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. Last Updated: 07/27/2016

Careening Blindly Toward Catastrophe

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Whenever I come to Russia, I am overwhelmed by the achievements it has made in the current decade. Since having to appeal to its old Cold War foe, the United States, for $1 billion of food aid in 1999, Russia has now become a regular grain exporter. It has enjoyed sustained economic growth for the past five years. Compare that with the average negative growth in the 1990s, and you get some idea of how Russia has turned around.

But with so much gained, I have to voice my deep concern that all this and more could be lost. As things stand, the next generation of Russians is facing a threat even more horrific and catastrophic than that posed by Hitler's invading armies in 1941. At present, the threat is still invisible, but over the next few years, it could cut like a scythe through communities and families across the country.

About 1 million Russians today are thought to be infected with HIV, the virus that causes AIDS. In global terms, AIDS is relatively new to the CIS, so not many of them are sick yet. But the virus is spreading more quickly here than anywhere else in the world, mainly among drug takers using contaminated needles, but also -- and to a rapidly growing extent -- through high-risk, unprotected sex.

In my visits to southern Africa, I have seen for myself all too clearly what that means. I have seen villages where fresh graves outnumber the surviving inhabitants, where grandparents struggle to care for orphaned children. I have seen schools without teachers, hospitals without doctors and empty government offices. Countries in the region are losing their abilities to govern, to educate their children and to provide crucial services to populations with ever greater needs.

In the CIS and Eastern Europe today, an estimated 1.7 percent of men and 0.8 percent of women between the ages of 15 and 24 are HIV-positive. Over the next 25 years, these men and women are likely to infect millions more: Estimates put the number of new infections in Russia over the next decade at 8 million. That would be 10 percent of the workforce. Imagine what will happen to the economy when they are no longer able to work, or die before they are old enough to work.

There is still a widespread tendency in Russia to stigmatize AIDS and point fingers. Those infected, we tend to say, are lowlifes: drug addicts and prostitutes. The rest of us -- upstanding, clean-living citizens -- have nothing to worry about. There are two points to make about that. First, society has an obligation to all its members, and everyone has a right to protection. And second, it's simply not true that we have nothing to worry about. If we think that we are immune, we are burying our heads so deeply in the sand that we are unlikely to ever see straight again.

Just as it is in New York, London, Tokyo and Johannesburg, HIV/AIDS is with us in Moscow and St. Petersburg. The virus does not discriminate; rich and poor alike are vulnerable. The discrimination only starts with our response: Medical advances mean that for the rich, AIDS is a chronic disease rather than a death sentence.

But unless we work now to make treatment more widely available and, even more importantly, to raise awareness of how the virus is transmitted and to improve people's ability to protect themselves, we will be pronouncing a death sentence on Russian society.

It's time to throw open the debate, for politicians, celebrities and all those with influence today, and stop trying to pretend that AIDS is not there. We owe it to our children and the future of this country.

James Morris is executive director of the UN World Food Program. In Moscow this week for a meeting of the Committee of Cosponsoring Organizations of UNAIDS, the joint UN Program on HIV/AIDS, he contributed this comment to The Moscow Times.




By Cesar Chelala



In recent years, Russia's HIV/AIDS epidemic has spread with dramatic speed, making its rate of infection the fastest growing in the world. Experts estimate that over 1 million Russians are HIV-positive. Unless contained, the large and growing number of people with HIV/AIDS will have a significant impact on Russia's social stability, national security and economic development.

AIDS is now moving into the general Russian heterosexual population. This has been accompanied by an explosive increase in the incidence of other sexually transmitted infections. Russia has syphilis infection rates that are hundreds of times higher than those of Western Europe. Because of the lesions they cause, syphilis and other sexually transmitted infections greatly increase a person's chance of becoming HIV-infected.

The Russian government's reaction has so far been inadequate to deal with the level of threat posed by HIV/AIDS. It has yet to learn from the approaches other countries have been successfully using to control the infection. Several experts believe Russia's AIDS policies are fueling the epidemic, rather than controlling or reversing it. For example, although the majority of Russians now living with HIV/AIDS were infected through drug use, drug addicts with AIDS are excluded from anti-retroviral treatment. The Russian government is also wary of foreign aid. Lee Reichman, executive director of the New Jersey Medical School National Tuberculosis Center, calls the refusal of Russian authorities to accept foreign assistance to deal with the epidemic "the Kursk syndrome," after the ill-fated nuclear submarine. When the Kursk sank, Russian authorities refused foreign help until it was too late to be effective.

Successful campaigns in other countries have shown that significant improvements in controlling the epidemic can be achieved through strong government leadership, and by partnering with business, labor and religious leaders, as well as with the people living with HIV/AIDS.

AIDS is both a social problem and a public health one. Given the extent of the epidemic, an interdisciplinary commission on HIV/AIDS is needed to attack the problem creatively. It should be composed not only of public health experts, but also of social and political leaders across the spectrum, and of people living with HIV/AIDS. Such a commission must be given broad powers to coordinate policies among ministries and to partner with other national and international nongovernmental organizations.

Russia is presently undergoing a reform of its national health care system. Part of that reform should include training individual doctors to prescribe anti-retroviral drugs independently of specialized AIDS centers. While treatment under the old Soviet system was provided through centralized specialists and hospitals, the epidemic demands that primary healthcare settings become part of the new approach to treatment.

At the same time, the Russian government should increase its current funding levels for prevention and treatment. At present, prevention efforts are practically nonexistent. In 2003, the government provided about $4 million to fight HIV/AIDS, a paltry sum when compared with the $1.3 billion in federal funds that President Vladimir Putin allocated for the celebration of St. Petersburg's 300th anniversary.

HIV/AIDS has now reached ominous proportions in Russia, posing serious consequences for life expectancy, demographic growth and economic development. Unless more effective treatment and prevention measures are implemented soon, the effect on Russia's population and on its economic development and political security will be nothing short of catastrophic.

Cesar Chelala, an international public health consultant for several UN organizations, contributed this comment to The Moscow Times.