Infected Russia

Record money is allocated to fight HIV, but the epidemic does not go to the decline, and there is no money, as it turns out,

In the budget for 2016, unprecedented funds were allocated to combat HIV infection, but there are few hopes that the epidemic who has overwhelmed Russia will retreat. Radio correspondent Freedom spoke with specialists and visited Irkutsk-one of the demonstrative regions, which is in second place by the affection of HIV infection in Russia.

Karina is 35 years old, although in fact, maybe more, or maybe less. Unwashed hair, a down jacket on top of a colorful jacket and a wide gypsy skirt, a face, ineptly painted with cheap cosmetics. Karina speaks nervously, jumps from the thought of thought, constantly laughs, showing rare bad teeth, but does not swear obscenities: after the prison she tied. It seems not that under the high, but not too sober, she probably threw herself in the morning before going to work: Karina sells perfume in one of the Irkutsk markets. "I buy them from the Chinese, well, and then I sell them as expensive. And what? This is the 159th <article-fraud>, but it is unprovable. Haha. Well. Well. We must live."

In prison, such a bzik walks, where everyone is sick with hepatitis - some at the last stage, some like. And here are those who, at death, are fed with live lice. You pushing the loser, and then she heals there the liver there

Karina is a consumer of injection drugs (PIN) with experience, HIV-infected-a classic representative of a vulnerable group for HIV and AIDS, Pinov in 2015 accounted for 53.6% of new cases of infection. Karina does not accept therapy, she didn’t even take tests for a long time: he feels good - and okay. "Why drink something? They gave me during pregnancy in 2008. And then I took tests back in 2011. After I didn’t give it up. When I am insane, I can’t have pills. But you can’t throw it. I don’t see them with me. Well. Well. Well. Look at me. I look normal." I'm watching. Karina does not look very good. She had just served six months under investigation in pre -trial detention center No. 1 of Irkutsk, and received three years conditionally for theft. According to Karina, in a pre -trial detention center, no one receives therapy at all: when taking, they donate blood for HIV, but there is no one to take tests to the level of the virus and CD4. HIV-positive "put" on a special diet: eggs, cottage cheese, a glass of milk per day. “It’s impossible to have a table of pills. There is even aspirin in the prison, there is no analgin,” says Karina. “Mokeev, this is the owner of the prison, announced < Igor Mokeev-the head of the SIZO No. 1.> . I went to each apartment <camera> . What if you are seriously, you can buy pills from the will. But there must be a mandatory indication from the prison. And you can call relatives. And you can call relatives once every time. This is already possible to replace the HIV, because there is no testimony from the prison They say, it is so cool in the prison: they probably want to drive all the cancer, but they don’t want to drive on the HIV ... Open tube.

Problems, however, are not only in jail, but in general in the UFSIN system of the Irkutsk region. In the zones, therapy is prescribed, but they give what is. If there are two drugs of three prescribed ones, they will give two, reducing the effect to zero; If the medicines are not brought, the reception will be stopped. There is no therapy at the stages that can last several days, if not weeks, and this often causes resistance to the assigned course.

Prison is not a hospital

With this diagnosis, you can easily kill you

In 2013, a new AIDS Center was opened in Irkutsk, its chief physician Yulia Plotnikova says that there are enough drugs for everyone who needs treatment, in remote areas of drugs are delivered and distributed by local infectious disease specialists, blood for tests that cannot be done in district centers are brought to Irkutsk. However, as Yekaterina Dvorak, the chairman of the Irkutsk regional public organization Center for Social Assistance Navigator, explained, not everything is so rosy: drug consumers are registered, but there is no commitment when patients are explained that even a delay in several hours threatens that resistance will be developed for the medicine and will need to be prescribed by another course. Then they stop - reluctance to suffer with them, ”says the courtyard. The problem is also with remote areas: there are specialists there, but the medical secret is bad, patients run the risk of encountering an infectious disease specialist with acquaintances, gossip quickly becomes the public’s property.“ They can easily kill you with such a diagnosis, ”says Ekaterina Dvorak. -I have a friend of HIV-infected with Sayansk, she has a doctor’s sister, works in a local hospital. And this of my familiar house has her own towels, her own dishes, she can’t touch other people's things, wash someone else's dishes-everyone is afraid to get infected. "Because of this, many prefer to spend a vacation for a trip to Irkutsk, but if you consider that from some district centers to the capital of the region, not everyone can afford such vacations.

