Treatment Issues: Newsletter of Experimental AIDS Therapies - Volume 17, Number 5, May 2003
Gregg Gonsalves

There was a joyous sing-along at a party closing the first regional meeting on AIDS activism for 17 states of the former Soviet Union, which took place in Minsk, Belarus, from May 7 – 10. Partially fueled by the camaraderie of working together over four days and partially by copious amounts of vodka, participants from each of the countries sang their national favorites (the Americans sang Lou Reed's, Walk on the Wild Side). There were two songs that all the Russian-speaking participants knew by heart: the old national anthem of the USSR and a song called "Goodbye, America." Goodbye America is about disillusionment with the United States and more broadly the West, in which the lure of Western culture and its forbidden fruits during the Soviet era turns out to be a mirage for contemporary Russians. "Goodbye, America — The place where I'll never ever be," goes the song, testifying to the fact that the "good life" the U.S. and the West symbolize remain out of reach for most people in the region. I couldn't help thinking that this song was an appropriate coda to a meeting that stressed the stunning lack of access to basic HIV treatments and diagnostics and the unwillingness of the West to intervene on any appropriate scale to assist these countries on the doorstep to Europe in confronting an epidemic that is exploding all around them.

The conference, "Increasing Advocacy Possibilities for the Rights of People Living with HIV/AIDS (PLWHA) in the Newly Independent States," was sponsored by the International Harm Reduction Development Program of the Open Society Institute, the Tides Foundation, the Ford Foundation and the Joint United Nations Programme on HIV/AIDS. Despite the grave situation in the region, the conference felt like a watershed event for the PWLHAs, drug users, sex workers, and gay men who gathered there from over 20 countries, to attend a training on advocacy skills and to strategize together about the needs for their communities.

While there are strong AIDS advocacy movements in a few countries in the region, particularly Ukraine, the idea of "acting-up" was new to many from the former Soviet states. By the end of the four days, the diverse group had settled on a few priorities for their work together: antiretroviral therapy access; access to harm reduction and substitution therapy (e.g. methadone); the reduction of stigma and discrimination towards PWLHAs and drug users; and the improvement of social services. Despite the obstacles they face, I was amazed by the participants' energy, intelligence and passion to move forward. Advocacy projects on issues identified at the conference will now be supported by a grant-making process. In a novel twist, the scope of projects to be supported and the proposals themselves will be reviewed by advocates from the region, with logistical support provided by the Tides Foundation, which has raised money and set up a fund to disburse the grants.

The former Soviet Union has the fastest growing epidemic in the world, yet the West has only recently taken notice of the looming catastrophe there. One cannot help think that there is a bit of queasiness by Western donors for an epidemic that is largely fueled by drug use. For instance, the U.S. government's aversion towards harm reduction, specifically needle exchange, and its own domestic policies on drug use, make it far easier to ignore what is happening in Eastern Europe and Central Asia, than to confront the irrationality of its approaches here at home. George Soros' Open Society Institute is a vital exception in the region and funds 65 percent of the harm reduction efforts there. Yet, in the context of the scarcity of other funding, there is little support for services for PWLHAs, much less HIV-positive drug users, which makes the harm reduction effort stand out like a sore thumb, exacerbating tensions between communities of drug users and those of PWLHAs.

The question "What is to be Done?" has a thorny history in the former Soviet Union, but unless great change comes to the region, the devastation will be tremendous. It's time for Western donors to step up and confront what is happening with a commitment of cash and resources, and particularly for the U.S. to give up its radically conservative vision of how to deal with drug use. Activists around the world also need to support our colleagues in the East and stand in solidarity with them as they begin the struggle that started to take shape a week ago in Minsk.

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