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Praised Russian Prevention Program Faces Loss of Funds

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Science  09 Jul 2010:
Vol. 329, Issue 5988, pp. 168
DOI: 10.1126/science.329.5988.168

In 2006, then-President Vladimir Putin pledged increased support for HIV/AIDS programs, but the government recently declined to fund some key efforts.

On 21 April 2006, Vladimir Putin, then president of the Russian Federation, unexpectedly called for increased spending and urgent new measures to combat HIV/AIDS. “We need more than words; we need action, and the whole of Russian society must get involved,” Putin declared.

Putin's critics long had accused him of turning a blind eye to the country's epidemic; a 2004 report from Human Rights Watch complained that “the Russian government has for too long been acting as though HIV/AIDS is little worse than hemorrhoids.” In particular, Putin and his underlings did not support harm-reduction efforts that aimed to slow the spread of HIV among injecting drug users (IDUs), who account for most infections in the country. Nor did the government target prevention efforts to other vulnerable groups like sex workers and men who have sex with men. Nongovernmental organizations (NGOs) picked up the slack and launched their own projects, receiving substantial financing from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Skeptics linked Putin's sudden concern for HIV/AIDS to Russia's first hosting of the annual Group of Eight (G8) summit, which would take place in St. Petersburg in July 2006. “He wanted to show we are normal people and care about HIV,” says Alexey Bobrik, a clinician and director at the Open Health Institute, an NGO in Moscow. “It was much less sensitive than nuclear proliferation or other problems.”

The Russian government did for a time take dramatic action. At the G8 summit, Russia announced that it would shift from being a Global Fund recipient to a donor. In another generous move, it pledged to reimburse the fund for the $217 million that Russian grantees—mainly NGOs—were slated to receive between 2007 and 2010 and also offered $40 million to help Africa. The 2007 federal Russian HIV/AIDS budget grew to $445 million—a 57-fold increase from 2005. And the government indicated that it would finance efforts aimed at high-risk groups.

The Russian NGOs working on HIV/AIDS were elated, if wary. They had organized themselves into a consortium, Global Efforts Against HIV/AIDS in Russia (GLOBUS), led by Bobrik and operating in 10 different regions. Nearing the end of a 5-year Global Fund grant of nearly $90 million, GLOBUS in May 2008 took heart when Russia's minister of health and social welfare, Tatyana Golikova, assured delegates at the 2nd annual Eastern Europe and Central Asia AIDS Conference (EECAAC), held in Moscow, that GLOBUS's work was appreciated. According to a press release from her office, “all projects and programs that were initiated by nonprofit organizations must be continued.”

Climate change.

Vladimir Putin's (above) bold HIV/AIDS stance has weakened, leaving the Global Fund to rescue Alexey Bobrik's (below) NGO consortium.

CREDITS (TOP TO BOTTOM): G8 RUSSIA (WWW.EN.G8.RUSSIA.RU); MALCOLM LINTON

Yet in July 2009, a month before the end of the GLOBUS grant, Bobrik received word that the government would not bankroll the consortium after all. Several other NGOs had to lay off employees or close up shop. One is LaSky, a prevention project for men who have sex with men in St. Petersburg. “Our clients have no place to go,” says Ilya Kurmaev, who runs the effort. A recent study by Stellit—another NGO in the city—found a prevalence in that population approaching 12%.

Evgeniy Petunin, who is based in Moscow and heads the Russian Harm Reduction Network—an NGO that has depended on Global Fund money—says the government has no specialists who work with IDUs. “Harm reduction in Russia is dying,” says Petunin. “The government doesn't pay attention to the problem.”

Nicolas Cantau, the portfolio manager for the Global Fund in charge of the GLOBUS grant, says a battle between government agencies led to the sudden change of heart about supporting GLOBUS: The health ministry argued that it made more sense to promote “healthy lifestyles” to prevent HIV infection than to back ineffective harm-reduction programs. “There's been an ideologically based approach as opposed to following scientific evidence,” says Cantau. “GLOBUS is one of the most successful programs worldwide since the beginning of the Global Fund.”

Complaints about the government's decision to abandon GLOBUS took center stage in October 2009 at the 3rd EECAAC, again held in Moscow. Attendees included Michel Kazatchkine, the head of the Global Fund, but no one came from the Russian health ministry. The next month, the Global Fund's board, on “an extraordinary basis” that recognized “an emergency situation,” awarded GLOBUS $24 million to keep the consortium alive through 2011. “There's a lot of concern about the future,” says Cantau. “It's just for 2 years, and 2 years is going to pass very quickly.”

Bobrik has mixed feelings about the emergency grant; he's grateful to the Global Fund but says the new money lets the government off the hook for two more years. Maia Rusakova, a sociologist who runs Stellit, similarly contends that Russia must support these efforts at the local and federal level. “Our politicians know how to look quite nice and they say a lot of things, but they don't do it,” says Rusakova. “The situation is very, very serious, and I'm concerned that it looks like a ticking bomb.”

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