Russia is home to the fastest-growing HIV epidemic in the world, with an estimated 1 in 100 Russians living with HIV. Russia's epidemic is unique as it is largely driven by injecting drug use, although it is now spreading into the general population. An estimated eight in 10 people living with HIV became infected through sharing needles. Injecting drug users are one of the most marginalised groups in our society.
I know, from being a former addict myself, that when caught in the cycle of drug addiction, people do not care about contracting HIV. I remember very well that there could be 10 people in a room and they would all share the same needle. Even if they did have money to buy clean syringes, they didn't because they were too lazy. So that's how a lot of people became infected.
That's why successfully treating drug addiction is critical to tackling the spread of HIV. But here in Russia, drug addiction is treated as a crime, not a disease.
The biggest challenge I see is the huge intolerance, stigma and discrimination against people with HIV. Things are slowly improving, as awareness of the drug problem and HIV is higher than five years ago. But from my experience from the rehab centres, ex-addicts living with HIV face huge stigma and discrimination – from society at large, as well as from much of the public health system. Sometimes it even comes from their own family. In most cases this is simply because of ignorance. So most people living with HIV feel they have no option but to lead a double life, hiding their status.
It is very hard for me to know if Russia will achieve MDG6, as the picture in the whole of the country is hard to see from here. But from my experience I see that access to treatment and awareness of HIV has improved since 2005. We refer patients to regional Aids centres where they can access testing, counselling and treatment. But in comparison with our European neighbours or the US, it is very poor.
Funding is a significant issue, particularly for non-government work and non-commercial operations, as they seek to stem the spread of HIV among the most vulnerable groups. A sad reality is that funding for palliative care, such as hospices, is increasingly necessary. Russia needs more training and better expertise in preventing the spread of HIV, particularly among drug users.