BBC News - Monday, 19 November, 2003
Sarah Rainsford, BBC correspondent in Moscow

He is an outreach worker with the non-government project Return to Life - a group that is spreading the word about HIV and Aids among drug users in Russia.

The HIV virus is still young here. The epidemic really took hold in the mid-1990s when it spread like wildfire among injecting drug users.

Russia now has one of the fastest-growing rates of HIV-infection in the world, and addicts who used infected needles still make up the vast majority of those living with the virus.

Needle sharing

Return to Life have been promised premises for a formal needle exchange, but staff say the process has been delayed by bureaucracy.

In the meantime Misha and his team of four tramp the freezing streets and gloomy yards looking for addicts.

Lera, aged 22, is a former intravenous drug user who now works with the project.

She tells me almost every user in Moscow now knows someone affected by HIV. The virus has forced many addicts to clean-up their act.

"It was wild before. Five of us would share one needle. We didn't care if it was clean - all we cared about was the hit" Lera says.

"But Aids has changed things. Our friends starting getting sick, and we got frightened."

New phase

Russia's HIV epidemic has entered a new phase. Test centres report an increasing number of new infections, contracted through sexual contact.

Experts judge that the virus is now spreading to the wider population along a well-studied model.

UNAids representative in Moscow Dr Pedro Chequer says the authorities need to take urgent steps to raise public awareness about what he calls the "new profile" of the HIV epidemic.

"There is an understanding in Russia that HIV/Aids is just for commercial sex workers and drug addicts," Dr Chequer explains.

"Many other people don't feel they're at risk, even if they have multiple partners and don't use a condom."

Treatment gap

Roman tested positive for HIV in 1995 and is now taking medication. In Moscow the local authorities foot his bill but full "combination therapy" - the cocktail of drugs needed to contain HIV effectively - costs around $8000 a year and many poorer cities cannot afford to pay.

According to Russian law anyone who is HIV-positive is entitled to free treatment at their local Aids Centre.

But there is still a large gap between policy and implementation.

"What can I say? It's Russian reality," Roman says. "There are a lot of laws here that don't work."

Experts suggest that at the current phase of the epidemic, around 10% of people with HIV require medication.

Lack of funds means Russian Aids centres are currently treating a fraction of that amount.

Drug costs

Roman fears Russia is heading for disaster. "Most of our HIV positive people were infected a few years ago and they don't need treatment right now," he says.

"That's why the Ministry of Health doesn't talk about it. But they just don't think that in five years - or maybe even three - we will have a huge problem. If they don't think - millions of people could die"

But despite such gloomy prognoses, there is little hint that the government is in any hurry to help cut costs.

"Russia is paying for the most expensive drugs in the world. It is impossible to maintain," says Dr Chequer.

"There is a need for price negotiation with western drugs companies, and local production of generic drugs. Russia needs to make that political decision."

As HIV begins to spread from drug users to the wider population, there are signs that Russia is belatedly waking up to its epidemic.

Experts' warning

Russia now has a National Advisory Council on Aids. President Putin referred to the issue for the first time in his annual state-of-the-nation address this spring.

But for policy makers the issue is still far from a priority and despite a healthy budget deficit this year federal funding for HIV/Aids projects remains a tiny fraction of what is needed.

With experts warning that up to five million people could be carrying the HIV virus in five years, many say Russia can not afford to stall much longer.

"I do think the situation in Russia will change," Roman says. "We will get money, we will get treatment. But I think it will take a long time. And before that, we will lose a lot of people's lives."
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