Vladislav Inozemtsev: The Foreign Agent in the Kremlin

lakhta wreck

The Foreign Agent in the Kremlin
Vladislav Inozemtsev
The Insider
December 31, 2019

One of the crucial events of the past year was passage of the law on labeling Russian nationals as “foreign agents.” Although the law emphasizes that such “agents” should disseminate information from foreign media outlets and receive financial remuneration from abroad, the notion of “foreign agent” has a quite definite meaning for most Russians: someone who works on behalf of a foreign government to the detriment of their own country.

However, if you think hard about the new law and its implementation (the Justice Ministry has been charged with designating individuals foreign agents, but citizens and NGOs will probably also be able to take the initiative), the first thing that comes to mind is the man who signed it so showily into law on December 2—Vladimir Putin, president of the Russian Federation, who took office exactly twenty years ago today, albeit as acting president.

When Putin moved into the Kremlin, Russia was successfully emerging from an economic crisis triggered by a sharp drop in oil prices in the late 1990s and the ruble crisis of 1998. These two events largely brought to a close the aftermath of the Soviet Union’s collapse and the transition from a planned economy to a market economy. Welcoming the new president, people believed him when he said, “The country’s future, the quality of the Russian economy in the twenty-first century, depends primarily on progress in those industries based on high technology and hi-tech products,” while the world took him at face value when he claimed, “Today we must declare once and for all that the Cold War is over. We abandon our stereotypes and ambitions, and henceforth we will jointly ensure the safety of the European population and the world as a whole.” It seemed that the coming decades should be extremely successful ones for Russia, and the country would inevitably takes its rightful place in the world economy and politics. However, events unfolded following a different scenario, and nearly all the trends that we can now ascertain as well-established suggest that if a CIA officer had taken charge of his country’s recently defeated enemy he would have done less damage to it than Putin has done.

First, Russia in the early noughties had very low labor costs: according to Rosstat, the average salary was $78 a month in 2000. Given that energy prices in Russia were then seven to ten times lower than in Europe, it was self-evident the country should decide to undertake large-scale industrialization by attracting foreign investors. The Central European countries, which in the late nineties and early noughties became successful industrial powers by attracting European capital (we can recall what happened with Škoda’s factories) were an example of the strategy’s wisdom.

However, despite what Russian authorities said at the time, preventing foreign capital from entering strategic industrial sectors became policy. Almost immediately after Putin came to power, the government began renationalizing assets that had been privatized in the nineties: instead of raising taxes on companies owned by Russian oligarchs, the regime commenced buying them out, constantly ratcheting up the price, culminating with Rosneft’s purchase of TNK-BP for $61 billion in 2013. In fact, taxes raised from the competitive sectors of the economy and redistributed through the budget went to buy assets in the extractive sector and were invested in rather dubious projects. Consequently, by the early teens, the share of raw materials (mineral products, ore, and metals) in Russian exports had reached 79–80%, as opposed to 50.4% of Soviet exports in 1989. Finally, in recent years, Russia has begun “diversifying” its raw materials exports by reaching out to China, effectively becoming an “energy appendage” not only of Europe but also of the whole world.

Second, as the economy became ever more dependent on extractive industries, Russia under Putin began to deindustrialize rapidly, resulting in a sharp decline in the demand for skilled workers, who could have been employed to develop the country on new foundations. According to various estimates, 16,000 to 30,000 industrial enterprises, which had employed over 13 million people in the late-Soviet period, were closed between 2000 and 2018. As of 2017, 9.9 million people were employed in Russian processing industries, as opposed to 21.7 million people in the RSFSR in 1989, although there was no significant increase in labor productivity. We can concede, of course, that a good many of these enterprises were not competitive, but most of them were never put up for auctions in which foreign investors were allowed to bid, the Russian government did not provide potential investors guarantees on investments in technically modernizing enterprises, and so on. Essentially, the government adopted a consistent policy of simplifying the industrial infrastructure, increasing dependency on imports, and most significantly, downgrading whole cities that had previously been important industrial centers. It would be no exaggeration to say that the bulk of Soviet industrial enterprises was destroyed not in the “accursed nineties,” but in the noughties and the early teens.

Third, the process went hand in glove with a demonstrative lack of attention to infrastructural problems and managing Russia’s vast expanses. About 700 airports were closed between 2000 and 2010, domestic passenger traffic dropped below international passenger traffic, and so many roads fell into disrepair and collapse that since 2012 city streets have been counted as roads in order to buff up the statistics. Infrastructure projects have been concentrated either in Moscow (e.g., the Moscow Ring Road, the Central Ring Road, expansion of the Moscow subway) or on the country’s borders as a kind of exercise in “flag waving” (e.g., Petersburg and environs, Sochi, Chechnya, the Crimean Bridge, the reconstruction of Vladivostok and Russky Island).

