support for HIV service organizations will help defeat AIDS by 2030

AIDS can be eradicated worldwide by 2030 if the necessary funding is provided to communities fighting the disease in every country. Experts from the Joint United Nations Program on HIV/AIDS (UNAIDS) came to this conclusion. Russian activists agree that it is necessary to help HIV service organizations, but the fight against HIV is a medical problem, and its solution depends on the availability of medicines and medical care.

According to the Joint United Nations Program on HIV/AIDS (UNAIDS), every minute a person dies due to AIDS, every week 4,000 girls and young women become infected with HIV, and of the 39 million people living with the disease, 9.2 million people do not have access to the necessary treatment. On the eve of World AIDS Day (December 1), the organization published a report on its website, “Leadership to Communities!”, which claims that AIDS can be eradicated by 2030 if governments and donors provide the necessary funds to communities working “on the front lines.” lines of fight against HIV”. According to the organization, NGO campaigns have helped open up access to generic HIV treatments, leading to a sharp reduction in the cost of antiretroviral therapy from $25,000 per person per year in 1995 to $70 in many countries most affected by the epidemic.

“Community-based programs in Nigeria have been estimated by the World Bank to have increased access to HIV treatment by 64%, doubled the likelihood of using HIV prevention interventions, and quadrupled condom use among people at risk of HIV infection. In Tanzania, HIV incidence among sex workers who received a peer support package was more than half (5%) lower than among sex workers who did not participate in the program (10.4%),” the document clarifies.

Co-chairman of the interregional organization “Together against Hepatitis” (some patients with hepatitis are infected with HIV) Nikita Kovalenko notes: AIDS is the final stage of HIV infection, which results from lack of treatment or incorrectly selected therapy; and HIV is actually the disease itself, with which, if you have the right therapy, you can live “happily ever after.” “If all HIV-positive people are provided with the correct antiretroviral therapy, then the disease will simply not progress to the AIDS stage and no one will die from AIDS. Therefore, in my opinion, the UNAIDS declaration is quite realistic,” comments Mr. Kovalenko.

Activist of the movement of people living with HIV and other socially significant diseases, “Patient Control” Yulia Vereshchagina, says that the ideal picture of victory over HIV looks like this: the entire population has been tested, all identified infected people are provided with therapy, and it is effective. This is the essence of the “90–90–90” strategy adopted by UN member states, including Russia. Initially, she assumed that by 2020, 90% of people with HIV in our country would know about their status, 90% of them would receive treatment, and in 90% of the latter, the viral load would decrease and be undetectable. However, the targets were not achieved by the deadline, and the Ministry of Health postponed achieving the main goals of the HIV strategy until 2030.

Yulia Vereshchagina points out that in Russia there are still no accurate statistics on the number of people infected with HIV. Rospotrebnadzor and the Ministry of Health differ in their estimates by several hundred thousand people, since the first agency counts those who passed positive tests, and the second – those who registered at the dispensary. Thus, from Rospotrebnadzor data for 2022 it follows that there were 1,168,076 Russians living in the country with a laboratory-confirmed diagnosis of HIV infection. There were 835,154 patients registered at the dispensary (according to the Ministry of Health of the Russian Federation – 850 thousand), that is, 69.5% of the number of Russians living with diagnosed HIV infection. 711,412 patients received antiretroviral therapy in 2022 (including 61,279 patients in prison). Treatment coverage was 85.2% of those undergoing dispensary observation and 59.2% of those living with a diagnosis of HIV infection.

Yulia Vereshchagina says that in 2022, the therapy coverage rate became the highest over a five-year period, but this was achieved only thanks to funds from the 2023 budget: the Ministry of Health of Russia (FKU FCPiLO Ministry of Health of the Russian Federation) carried out additional purchases using funds from the budget allocated for ARVs. drugs for 2023, in the amount of 8.5 billion rubles. At the same time, the amount provided for the purchase of ARV drugs for the treatment of HIV (together with the purchase of drugs for tuberculosis and hepatitis B and C) within the framework of Resolution No. 1512 for 2023–2025 was not increased and amounts to 31.7 billion rubles annually. In 2023, the amount of contracts of the Russian Ministry of Health for ARV drugs amounted to 24 billion rubles. These funds are completely insufficient to cover the shortage of ARV drugs in many regions, notes Ms. Vereshchagina. Since the beginning of 2023, Patient Control has received more than 500 reports of shortages of ARV drugs and forced replacement of HIV treatment regimens without medical indications from 56 regions, including new ones, 17 FSIN institutions and three FMBA institutions. In 2022, there were 210 such messages. “How can we talk about victory over HIV? — Mrs. Vereshchagina asks. “In our memory, the most disruptive year was 2017, when Russia switched from regional to federal procurement. Then everything began to level out, but last year it died down. As a result, we have more complaints about outages this year than we did in what we thought was a terrible 2017.”

Yulia Vereshchagina considers government support for communities that are at the forefront of the fight against HIV to be truly important. According to her, only volunteers and activists will be able to reach key groups, that is, potential patients. At the same time, right now the situation for HIV service organizations, in her opinion, is difficult. “The participation of NGOs in HIV prevention is provided for by the state strategy to combat the spread of HIV infection. At the same time, the funds allocated by the state are not enough, and funding from foreign sources is limited by laws on foreign agents. But no organization can survive solely on donations from citizens,” explains Yulia Vereshchagina. According to Nikita Kovalenko, it is not entirely correct to make the problem of HIV/AIDS dependent on the funding of NGOs: “This is still a medical problem. And its solution primarily depends on medical issues: the provision of medicines and medical care in general.”

Earlier, the chief freelance specialist on HIV infection, Alexei Mazus, told Kommersant that experts are recording a confident trend towards an annual decrease in the number of new patients – for example, in 2021 there were 59 thousand new cases, which is 2% lower than in 2020. In addition, he recalled, Russia maintains its leading position in the world in HIV testing coverage – in 2021 this figure was more than 28%. Mr. Mazus turned to data from “long-term representative studies” that show that high motivation for HIV testing, as well as a generally high level of knowledge about the infection, was the result of “large-scale educational campaigns to which Russian health care pays significant attention.” “Today, every eleventh person with HIV infection in the country does not know about their diagnosis. In Europe we are talking about every eighth patient! – says Alexey Mazus. “Such a situation, which allows us to talk about a hidden epidemic of HIV infection in the European region, is of concern to the professional community and is on the priority panel of issues of the high-level working group of the Russian Ministry of Health and WHO on HIV infection.”

Natalia Kostarnova