25.04.2005 N 16
Russian version: http://www.gsen.ru/doc/postan/ps_16_2005.html
Chief State sanitation physician of Russian Federation, G,G. Onishenko, upon analysis of epidemic situation with HIV infection in the country and effectiveness of measures to control it found the existing serious defects in organization, implementation of preventive and anti-epidemic measures hamper attempt to combat the epidemics.
In Russian Federation presently 313 thousand HV cases are registered, 80% of them are among 15-30 years old, 1268 persons died from AIDS. HIV morbidity increased from 121 per 100'000 population in 2001 to 218.3 per 100'000 in 2004, among 15-40 years old it is 327.7 per 100'000.
Heads of local governments in Russian federation pay little attention to questions of countermeasures to spread of HIV infection. As a result situation with epidemics continue to worsen. The most unfavorable situation is presently in Irkutsk, Kaliningrad, Moscow, Leningrad, Orenburg, Samara, Sverdlovsk, Tuymen and Uljanovsk regions, city of St.Petersburg and Hanty-mansiisk autonomous district, where prevalence is 2-3.5 times higher than Russia average.
Poorly organized and not sufficiently effective preventive work and work on combating illicit drug use lead to the fact that in majority of regions of Russian Federation 72% of HIV infected were infected as a result of intravenous drug use.
There was also significant rise in the number of people infected by sexual route, their proportion rose from 6% in 2001 up to 25-27% in 2004. The activities directed to HIV prevention among injecting drug users and commercial sex workers are not sufficient in volume and there is no coordination and collaboration between government, NGO and other organizations working in this area as well as health care organizations and health care administration.
The harm reduction programs and other modern methods of HIV prevention among vulnerable groups are very slowly implemented. Until now there is no legal acts from Federal Narcotics Committee, regulating implementation of such programs.
Absence of goal-directed policy on working with youth, is leading to the fact, that HIV prevention efforts among youth are organized without considering real epidemic situation, and without consideration of negative social tendencies that are evident in this group. Majority of projects directed to preventing spread of HIV/AIDS among youth are implemented with money, provided by foreign organizations and there is no coordination between preventive and counter-epidemic measures, there is virtually no evaluation of its effectiveness.
Due to lack of attention from Ministry of Education and Science to the HIV infection problem, the special educational programs for counteracting IDU and HIV-infection spread in schools and universities are slowly implemented.
Many mass media, especially stated-owned TV-channels underestimate danger of IDU and HIV spread among youth and refuse to air corresponding information materials.
Adopted earlier statements of Chief Sanitation Physician of Russian Federation about activization of work, directed to combating HIV-infection spread were not implemented, especially in parts on activities among youth and groups of individuals with high risk of HIV infection.
In last years the proportion of fertile women among HIV-infected has raised significantly, reaching in 2004 38% of all new HIV cases and in some regions of Russian Federation (Kaliningrad, Leningrad, Murmansk, Novgorod, etc.) has exceeded 50% which results from more often heterosexual spread of HIV. Number of HIV cases among pregnant women raised from 300 cases in 1999 to 3505 in 2004. Preventive work directed to case finding and treatment, especially among pregnant women in risk groups are not sufficient (Leningrad, Sverdlovsk and Saratov region).
The number off children born by HIV-infected mothers reached 13 thousands, from them 1000 became so-called refusals (mother refused to take child with her back home).
In some regions of Russian Federation (Republic of Tatarstan, Leningrad, Moscow and Sverdlovsk region) the questions of finding living place for "refusal" children born by HIV-infected mothers are not solved properly and they stay in health care institutions for prolonged period of time.
Still question of availability of antiretroviral treatment for HIV/AIDS is very important, especially prevention of vertical transmission of HIV from mother to baby, which shows that regional governments of Russian Federation are negligent towards legal requirements of free guaranteed treatment, diagnosis and prevention of HIV infection.
Many infectious hospitals (infectious diseases wards) unprepared to providing high-quality care of HIV/AIDS patients with concurrent diseases (tuberculosis, viral hepatitis, mycosis).
Due to insufficient work up to now there is no guidelines for care for HIV patients.
Unfavorable influence on epidemics exerted by increased number of HIV patients in prison system that has increased from 7.5 thousands in 1999 to 33 thousands in 2004, of them 10% are females.
Federal prison administration pays insufficient attention to prevention and treatment of HIV infection. For example, no one of 4500 HIV patients needed treatment gets it, of them 2500 have HIV and tuberculosis and receive treatment only for tuberculosis.
Budget of subproject "Anti-HIV/AIDS" of the Federal Goal-directed program "Prevention and treatment of socially important diseases (2002-2006)" allows no centralized purchase of antiretroviral drugs for free treatment according to the demands of existing legislation. The money from regional budgets are allocated only minimally. As a result, from 18-20 thousands of HIV patients demanding antiretroviral therapy only 1000 are receiving it.
The majority of modern antiretroviral drugs are not produced in Russian Federation.
There are serious mistakes in organization of diagnostic testing on HIV. For example, in some regions of Russian Federation in violation of the laws of Russian Federation rectors of Universities introduced obligatory HIV-testing for applicants. In the same time the number of unnecessary (illegal) tests decreased by 5 millions, but concomitantly number of tested from risk groups has decreased which may adversely affect epidemical situation in the country. More and more tests are performed on charge base.
