Official says Russia 'not ready' for tough HIV steps

Gennady Onishchenko said regulations are not strong enough to allow measures such as methadone replacement therapy for heroin addicts to work properly.

Health advocates say such therapy is vital to Russia because of the particular way HIV has spread through the country.

Up to 80 percent of Russia's 1.6 million HIV-positive people became infected through dirty needles, according to various estimates. The World Health Organization, the United Nations and United States, among others, have published studies showing that injecting drug users who switch to clinic-supplied methadone are up to five times less likely to contract HIV.

Nevertheless, Onishchenko said he was "not convinced" about the effectiveness of the so-called substitution therapy, which is illegal under current legislation.

Even if it were effective, Onishchenko said, weak law enforcement would mean the clinics would "turn into shops for drugs." He spoke at a news briefing at the conclusion of a conference in Moscow on AIDS.

Craig McClure, executive director of the International AIDS Society, said scientific evidence about the effectiveness of substitution therapy is overwhelming.

Substitution therapy, he said, "could have a dramatic impact if implemented properly."

Michel Kazatchkine, the director of the Global Fund to Fight AIDS, said substitute therapy is serious and Russia should not handle the issue as it does regular politics.

"You have countries that are moving in the right direction...and others that do not move. Russia is like an isolated island," Kazatchkine said. "Where intravenous drug use drives over 60 percent of the epidemic, you cannot afford not to have a comprehensive approach."

Compounding the problem, activists said, Onishchenko's sentiments on substitution therapy reflect the attitudes of the government and the population as a whole. Kazatchkine said few voices in the national legislature and the dominant political party support such initiatives and the Moscow government is overly conservative in its approach toward AIDS issues.

"There is a basic lack of political support," he said.

Onishchenko said uninformed Russians have little patience for drug users, preferring to ostracize them rather than address their needs.

Still, most activists and officials agrees there has been progress in Russia, highlighted by a general slowing in the number of new cases registered annually.

McClure said the myths about AIDS are gradually being erased from the public's consciousness, with TV ads that try to convince people that they can't catch HIV from washing the dishes or, say, holding hands.

Russia has pledged at least 9.3 billion rubles (US$392 million (euro254 million) to fight AIDS in 2009, more than 20 times the amount spent in 2005. The money will go to equipment for diagnosis and treatment, and education campaigns.

"The money is enough; the question is whether the money is spent on the right things," Kazatchkine said.

Russia's heroin problems stem from the country's location as a trafficking route connecting opium-producing Afghanistan with Europe.