Cablegate: Russia's Hiv/Aids Epidemic Grows Steadily

DE RUEHMO #0536/01 0581454
R 271454Z FEB 08





E.O. 12958: N/A

REF: A. 06 Moscow 5353
B. 06 Moscow 4543
C. 06 Moscow 1811

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1. (SBU) SUMMARY: Russia's HIV/AIDS epidemic continues to grow,
though not at the same fast pace that occurred in 2000-2002.
Infections continue to be concentrated among injecting drug users,
but the epidemic is also spreading through heterosexual sex,
primarily among the partners of high risk groups such as sex workers
and drug users. In 2007, 44 percent of new cases were among women,
most estimated to be among or linked to high risk groups. Russian
Government spending on HIV/AIDS treatment has grown exponentially,
and over 30,000 people are now receiving anti-retroviral therapy.
Although the government has spent comparatively little on HIV
prevention activities, Government officials recognize that they must
increase spending in this area, and have been looking to the NGO
community for examples of successful outreach, prevention and care
programs. Russia will face significant challenges to increase
adherence to therapy among patients, and to effectively tackle
AIDS-related co-infections such as tuberculosis and hepatitis. END

HIV/AIDS Cases Growing Steadily

2. (U) Some 400 medical professionals and researchers from regional
AIDS centers, the Health and Social Development Ministry, health
NGOs, and research institutes gathered in Suzdal December 4-6 for
the annual All-Russian Conference on HIV/AIDS. Gennadiy
Onishchenko, Russia's Chief Medical Officer and the head of the
Federal Surveillance Service for Consumer Rights Protection and
Human Well-Being (Rospotrebnadzor), opened the conference by stating
that despite substantial efforts over the last several years,
Russia's HIV/AIDS epidemic was growing steadily. About 403,100 HIV
cases had been officially registered in Russia since the HIV/AIDS
epidemic began 26 years ago, of whom some 350,000 people were still
alive today.

3. (U) According to Vadim Prokovskiy, Director of the Federal AIDS
Center, the number of newly registered HIV cases in 2006 stood at
39,652, a 1.7 percent increase over the number of cases registered
in 2005. This number was still well below the 87,823 cases recorded
in 2001, when the number of new cases reached its highest level.
Intravenous drug use remains the most common route of transmission
of HIV infection, with 65 percent of newly registered cases among
drug users. More than 44 percent of new HIV cases were registered
among women in 2006, indicating a growth of heterosexual
transmission, though experts believe this growth is primarily
because of transmission to sex partners of intravenous drug users.
There are a growing number of secondary opportunistic diseases, such
as Tuberculosis (TB), hepatitis, and kaposi sarcoma, among
HIV-positive individuals, which was reflected in a forty percent
growth in the amount of deaths among HIV positive individuals in
2006 compared to the previous year. Some 9,000 Russians have active
TB/HIV co-infections, and a significant proportion of HIV-positive
people also have hepatitis B or C. By the end of 2006, there were
41,500 HIV positive Russian prisoners out of a total population of
871,693 prisoners. Some 3,037 prisoners are currently receiving
anti-retroviral therapy (ART) through programs supported by the
Global Fund, but prison authorities estimate at least 4,800
prisoners currently need such therapy.

Russians Bristle at International Criticism

4. (SBU) UNAIDS estimates there are over one million people living
with HIV/AIDS in Russia, making up two thirds of all HIV/AIDS cases
in Eastern and Central Europe. Federal AIDS Center head Pokrovskiy
has stated he generally agrees with that assessment, but Chief
Medical Officer Onishchenko has publicly disagreed and complained
about the lack of clarity in how UNAIDS derives its estimates.
Onishchenko has also bristled at suggestions from former USUN
Ambassador Holbrooke (now head of the Global Business Coalition on
HIV/AIDS, TB and Malaria) that Russia is losing the battle against
the epidemic. Last November, Onishchenko and drug control
authorities were also quick to reject a recommendation from Human
Rights Watch International that Russia legalize the treatment of
drug substitution therapy with methadone for heroin addicts, an
issue which affects many HIV/AIDS patients (Ref A). Likewise, on

MOSCOW 00000536 002.2 OF 003

February 18, some 30 protesters from United Russia's "Young Guard"
movement shouted "We will not let you take methadone!" outside an
international conference on Evidence-Based Substance Abuse Treatment
in the Era of HIV/AIDS, which was organized by the Russian Mental
Health Research Institute and Transatlantic Partners Against AIDS.

