Tag: Russian Health Ministry

HIV Is on the Rise Again in Russia

The number of new cases of HIV infection in Russia has been growing again. In 2022, 63,150 people were diagnosed with HIV, while a year earlier this figure was 61,098 people, according to the Russian Health Ministry. During the pandemic, fewer cases of HIV infection were detected in Russia due to reduced testing coverage and lockdowns.

The HIV detection rate in Russia increased by eight percent per 100,000 people in a year. There was an even bigger jump in particular regions. Compared with 2021, this figure almost doubled in the Belgorod Region. It increased by 76% in the Kaluga Region, by 66% in Yakutia, and by 60% in Ingushetia and the Altai Republic.

HIV infection rates in Russia per 100,000 people between 2004 and 2022, according to the Russian Health Ministry.

However, the Health Ministry’s data encompasses only people who have registered as outpatients at AIDS centers. They do not reflect those who have tested positive for HIV, but were not registered. The number of such people is as high as twenty percent of all confirmed cases of infection, estimates Vadim Pokrovsky, head of the Epidemiology and AIDS Prevention Research Department at Rospotrebnadzor’s Central Epidemiology Research Institute. Nor does this figure include foreign nationals and anonymous positive tests.

In 2021, 1,138,000 people with a confirmed diagnosis of HIV diagnosis resided in Russia. In 2022, another 60,000 people were diagnosed with HIV. To these groups we need to add around 300,000 people (according to Pokrovsky’s estimates) who have HIV but don’t know it because they haven’t been tested. Thus, the number of HIV-positive people in Russia is one and a half million, which is one percent of the country’s population.

2.6% of pregnant women in the Irkutsk Region are HIV positive.

At the Congress on Infectious Diseases, Pokrovsky said that almost a third of Russia’s regions are undergoing the generalized (third) stage of the HIV epidemic. He explained that there are three stages of the epidemic. The first (initial) stage involves isolated cases. The second (concentrated) stage occurs when more than five percent of any high-risk subpopulation is infected (for example, prison inmates, drug addicts, or sex workers, while the third (generalized) stage occurs when more than one percent of pregnant women are infected with HIV.

According to Pokrovsky, nine Russian regions are in the first stage of the epidemic, while forty-eight are in the concentrated stage, and twenty-seven are in the generalized stage. In the Irkutsk Region, 2.6% of pregnant women have been diagnosed with HIV, he noted. Ten percent of Russian prison inmates are infected with HIV, and four percent of Russian men over the age of forty have HIV, adds Pokrovsky.

In 2022, regions of Siberia and the Urals — Krasnoyarsk and Perm Territories, Orenburg, Kemerovo, Irkutsk, Tomsk, Chelyabinsk, Novosibirsk, Kurgan and Sverdlovsk regions — remained the leaders in the rate of HIV spread, as in previous years.

“Regions of Siberia and the Urals are leaders in the rate of HIV spread. Number of new HIV infections per 100,000 people.
Click on the region or start typing its name in the search box to see specific figures.”
This map is interactive in the original article, as published on the Important Stories website.

And yet, flying in the face of its own data, which showed an increase in cases, in March of this year the Health Ministry reported a reduction in the number of new cases of HIV infection in 2022.

According to the UN strategy for eradicating HIV, a country should seek to hit the “90–90–90” treatment target if they want to beat the epidemic. This means that ninety percent of people with HIV should know their status, ninety percent of people who know they are HIV positive should receive sustained treatment, and ninety percent of patients undergoing treatment should have an undetectable (i.e., very low) viral load. When this is the case, an HIV-positive person undergoing antiretroviral therapy cannot transmit the virus to another person.

Antiretroviral (ARV) treatment is the principal means of combating HIV. Every person living with the immunodeficiency virus should receive this therapy. But that is not the case now.

In 2021, 82% of people who had regular medical check-ups and 56% of all those living with a confirmed diagnosis of HIV infection received ARV treatment, according to Rospotrebnadzor’s AIDS Prevention and Monitoring Center. An undetectable viral load was attained by eighty percent of those receiving ARV treatment.

The rest — more than half a million people with a confirmed diagnosis — do not receive treatment. Their viral load remains detectable, so they risk spreading the infection.

