Dreams at Risk: Overcoming Barriers for At-Risk Populations
07/22/2010
Challenges of marginalized, HIV positive in Eastern Europe
Irina Maslova of Russia and Global Health Council CEO Jeffrey L. Sturchio.
Life is not that good for injecting drug users in Eastern Europe. Or, for that matter, sex workers, prisoners or anyone else in the high-risk group of marginalized people who have HIV and live on the edge of society there.
Russia is most problematic on the harm-reduction front, said Gregory Vergus of Russia, who is the regional coordinator of the International Treatment Preparedness Coalition in Eastern Europe and Central Asia. He was speaking at a session, sponsored by the Global Health Council June 21at the International AIDS Society conference in Vienna. The session, called Dreams at Risk: Overcoming Barriers to Better AIDS Policy for Most At-Risk Populations in Eastern Europe, explored the most marginalized populations in Eastern Europe and their struggle to shape public policy around HIV/AIDS.
"Russia has the old Soviet Union medical system that does not deal with social diseases, such as HIV and TB," said Vergus, who works with injecting drug users and people living with HIV/AIDS. The general population in Russia is "just living, just working. In the end, nobody cares. Infected people have to take care of themselves. It is hard to demand rights in Russia. The problem is at the government level. No one is willing to stop AIDS or TB."
Sex work is criminalized and its workers live on the fringe, said Irina Maslova, a former sex worker in Russia, who now dedicates her career to bringing human rights to her former colleagues. She is the head of the Center of Social and Psychological Help for Sex Workers (Silver Rose), which offers support to sex workers along with testing and ARV therapy.
Maslova said Kyrgyzstan, formerly with the Soviet Union, is a "very interesting country" in that people infected with HIV are so marginalized that they are taken care of by sex workers.
Since 2001, HIV prevalence in Eastern Europe and Central Asia has roughly doubled, bringing the number of people living with HIV to 1.5 million in 2008 (a 66 percent increase), and making it the only region where HIV prevalence clearly remains on the rise, according to UNAIDS. The epidemic is concentrated among people who inject drugs, sex workers and their sexual partners, with significant increases being noted in women. Contaminated injecting equipment accounted for 57 percent of new infections in 2007.
Tudor Kovacs, a gay activist who works for Population Services International in Romania, said there is no cooperation from the government. "They won't give funds to vulnerable groups, like MSM and drug users, because they won't get votes in the next election."
Yet, Vladimir Hotineanu, minister of health of the Republic of Moldova, said his country is taking HIV seriously. Until 1995, most of the people with HIV were coming into the country, he said. Then the second wave of infections occurred from 1995-2000 with the concentration of infections in MSM and injecting drug users. Now, the disease has spread throughout the general population. "People infected in rural areas and prisons are quite substantial," he said. Some 70 percent of the country's population lives in small towns and rural areas.
In the past injecting drug use was the main driver of the epidemic, accounting for 80 percent of the infections in the early part of the decade. But since 2005, the picture has changed dramatically with sexual transmission becoming far more important.
According to the Global Fund, Moldova with a population of less than 4 million has approximately 9,000 people living with HIV. It is Europe's poorest country, with a gross national income per capita of US$1,210.
Moldova in 2007 passed law to provide the general population with prevention programs, Hotineanu said. Steps taken include the introduction and scale-up of a range of harm-reduction programs, notably methadone maintenance treatment for injecting drug users both in the penal system and in society at large. Under Moldova's Round 1 grant from the Global Fund, which concluded in 2008, ARV treatment became freely available to people living with HIV. And the country is expanding its laboratory capacity to test for HIV and TB. Yet, according to the Global Fund, only 871 people are receiving ARVs.
Annmarie Christensen is director of publications and new media at the Global Health Council and executive editor of GLOBAL HEALTH.
I suggest that this type of clinical trial should also be done in Russia and in the Eastern European countries where HIV infections are thriving at alarming rate. I doubt if the governments of these countries will allow her people to be used as guinea pigs in the name of HIV prevention and not “Comercial purposes”
— Dr. Kadri Ajileye on 2010-07-26