The Hit-and-Miss Approach to HIV Prevention in Russia

“#testforthefuture. HIV-infection risk group. A topic that affects everyone. Take an HIV test free and anonymously. Humanitarian Action Foundation.” Public service ad in central Petersburg, October 29, 2016. Photo by the Russian Reader. Typically, the ad is plastered with flyers offering the services of prostitutes.

Health Ministry Did Not Include HIV Test in Compulsory Medical Exam
Polina Zvezdina
RBC
November 21, 2016

Optional and Anonymous

The Health Ministry has changed its annual medical exam program for adults, judging by the amendments posted on the Federal Website for Draft Regulations. Free HIV testing was not included in the document. In September 2016, Health Minister Veronika Skvortsova had promised testing would be included in the annual wellness examination program beginning in 2017.

If the amendments are adopted, beginning next year, general practitioners will be obliged to inform everyone between the ages of 21 and 49 who is undergoing a physical exam that they can take an anonymous HIV test at specialized medical clinics. Physicians should provide patients with a list of the clinics where the test is performed.

The Health Ministry had planned to receive funds to expand the program by eliminating ineffective research. Our sources at the ministry did not explain to us why the HIV test had been turned down for inclusion in the compulsory program.

MPs Fedot Tumusov and Alexandrev Petrov, who sit on the State Duma’s Healthcare Committee, believe the ministry rejected the HIV test as part of its physical exam program due to a lack of funds. Andrei Skvortsov, coordinator of the Patient Monitoring movement, agrees with them.

This is not the first time the government has been unable to find funds in the federal budget to fight HIV. Thus, on November 15, due to a lack of financing, a special interdepartmental commission decided not to add new drugs for suppressing HIV to the list of essential drugs. Elena Maximkina, director of the Health Ministry’s Department for Drug Provision, said that 20.8 billion rubles had been spent in 2016 on purchasing anti-HIV drugs. Yet in the three-year federal draft budget, 17.8 billion rubles have been slated for prevention and treatment of HIV and hepatitis B and C in 2017, 17.5 billion rubles in 2018, and 17.1 billion rubles in 2019.


Mandatory and Unethical

Another reason the free test could not be included in the medical exam program is legal. At present, the test is only administered voluntarily, explained Tumusov. Testing as part of the standard medical examination should be obligatory, believes Tumusov, A Just Russia party MP, but first you must explain to the public why it is necessary. We can already observe positive outcomes in Yekaterinburg, where reports of an unofficial [sic] HIV epidemic sparked widespread testing for the infection, said Tumusov.

Skvortsov argues that testing could be included in the medical check-up program if doctors in district clinics and non-specialized hospitals were better informed about the specifics of HIV and the means of its dissemination.

“Medical personnel often refuse to give HIV-infected patients necessary medical treatment, and such patients face other forms of discrimination,” he noted.

Doctors at ordinary clinics are also often not able to carry out the pre-test and post-test consultations that would be required if obligatory testing were included in the medical examination program, said Skvortsov.

Another factor is that patients are now often reluctant to be tested under the voluntary health insurance program, argues Igor Pchelin, chair of the Steps Regional Public Charity Foundation to Fight AIDs. This is due to the fact that physicians may not comply with medical confidentiality and reveal test results to colleagues, neighbors, and friends of infected patients.

Provided there is sufficient financing in 2020, the government plans to test 35% of the public for HIV annually, according to the strategic plan for combating the spread of the infection. From the draft of the plan, which RBC has seen, it follows that financing should amount to an additional 3.2 billion rubles per year. This amount is needed to test an additional 20 million people at a cost of 150 rubles per test. It is currently not known whether the funds will be allocated or not. In 2015, HIV testing covered around 30 million people or 19.3% of the population.

Translated by the Russian Reader. If you found this article fascinating and depressing, you should definitely read Daria Litvinova, “Russia Wishes Away Its HIV Epidemic,” The Moscow Times, November 18, 2018.

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