By law, Russian citizens should receive ARV treatment for free. However, the Health Ministry procures less medicine than HIV-positive people need, and has not increased the treatment budget despite the fact that the number of patients has been growing every year. Every day, the project “Interruptions.ru” fields messages from patients complaining about the unavailability of treatment.

49% of Russians registered as HIV positive are covered by drugs purchased by the state.

In 2021, Russia procured only 391,000 annual doses, according to the International Treatment Preparedness Coalition. This covers approximately 49% of the number of people who receive follow-up care, and 34.4% of all people registered as HIV-positive. Therapy coverage was thus fifteen percent lower in 2021 than in 2020.

The drugs procurement budget for 2023–2025 must be increased by at least fifteen billion rubles annually in order to provide all patients with the necessary treatment. However, the Finance Ministry is willing to allocate 31.7 billion rubles for drugs procurement annually during the period 2023–2025 — that is, it does not plan to increase spending.

And yet, according to one estimate, Russia spent ten trillion rubles on the war over the past year. This same amount of money could provide all Russians in need of it with ARV treatment for 270 years in a row.

The Health Ministry procures drugs for ARV treatment on the federal level, while the regions must purchase the drugs they lack themselves, an activist who helps people with HIV explained to Important Stories on condition of anonymity.

According to her, AIDS centers in the regions submit applications to the Health Ministry for the amount of drugs they need. But the Health Ministry buys less than requested — for example, AIDS centers might apply for ten thousand doses, but the Health Ministry buys them only seven thousand. The regions have to find the money to make up for the shortfall in drugs.

“We must increase the number of patients in treatment and increase coverage,” our source told us. “At the moment, it is unclear what to do without additional allocations of money for purchasing medicines.”

If the Russian authorities spent ten trillion rubles on medicines, rather than on the war in Ukraine, they could provide HIV-infected Russians with the treatment they need for 270 years in a row.

The regions are not required to buy additional medicines, nor do all of them do it. Consequently, patients find themselves in unequal conditions: in richer regions, they receive the appropriate treatment, while in poorer regions they do not. Moreover, spending on drugs does not depend on how bad the HIV epidemic is in a particular region. This can be seen by looking at procurements of the drug Dolutegravir. According to our source, it is a well-researched and rather expensive drug that is suitable for many patients. But the Health Ministry has been reducing its purchases of the drug, while the country’s richest regions — the Tyumen Region, Moscow, St. Petersburg, and the Khanty-Mansi Autonomous District — spent the most of their own funds on it in 2022.

More than half of Russia’s regions did not purchase additional Dolutegravir for their patients at all, including, for example, the Sverdlovsk Region, where almost three thousand new patients were registered in 2022.

More than 77% of the money spent on Dolutegravir was spent by regions where only 23% of new HIV patients live.

Cutting-edge HIV treatment is available mainly to residents of rich regions

More than 77% of the public funds spent on procuring the drug Dolutegravir in 2022 were allocated by regions where only 23% of new cases live

A table showing how much Russia’s regions spent, in rubles and as a percentage of nationwide spending, on the ARV drug Dolutegravir in 2022, versus new cases of HIV infection last year, both in sheer numbers and as a percentage of the national total. The list includes Tyumen Region (at the top), Moscow, St. Petersburg, Khanty-Mansi Autonomous District, Chelyabinsk Region, Irkutsk Region, Tula Region, Novosibirsk Region, Yamalo-Nenets Autonomous District, Murmansk Region, and “all other regions.”

In 2022, Kommersant wrote about the reduction of purchases of expensive drugs for which there are no less-expensive substitutes. In 2021, such drugs accounted for 67% of the total volume of ARV treatment purchases, while in 2022, this figure was 55%. Cheaper drugs are being purchased to replace them.

Reducing the choice of drugs available makes it more difficult for patients to choose a treatment that suits them without causing side effects. It happens that only one drug out of four is suitable for a person, but the region where they live does not supply it.

Pokrovsky notes that the 63,000 new cases in 2022 is a high rate of infection. In reality, there are even more HIV-positive people in Russia, since the country’s most vulnerable groups are less likely to be tested.

“In part, the large number of new cases is due to the fact that we do test a large portion of the population: more than forty million tests were done in 2022. (But we must take into account the fact that, for example, pregnant women and donors are tested several times a year.) On the other hand, people who are particularly vulnerable to HIV infection — drug users and men who have sex with other men — are not tested enough,” Pokrovsky says.

