Russia and Germany have many differences. But one of them is amazing: the annual increase in the number of HIV-infected people. Last year, this figure in Russia exceeded 100,000 people. A similar figure in Germany is only about 3.2 thousand, that is, 30 times less, said on Tuesday, October 17, at a conference held under the motto "Invisible epidemic", a member of the board of the organization Deutsche AIDS Hilfe Sylvia Urban (Sylvia Urban) . And this despite the fact that only one and a half times fewer people live in Germany than in Russia.
The key role of civil society
"Catastrophe". This is how Urban describes the avalanche-like spread of HIV in Russia, which has taken on the character of an epidemic. According to her, prevention does not work, and funds for the fight against HIV and AIDS are reduced. And this despite the fact that worldwide the number of new HIV-infected people has decreased by a third since 2000, and the death rate among HIV-infected people by half. Everywhere except Eastern Europe. A conference organized in Berlin by three German non-governmental organizations - Deutsche AIDS Hilfe, Brot für die Welt and Aktionsbündnis gegen AIDS - was dedicated to this monstrous situation in the region. Speaking of Eastern Europe, the organizers and participants of the conference meant three countries - Russia, Ukraine and Belarus.
As Sylvia Urban says, improved prevention measures, testing programs and access to therapy for those infected are bearing fruit around the world, which, in turn, dramatically reduces the risk of transmission of the virus. In Eastern Europe (above all, in Russia), everything is different: “risk groups” are subjected to persecution and discrimination, the topic of sexuality in general and homosexuality in particular is hushed up, and international funding for HIV programs is being reduced. On the plus side, government agencies are increasingly persecuting non-governmental organizations that receive donations from abroad.
According to Urban, the German experience in the fight against HIV shows that non-governmental organizations play a key role in prevention. "The huge success of HIV prevention in Germany shows how effective the interaction of the state with civil society structures can be," Urban said.
"There's a lot to learn"
Russia can only dream of such interaction today. Vadim Pokrovsky, head of the Federal AIDS Center, is extremely careful in his expressions. "Recently," he says, "the religiosity of the population has intensified in Russia, which sometimes takes on very conservative forms that do not correspond to the modern development of society."
According to him, homophobia, "bad attitudes" towards those who use drugs, as well as the unclear legal status of those who engage in prostitution, mean that Russia cannot implement even half of the HIV prevention measures that are recognized as scientifically effective and are used all over the world. "We have a lot to learn from Germany," Pokrovsky said, referring to Russia's meager number of new HIV infections in a country of more than 80 million people.
Drug use remains the main mode of HIV transmission in Russia, Pokrovsky said. But since heterosexual men predominantly use drugs, their partners are at risk. It is "very easy" for a woman in her 25s and 30s to meet an infected man, he said. Pokrovsky estimates that about 3-4 percent of Russian men aged 30-40 are infected with HIV. Like every fifth drug user and every tenth gay in Russia.
"An Epidemic of Hatred of Sexuality"
According to Luis Loures, Deputy Director General of UNAIDS, in Eastern Europe there is not just an HIV epidemic, but an epidemic of discrimination, hatred of sexuality and xenophobia. And the front of this epidemic passes through Eastern Europe. "AIDS spreads fastest where people are discriminated against," explains Lourdes. "The situation in Eastern Europe today is worse than in Africa!"
According to him, the countries of the region lose billions of dollars a year due to homophobia, and discrimination only reduces the level of security in these states. And if the region does not find the resources today to stop the rapid spread of HIV, the cost of fighting the virus in the future will only be higher.
Silvia Urban from Deutsche AIDS Hilfe echoes him: "Money is not everything. Openness and the fight against discrimination are very important." Detabooization of the topic of sex in the public mind plays a huge role: "Sex should bring joy, good sex is a factor in the quality of life." Therefore, it is necessary to talk about sex from the school bench and not in a negative way, Urban points out.
