Russia faces shortage of HIV/AIDS drugs

Patients of an HIV/AIDS prevention and control center in Moscow warned last month on a patient website that pharmacies in the Russian capital were no longer dispensing Dolutegravir, an antiretroviral medicine.

It isn't the only HIV medication that's unavailable.

"Patients have already reported 400 incidents of drug shortages to the Disruptions website, which monitors the availability of HIV and hepatitis treatment in Russia," wrote the independent Russian news site Novaya Gazeta Europe in November.

The news site estimated that medical facilities cut procurement of almost half of all HIV medicines available and stopped supplying 13 medicines completely.

An epidemic out of control

It's thought that more than 1.13 million people in Russia live with the human immunodeficiency virus (HIV), which can lead to acquired immunodeficiency syndrome (AIDS).

The actual number is probably much higher, said Ekaterina Stepanova, a doctor at a private clinic in Russia.

"More than 27 regions are currently experiencing an HIV epidemic," she said. "That means that more than 1% of all pregnant women test positive for HIV. That is awful. It shows just how far the virus has spread throughout Russia."

Only about 52% of all registered patients receive medication for free. In exchange, they must register their status as a person infected with HIV, which is recorded in a database.

Many don't want to be registered — they fear discrimination and social exclusion. In Russia, AIDS is still a taboo topic.

This is not only due to a lack of information but also to the prejudice associated with the virus: Many assume that only homosexual people, sex workers, and people with substance addictions can contract HIV.

In society, these groups are widely stigmatized and liable to criminal prosecution.

"That is why working with these groups is very difficult," Dr. Stepanova told DW.

Prejudice and ignorance

Aleksei is one of the few Russians who is forthcoming about his infection. He lives in Moscow and still remembers the day he received his diagnosis.

"I was eight years old the day I learned that I had been infected since birth through my biological mother. At the time, I was in the hospital for [something else], and they discovered it by chance. I didn't think much of it at the time. I was just a kid without any preconceived notions."

He lived in several foster homes until he turned 14. At first, he didn't notice any discrimination due to his infection. It was only later that he realized he was being treated differently.

"As a child, I always wondered why my cutlery, plate and cup always went with me when I moved foster homes. I actually kind of liked it. Only later did I realize that it was because of my HIV diagnosis."

He thinks, though, that this wasn't done out of spite but because those responsible did not know much about the virus.

Nevertheless, Aleksei was deeply hurt when he experienced discrimination later in life.

"One time, I was at a bar with friends, and I told them about my HIV infection," he told DW. "They asked me which glass I had drunk from so they wouldn't get mixed up. For some reason, that hurt me so much that tears came to my eyes."

HIV is not easy to pass on from one person to another. The virus lives in the blood and in some bodily fluids. In most cases, fluids from someone with HIV must pass directly into the bloodstream, for instance, through open wounds or mucous membranes during unprotected sex.

Medicine in short supply

There is, of course, also the option of being treated in private clinics. However, patients have to pay for their medication out of pocket. This usually costs between 4,000 and 9,000 Russian rubles ($44-$98 or €40- €90), which not everyone can afford.

"For the most part, my patients buy their own medication," Stepanova said. "Those who receive free treatments or have the money to buy extra bring it over so we can distribute it to those who don't have any. We look out for each other."

But why is medication in such short supply? The international sanctions against Russia make an explicit exception for life-saving medicines. Cheaper Russian generic drugs are also available. But even these aren't enough to treat all those in Russia with HIV.

One possible explanation is that Russia's health ministry's budget for acquiring HIV medication has been stagnating for years — despite rising infections. According to the International Treatment Preparedness Coalition, an NGO fighting for universal access to HIV treatment, Russia dipped into its designated funds for 2022 and 2023 to cover its 2021 medication costs.

That most of Russia's funds are currently being invested in the war in Ukraine has only exacerbated the situation.

To make matters worse, Russia's population is growing, which means that HIV numbers are also on the rise. In September 2022, the illegally annexed territories in eastern Ukraine, Kherson, Luhansk and Zaporizhzhia, were declared Russian territory, meaning that Russia technically counts the 11 million people living there as part of the Russian healthcare system.

By the end of 2023, some 60,000 new HIV infections are anticipated in Russia.

This article was originally written in German.