Russia and neighbours encouraged to get to grips with world's fastest-growing HIV problem

Russia and its neighbours stepped up official recognition of the seriousness of the HIV crisis in the region yesterday with the opening of the First Eastern European and Central Asian AIDS Conference in Moscow, described as `long overdue` by UNAIDS head Dr Peter Piot.

Although Russia has around 351,000 officially registered HIV-positive people, some experts estimate the number could be as high as 900,000, with 1.6 million already infected across the region.

The greatest risk is now faced by the central Asian countries, including Uzbekistan and Kazakhstan, where HIV is beginning to sweep through the injecting drug user population. In Russia and Ukraine HIV is already well established among injecting drug users, and sexual transmission of the virus is a growing problem, particularly among young people.

Although huge sums of money are flowing into the region through grants from the Global Fund to Fight AIDS, the World Bank, USAID and the UK Department for International Development, local non-governmental organisations say that the money has been slow to translate into scaled up prevention activities or treatment.

In Ukraine for example a Global Fund grant was removed from government administration and placed in the hands of the International HIV/AIDS Alliance because of irregularities, whilst a World Bank programme in Ukraine was recently suspended. In Central Asia a World Bank programme to support prevention and care is mired in deep bureaucratic mud as a result of the need to coordinate all decision-making between five health ministries.

The two biggest controversies in the region, however, affect the field of HIV prevention: opioid substitution therapy for injecting drug users and sex education for young people in schools.

In Russia substitution therapy is prohibited, despite a strong positive recommendation from the World Health Organization (WHO) and advice today from Martin Donoghoe of WHO that up to 700,000 infections in the region could be averted between now and 2015 if substitution therapy were implemented.

Harm reduction approaches to HIV prevention with injecting drug users are also being hampered by an array of legal restrictions as well hostility to needle exhange from law enforcement, politicians and religious groups.

Preventing a wider sexually transmitted HIV epidemic will require education to begin in schools, but activists in the region charge that efforts to talk about sexuality in schools are being systematically opposed by the Russian Orthodox Church and its supporters in the educational system. At present there is no education on sexuality or HIV prevention for young people in most countries in the region, despite the fact that the Eastern Europe epidemic has the lowest average age of infection in the world – the typical person with HIV in the region has become infected before the age of 25, and a large proportion before the age of 20.

Later this week the conference will look at substitution therapy policy and treatment programmes in more detail.