Context
"Toxic environment" for HIV prevention
Raminta Stuikyute, lead adviser to the UN Special Envoy for HIV in Eastern Europe, describes the environment in Russia as "toxic" for effective HIV prevention. According to her, Russia does not use world experience, scientific achievements and recommendations of the World Health Organization (WHO) - everything that has been tested in practice and works in many countries, including Germany. "Sooner or later, science must defeat ideology," Stuikyute nonetheless predicts.
But when will this happen and how? It is very important, Stuikyute continues, that Russia draws the maximum from the experience of other countries, including Germany: "For the exchange of experience in HIV prevention, dialogue is extremely important, and not self-isolation in matters of health and law enforcement practices."
Will the leadership of the Russian Federation heed the calls of the international experts and civil activists gathered in Berlin? According to one of the activists of the charitable foundation for HIV prevention who came from Moscow, in Russia today everything is decided by a single person. Therefore, the activist asked, "Could Angela Merkel talk to him about this?"
See also:
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10 stars who have contracted HIV
One of the first and most famous victims of HIV infection was the British singer of Parsi origin, songwriter, vocalist of the rock band Queen Freddie Mercury. He died in 1991 at the age of 45 in the prime of his life. Just a day before his death, he announced that he had AIDS.
10 stars who have contracted HIV
Rudolf Nureyev
The famous Soviet and British ballet dancer Rudolf Nureyev asked for political asylum in 1961 during a tour of the troupe of the Leningrad Opera and Ballet Theater in Paris. He lived in the West for a little over 30 years. Nuriev died of AIDS on January 6, 1993 at the age of 54. For many years, the dancer hid and denied rumors about his illness.
10 stars who have contracted HIV
The Swedish musician is known not only in his homeland, but also in Europe. He founded the pop group Alcazar, and for a long time was its main soloist. In 2007, he publicly admitted that he was HIV positive. Lundstedt's open statement was met with great approval by representatives of the world of politics and show business.
10 stars who have contracted HIV
Another musician who came out as HIV-positive was Erasure band member Andy Bell. The Englishman made the corresponding public statement in 2004, although the diagnosis was made 6 years before coming out. It is known that the musician makes donations for education and research in the field of HIV infection.
10 stars who have contracted HIV
The American photographer and writer Mary Fisher, who openly declared her status, has been a Goodwill Ambassador for the United Nations Program on HIV and AIDS (UNAIDS) since 2006. She leads her own foundation dedicated to research and education in the field.
10 stars who have contracted HIV
Irvin "Magic" Johnson
There are many HIV-infected people among successful athletes. Irvin "Magic" Johnson is one of the most famous basketball players in NBA history. With his confession, he turned people's ideas that only drug addicts and homosexuals can get HIV. The former basketball player is engaged in educational and charitable activities for the same HIV-infected people as he is.
10 stars who have contracted HIV
The former heavyweight boxer who starred in Rocky 5 alongside Sylvester Stallone died on September 1, 2013 at the age of 44, allegedly from AIDS. The athlete contracted HIV almost 20 years ago, but for a long time did not want to believe it, refusing therapy.
10 stars who have contracted HIV
American Greg Louganis is one of the best divers, a four-time Olympic winner and a five-time world champion. He learned about his status in 1988, but continued to participate in big sport, winning two more Olympic gold medals. However, Louganis found the strength to openly admit that he was HIV-positive only in 1995, when his autobiography was published.
10 stars who have contracted HIV
German singer Nadia Benayssa rose to fame as a member of the pop group No Angels. In 2010, Nadia left the group after receiving a two-year suspended sentence for infecting her sexual partner with HIV. The singer has a daughter who was born in October 1999. During pregnancy, Nadia was diagnosed with HIV. Today she leads a normal life and participates in projects to combat AIDS.
10 stars who have contracted HIV
American actor Charlie Sheen is known for numerous scandals in his personal and public life, including drug abuse. On November 17, 2015, Charlie Sheen admitted that he was infected with HIV. According to him, he was diagnosed about four years ago. The reason for the coming-out was the blackmail of one of the prostitutes, who demanded a huge amount of money for her silence.
