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The loyal opposition

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Science  15 Jun 2018:
Vol. 360, Issue 6394, pp. 1175
DOI: 10.1126/science.360.6394.1175

Vadim Pokrovsky runs the federal AIDS center in Moscow, but criticizes the government response.

PHOTO: MISHA FRIEDMAN

Vadim Pokrovsky, head of the Federal Center for the Prevention and Control of the Spread of AIDS in Moscow, is—to borrow from a Russian saying—deft enough to “shoe a flea”: He's a top government official who speaks critically about its policies and yet keeps his job. “At the present moment, there are no real attempts to overcome the epidemic,” he says, noting that Russian President Vladimir Putin has not mentioned HIV/AIDS in a decade. “We need something new.”

Pokrovsky's to-do list runs long. The government now spends 24 billion rubles (about $400 million) on HIV/AIDS prevention and treatment, a sum he thinks should be quadrupled. He dismisses the government's boast that it has expanded testing to some 32 million people each year. “Who was tested?” he asks. “Old women and children.” The conservative Russian Orthodox Church, he complains, has stifled sex education and condom campaigns. “I think it's better first to save the life and then to save the soul,” he says.

Gregory Vergus, the St. Petersburg–based regional coordinator of a nongovernmental organization, the International Treatment Preparedness Coalition in Eastern Europe and Central Asia, says Pokrovsky's voice is essential because the entire system, from testing to delivering drugs, is badly broken. “Nobody in the government cares at every step of the way,” says Vergus, whose group advocates to make anti-HIV drugs more accessible in Russia. “He's the only one.”

But other people question the extent of Pokrovsky's commitment. One U.S. AIDS researcher sharply criticized Pokrovsky's plenary talk in April at an HIV/AIDS conference in Moscow. “He addressed no modern preventive interventions beyond the era of the condom, did not speak to treatment as prevention, did not address the urgency around harm reduction, and did not address pre-exposure prophylaxis for those at risk,” says Chris Beyrer of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. Beyrer says Pokrovsky may have held his tongue because the conference included many health officials from countries Russia wants to influence. “It was difficult not to come away with the take-home that the federal authorities were again refusing to take an evidence-based approach to the expanding HIV epidemic in Russia.”

Pokrovsky concedes his job is “rather difficult. … Every morning I say it's necessary to quit this work if there are no results, no progress. But in the evening, I'm thinking about what problem to go after the next day.”

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