Consequently, rural settlements have begun dying out massively in most regions of the country: since 2000, around 30,000 villages in Russia have disappeared, and nearly 10,000 of them have eight or fewer residents. The number of residents in cities with populations ranging from 50,000 of 200,000 people has decreased: population reductions have been recorded in 70% of these cities, while the population has dropped by a quarter in more than 200 such cities. There has been a massive exodus of people from the Russian Far East.  Even the solution of longstanding problems that were handled for better or worse in the nineties has been abandoned, including disposing solid wastes, minimizing harmful emissions, and storing hazardous industrial waste. Russian infrastructure is close to collapse: depreciation of the power grids exceeds 70%, while 75% of the heating network is obsolete. Only 52.8% of local roads meet Russia’s poor standards. All attempts to remedy the situation are propaganda tricks more than anything, and yet budget funds for infrastructure are allocated regularly, just as taxes are collected from the populace.

Fourth, despite formal achievements, such as increasing life expectancy and reducing per capita alcohol consumption, the nation’s physical and mental health is verging on the disastrous. From 2000 to 2016, the number of HIV-infected Russians increased almost twelve times, reaching 1.06 million people, meaning that the threshold for an epidemic has been crossed. Spending on health care has remained extremely low. It is usually measured as a percentage of GDP, but a comparison of absolute figures is much more telling: in 2019, the government and insurance companies allocated only 23,200 rubles or €330 for every Russian, which was 14.2 times less than in Germany, and 29 times less than in the US, not counting out-of-pocket expenses.

Despite the huge influx of immigrants and migrant workers during Putin’s rule, the population of Russia (without Crimea) decreased by 2.7 million people from 2000 to 2019. Drug addiction has been spreading rapidly, becoming one of the leading causes of death among relatively young people in small towns. And yet the authorities see none of these things as a problem, limiting access to high-quality foreign medicines and accessible medical care (the number of hospitals has been halved since 2000, while the number of clinics has decreased by 40%), all the while believing the HIV crisis can be solved by promoting moral lifestyles. There is little doubt that Russia’s population should began dying off at a furious pace now that the reserves of economic growth have been exhausted.

Fifth, the formation of a bureaucratic oligarchy, able to appropriate at will what the authorities see less as “public property” and more as “budget flows,” has generated enormous corruption and blatantly inefficient public spending. A sizeable increase in spending on the space program—from 9.4 billion rubles in 2000 to 260 billion rubles in 2019—producced a drop in the number of successful launches from 34 to 22. Despite promises in 2006 to build almost 60 new nuclear power units, only 12 units have been brought online over the last twenty years. Programs for growing the military-industrial complex have not been consistently implemented: production of new weapons has been minuscule, amounting to only ten to twenty percent of Soviet-era production. The country’s only aircraft carrier has for the second time suffered combat-like damage during an “upgrade,” while its only 4.5-generation fighter has just crashed during a test flight.

The latest challenges posed to Russia by the development of information technology around the world have elicited no response whatsoever from the regime. On the contrary, the bureaucrats and siloviki have consistently acted to discourage researchers and innovators. The dominance of the siloviki in most government decision-making, their utter lack of oversight, and unprecedented incompetence have meant that much of the money that could be used effectively in the military sector and open up new frontiers for Russia has been simply been embezzled.

Sixth, Putin’s rule has been marked by the impressive “gifts” he has made to countries which the Kremlin has often identified as potential enemies. Around $780 billion was spirited from Russia between 2009 and 2019, whereas less than $120 billion was taken out of the country during the entirety of the nineties. The most important cause of this outflow was a law, passed in 2001, establishing a nine-percent tax on dividends paid to “foreign investors” or, rather, the offshore companies registered as owners of Russian assets. (The subsequent abolition of this measure in 2015 has changed little.) Much of this money was invested in passive sources of income in the west or spent on the luxurious lifestyles of Russian billionaires, thus supporting local economies in other countries.

Even more “generous,” however, was Putin’s gift to west in the form of the four million Russian citizens who have left Russia during his presidency: mainly young and middle-aged, well-educated, willing to take risks and engage in business, they now control assets outside the country that are comparable to the Russian Federation’s GDP. This wealth has been generated from scratch by talented people the Russian regime regarded as dead weight. The destruction of human capital is the biggest blow Putin has dealt to Russia, and it is no wonder western analysts argue Russia will need a hundred years at best to bridge the emerging gap.

