On May 16, 2010, an event to mark the AIDS Memorial Day took place in Volgograd under the motto: Remember in Order to Live.

The event included activities to raise public awareness of the importance to take care of one’s own and other people’s health, and HIV prevention. To demonstrate tolerance to people living with HIV, all participants of the event were to put on red-ribbons, symbolising the fight against HIV/AIDS. Information products (balloons with messages from HIV-positive people) were handed out to participants. The event culminated into a launch of hot air red balloons.

The campaign was organised by the Volgograd Regional AIDS Centre, Volgograd City Department of the Red Cross Organisation, Positive Life Volgograd Regional NGO, Communication+ Group, which implements an HIV direct non-medical service project in Volgograd as part of the Program: Promoting a Strategic Response to HIV/AIDS -- Treatment and Care for Vulnerable Populations in the Russian Federation.


Now, multi-professional teams include information managers.

In late April 2010, the Return Regional NGO hosted a seminar on information support for multi-professional teams. The seminar took place in St-Petersburg and was attended by specialists of multi-professional teams (MPTs) from the Leningrad Oblast, St-Petersburg, Chelyabinsk, Kemerovo, Khanty-Mansiysk, and Irkutsk.

According to Dmitriy Ostrovskiy from the Return Regional NGO (the Manager of an MPT staff training project, supported by the RHCF), it is high time to provide more detailed information about multi-professional teams, which operate in 22 Russian regions. Over 500 specialists (physicians, psychologists, social workers, epidemiologists) are united with the same approach to HIV care, which is not confined to pharmaceutical treatment, as HIV patients need more than that - they are in need of integrated health and psychological care based on the multi-professional approach.

In Russia, MPTs have been operating for more than four years. Their specialists have gained enormous experience in treatment adherence stimulation and maintenance. Results of their joint efforts are impressive. Among patients of MPTs, default rates are lower than among other patients. E.g., in the Sverdlovsk AIDS Centre, the default rate among patients of MPTs is 4%, while 14% is considered to be normal according to Russian conventional standards for ordinary patients, and for “difficult cases”, it is even higher.

It is noteworthy that the multi-professional approach is used to address such “difficult cases” as drug users, alcoholics, and disadvantaged people.

Recent years see the emergency of new interesting care provision arrangements in many MPTs. E.g., in 2010, a mobile team started to operate in St-Petersburgк; it consists of a feldsher, social work specialist, and an epidemiologist, who visit their patients if they cannot come to the AIDS Centre to be tested, receive drugs or consultations. Their patients are disable people, lone mothers, patients who cannot afford fare to the AIDS Centre. The Khanty-Mansiysk AIDS Centre is staffed with a narcologist who is a client-friendly specialist of the MPT, operating under the AIDS Centre. In Volgograd, the client-friendly specialist for the MPT is a priest. In Irkutsk and Yekaterinburg, MPTs for HIV-positive children were put in place and are operational. These are but a few examples of the creative approach to project implementation.

Information managers of multi-professional teams were trained at the seminar in St-Petersburg and will provide information about new developments in regional MPTs, their performance, new activities, prospects and problems.

Multi-professional teams are supported by the Russian Health Care Foundation under the Program: Promoting a Strategic Response to HIV/AIDS -- Treatment and Care for Vulnerable Populations in the Russian Federation.


Yesterday, another Time to Live Talk Show was hosted, as always, by Vladimir Pozner - this time, in Tolyatti. First of all, he had a meeting with local mass media to talk about the importance of the problem to be discussed. “This problem is of great concern for society, for each person, to say nothing about journalists”, says V. Pozner. The venue for the talk-show (Tolyatti) was chosen in view of the most severe HIV situation there.

Pozner says that the situation is very grave there: the city is among areas which are most heavily affected with the HIV epidemic in the country. And, in some age groups, it is scaring. There are port cities and communities visited by lots of tourists. There are cities situated along drug trafficking routes. But it is not quite clear why the situation is so bad in Tolyatti.

The objective of the TV project is educational rather than medical. Its participants try to covey information about HIV and AIDS to as many people as possible. This includes such issues as infection prevention, attitude to HIV-positive adults and children. “It is not my vocational endeavour”, stresses V.Pozner - “But I deem that journalists should highlight this problem. It poses a great threat: as of today, Russia officially reports 540,000 registered HIV cases. But, to arrive at their actual number, this figure should be multiplied by three, because many people would not be tested and do not know that they are infected. And it means over 1.5 million people or more than 1% of the total population. I think that we, journalists, have a unique opportunity to convey information about the actual situation to as many people as possible. In my opinion, Russian mass media do too little to this end, and often, their efforts fail to be competent”.