Yulia Egorova on the rights of doctors and patients in the context of HIV
HIV infection has long ceased to be a rarity. According to the Federal AIDS Center (www.hivrussia.ru), as of December 31, 2013, 798,866 HIV-infected people were registered in Russia. The incidence was 479 people for every one hundred thousand of the population, that is, about one in two hundred is infected. In 2013, 77,896 new cases of infection were recorded among citizens of the Russian Federation.
And that's just the official statistics. The real numbers are much higher, so the doctor needs to be well aware of the laws governing the work with HIV-infected patients.
The main document that defines the legal status of HIV-infected people is Federal Law No. 38-FZ “On Preventing the Spread of Disease Caused by the Human Immunodeficiency Virus (HIV) in the Russian Federation”, adopted in 1995. This law regulates state guarantees for diagnosis and treatment, protection of the rights of HIV-infected people and financial support for preventive measures. Despite the solid age of the law, it complies with modern humanistic principles and differs slightly from European legislation on the same topic.Medical examination for HIV infection is carried out voluntarily and, at the request of the person being examined, may be anonymous.
Article 8 of Federal Law No. 38-FZ
Rights and obligations of HIV-infected citizens in Russia
HIV testing — voluntary
Only donors of blood, organs and tissues, as well as employees who are required to undergo preventive medical examinations, undergo mandatory HIV testing. In this case, the consequence of the detection of the virus, specified in the law, will only be a life-long suspension from donation. In other words, HIV infection is a “private matter” for everyone.
You should not force or oblige a patient to take an HIV test, even if you have suspicions. Can only recommend. But let's face it, compliance with this paragraph comes with a creak, especially when providing emergency assistance.
The fact is that in urgent situations, the “presumption of consent” often operates, that is, it is believed that patients who did not refuse the analysis agreed to take it. The requirement to be tested for HIV before elective surgery or hospitalization is also illegal. From a legal point of view, it is determined by orders of the Ministry of Health, that is, documents that must not violate federal law and the guarantees approved by it. If the patient is unwilling to take an analysis, this should be recorded in the documents, but it is unlawful to refuse hospitalization on the basis of the absence of this analysis.
A 1998 report by the Names Foundation on violations of the rights of HIV-infected people provides numerous examples of how health workers, employers and even government agencies force people to be tested for HIV. Much has been done since then to uphold the rights, but violations remain.
The rights of HIV+ to medical care are the same as everyone else
Article 14 of Federal Law No. 38-FZ states: “HIV-infected people are provided on a general basis with all types of medical care according to clinical indications, while they enjoy all the rights provided for by the legislation of the Russian Federation on the protection of public health.”
But the implementation of this article in practice is a serious problem. More than once I heard from paramedical personnel: “Put it wherever you want, they don’t pay me for it, I won’t do anything with the “vichuha”. Let him get treatment in the AIDS center.” At the same time, possible disciplinary sanctions seem to them less frightening than an infected patient, and persuasion simply does not work. But not to warn the staff about the presence of HIV in a patient with whom they will work in an operating room or treatment room - this, although maintaining a medical secret, is, in fact, deeply unethical.
A typical way of putting pressure on doctors and staff is threats of criminal liability under article 124 of the Criminal Code “Failure to provide medical care”. We remind you that liability under this article occurs only in case of causing harm to health by this inaction.
Despite humane and advanced legislation, the perception of HIV infection by society, including health workers, is at the level of the deep Middle Ages. It is possible that the administration of the clinic, having learned about the diagnosis, will try with all its might to get rid of the employee, fearing not so much cases of nosocomial infection, but problems with public opinion.
The right of an HIV-infected patient to privacy
Do doctors have the right to disclose an HIV diagnosis? Public opinion regarding HIV is still not humane enough and not quite civilized, so you should not expect that patients, having learned about such a diagnosis from a neighbor in line or in the ward, will be calm. In this case, the preservation of medical secrecy requires great attention and tact from the doctor, as well as explanatory work with the middle staff.
