Eight thousand infected

Reporting Eugene Berg from Orsk - a city with the highest HIV level in Russia

On January 25, the Russian government refused to allocate an additional 17.5 billion rubles a year for the fight against HIV. Without this money, by 2020, the authorities will be able to provide therapy with only half of the infected residents of Russia, and voluntary testing for HIV will be able to pass annually no more than a quarter of the population. In Russia, more than a million HIV-infected people have been registered. In some cities, the share of HIV-positive population exceeds 3%. The highest level of HIV incidence in Russia is in the city of Orenburg region: 3.5% of the population live here with this diagnosis, that is, more than 8 thousand people. The Medusa correspondent Yevgeny Berg went to Orsk to figure out what happened and local officials and activists are trying to cope with this.

Centr.Speed

In the new building of the Center for the prevention and combating of AIDS on the outskirts of Orsk, only one window is glazed. The building began to be built in 2008, but after a year financing ended-only concrete walls of the first floor managed to build. Local patients with HIV go to the reception in a nearby two-story house, built, like all the buildings around, back in the 1930s for workers' local nickel factory.

Residents of the working area are used to the neighborhood with the institution. The facades of houses are written graffiti "Centr.Speed". “Why be afraid of them? - The saleswoman in a grocery store is surprised at the question. "They carry us blood here, in your opinion?"

3.5% of the city’s residents with a population of 240 thousand people are infected with HIV (according to the report of Rospotrebnadzor of the Orenburg region for 2015). According to the Federal AIDS Center, the Orenburg region ranks fifth in Russia in the spread of the disease (in the first place Irkutsk region, then Sverdlovsk). Of all the relatively large cities of the country, Orsk will be affected by the disease most of all; This is a kind of HIV-old Russian.

Despite the difficult situation, the local preventive center is constantly experiencing difficulties in work - both its employees and local public activists are talking about this. The head of the Autonomous Non-Profit Organization of Alternative (since 2005 has been fighting HIV in Orsk), Rostislav Lamert says that the difficulties with antiretroviral therapy ( ARVT; it does not allow HIV to develop in AIDS-approx. Medusa ) already at the stage of testing the productivity of treatment.

“I could not make a viral load test for a year. There are no consumables, they didn’t buy, ”Lamert explains the situation by his own example: he lives with HIV and does not hide it. The head of the Alternative recalls that in 2014 the center could not even hold HIV tests to everyone; The local publication Ural56.ru then wrote that federal financing was not received in Orsk. The center also has difficulty with personnel: according to Lamert, doctors do not withstand a huge load and go to work in other institutions, “calmer”.

The Deputy Head of the Center, Veniamin Khudyakov, described the problem: “Instead of eight infectious disease doctors who should work with so many cases, only one works, instead of four epidemiologists-one, there are no narrow specialists.”

A resident of Orsk Elena ( the name was changed at her request - approx. Medusa ) found out about her diagnosis when she was pregnant and got to the hospital for preservation. “I was registered, issued therapy only before childbirth,” she says. “After childbirth, they gave the therapy for the baby.”

Despite the diagnosis, Elena herself does not receive free therapy by law: she has too good tests. She “would like to have an uncertain viral load”, but “this is impossible without constant therapy.” Viral load uncertainable by the test is an almost zero level of particles of the virus in the human blood; The risk of health deterioration due to HIV infection is minimal.

Other problems with therapy relate to the selection of a suitable treatment regimen. According to Rostislav Lamert, after the federal center began to be responsible for the purchases of the ARV, many people living with HIV lost the opportunity to select therapy and have to suffer heavy side effects from those drugs that are in the field. “They buy what is beneficial to them. And then what will be thrown here, then you drink. Here I have the esophagus constantly hurts from the drug, ”Lamt explains.

He complains about the procedures and bureaucracy and the head of the Orsk Center Alexander Vorotnikov. “We are fighting, only our struggle is not enough,” he says. - Previously, we were independent, now - a branch [of the Orenburg Regional Clinical Infectious Diapsychic Hospital]. While we were filled with papers: give it, give it, monitoring, screening, state register. And there are no steps. " Vorotnikov talked on the phone with Medusa, and refused to meet without permission from Orenburg: “I will tell you this, and then I will get it myself and get it.”

They talk about the problems in the Center for AIDS prevention in Novotroitsk - an industrial single -industry -farm near Orsk, built around a metallurgical plant launched in 1955.

“It is almost impossible to sign up for a doctor. I need to get up at five in the morning to take the line in the registry, and it is not the fact that there are still enough coupons for me. And if you sign up, it’s not a fact that they will accept it, ”says Irina ( the name changed at her request - approx. Medusa ), living with HIV, explaining that all the inhabitants of the city are faced with such problems.

Irina says that she was “not a drug addict, did not sleep with anyone”, but became infected, most likely, from her ex-husband, who at some point “began to walk well”. “When I found out, I left the hospital, sat on a curb and began to roar. A few months after that it just died, there was a depressive state, broke into the children. We do not provide any psychological assistance, they simply confront the fact, ”says Irina. “I remember, I asked the infectious disease specialist how much they live with HIV at all, she grinned:“ Well, since 2000 there are still alive ”.”