”It was reported that in Tolyatti, 99.9% of boys and girls know that HIV/AIDS is a fatal disease; and even that 99.3% of boys and 99.8% of girls know that it is associated with drug use. But we know that these data are not true”, commented V. Pozner. The TV project team just asked passing by young people what they knew about HIV. Answers of teenagers made the officially reported data doubtful.

The Time to Live Talk Show is funded by the Russian Health Care Foundation under the Program: Promoting a Strategic Response to HIV/AIDS -- Treatment and Care for Vulnerable Populations in the Russian Federation (Round 4 of the Global Fund).

Цель марафона — не медицинская, а просветительская. Его участники пытаются довести до как можно большего количества людей, что такое ВИЧ и что такое СПИД. Какие существуют способы защиты. И как относиться к ВИЧ-положительным взрослым и детям. «Для меня это не профессиональная работа, - подчеркнул Познер. - Но я считаю, что журналистам следует заниматься этой проблемой. А она очень опасна. Сегодня, по официальным данным, в стране зарегистрировано 540 тыс. ВИЧ-положительных. Но реально эту цифру можно увеличить на три, так как многие не проверяются, а многие не знают о болезни. И тогда получается больше трех миллионов человек, а это больше 1% населения страны. Я считаю, что мы как журналисты имеем редкую возможность делать положительную работу, доводя до сведения как можно большего количества людей информацию о реальном положении дел. На мой взгляд, СМИ России мало делают в этом смысле. И часто неумело».

«Есть удивительные данные, которые мы получили: якобы среди мальчиков и девочек Тольятти 99,9% знают, что ВИЧ, СПИД – смертельные заболевания. И даже 99,3% мальчиков знают, что это связано с наркотиками, и 99,8% девочек знают это тоже. Но мы знаем, что это точно не так», - комментировал Познер. Как выяснилось, съемочная группа телемарафона просто останавливала молодых людей на улице и спрашивала, что им известно о ВИЧ-инфекции. И ответы подростков поставили полученные из официальных источников цифры под сомнение.

Проведение телемарафона «Время жить» финансируется фондом «Российское здравоохранение» в рамках программы «Развитие стратегии лечения населения Российской Федерации, уязвимого к ВИЧ/СПИДу» (4-й раунд Глобального фонда).


On the eve of the International AIDS Memorial Day (May 16), a press conference was held in Moscow to talk to Academician Vadim Pokrovsky, Director, Federal AIDS Centre, who spoke, among other things, about the failure to finalise and adopt a national strategy, a clear concept of response to HIV in Russia, and a comprehensive approach to answer the HIV challenge, and implications of such a failure.
According to Vadim Pokrovsky, the number of HIV cases is growing in Russia, which testifies to the effect that government fails to make adequate efforts to control the epidemic. He says that our government is making a disproportional focus on treatment, with treatment of an HIV patient per year costing about RUR 180,000.

He also told the journalists that in 2009, treatment had been initiated for 20,000 HIV patients though the number of newly identified cases was about 58,500; and in 2010, treatment will be provided to 50,000 patients who have already been treated and to 20,000 new patients. By the end of this year, treatment will be provided to 70,000 out of 450,000 surviving registered HIV patients in Russia. It means that in about two years, the gap between the number of Russian patients in need of treatment and the number of those under treatment will significantly increase.

As reported by V. Pokrovsky, today, the number of Russian HIV patients in need of treatment exceeds 100,000, but by 2015, their number is expected to increase at least to 400,000. For this reason, public expenditures on HIV treatment will have to be increased 5-10 times. In addition, Academician Pokrovsky is surprised with the failure of the Russian Government to make funding available or HIV prevention: “It is rather odd because prevention helps to cut future costs of treatment”.

He says that this year the MOHSD refused to support the request for funding to continue treatment under the GF project: “The Global Fund made available about US$ 100 million for HIV treatment over 5 years. This year, the grant will be closed, however, the MOHSD would not sign the request for continued funding”. V. Pokrovsky also says that applications for HIV treatment are re-estimated now due to the curtailment of funding for this purpose: “Pharmaceuticals are likely to be procured only in summer and their delivery will start in autumn. It will inevitably cause problems with drug supply for patients in need in Russia”.