It happens that a nurse “accidentally” hints to patients about the diagnosis of a neighbor in the ward, so that they themselves “survive” the one with whom they don’t want to and it’s scary to contact. Nurses and staff should be clearly instructed that such an act is a criminal offence.
Physician's rights
HIV+ healthcare worker is not required to quit
If HIV infection is a private matter, then, for example, does an HIV-infected nurse in a treatment room have the right to continue working? Theoretically yes. Moreover, no one has the right to report the test results to work, this is a criminally punishable violation of medical secrecy. If the diagnosis became known to the management, then on the basis of the Law “On the Sanitary and Epidemiological Welfare of the Population” No. 52-FZ of March 30, 1999, the employee must be transferred to work that is not associated with the threat of the spread of HIV, or suspended from work with the payment of benefits for social insurance.
In this regard, it is reasonable to reduce the risk of infecting patients without waiting for administrative measures. A doctor can switch to a consultative appointment, expert work, a nurse can work in the registry, archives, and physiotherapy. Perhaps this is not the best option, but given that each newly diagnosed case of HIV infection is subject to an epidemiological investigation, it is wiser not to participate in invasive manipulations at all than to prove one's innocence in case of infection.
Nursing staff are eligible for benefits
What about "we don't get paid for this"? In fact, most of the time they don't get paid. Only employees of specialized medical institutions for HIV-infected people have the right to receive an allowance for harmful working conditions associated with the risk of HIV infection and insurance in the event of an occupational disease.
The issue of the right to a bonus in other health facilities is rather controversial, but according to the order of the Ministry of Health and Medical Industry No. 307/221, non-core health facilities are included in the list of organizations where work entitles them to receive a twenty percent bonus to their salary for diagnosing and treating HIV+ patients.
The problem is that the administration does not always know how to properly issue this allowance, and simply refuses extra paperwork, because it is “a penny anyway”. The money is really small, because it is calculated by the hour and based on salary. In addition, it will be possible to calculate these hours only in a hospital, but, for example, in the treatment room of a polyclinic, it is technically impossible.
Ethics first
When working with HIV+ patients, first of all, you need to remember that these are ordinary people who are in trouble and need your support, perhaps more than anyone else. They need not only help in the fight against the disease, but also protection from illiterate inhabitants who are ready to lock up HIV-infected people in concentration camps and reservations, just to protect themselves from infection.
The position of doctors in this case is difficult and ambivalent. It is necessary to fight the spread of the virus and at the same time support patients who are potential sources of infection. But no one except doctors in modern society will be able to competently draw the line between risky and acceptable actions in relation to HIV-infected people in order to ensure not only general safety and observance of legal rights, but also human relations.
The only regions in the world where the HIV epidemic continues to spread rapidly are Eastern Europe and Central Asia, according to a new UNAIDS report. Russia in these regions accounts for 80% of new HIV cases in 2015, the international organization notes. Another 15% of new diseases are in Belarus, Kazakhstan, Moldova, Tajikistan and Ukraine.
In terms of the spread of the epidemic, Russia has even surpassed the countries of South Africa, according to recent statistics on the incidence. Meanwhile, the Russian authorities not only do not increase funding for the purchase of medicines for patients, but, according to reports from the regions, they even increase the savings on this item.
Comparing the published UNAIDS statistics on new HIV cases in different countries with the number of patients already in these countries, Gazeta.Ru made sure that our country is the leader in terms of HIV spread not only in its region.
The share of new cases of HIV in 2015 in Russia is more than 11% of the total number of people living with HIV (95.5 thousand and 824 thousand, respectively, according to the Federal AIDS Center). In the vast majority of African countries, the number of new cases does not exceed 8%; in the largest countries of South America, this proportion in 2015 was about 5% of the total number of patients.