However, Julia Plotnikova hears about problems with registration for the first time. “We must understand each specific case,” she says and reports on the successes of the region in the fight against HIV: “We have the lowest increase. In 2014 in the Northern Federal District, the growth was 25%, in Russia 13%, and we have 7.9%.” According to Plotnikova, HIV mortality in the region decreased 1.5 times in 2013, if five years ago, HIV was transferred from the mother in 12% of cases, today this figure is only 3.1% (for 2% purposes), about 30% of the total number of registered infected are obtained, as Russian standards are mostly prescribed (therapy in Russia is mainly prescribed when reducing the number of CD4 lymphocytes below 350 cells/μl (if there are no additional indications such as hepatitis B/s or tuberculosis), and in the EU countries it is recommended to take therapy immediately after the diagnosis is established, the main thing there is the patient's desire, this led to the fact that the treatment receives about 70% of the infected ones). Everything is fine in Irkutsk, and as for the Federal Penitentiary Service, this is not included in the sphere of responsibility of the regional AIDS center, despite the fact that Julia Plotnikova also holds the position of chief specialist of the Russian Ministry of Health on the Siberian Federal District on HIV infection. "The Federal Penitentiary Service is another federal subordination. We purchase drugs ourselves, the fsin purchases the central Ministry of Health," the head physician explains. To the question why, for example, there are no such problems in Moscow and the Moscow region, it answers that it just happened: "They agreed there ... And we work in the legal field, we have streams. We should not treat prisoners. We only do what is prescribed to us."

Piece prevention

Russia crossed the threshold into a million HIV-infected people, and this is only officially registered

In 2015, the Irkutsk region took ninth place in terms of incidence of HIV infection (new cases) after the Kemerovo, Sverdlovsk, Tomsk and Novosibirsk, Chelyabinsk, Samara regions, Altai and Perm region. Moreover, the Irkutsk region is one of the 19 regions, where the epidemic passed into the so -called generalized stage. According to WHO standards, it is necessary to beat the alarm when an infection is found in 1% of pregnant women, in Irkutsk this figure reached 1.7% in 2014, in the whole country - 0.76%. This says one thing: the disease has long gone beyond the vulnerable groups-consumers of injectable drugs, sex workers and men practicing sex with men, today at risk are ordinary women, including those who have only one permanent partner, and 40% recognize their diagnosis during pregnancy.

According to the AIDS Federal Center, in 2016, Russia crossed the threshold to a million HIV-infected people, and this is only officially registered, according to some estimates, the real number can be 1.5–2 times higher. A million, however, is considered from the beginning of the HIV in 1987, over 30 years more than 212 thousand patients have died, and if all over the world, HIV mortality is reduced (according to Unaids by 42% compared with the peak 2004), then in Russia it grows 10% per year. In 2015 alone, for various reasons, 27 thousand HIV-infected people died. The increase in new cases of infection in 2015 in Russia amounted to about 10%, and 44% of the infected received HIV through heterosexual sexual contact. However, according to Natalia Ladia, senior researcher at the Federal Scientific and Methodological Center for the prevention and combating of AIDS, despite the fact that the outbreaks of HIV infection in almost all regions of the country originally took place among drug users and only then entered the general population, to fight the virus is still necessary among vulnerable groups, as is done throughout the world. From 2006 to 2009, Rospotrebnadzor received state funding for preventive programs, including among vulnerable groups of the population. “We saw progress,” says Natalya Ladnaya. “We have reduced the growth of new cases of HIV infection, stabilization came in 2010. But in 2010, all this was transferred to the Ministry of Health, and they turned this work.”