Russia Expands HIV Treatment

5. (U) Under Russia's National Priority Health Project (Ref C),
federal government spending on HIV/AIDS treatment has gone up
exponentially since 2005, and now stands at over $200 million per
year. The government exceeded its target of 30,000 HIV-positive
people receiving ART by the end of 2007. The GOR expects to provide
40,000 patients with access to ART during 2008, and treat 52,000
with ART by 2009. These targets are for federally funded programs.
In addition, more than 9,000 people living with HIV in Russia are
receiving ART under Global Fund programs, according to the Russian
Healthcare Foundation. Despite the federal and Global Fund
programs, many more Russians need ART than are currently receiving
it, and that number is expected to continue rising over the next few

6. (SBU) Most Russian experts believe that problems of stigma, lack
of consistent drug supply (ART) and access to care remain critical
problems for those in need of treatment. The failure of physicians
to implement diagnostic and monitoring standards for out-patients at
HIV centers is another reason why not everyone who needs ART is
receiving this life-saving therapy. Observers also state it has
been difficult for the GOR to conduct outreach to most at-risk
populations, such as drug users and commercial sex workers. During
the past year, however, the Health and Social Development Ministry
has awarded tenders to some NGOs to conduct outreach activities
among vulnerable populations, which has supplemented existing
outreach programs supported by the Global Fund and USG.

7. (SBU) Russian adherence rates (i.e., how many people who start
ART continue treatment) are on par with levels in other parts of
Europe, with about ten percent of patients abandoning treatment per
year. Some 2,771 patients gave up treatment for various reasons
during 2007. Mikhail Rukavishnikov, head of the Society of People
Living With HIV/AIDS, told us recently that adherence is one of the
biggest concerns of his organization. In his view, the GOR is
failing to counsel, provide social support, and to educate those on
ART about the need to continue taking medicines, and many patients
do not understand that they need to receive ART indefinitely. The
lack of availability of quality drug rehabilitation programs also
contributes to adherence problems in Russia. Government officials,
however, have made positive comments about the impact of faith-based
groups and other NGOS that have developed psycho-social support
programs for drug addicts undergoing rehabilitation.

Government Prevention Efforts Lagging

8. (U) Despite the massive spending on treatment and care, Russia
spends comparatively little on efforts to prevent the further spread
of HIV. The GOR budgeted around $8 million for prevention
activities in 2007, though the number is expected to rise to over
$16 million in 2008 and over $28 million in 2009. In addition, only
about 25 percent of the prevention funds in 2007 are being spent on
prevention activities among high-risk groups. Leading health
officials such as Pokrovskiy and Onishchenko publicly acknowledge
that the country needs to devote more resources to prevention, and
they have pledged to seek additional funding from the government for
these activities.

Rising Tide of Co-Infections

9. (U) Observers expect that the number of AIDS-related
co-infections will grow over the next few years, as the immune
systems of the large number of people infected with HIV from 2000 to
2002 become compromised. Accordingly, the need for treatment and
care of AIDS patients is expected to increase significantly. TB is
already the leading cause of death among HIV positive people,
accounting for 59 percent of all deaths among this group in 2006
(Ref B). The number of active TB/HIV co-infections has risen from
2,524 cases registered in 2002, to 9,102 cases in 2006.

10. (SBU) Chief Medical Officer Onishchenko has also expressed

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concern over the high rates of hepatitis B and C co-infections among
people living with HIV/AIDS. During 2008 Rospotrebnadzor will begin
supplying 32 pilot regions with lab equipment and medicines to
diagnose and treat 8,500 patients suffering from Hepatitis/HIV
co-infections. In a recent meeting, Onishchenko told us privately
that he is concerned about the fact that treatment for co-infections
is funded by regional budgets, whereas the federal government pays
for HIV/AIDS treatment. He said the federal government will review
that funding arrangement, and may ultimately decide to fund
treatment of co-infections at the federal level as well.


11. (SBU) While making great strides in HIV treatment, Russia's
health professionals and policy-makers still face tough challenges
in conducting prevention, treatment and care activities among
socially-marginalized and vulnerable populations like drugs users
and commercial sex workers. The country will have to grapple with
how to procure drugs at affordable prices and maintain an adequate
supply of drugs to treat co-infections. It was encouraging that the
GOR created a national HIV/AIDS Commission in 2006, chaired by the
Health and Social Development Minister, that included both health
professionals, health NGOs, and people living with HIV/AIDS.
Unfortunately, the commission has only met twice, and has done
little so far to develop national policies or strategies for
tackling the thorny HIV/AIDS issues that lie ahead.


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