"We do not like in Africa - we have worse"

On World AIDS Day, one of the leading HIV experts Denis Godlevsky answered the questions of TD.

- Since 2013, I have been working in the AIDS Assistance Fund. We have three main areas of work. The first is an express testing program. That is, using fast tests that give out the result within 15 minutes and which can be used in essence in any “field” conditions, this testing is as close as possible to people. The main objective of such testing is not just the identification of those who did not know about their status, but bringing them to state medical institutions for the final diagnosis, registration and further treatment. The second-we support medical institutions in the framework of our “clinical” program-we provide training, purchase of some drugs, medical devices for which they lack the budget, some additional services that are necessary for people living with HIV, but there are no budgetary institutions, because for this or another there are no resources-then we do this.

And the third direction is, in fact, PR, as an attempt to change the situation at the system level, a change in the attitude to the problems of HIV, to testing, to people living with HIV.

- Recently, they started talking about the HIV epidemic in Russia, and in July, Yunads recognized Russia with the center of the world epidemic of HIV.

- In fact, we have long have an epidemic. Materials periodically appear: "An epidemic of HIV-infection has broken out in Russia." No, you noticed that it is. And she flared up for a long time. There is no epidemic in the sense that it is not necessary to introduce a state of emergency, close the boundaries ...

Denis Godlevsky at the scientific and practical conference "Modern aspects of the prevention, diagnosis and treatment of HIV infection" Photo: Valery Zaitsev/Schschi for TD

What is an “epidemic” in relation to HIV? The WHO shares “concentrated”-that is, when individual groups of the population are most affected, for example, people who use drugs, and “generalized”-this is when more than 1% of the population in the country or region is diagnosed with HIV infection. How do we calculate this percentage? This is testing pregnant women. That is, when in the country, the region or a large subregion, 1% of pregnant women visiting antenatal female consultations are detected, an HIV infection is detected, this is a generalized epidemic.

-We, in my opinion, have about 20 regions of these?

-Yes, we often distinguish 10 of the most affected regions and about 20, according to WHO estimates and the UN, where in the population of pregnant women, sorry for the word “population”, more than 1% of HIV-infected are detected. And then local statistical games begin - “My statistics are just a fact, and your facts are just statistics”, and here they begin to twist, twirl, from what to count. If it is beneficial for someone to “reduce” the incidence, then we recount, if we need to “increase”, we recalculate differently. Everything with statistics is very bad for us, because it is often twisted as this or that leadership should. But the epidemic we have a lot of where - for a long time.

“But this is not a pandemic yet?”

- Here we do not have a pandemic yet. This is an epidemic that is uncontrolled in nature, covers continents, continents. This is actually, according to the recommendations of the UN for the use of terminology in the field of HIV, not even the right term, it is recommended not to use it. They said that there is a pandemic in South Africa, for example, where 19% of the population live with HIV infection, but even there they take control of the epidemic.

Sorry, in Zimbabwe, as it turned out, the situation is better than in our own number of systemic aspects

But what I want to say: in July, a large international conference on HIV infection was held in South Africa. And having returned from there, I can say: we have the situation with HIV not as in Africa - we have worse. Because they have 19% of the population are infected with HIV infection, but in any medical institution there are condoms, the government provides three million people with antiretroviral therapy. More than 800 thousand people live with HIV in total, according to the reports of the Ministry of Health, 220 thousand receive treatment, and colleagues from NGOs consider purchases and see that they purchased a maximum of 180 thousand annual courses. And how they could “stretch” this treatment for 220 thousand people, I still can’t understand, and many colleagues too.

As for attention, which the government is not declarative, but de facto-both budgetary and programmatically devotes this problem, sorry, in Zimbabwe, as it turned out, the situation is better than in our own number of systemic aspects ... I have long known about South Africa. In fact, South Africa is doing better with HIV today than all other countries of the world. But they have this problem number one health care in general.

-Is there any decrease?

- Yes, the pace of the epidemic is very reduced for them. Including due to the coverage of ARV-therapy, which is also prevention at the same time. Over 10 years, the number of people in ARV therapy has increased from 300 thousand to three million. For the same time, we have gone from 12 thousand to 200 thousand.

Let's get back to Russia. According to official figures, one of the most "clean" cities is Moscow ...

In fact, what is happening in Moscow? In Moscow, very few people are tested from risk groups. There are several organizations that really work. But their resources cannot be enough for a huge metropolis. This is a drop in the sea. Where they are looking for a lot and strongly - there is it. An example is Yekaterinburg. They really identify. And in Moscow they are not looking for, they bury statistics. Therefore, "there is no epidemic."

- What is happening in this regard in St. Petersburg?

- There are quite a lot of different programs in St. Petersburg. We have a quick test program. We also have why high numbers on HIV infection-we really test. And not only with us - in all cities with high indicators, testing is carried out. Work is carried out to popularize testing, quick testing in general among all. Promotions are held with trips to shopping centers, to factories, somewhere else. But most importantly, in parallel there are programs for testing in risk groups, routes among drug users are established.