For example, in terms of the rate of growth of new cases in 2015, Russia overtakes African countries such as Zimbabwe, Mozambique, Tanzania, Kenya, Uganda, each of them has almost twice as many patients as in our country (1.4-1.5 million people ).
More new cases than in Russia now occur annually only in Nigeria - 250 thousand infections, but the total number of carriers there is a multiple of 3.5 million people, so the incidence rate is lower in the share ratio - about 7.1%.
HIV epidemic in the world
In 2015, there were 36.7 million people living with HIV worldwide. Of these, 17 million received antiretroviral therapy. The number of new infections was 2.1 million. Last year, 1.1 million people died from AIDS worldwide.
The number of new HIV infections in Eastern Europe and Central Asia has increased by 57% since 2010. Over the same period, the Caribbean saw a 9% increase in new cases, the Middle East and North Africa 4%, and Latin America 2%.
The decrease was noted in Eastern and Southern Africa (by 4%), as well as in the Asia-Pacific region (by 3%). In Europe, North America, West and Central Africa, there was a slight decrease.
In the largest countries of Latin America - Venezuela, Brazil, Mexico - the proportion of new HIV infections remained at the level of 5% of the number of carriers. For example, in Brazil, where the number of people living with HIV is about the same as in Russia (830,000), 44,000 people were infected in 2015.
In the United States, where there are one and a half times more HIV patients than in Russia, about 50 thousand people fall ill every year, according to the AVERT charity, which finances the fight against AIDS.
Russia can't cope on its own
UNAIDS experts see the main reason for the deterioration of the situation in the fact that Russia has lost international support for HIV programs and has not been able to replace it with adequate prevention at the expense of the budget.
In 2004-2013, the Global Fund remained the largest donor of HIV prevention in the region (Eastern Europe and Central Asia), but as a result of the classification of Russia as a high-income country, international support has gone, and domestic funding for HIV has not ensured adequate coverage of antiretroviral therapy (prevents the transition of HIV to AIDS and provides prevention of infection).
The amount of grants from the Global HIV Fund amounted to more than $200 million, the head of the Federal AIDS Center told Gazeta.Ru. “Many preventive and treatment programs were carried out with this money in the country. After the government returned this money to the Global Fund, it focused mainly on financing treatment, and there was no one to finance prevention programs, they stalled,” he complains.
Similar messages come from St. Petersburg, the Perm Territory and other regions. At the same time, the total amount of funds provided in the federal budget for 2015 and 2016 for the purchase of antiretroviral drugs is approximately the same - the amount remains at the level of about 21 billion rubles, part of the funds from it is directed to purchases for federal medical institutions.
In the budget of 2015, 17.485 billion rubles were allocated directly to the regions, in 2016 the amount slightly decreased and amounted to 17.441 billion rubles. Information about whether the funds were brought to the regions in full or somehow redistributed or frozen, the federal ministries keep secret. The Ministry of Finance and the Ministry of Health did not respond to the relevant requests from Gazeta.Ru.
According to the government report on the implementation of the anti-crisis plan, which Gazeta.Ru managed to get acquainted with, the money was transferred to the budgets of the regions in full, but they refused to confirm this information.
How the world is fighting HIV
Measures to combat HIV are generally the same all over the world: prevention includes informing the population, identifying the most vulnerable groups of citizens, distributing contraceptives and syringes, active measures are antiretroviral therapy that maintains the standard of living of those who are already sick and does not allow the patient to infect others. However, each country has its own regional peculiarities.
Governments in the United States primarily fund social campaigns against the taboo of AIDS. Also, with the help of social actions, Americans are called for regular testing, especially if a person belongs to one of the most vulnerable groups - black citizens, men who have had homosexual contacts, and others.
Another way to combat the spread of HIV and AIDS is sex education. In 2013, HIV was taught in 85% of American schools. In 1997, these programs were taught in 92% of American schools, but due to the resistance of religious groups of citizens, the enrollment rate has declined.
From 1996 to 2009, more than $1.5 billion was spent promoting abstinence as the only way to fight HIV in the United States. But since 2009, funding for "orthodox" methods has been declining, more funds have been allocated to bring comprehensive information.
