Although the Russian government has recently shown signs of comprehension regarding the gravity of its HIV epidemic, measures which have been so far proposed and implemented are insufficient to bring the virus under control. Russia needs to leave its conservative discourse behind and invest in providing adequate information and treatment. Alternatively, its already weakened economy will be further undermined by the economic burdens of HIV.
While HIV infection rates are declining globally, Russia is among the few remaining industrialized countries where they are currently on the rise. The number of HIV-positive patients in the country has recently reached one million, doubling from 500,000 only five years ago.
With the rate of transmission accelerating each year and the spread of the disease into the general population beyond high-risk groups, Russia is facing a full-fledged HIV epidemic. The political risks associated with the disease could become a major destabilising force for an already crippled economy.
Russia’s Minister of Health Veronika Skvortsova estimated that if current national trends in HIV prevalence were not tackled adequately, the number of HIV patients could surge by 250% by 2020. Although state authorities had always been aware of the deteriorating HIV situation, Skvortsova’s appraisal of the severity of HIV epidemic has opened up a debate in the government and the national media.
In fact, Prime Minister Dmitry Medvedev promptly instructed the Ministry of Health to develop a national strategy to combat the life-threatening virus, which should be finalized by March 2016.
Access to antiretroviral therapy in Russia
In 2014 alone, over 24,000 Russians died due to AIDS-related illnesses. Vadim Pokrovsky, the head of the Federal AIDS Centre in Moscow, argues that although this figure is close to the number of yearly road fatalities, state measures taken are incomparably weaker.
Recently, due to the ongoing economic crisis and the currency depreciation, Russia has been experiencing a shortage of antiretroviral (ARV) medications, necessary to treat its HIV-positive citizens, particularly outside major cities. The country imports 80% of medical drugs and does not manufacture any ARVs domestically, making access to them limited at the time of the recession.
Although the World Health Organisation recommends starting ARV therapy right after diagnosis is confirmed, in Russia treatment would begin when a patient’s levels of CD4 lymphocyte cells in blood fall below 350 cells/mm3.
This has been lowered to 200 cells recently, the level at which a patient’s immune system is seriously damaged and there is a direct threat of developing AIDS. Thus, HIV-positive Russians are unable to continue with their normal lifestyles as well as become a significant burden for the economy.
Only 23% of all HIV-positive patients received ARV therapy in Russia in 2014. According to WHO, the treatment should be accessible to 60-80% of individuals living with the virus. As the Russian government has been more perceptive of the issue, it has pledged to provide $600 million in 2016 to the fight against HIV, compared to only $300 million in 2015.
Although the additional financing will make medications available to many more HIV-positive patients, AIDS experts say that this amount still falls short of the real investment that is required to tackle the epidemic.
Conservative thinking and social stigma
Almost all of the budgetary spending is channeled towards the provision of ARVs and when it comes to the prevention and harm reduction programmes, the Russian leadership takes a conservative approach.
It favours promoting family values and fidelity over the financing of information campaigns, clean needle exchange schemes and condom distribution. Opioid Replacement Therapy, WHO-recommended treatment that ended the HIV epidemic in Western Europe, is banned as the Russian political elite considers it unethical.
Instead of developing a comprehensive plan to combat the disease, Russian lawmakers propose scattered and counterproductive legislations.
For instance, a suggestion to impose mandatory HIV testing on couples applying to get married is currently under consideration in the Duma. If currently implemented, the measure would likely discourage Russians from registering their relationships as testing positive for HIV could mean losing the partner and being subject to discrimination.
In fact, due to the lack of tolerance and acceptance campaigns and a very limited knowledge of essential facts about the disease, prejudice is still strong and HIV-positive individuals are widely feared and resented.
In numerous cases, Russians living with the virus reported having lost their jobs after the disclosure of their HIV states, as well as having been refused medical assistance. Therefore, being HIV-positive is widely seen as an admission of guilt and thus Russians avoid undergoing tests voluntarily and risk unknowingly spreading the disease further.
Threats to political and economic stability
The HIV epidemic in Russia could soon spiral out of control and have severe economic implications for the country which already finds itself in a profound recession. According to Stratfor, 70% of new cases are registered among Russians aged 20 to 39, indicating that the working age population is severely affected.
Firstly, HIV mortality and morbidity leads to unbalance within the demographic pyramid. Indeed, due to shrinking tax payments, social protection of children and the elderly is harder to provide. Secondly, the fact that only a relatively small proportion of the country’s population has access to treatment, the labour productivity of the HIV-positive Russians is further reduced.
According to a World Bank study, an adult prevalence rate of 10% may reduce the growth of national income by up to one third.
The CIA has added AIDS prevalence to the list of factors that have an impact upon a state’s stability. In fact, in the longer term the disease could damage the demographic situation in Russia, its social institutions, overwhelm its healthcare system, and push poverty and crime rates up.
If Russia remains as economically and financially vulnerable as it is currently, it will be increasingly difficult to address the spread of HIV. Unless the virus is tackled quickly and effectively, the epidemic will inevitably increase uncertainty and undermine the confidence of private and foreign investors in the Russian market.
Alina is a political risk analyst covering Russia and Eastern Europe. A Russian-born Londoner, she holds an MA (SOAS) and a BA (Warwick) in Politics, International Relations and Diplomacy. Alina has experience in working in international and government institutions. She speaks English, Russian, French and Spanish.