After learning Russia would no longer fund grassroots outreach organizations, the Global Fund decided to continue its work within Russia, but with a fraction of the previous budget. As a result, only 4,300 people have received anti-retroviral drugs this year, compared to 66,000 people in 2009 who had access to the HIV medication with the help of Global Fund aid money. The Fund has again made plans to leave Russia by the end of 2017.
Approximately 30 percent of Russians in need of anti-retroviral drugs currently do not have access to them, according to the Health Ministry.
The U.S. Agency for International Development and the Open Society Foundation, which collectively sponsored over 200 organizations working with HIV, were both forced out of Russia in 2012.
Methadone substitution therapy is widely used globally to wean addicts off intravenous drugs. In Russia, however, the outdated “cold turkey” method is the only available rehabilitation route for addicts; distributing methadone can bring a prison sentence of up to 20 years.
In neighboring Ukraine, whose HIV epidemic has mirrored Russia’s, methadone therapy is legal and increasingly prevalent. After years of rapid growth in infection rates, the number of new HIV infections among drug injectors was down in 2013 by 33 percent, according to the HIV/ AIDS Alliance of Ukraine, a decline that has largely been attributed to the introduction of methadone therapy.
Crimea is frequently cited as an example of what happens when methadone therapy is suddenly made unavailable. After the Ukrainian peninsula was annexed by Russia in March 2014 and methadone became illegal, an estimated 80 to 100 of its 12,000 HIV-positive residents died from suicide and overdose, according to UNAIDS.
“Russia decided to come up with its own plan to deal with its drug problem, but 15 years have passed and there is no alternative plan,” said Vadim Pokrovsky, the head of the Federal AIDS Center in Moscow, who diagnosed the first HIV case in the Soviet Union in 1987.
In October, Russia announced it would double spending on HIV care and prevention next year to $600 million.
Maxim Malyshev, who runs a clean needle distribution program with the Rylkov Foundation, is skeptical that the increase in government funding will have much positive effect.
“Look at what they are currently doing with their budget. Will we get more signs on the metro telling us HIV doesn’t occur in monogamous relationships?” Malyshev said, referring to a current public information campaign on the Moscow subway. The signs read: “Love and loyalty to your partner is your protection from AIDS” and “HIV isn’t transferred through friendship.”
Bishop Methodius runs purity education programs at Russian Orthodox Churches, advocating a wholesome life to protect against HIV infection. “For us, the lessons of chastity are more important than sexual education,” he said.
Sexual education programs in schools, also widely believed to slow the spread of HIV, have also been shot down by conservative government officials who say they promote sexual activity among children.
“I am often asked: When will you have sex education? I say never,” Pavel Astakhov, the president’s children’s rights commissioner, said at a press conference last year. Astakhov has also famously remarked that the best sex education is Russian literature.