VZCZCXRO8720
RR RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHMO #0536/01 0581454
ZNR UUUUU ZZH
R 271454Z FEB 08
FM AMEMBASSY MOSCOW
TO RUEHC/SECSTATE WASHDC 6832
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHYG/AMCONSUL YEKATERINBURG 3047
RUEHVK/AMCONSUL VLADIVOSTOK 2706
RUEHZN/EST COLLECTIVE
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 03 MOSCOW 000536 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR OES/IHA 
USAID FOR GH, E&E 
HHS FOR OGHA 
 
E.O. 12958: N/A 
TAGS: KHIV TBIO SOCI SCUL RS
SUBJECT: RUSSIA'S HIV/AIDS EPIDEMIC GROWS STEADILY 
 
REF: A. 06 Moscow 5353 
 ¶B. 06 Moscow 4543 
 ¶C. 06 Moscow 1811 
 
MOSCOW 00000536  001.2 OF 003 
 
 
THIS CABLE IS SENSITIVE BUT UNCLASSIFIED.  PLEASE PROTECT 
ACCORDINGLY. 
 
¶1. (SBU) SUMMARY:  Russia's HIV/AIDS epidemic continues to grow, 
though not at the same fast pace that occurred in 2000-2002. 
Infections continue to be concentrated among injecting drug users, 
but the epidemic is also spreading through heterosexual sex, 
primarily among the partners of high risk groups such as sex workers 
and drug users.  In 2007, 44 percent of new cases were among women, 
most estimated to be among or linked to high risk groups.  Russian 
Government spending on HIV/AIDS treatment has grown exponentially, 
and over 30,000 people are now receiving anti-retroviral therapy. 
Although the government has spent comparatively little on HIV 
prevention activities, Government officials recognize that they must 
increase spending in this area, and have been looking to the NGO 
community for examples of successful outreach, prevention and care 
programs.  Russia will face significant challenges to increase 
adherence to therapy among patients, and to effectively tackle 
AIDS-related co-infections such as tuberculosis and hepatitis.  END 
SUMMARY. 
 
------------------------------- 
HIV/AIDS Cases Growing Steadily 
------------------------------- 
 
¶2. (U) Some 400 medical professionals and researchers from regional 
AIDS centers, the Health and Social Development Ministry, health 
NGOs, and research institutes gathered in Suzdal December 4-6 for 
the annual All-Russian Conference on HIV/AIDS.  Gennadiy 
Onishchenko, Russia's Chief Medical Officer and the head of the 
Federal Surveillance Service for Consumer Rights Protection and 
Human Well-Being (Rospotrebnadzor), opened the conference by stating 
that despite substantial efforts over the last several years, 
Russia's HIV/AIDS epidemic was growing steadily.  About 403,100 HIV 
cases had been officially registered in Russia since the HIV/AIDS 
epidemic began 26 years ago, of whom some 350,000 people were still 
alive today. 
 
¶3. (U) According to Vadim Prokovskiy, Director of the Federal AIDS 
Center, the number of newly registered HIV cases in 2006 stood at 
39,652, a 1.7 percent increase over the number of cases registered 
in 2005.  This number was still well below the 87,823 cases recorded 
in 2001, when the number of new cases reached its highest level. 
Intravenous drug use remains the most common route of transmission 
of HIV infection, with 65 percent of newly registered cases among 
drug users. More than 44 percent of new HIV cases were registered 
among women in 2006, indicating a growth of heterosexual 
transmission, though experts believe this growth is primarily 
because of transmission to sex partners of intravenous drug users. 
There are a growing number of secondary opportunistic diseases, such 
as Tuberculosis (TB), hepatitis, and kaposi sarcoma, among 
HIV-positive individuals, which was reflected in a forty percent 
growth in the amount of deaths among HIV positive individuals in 
2006 compared to the previous year.  Some 9,000 Russians have active 
TB/HIV co-infections, and a significant proportion of HIV-positive 
people also have hepatitis B or C.  By the end of 2006, there were 
41,500 HIV positive Russian prisoners out of a total population of 
871,693 prisoners.  Some 3,037 prisoners are currently receiving 
anti-retroviral therapy (ART) through programs supported by the 
Global Fund, but prison authorities estimate at least 4,800 
prisoners currently need such therapy. 
 
------------------------------------------- 
Russians Bristle at International Criticism 
------------------------------------------- 
 
¶4. (SBU) UNAIDS estimates there are over one million people living 
with HIV/AIDS in Russia, making up two thirds of all HIV/AIDS cases 
in Eastern and Central Europe.  Federal AIDS Center head Pokrovskiy 
has stated he generally agrees with that assessment, but Chief 
Medical Officer Onishchenko has publicly disagreed and complained 
about the lack of clarity in how UNAIDS derives its estimates. 
Onishchenko has also bristled at suggestions from former USUN 
Ambassador Holbrooke (now head of the Global Business Coalition on 
HIV/AIDS, TB and Malaria) that Russia is losing the battle against 
the epidemic.  Last November, Onishchenko and drug control 
authorities were also quick to reject a recommendation from Human 
Rights Watch International that Russia legalize the treatment of 
drug substitution therapy with methadone for heroin addicts, an 
issue which affects many HIV/AIDS patients (Ref A).  Likewise, on 
 
MOSCOW 00000536  002.2 OF 003 
 
 
February 18, some 30 protesters from United Russia's "Young Guard" 
movement shouted "We will not let you take methadone!" outside an 
international conference on Evidence-Based Substance Abuse Treatment 
in the Era of HIV/AIDS, which was organized by the Russian Mental 
Health Research Institute and Transatlantic Partners Against AIDS. 
 