The problem of prevention of HIV spread through tainted blood is not solved. In 2004 898 donors were found to be HIV infected and were removed from donors list. There is no effective means for selecting, educating and medical monitoring of blood donors. In 35 regions of Russia there is no quarantine system for the blood.
The unfavorable situation with HIV infection in Russian Federation demands additional measures to control epidemics spread.
To protect public health, increase effectiveness of measures against HIV/AIDS epidemics and according to the Article 51 of Federal Law from 30.03.1999 ¹ 52-FZ "On sanitation and epidemiological welfare of population" (Collection of Russian Federation Laws, 1999, ¹ 14 page 1650) and Federal Law from 30.03.1995 ¹ 38-FZ "On preventing spread in Russian Federation disease, caused by human immunodeficiency virus" (Collection of Russian Federation Laws 1995, ¹ 14 page 1212)
1. Recommend to executive powers of subjects of Russian Federation:
1.1. Discuss possibility of creating interagency councils on controlling HIV/AIDS to coordinate activities and increase collaboration between governmental structures, NGO and other institutions working in this area to rise effectiveness of organizational and preventive measures.
1.2. Correct programs of controlling HIV/AIDS in subjects of Russian Federation according to epidemic situation, paying more attention to organizing and implementing preventive programs among youths, IDU and commercial sex workers, provide financial support to NGO working in this field.
1.3. Provide in this year financial resources for purchasing HIV test kits and antiretroviral drugs for treatment HIV infected and antiviral prevention of vertical transmission from mother to the child.
1.4. Help health care administration of the regions of Russian Federation to improve material base and human resources of the AIDS prevention centers to improve their activity to combat spread of HIV infection.
1.5. Organize care for "refusal" children born by HIV-positive mothers, according to the laws of Russian Federation.
1.6. Provide participation of mass media in providing information to the population on personal and public measures to control HIV and IDU, realization of the Russian Federation laws in parts regarding preventing spread of socially important diseases.
2. Recommend to Ministry of Health and Welfare to introduce to State Council of Russian Federation question on creating Federal Commission on controlling HIV/AIDS in Russian Federation according to the recommendation of the 26 Special session of UN General Assembly on HIV/AIDS (resolution S-26/2 from 27.06.2001).
3. Recommend to Ministry of Economics and Ministry of Finance:
3.1 Provide, in addition to the budget of subprogram "Anti-HIV/AIDS" of the Federal goal-directed program "Prevention and control of socially important diseases (2002-2006)" in 2005 560 million rubles for free treatment of HIV-infected according to the laws of Russian Federation.
3.2. Increase in 2006 budget of subprogram "Anti-HIV/AIDS" to 812 million rubles for free treatment of HIV infected, taking into account rise in number of patients needed treatment.
4. Recommend to Ministry of Health and Welfare together with Federal Custom and Duties Service introduce to the Government of Russian Federation proposal to decrease custom duties and excise taxes on imported antiretroviral drugs used for HIV/AIDS treatment.
5. Recommend to Ministry of Education and Science, Ministry of Health and Welfare, Federal Narcotics Service, Ministry of Justice, Ministry of Culture, Ministry of Internal Affairs and Ministry of Defense develop a Concept of preventing HIV/AIDS in educational institutes.
6. Ministry of Education and Science and Ministry of Health and Welfare should implement special educational programs combating spread of IDU and prevention of HIV/AIDS among teenagers and young adults, health promotion in schools and other educational organization of secondary general and special education.
7. Recommend to Federal Narcotics Committee pass an instruction on practical implementation of modern technologies of preventing spread of HIV among vulnerable groups, especially "harm reduction" programs.
8. Recommend to Federal Narcotics Committee and Ministry of Internal Affairs should oblige institutions and organizations reporting to them help and support organizations and administration of health care realizing HIV preventive programs among IDU and commercial sex workers.
9. Ministry of Industry and Energy, Ministry of Economics and Ministry of Health and Welfare should start measure directed to development and production of antiretroviral drugs for HIV/AIDS in Russian Federation.
10. Recommend to heads of TV and radio to prepare and air special programs, video and audio materials aimed to prevention of IDU and HIV/AIDS in prime time.
11. Chief state sanitation physicians in Russian Federation subjects and heads of health care administration should:
11.1. Make analysis of implementation of the programs on preventing and controlling HIV/AIDS in subjects of Russian Federation, prepare proposals for executive branch of governments on correcting those programs due to changing situation with epidemics.
11.2. Provide coordination and widening collaboration between health care organizations, especially Centers on AIDS prevention and territorial administrations of Federal Service on Consumer Protection and Human welfare with the goal to increase effectiveness of organization and implementation of measures, aimed on controlling spread of HIIV/AIDS.
12. Health care administrations of the subjects of Russian Federation:
12.1. Implement practical measures for creating in infectious hospitals and large multispeciality hospitals conditions for qualified medical care for HIV/AIDS patients, having co-morbidities.
12.2. Complete introduction of the system of blood quarantine, provide blood donors selection, education and medical screening.
13. Chief state sanitation physicians of the subjects of Russian Federation:
13.1. Strengthen state sanitation-epidemiological control over HIV infection countermeasures.
13.2. Forbid HIV testing violating laws of Russian Federation.