Seventh, we cannot ignore the holy of holies: national security. We have already touched on the military sector in passing. It is a realm in which technological progress has largely boiled down to showing cartoons to members of the Russian Federal Assembly: space launches are still carried out using Soviet Proton rockets, designed in the sixties; the last of the Tu-22M strategic bombers rolled off the line in 1993; the Su-57 is based on groundwork done while designing the Su-47 during the late eighties;  and the advanced Angara (S-200) missile was developed as part of the Soviet Albatross program from 1987 to 1991. Things are no better in the secret services: agents sent on secret missions set off Geiger counters, like Lugovoy and Kovtun, blow their cover wherever they can, like Mishkin and Chepiga, or get caught in the act, as was the case with Krasikov.

The elementary inability to carry out their work in secret is the height of unprofessionalism: a handful of journalists can dig up nearly all the dirt on Russian agents, using information freely available on the internet. The same applies, among many other things, to the downing of Malaysia Airlines Flight 17 over the Donbass and the regime’s use of unprofessional, incompetent mercenaries from various private military companies.

Finally, eighth, President Putin’s foreign policy deserves special attention. Over the past ten years or so, the Kremlin’s own efforts have led to the creation of a buffer zone of neighboring countries that fear or hate Russia. If something like this could be expected from the Baltic states, which sought for decades to restore the independence they lost in 1940, no one could have imagined twenty years ago that Russia would make Georgia and Ukraine its worst enemies. However, our country’s principal “patriot”—whose daily bedtime reading seemingly consists of the works of Zbigniew Brzezinski, who once argued that Russia’s “imperial backbone” would be broken only when it lost Ukraine once and for all—has consistently sought to make Kiev recognize Moscow as its principal existential threat.

Similar sentiments have emerged in Minsk, where the authorities and populace of the country that suffered the greatest losses in the Great Patriotic War for the sake of the Soviet Union’s common victory have been nearly unanimous in their opposition to further rapprochement with Russia. We won’t even mention Russia’s damaged relations with the US and the EU: at the behest of Moscow, which is immeasurably weaker than the collective west, a new cold war has been launched that the Kremlin has no chance of winning but that could lead Russia to the same collapse suffered by the Soviet Union during the previous cold war. Meanwhile, Moscow’s hollow propaganda and its theatrical micro-militarism have been a genuine godsend to western military chiefs, who have been securing nearly unlimited defense budgets, just like the designers of advanced technology, who have been developing new weapons and gadgets in leaps and bounds.

I will not catalogue the current president’s other achievements—from destroying the Russian education system and nourishing a cult of power in society, thus generating a crisis of the family, to undermining Russian federalism and nurturing an unchecked power center in Chechnya. I will only emphasize once again that not just any foreign agent, after spending decades infiltrating the highest echelons of power in an enemy country, would be able to inflict such damage. I don’t consider Putin a foreign agent in the literal sense of the word, of course, but if it is now comme il faut in Russia to identify those who are working, allegedly, for hostile powers and thus inflicting damage on their own country, it is impossible to ignore what Putin has done over the past twenty years.

The current head of the Russian state should have a place of honor on the list of “foreign agents,” just as “Party card number one” was always reserved for Lenin in bygone days. And the west should be advised not to seek to undermine Putin’s regime but, on the contrary, do its utmost to extend his term in the Kremlin, simply because as long as Russia is so inefficient, backward, and profligate it poses no threat to the rest of the world, however much the strategists at the Pentagon try and convince the top brass otherwise.

Photo and translation by the Russian Reader

We Wouldn’t Mind If You Died of AIDS and Hepatitis C

aids flagRussia has an HIV epidemic. According to the Federal Aids Prevention Center, approximately a million Russians are infected. A third of them also have hepatitis C. At best, only hundreds of these patients receive state-of-the-art treatment. Image by Yaroslava Chingayev, special to Vedomosti

Officials Want to Replace Current Hepatitis C Treatment with Outmoded Therapy
Industry and Trade Ministry Supplied Money for Manufacture of Drugs
Irina Sinitsyna and Olga Sukhoveiko
Vedomosti
December 13, 2018

The Russian Health Ministry plans to significantly reduce procurements of the most effective treatment for viral hepatitis C, combined interferon-free treatment, thus reducing the availability of the drugs for patients infected with HIV in combination with hepatitis B and hepatitis C. Instead, the ministry has proposed putting these patients on interferon therapy. Maria Onufriyeva, director of Community of People Living with HIV, an interregional grassroots organization, has written about the matter to Health Minister Veronika Svkortsova. Ms. Onufriyeva has also sent a letter to Valery Alexeyev, director of the Honest Procurements Project at the Russian People’s Front (ONF). Vedomosti has seen copies of the letters. Ms. Onufriyeva confirmed she sent them. A spokesperson for Mr. Alexeyev said he received the letter. The Health Ministry has not responded to her query.