However, according to the Kaiser Family Foundation, only 15 states so far mandate contraception when talking to schoolchildren about HIV prevention, despite the fact that, according to statistics, 47% of high school students have had a sexual experience. HIV education remains optional in 15 states, as is sex education, and in two more states only sex education is included in the program.
In China, according to 2013 data, 780 thousand people live with the immunodeficiency virus, of which more than a quarter receive antiretroviral therapy. The most vulnerable populations are gays and bisexuals, young Chinese under 24, drug addicts who inject themselves, and there is a high proportion of infections from mother to child. In the PRC, infection most often occurs through unprotected sex, so preventing sexual transmission of the virus accounts for the bulk of the effort. Among the measures are treatment for couples in which one of the partners is infected with HIV, distribution of free condoms, popularization of testing for the virus, informing children and adults about the disease.
A separate category of efforts is the fight against the illegal market for donated blood, which flourished after the ban in the 1980s on imported blood products. Entrepreneurial Chinese, according to Avert, were looking for plasma donors in rural areas, completely unconcerned about the safety of the procedure. Since 2010, China has begun testing all donated blood for HIV.
In India, the world's second largest country, 2.1 million people were living with HIV in 2015, one of the highest rates in the world. Of the patients, 36% received treatment.
Hindus distinguish four risk groups. These are sex workers, illegal immigrants, men who have had homosexual contacts, drug addicts and the hijra caste (one of the untouchable castes, which includes transgenders, bisexuals, hermaphrodites, castrates).
As in many other countries, the fight against HIV in India is carried out through reaching out to the most vulnerable populations, providing information, distributing condoms, syringes and needles, and methadone substitution therapy. The epidemic in the country is on the decline: in 2015, according to UNAIDS, fewer people were infected here than in Russia - 86 thousand people.
In Latin and Central America, 1.6 million people were living with HIV in 2014, 44% of whom received the necessary treatment. Among the measures taken by the countries of the region to combat the epidemic are social campaigns explaining what HIV is and why those who are sick cannot be discriminated against. Such actions were held, in particular, in Peru, Colombia, Brazil, and Mexico. Five countries—Argentina, Brazil, Mexico, Paraguay, and Uruguay—had needle and syringe programs, and substitution therapy was used in select cities in Colombia and Mexico. In some countries of the region, sick people receive cash benefits.
Australia, which has one of the lowest incidences in the world, has achieved this by implementing comprehensive prevention programs and by never stopping them. She also started the fight against HIV earlier than others, draws the attention of Pokrovsky from the AIDS Center. “For example, back in 1989, I got acquainted with the work of the Australian Prostitutes Collective, which was engaged in the prevention of HIV among sex workers. This and dozens of similar projects have been constantly funded by the government,” he emphasizes.
According to the report announced at the Fifth International Conference on HIV, held in March 2016 in Moscow, the following ranking of 10 countries was compiled by the number of people infected with AIDS. The incidence of AIDS in these countries is so high that it has the status of an epidemic.
AIDS Acquired immune deficiency syndrome secondary to HIV infection. It is the last stage of the disease of an HIV-infected person, accompanied by the development of infection, tumor manifestations, general weakness, and ultimately leads to death.
10th place. Zambia
1.2 million patients with 14 million population. Therefore, it is not surprising that the average life expectancy there is 38 years.
9th place. Russia
In 2016, the number of people infected with AIDS in Russia exceeded 1 million people according to Russian health care, 1.4 million according to the EECAAC-2016 report. Moreover, the number of infected in the last few years has been growing rapidly. For example: every 50th inhabitant of Yekaterinburg is HIV-positive.
In Russia, more than half of patients became infected through a needle while injecting a drug. This way of infection is not the main one for any country in the world. Why exactly in Russia such statistics? Many say it was driven by the move away from oral methadone as a substitute for injecting drugs.