---------------------------- 
Russia Expands HIV Treatment 
---------------------------- 
 
¶5. (U) Under Russia's National Priority Health Project (Ref C), 
federal government spending on HIV/AIDS treatment has gone up 
exponentially since 2005, and now stands at over $200 million per 
year.  The government exceeded its target of 30,000 HIV-positive 
people receiving ART by the end of 2007.  The GOR expects to provide 
40,000 patients with access to ART during 2008, and treat 52,000 
with ART by 2009.  These targets are for federally funded programs. 
In addition, more than 9,000 people living with HIV in Russia are 
receiving ART under Global Fund programs, according to the Russian 
Healthcare Foundation.  Despite the federal and Global Fund 
programs, many more Russians need ART than are currently receiving 
it, and that number is expected to continue rising over the next few 
years. 
 
¶6. (SBU) Most Russian experts believe that problems of stigma, lack 
of consistent drug supply (ART) and access to care remain critical 
problems for those in need of treatment.  The failure of physicians 
to implement diagnostic and monitoring standards for out-patients at 
HIV centers is another reason why not everyone who needs ART is 
receiving this life-saving therapy.  Observers also state it has 
been difficult for the GOR to conduct outreach to most at-risk 
populations, such as drug users and commercial sex workers.  During 
the past year, however, the Health and Social Development Ministry 
has awarded tenders to some NGOs to conduct outreach activities 
among vulnerable populations, which has supplemented existing 
outreach programs supported by the Global Fund and USG. 
 
¶7. (SBU) Russian adherence rates (i.e., how many people who start 
ART continue treatment) are on par with levels in other parts of 
Europe, with about ten percent of patients abandoning treatment per 
year.  Some 2,771 patients gave up treatment for various reasons 
during 2007.  Mikhail Rukavishnikov, head of the Society of People 
Living With HIV/AIDS, told us recently that adherence is one of the 
biggest concerns of his organization.  In his view, the GOR is 
failing to counsel, provide social support, and to educate those on 
ART about the need to continue taking medicines, and many patients 
do not understand that they need to receive ART indefinitely.  The 
lack of availability of quality drug rehabilitation programs also 
contributes to adherence problems in Russia.  Government officials, 
however, have made positive comments about the impact of faith-based 
groups and other NGOS that have developed psycho-social support 
programs for drug addicts undergoing rehabilitation. 
 
------------------------------------- 
Government Prevention Efforts Lagging 
------------------------------------- 
 
¶8. (U) Despite the massive spending on treatment and care, Russia 
spends comparatively little on efforts to prevent the further spread 
of HIV.  The GOR budgeted around $8 million for prevention 
activities in 2007, though the number is expected to rise to over 
$16 million in 2008 and over $28 million in 2009. In addition, only 
about 25 percent of the prevention funds in 2007 are being spent on 
prevention activities among high-risk groups. Leading health 
officials such as Pokrovskiy and Onishchenko publicly acknowledge 
that the country needs to devote more resources to prevention, and 
they have pledged to seek additional funding from the government for 
these activities. 
 
---------------------------- 
Rising Tide of Co-Infections 
---------------------------- 
 
¶9. (U) Observers expect that the number of AIDS-related 
co-infections will grow over the next few years, as the immune 
systems of the large number of people infected with HIV from 2000 to 
2002 become compromised.  Accordingly, the need for treatment and 
care of AIDS patients is expected to increase significantly.  TB is 
already the leading cause of death among HIV positive people, 
accounting for 59 percent of all deaths among this group in 2006 
(Ref B).  The number of active TB/HIV co-infections has risen from 
2,524 cases registered in 2002, to 9,102 cases in 2006. 
 
¶10. (SBU) Chief Medical Officer Onishchenko has also expressed 
 
MOSCOW 00000536  003.2 OF 003 
 
 
concern over the high rates of hepatitis B and C co-infections among 
people living with HIV/AIDS. During 2008 Rospotrebnadzor will begin 
supplying 32 pilot regions with lab equipment and medicines to 
diagnose and treat 8,500 patients suffering from Hepatitis/HIV 
co-infections.  In a recent meeting, Onishchenko told us privately 
that he is concerned about the fact that treatment for co-infections 
is funded by regional budgets, whereas the federal government pays 
for HIV/AIDS treatment.  He said the federal government will review 
that funding arrangement, and may ultimately decide to fund 
treatment of co-infections at the federal level as well. 
 
------- 
COMMENT 
------- 
 
¶11. (SBU) While making great strides in HIV treatment, Russia's 
health professionals and policy-makers still face tough challenges 
in conducting prevention, treatment and care activities among 
socially-marginalized and vulnerable populations like drugs users 
and commercial sex workers.  The country will have to grapple with 
how to procure drugs at affordable prices and maintain an adequate 
supply of drugs to treat co-infections.  It was encouraging that the 
GOR created a national HIV/AIDS Commission in 2006, chaired by the 
Health and Social Development Minister, that included both health 
professionals, health NGOs, and people living with HIV/AIDS. 
Unfortunately, the commission has only met twice, and has done 
little so far to develop national policies or strategies for 
tackling the thorny HIV/AIDS issues that lie ahead. 
 
BURNS