HIV/AIDS in the Countries of the Former Soviet Union: Societal and Attitudinal Challenges

Abstract

For several years, some of the countries of the former Soviet Union have experienced the fastest growing HIV epidemic in the world, with the vast majority of reported infections contracted through injecting drug use. However, most governments of the region have been slow to recognize the severity of the problem. The scope and coverage of governmental HIV/AIDS programmes have remained very limited. Harm reduction programmes are mainly financed by external donors, while substitution treatment remains illegal in Russia and unavailable in some other countries of the region. Being based on a review of published and grey literature, this paper explores attitudinal and societal barriers to scaling up HIV programmes in the countries of the former Soviet Union. A major challenge in many countries is negative public attitudes towards people living with HIV, as well as towards those most at risk of contracting the disease: injecting drug users, sex workers, and men who have sex with men. This extends to the actions of state authorities which often pursue a punitive approach to drug users, with high rates of incarceration for minor drug offences. While many of the findings reported here relate to the Russian Federation, there is reason to believe that similar challenges exist in many other countries of the former Soviet Union. More needs to be done to document challenges to HIV prevention and treatment programmes across the region, so that policy interventions can be more effective.

The Soviet legacy in diagnosis and treatment: Implications for population health

“…19 Narcology A major barrier to improving access to HIV prevention and treatment in this region is the punitive approach to users of intravenous drugs and to people living with HIV. 20,21 Existing services for drug users provide social control and enforcement, but do little to treat addiction. 22 The underlying conviction is that drug users are 'a criminal class that needs to be put under control, and if necessary, isolation'.…”

“…28,47 Social attitudes Negative social attitudes towards people suffering from tuberculosis and drug addiction also shape diagnosis and treatment as these attitudes are often shared by state authorities and health-care providers. 21 The labelling of these patients assumes an element of coercion and social control that fosters stigmatization by wider society. Often, patients are judged by health workers as to whether they are 'asocial'.…”

Contraception use and unplanned pregnancies among injection drug-using women in St Petersburg, Russia: Table 1

“…212428 This may lead to harassment by police or loss of basic privileges such as driving licenses, employment and parental rights. 242930 Although anonymous services are available, which implies that patients must not provide their names when seeking treatment, 26 these services require a fee. Because the Russian health care system often relies on informal fees 2326 for certain laboratory tests, medications or physician services, 2426 many health services are unavailable or of substandard quality for patients unable to provide out-of-pocket payments.…”

Gender Disparities in HIV Risk Behavior and Access to Health Care in St. Petersburg, Russia

“…19 In an effort to address this crisis, both preventative and harm reduction programs have been initiated. 20,21 These programs can be enhanced by improved knowledge pertaining to patient characteristics and barriers to care. Key findings from our evaluation include the presence of a heavy burden of concurrent infectious disease, substance use, mental health illness, and the need for social service support.…”