Many mistakenly believe that the problem of infection of drug addicts is only their problem, it is not so scary if the "dregs of society" acquire diseases that lead to death. A person who uses drugs is not a monster that can be easily identified in a crowd. He leads a completely normal life for a long time. Therefore, spouses and children of drug addicts are often infected. There are cases when infection occurs in clinics, beauty salons after poor disinfection of instruments.
Until society realizes the real threat, until casual partners stop assessing the presence of STDs “by eye”, until the government changes its attitude towards drug addicts, we will rapidly rise in this rating.
8th place. Kenya
6.7% of the population of this former English colony are HIV carriers, namely 1.4 million people. Moreover, among women, the infection is higher, since in Kenya the social level of the female population is low. Perhaps the rather free manners of Kenyan women also play a role - they easily approach sex here.
7th place. Tanzania
Of the 49 million people in this African country, just over 5% (1.5 million) have AIDS. There are areas in which the infection rate exceeds 10%: this is Njobe, far from the tourist routes, and the capital of Tanzania, Dar es Salaam.
6th place. Uganda
The government of this country is making great efforts to combat the problem of HIV. For example, if in 2011 there were 28 thousand children born with HIV, then in 2015 - 3.4 thousand. The number of new infections in the adult population has also decreased by 50%. The 24-year-old king of Toro (one of the regions of Uganda) took control of the epidemic into his own hands and promised to stop the epidemic by 2030. There are one and a half million cases in this country.
5th place. Mozambique
More than 10% of the population (1.5 million people) are infected with HIV, and the country does not have its own forces to fight the disease. About 0.6 million children in this country are orphans due to the death of their parents from AIDS.
4th place. Zimbabwe
1.6 million infected per 13 million inhabitants. Such figures have led to widespread prostitution, lack of basic knowledge about contraception and general poverty.
3rd place. India
Official figures are about 2 million patients, unofficial ones are much higher. Traditional Indian society is quite closed, many people ignore health problems. Educational work with young people is practically not carried out, it is unethical to talk about condoms in schools. Hence the almost complete illiteracy in matters of protection, which distinguishes this country from the countries of Africa, where getting condoms is not a problem. According to surveys, 60% of Indian women have never heard of AIDS.
2nd place. Nigeria
3.4 million HIV patients per 146 million population, less than 5% of the population. The number of infected women is higher than men. Since there is no free medicine in the country, the most terrible situation is in the poor segments of the population.
1st place. South Africa
The country with the highest incidence of AIDS. Approximately 15% of the population is infected with the virus (6.3 million). About a quarter of high school girls already have HIV. Life expectancy is 45 years. Imagine a country where few people have grandparents. Scary? Although South Africa is recognized as the most economically developed country in Africa, most of the population lives below the poverty line. The government is doing a lot of work to stop the spread of AIDS, providing free condoms and testing. However, the poor are convinced that AIDS is a white invention, as are condoms, and therefore both should be avoided.
Bordering South Africa, Swaziland is a country of 1.2 million people, half of whom are HIV positive. The average resident of Swaziland does not live up to 37 years.
The problem of HIV in Russia and Eastern Europe has assumed epidemic proportions. How to stop it was discussed at a conference in Berlin.
Russia and Germany have many differences. But one of them is amazing: the annual increase in the number of HIV-infected people, writes.
Last year, this figure in Russia exceeded 100,000 people. A similar figure in Germany is only about 3.2 thousand, that is, 30 times less, said on Tuesday, October 17, at a conference held under the motto "Invisible epidemic", a member of the board of the organization Deutsche AIDS Hilfe Sylvia Urban (Sylvia Urban) . And this despite the fact that only one and a half times fewer people live in Germany than in Russia.
