AIDS Just Beats Out Books in Budget

But despite the troubling forecasts, the federal government spends about the same amount of money to combat AIDS as it does to support the national book publishing industry.

Yet, it is not too late to lessen the epidemic's impact, said a Nov. 23 report by UNAIDS and the World Health Organization. "There is considerable scope for further expansion of the epidemic in this vast country -- alongside great opportunities to prevent such an outcome," said the report, released ahead of World AIDS Day on Wednesday.

With a population of 144 million, Russia has 860,000 people infected with HIV, according to the report. Official estimates [не оценки, а реальное число зарегистированных людей] put the number at 300,000 people, while some other experts, such as those at the Federal AIDS Center, said at least 1 million people are infected [клинический случай самоедства, требущий изучения].

The rate of AIDS-caused deaths may soar as soon as 2007, and 100,000 people may die that year alone, said Rian van de Braak, executive director of AIDS Foundation East-West, or AFEW, a Dutch nongovernmental organization dedicated to fighting AIDS in the former Soviet Union. These are the people who contracted the virus in 1996 and 1997, when the infection rate began to rise, and will have developed full-blown AIDS, she said [при том условии, что антиретровирусная терапия станет (останется) недоступной по цене].

The national economy may lose up to 4.5 percent of its gross domestic product by 2010 because the epidemic will affect much of the labor force, according to a 2002 World Bank report [с потолка]. Despite the looming health and economic crisis, federal funding has been scarce: just 126 million rubles (currently about $4.5 million) per year, which is comparable to the 119 million rubles that the state spends to support book publishers.

"The peasant will not cross himself before it begins to thunder," said Alexander Goliusov, head of the Health and Social Development Ministry's department for surveillance of HIV and AIDS, citing a proverb illustrating how people tend to take precautions only after the threat becomes imminent.

"Too bad the people who draft the national budget don't realize the terrible prospects."

Goliusov's department has only five employees. [это верно (в порядке), но из этого не следует, что только эти пять человек в РФ работают в теме]

"The problem will arise when millions of people will die," van de Braak said by telephone from AFEW headquarters in Amsterdam. "At this moment the problem is invisible."

As of Oct. 5, only 4,598 HIV carriers had died in Russia, and the causes might have been other than AIDS, Interfax reported, citing official statistics.

One reason why the government has paid little attention to AIDS is that until recently, the disease affected only marginalized groups such as drug users, prostitutes and homosexuals, van de Braak said. "As soon as the problem hits the family of a president or authorities at the top or famous people, the problem becomes more high-profile," she said.

The country's leaders rarely talk about the issue. President Vladimir Putin has only mentioned AIDS in his state of the nation address once, in 2003.  His not doing so this year was "extremely disappointing," Braak said.

"It shows that the issue has dropped off the agenda instead of becoming more important," Braak said. "Apparently, they have too many other problems and this problem seems too far away."

The UNAIDS/WHO report said Russia should make an immediate effort to raise public awareness about AIDS, reduce drug use and promote safe sex. The last item is crucial as the epidemic spreads to the population at large, the report said.
 

The Search for Funding

Russia has been under international pressure to step up funding for AIDS prevention and treatment, particularly given its consistent budget surplus in recent years. Goliusov said Russia needs to spend at least $144 million on prevention, or $1 for each Russian citizen.

Vadim Pokrovsky, head of the Federal AIDS Center, said Russia should tap into its stabilization fund, which has swelled due to high oil prices. He proposed setting aside 8 billion rubles ($285 million) every year to combat AIDS. "The stabilization fund is created for an emergency, and I see the current AIDS situation as an emergency," he said.

Young men under the age of 30 account for 200,000 of the 300,000 people officially registered as HIV carriers, Pokrovsky said. "They'll never be able to serve in the Army," he said. "It's a direct threat to national security."[если бы они были до 18, МО почесалось бы]

The Finance Ministry has said it may spend some of the windfall from the stabilization fund on early payment of foreign debt, but it has so far resisted heavy pressure from other ministries to spend the money on a wide variety of projects.

Meanwhile, international donations to Russia have ballooned in the past year. The first $10.9 million under an $88.7 million five-year program came through from the Global Fund to Fight AIDS, Tuberculosis and Malaria in September. The World Bank has an agreement to loan Russia $50 million, which came into force in December 2003, said Vladimir Gri[e]chukha, projects director at the Fund for Russian Health Care, the state agency authorized to spend the money. He declined to say how much of the $50 million has been spent. The person in the World Bank's Moscow office who could speak on the status of the loan was unavailable Monday and Tuesday.[хочется верить, что денег нет]

The foreign money will make it possible to provide antiretroviral treatment to up to 60,000 people annually until 2010, Pokrovsky said. It will not be enough to cover the 300,000 people who will require treatment in 2010, he said.

The U.S. Labor Department plans to start a program this year, with a budget of $946,000 over three years, to raise AIDS awareness at workplaces in the Moscow and Murmansk regions.

