The countries of the former Soviet Union and central and eastern Europe are, according to Peter Piot, “experiencing the fastest-growing epidemic in history, yet it is the most under-addressed in terms of response.” But, as Kasia Malinowska-Sempruch reminded us in yesterday’s plenary meeting, the late start of the epidemic in this part of the world presents us with “an opportunity to apply lessons learned so tragically in other parts of the world.”
According to the Central and Eastern European Harm Reduction Network (CEEHRN), over 82% of all cases in this region are among injecting drug users. (IDU). Governments in the region continue to pursue an authoritarian approach to managing HIV and drug use instead of providing the necessary continuum of care, support and prevention to this vulnerable and stigmatized group.
The bulk of government funds allocated to HIV/AIDS are spent on a mass HIV testing campaign. Nearly 20 million citizens are tested each year in Russia. This testing is rarely confidential or accompanied by counselling. Law enforcement bodies still focus more on drug users than on suppliers.
Over 30% of all PLWHA in Russia are incarcerated, mostly on drug charges. This contributes to growing epidemic of multidrug resistant tuberculosis which is currently being pumped into the world at astonishing rates by Russian prisons. TB is already the number one killer of PLWHA in the region.
Harm Reduction (HR) activities, including needle exchange and methadone treatment, have been proved effective, and methods for applying them in the region have been developed. But though there are over 200 HR programs operating throughout the region, this falls drastically short of the estimated 200,000 needed to provide adequate coverage.
According to Dave Borrows, who has been active in promoting the HR approach in the region, existing programs are estimated to reach an average of less than 5% of the populations they target. Methadone treatment, which is the most effective means of treating drug addiction, is employed rarely and is illegal in most countries in the region.
Treatment of HIV is also inadequate with only 2% of registered PLWHA receiving triple combination therapy. Moreover, though IVDU account for over 82% of all cases they account for only 23% of those receiving any form of ARV.
The Brazilian model of applying harm reduction and universal access to ARV could prevent this region from suffering as so many countries already have. Dr Palou Teixeira, the director of the Brazilian National Program on STI and AIDS, described at the symposium how the Brazilian approach, which combines harm reduction with the provision of universal access to ARV, significantly reduces HIV/AIDS-related morbidity and mortality as well as expenditures on the epidemic.
He also described high rates of compliance among IVDU in Brazil. He announced that the Brazilian Government had spoken with the Russian government about offering technical assistance to Russia in perusing access to generic and/or locally produced drugs.
In the 1950s the Soviet healthcare system was praised and held as a model by the WHO for the degree to which it made primary care accessible to its population. Post-Soviet countries can potentially take advantage of this infrastructure to make ARV available.
As Kasia Malinowska-Sempruch mentioned during her plenary session “It is not a question of not having enough resources and know-how. Russians have orbited the moon and built tens of thousands of nuclear warheads. If they can accomplish these two expensive and complex tasks, they have the infrastructure to produce generic antiretrovirals that are needed right now.”
Access to treatment and prevention in this region, as in other parts of the world, is a question of political will.
Political will of regional governments, of neighboring governments and PLWHA in the region can potentially still prevent the repetition of the disastrous scenario seen in so many other countries.
Dr Konstantin Lezhentsev of MSF Ukraine described the success of pilot programs that distribute generic ARV in Ukraine and emphasized the important role that networks of PLWHA and the will of the Ukrainian government had in making these programs a reality.
Delegates from Poland, Lithuania and Russia described the successes of Harm Reduction programs. To truly impact the epidemic though these programs must be scaled-up and implemented throughout the region.
In Ukraine, the rate of infection is already estimated to be 1% of the population, the highest rate in Europe. Western Europe and the rest of the world that cannot afford to repeat the mistakes of the past and should offer assistance both technical and financial for to promote drug access and harm reduction in this region. A window of opportunity in this region, though closing rapidly, is still open.
AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team