AIDS experts say Russia needs new HIV strategy

AIDS specialists meeting here urged Russia on Wednesday to adopt successful strategies like needle-exchange programs and heroin substitutes such as methadone for drug addicts.

The number of HIV infections in Russia has doubled in the past eight years and there is evidence that in this region the virus is increasingly being spread by heterosexual sex.

The rapid growth of the epidemic in Russia is in contrast to sub-Saharan Africa and South and Southeast Asia, where prevalence of the virus fell during the same eight-year period, according to UNAIDS, the United Nations AIDS agency.

Russia's chief public health officer, Gennady Onishchenko, told a regional AIDS conference Wednesday that Russia is "emphatically against" the use of drug replacement therapy. Meanwhile, he criticized programs that exchange clean needles for used ones, saying such programs may promote illicit drug sales and HIV transmission.

Both are part of a so-called harm reduction strategy, in contrast to the just-say-no programs that urge abstinence from drugs and risky sex. Russian health officials say they are committed overall to a "healthy lifestyles" rather than a harm reduction approach to improving public health.

That isn't good enough, a number of foreign experts say.

"International studies show that an abstinence-based message on drug use or sex simply doesn't work," said Robin Gorna, executive director of the International AIDS Society. In Russia, she said, "it does appear that ideology is getting in the way of public health care policy."

Russia has increased spending on AIDS programs by 33 times since 2006, making it a central part of an ambitious new national health care strategy. It has expanded drug treatment dramatically for AIDS sufferers and is among the leaders worldwide in reducing the incidence of transmission of the disease between mothers and their babies.

But many Russian officials view harm reduction efforts as encouraging criminal or shameful behavior. The position has left it increasingly isolated, as China recently embraced such programs, foreign AIDS experts here said.

Russia has some highly successful needle exchange programs and free condom programs, several foreign specialists said, but many have been paid for through grants from the international Global Fund to Fight AIDS, TB and Malaria.

Now those grants are being terminated under Global Fund rules, the specialists said, because Russia is too wealthy to qualify for them.

Chris Beyrer, a professor at the Johns Hopkins School of Public Health, said Russian officials "have never really embraced" needle exchange, free condom distribution and other harm reduction techniques.

"It is the reason I think that they continue to have one of the most severe epidemics in the region," said Beyrer, director of Hopkins' AIDS International Training and Research Program. He was in Moscow for the regional meeting, which runs through Friday.

Gorna of the International AIDS Society said the only needle exchange programs in Russia are some 75 funded primarily by foreign donors, 22 of which shut down in August after their grants ran out. She and other experts said the regions where those programs have operated have seen slower transmission rates than the rest of Russia.

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