In November, Minister Skvortsova said that over 714,000 Russians were infected with HIV. According to the Federal Aids Prevention Center, whose figures Ms. Onufriyeva cites, there are 978,443 Russians infected with HIV. A third of them also have hepatitis C.

In late October, the Health Ministry published the final list and amounts of drugs it would be procuring in 2019 and providing to HIV patients, including HIV patients who also have hepatitis B and hepatitis C, writes Ms. Onufriyeva. (Vedomosti has seen a copy of this list.) In particular, the Health Ministry wants to reduce procument of dasabuvir by 750%, meaning one hundred patients would have access to the drug, while this year 748 people could count of getting it, according to the Community’s calculations.

In monetary terms, this would mean a drop in expenditures on the drug from 431.6 million rubles [approx. 5.7 million euros] to 57.9 million rubles [767, 754 euros].

The Health Ministry plans to switch to narlaprevir, intended for the treatment of hepatitis C in combination with other antiviral drugs. In 2018, as the Community has discovered, and as is borne out by information accessed on the federal procurements website, narlaprevir was not purchased by the Russian governmennt. In 2019, the Health Ministry could spend 139 million rubles [approx. 1.8 million euros] on procuring the drug in order to treat 430 people, the Community argues.

Dasabuvir is the most up-to-date antiviral drug. According to the Community, it can cure 98% of hepatitis C patients in twelve weeks.

This figure was confirmed by Vadim Pokrovsky, director of the Federal AIDS Prevention Center.

In Russia, HIV patients who also have hepatitis C have been treated with dasabuvir in combination with ombitasvir/paritaprevir/ritonavir, manufactured under the brand name Viekira Pak by the American company AbbVie. Dasabuvir was placed on the official Russian list of vital and essential drugs for this year. Two years ago, Alexey Repik’s R-Pharm and AbbVie agreed to partly localize manufacture of the drug at R-Pharm’s plant in Kostroma. As R-Pharm reported then, the deal covered repackaging of the drug and quality control. According to AbbVie, Viekira Pak is distributed in Russia by R-Pharm and Euroservice.

Ms. Onufriyeva writes that interferon therapy is much less effective in treating chronic hepatitis C patients with HIV. The treatment significantly reduces quality of life, since it requires weekly injections.

Mr. Pokrovsky explained the difference. Interferon treatment has almost no effect on the virus itself. It stimulates the body’s immune response, but it has numerous side effects, from impotence to mental disturbances. The treatment lasts a year.

Due to the length of the treatment, Ms. Onufriyeva said, it was between 52% and 133% more expensive than interferon-free treatment.

Tableted by R-Pharma, narlaprevir has to be taken together with ritonavir, pegylated (long-acting) interferon, and ribavirin, as indicated in the instructions.

In 2012, R-Pharma acquired a license for the production and sale of narlaprevir from Merck & Co. It tried to refine the drug with support from a federal targeted program administered by the Russian Industry and Trade Ministry. Trade publication Vademecum wrote that R-Pharm invested 700 million rubles in narlaprevir. The Industry and Trade Ministry would allocate 120 million rubles on clinical trials, Sergei Tsyb, head of the ministry’s Department for Chemical Engineering and Bioengineering, promised in 2012.

A R-Pharm spokesperson confirmed receipt of the funds.

R-Pharm registered narlaprevir in 2016. In the spring of 2017, during a meeting with the business community, President Putin promised R-Pharm’s director general Vasily Ignatiev that the government would allocate funds to procure the company’s drugs for hepatitis C patients.

“I will also keep this in mind when allocating resources for healthcare in 2018 and the following years, in 2019 and 2020. It will be necessary, of course, to use what you have developed,” Putin said.

Mr. Pokrovsky is certain the Health Ministry’s decision to reduce procurements of interferon-free drugs could have been influenced by Russian manufacturers wanting to compensate their costs at the state’s expense.

The R-Pharm spokesperson insisted that the company, like other manufactures, received a request from the Health Ministry to quote its prices for narlaprevir and dasabuvir.

“Our price offers for the drugs were the same as last year’s,” he said.