68% of new HIV infections in Russia were the result of heterosexual sexual contact,
so sex education is needed to combat the epidemic.

Pokrovsky argues that to effectively combat the epidemic, the Russian government should promote sex education and fund social advertising campaigns.

“Nowadays, the biggest chunk of funding, over 30 billion rubles [per year], is spent on procuring drugs,” he says. “Treatment is supported by the pharmaceutical companies, so that is where the bulk of the funds are allocated. But there are no market-based solutions to prevention. In this case, you can only count on public funds. Very little is allocated for prevention, literally 500 million rubles [per year], and this amount does not grow from year to year. Most of it is spent on appeals to get tested, rather than on teaching people how not to get infected with HIV. Sex education is now practically prohibited [in Russia].”

Russia was among the top five countries in terms of new HIV case numbers in 2021. According to UNAIDS (the United Nations HIV/AIDS program), Russia accounted for 3.9% of the one and a half million new cases of infection in the world. Russia was bested, in 2021, only by South Africa (14% of all new cases), Mozambique (6.5%), Nigeria (4.9%), and India (4.2%). The Russian Foreign Ministry dubbed the news a “dirty information campaign” on the part of the West. Instead of receiving support, many Russian NGOs campaigning for HIV prevention and patient care have been labeled “foreign agents” by the Russian authorities.

Contrary to the stereotype that drug addicts are the most infected segment of the populace, heterosexual sexual contact is now the primary mode of HIV transmission in Russia, accounting for 68% of new cases.

You can take an HIV test free of charge and anonymously at AIDS centers in all regions of the country.

Source: “Every third region of Russia is experiencing a third-stage HIV epidemic. But the authorities refuse to recognize the growth of infections and purchase the medicines needed. Cutting-edge drugs are available to patients only in the wealthiest regions,” Important Stories (IStories), 13 April 2023. Translated by the Russian Reader

In Russian prisons, they said they were deprived of effective treatments for their H.I.V. On the battlefield in Ukraine, they were offered hope, with the promise of anti-viral medications if they agreed to fight.

It was a recruiting pitch that worked for many Russian prisoners.

About 20 percent of recruits in Russian prisoner units are H.I.V. positive, Ukrainian authorities estimate based on infection rates in captured soldiers. Serving on the front lines seemed less risky than staying in prison, the detainees said in interviews with The New York Times.

“Conditions were very harsh” in Russian prison, said Timur, 37, an H.I.V.-positive Russian soldier interviewed at a detention site in the city of Dnipro in central Ukraine, and identified only by a first name, worried that he would face retaliation if he returned to Russia in a prisoner swap.

After he was sentenced to 10 years for drug dealing, the doctors in the Russian prison changed the anti-viral medication he had been taking to control H.I.V. to types he feared were not effective, Timur said.

He said he did not think he could survive a decade in Russian prison with H.I.V. In December, he agreed to serve six months in the Wagner mercenary group in exchange for a pardon and supplies of anti-viral medications.

“I understood I would have a quick death or a slow death,” he said of choosing between poor H.I.V. treatment in prison and participating in assaults in Russia’s war in Ukraine. “I chose a quick death.”

[…]

Source: Andrew E. Kramer, ‘”A Quick Death or a Slow Death’: Prisoners Choose War to Get Lifesaving Drugs,” New York Times, 21 April 2023

Coat Hangers for the Health Ministry

chelyab“#Hangers for the Health Ministry,” “Give us a choice,” “Without state-funded abortions there will be backroom abortions,” “The Health Ministry violates human rights,” “Banning abortions is no solution”: a protest installation set up by feminists outside of Hospital No. 1 in Chelyabinsk. Photo by Anastasia Zelentsova. Courtesy of Novaya Gazeta

“Go Find a Place That Will Give You an Abortion When You Have a Cough like That”: The Challenges Women Face During the Pandemic
Alla Konstantinova
Mediazona
June 4, 2020

Since early April, most hospitals in Russia have been focused on battling the coronavirus pandemic, and the Russian Health Ministry has recommended postponing routine surgeries. Under this pretext some medical facilities have begun refusing to perform abortions and other gynecological operations. Consequently, unemployed women have been forced to take out loans for abortions at private clinics or give birth to children they may not be able to feed.