"But any foreign aid is only temporary," Pokrovsky said. "Russia must spend money itself."

The federal budget for AIDS has remained steady since 2002, and inflation has devoured 40 percent of its value, he said.

Goliusov said a third of the federal budget money goes to pay for medicine to treat HIV-carriers and for the testing of those in risk groups in order to identify new cases. Annually, 500 people are treated and 29 million people aged 15 to 30 are tested, he said. The work is done through a system of 112 AIDS centers throughout the country, which also operate hotlines.

Another third of the federal spending is set aside to examine and quarantine donor blood, Goliusov said.

Just about $1 million of the total goes toward prevention activities done by the AIDS centers and NGOs that bid for the money, he said. Last year, the Center for Social Development and Information -- the Russian branch of PSI, an international nonprofit organization -- won a $50,000 contract to produce television commercials on AIDS prevention and to have them shown,  he said.

In addition, officials are engaged in some prevention and educational activities that do not require funding. Goliusov said he often conducts question-and-answer sessions on web sites dedicated to the issue.
 

The Regions Step In

Regional authorities have been trying to make up for the lack of federal assistance. The regions spent 900 million rubles to fight AIDS last year -- about eight times as much as the national budget, said Larisa Dementyeva, senior expert at Goliusov's department.

The Krasnodar region has been consistently increasing funding to combat HIV/AIDS and has managed to push down its rate of new cases, to the 14th- fastest-growing in Russia last year from the second-fastest in 1997, said Valery Kulagin, chief doctor of the regional AIDS center. This year's anti-AIDS budget amounts to 3.8 million rubles, compared with 2 million rubles last year, he said.

The center is now adapting to the new trend of the virus spreading into the general public. The key sign of the spread -- the rate of HIV's sexual transmissions -- soared to 57 percent in this southern territory last year, Kulagin said by telephone. The country's average is 30 percent. The center began combating the trend in 2003 with booklets promoting safe sex for men and women, special school lessons beginning in the fifth grade, college lectures, and in radio and television interviews.

"We have good contacts with mass media," Kulagin said. "We tell people that AIDS is among us, that it's not something distant."

Yet much more funding is needed, he said. The Krasnodar region budgeted only 900,000 rubles for antiretroviral treatment in 2004, a far cry from the 8 million rubles needed, he said. The medicine is earmarked only for expectant mothers, and it has proved to be effective. Of the 62 babies born this year to HIV-infected mothers, only 18 were diagnosed with the virus, he said [это очень много, видимо кореспондент ошибся].

Infection levels among pregnant women in Russia have risen at an alarming rate, from less than .01 percent in 1998 to .11 percent in 2003, the UNAIDS/WHO report said [на самом деле данные Федерального центра по профилактике и борьбе...].

Krasnodar's total AIDS expenditures for next year are planned to increase again, to 5.7 million rubles, but the efforts require at least 25 million rubles, Kulagin said.

An understanding that the epidemic could be crippling for the economy does exist at the level of the regional government, and they "increase the funding as much as possible," he said. "A whole lot of other programs, such as those for disabled children and mentally disturbed people, have been scrapped altogether."

Goliusov and Pokrovsky said the federal authorities, not the regions, should be carrying the bulk of the responsibility for the AIDS situation in the country.[вразрез с политикой удвоенного ВВП -- доходы в центр, расходы на места]

One of the priorities is to bring down the price of antiretroviral treatment. Various estimates put the number of HIV-carriers that are currently in need of medicine at between 5,000 and 50,000, but only 1,700 receive the treatment. According to Goliusov, 1,200 of them have their antiretroviral treatment paid for by the regions and 500 by the federal government.

Gennady Onishchenko, head of the Federal Service for Supervision of Consumer Rights and Human Welfare, which oversees Goliusov's department, said Russia has been negotiating with foreign pharmaceutical companies for a 70 percent discount. It also wants to be allowed to produce generic drugs domestically in order to make them more affordable, he said [не факт, что произведённое в России будет дешевле (при том же качестве)]. Antiretroviral treatment currently costs $5,000 to $14,000 per year, depending on the individual case. Russia's goal is to lower this to $1,000.

The number of newly reported HIV infections in Russia has declined in the past few years, following a typical pattern of any epidemic to subside before surging again, Goliusov said. How high AIDS rates rise in the future depends on measures taken today, he said.

Meanwhile, people are beginning to stage protests against the government's apathy. About a dozen HIV-positive Russians chained themselves for a few hours to the door of the Kaliningrad city hall's main entrance in October to demand proper medical treatment. Some of the young people held signs saying, "Our Death Is Your Shame" [перекладывать свои проблемы на других = старая добрая русская традиция] and "HIV Is Not a Sentence -- We Need Medicine." [бесплатно !]

Another group held a rally in Moscow in May, Goliusov said. "There were few people and it was insufficiently organized, but it's a matter of time," he said. "At issue are the lives of active young people."