In total, according to the Community’s calculations, in 2019, the Health Ministry can spend 473.5 million rubles [approx. 6.3 million euros] on the procurement of drugs for treating chronic hepatitis C, as opposed to 1.1 billion rubles [approx. 14.6 million euros] last year.

In November, Vademecum wrote that, in 2019, the Health Ministry would also reduce its overall procurement of antiretroviral drugs under its program for providing drugs to people infected with HIV, including patients who were infected with HIV in combination with the hepatitis B and C viruses. However, although it would spend far less money, it planned to expand coverage to a mere sixty percent of those needing treatment.

Ms. Onufriyeva has asked the Health Ministry to consider increasing procurements and moving away from the chronic hepatitis C drugs scheduled for purchase in 2019 and towards drugs that have proven effective. The latter should be supplied to patients with HIV plus viral hepatitis C, including those suffering from advanced liver fibrosis and cirrhosis.

She has asked Mr. Alexeyev to assist her in protecting the interests of patients by sending inquiries to the Health Ministry, asking them to explain the reasons for the cuts in procurements and the selection of outmoded drugs. She also asked him to verify whether the Health Ministry’s actions were in compliance with antitrust laws.

She told Vedomosti she had not received replies to her letters.

vich

“How the Numbers of HIV-Infected Patients Have Changed, 2013–2018.” The red columns indicate total numbers of patients; the orange columns, first-time infections. Figures are given in thousands of people. Source: Rosstat. Courtesy of Vedomosti

Mr. Alexeyev explained the delay in replying. The letter contained a good deal of specialized and medical information, and it was under review by independent experts working for the Russian People Front’s Honest Procurements Project.

“The Russian People’s Front has drawn attention to problems with the list of essential and vital drugs, and their procurements, and this letter is the latest alarm,” he said.

According to Mr. Alexeyev, the Russian People’s Front has been reviewing the Health Ministry’s procedure for including medicines on the list and had already been in touch with the government.

hep b and c

“How the Numbers of Hepatitis Patients Have Changed, 2013–2018.” The dark blue bars indicate first-time cases of chronic hepatitis B; the light blue bars, first-time cases of chronic hepatitis C. Figures are given in thousands of people. Source: Rospotrebnadzor. Courtesy of Vedomosti

If the grassroots organization Community of People Living with HIV believes the industry regulator acted in a way that violated specific regulations on procurements or antitrust statutes, it can file a complaint with the Federal Anti-Monopoly Service (FAS) in the manner prescribed by law, said Maxim Degtyarev, deputy head of the Department for Oversight of the Social Sector and Trade at FAS. For the time being, however, FAS had no grounds to perform an inspection.

The Industry and Trade Ministry did not respond to our request for information.

Elena Filimonova contributed to this article.

Translated by the Russian Reader

We Wouldn’t Mind If You Died of AIDS

nutter

HIV Prevention Organization in Altai Territory Closes Due to Inability to Pay Court Fine
Takie Dela
December 4, 2018

Choice (Vybor), a non-profit HIV service organization, has been forced to close its office in Biysk, Altai Territory, due to its inability to pay a court-imposed fine, reports Kommersant. The NGO had been found guilty of refusing to acknowledge it was a “foreign agent.”

The Altai Territorial Court upheld the ruling of the Biysk City Court, which had fined Choice 150,000 rubles [approx. €2,000] for failing to recognize itself as a “foreign agent” and voluntarily place itself on the registry of “foreign agents.”

According to Maxim Olenichev, a lawyer from Attorneys for Equal Rights who represented Choice in court, on November 30, the organization was forced to close its office and cancel its HIV prevention programs in the region, including programs for intravenous drug users and other risk groups.

“HIV-service NGOS have access to ‘closed’ groups of people who are unwilling to turn to state institutions for help,” Olenichev said in an interview with reporters. “Attacking such NGOS reflects a policy of ‘traditional values,’ a policy focused on criminalizing the actions of people who do not comply with these values or ignore them. By using the law on ‘foreign agents’ to destroy NGOs, the state promotes the growth of HIV-infected people, although by joining forces with NGOs the state could halt the epidemic’s growth.”

The court ruled that several of Choice’s campaigns, during which the NGO handed out HIV express tests (41 people tested positive — TD), over 100,000 clean syringes, and 20,000 condoms for free, were “political” in nature. Choice employees noted they worked with the primary vulnerable groups as defined by the Russian state, using the same methods as specified in the official rules for HIV prevention. The court chose to ignore these arguments.

