VZCZCXRO3701
RR RUEHAST RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHTM
DE RUEHMO #1973/01 1921107
ZNR UUUUU ZZH
R 101107Z JUL 08
FM AMEMBASSY MOSCOW
TO RUEHC/SECSTATE WASHDC 8968
INFO RUEHYG/AMCONSUL YEKATERINBURG 3240
RUEHVK/AMCONSUL VLADIVOSTOK 2887
RUEHLN/AMCONSUL ST PETERSBURG 5002
RUEHZN/EST COLLECTIVE
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 03 MOSCOW 001973 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR S/GAC (CLANGLEY), EUR/ACE 
USAID FOR GH, E&E 
HHS FOR OGHA 
 
E.O. 12958: N/A 
TAGS: KHIV EAID EINV EAGR ETRD PREL SOCI RS
SUBJECT: PEPFAR HIV/AIDS DISCUSSIONS IN RUSSIA 
 
MOSCOW 00001973  001.2 OF 003 
 
 
THIS CABLE IS SENSITIVE BUT UNCLASSIFIED.  PLEASE PROTECT 
ACCORDINGLY. 
 
¶1. (SBU) SUMMARY: USAID's Assistant Administrator for Global Health, 
Dr. Kent Hill, visited Moscow and St. Petersburg June 18 to 22 to 
discuss President Bush's Emergency Plan for AIDS Relief (PEPFAR) 
HIV/AIDS program in Russia with representatives of the Ministry of 
Health and Social Development (MOHSD), the Global Fund for AIDS, TB 
and Malaria (GFATM), UNAIDS and key NGO groups working on HIV/AIDS 
prevention programs.  While significant GOR resources are committed 
to addressing the HIV epidemic, there are serious gaps in technical 
expertise and experience.  Post believes continued USG engagement is 
essential to target and help mobilize these GOR resources.  The HIV 
epidemic remains a concentrated epidemic but without international 
support providing access to international best practices, Russia is 
at risk.  Adequate USG funding is needed to enable USG to carry out 
an effective program of targeted technical support through 2013 
leading to a full transfer of the USG program in the sector by that 
year.  Dr. Hill's discussions highlighted areas for continued 
USG-Russia cooperation on prevention and care efforts, particularly 
in St. Petersburg where there is considerable potential for 
deepening current US-Russian collaboration on HIV/AIDS. 
 
----------------------- 
AIDS Epidemic in Russia 
----------------------- 
 
¶2. (SBU) The HIV/AIDS epidemic in Russia continues to expand, 
although there has been a marked decline in HIV transmission since 
the peak in 2001.  More than 440,000 people have been officially 
registered with HIV/AIDS in Russia, although the unofficial estimate 
is one million.  Although injecting drug users (IDU) continue to 
account for the majority of newly reported HIV/AIDS cases, a growing 
number of these infections are attributable to heterosexual sex (one 
third in 2007), linked to sex partners of IDUs.  Women constitute an 
increasing share of newly reported cases, 44% of cases registered 
last year, up from 24% in 2001.  This suggests that a window of 
opportunity exists to contain the epidemic in Russia with 
appropriate intensification of prevention and other activities.  It 
also suggests that there is a risk that the epidemic could expand 
beyond the IDU or IDU-linked population.  Continued USG technical 
assistance to help the GOR target the growing resources that it is 
committing to combat this scourge is essential and timely. 
 
------------------------------ 
Meeting the Ministry of Health 
------------------------------ 
 
¶3. (SBU) In Dr. Hill's meeting with Deputy Health and Social 
Development Minister Ruslan Khalfin the Deputy Minister praised the 
work of USG programs in Russia and stressed that MOHSD supported 
efforts to disseminate nationwide the lessons learned in regional 
HIV/AIDS programs.  Khalfin expressed interest in continued 
international, including USG, support for programs aimed at training 
of health professionals and acknowledged the need for prevention 
programs such as substance abuse programs for IDUs, including a 
greater focus on life skills and prevention programs.  Khalfin 
reiterated that methadone treatment for IDUs remains illegal in 
Russia, but noted that some forms of medication assisted therapy 
could be considered.  Khalfin noted that with the recent selection 
of a new Director for the Federal Drug Control Service, there may be 
opportunities to bring policy leaders and experts together to 
discuss options for addressing the IDU-driven epidemic, including 
programs that the USG could support such as study tours and training 
on HIV-related issues - exposing Russian policy makers to 
international experiences (and allowing them to share their own 
experiences) on combating substance abuse. 
 