In addition, he informed journalists about anti-AIDS vaccine development projects in Russia. They are implemented in close cooperation with foreign scientists; but this year, such programs are not financed either.

In conclusion, the Director of the Federal AIDS Centre reminded that people should take care of themselves (“you will sink unless you swim”), adopt safe sex practices, i.e. use condoms when partners’ HIV status is unknown.


On April 14, 2010, V.Pozner, a well-known Russian TV-journalist, visited Ryazan to prepare his regularly produced TV program under the Time to Live Talk-Show Project, which is the first long-term social HIV/AIDS project. It was launched in 2004 by an alliance of Russian non-governmental organisations. Ryazan is the 44th region to host the talk-show. The project is sponsored by the Russian Health Care Foundation under the R4 Project funded by the GF.

Prior to the Talk Show, Vladimir Pozner held a press conference for Ryazan journalists. He noted that the program was not broadcast through federal TV channels as it was deemed more effective to show it locally: “It is more effective to discuss a local problem with local people who know each other or about one another”.

The Ryazan Oblast is the 35th among the Russian regions in terms of HIV rates per 100,000 population. It is a fairly good indicator; however, the problem does exist here as well. One of the highlighted aspects is the attitude to HIV-positive children at the point when they start to go to preschool. In Ryazan, such children are denied the opportunity to be included into a kindergarten group without prior consent from parents of other children, which is not lawful.

The journalist stressed that he was keen to highlight this issue because there used to be a lot talks to the effect that only the few risk groups (CSWs, IDUs and MSMs) could contact HIV and they made up a small share in the total population - so it was clearly a misunderstanding. Today, it is obvious that in most regions, the highest HIV growth rates are found among people who go through normal sexual development, they are absolutely ordinary people like all of us, and it is they who compose the risk group.

He also pointed out that journalists should highlight this issue because they could directly communicate with the audience. It is necessary to convey information about the HIV spread to people. In V. Pozner’s opinion, the journalist community fails to pay appropriate attention to the issue: “I know that this theme does not yield benefits for journalists, but we ought to cover it”.

V. Pozner also informed regional mass media about results of the Time to Live Program. They include adoption of by-laws and resolutions. He emphasizes that public sector organisations engaged in HIV/AIDS response are catastrophically few, saying: “In Russia, one of the problems is lack of prevention efforts in the broad sense, i.e. lack public education and awareness activities”.

The medical dimension of HIV/AIDS is not covered under the project. The project is focused on informing general public about the HIV problem. V. Pozner says that a social survey shows that in each region, there are people believing that HIV may be transmitted through kisses, mosquito bites and in swimming pools. “The program results into sharply reduced numbers of such respondents, people become more aware and informed”, says the journalist.

V. Pozner classifies the Time to Love Talk Shaw as a public education program, aimed at raising pubic awareness and changing people’s thinking: “People should understand how HIV is transmitted, that it is a plague rather than a sin or blame, and be aware of the threat”.
During the meeting, journalists asked V. Pozner to share his opinion about the position of the Ryazan authorities with respect to HIV and tell them whether he had had meetings with the regional authorities to discuss this issue. Pozner noted that the attitude of the authorities to this problem is fairly tolerant.

The program will be broadcast on April 17, 2010.


As of February 1, 2010, in the Sverdlovsk Oblast, the number of identified people with HIV reached 43,369.

In 43 prisons located in the Sverdlovsk Oblast, 10% of all inmates are HIV-positive patients. Some of them are in need of medical care, including treatment with antiretroviral drugs. These drugs do not cure HIV, but contain the development of the virus, preventing it from replication and thus they not only prolong the life of patients, but also make them less infectious.

In prison, HIV patients are monitored by prison health personnel, and provided with ARV treatment, if necessary. It should be noted that the treatment of all HIV patients is funded by the National Priority Health Project and the Global Fund Project, which means that it is free of charge for PLWH, including prisoners. Government spends RUR 450 000 per year to treat one patient. Treatment requires life-long administration of ARV drugs in one and the same time without interruptions and delays. Termination or interruption of treatment results into the development of drug resistance and deterioration of patient condition.

Upon release, an HIV-positive prisoner must be registered at the community-based infectionist office. However, most of PLWH fail to visit medical doctors upon release from prison for various reasons. According to a survey of the prison social care team, undertaken by the Public Health and Health Care Chair of Urals Medical Academy, 54.5% of prisoners do not believe that the treatment will be effective; 18.2% do not believe their diagnosis; and 18.2% are not motivated to take care of their health.
To improve treatment adherence among released prisoners, the Ministry of Health of the Sverdlovsk Oblast and the Directorate of the Federal Prison Service for the Sverdlovsk Oblast entered into a cooperation agreement in 2009. This Agreement provided a basis for the cooperation between the Regional AIDS Centre (the Time to Live Social Bureau), prison psychologists and the prison social care team.