The court also agreed with the Russian Justice Ministry’s claim that Choice had received foreign funding in 2014 and 2016. Choice received 147,000 rubles from ESVERO, a non-profit partnership, and 272,000 rubles from the AIDS Healthcare Foundation.

Olenichev pointed out that ESVERO had been implementing a project of the Global Fund for Fighting AIDs, Tuberculosis and Malaria, which receives funding from the Russian government, in thirty-four Russian regions. The NGO was thus using grants to put the money back into the Russian economy. As for the AIDS Healthcare Foundation, which sponsored Choice with funding in rubles, Olenichev claimed there was no evidence in the case file that the organization was foreign. Nevertheless, the court refused to reverse the fine.

According to the latest data from the Russian Health Ministry, in 2017, 53.5% of new cases of HIV infection were caused by sexual intercourse, while 43.6% of new infections were caused by the use of intravenous drugs. According to official statistics, the number of HIV-infected people in Russia is 998,525. Eighty-one percent of them know they are infected.

The World Health Organization (WHO) has recognized Russia as leading Europe in new cases of HIV infections at 71.1 cases per every 100,000 people. The virus is primarily transmitted through heterosexual sex (59%) and intravenous drug use (30%). The Russian Health Ministry has called these figures “extremely inaccurate.”

In late October, the Saratov Regional Organization of Chronic Diabetes Sufferers announced its closure: a court had also fined it 300,000 rubles for violating the law on “foreign agents.” The expert employed by the prosecutor’s office to audit the organization concluded it had “shape[d] preconditions for discrediting the authorities” and “report[ed] about the region’s so-called sore points to [its] foreign partners.”

Thanks to Alexander Feldberg for the heads-up. Translated by the Russian Reader

The Injustice Ministry

rainbowWhile rainbows do occasionally appear in the skies above Russia, the Putin regime has pursued a consistent course of official homophobia and avoidance of the country’s out-of-control HIV epidemic. Photo by the Russian Reader

Russian Justice Ministry Proposes Tightening Oversight of Foreign HIV Prevention Programs
Mediazona
September 3, 2018

The Justice Ministry has drafted a law bill that would introduce a new procedure for running foreign programs in Russia for preventing the spread of HIV. The text of the draft law has been published for public discussion.

The ministry proposes introducing a mandatory notification procedure for all noncommercial organizations planning to combat HIV in Russia, but which receive foreign funding, whether from other countries, international organizations, foreign nationals, stateless persons, their representatives, and Russia legal entities and individuals receiving money and other property from these sources.

After receipt of such a notification, the Justice Ministry will have a month to review it. It will then either have to issue permission to operate in Russia or a substantiated rejection. If a noncommercial organization continues to work on preventing HIV after receiving a rejection notice, it will be abolished.

As the BBC has noted, four foundations preventing the spread of HIV in Russia have been registered as “foreign agents” by the Justice Ministry.

Approximately a million Russians are infected with HIV. In July, RBC reported a spike of infections in Moscow. The Russian Health Ministry responded to the report by claiming the situation was stable. It urged journalists to focus only on official statistics.

Translated by the Russian Reader

There Are No Condoms in Russia

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Developing a Moral Immunity to HIV
The Education and Science Ministry doesn’t want young people to talk about condoms
Anna Makeyeva and Valeriya Mishina
Kommersant
November 3, 2017

As Kommersant has learned, a scandal has erupted in the Education and Science Ministry over an online HIV prevention lesson for high school and university students. The people responsible for the internet project have refused to fulfill demands by officials to vet answers to users’ questions in advance, as well as their recommendations to “talk about morality in order to get away from slippery topics” and avoid such words as “condom.” It is still unclear how the lesson, scheduled for December 1, will be taught.

The Nationwide Internet HIV Prevention Lesson, timed to coincide with World AIDS Day on December 1, has been held by order of the Education and Science Ministry since 2015. On the eve of the lesson in 2016, Education and Science Minister Olga Vasilyeva noted that the issue of countering the spread of the HIV infection among children and adolescents, given the complicated epidemiological circumstances, had long been a focus of the Education and Science Ministry, and occupied a vital place in a set of measures for preserving and strengthening the health of children and young people.

“The use of such innovative methods as open internet lessons at preventive events in educational institutions will help us cope more effectively with the existing problem,” Izvestia quoted the ministry’s stated position in 2015.

On November 2, a working meeting in preparation for the upcoming internet lesson was chaired by Larisa Falkovskaya, deputy director of the department for state policy on children’s rights at the Education and Science Ministry.

