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Bureaucracy Delays Treatment in Russia

The budget for treatment of HIV and AIDS has been doubled in Russia, but patients are complaining they still do not have access to adequate treatment.

Chief epidemiologist Gennady Onishchencko has blamed the bureaucracy for acute shortage of AIDS/HIV medicines. "A problem in the sufficiency of antiretroviral drugs in Russia exists," he said in a statement. "We know about this issue and are trying to regulate it, but I will say that it won't be solved right now."

In all 11,861 people have died of AIDS in Russia in the past 20 years, the Russian Federal Consumer Protection and Human Welfare Control Service (Rospotrebnadzor) reports. More than 362,000 HIV infection cases had been registered by Nov 30, 80 percent of them aged 15 to 30.

"About 72 percent of HIV-infected persons contracted the virus through intravenous drug injection," the group reports. "Along with this, the number of those infected sexually is growing rapidly. Their share in the overall number of those infected has grown from six percent in 2001 to 45 percent in 2005."

The HIV rate is low in 43 regions of Russia, and very high in 12, including Moscow.

While governments in western countries have adopted a relatively liberal approach to combating AIDS, Russian authorities have been slow to work directly with hard hit communities such as prostitutes, drug users and gay men.

And the new money available for treatment is not reaching where it should. "Given that treatment and relevant social services are guaranteed by the state and there is a special budget allocated for purchasing ARV (antiretroviral) therapy, the fact that for several months people in several regions have not received treatment speaks for itself. When something is guaranteed and is not given, it is a failure," Sergey Smirnov, director of the Russian Association of People Living with HIV told IPS.

"Those who are in charge of such processes both at federal and regional levels must take personal responsibility for such violations," he said. "Excuses based on administrative protraction are irrelevant. Russia has necessary resources to ensure medication, but the main problem is that there is no efficient system and mechanism of monitoring, logistics, dissemination and storage."

"The government has shown its commitment this year by announcing an increased budget to fight against HIV/AIDS, and treatment for 15,000 patients was bought," Anastassia Makryshina from the group told IPS. "But over the past six months, people badly in need of treatment had to quit scheduled medical treatment due to shortage of drugs." She cited weak delivery systems and corruption as possible reasons.

The government has promised medicine for 30,000 patients in 2007. But a major challenge will be to generate demand among those in need. Many people do not know that treatment exists and is free -- and many do not know they have the virus in the first place.

"We don't say that the government is fighting the disease only with words and promises," Makryshina said. "But the efforts made are not enough. Treating a few thousand infected people is just the tip of the iceberg. What happens to the majority? HIV/AIDS cannot be overcome by money and medicines alone. We need a highly coordinated national strategy, and highly competent decision-makers at all levels."

Stigma and discrimination affecting people with the infection are still pervasive, and this discourages people from appealing for help, she said. Drug users are at particular disadvantage.

"Drug-addiction treatment in Russia is not based on systematic methodology," she said. "Opiate substitution therapy recommended by the World Health Organisation (WHO) is not legal in Russia. This creates another barrier for the overwhelming majority of drug users in getting access to treatment for indiscriminately injecting drugs."

Many infected people are turning to the Church for help. A group from the Orthodox church developed a programme to fight HIV/AIDS spreading back in 2001. The church offers support in prevention measures, and spiritual healing.

"The religious community used to think of HIV/AIDS infected persons as sinners who are rightly punished for their sin," Rev. Mikhail Dudko said at a news conference. "This perception is becoming a thing of the past. People understand that there could be different reasons for the disease, and that the sick persons need help, sympathy and sometimes to repent."

An expert at the UNAIDS agency in Moscow told IPS that "Russia complains of declining population without taking cognisance of the major factors contributing towards it."

Urgent action is necessary, he said. "If Russia does not quickly tackle drug addiction, the growing AIDS epidemic, rising suicide, chronic alcoholism and other health problems, the population will move towards extinction. It's about time to stop paying lip service, and to pull the bull by the horns."


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