--------------------------------------------- ---- 
UNAIDS and Other Partners in the Fight against HIV 
--------------------------------------------- ----- 
 
¶4. (SBU) In meetings with UNAIDS and GFATM representatives, Dr. Hill 
discussed the status of the epidemic and the need for greater 
emphasis on prevention programs.  Both organizations noted that 
currently over 200 NGOs work on HIV issues in Russia, a significant 
increase in recent years primarily due to external support from 
international donors such as the USG and the GFATM.  While this is 
impressive growth, the downward trajectory of external funds has the 
potential to thwart progress made in this area.  Programs receiving 
support from USG and other external partners are still needed as 
many barriers limiting NGO access to GOR support persist.  These 
 
MOSCOW 00001973  002.2 OF 003 
 
 
barriers include limited funding opportunities from GOR federal and 
regional budgets and complicated funding disbursement systems. 
According to UNAIDS and the GFATM, 83 percent of NGOs rely on 
international funding.  GFATM representatives noted the success of 
grants in reaching targeted goals and treatment levels, but 
indicated that the future sustainability of these NGOs after phase 
out of GFATM support is in doubt without a firm transition plan. 
 
----------------------------------- 
HIV/AIDS PROGRESS IN ST. PETERSBURG 
----------------------------------- 
 
¶5. (SBU) In St. Petersburg, Dr. Hill and U.S. Consul General Kruger 
met with representatives from the city's Health Committee and Social 
Services Administration, which signed a Memorandum of Understanding 
(MOU) with the USG in July 2007 to fight HIV/AIDS.  The USG team 
presented city officials with a six-month progress report on 
achievements under the MOU. City officials emphasized the positive 
impact of the MOU on coordination of joint efforts and expressed 
their willingness to strengthen such collaboration in the future. 
The City Health Committee praised Russian-American cooperation for 
its important contribution to successful implementation of the St. 
Petersburg City Government HIV/AIDS Action Plan as well as the GOR's 
National Priority Project on HIV/AIDS. Officials highlighted 
achievements in significantly decreasing the HIV mother-to-child 
transmission rate from 19 percent to 6 percent and increasing 
fivefold the number of people living with AIDS (PLWA) receiving 
anti-retroviral therapy (ART) as a result of targeted USG support 
under the MOU. 
 
¶6. (SBU) St. Petersburg City health officials expressed the need for 
continued USG support in critical areas such as improving 
effectiveness of prevention programs for injecting drug users(IDUs), 
patient treatment adherence to HIV treatment, improved links with 
social services, and outreach to youth and street children.  Health 
officials explained their readiness to work collaboratively under 
the MOU to further advance HIV prevention among IDUs by launching a 
program using naltrexone as a medication assisted therapy in drug 
rehabilitation.  This use of naltrexone is a positive first step in 
a path that may lead to the introduction of other drugs such as 
buprenorphine or methadone as an accepted drug therapy. 
 
¶7. (SBU) Faith-Based Leaders and NGOs:  USG partners from the 
faith-based community and NGOs highlighted their role in preventing 
the spread of HIV among most at risk populations (MARPS).  St. 
Petersburg City officials present acknowledged the catalytic role of 
USG supported program in strengthening government-NGO cooperation. 
Last year 9,000 MARPs received outreach and HIV prevention messages, 
the largest number of outreach activities in any one city in Russia. 
 Faith-based organizations are increasingly engaged in promoting 
behavioral changes among vulnerable youth, provision of care to 
PLWA, and drug-free rehabilitation services for IDUs.  St. 
Petersburg is now planning to replicate successful drug-free 
programs developed by NGOs into state-run facilities. 
 
¶8. (SBU) The USG team also visited a unique USG-support street youth 
drop-in center and met with the heads of the Municipal 
Administration and the Social Services Administration, strong 
supporters of the USG program.  The Municipal Administration has 
directed funds to cover rent and other recurrent costs of this youth 
center.  The center is the first municipal social services program 
to introduce HIV/AIDS tested services for street children and youth, 
especially important in St. Petersburg where HIV rates among street 
kids reached 37% in 2006, according to a study by the U.S. Centers 
for Disease Control and Prevention.  Municipal authorities plan to 
expand the program to other districts within St. Petersburg in 
collaboration with a USG-funded partner. 
 
¶9. (SBU) COMMENT:  The GOR is increasingly prepared to commit 
financial resources to combat HIV/AIDS in Russia, but faces serious 
gaps in technical expertise and experience. USG engagement can play 
a critical role in helping the GOR overcome this technical capacity 
gap and contribute substantially to containing the HIV epidemic in 
Russia.  With the existing support and leadership of GOR 
counterparts, the PEPFAR program in Russia is well positioned to 
support a bilateral compact or compacts with national and regional 
governments in Russia to bring collaboration on HIV/AIDS to a new 
level, mobilize significant additional Russian resources, and ensure 
an orderly transition of USG-supported program to the GOR. Such a 
compact could serve as a model for other graduating countries on how 
to solidify collaboration with host country governments and how to 
leverage and target host government resources. 
 
MOSCOW 00001973  003.2 OF 003 
 
 
 
BEYRLE