InterPress News Service (IPS) - August 30, 1998
Andrei Ivanov

Dr Bernhard Schwartlaender, senior epidemiologist at the Joint U.N. Programme on HIV/AIDS, and Dr David Heymann, head of the emerging diseases division at the World Health Organisation (WHO), have expressed alarm over the new production method.

They fear that it will undermine their agencies' efforts to educate drug users in the former Soviet Union about the dangers of HIV. "It is a shocking new phenomenon for us, because our nice messages might not be that valid for this part of the world," Schwartlaender explains.

Producers have starting putting blood into drugs to test their quality. U.N. experts believe this could be one reason why the AIDS epidemic has spread so rapidly in Eastern Europe and the former Soviet Union. If such drugs are injected, using sterile needles provides no protection.

However, there is evidence that information about the new dangers may be getting across to users, with reports that some addicts, heeding medical advice, have begun to sterilise the ready-to-use drugs they buy.

There are also signs that the spread of HIV as a whole may be slowing in Russia. In the first half of this year of total of 1,468 new HIV cases were recorded, 16 percent down on the same period of last year. First Deputy Health Minister Gennadi Onishchenko warns against complacency, however, saying that the figures were "still high".

Since 1987, 8,956 HIV carriers have been registered in Russia, of whom two-thirds, or over 6,000, contracted the infection in 1997- 98. In the past 11 years, 210 Russians have died of AIDS, including 72 children. In total, 320 Russians, including 111 children, have developed full-blown AIDS.

Experts say that the slowdown should in no way be interpreted as containment of the epidemic and point out that the number of cases is still increasing rapidly. Vadim Pokrovsky, head of the Republican AIDS Centre, says the improved figures may be due to the serious preventive measures which have been taken in the areas most gravely affected by HIV, such as Kaliningrad, Nizhny Novgorod and Tver.

Intravenous drug use is still a major factor, and the first needle exchange centre in Russia opened in the city of Kaliningrad in July. The Kaliningrad Oblast (regional authority), with 926,000 residents, has more registered AIDS cases than any other region.

As of March 1998, some 1,700 people in Kaliningrad were known to carry HIV. The oblast centre for psychotherapy and a local foundation working against AIDS and drug addiction are sponsoring the programme, which allows drug users to exchange used needles for new ones free of charge. Free AIDS tests and other medical services will also be made available.

Pokrovsky stresses that one of the most important things in the anti-AIDS campaign is to continue educating drug addicts on how best to minimise the risk of infection if they are unable to get themselves off narcotics.

There have also been changes in disease transmission patterns compared with last year. HIV-infection is now more often transmitted through sexual intercourse, with prostitutes being a high-risk group. Pokrovsky expects the incidence of HIV infection to rise in Moscow, Moscow region and central Russia by the end of this year.

His centre is currently conducting clinical tests of Phosphazide, a new medicine for treating HIV patients. He says the medication is not only equivalent to foreign analogues, but may be superior to them because it is less toxic. Patients are able to take it in larger doses compared with azidotimidine (AZT). Phosphazide was developed by a group of molecular biologists led by academician Alexander Krayevsky.

Russian doctors are still investigating the best combination of drugs involving phosphazide and are also looking at whether it can be used alone, or whether it alone is potent enough to drastically reduce the concentration of HIV in the body.

However, Pokrovsky admitted that the centre is having financial difficulties and needs two million roubles to continue with the tests as the state has allocated no money for the purpose.

Much of the anti-AIDS work, including health education, is being left to NGOs such as AIDS Infoshare. However, they are facing resistance from the public.

"Although we are striving to improve the clinical and diagnostic information available to doctors and other medical workers, the fear and distrust of the medical system on the part of many Russian citizens keep people from getting tested or treated," explains Infoshare's executive director, Julie Stachowiak. She points out that such fears are not groundless. "Once someone tests positive, they may be refused treatment on basis of their condition and their lack of financial resources to pay the new black market prices," she says, They may also be subjected to tests without their consent.

"They may be unknowingly given experimental treatments or medication. Or they may simply be told that they have a chronic condition and then be turned away with no further information." Some may undergo a procedure without proper sanitary conditions or anaesthesia, or have information about their condition made public.

"We have started a programme to begin researching the human rights situation in the health system and to help organisations and individuals advocate change," says Stachowiak. "The process of attaining real improvements will be a long one, and we hope to see many Russians and those outside of Russia working on HIV/AIDS and human rights problems in this region." (END/IPS/AI/AN/98).

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