HIV prevention efforts in Russia and other members of the Confederation of Independent States are being crippled by religious dogmatism, paranoia about teenage sexuality and extremely repressive attitudes towards injecting drug use, as well as hostility towards non-governmental organisations perceived to be influenced by the west, according to delegates attending last week’s first Eastern European and Central Asian AIDS Conference in Moscow.
Although Russia’s government recently announced a big increase in AIDS funding, prevention activity in the region has been undertaken largely by non-governmental organisations, supported by funding from external donors.
The Russian government’s most recent contribution to HIV prevention was a campaign launched this spring that proclaims “There’s no such thing as safer sex”, advocating abstinence and sex with one exclusive partner as the only ways to avoid HIV.
The ABC (abstinence, be faithful, use condoms) approach that characterises the US approach to HIV prevention sits very well in a region that is confused about the difference between public health and public morals.
“People say these issues are difficult to address in my country. I’ve not yet been to any country where these issues are not difficult to address”, said Dr Peter Piot, head of UNAIDS.
Vladimir Pozner, one of Russia’s most famous television journalists, told the conference that Russia’s HIV problem needed to be tackled in schools, with comprehensive education on sexuality and drug use. Instead, he said, attempts to educate young people were being opposed as immoral and contrary to traditional Russian values.
Recent examples include an attack on an NGO in Ekaterinburg by local politicians who claimed it was corrupting youth, and an attack on foreign-funded NGOs by Andrey Metelskiy, deputy chairman of the Moscow City Duma, who urged that all NGOs should be brough under state control.
Suspicion of foreign influences run deeps throughout the region, and whilst officials at last week’s conference paid lip service to the need for civil society involvement in HIV work in the region, NGO representatives are nervous about the growing climate of intolerance towards non-governmental organisations in the region, which is a backlash against the role of US-funded non-governmental groups in recent elections in Georgia, Ukraine and Belarus.
In Uzbekistan the backlash has been especially severe following the political unrest that followed the Uzbek elections in 2004. The number of NGOs carrying out some form of HIV prevention has fallen from 50 to five in the past year because of closure of organisations by the government.
Prevention work with marginalised groups is especially difficult. Only 10% of sex workers in the region have access to HIV prevention programmes, according to Dr Peter Piot, and work with gay men is so stigmatised that the subject did not merit one single presentation throughout the three-day conference, despite the obvious presence of numerous gay men working in non-governmental organisations.
Homophobia in Russian politics is respectable and unremarkable, and strongly supported by the politically influential Russian Orthodox church. Moscow mayor Yuri Luzhkov recently banned Russia’s first gay pride march, due to take place in the capital on May 27th, despite an appeal from the Council of Europe. Luzkhov’s spokesman said this week that the mayor “was firm that the city government will not allow a gay parade in any form, open or disguised, and any attempts to organise an unsanctioned action will be resolutely quashed.”
However, the biggest prejudice the region must deal with is extreme hostility towards injecting drug users. Punitive laws against drug use make harm reduction programmes involving needle exchange, supply of sterile injecting equipment and substitution therapy difficult if not impossible, although some conference delegates were able to describe successful examples of work to educate local police forces. For example, Alexander Tikhanovich of Humanitarian Action in St Petersburg explained how in-service training of police officers had dispelled the widespread belief that outreach workers were distributing drugs and led to an end to harrassment.
Lars Kalling, the UN Special Envoy for HIV/AIDS in Eastern Europe, told the conference that 700,000 new infections could be averted between now and 2015 if governments in the region establish effective prevention programmes. However, political resistance to harm reduction programmes in the region remains entrenched, despite growing fears that Russia is facing a profound demographic crisis that will result in a shrinking population.