In April 29-year-old Tatyana Shapovalova, from the village of Solomenny, which is part of Petrozavodsk but is physically separated from the city, found out that she was eight weeks’ pregnant. Shapovalova already has four children, but only the youngest lives with her and her common-law spouse. Her parental rights have been restricted, so one child is being raised by Shapovalova’s sister, and the other two by foster parents.

“Our living conditions are very bad,” Shapovalova says, explaining the decision.

She and her husband decided to end the pregnancy: the village obstetrician-gynecologist sent Shapovalova off for tests, an ultrasound, and a consultation with a psychologist. The trips to the psychologist and doctors and waiting for the test results took a month.

“It took a week for the blood panels to arrive, and a week for everything else,” she says.

The fact that she would have to pass a Covid-19 test before the surgery was something Shapovalova learned from the village gynecologist one week before her appointment at the perinatal center in Petrozavodsk—ending a pregnancy as covered by compulsory health insurance is currently done only at this facility. One building at the Gutkin Municipal Maternity Hospital has been turned into a coronavirus observation ward, while the other has been converted into a coronavirus treatment facility. Tatyana caught a cold and had a strong cough, but she had the Covid-19 test smear.

“Six days later, I got a negative result for the coronavirus. The next day, I traveled to Petrozavodsk to the perinatal center,” Shapovalova continues. “I was already at twelve weeks. But in the reception area they heard my cough and went to consult with the head physician. I sat there for about forty minutes. Then the nurse came out and said, ‘You’re denied hospitalization.’ I said, ‘I have a negative test result for the coronavirus.’ And she replied, ‘Go find a place that will give you an abortion when you have a cough like that.’”

Petrozavodsk residents have at times had to wait even longer—sometimes two weeks—for the results of Covid-19 tests, says Irina Koroleva, the director of Women’s Clinic No. 1.

“For example, on June 1 we received the test results only for May 14. All of the labs in the city have had problems with the reactive agents for the swabs. If check-up results are not provided in time, the perinatal center has the right to refuse a woman service. It is the same with childbirth: if a woman is in labor, she’s sent to the maternity hospital, which has been converted into a coronavirus observation ward. Or the baby will be delivered in a single-bed ward in the perinatal center’s emergency room.”

The head doctor of the perinatal center, Yevgeny Tuchin, explained that Shapovalova had been denied treatment on the basis of a Health Ministry order.

“An artificial termination of pregnancy is not performed when acute infectious diseases and acute inflammatory processes are present in any location, including a woman’s reproductive organs,” he wrote in response to a query from Mediazona. “The abortion is performed after the patient recovers from these illnesses.”

Shapovalova insists that they did not even examine her at the perinatal center, and the only person with whom she spoke was the nurse, who merely heard her cough.

In Russia, an abortion is performed at a woman’s request only within the first twelve weeks of pregnancy; abortions are provided to rape victims “according to social indicators” for up to twenty-two weeks. Because of the delays with tests and the unexpected refusal at the perinatal center, Shapovalova missed this deadline.

Now Shapovalova, who is currently unemployed, lives in an unfinished wooden house, and was already restricted in her parental rights, has to give birth to a fifth child.

[In early April, the Health Ministry recommended that the heads of Russian hospitals “consider postponing” routine surgeries, citing as a reason for the decision the complicated epidemiological conditions in the country. At the same time, the ministry recommended not reducing routine treatment for patients with renal, cardiovascular, or endocrine diseases, or cancer. The Ministry of Health did not mention gynecological diseases or abortions, thereby creating additional problems for Russian women.]

Not Only Karelia
Shapovalova did not demand a written refusal of an abortion from the doctors. Medical lawyer Anna Kryukova says that now it will not be easy to prove the illegality of the doctors’ actions.

“A written refusal is provided after a written inquiry,” says Kryukova. “She didn’t insist on it, and the powers that be took advantage of it.”

In April, a female employee at the No to Violence Center (nasiliu.net) telephoned forty-four Moscow hospitals: only three of them agreed to schedule her for an abortion as paid for by compulsory health insurance. The Moscow Department of Public Health told us that, during the pandemic, many hospitals had classified elective abortions as routine or non-urgent surgeries. Later, the Department of Public Health reported that hospitals that had not been repurposed for treating Covid-19 are performing abortions, as before.