In the Irkutsk AIDS Center, two employees work with risk groups

They turned, however, not all. At the end of 2015, the Irkutsk AIDS Center held an information campaign-10 posters with droplets of infected blood and an explanation were placed in the city what HIV is. And in the Irkutsk AIDS Center, two employees work with risk groups, conduct seminars, communicate with people. For example, in 2014, 10 seminars were held for drug users, about 10 people at each, with sex workers the situation is better-about 240 women went through the hands of doctors of the AIDS center. At the same time, according to the appraisal data of the Irkutsk neuropsychiatric dispensary, in the city of Irkutsk, drugs intravenously use more than 36 thousand people, and the Federal AIDS Center has calculated that in most Russian cities the number of citizens employed in the sex industry is from 0.1 to 0.3% of the adult population, that is, there are from 1.5 to 4 thousand people in Irkutsk. The attempt to reach visitors to the Irkutsk Gay Club Mix was unsuccessful: the administration of the institution did not make contact. But good numbers give seminars on the zones: 90, 120 listeners at a time. However, even if it is possible to convince the prisoners of the benefits of therapy and debunk myths about terrible side effects, which are supposedly worse than the disease, what to do for those who want to be treated, but who does not have enough drugs-there is still no answer to this question.

AIDS-centers should not be engaged in prevention, according to the head of the association of people living with HIV (LZHV), Igor bee. "Doctors are treating all over the world, and different funds are engaged in prevention, which receive financing, including from the state." NPOs working with risk groups are in Russia, they not only conduct training seminars, but also distribute condoms and hygiene napkins to sex workers, disseminate information and the same condoms in gay clubs and gay-saunas, and distribute syringes to drug users. Syringes and condoms - just a way to enter trust, start communication with the group representatives, the ultimate goal is to persuade the HIV test and, if necessary, start taking therapy. All this costs money, and before many programs in Russia were sponsored by Western funds. “But in 2013, many left - Unisef, Unaids, UNFPA, Unods,” Ekaterina Dvorak lists. “Then they adopted the law against NPOs and generally began to fight foreigners. There were very few money left.” The lack of financing by the RS was confirmed by Sergey Davidyan, the chairman of the Irkutsk branch of the Red Cross: "Compared to 2012, financing of projects has reduced twice as well."

HIV, Orthodoxy, nationality

Many doctors surveyed are sure: the main problem is not only that not everyone receives treatment, but in the general state policy for the prevention of HIV infection, which is not de facto. “If we talk about drug consumers, that is, the experience of the Western European countries in“ reducing harm ”programs, but our state does not support these programs,” says Natalya Ladnaya. “The head of the Federal AIDS Center Vadim Pokrovsky has repeatedly stated that it is a supporter of harm and programs for replacement therapy. There would be no one in our country, but we just have no other effective ones For decades, we have expected that some new method would appear, but so far we still have no effective mechanisms for working with drug consumers, including HIV-infected and patients with tuberculosis. ” The situation is no better with sexual education: if in the West children are already lectured at 11–12 years old, in Russia, even when working with high school students, they have to look back at officials and the church, who believe that the best HIV prevention is sex with one partner after marriage. In the new strategy for the fight against HIV infection presented by the Ministry of Health in early February, the propaganda of family values, not safe sex, is again listed. According to Sergey Davidyan, every year the Red Cross department in Irkutsk holds seminars in schools, and sometimes you have to meet your parents first to explain the essence of the program. However, even during such seminars, NPO representatives are forced to speak with caution: to advise "abstinence and fidelity" before moving on to the main one. “We have no teenagers how they can protect themselves not only from HIV, but also from an undesirable pregnancy, from other diseases,” Natalya Ladnaya complains. “They don’t know about condoms, many simply do not know how to handle them. They use them incorrectly, condoms are torn, here it will not work for them and will not use it.”

If HIV is found in a pregnant woman, it will most likely be forced to have an abortion

