and there are many health professionals and scientists who support evidence-based HIV prevention among people who inject drugs. But Russia lacks leadership among those in power who can really make a difference for the disenfranchised groups in society most affected by HIV.

There is one key difference with the U.S. approach to HIV: Russia lacks the outspoken and high-level support of business leaders to battle the disease. It was significant that the HIV forum in Moscow had no representation of the Russian business community. George Soros is a vivid example of a business leader and philanthropist from the United States who is not afraid to support and fund approaches that were not condoned by his own government.

It is in the interest of Russia and the world to see Russia, a Group of Eight member, containing its HIV epidemic. Therefore, it is hoped that we will see high-level governmental and business leadership on this issue occurring in Russia soon — hopefully, well before 2015.

Joost van der Meer, a medical doctor, is executive director of AIDS Foundation-East West, which has run HIV projects in Russia since 2001.

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