We spend money mainly once a year - December 1, on World AIDS Day and to run balls into the air

We have low -powered prevention programs, including right on the basis of the St. Petersburg AIDS center. The head doctor recently changed there, an absolutely brilliant person Denis Aleksandrovich Gusev came. On the part of NPOs, in the city, social activists began to support it very actively, and we really hope that the experience of the St. Petersburg center will spread wider, including other regions, including in terms of working with people who use drugs.

- But now we use exclusively repressive and prohibitive methods ...

- With regard to one of the main risk groups - drug users, power departments in our majority occupy a very definite position - zero tolerance. There is no acceptance of the fact that addiction is a disease. Proven. Science. Why am I talking about this, because people who use drugs have been and still remain one of the most affected by the Epidemic of HIV groups. And if we want to take control of the epidemic, we must work with this group, relying on a scientific approach. And in matters of treatment of dependence, and in issues of prevention, and not promote responding methods.

And you also need to rely on common sense. For example, take a young man, student, if he has a choice - buy a bottle of wine and spend time with a girl behind a bottle of wine without a condom or spending time with a girl without a bottle of wine, but with a condom, which, in principle, are equal in cost, he will buy a bottle of wine.

We talked about drug consumers, did not talk about men who have sex with men. Actually, it is clear that in connection with the generally homophobic position of a number of departments, we have any prevention program for men who practice sex with men is not supported by the public expense.

Denis Godlevsky photo: Valery Zaitsev/Schschi for TD

We have no preventive work at the federal level. What I mean. Prevention should not be a “action” or “campaign”. This should be system work every day on all fronts - school, SUS, universities, all media channels, separate programs for risk groups, youth and so on. Every day. Systematic. In the meantime, everything is very fun with prevention. Public organizations are now a very large direction-procurement monitoring in the field of HIV infection, both drugs and preventive programs. And there are descriptive reports that show that our money is spent mainly once a year - December 1, on World AIDS's struggle and to launch balls into the air. That is, in our mass, money is transformed into balls that fly into the air. Here is such a prevention.

In everything I am talking about, there are bright examples, but in general the vector is still very sad

I will make an important disclaimer-in everything I am talking about, there are bright examples, there are AIDS centers, local health departments, officials at the local, at the federal level, parliamentarians who really do what they can and in their power. But in general, the vector is still very sad.

-What are the prospects for the treatment of HIV infection?

- With the HIV vaccine, such a story. There are two directions that often confuse. There is a so -called therapeutic vaccine that “injected and cured”, the whole HIV evaporated from everywhere, and the person became healthy. This is one branch. The second branch is a preventive vaccine, what we all get in childhood to become immune to the virus so that immunity immediately torn it. These branches of developments in the media are often confused, including in connection with a frequent incorrect translation. This is important. But - today nowhere in the world there are no promising developments for any one or another vaccine. Just not. Bye.

- That is, the story that in the Malaysian “Boeing” the AIDS vaccine allegedly died ...

- This is a complete garbage, because, yes, our colleagues flew there at an international HIV conference in Australia. Lang flew there, the guys from WHO flew there, the guys from several funds flew there. But they just flew this flight. There were no samples of the vaccine there, there was nothing there. This is more about the media.

-In the Russian media, they also often write that we are about to have a vaccine ...

- We regularly have the Minister of Health allows himself in the media to say that in Russia in two years there will appear a vaccine from HIV ... That's just all, no comments. We have two laboratories in St. Petersburg and in Novosibirsk. There is a “vector”, a half-willed, old, remaining from the Soviet era, which receives a billion, in my opinion, in the year to develop HIV vaccines, and in St. Petersburg there is a laboratory of Dr. Kozlov, whom all at least any authoritative scientists and doctors are already open, in my opinion, will soon begin to call a charlatan. He constantly appears in the media and says: "We are cut out by financing to develop a vaccine from HIV." They have no horseradish there, they test these vaccines there, transfer the same and the same 25 times, receive money for this. This is an absolutely hopeless direction. This is not Denis Godlevsky says. This is said by scientists, doctors who saw these "achievements." And I quote them in this case.

-How, in your opinion, will the situation with HIV in Russia develop? Is it possible to count on a change in the attitude of the authorities to this problem?

- There are positive shifts, despite everything said above. But, unfortunately, the problem is that measures of response of the Ministry of Health and other departments today are late. Moreover, they are late for several years compared to the speed of the epidemic. It is necessary to play ahead of lead, ensuring a sharp expansion of coverage of therapy, commitment, innovative approaches in prevention, use modern technologies, marketing. But the bureaucratic machine unfolds slowly. If now, due to political will, putting science and common sense at the forefront, and not cheap populism, accelerate retaliatory measures, spread the most widely used, including the country, the best practices, then the problem can be taken under control in the foreseeable time.