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3 July 2016

HIV: a real threat to Russia’s national security

How the Kremlin ignores real, non-imaginary threats

In 2014, 142,197 individuals in the European World Health Organization (WHO) region learned of their HIV positive status. Approximately 60 percent, or 85,252 people, were Russian citizens. As a proportion of Russia’s total population, the number of new HIV diagnoses comprised 58.4 per 100,000 or 1 in every 1,712 in 2014.

In 2015, against the backdrop of cuts to public spending on healthcare, the situation worsened: as many as 120,000 Russians were diagnosed. This was 70% of the total number of new diagnoses in Eastern Europe and Central Asia. The number of officially registered HIV carriers in Russia exceeded one million.

19% of Russians are tested for HIV each year. However, this figure is largely made up of those who are obliged to undergo annual medical checks: law enforcement officers, blood donors, medical personnel, prison inmates, etc. It is therefore safe to say that we can only speculate as to the true scale of the epidemic. Results of rapid HIV tests carried out in Novosibirsk are indicative in this respect: the virus was detected in 40 of 888 tested individuals. Only seven had previously been aware of their HIV positive status. In other words, five out of six HIV positive persons are unaware that they are infected.

Experts believe that at least a further 500,000 residents of Russia remain unaware of their HIV positive status. However, the true figure could even exceed one and a half million. Over the last decade, on average, the rate of new infections increased by 10 percent per annum.  Russia is heading for demographic disaster. As of today, in twenty regions of Russia, the epidemic has reached a generalized (highest) level according to WHO and Joint United Nations Programme on HIV/AIDS (UNAIDS) criteria: more than 1 percent of pregnant women are infected with HIV in these regions which means that the epidemic has moved beyond traditional risk groups and is rapidly spreading among heterosexual, sexually active, and able-bodied individuals.

Even according to the official, understated statistics, 2.5 percent of men aged 30-40 and nearly 2 percent of women aged 25-30 are HIV carriers in Russia. According to Vadim Pokrovsky, the head of the Federal Research and Methodological Centre for Prevention and Control of AIDS, these figures are even higher in reality and the number of men living with HIV among this age group in some towns is as high as 8 percent. According to Pokrovsky, “[a]pproximately 230,000 HIV positive Russians have died during the years of observation since 1987, including 28,000 in 2015. The average age of death - 35. This means that the demographic damage done by HIV/AIDS is already substantial and is constantly growing”.

Another statistic serves to evidence the extent of the impending demographic disaster - the spread of infection among children and adolescents. In 2015, the number of juvenile Russians living with HIV rose by 13 percent compared to 2014: in children under 7, there was an increase of 5 percent; 22.5 percent in children aged 8-14; and 34.7 percent in adolescents aged 15-17.

HIV is not the only disease that necessitates a revision of current Kremlin policy. The incidence of hepatitis C has increased from thirteen to forty cases per 100,000 citizens over the last 15 years, and 2.5 percent of Russians are infected with the virus according to official estimates. In reality, the numbers may be much higher – prevalence ranges from 5.7 million to 10 million people living with hepatitis C (according to the WHO). Moreover, the number of cases of syphilis has increased more than thirty fold over the last ten years in the country -over 270,000 cases are recorded each year. This incidence is nearly ten times higher than in the EU and the US. 

The statistics speak for themselves. The Kremlin should draw conclusions from its own mistakes and effect a change in policy. However, refusal to admit defeat is an ever-present feature of Putin’s personalist regime. Therefore, despite the recognition of the existence of the problem, the Kremlin will continue to treat the effects with the cause while ignoring the need to adopt time proven methods (substitution therapy for drug addicts, promotion of safe sex among the population, awareness-raising campaigns among adolescents) – and all of this in the interests of emphasizing Russia’s “special path”.

“Conservative” populism only exacerbates the problem

In today’s Russia, traditional values, whose imaginary “renaissance” is underlined by the Putin elite with fervor, are seen as the universal treatment for all ills. Traditional values are destined to save the country from Western “immorality” and have been assigned a leading role in the fight against HIV.

This was the conclusion of the report by the Russian Institute for Strategic Studies (RISS) presented at Moscow’s City Council in late May. Curiously enough, the Moscow authorities entrusted the task of analyzing the situation not to physicians, but to the state think-tank responsible for “issues related to ensuring national security” whose work is clearly commissioned by the Kremlin and whose agenda thereby replicates those of Russian state-owned media outlets. The RISS report is akin to Kremlin propaganda in that it obsesses about the West, ignores and deliberately downplays the existing internal problems, turns cause-and-effect relationships upside down, etc.