The key role of civil society
"Catastrophe". This is how Urban describes the avalanche-like spread of HIV in Russia, which has taken on the character of an epidemic. According to her, prevention does not work, and funds for the fight against HIV and AIDS are reduced. And this despite the fact that worldwide the number of new HIV-infected people has decreased by a third since 2000, and the death rate among HIV-infected people by half. Everywhere except Eastern Europe. A conference organized in Berlin by three German non-governmental organizations - Deutsche AIDS Hilfe, Brot für die Welt and Aktionsbündnis gegen AIDS - was dedicated to this monstrous situation in the region.
As Sylvia Urban says, improved prevention measures, testing programs and access to therapy for those infected are bearing fruit around the world, which, in turn, dramatically reduces the risk of transmission of the virus. In Eastern Europe (above all, in Russia), everything is different: “risk groups” are subjected to persecution and discrimination, the topic of sexuality in general and homosexuality in particular is hushed up, and international funding for HIV programs is being reduced. On the plus side, government agencies are increasingly persecuting non-governmental organizations that receive donations from abroad.
According to Urban, the German experience in the fight against HIV shows that non-governmental organizations play a key role in prevention. "The huge success of HIV prevention in Germany shows how effective the interaction of the state with civil society structures can be," Urban said.
"There's a lot to learn"
Russia can only dream of such interaction today. Vadim Pokrovsky, head of the Federal AIDS Center, is extremely careful in his expressions. "Recently," he says, "the religiosity of the population has intensified in Russia, which sometimes takes on very conservative forms that do not correspond to the modern development of society."
According to him, homophobia, "bad attitudes" towards those who use drugs, as well as the unclear legal status of those who engage in prostitution, mean that Russia cannot implement even half of the HIV prevention measures that are recognized as scientifically effective and are used all over the world. "We have a lot to learn from Germany," Pokrovsky said, referring to Russia's meager number of new HIV infections in a country of more than 80 million people.
Drug use remains the main mode of HIV transmission in Russia, Pokrovsky said. But since heterosexual men predominantly use drugs, their partners are at risk. It is "very easy" for a woman in her 25s and 30s to meet an infected man, he said. Pokrovsky estimates that about 3-4 percent of Russian men aged 30-40 are infected with HIV. Like every fifth drug user and every tenth gay in Russia.
"An Epidemic of Hatred of Sexuality"
According to Luis Loures, Deputy Director General of UNAIDS, in Eastern Europe there is not just an HIV epidemic, but an epidemic of discrimination, hatred of sexuality and xenophobia. And the front of this epidemic passes through Eastern Europe. "AIDS spreads fastest where people are discriminated against," explains Lourdes. "The situation in Eastern Europe today is worse than in Africa!"
According to him, the countries of the region lose billions of dollars a year due to homophobia, and discrimination only reduces the level of security in these states. And if the region does not find the resources today to stop the rapid spread of HIV, the cost of fighting the virus in the future will only be higher.
Silvia Urban from Deutsche AIDS Hilfe echoes him: "Money is not everything. Openness and the fight against discrimination are very important." Detabooization of the topic of sex in the public mind plays a huge role: "Sex should bring joy, good sex is a factor in the quality of life." Therefore, it is necessary to talk about sex from the school bench and not in a negative way, Urban points out.
"Toxic environment" for HIV prevention
Raminta Stuikyute, lead adviser to the UN Special Envoy for HIV in Eastern Europe, describes the environment in Russia as "toxic" for effective HIV prevention. According to her, Russia does not use world experience, scientific achievements and recommendations of the World Health Organization (WHO) - everything that has been tested in practice and works in many countries, including Germany. "Sooner or later, science must defeat ideology," Stuikyute nonetheless predicts.
But when will this happen and how? It is very important, Stuikyute continues, that Russia draws the maximum from the experience of other countries, including Germany: "For the exchange of experience in HIV prevention, dialogue is extremely important, and not self-isolation in matters of health and law enforcement practices."
Will the leadership of the Russian Federation heed the calls of the international experts and civil activists gathered in Berlin? According to one of the activists of the charitable foundation for HIV prevention who came from Moscow, in Russia today everything is decided by a single person. Therefore, the activist asked, "Could Angela Merkel talk to him about this?"
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