In an interview with Mediazona, Karina Denisova, a spokesperson for Hospital No. 1 in Chelyabinsk, called a social media announcement that they would no longer be performing abortions in their outpatient clinic a “misprint.” After protests by Chelyabinsk feminists, who set up an installation featuring clothes hangers next to the hospital entrance (in Soviet times, some women performed abortions on themselves using hooks made out of hangers) the hospital admitted that the published information had been “incorrect.”

Like Shapovalova, a resident of Kovrov in the Vladimir Region will also have to give birth. Obstetrician-gynecologist Alexander Rusin says that the woman was also denied an abortion.

“At Kovrov Central Municipal Hospital,” Rusin says. “They said, ‘It’s the coronavirus: we are closed for routine surgeries.’ What did the woman do? Nothing, as far as I know. Well, deadline was nearing, she was at eleven weeks. She left. Of course, I consider [the hospital’s actions] illegal, a violation of the law.”

“I Eat Macaroni to Save Money”
Irina Drozdova of Vsevolozhsk was supposed to have her tubes tied on April 13. Twenty-five-year-old Irina decided on the operation after an exceedingly difficult childbirth.

“The anesthesia for the C-section and the post-natal stress triggered cardiomyopathy,” she says. “Now I take pills that are incompatible with pregnancy, and I’ll be taking them for the rest of my life. Plus, they put me on a defibrillator, and it is just one of the indications for sterilization under compulsory health insurance.”

Getting ready for the operation, Irina underwent dozens of tests, but it was suddenly canceled.

“They refused because of the situation with the coronavirus, but I had spent three months doing the paperwork, consulting with a cardiologist, and undergoing an ultrasound—everything was ready. In order to reschedule, I have to go through another complete workup,” Irina says.

In April, dozens of maternity hospitals across Russia were repurposed to treat the coronavirus, and the Health Ministry recommended that facilities that did not close should do consultations with pregnant women online.

Twenty-nine-year-old Muscovite Anastasia Kirsh, who gave birth to a daughter in May, connected via WhatsApp with her gynecologist in the women’s clinic at the Yeramishantsev Maternity Hospital.

“If I needed to find out test results, get a referral to the infant feeding center, renew a prescription, or had an urgent question, it was possible to resolve that online, which was very convenient. Other services—gynecological exams, measurements, ultrasounds—were performed in the clinic as usual.”

Coda Story has told the tale of a Moscow woman who had to take out a loan for an abortion, because her husband had lost his job when the quarantine started, and the family had no means of support left. At Moscow Hospital No. 40, she was denied a free abortion under compulsory health insurance.

“You should not even count on a surgical abortion under compulsory health insurance. Routine surgeries, except in emergency cases, are currently not being performed,” a doctor told the woman. “Your case is not an emergency: there is no reason to hospitalize you. […] If you want to fight for your rights, you will miss all the deadlines.”

Unemployed single mother Anna Kazakova, from the Moscow suburb of Yegoryevsk, where the maternity hospital had been turned over to battling the pandemic, was faced with a choice: schedule an abortion under compulsory health insurance in Kolomna, fifty kilometers from home, and make numerous trips back and forth, first for tests and then for the operation, or pay to terminate the pregnancy at a private Moscow clinic, which would take a single day.

“They were sending everyone off to give birth fifty kilometers away at the Kolomna perinatal center,” she explains. “But what was I supposed to do with my four-year-old daughter? Drag her back and forth with me? They would start ‘losing’ the tests and making lots of referrals to psychologists, as is usually the case. There is all this hubbub in Russia about supporting families and mothers. But in fact, you have nothing coming to you. And an existing child doesn’t count either. If I tell them I won’t be able to support a second one in such conditions, I won’t get anything but condemnation,” says Anna.

After borrowing 15,000 rubles from a friend, Anna had a medical abortion at a private clinic in Moscow. Now she thinks about how to repay the debt.

“I eat macaroni to save money on food,” she says. “I applied for social security, but they said that I was not eligible for any benefits.”

“They Were Turned Down—and They Left, Sadly Wiping Away Tears”
Medical lawyer Anna Kryukova believes that “no one has directly prohibited” abortions in Russia, but that all the instances of refusal are the consequence of fear and ignorance on the part both of doctors and patients.

