Russia offers a surprising array of promising potential partners outside
government.Introduction
Russia remains a fluid, acutely complex and mixed environment in which to
address the growing threat posed by HIV/AIDS. The epidemic has reached serious
proportions: credible estimates are that 1 million or more Russians, or just over 1
percent of the adult population, are infected with HIV, concentrated among injection
drug users (IDUs), commercial sex workers (CSWs), and to a less well
understood degree, men who have sex with men (MSM). It could become a far
larger, more generalized epidemic that threatens Russia's youth, women, and others.
Already, the costs borne of HIV/AIDS in Russia are intensifying demographic,
economic, and security concerns.
Stigma and denial about HIV/AIDS and its threats to Russia's future complicate
the task of preventing its spread. Political leadership at the highest levels is essential
to craft an effective response, but so far that leadership has been largely absent.
These stark realities notwithstanding, there is reason for hope in Russia.
At several levels of government there are promising signs of recent movement.
The institutional, financial, and human capacities to respond, in both government
and Russian society, are considerable. The current size of Russia's epidemic is manageable,
at least for now, and Russia's public health system, if appropriately
mobilized and resourced, is clearly capable of curbing future increases in HIV
infection. The prospective flow of resources from the World Bank, the Global Fund
to Fight AIDS, TB and Malaria (Global Fund), and multilateral as well as bilateral
organizations and donors is stirring the possibility of a new, promising phase of
innovative policy and expanded action by government and nongovernment organizations
alike. So too, Russia's hosting of the G-8 summit in 2006 creates an
important moment of opportunity to engage with Russia on strengthening both
the global response to HIV/AIDS and the specific needs of Russia.
To effectively control the threat posed by HIV/AIDS, the Russian leadership will
need to elevate HIV/AIDS, explicitly, as a national priority. This will be most successfully
done through the creation of a dynamic national HIV/AIDS strategy
anchored within a broader mobilization to upgrade Russia's deteriorating public
health systems, including, as an immediate priority, strengthening its disease surveillance
system to focus more effectively on high-risk groups. Furthermore, a
national strategy should support the enlargement of the role of nongovernmental
organizations (NGOs), which have been at the very center of the progress achieved
thus far in Russia. Improved coordination is also imperative along with the establishment
of an appropriate authority to guide an expanded response.
There is an important partner role that international organizations, the U.S.
government, and other governments can and should play in encouraging the
advance of an HIV/AIDS agenda in Russia. The Global Fund has emerged as a key
player, in the major awards it is making both to the government and NGO sectors in
Russia.
While in St. Petersburg, the delegation heard from both the city's mayor and the
rector of St. Petersburg State University of the strong desire for expanded collaboration
with external partners on HIV/AIDS, as part of the lead up to the 2006 G-8
summit and beyond. The U.S. government and other U.S.-based organizations
should pursue this promising opportunity and perhaps other similar opportunities
elsewhere in Russia. As these initiatives take shape, the United States should systematically
encourage the additional involvement of international organizations, other
G-8 member states, and nongovernmental partners.
More generally, the United States should maintain HIV/AIDS as a diplomatic
priority and further enlarge its engagement with Russia on HIV/AIDS. There are
numerous opportunities to develop strong collaborations: help upgrade the quality
of HIV/AIDS and HIV-TB surveillance and data management; provide support to
strengthen Russian NGOs, especially in the area of prevention; increase the training
of doctors, nurses, and community workers in treatment, care, and prevention;
expand collaboration in scientific research, including in the development of vaccines
and microbicides; and create new collaborations between Russian and
American faith-based groups, businesses, and media.
A joint delegation of the Brookings Institution and the Center for Strategic and
International Studies (CSIS) visited Moscow and St. Petersburg in February 2005 as
part of the CSIS Task Force on HIV/AIDS, a project mandated to strengthen U.S.
leadership in battling the HIV/AIDS pandemic. The CSIS Task Force, funded by the
Bill and Melinda Gates Foundation and cochaired by Senators Bill Frist (R-Tenn.)
and Russell Feingold (D-Wis.), has since 2003 given high priority to fielding expert
missions to populous, major states at risk of a generalized epidemic: China, India,
Nigeria, Ethiopia, and Russia. Lisa Carty and Helene Gayle, of the Bill and Melinda
Gates Foundation, each provided integral guidance for these missions.
The principal goal of the February mission to Russia was to gain an understanding
of the country's current HIV/AIDS situation; learn about official and private
efforts in prevention, treatment, and care; and provide practical recommendations
to policymakers in Congress and the Bush administration, along with interested
policy experts, for increased U.S.-Russian cooperation to control the disease both in
Russia and globally. Specifically, the mission was charged with examining whether
there are concrete, emergent openings for expanded U.S. engagement with Russia,
with special reference to the Russia-hosted G-8 summit in 2006. The mission's findings
and recommendations speak to these priority concerns and are not intended to
be comprehensive in scope.
Brookings president Strobe Talbott and CSIS president John Hamre co-led the
delegation. Other participants included Celeste Wallander and J. Stephen Morrison,
CSIS; Judyth Twigg, Virginia Commonwealth University; Allen Moore, CSIS
and the Global Health Council; Brooke Shearer, International Partnership for
Microbicides; Phillip Nieburg, CSIS; and Sarah Mendelson, CSIS.
The group met with Russian national and local officials, persons living with
HIV/AIDS, U.S. officials, representatives of UN agencies active in the area of HIV/
AIDS in Russia, representatives of Russian and international NGOs, Russian media,
university officials, scholars, and experts. In the planning and implementation of
the trip, the delegation benefited from the advice of many individuals and organizations.
Of special note are the U.S. Embassy in Moscow, under Ambassador
Alexander Vershbow's leadership; UNAIDS/Moscow, led by Bertil Lindblad; AIDS
Foundation East-West, led by Rian van de Braak; and Humanitarian Action, led by
Sasha Tsekanovich. All of them made exceptional contributions to the success of the
mission's visit.
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