Fully in line with the main message of propaganda in recent years (“the West is to blame for everything”), green “experts” on HIV issues stated that Western countries “are using the HIV/AIDS problem as a weapon in the information war against Russia” and, by suggesting that Western methods of combating the virus are implemented in Russia, the global community uses the topic of the epidemic in order to “confront Russia as a country which allows itself to independently pursue foreign and domestic policy”.

So, what are the “Western methods” according to the “experts”? First of all, the effectiveness of condoms was undermined by the “experts” who indirectly linked them to the cause of the epidemic and the contraceptive industry was accused of being “interested in engaging the maximum number of minors in early sexual relations”. Secondly, sex education for schoolchildren is apparently imposed by the West as a means of “demographically deterring countries seen as geopolitical competitors”. According to the president’s “experts”, the best forms of protection against AIDS are abstinence and the monogamous, heterosexual family.

Such an irrational, populist approach is also apparent in the draft of the “2020 Strategy to Combat HIV” which is now being considered by the Russian government. The document is based on the premise that “the leading role in the spread of the epidemic is played by risk groups of the population”. However, in practice we can see that socially active citizens who are not in the traditional high-risk categories are increasingly at risk of becoming infected. Still, the draft policy is misleading when it comes to describing the true scale of the epidemic as it rates the spread of HIV infection as “moderate” in Russia. This classification has already been criticized by the expert council of the National Immunobiological Company in a letter to the Ministry of Health of the Russian Federation. The experts note that the situation should be referred to as “rapidly-evolving” at the very least.

Preventive measures are at the core of the draft strategy. They include “promoting a healthy lifestyle as well as family and moral values” and yet not a word about condoms - the sale of which, incidentally, fell by 20.5 percent in the first quarter of 2016 - is uttered. The verdict of the experts provides very little solace: the strategy is “yet another declaration of intent which will not bring about any real change and will not halt the further spread of the epidemic”.

But the Russian political elite seems unprepared to change its approach and disregards the opinions of qualified experts. When the most prominent Russian HIV expert, Vadim Pokrovsky, highlighted the necessity to introduce sex education classes at school and urged the authorities to allow Methadone maintenance treatment, the deputy of the Moscow City Council labeled him an “agent acting against the interests of Russia”. The same deputy believes that “we advocate fidelity to one’s partner and call on our youth to establish healthy families which is far more effective than distributing condoms”. A similar destructive stance is assumed by the Russian Orthodox Church, the main lobbyist for the banning of sex education. And it is not just about schools. For example, only individuals over the age of 18 were allowed to attend a conference on AIDS in Eastern and Central Europe held in 2014 in Moscow – and this is despite the fact that, as stated above, the number of those aged 15-17 living with HIV rose by 34.7 percent last year.   

Moreover, organizations which do not share the Kremlin’s stance and try to introduce alternative methods of combating the spread of infection at the grassroots level risk being blacklisted as “foreign agents”. Just last week, the Ministry of Justice added two more organizations that deal with HIV prevention to the list of “foreign agents” – “Esvero” and “Andrey Rykov Foundation on promoting the protection of health and social justice”. The same happened earlier to the “Sotsium” organization based in the Saratov region that was blacklisted upon request made by the prosecutor's office for conducting surveys among HIV-infected persons and distributing 100,000 syringes and 10,000 condoms allegedly bought with funds obtained from abroad. To substantiate its claims, the prosecutor’s office referred to the “expert” opinion of Professor of History at the local Law Academy, Ivan Konovalov, who concluded that Sotsium “can be regarded a participant of the hybrid war against Russia aimed at changing the political regime in our country”. The distribution of free condoms and syringes was considered destructive to Russia’s “traditions and… national values” by Konovalov. As a result, the court labeled Sotsium a foreign agent, and the organization was forced to close down. One should note that the court took into account the “expert” opinion of a historian and not a physician-therapist for drug abusers, Vitaly Gorshkov, who acknowledged that the activities of the NGO in question had helped to curb growth in cases of HIV infection.

This cynical approach is, in fact, hardly surprising - the fight against HIV and improvement of the quality of life of Russians do not constitute goals for the Putin regime. The preservation of power is an end in itself, and the inflation of anti-Western rhetoric, the juxtaposition of “traditional” Russian and Western values, as well as the creation of the image of the enemy, are all means of achieving this. Meanwhile, an epidemic continues to take root in the country… 

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