Russia's HIV epidemic

World AIDS Day 2016 marks an alarming milestone in Russia; not only did the country register its 1 millionth case of HIV, the virus that causes AIDS, but experts also have reason to believe up to 1 percent of the Russian population could be infected with the virus. Despite widespread improvement in the fight against AIDS around the globe, the Russian epidemic is one of the fastest growing in the world and according the United Nations is the worst in the European region. Prime Minister Dimity Medvedev has described HIV/AIDS as an "issue of national security."

Russia recorded its first HIV case in the late 1980s and traditionally, the so-called high-risk groups like sex workers, men who have sex with men and injection drug users, are hit the hardest. The fall of the Soviet Union saw an explosion in injection drug use, particularly in central Russia and around the Ural Mountains. And the prevalence of dirty needles is helping spread HIV into mainstream populations.

Vadim Pokrovsky, the head of Russia's federal AIDS center, has been quoted by local media as saying he fears the HIV epidemic is at a turning point, threatening to spill over into the general population and causing a generalized epidemic.

"The reasons for the growth of the epidemic is the complete absence of prevention work in Russia," says Anja Sarang, president of the Andrey Rylkov Foundation for Health and Social Justice, an NGO that works with drug addicts and HIV patients that was blacklisted under Moscow's "foreign agent" registration law. "To date [government agencies] offer almost across-the-board testing of all Russian citizens. However, they haven't gotten a handle on financing prevention efforts."

UNAIDS, the United Nation's division dedicated to the fight against the virus, has also been heavily critical of the Kremlin's approach to prevention. Speaking to DW, Vinay Saldanha, UNAIDS Regional Director for Eastern Europe and Central Asia, commented: "We know absolutely everything we need to know about how to stop someone from being infected. There is no excuse for allowing someone to be infected in 2016 in a country as advanced as Russia."

Stigma a hurdle to prevention

Since returning to the presidency, Vladimir Putin has increasingly worked to link his government to the fortunes of the Orthodox Church in a bid to garner support in a nation that is still rediscovering its traditional faith. However, Putin's rebirth as the champion of traditional values makes embracing some proven prevention methods difficult. Due to its emergence among sex workers and the LGBTQ community, HIV/AIDS is still widely viewed as a "disease of moral failing" among many in Russia. And in course, many government officials have been reluctant to embrace or openly hostile toward prevention methods like needle replacement and large-scale sex education programs, says Anja Sarang.

"It's not based on any scientific evidence. All the studies of the effectiveness of harm reduction programs showed positive results, including in Russia," she says. "The position is purely ideological - the minister of health in 2009 [said] that the health ministry will seek their own [prevention program], different from the Western way of HIV prevention. And they're still looking for one."

In the face of government inaction, many private organizations have found themselves at the forefront in the fight against HIV/AIDS. However, several recently-passed laws are also getting in the way of prevention efforts. Russia's 2013 legislation forbidding so-called "gay propaganda" has hampered education programs among Russia's LGBTQ population. Activists say they've had their pamphlets confiscated for "promoting the homosexual lifestyle."

The "foreign agent" registration law has also had a chilling effect on prevention efforts. The act forces NGOs who receive funding from outside Russia to register as so-called foreign agents. Many of the blacklisted organizations complain they are subject to excess government scrutiny and the stigma associated with the act has cut many NGOs off from traditional sources of funding. Some groups, like the Andrey Rylkov Foundation, have been forced to turn to crowd-sourcing for raising money.

2016: A sea-change in fight

Federal AIDS center director Pokrovsky has stated on multiple occasions the number of HIV cases could climb to 2 million in the next four years if the government fails to act. But not everyone is so pessimistic. As Russia approaches the 30th anniversary of its first diagnosed HIV case, Vinay Saldanha of UNAIDS says Moscow's approach is starting to shift: "We are seeing a very positive change this year. I'd almost call it a sea-change.”

Saldanha points to the Russian government's recent efforts to embrace the UN's 90-90-90 treatment target, which calls for 90 percent of a country's HIV positive population to be diagnosed, 90 percent to receive active treatment for the virus and 90 percent to achieve viral suppression. Russia is admittedly far off the 90 percent treatment target; only around 250,000 patients - around a third of the country's infected population - are receiving anti-retroviral drugs, the main treatment for HIV. However, the UN goals were incorporated into a recently adopted national strategy to fight HIV/AIDS signed by Prime Minister Medvedev, in a first for his nation.

The UNAIDS regional director also welcomed an awareness campaign spearheaded by a foundation lead by Medvedev's wife Svetlana, calling the media blitz "unprecedented."

Despite the positive signals from Moscow's elite, Saldanha admits Russia's fight against HIV is only just beginning: "We're in a critical phase. The next couple years will tell us which way the infection rate is going to go."