Science special section examines HIV/AIDS in Russia, Ukraine

In a special section in advance of the International AIDS Conference, Science examines the "state of the HIV/AIDS epidemic in Russia and Ukraine, which account for more than 90% of HIV infections in Eastern Europe."

"With a travel grant from the Open Society Institute's Public Health Program, correspondent Jon Cohen and photographer Malcolm Linton visited researchers, clinicians, advocates, and affected communities in both countries," according to the introduction. "The central dilemma is that HIV in the region has been mainly transmitted by injecting drug users [IDUs] sharing needles, and the 'harm reduction' strategies successfully used in Western Europe and elsewhere, such as needle exchange or opiate-substitution treatment, have not taken root in the more conservative climate of the East. ... Building a strong response to HIV/AIDS takes several years in almost every country. But Russia, Ukraine, and their neighbors have an advantage: They can learn from the many other countries that began confronting the virus more than a decade before it hit Eastern Europe" (Jasny et. al., 7/9).

One article looks at the spread of HIV/AIDS in Eastern Europe and Central Asia and countries' responses to the epidemic. "In all of the regions of the world, it was possible with awareness and prevention to stop the growth, and yet the epidemic is still growing here," according to Dennis Broun, the UNAIDS regional director based in Moscow. "Many on the frontlines of combating the epidemic in both countries stress that great strides have been made in preventing mother-to-child transmission and providing anti-HIV drugs for treatment. But they have become deeply frustrated by many other aspects of the response to their epidemics—particularly the limited help available for IDUs, who often are reviled," the publication writes (Cohen, 7/9).

Another article takes a closer look at the resistance to harm-reduction approaches, including methadone, which aim "to protect IDUs from infections and other health risks." According to Science, "the Russian Federation seems outright hostile toward harm reduction, to the outrage of researchers, public-health specialists, and activists. The banning of opiate-substitution treatment (OST) has evoked the sharpest criticism." Things are a bit different in Ukraine, where advocates are pushing for the expansion of OST. The "government has not fully embraced harm reduction," but it is "delivered by nongovernmental organizations (NGOs) that receive support from the Global Fund to Fight AIDS, Tuberculosis and Malaria" (Cohen, 7/9).  "In a March raid on an opiate-substitution treatment center in Ukraine, a client, the clinic's doctor, and a nurse were arrested. ... Clients say the raid on the clinic undermines a broader agenda to encourage injecting drug users to seek help and, if they're still injecting, take advantage of other harm-reduction programs such as needle exchange or treatment and counseling for their HIV infection," according to a related article (Cohen, 7/9).

Another piece in the series reports on the Russian government's decision in July 2009 to withhold funding of a consoritum of Russian NGOs working on HIV/AIDS. This announcement countered former Russian President Vladimir Putin's 2006 call for "increased spending and urgent new measures to combat HIV/AIDS." The decision led several NGOs "to lay off employees or close up shop," Science notes (Cohen, 7/9).

The series also explores the spread of HIV among homeless youth, the prevention of mother-to-child transmission of HIV and infant abandonment and HIV research in Russia. Additional features include a photo essay and a podcast interview with the series correspondent Jon Cohen.

The current edition of the journal includes articles, research and an editorial about other related HIV/AIDS topics.