“For the first time in my life, a meeting at the Education and Science Ministry ended in scandal because of my fault. I refused to write the answers for those taking part in the online HIV prevention lesson,” said Sergei Bulanov, who is in charge of organizing the online lesson and heads the Center for Modern Education Technologies, a group of non-profit organizations engaged in educational and related projects.

According to Bulanov, the officials at the meeting deemed use of the word “condom” “unacceptable,” and consequently the meeting was adjourned.

Project organizers suggested to officials they give up the practice of using prepared answers in the video lesson and discuss issues of prevention in a playful way, for example, by arranging a rap battle between student teams from two regions.

“But we were told to talk about morality in order to get away from slippery topics,” complained Bulanov, adding, “The topic is ratherly widely represented in the school curriculum, but currently the Education Ministry has adopted a surprising stance, based on substituting HIV prevention, which is mostly a matter of personal hygiene, with lessons in moral values.”

Besides, Bulanov argues it is incorrect to equate the risk of infection only with antisocial behavior.

“Thirty percent of HIV-infected women were infected by the only sexual partner they ever had. Can we reproach them for antisocial behavior? HIV-positive teenagers who have been infected from birth did not lead an antisocial lifestyle.”

Vadim Pokrovsky, head of the Federal AIDS Center, argues the view it is better not talk to children about sex currently prevails in Russia.

“It is one of the reasons HIV has spread so widely in Russia,” he said.

According to Pokrovsky, twenty percent of young women are already having sex by the age of fifteen. He added that in Germany, for example, sex education is an obligatory subject in schools. Last year, only 3,500 cases of infection were registered there, while over 100,000 cases of infection were registered in the Russian Federation.

“We see two fundamentally [different] approaches and two different outcomes,” Pokrovsky concluded.

The Education and Science Ministry declined to comment on the situation when approached by Kommersant. The Russian Federal Health Ministry learned about the conflict from Kommersant. The ministry said the online HIV prevention lesson was an undertaking of the Education and Science Ministry.

“They did not come to us with this or consult with us,” our sources at the Health Ministry said.

Sergei Bulanov assured Kommersant preparations for the open HIV prevention lesson for young people would be continued.

“We will keep on working, focusing more on recommendations from specialists at the Health Ministry and Rospotrebnadzor [the Russian federal consumer watchdog] than on the client [i.e., the Education and Science Ministry].

The internet lesson will take place on December 1, 2017.

Translated by the Russian Reader. Photo courtesy of Pravda.ru

Russian Government Refuses to Allocate 70 Billion Rubles to Combat HIV

Government Refuses to Allocate 70 Billion Rubles to Combat HIV
Polina Zvezdina
RBC
January 26, 2017

The Health Ministry has sent the government a plan for implementing the national strategy for preventing the human immunodeficiency virus (HIV) until 2020. RBC has a copy of the document, whose authenticity has been confirmed by a source close to the government, in its possession. The plan does not stipulate allocating additional funds for combating the infection. In the financial feasibility study appended to the draft plan, officials noted the agencies responsible for its implementation, as well as the regions, would have to finance the plan’s implementation.

Additional financing of the plan was stipulated in a earlier draft, also examined by RBC. In the draft, the Health Ministry had indicated additional monies from the budget, 17.5 billion rubles per annum, would be required to meet the strategy’s targets. There were plans to spend 13.2 billion rubles of this money on treatment, 3.2 billion rubles on diagnosis, and 1.1 billion rubles on treatment oversight. This funding should have made it possible for all HIV patients currently registered at AIDS centers to undergo special treatment and increase to 35% the share of the population tested annually for HIV. In 2015, 19.3% of the population was tested for HIV, while 37.3% of infected patients were provided with medical treatment.

It was the Finance Ministry that did not approve allocating the 70 billion rubles, judging by a ministry review sent to the Health Ministry on December 22, 2016. First Deputy Finance Minister Tatyana Nesterenko did not support the additional allocation, because these funds were not included in the approved federal budget for 2017–2019. In the review, the Finance Ministry argued that budgetary allocations for new spending could be contemplated only at the beginning of the fiscal year and provided that the government had additional revenues.

The government will continue its discussion of the draft plan for HIV prevention, said Denis Godlevsky, an expert at the HIV Assistance Foundation. There is a chance the Health Ministry will succeed in obtaining the full funding, he said.