According to the Orsk Center for Prevention and AIDS, half of cases of HIV infection in 2011-2015 fell on socially adapted residents - workers (36%) and employees (12%). The most vulnerable age group is from 31 years to 50 years.

“The mentality is like that,” the interlocutor of “Medusa” in the government of the Orenburg region, asking him to not be called not to call his name. “Residents of Orsk and Guy ( a city with a population of 35 thousand people; Gai district of the Orenburg region leads in the region in terms of incidence growth - approx. Medusa ) do not go for rehabilitation.”

Without an alternative

“They started talking about HIV and AIDS in Orsk in 2005, when they showed me on television,” says Lamt. Then he worked in a public organization engaged in the prevention of infection - and in order to anonymously talk about one of the upcoming events, he contacted the local television channel.

“They suggested showing me on the air, but [darken] so that no one would know. As a result, everyone recognized me. The voice was not changed, removed from the side, and not from behind. At that time, my children still studied at school ... I was in shock, ”recalls Lamert. After revealing his status, he "sent everyone to FIG, registered the organization and began to hammer everyone."

According to him, thanks to Alternative, by 2010, mutual assistance groups worked in several cities of the region, including in Orsk and in the neighboring district center of Novotroitsk - the latter heads the regional rating for the number of new cases of infection.

“They rented an apartment, repaired, brought office equipment,” Lamert recalls how Alternative opened an office for a mutual assistance group in Novotroitsk. According to him, for a long time the effective work of his project was facilitated by financing of international funds. “Several years ago, we trained all medical and social workers of the city [the basics of prevention and fight against HIV]. They were taken out for three days out of town for seminars, there it is beautiful, river, bathhouse! In two years, all the city institutions have gone through this, ”says the activist.

The most serious support was provided by the Global Foundation for AIDS, Tuberculosis and Malaria (he worked in ten regions of the country). After in 2012, Russia tightened a policy in relation to NPOs with foreign financing, it was decided to refuse its help. Other sponsors began to leave; Lamert says that “alternative” does not conduct such large -scale programs as before.

It became more complicated even after the health care reform - the city health department was closed, and the medical institutions of the region began to directly obey the regional Ministry of Health. According to Lamert, now there is no HIV prevention programs in Orsk.

"Fornication is not good"

The Deputy Mayor of Orsk for domestic politics, Sergei Dunaev, says that in fact the city administration practically cannot affect the situation. Sitting in the Armenian cuisine restaurant (“They begin to work after dinner, but they will let us in”), he smokes a cigarette behind a cigarette and carefully listens to the questions of the Medusa correspondent; Some of them sits next to the subordinate Dunaev in a diary.

“In fact, everything that the administration can be engaged in propaganda of prevention [HIV],” he says. “Of course, I believe that one of its components is the propaganda of traditional values.”

Dunaev begins to talk about gays (“I treat them evenly if they do not complain that they are oppressed”) and about free sexual ties (“fornication is not good from the point of view of fundamental values”). When asked about the distribution of free condoms (81% of the new HIV infections in Orsk are sexually carried out) Dunaev says that "there are different opinions on this subject."

- It turns out that we force a person to put on a condom. Here, friend, you are an elastic band in the form of indulgence - and come on, left and right. So what? - asks the official.

- Maybe if a person is about to have sex, contraception will help more than family values?

- It should go in the complex. In the end, our task is to build a full -fledged society without all this fornication. Of course, maybe I was stuck in the last century ... But, by the way, we are distributing condoms from us, I somehow saw in the youth committee. Still surprised.

- Maybe you give free syringes from you?

“Lord, why?” - the deputy mayor of Orsk is perplexed.

Before saying goodbye, Dunaev shows a banner's layout with a local hockey player on a smartphone calling to pass the HIV test. According to him, the administration does not have their own advertising squares - you will have to "negotiate with the local business: an administrative resource and so on." The secretary of Dunaev promises answers to questions to send by mail.

On January 31, Medusa really received a letter from the Orsk administration. In particular, it is reported that the HIV and AIDS in the city “annually held a round table with the participation of representatives of the youth environment”, “training sessions for students of osuzes and universities on the topics” are held: “prevention of extremism”, “marriage is important”, “how to get involved with parents”, and in honor of the World Contraception Day on one of the city areas in residents "The brochures were heard."

"Residents began to look for what to do with themselves"

According to the interlocutor of the Medusa in the regional government, the current level of defeat of the HIV population in the east of the region is a consequence of the general drug addiction of 15 years ago: "Those who have not died then remained sources of infection now."

The editor-in-chief of the Orsk Internet publication "Ural56.ru" Anna Vandysh recalls: at the turn of the 1990s and 2000s there was a really catastrophic situation with drugs in the city.

