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Project: Stimulating an Effective National Response to HIV/AIDS in the Russian Federation (GLOBUS)

GF.2004.A
15/08/2004 - 01/12/2009 (ongoing project)

Project goals

The goal of the component is to is to stimulate an effective national response to HIV/AIDS in the Russian Federation and to spearhead such a response in ten selected regions. The criteria for selection of regions include a combination of factors including, among others, prevalence and incidence rates of HIV/AIDS, co-operative spirit among regional authorities, existing activities by governmental and non-governmental organisations and the level of significant international donor support. The programmes will improve the knowledge level of youth and the general population and address the needs of specific vulnerable groups including injecting drug users, sex workers, street children, men who have sex with men and prisoners. A treatment, care, health promotion and social support module will address the needs of people living with HIV/AIDS. The proposal also includes an advocacy module to improve the participation and effectiveness of government counterparts in HIV/AIDS policy.

Russia is a country that spans 11 time zones and includes 89 administrative regions. The NGO consortium will make a significant impact in ten of these regions, acting as leverage in the country as a whole.

The current HIV/AIDS epidemic in Russia, commonly believed to be at an early stage, will have a devastating effect not only on health, but also on social stability and on the economic development of the region. The relatively delayed arrival of HIV/AIDS in the Soviet Union in 1987, combined with its isolated political position in the world had led to a lack of basic HIV/ AIDS knowledge among its medical professionals, political decision makers and the general population at large.

Russia signed the 2001 UNGASS Declaration of Commitment on HIV/AIDS that calls for the 'development and implementation of multi-sectoral national strategies and financing plans for combating HIV/AIDS'. Russia also joined other CIS countries in a declaration by heads of states on the importance of fighting HIV/AIDS in May 2002.

The Ministry of Health enacted an ordinance on 9 September 2002 titled, 'Re: Intensified HIV control action in the Russian Federation'. This was the first high-level document to stress the need to focus efforts on injecting drug users (IDU), sex workers (SW) and prisoners. It also explicitly endorses harm reduction as an effective HIV prevention strategy. However, beyond limited efforts within government ministries, HIV/AIDS does not yet play a prominent role in national politics.

Efforts to address HIV/AIDS by the Russian Government have been patchy for several reasons. First, despite the steep increase, HIV/AIDS prevalence rates remain below 1% of the adult population, very low compared to the worst affected regions of sub-Saharan Africa, Asia and the Caribbean. Second, the epidemic is driven mainly by transmission among the high- risk core group of IDUs, a group shunned by society as a whole. Third, political advocacy has not been linked to the evidence base, with limited results from exhortations and rights-based advocacy. As such, it has been politically difficult to mobilise effective programmes on a large scale for a problem that is perceived to be confined to a group with limited political importance.

Mass screening for HIV was and still is considered one of the key interventions to fight the HIV/AIDS epidemic in the RF; officially an HIV test is performed on a voluntary basis, except for blood donors, prisoners, professionals exposed to HIV and foreigners. Yet, routine mandatory testing without pre- and post-HIV test counselling of people engaged in 'high-risk' behaviour, like injecting drug users, commercial sex workers, STI patients and pregnant women remains a routine exercise throughout Russia.

A comprehensive health and social infrastructure needed to adequately support people living with HIV/AIDS and their families and partners is not in place. The existing health system is over-expanded and severely under-funded. This has led to material shortages, lack of appropriate drugs and treatment possibilities and non-payment of salaries, all of which have hurt the capacity and morale of health care workers. The present number of health and social professionals experienced in HIV/AIDS prevention, treatment, care and support is extremely limited.
The Advisory Council to Fight HIV/AIDS has been established only recently and consists of 25 governmental and non-governmental organisational members. UN agencies are invited to participate as observers. The Advisory Council has a potential to become the country's CCM, but has not yet achieved that status, while the process and timeframe are still unclear.
Objectives:
The goal of this five-year proposal is to stimulate an effective national response to HIV/AIDS in the Russian Federation and to spearhead such a response in ten selected regions.
Objective 1: Supporting sustainable prevention programmes to increase awareness and reduce the transmission of HIV/AIDS among youth and the general population
Activities in Objective 1 focus on mass media campaigns, development of voluntary counselling and testing, health education in secondary schools and improvement of the Russian condom market.

