The Russian Ministry of Health has been on the defensive for the past few months, denying charges that it has failed to prioritize the needs of people with AIDS, resulting in widespread treatment interruptions.
As in Africa, where patients have used cell phones and Google maps to document empty pharmacy shelves, Russian activist efforts have featured a combination of new media and old-fashioned street theater. Patients experiencing treatment problems email to a central website run by the Russian group International Treatment Preparedness Coalition (ITPC.ru), an Open Society Foundations grantee, whose site has page after page of entries detailing medication shortages, doling out of expired drugs, or regimen changes due to supply interruption.
Heads turned in Red Square in September when "nurses," whose blonde wigs evoked Russian health minister Tatyana Golikova, led a colleague dressed as a bear (symbol of Russia, equivalent to America's eagle) around on a leash (view a photo from Russian citizen journalism site Demotix). While interpretations varied—some commentators said the action symbolized the need for the health authorities to leash the uncurbed appetites of Russian businessmen, while others saw a comment on how the health ministry was leading Russia to disaster—the action, followed by another where activists chained themselves in front of the health ministry, got the attention of the press. And of the authorities, who continue to insist that the Russian AIDS treatment system is doing just fine.
Government representatives may soon have to tell that to the judge, and to human rights specialists in Geneva. In Russia, people with HIV have brought nine different lawsuits against AIDS centers that have stopped or changed medical treatments for nonmedical reasons. This week, a complaint was filed with the United Nations Special Rapporteur on Health.
While stock-outs are the most pressing issue, community advocates have also revealed another pernicious problem with Russian AIDS treatment system: the medical commission. According a report, "ARV in Russia: Problems and Recommendations for Improvement" [pdf], drawn from interviews in 19 cities surveyed by a network of community correspondents calling themselves SIMONA+, any patient seeking HIV treatment has to have medical records reviewed by a commission of multiple doctors, most or all of whom have never seen the patient in question.
Many of these commissions require multiple and unnecessary tests and do not consider the opinions of the social workers most familiar with the patient's likelihood of sticking to their medical regimen. In more than half, the commissions use drug use as a criterion for denying treatment. While Russia has come a long way since the bad old days when even AIDS doctors in cosmopolitan centers like St. Petersburg decided that drug users were socially unproductive and so undeserving of treatment, mechanisms like the treatment commissions subject drug users to a softer, but no less deadly, form of bigotry and treatment denial.
Prime Minister Vladimir Putin has sought to redeem Russia from perceptions of moral and financial backwardness on HIV, pledging universal treatment for all people with AIDS in Russia, and returning the monies received from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. These promises, however, will remain hollow so long as old models like centralized, inflexible procurement of medication, and commissions that deny treatment to active drug users, remain in place. The number of Russians living with HIV continues to grow steadily, according to the UNAIDS 2010 Global Report, and some 70 percent of Russian HIV infections are among those with a history of intravenous drug use. Instead of universal access, what Russia currently offers is an AIDS system unavailable to the majority in need.