At the end of December, the government allocated 21 billion rubles to combat an epidemic of HIV infection and hepatitis B and C, that is, nominally increased HIV-expenses. This money is registered with a separate line in the budget for 2016, but in the anti -crisis plan that the government discussed, but did not approve on February 18, did not include the sources of these funds. According to the Vedomosti newspaper, 2 billion rubles were supposed to be taken from the anti -crisis fund, the rest - to find during the execution of the budget. In addition, the ruble has lost half of its value over the past year, and most drugs are purchased abroad. According to Natalia Ladnaya, even if the money is found, it is difficult to determine the real increase in expenses, because when purchasing large batch of medicines, manufacturers of medicines provide quite large discounts, the experience of other countries shows that prices may differ by an order of magnitude, but "until we decrease," Ladnaya admits. There is practically no additional money for prevention in vulnerable groups, this work was supposed to be presented in the AIDS strategy, but it was not in two versions of the document submitted by the Ministry of Health. In the meantime, in the regions it was perplexed that financing in 2016 in 47 entities does not only increase, but even decreases compared to 2015: this is how the Stavropol Territory will receive 51%less funds for the purchase of drugs, the Republic of Tatarstan-by 27%, the Krasnoyarsk and Trans-Baikal Territory-by 20%, the Chelyabinsk region-by 12%, Irkutsk-by 5%. According to Natalia Lada, a decrease in financing probably occurred due to a technical error in the calculations of the Ministry of Health: "For our part, we sent proposals for the distribution of financing, but the Ministry of Health did not take them into account on antiretroviral drugs," Ladnaya says. They plan to compensate for losses at the expense of Medvedev’s money, and doctors do not yet understand how the purchase of medicines will be purchased: the regions will still spend their own funds allocated, while additional money will be spent centrally through the Nazimbio company created for this.

Help for imam

They said that my cells seem to be under evidence, but they insist that I waited a little

HIV problems in Russia vary from region to region. For example, in Chechnya, imams require a certificate of HIV tests to marry (not everyone does not go to the registry office here). However, as the sources in Chechnya told RS, these certificates are bought, no one even gives blood. And if HIV is found in a pregnant woman, it will most likely make it an abortion, so no perinatal therapy is also necessary. В Москве другая сложность: не ставят на учет пациентов без постоянной московской прописки, а московские суды часто становятся на сторону СПИД-центра. К примеру, 25-летний Александр из Кирова пару лет назад почувствовал ухудшение самочувствия и решил начать терапию, но в московском СПИД-центре его отправили в Минздрав – писать некое прошение. "В Минздраве сказали, что без прописки терапия невозможна", – говорит Александр. В родном Кирове Сашу долго отговаривали от того, чтобы начинать курс, несмотря на результаты анализов: 350 CD4 клеток/мкл при вирусной нагрузке в 15 тысяч копий/мл. "Они говорили, что у меня клетки как будто бы под показания, но они настаивают, чтобы я немного подождал, чтобы посмотреть динамику, – рассказывает Саша. – Я говорю, что нет, я сознательно готов к началу терапии. Они долго сопротивлялись, потому что им невыгодно давать препараты, но в итоге назначили лечение". Из Москвы Саша уехал в Сочи, где нашел работу, первое время получал таблетки из Кирова, потом без больших трудностей и без местной прописки встал на учет в Сочи. Даже СПИД-центр Московской области ставит на учет пациентов из других регионов, нужна лишь временная регистрация. По словам главного врача подмосковного центра Александра Пронина, его подчиненные объясняют пациентам, что регистрация нужна настоящая, но возможности проверить аутентичность бумаг у врачей нет, так что лечиться здесь может практически каждый.

Историю кировчанина Александра можно сравнить с другим ВИЧ-положительным россиянином Максимом, который инфицировался в России, но уехал учиться в Германию (ситуация, невозможная в России даже гипотетически, иностранцы для получения долгосрочных виз сдают тест на ВИЧ, инфицированные подлежат депортации). В Германии по медицинской страховке, оплаченной университетом, Максим прошел все обследования: анализы крови, мочи, анализ емкости легких, исследование брюшной полости, анализы на переносимость препаратов, а также анализы, которые вообще не делаются в России – на ингибиторы интегразы и протеазы, то есть исследования самих инфицированных ВИЧ-клеток и вирусных ДНК. Все это при показателях в 700 клеток, когда в России лечения не назначают, и все бесплатно, стоимость назначенного курса – €1100 в месяц – покрывается страховкой.

По словам Натальи Ладной, новые бюджетные ассигнования при удачном стечении обстоятельств постепенно, не за один год, могут привести к 60% охвату терапией – цифра, близкая к американским и европейским показателям, но все же далекая от целей ВОЗ на 2020 год: 90-90-90, то есть 90% из ВИЧ-инфицированных по всему миру должны знать о своем диагнозе, 90% из них должны получать антиретровирусную терапию и у 90% вирус в крови не должен определяться. Но вот если доступность терапии зависит от государства, узнать свой диагноз может каждый, причем в России – совершенно бесплатно. Все мы – в группе риска, нужно просто сдать анализы.