Objective 2: Supporting sustainable prevention programmes to reduce the transmission of HIV/AIDS among vulnerable groups

Activities in Objective 2 support prevention efforts toward the groups most vulnerable to the HIV epidemic in Russia: injecting drug users (IDU), prisoners, sex workers, children born to mothers with HIV and men who have sex with men.

Objective 3: Providing treatment, care, health promotion and social support to people living with HIV/AIDS
Objective 3 will aim to promote the development of medical and counselling services, support to parents living with HIV after the birth of their children and solidarity with people with HIV/ AIDS. The implementing organisations will also take the first steps toward comprehensive ARV treatment of people living with HIV/AIDS with an MTCT-plus programme and ensuring that marginalised groups, such as IDUs, have equitable access to treatment.
Objective 4: Advocating improvement in the HIV/AIDS policy environment and building capacity to reduce the impact of HIV/AIDS on infected, affected and vulnerable people These activities will work to advocate improvements in national and regional HIV/AIDS policies to ensure an adequate national response to the epidemic, including legislative changes, reduction of ARV prices, increased co-ordination and mobilisation of additional national and international resources.

Target groups/Beneficiaries:

The component focuses on prevention among youth (33.5 million in all of Russia) and the general population (144 million) through mass media and health services and direct outreach prevention work with vulnerable groups in ten regions. The vulnerable groups include injecting drug users (2-4 million in all of Russia), sex workers, street children, prisoners (870,000 in all of Russia) and men who have sex with men. The needs of people living with HIV/AIDS (estimated 1.17 million in all of Russia) will be addressed through the development of support structures, anti-stigma campaigns and prevention of mother-to-child transmission of HIV. Antiretroviral (ARV) treatment of mothers with HIV after birth and ARV treatment to injecting drug users will serve as a first step to comprehensive ARV treatment for all people with HIV. Lastly, the consortium will target government officials and seek to create conditions for an effective and urgent response on the part of the Russian government. There are no reliable estimates of the sizes for some of these vulnerable populations, but steps to improve monitoring capacity are included in this proposal.

Activities

Activities in Objective 1 focus on mass media campaigns, health education in secondary schools, development of voluntary counselling and testing, and improvement of the Russian condom market.
Activities in Objective 2 support prevention efforts toward the groups most vulnerable to the HIV epidemic in Russia: injecting drug users (IDU), street children, prisoners, commercial sex workers, and men who have sex with men.
Objective 3 aims to promote the development of medical and counselling services, support to parents living with HIV after the birth of their children and solidarity with people with HIV/AIDS (PLWH).
Currently in Russia, access to ARV therapy is extremely limited. This is especially true for highly vulnerable groups such as injecting drug users, prisoners) which comprise 90% of people with HIV/AIDS in Russia. The implementing organisations will also take the first steps toward comprehensive ARV treatment of people living with HIV/AIDS with an MTCT-plus programme and ensuring that marginalised groups, such as IDUs, have equitable access to treatment.

Activities in Objective 4: These activities will advocate improvements in national and regional HIV/AIDS policies to ensure an adequate national response to the epidemic, including legislative changes, a price reduction in ARV medication, increased co-ordination and mobilise additional national and international resources. A price reduction of ART (that is currently between $5 000 - $10 000 per person per year) is key in achieving this goal and is an important component of the advocacy activities of the NGO Consortium.