"Percentages of HIV infected people in Russia. The percentage of people infected nationwide is 0.72%." In the original article, this map is interactive by region.
Percentages of HIV infected people in Russia by region. The percentage of people under the age of 60 infected nationwide is 0.72%. In the original article (go to the link at the top of the page), this map is interactive by region. The figures for Crimea and Sebastopol reflect the percentage of infected residents among all age groups. Infographic courtesy of RBC

Testing 35% of the population annually for HIV and providing 100% treatment for all registered patients were goals the Health Ministry hoped to achieve only if it received the “requisite” financing, as outlined in the HIV prevention strategy adopted by the government. If this money is not provided, the ministry proposes focusing on a different set of figures. Under the current healthcare budget, the number of people undergoing testing would increase to only 24%, while 56% of infected patients would receive treatment.

The Health Ministry has not responded to RBC’s questions as to which set of targets the ministry would follow when implementing the strategy.

If government agencies would use the funds already available effectively and rationally, the situation would begin to change for the better anyway, said Alexei Lakhov, deputy director for public relations at E.V.A., a noncommercial partnership.

“And when the situation changes for the better, a financial feasibility study can be done requesting additional appropriations,” Lakhov suggested.

The HIV prevention strategy was approved on October 20, 2016. It contained no information about funding.

Translated by the Russian Reader

Onward and Upward (The HIV Epidemic in Russia)

"HIV Positive." Photo courtesy of Gazeta.ru and Shutterstock
“HIV Positive.” Photo courtesy of Gazeta.ru and Shutterstock

UN Identifies Russia as Epicenter of HIV Epidemic
Takie Dela
July 15, 2016

UNAIDS, the United Nations organization that deals with HIV prevention, has published a report that claims Russia has the largest HIV epidemic in the world, writes Gazeta.ru.

According to UNAIDS, Russia’s regions accounted for approximately 80% of new HIV cases last year. The countries of Eastern Europe and Central Asia accounted for another 15%.  The study says that, in terms of the speed with which the number of patients has been increasing, Russia has bypassed such countries as Mozambique, Kenya, Uganda, and Zimbabwe, although the numbers of people who are infected are twice as many as in these countries as in the Russian Federation.

According to the Federal AIDS Center, there are currently 824,000 HIV-infected people in Russia. Moreover, the proportion of new cases is 11% or 95,500 people. UNAIDS experts claim the deteriorating situation is due to the fact that Russia lost international support [sic] in the form of HIV programs and has failed to replace it with adequate preventive methods paid for by government funds.

According to data from the Ministry of Health, only 37% of patients under constant medical observation receive the medicines they need, that is, 28% of the total number of patients. On June 12, it came to light that Russia’s regions have begun receiving less money from the federal government for the purchase of drugs for HIV-infected patients. The funding cuts have ranged from 10% to 30%. Due to the fact that funding is insufficient, medicines are prescribed only to patients suffering critical levels of immunosuppression.

Another factor contributing to the spread of HIV in Russia is intravenous drug use. More than half of HIV-infected people were infected in this way.

Translated by the Russian Reader

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Relevant excerpts from Prevention Gap Report (UNAIDS, 2016):

Page 174. The scale of prevention programmes for key populations was insufficient to curb the region’s surging epidemics. This was particularly true in the Russian Federation, home to the region’s largest HIV epidemic and largest population of people who inject drugs (1.5 million).

Page 178. On average, 82% of people on antiretroviral therapy have a suppressed viral load. The highest rate was in the Russian Federation (85.2% of people on antiretroviral therapy), followed by Ukraine (77.7% of people on antiretroviral therapy); the lowest rate was in Tajikistan (32%). Given that only 21% of people living with HIV were on treatment, however, the prevention effect of the suppressed viral load would have only a marginal effect on reduction in HIV incidence.

Page 178. Even the limited coverage by prevention programmes was under threat. The Global Fund has been the region’s largest donor for HIV prevention among key populations since 2004. As of July 2013, however, the Russian Federation was classified by the World Bank as a high-income country; 7 of the other 14 countries are classified as lower-middle-income countries. As a result, international support to HIV programmes in the region is decreasing, and new domestic funding for HIV prevention is not keeping pace as the priority of HIV programmes in many countries is to increase coverage of antiretroviral treatment. In the Russian Federation, 30 projects serving some 27,000 people who inject drugs were left without financial support after the Global Fund grant ended in 2014. Although remaining projects in 16 cities continued to provide essential HIV services to people who inject drugs in 2015, their scale is not sufficient to change the trajectory of the HIV epidemic in the Russian Federation.

Page 179.  In the Russian Federation a so-called “law on foreign agents” interrupted the work of community-based organizations that receive international funding to provide HIV prevention services to key population in the absence of domestic funding for these purposes.