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.