Results

The goal of the component is to is to stimulate an effective national response to HIV/AIDS in the Russian Federation and to spearhead such a response in ten selected regions. The criteria for selection of regions include a combination of factors including, among others, prevalence and incidence rates of HIV/AIDS, co-operative spirit among regional authorities, existing activities by governmental and non-governmental organisations and the level of significant international donor support. The programmes will improve the knowledge level of youth and the general population and address the needs of specific vulnerable groups including injecting drug users, sex workers, street children, men who have sex with men and prisoners. A treatment, care, health promotion and social support module will address the needs of people living with HIV/AIDS. The proposal also includes an advocacy module to improve the participation and effectiveness of government counterparts in HIV/AIDS policy.

Russia is a country that spans 11 time zones and includes 89 administrative regions. The NGO consortium will make a significant impact in ten of these regions, acting as leverage in the country as a whole.

The current HIV/AIDS epidemic in Russia, commonly believed to be at an early stage, will have a devastating effect not only on health, but also on social stability and on the economic development of the region. The relatively delayed arrival of HIV/AIDS in the Soviet Union in 1987, combined with its isolated political position in the world had led to a lack of basic HIV/ AIDS knowledge among its medical professionals, political decision makers and the general population at large.

Russia signed the 2001 UNGASS Declaration of Commitment on HIV/AIDS that calls for the 'development and implementation of multi-sectoral national strategies and financing plans for combating HIV/AIDS'. Russia also joined other CIS countries in a declaration by heads of states on the importance of fighting HIV/AIDS in May 2002.

The Ministry of Health enacted an ordinance on 9 September 2002 titled, 'Re: Intensified HIV control action in the Russian Federation'. This was the first high-level document to stress the need to focus efforts on injecting drug users (IDU), sex workers (SW) and prisoners. It also explicitly endorses harm reduction as an effective HIV prevention strategy. However, beyond limited efforts within government ministries, HIV/AIDS does not yet play a prominent role in national politics.

Efforts to address HIV/AIDS by the Russian Government have been patchy for several reasons. First, despite the steep increase, HIV/AIDS prevalence rates remain below 1% of the adult population, very low compared to the worst affected regions of sub-Saharan Africa, Asia and the Caribbean. Second, the epidemic is driven mainly by transmission among the high- risk core group of IDUs, a group shunned by society as a whole. Third, political advocacy has not been linked to the evidence base, with limited results from exhortations and rights-based advocacy. As such, it has been politically difficult to mobilise effective programmes on a large scale for a problem that is perceived to be confined to a group with limited political importance.

Mass screening for HIV was and still is considered one of the key interventions to fight the HIV/AIDS epidemic in the RF; officially an HIV test is performed on a voluntary basis, except for blood donors, prisoners, professionals exposed to HIV and foreigners. Yet, routine mandatory testing without pre- and post-HIV test counselling of people engaged in 'high-risk' behaviour, like injecting drug users, commercial sex workers, STI patients and pregnant women remains a routine exercise throughout Russia.

A comprehensive health and social infrastructure needed to adequately support people living with HIV/AIDS and their families and partners is not in place. The existing health system is over-expanded and severely under-funded. This has led to material shortages, lack of appropriate drugs and treatment possibilities and non-payment of salaries, all of which have hurt the capacity and morale of health care workers. The present number of health and social professionals experienced in HIV/AIDS prevention, treatment, care and support is extremely limited.

The Advisory Council to Fight HIV/AIDS has been established only recently and consists of 25 governmental and non-governmental organisational members. UN agencies are invited to participate as observers. The Advisory Council has a potential to become the country's CCM, but has not yet achieved that status, while the process and timeframe are still unclear.

Objectives:
The goal of this five-year proposal is to stimulate an effective national response to HIV/AIDS in the Russian Federation and to spearhead such a response in ten selected regions.

Objective 1: Supporting sustainable prevention programmes to increase awareness and reduce the transmission of HIV/AIDS among youth and the general population

Activities in Objective 1 focus on mass media campaigns, development of voluntary counselling and testing, health education in secondary schools and improvement of the Russian condom market.

