Russia is reforming its national health-care service as part of an internationally-supported medical program to confront an unprecedented HIV/AIDS and TB epidemic, which is rapidly spreading across the former Soviet empire.
The World Bank is backing the country's first ever nationwide health program addressing TB and HIV/AIDS and other sexually transmitted diseases, to the tune of nearly US$250 million this year, while more cash is coming from regional governments, other donors and international development finance institutions including US$11.2 million raised by the European Bank for Reconstruction and Development.
The HIV rate in most countries of the former USSR from the Baltic to the Pacific has doubled every year for the last four years.
Data collected from 27 states in the region provide gloomy reading. In many countries including the Russian Federation, Ukraine, Estonia and Kazakhstan, HIV had been spreading mainly through intravenous drug use. Now, the disease is largely transmitted through heterosexual contact because many drug users have unprotected sex regularly with multiple partners.
One recent survey in the relatively prosperous town of Togliatti, on the banks of the Volga in western Russia, found that 56 percent of young drug users were HIV-positive. Most of them had acquired the infection during the last two years, although 75 percent were ignorant of their infection.
At least 450,000 Ukrainians are HIV-positive, one per cent of the population. Nearly 90 percent of them have caught the infection through drug use and most of these also have hepatitis B and C.
Key to the programme is the reorganization of the Russian family doctor service. In the past, the Soviet health care system was rooted in centralized specialist treatment and hospital care. The reorganization aims to create a cost-effective modern family-doctor service more responsive to the needs of the population.
But while emphasis is being placed on reforming the role of the family doctor, the major part played in the transmission of TB as well as HIV/AIDS by Russia's notoriously underfunded, over-crowded and often insanitary prison system is also being brought into focus.
Incidence of disease and death rates among inmates are often 10 times higher than in the general population and the success of the health-care reforms within prisons is seen as crucial to the entire Russian effort. Prison has come to function as a gruesome infection pump transmitting ill-health throughout the wider community, with prisoners regularly released at the end of their sentences without any medical follow-up or treatment. But one hurdle, at least, has been overcome with the recognition within the prison service that some of the most urgent reforms must involve improvements to the basic living and health-care conditions of prisoners.
The aim of Russia's health planners is to establish a modern, patient-oriented health service. The HIV/AIDS program will focus on prevention and education involving groups at most risk and aim to create capacity to treat HIV-positive patients and improve the laboratory service to ensure blood safety and the proper monitoring of antiviral drugs.
Waging the campaign against TB, organizers say the project will provide antibiotics and flexible health-care services to improve diagnosis and treatment and seek substantial improvements in surveillance, monitoring, quality control, case detection and management.
Jean De Stoine, World Bank task manager for the programme put the Russian crisis in context.
"The first HIV/AIDS cases in Eastern Europe were recorded in 1995," he said, "and today, the region is experiencing the fastest-growing HIV/Aids epidemic in the world and it is coinciding with the deadly resurgence of TB.
"The two epidemics have now formed a disastrously potent combination," he said.
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