“My courtyard in the city center was simply strewn with syringes. I remember these drug addicts, it was very scary. They bred heroin and pricked, not leaving the place. There was [on the outskirts of Orsk] the village of Pervomaisky, in which the gypsies lived, they traded drugs absolutely openly, even in schools they sold children, ”recalls Vandysh. She says that the high level of HIV in Orsk is the consequences of drug trafficking from nearby Kazakhstan. Other Medusa interlocutors share its point of view.

“Piglets, where the drugs were sold, were right in the city center,” says Rostislav Lamt. - As the pigeons gather around the grandmother, who feeds them, as well as drug addicts on the “heels” gathered. ” He says that due to drugs in the city "two generations died out."

According to a senior employee in the regional government, who asked not to indicate his name, in the first half of the 1990s in Orenburg, only single cases of HIV infection were recorded-a sharp jump occurred in 1997. It turned out that new patients were revealed among drug addicts, who entered the hospitals in a short period of time due to an overdose.

“Then the dose was cheaper than a bottle of vodka. Workers live in Orsk, they are used to being busy. In the 1990s, enterprises were closed in the city, residents began to look for what to do with themselves, ”says the interlocutor of Medusa.

In 2015, the Minister of Health of the region Tamara Semvelichenko recalled the situation in Orsk at the turn of the decade: “In the [local] cemetery there are a number with the graves of adolescents who are not 18 years old, and they are one -on -one dates. I remember when the mothers of children with AIDS went to Orenburg in a crowd, saying "save our children, they are poisoned."

In the Orsk AIDS-Center, it was noted that the peak years in terms of incidence were 2000-2002, when up to 1,500 new cases were recorded (in 2015, according to the regional Rospotrebnadzor, 462 cases).

After 2002, the situation with drugs began to change. One of the former residents of Pervomaisky says that not only law enforcement agencies, but also the local population made his efforts to this: “They occupied a whole street in the Pervomaisky gypsy. They came to the drunks [living there]: “Dear, love, let's give you you”. Then the papers were formed, and the house became a gypsy, and the drunk-to friends or somewhere in the river. Thirty houses took this way. Naturally, this street has become a trading center for the sale of drugs. Dissatisfaction in the village has been accumulating for a long time. The catalyst was that the gypsies offended the younger brother of one of the children's children. Young guys went to understand - I was then a teenager, I watched all this. They raised all the gypsies out into the street and burned them at home to the damn mother. The riot police who arrived in the next morning, cleaned the village - they checked everyone without exception for a residence permit, whether you live here or not. A month later, you could calmly walk around the village even at night. Everything is still culturally and civilized there. ”

"We just did not be silent"

The director of the Orenburg non -profit organization New Life (it has been involved in HIV in the region for 14 years) Elena Shastina says that social activists with state institutions working with the same problems are difficult relations. “When we carry out preventive measures, we ask you to help with the organization or send a specialist, the center, like the Ministry of Health, always respond,” explains Shastina. - But as soon as we begin to touch on questions for which they can be asked from them - for example, how many people receive ARVT - all, they close from contact. And I want us to be strategic partners! "

According to Shastina, the regional Ministry of Health “shares statistics”, underestimating indicators. Indeed, different departments here are given by very contradictory information. Alexander Vorotnikov, head of the AIDS prevention center in Orsk in November 2016, stated that 4491 people with HIV status live in the city, while, according to the regional Rospotrebnadzor, at the end of 2015 there were at least eight thousand.

“Take any provincial city in Russia - there is the same situation as here,” says an activist from Orsk Lamt. - We just did not become silent, so officials had no choice but to talk about the situation. And what is actually happening in the regions where the official defeat is lower, you can only guess. ”

Representatives of the regional Ministry of Health refuse to comment on the situation with HIV in Orsk. Sergey Mikhailov, Deputy Chief physician of the Orenburg Clinical Infectious Destoteurs Hospocation Hospital, refused to talk with Medusa. Galina Zebzeeva, deputy chief physician for epidemiological issues in the same hospital, agreed to an interview on the phone, but at a personal meeting she said: “The head doctor just came and banned all the contacts with the press.”

Assistant at the Minister of Health of the Orenburg Region Tamara Semizhevelychenko said that her boss was on sick leave. Заместитель министра по организации лечебно-профилактической помощи населению Юлия Балтенко несколько дней не отвечала на рабочий телефон. Сотрудница пресс-службы ведомства Наталья Чепургина сначала попросила прислать «темы разговора, чтобы спикер мог подготовиться», но на следующий день отказалась пропускать корреспондента «Медузы» в здание регионального Минздрава, заявив, что ведомство ответит письменно. На вопрос, почему невозможна очная беседа, она ответила: «Сейчас так решено».

В письме корреспонденту «Медузы» заместитель министра здравоохранения региона Галина Зольникова сообщила, что «в области достигнуто улучшение эпидситуации по ВИЧ-инфекции». Ответов на заданные корреспондентом «Медузы» вопросы документ не содержал.

В пресс-службе губернатора Оренбургской области Юрия Берга сообщили, что график руководителя региональной администрации не позволяет прокомментировать ситуацию с ВИЧ: «Это обычный рабочий вопрос».

Evgeny Berg

Орск — Оренбург