- Russia's epidemic has attained significant proportions and is now spreading beyond marginalized risk groups to threaten youth and women. At the same time, weak epidemiological data confound an effective policy response.
- An integrated approach to HIV/AIDS will not be easy to achieve but is essential to the success of expanded future programs.
- The costs and popular pressures borne of HIV/AIDS will intensify.
- There is reason for hope in Russia—provided its leadership mobilizes in time.
- The upcoming G-8 summit, hosted by Russia in 2006, provides a pivotal opportunity for enhanced dialogue and collaboration on HIV/AIDS.
- Russia offers a surprising array of promising potential partners outside government.
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.
Co-published by the Brookings Institution and the Center on Strategic and International Studies
J. Stephen Morrison
Celeste A. Wallander
Task Force Executive Director
J. Stephen Morrison