Objective 2: Supporting sustainable prevention programmes to reduce the transmission of HIV/AIDS among vulnerable groups

Activities in Objective 2 support prevention efforts toward the groups most vulnerable to the HIV epidemic in Russia: injecting drug users (IDU), prisoners, sex workers, children born to mothers with HIV and men who have sex with men.

Objective 3: Providing treatment, care, health promotion and social support to people living with HIV/AIDS

Objective 3 will aim to promote the development of medical and counselling services, support to parents living with HIV after the birth of their children and solidarity with people with HIV/ AIDS. The implementing organisations will also take the first steps toward comprehensive ARV treatment of people living with HIV/AIDS with an MTCT-plus programme and ensuring that marginalised groups, such as IDUs, have equitable access to treatment.

Objective 4: Advocating improvement in the HIV/AIDS policy environment and building capacity to reduce the impact of HIV/AIDS on infected, affected and vulnerable people These activities will work to advocate improvements in national and regional HIV/AIDS policies to ensure an adequate national response to the epidemic, including legislative changes, reduction of ARV prices, increased co-ordination and mobilisation of additional national and international resources.

Target groups/Beneficiaries:

The component focuses on prevention among youth (33.5 million in all of Russia) and the general population (144 million) through mass media and health services and direct outreach prevention work with vulnerable groups in ten regions. The vulnerable groups include injecting drug users (2-4 million in all of Russia), sex workers, street children, prisoners (870,000 in all of Russia) and men who have sex with men. The needs of people living with HIV/AIDS (estimated 1.17 million in all of Russia) will be addressed through the development of support structures, anti-stigma campaigns and prevention of mother-to-child transmission of HIV. Antiretroviral (ARV) treatment of mothers with HIV after birth and ARV treatment to injecting drug users will serve as a first step to comprehensive ARV treatment for all people with HIV. Lastly, the consortium will target government officials and seek to create conditions for an effective and urgent response on the part of the Russian government. There are no reliable estimates of the sizes for some of these vulnerable populations, but steps to improve monitoring capacity are included in this proposal.

Location

  • Krasnoyarsk Territory
  • Nizhniy Novgorod oblast
  • Orenburg oblast
  • Pskov oblast
  • Republic of Buratiya
  • Republic of Tatarstan
  • Saint-Petersburg
  • Tomsk oblast
  • Tver oblast
  • Vologda oblast
  • Related Organisations

    Counterparts:   State health facility “The Vologda regional center on prevention of AIDS and communicable diseases”
    Beneficiaries:   AIDS Foundation East & West (AFEW)
    Public Health and Social Development Foundation FOCUS-MEDIA
    Population Services International (PSI)
    Open Health Institute
    SPID Info Svyas
    Financiers:   The Global Fund to Fight AIDS, Tuberculosis and Malaria (GF)
    Contractors:   no information

    Project Budget

    88 742 345 US Dollar.

    Project Documents

    The following table lists the documents created by or used in the project. In order to see details about a document, or to download it, please click on its title or on 'details'.

    Document Type Title Format More...
    Contracts Full Proposal This document can be downloaded This document has been written by the project View Details of the Document
    Contracts Grant Agreement This document can be downloaded This document has been written by the project View Details of the Document
    Contracts Summary of Proposal This document can be downloaded This document has been written by the project View Details of the Document
    Topics: 

    This project is characterised by the topics below. Please click on one of these topics to see a list of other projects with that topic.

    HIV/AIDS

    ФГУ «ЦНИИОИЗ Минздравсоцразвития РФ» официальный сайт

     Copyright  2002—2020, Federal Public Health Institute
     The project is funded by WHO/CIDA Health Care Policy and Stewardship Programme in Russia
     Developed in co-operation with the EU funded Tacis "North West Health Replication Project"
    WHO EU