“The battle against Covid-19 has been farmed out by the federal government to the regions, but they all still look to Moscow,” Kryukova argues. “Doctors are used to saluting at every turn—god forbid they do something wrong, or they will be dismissed from their posts. This is due to fear: it is easier to follow orders now than to get whacked upside the head for these violations later. The outreach work has also been done very poorly: people are already so frightened of the virus, and nobody is explaining anything to them.”

Many patients need surgical help now, but they are afraid to go to the doctor because of the coronavirus, says Ph.D. in medicine and obstetrician-gynecologist Kamil Bakhtiyarov. He works in a private clinic in Moscow where paid medical and surgical abortions are performed.

“Women are so frightened that they come in for termination of pregnancy practically wearing spacesuits,” he says. “They’re terrified, deeply terrified. The first question they ask is, ‘Are you working with Covid patients?’ For patients who need surgical treatment the problem of hospitalization comes up: in the first place, many clinics have been repurposed to threat Covid cases, and secondly, people themselves are very much afraid. A person doesn’t want to go to an ordinary hospital because there it’s six people to a room.”

Despite the pandemic, patients should insist on their right to medical care, argues Kryukova.

“People should still seek medical care and exercise their rights. The problem is that the victims [mentioned in this article] apparently did not do that,” she says. “Unfortunately, the patient community does not know its rights very well. These women were simply turned down verbally—and they left, sadly wiping away tears. Nobody chases after patients nowadays: for something to change, the person who needs the medical treatment has to take the first step.”

Translated by Mary Rees

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

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

Sorry, We Have No Medicine

Unlike life-saving prescription drugs, hashish and other narcotics are easy to come by in Russia. Photo by the Russian Reader
Unlike life-saving prescription drugs, hashish and other narcotics are easy to come by in Russia. Photo by the Russian Reader

Sorry, We Have No Medicine
Alfia Maksutova
Takie Dela
November 24, 2016

What doctors and officials do to avoid giving patients the free drugs they have coming to them

“You’re not ill.”

“You don’t have that.”

“You don’t need that drug.”

“You need that drug, but a cheaper substitute will also do.”

“You need the drug, but we’re out of it, so you’ll have to wait.”

This is how doctors and officials respond to thousands of people who, by law, are supposed to receive subsidized medicines. They trick them. They know these people are ill, and they know what drugs they need. According to rough estimates, however, the state now lacks 45 billion rubles for providing drugs to the populace. In certain regions, only 10% of applicants can be supplied with subsidized medicines. Officials and doctors turn down patients in such a way that it is as difficult as possible to prove they have broken the law. The Health Ministry and the health care regulator Rosdravnadzor regularly report that things are stable when it comes to preferential drug provision in Russia. The figures underpinning the reports bear no relation to reality. The true scale and brutality of the war between patients and the state is striking.

***

“Every time, they say, ‘Sorry, we have no medicine. There is nothing we can do about it.’ But by law I am supposed to get them. If they are out of them today, the state should purchase them tomorrow. Isn’t that right?”

Veronika has repeated the question over and over, but her voice still sounds surprised. When she speaks, her hands, with their long, elegant fingers, tremble slightly, as if they too are incapable of coping with the surprise. She has used hormonal inhalers for fifteen years. Without them, she cannot breathe. She has asthma, a host of related ailments, and official status as a disabled person. She is entitled to get the necessary dose at the pharmacy for free, but the medicine has not been issued for a year and a half now.

“It was always given out intermittently,” says Veronika. “You had to find out ahead of time the day when the drug would show up and run to the clinic when it opened to be in time to get it. If you were late, they would tell you they had run out, and it was your problem. But it was only last year I had to deal with the medicine not being available for months at a time.”

Then, after waiting six months, Veronika first turned to the Moscow Health Department for help. It was enough to file an application and the inhaler, which the pharmacy did not have in stock in the morning, turned up in the evening. But the magical effect of phoning the health department did not last long. A couple of months later, the drug was once again no longer available. When Veronika called the health department this time, she was told the situation was complicated. She could file an application, but no one knew when the drugs would arrive. The same day, the pharmacy called her and said her request was pointless: the drugs would not be available. Currently, relatives have been paying for her inhalers to the tune of several thousand rubles a month. According to Veronika, many of the people queued up to see the pulmonologist could not afford to pay this amount. The phrase “we are out of drugs” is tantamount a death sentence to them.