As part of such cooperation, two training seminars on HIV counselling to stimulate treatment adherence among prisoners were delivered for the prison social care team and prison psychologists by specialists from the Regional AIDS Centre. Several specialists from the educational unit of the Preliminary Detention Facility attended a training seminar on HIV primary prevention. In addition, when specialists from the Regional AIDS Centre visit prisons to deliver treatment adherence seminars for HIV-positive prisoners to be released, they involve non-medical specialists (psychologists and specialists of the prison social care team) from visited prisons. Jointly provided individual and group consultations for prisoners are of better quality and improve systematic efforts of non-medical specialists to educate and consult HIV-positive prisoners.
The survey of the prison social care team shows that during the recent 3 months, the number of pre-release consultations increased (psychologists provide 13.2% of consultations and the share of the prison social care team is 43.2%). These very consultations are a major “bridge” to ensure continuity between treatment in prison and further treatment upon release. Post-release life and health of both ex-prisoners and their partners depend on the professionalism and effectiveness of such consultations, provision of all needed contacts for a future patient and comprehensible information about the sequence of actions needed to continue treatment.

The cooperation between the Regional AIDS Centre and Prison Service is a good example of an effective social partnership in HIV prevention and treatment. It is important to make specialists from these two agencies understand the significance and necessity of their joint efforts. About 70% of respondents from the prison social care team report that HIV treatment and counselling to improve adherence among prisoners reduce the risk of infection for the population of the Sverdlovsk Oblast. Thirty per cent of the respondents refer to the fact that both treatment adherence stimulation and HIV treatment of prisoners reduce the risk of HIV transmission to healthy prisoners.

In 2009, the social partnership of the two stakeholder agencies yielded its first benefits. As reported by the Sverdlovsk Oblast AIDS Centre, 57% of released prisoners got notified at their community-based infectionists’ offices.

The Time to Live Social Bureau for HIV-positive ex-prisoners operates in the Sverdlovsk Oblast and is supported by the Russian Health Care Foundation under the project to establish social bureaus for released HIV-positive prisoners as part of the Program Promoting a Strategic Response to HIV/AIDS -- Treatment and Care for Vulnerable Populations in the Russian Federation.


On February 8 - 10, 2010, the Russian Health Care Foundation held a seminar on HIV/AIDS treatment and HAART adherence stimulation to train personnel from the Medical Department of the Directorate of the Federal Prison Service for the Perm Kray. The seminar took place in Perm under a UNODC-funded project in support of activities to improve ARV therapy provision to HIV-positive prisoners.

The training covered over twenty staff from the Directorate of the Federal Prison Service for the Perm Kray, including physicians, nurses and psychologists. The seminar was aimed at developing basic knowledge and skills for HIV/AIDS treatment needed to promote specialist care programs in health facilities under the Directorate of the Federal Prison Service for the Perm Kray.

As of today, over 400 HIV-positive prisoners in the Perm Kray are provided with ARV treatment under the R4 GF Program. The Regional AIDS Centre (headed by its Chief Physician Kamil M. Khafizov) and the Directorate of the Federal Prison Service for the Perm Kray established good cooperation to identify patients in need of ARV therapy, which made it possible to cover with treatment so many patients and to arrange continued case management upon release.


9 On February 9 – 11, 2010, the Sverdlovsk Oblast AIDS Centre will host a training seminar on non-medical HIV services to be held by the Positive Development NGO of the Altai Kray (Barnaul).
Non-medical services are an important constituent of an HIV care system. Non-medical services include peer counselling provided by specially trained HIV-positive people to other HIV-positive people who visit health facilities for the first time; and such services as Schools of Life with HIV, Patient Schools, Schools for Pregnant Women, and mutual aid groups. It should be noted that non-medical HIV services are successfully provided under the Sverdlovsk Oblast AIDS Centre.

According to Anzhelika Podymova, Chief Physician of the AIDS Centre, HIV is a social disease affecting all areas of human life; and HIV care cannot be confined only to medical care (even to that of the highest level); therefore, they deem it necessary to develop non-medical services under this health facility.

