Russia’s HIV epidemic dismissed as part of Western ‘information war’

Russia’s HIV epidemic dismissed as part of Western ‘information war’

(latest in Sydney Morning Herald)

Even as a UN conference began last week in New York, taking up the subject of ending AIDS, a Kremlin-backed research institute claimed the West is using HIV and AIDS as part of an “information war” against Russia.

The Russian Institute for Strategic Research (RISR) presented a report to the Moscow City Council last week on HIV in Russia where, unlike almost everywhere else in the world, rates of HIV infection are on the rise.

According to RISR deputy director Tatyana Guzenkova and her colleagues, the real goal of the West’s fights against HIV “is the implementation of the economic and political interests of US-led global structures, relying on an extensive network of international and quasi-NGOs.”

But none of this comes as a shock to Anya Sarang, head of the Andrey Rylkov Foundation.

“We’re not surprised at these kinds of statements anymore,” she tells me from Moscow, where she works with drug users and sees the scale of Russia’s growing HIV epidemic firsthand.

“It’s the usual thing in Russia now to discard science for ideology.”

There are two models for fighting HIV, according to the RISR report. The Western model, it says, is made of “neoliberal ideological content, insensitivity towards national sensitivities and over-focus of certain at-risk groups such as drug addicts and LGBT people.”

The Russian model, on the other hand, “takes into account the cultural, historical, and psychological characteristics of the Russian population, and is based on a conservative ideology and traditional values.”

The Russian model

The science says the Russian model isn’t working.

Approximately 93,000 new HIV cases were reported in Russia in 2015 – a per-capita rate almost fifteen times that of Australia. A million people in Russia have HIV, including almost one percent of all pregnant women – the threshold for a generalised epidemic.
Dr Vadim Pokrovsky heads up Russia’s federal AIDS research centre and is a longtime critic of the Kremlin’s HIV policies.

“The last five years of the conservative approach have led to the doubling of the number of HIV-infected people” Pokrovsky told AFP last year.

The arch-conservative head of Moscow City Council’s health committee, Lyudmila Stebenkova, described Dr Pokrovsky last year as a “typical agent working against the national interests of Russia.”

Not surprisingly, Pokrovsky doesn’t think much of RISR’s report.

“They use some questionable sources of information and incorrectly interpret the data they present,” he tells me from Moscow.

“Their arguments are not convincing.”

The Western contraceptive industry

According to Igor Beloborodov, one of the RISR report’s co-authors, attitudes to condom use is one of the main factors behind Russia’s HIV epidemic.

“The [Western] contraceptive industry is interested in selling their products and encouraging underage people to engage in sex,” he told Moscow City Council.

He and his RISR colleagues argue in the report that condoms “create the illusion of the safety of sex” and should not be “gratuitously distributed” in Russian schools. The solution, they say, is to completely abstain from sex outside of (heterosexual) marriage.

Dr Pokrovsky is dismissive of arguments like these.

“This is traditional rhetoric that was used thirty years ago and still used in conservative circles throughout the world. It is not particularly troubling evidence.”

Pokrovsky also takes issue with the report’s argument that “risk elimination” – in other words, completely giving up drugs and extramarital sex – is superior to harm reduction approaches.

He stresses that “risk elimination” is actually impossible. “The experts who understand this know that people cannot just give up extramarital sex,” he says, “and people dependent on drugs cannot just stop using them.”

‘AIDS and drugs will solve each other’

Even though 60 per cent of HIV-positive Russians are injection drug users, methadone replacement therapy remains illegal in Russia despite clear evidence of its effectiveness.

It’s an approach that has led some commentators to question if the Kremlin is even that interested in the fight against HIV at all.

“I have had conversations with Russian government officials who have said things like ‘AIDS and drugs will solve each other,'” Daniel Wolfe, director of the International Harm Reduction Program at the Open Society Foundations (an organisation funded by frequent Kremlin target George Soros), told The Verge.

“So I think there’s some question about whether or not Russia is actually committed to protecting the lives of everyone, or whether drug users fall into the category of ‘socially unproductive citizens’ the state might just as well do without.”

In Moscow, Anya Sarang worries about the impact the “information war” rhetoric from the Kremlin and its allies might have on Russian with HIV.

“It send the completely wrong message,” she says of the RISR report. “Basically this report is saying that the HIV problem is something made up by western media.”

“The Russian population is really psyched up now with this whole anti-Western ideology and discourse,” she warns. “People might take this seriously and think ‘oh, HIV isn’t a Russian problem – it’s just a part of the information war.'”

