Responding to AIDS in Russia

1
Responding to AIDS in Russia
2
Increased political commitment

• The problem we are looking at today is global in
• nature and concerns not only Russia but the
  entire
• world. We are talking about measures to combat
  the
• spread of HIV infection.
• President Vladimir Putin
• Kreml, 21 April 2006

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Epidemiological trends
4
Epidemiological trends
Officially Registered HIV Cases in the Russian
Federation. 1987 Dec. 2006 (based on data from
the Russian Federal AIDS Centre)
New HIV cases in 2006 29,000 Total number of
HIV cases as of 14.12.06 364,000
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Epidemiological trends

• 364,000 cases of HIV infection registered in the
  Russian Federation.
• UNAIDS/WHO 860,000 (840,000 1,400,000)
• 80 of all people living with HIV under 30
• Injecting drug use remains main mode of
  transmission
• Heterosexual transmission increasing, as is
  number of HIV positive women and children born to
  HIV-positive mothers.
• Out of 15,400 people living with HIV currently in
  need of ARV therapy, fewer than 38 receive
  treatment.

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Russian Harm reduction Network
Source UNAIDS in the Russian Federation 2005
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Prevention

• Coverage of prevention activities limited,
  unlikely to impact epidemic.
• Comprehensive response targeting young people
  engaging in drug injecting and high-risk sexual
  behaviour lacking.
• Limited harm reduction programmes due to legal
  and financial constraints.
• No substitution treatment for drug dependent
  patients due to legal-political constraints.
• Despite recent increases, national allocations
  for prevention remain insufficient.
• Health, life skills and sexual education lacking.

8
Treatment

• More than 50,000 people, including approximately
  5,000 pregnant women, require ARV treatment
• Approximately 2,500 people receive combined ARV
  treatment (Onischenko said in his interview on
  29 Dec. 15,000 PLHIV receive treatment)
• ARV treatment costs remain high
• In 2005, 7,000 - 8,000 per patient a year
• ARV treatment prices expected to go down to
  1,600 in 2006

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Treatment Challenges

• National treatment targets and ART scale-up plans
  and normative protocols require updating to
  ensure consistency with WHO/UNAIDS guidelines
  (Global Fund and World Bank requirements).
• Insufficient national management capacity and
  experience among health care and non-health
  service providers.
• Limited harm reduction programmes due to legal
  and financial constraints.
• No substitution treatment for drug dependent
  patients due to legal-political constraints.

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National Consultation on Universal Access to
Prevention, Treatment, Care and Support

• Identified key obstacles and defined elements of
  a roadmap with
• milestones and key actions.
• Main obstacles
• Absence of strong single national authority, to
  subsume current plethora of coordinating entities
  above the level of the Ministry of Health
• Lack of one national action framework, aligning
  all sectors beyond the health sector scope of
  current planning of the Federal programme .
• Lack of one national monitoring and evaluation
  system.
• Lack of well-developed and explicit judicial
  basis (and implementation tools)
• Insufficient human resources capacity within
  health sector
• Weak inter-agency coordination
• Legal obstacles for substitution therapy

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National Consultation on Universal Access to
Prevention, Treatment, Care and Support

• Recommended key actions
• Improved procurement system for drugs and
  diagnostic tests, including development of
  strategy for reducing prices.
• Improved coordination of response with a leading
  role for the Ministry of Health.
• Development of one national plan for phased
  provision of, as close as possible, universal
  access to HIV prevention, treatment, care and
  support by 2010, including data on financing and
  coverage of interventions/services.
• Provision of increased funding for prevention
  programmes among general population with focus on
  young people and populations at higher risk of
  infection.

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Financing of Russias Response to AIDS

• Total budget for 2006 and 2007 including
  contribution from the federal level and regions
  is 10,7bn roubles (US400m).
• Despite significant increase of federal budget
  allocations to AIDS, funds remain insufficient
  for solid and comprehensive response.
• Major technical capacity gaps need to be
  addressed.
• International cooperation and support will remain
  critical for the foreseeable future.

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International Support to AIDS Response in Russia

• World Bank loan with 50 million HIV/AIDS
  component within Tuberculosis and AIDS Control
  project.
• Global Fund
• Round 3 89 million to Globus Project
  implemented by a consortium of 5 NGOs. Project
  covers 10 regions awareness raising, prevention,
  treatment, care and support and advocacy.
  Duration 5 years (agreement was signed in
  2004)
• Round 4 120 million. Project implemented with
  Government support (capacity building, policy
  development, training systems and testing
  services, strategies for ARV price reduction.
  Duration 5 years (agreement signed in 2005)

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International Support to AIDS Response in Russia

• DfID and Sida 2 million for 2-year initiative
  Coordination in Action. Executed by UNAIDS
  Secretariat and six Cosponsors (policy
  development, technical support and capacity
  building)
• UNAIDS and Cosponsors 13.5 million in 2005.
• U.S. Government 10 million for various projects
  across Russia through USAID.
• Russia designated PEPFAR country in 2006
• 5.2 million provided to UNDP, UNODC, WHO and
  UNAIDS Secretariat as expansion of Coordination
  in Action initiative
• Building on decisions taken by State Council, and
  efforts towards universal access to prevention,
  treatment, care and support.

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State Council Meeting on AIDS Moscow 21 April
2006

• Actions defined
• Development of long-term strategy for combating
  epidemic and overcoming its consequences.
• Federal programme 2007-2010, under development,
  to focus on prevention and treatment.
• Establishment of national monitoring system that
  meets international standards, including
  comprehensive data base.
• Establishment of National Commission on AIDS to
  ensure coordination.
• Review of relevant legislation.

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State Council Meeting on AIDS

• Expanded information/awareness campaigns
• Prevention activities targeting vulnerable
  populations
• Development of common strategy for prevention
• Engagement and involvement of civil society and
  business sector
• AIDS on the G8 agenda St. Petersburg

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2006 Milestones

• Regional consultation on universal access in
  Moscow
• Presentation of consultation outcome for Member
  States at the UN
• State Council Presidium Meeting on AIDS
• Meeting of G8 Health Ministers in Moscow
• First Eastern European and Central Asian AIDS
  Conference
• Russia participation in General Assembly High
  Level Meeting in New York
• Parliamentarian Conference in Moscow
• G8 Summit St. Petersburg

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UNAIDS Priorities

• Follow-up to State Council decisions
• Technical support to development of National
  Commission
• Technical support to development of new Federal
  Programme (on-going)
• Universal Access/Three Ones
• Key areas
• Policy/normative documents prevention/treatment
• Monitoring and Evaluation
• Human resources development
• Support to civil society/PLWH networks

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UNAIDS Joint UN Team on AIDS

• Enhancement of UN capacity at country level
• Establishment of Joint Team on AIDS
• Division of labour UNAIDS
• Technical Support Facility
• Universal Access Roadmap
• Strategic collaboration with key bilateral
  donors DfID, Sida, USAID, EC
• Donor coordination