Veronika’s case is one of thousands. It suffices to peruse the regional press for the past month to read a dozen such stories. In Mordovia, the pharmacies not only have no prednisolone for patients entitled to the free drugs benefits, but no iodine or bandages, either. In Oryol Region, a woman suffering from lymphoma managed to get medicine only after local media wrote about her case. In Khakassia, the Audit Chamber will be investigating the problems with subsidized medicines due to the large numbers of complaints by patients. Organizations involved in protecting patients’ rights talk constantly about the growing number of pleas for help. The Movement against Cancer, for example, has noted an uptick. In September of this year, there had been so many cases of cancer patients turned down for subsidized drugs that the Prosecutor General’s Office investigated legal violations in a number of regions. According to online monitoring data for September 2016, done by Alexander Saversky, head of the League of Patients, over 80% of those surveyed had trouble obtaining subsidized drugs. Only 35% of those people had managed to get a prescription for the drugs in question without problems. Similar figures were adduced in a survey done last year by the Russian People’s Front: half of the patients surveyed were not issued the medicines they requested on time.

A 2016 government report stated the subsidized drugs provision program was suffering a shortfall of 45 billion rubles [approx. 660 million euros]. This was no surprise. The standard cost per person receiving free drugs has dropped from 849 rubles a month, in 2011, to 758 rubles, in 2016. According to Rosstat, however, the price of drugs has increased this year by 24%. In 2015, the government allocated an additional 16 billion rubles to alleviate the situation, but, unexpectedly, they were not used. The Health Ministry has said that all necessary drugs have been purchased. Roszdravnadzor regularly monitors the supply of drugs nationwide and has remained satisfied with its results. According to the reports issued by these agencies, around 98% of beneficiaries in Moscow Region, for example, receive their drugs, and the situation in other regions is stable. The Health Ministry’s ability to force public health officials to bend reality for reporting purposes has amazed even the president. Continue reading “Sorry, We Have No Medicine” →

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.

Sixteen Blue, Part Two

Petersburg teens playing football on a snowy day, November 11, 2016. Photo by the Russian Reader

Investigative Committee Asks Health Ministry to Report on Minors Who Lose Their Virginity
Novaya Gazeta
November 11, 2016

The Investigative Committee has proposed that the Health Ministry inform law enforcement agencies when they come across cases of minors who have lost their virginity before the age of sixteen, reports Lenta.ru, quoting Yevgenia Minayeva, head of the special investigations procedural control directorate.

Law enforcement officers are thus hoping to prevent sexual offenses. Ms. Minyaeva insisted communication of this information “protects the rights and legitimate interests of minors.” According to her, it would be wrong to consider this cooperation a violation of doctor-patient confidentiality, because “the confidentiality of the preliminary investigation is protected by law to no lesser extent.”

Minayeva explained that  it is a criminal offense in Russia to have “sexual intercourse and other sexual acts with a person under the age of sixteen.” However, such crimes are usually concealed by those involved in the intercourse “by virtue of natural shyness or at the instigation of relative and friends.”

“At the same time, teenaged victims of such crimes acquire victimized behavioral patterns and in the future become victims of more serious crimes or eventually become perpetrators of sexual crimes themselves,” said Minayev.

Sexologist Alexander Poleyev called the proposal “incredibly strange.”

“Science has long known that sex steers teenagers with high hormonal levels away from crime, delinquency, vandalism, and aggression,” he said.

Poleyev also noted that doctors can disclose information about their patients only by court order. If doctors disclose this information on an extrajudicial basis, “there will be terrible distrust of physicians,” argued Poleyev.

The Health Ministry will consider the Investigative Committee’s proposal “in the prescribed manner, involving a large number of experts on the given topic,” Govorit Moskva radio station was told by the Health Ministry’s press service.

Translated by the Russian Reader. Thanks to Dmitri Dinze for the heads-up. See my previous posts in this occasional series on young people in Russia today and the moral panics generated around them by media, politicians, and the public.

Die

Room in Children's Tuberculosis Hospital, Astrakhan, 2011. Photo courtesy of uglich_jj
Room in Children’s Tuberculosis Hospital, Astrakhan, 2011. Photo courtesy of uglich_jj

One of the conclusions of a report by the Health Foundation was that the elimination of 41,000 beds in Russian hospitals had led to an increase in mortality of 24,000 people in 2015, RBC reports today. The Health Ministry acknowledged the increase in mortality, but said it was not due to a reduction in hospital admissions.