In Ukraine, mistrust of doctors remains high

In Ukraine, mistrust of doctors remains high

(latest in CMAJ)

Dr. Richard Styles was used to being trusted as a doctor in Britain, but that changed when he moved to Ukraine a decade ago, after working in a number of European Union-funded projects there.

“There is nearly no trust in doctors at all, even amongst doctors,” says the chief medical director at the American Medical Centre in Kyiv, Ukraine’s capital.

Indeed, a 2015 report by European Observatory on Health Systems and Policies, a partnership led by the World Health Organization (WHO), found that “popular mistrust of doctors [in Ukraine] is strikingly high,” and has been for many years.

Dr. Zoryana Chernenko, an assistant professor at the National University of Kyiv Mohyla Academy, points to Ukraine’s chronically low wages for doctors as one of the main culprits. This has forced doctors to supplement their incomes with informal out-of-pocket payments, despite the system supposedly being free at the point of service.

“Every day, doctors are just thinking about how to survive,” said Chernenko, who has worked on health system reform in Ukraine.

Wages for doctors in Ukraine have been low since before the 2014 Euromaidan Revolution, a series of violent events culminating in the ousting of the president. According to the European Observatory’s report, in 2013 the average monthly wage for a doctor in Ukraine was just over $400 a month, well behind that of professionals in many sectors of Ukraine’s economy.

More recent data on doctors’ wages in the Ukraine are not available, but an analysis published in October by the Ukrainian newspaper Komsomolskaya Pravda suggested that the average wage had fallen to less than $260 by mid-2015. Given that Ukraine’s currency has lost almost 20% of its value since the beginning of 2016, doctors’ wages are likely to drop even further.

Out-of-pocket payments have been a regular feature of Ukraine’s health care system since the 1990s following the collapse of the Soviet Union, according to the European Observatory’s report. During the subsequent severe economic downturn, doctors began levying informal payments to provide themselves with a more acceptable wage. Chronic government underfunding — including a 5% cut to health spending in 2016 — has contributed to these payments becoming an entrenched feature of the Ukraine’s health system.

“At the moment state funding covers only half of the financial needs of the system,” Konstantin Nadutyi, deputy chairman of the Ukrainian Medical Association, recently told The Lancet in a Feb. 20, 2016 article. “The rest is paid for by patients themselves.”

Patients in Ukraine usually give informal payments before a service is given. Sometimes these payments provide them with quicker access, other times with newer drugs and services.

This system of soliciting informal out-of-pocket payments, according to Chernenko, has led to Ukrainians feeling like their doctors are more concerned with their bottom lines than providing quality care.

This system of low wages and informal payments has also led to chronic overtreatment, which further erodes trust in doctors, says Styles.

“The problem is that people [in Ukraine] don’t get value for money.” Styles estimates that a substantial portion of Kyiv’s three million people is overtreated and prescribed drugs or forced to pay for services they do not need. “It’s rather strange in a health care budget that’s got its back to the wall.”

However, Styles is keen to point out that many of the Ukraine’s doctors, despite how they might be perceived, are hardworking, dedicated professionals. “I would be very careful not to denigrate Ukrainian doctors,” he stresses, pointing out the number of doctors who have risked life and limb in war-torn eastern Ukraine.

“In Ukraine, there are some very dedicated, very vocational doctors who are working for nearly nothing.”

Taskforce aims to bolster rural physicians

Taskforce aims to bolster rural physicians

(latest in CMAJ)

Having worked in the interior of British Columbia since 1989 Dr. John Soles life as a rural family physician has been nothing like his urban colleagues. He has done “the full spectrum,” he says, from delivering babies and treating colds to mentoring young physicians and managing the business side of his practice.

“It’s about how to work with fewer resources and always dealing with a degree of uncertainty,” says Soles, president of the Society of Rural Physicians of Canada (SRPC).

Although about 18% of Canadians live in rural or remote areas, only 14% of family physicians practise there. Adding to their stress is the fact that family physicians provide 85% of primary care needs. Continue reading “Taskforce aims to bolster rural physicians”

Britain debates “sugar tax” to fight obesity

Britain debates “sugar tax” to fight obesity

The United Kingdom is considering a “sugar tax” to reduce sugar intake and help tackle its obesity epidemic. The recommendation was made by Public Health England (PHE), the government’s advisory body on health.

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Continue reading “Britain debates “sugar tax” to fight obesity”