November 13, 2009
Geneva, Switzerland -- The International AIDS Society (IAS) and the International Harm Reduction Association (IHRA) today welcomed the announcement by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to extend by two years its funding of HIV prevention programmes (known as the GLOBUS grant) in the Russian Federation at a cost of US$24 million.
"This two-year extension will save thousands of lives," said Robin Gorna, IAS Executive Director. "While this decision is very welcome, it is nevertheless a band-aid measure, not a long-term solution. External funding cannot prop up Russia's HIV response forever. The onus is still on the Russian Government to listen to the science and 20 years of proven practice and put in place long-term harm reduction prevention programmes that will save tens of thousands of young Russian lives."
The GLOBUS Project (Global Efforts Against AIDS in Russia, 2004-2009) is Russia's first approved GFATM project, with funds amounting to almost US$89 million. The project is active in 10 administrative territories: City of St. Petersburg; Regions of Nigegorod, Orenburg, Pskov, Tomsk, Tver and Vologod; Republics of Buryatiya and Tatarstan; and Krasnoyarsk Kray.
GLOBUS addresses the needs of specific groups including prevention programmes specifically targeted at people who inject drugs, sex workers and men who have sex with men. Funding for GLOBUS ended on 31 August 2009, potentially leaving projects in ten regions subject to staff layoffs and closures, despite the fact that they have averted an estimated 37,000 HIV infections.1
An estimated one million people are living with HIV in Russia, 80 percent of whom are under the age of 30. An estimated 1.85 million Russians, two percent of the adult population, inject drugs, one of the highest rates in the world. In 2007, 64.5 percent of new HIV infections in Russia were the result of injecting drug use.
Despite considerable external funding, needle and syringe programmes remain very limited in the Russian Federation and there is no state funding for these programmes. Effective drug treatment is inaccessible and there are no confidential and free drug treatment services. Rehabilitation programs are rare and opioid substitution therapy (OST) programmes such as methadone are prohibited under the Federal Law on Drugs.
Against this backdrop of the fastest growing HIV epidemic in the world, there are deep concerns that the Russian Government's new strategic health plan promoting "healthy lifestyles" will not include HIV prevention programmes. Russia's Chief Public Health Officer Gennady Onishchenko told the Eastern Europe and Central Asia AIDS Conference in Moscow two weeks ago that the Russian Government was "emphatically against" the use of drug replacement therapy and at the same criticized clean needle exchange programs.
"Pressure on the Global Fund to maintain programmes that address the issue of HIV and injecting drug use has succeeded where lamentably, pressure on the Russian Government to implement similar interventions continues to fall on deaf ears," said Gerry Stimson, Executive Director of IHRA. "Ten years ago we were looking at 100,000 Russians having HIV, not even a decade later that figure is one million and rising. The Russian Government has to leave ideology aside and introduce some long-term harm reduction measures or else it is looking down the barrel of a severe long-term health crisis."
The IAS and IHRA are calling on the Russian Government for increased financial resources, widespread availability of confidential and free drug treatment services, and the removal of legal and regulatory barriers that inhibit evidence-based HIV prevention and drug treatment programmes. The groups specifically urged the repeal of laws that limit or prohibit opioid substitution therapy (OST) and access to clean needles and syringes.
The effectiveness of OST and access to clean needles and syringes is well-documented. According to the World Health Organization (WHO), OST reduces HIV prevalence and risk of HIV transmission and infection, while also reducing the proportion of users who inject drugs and the frequency of infection. For those infected with HIV, OST increases access and adherence to antiretroviral therapy. WHO also concluded that there is compelling evidence that increasing the availability and utilization of sterile injecting equipment by people who inject drugs reduces substantially the spread of HIV. The programmes are cost-effective, have no convincing evidence of unintended negative consequences, and show evidence of increasing recruitment into drug treatment.