The seminar on non-medical HIV services is part of efforts to this end. Its participants will discuss various non-medical services, arrangements for their delivery and development. An emphasis will be made on assessment of PLWH’s needs in non-medical HIV services.

The seminar will bring together peer consultants, specialists from health facilities, and representatives from four rehabilitation centres of the Sverdlovsk Oblast.

The seminar is sponsored by the Russian Health Care Foundation under the Program Promoting a Strategic Response to HIV/AIDS -- Treatment and Care for Vulnerable Populations in the Russian Federation.


The Time to Live Talk-Show in Yekaterinburg

The Time to Live TV project is unique because it is designated to increase the visibility of regional problems related to the spread of HIV, reveal the most sensitive issues for each city or region. The project geographical coverage makes it possible to draw attention of the authorities and broad public to HIV/AIDS and catalyse action on the ground to contain the epidemic growth.

The Sverdlovsk Oblast is among the most affected regions in Russia. As of January 1, 2010, there were 43,021 officially notified HIV infection cases in the region, and its HIV prevalence rate is 975.6 per 100,000, i.e. 0.97% of the regional population is infected with HIV. The actual regional number of HIV-positive people is estimated at 120,000 - 130,000 people. The Sverdlovsk Oblast is the region with the greatest number of HIV-positive people in the country, and its cumulative HIV prevalence rate (the number of registered HIV cases per 100,000) is the sixth highest in Russia.

Unless the existing trend is reversed, over 1% of the Sverdlovsk Oblast’s population will be infected with HIV by the end of 2010.

How to arrest the HIV epidemic growth in the Middle Urals? What are the problems of the highest priority? What resources are available? What should be done to make each resident of the region aware of HIV prevention measures? These questions were to be answered during the talk-show, which took place in Yekaterinburg on Wednesday, and was hosted by Vladimir Pozner.

In addition, a mobile facility for HIV rapid testing was operating outside the Ural State University. According to V. Pozner, the University authorised to locate such mobile testing facilities only when they got to know that Vladimir Pozner would visit them. He also notes that after his meeting with students, there was a line of students who decided to be tested for HIV.

In 2009-2010, Time to Live Talk-Shows are funded by the Russian Health Care Foundation under the R4 GF Program.


The multi-professional approach is a new developing practice, which is trying to “survive” in the Russian health sector. A team of specialists, consisting of a doctor, psychologist, nurse, social work specialist, narcologist, TB specialist, peer consultant and other specialists, provide health, psychological and social care in an integrated manner to most default-prone patients with a focus on treatment adherence stimulation.

Multi-professional teams (MPTs) are supported by the Russian Health Care Foundation under the Program: Promoting a Strategic Response to HIV/AIDS -- Treatment and Care for Vulnerable Populations in the Russian Federation. It should be noted that this Program helped to put in place and make operational 40 MPTs in Russia.

In the Sverdlovsk Oblast, 8 MPTs operate under the Regional AIDS Centre. As of December 29, 2009, they had 2,288 patients under their management. It is noteworthy that the Sverdlovsk teams (unlike their colleagues in other Russian regions) provide care to all patients receiving or preparing for antiretroviral treatment. Note: as per the contract signed with the RHCF, each MPT should consist of at least 5 specialists.

The number of patients in the Sverdlovsk Oblast AIDS Centre is increasingly growing every month; and the MPTs’ experience has proved to be very useful (the project has been implemented in the Sverdlovsk Oblast since 2006): close cooperation among the physician, psychologist, nurse, and the social work specialist to stimulate treatment adherence is very fruitful.
“If treatment is confined to supplying patients with ARV drugs without preparatory adherence efforts, it results into defaults or refusals to take treatment for 20-30% of patients and requires additional financial inputs (additional testing services, new regimens, treatment of opportunistic infections developing due to treatment interruptions). In this respect, the MPTs approach is the most cost-effective way to stimulate adherence. It is important to remember that an adhering patient is a person who has managed to arrive at undetectable viral load (when the level of the virus in the blood and the sperm is very low) and restoration of the immune status. It means that the probability of HIV transmission to anther person is significantly reduced even in the most risky situations; to say nothing about such outcomes as saved health, life and working ability, and the possibility to preserve or create one’s family, and have healthy children”, says Anzhelika Podymova, Chief Physician of the Sverdlovsk Oblast AIDS Centre.

In 2009, almost 4,000 new HIV infection cases were notified in the Sverdlovsk Oblast. All these people will require treatment sooner or later. Public expenditures on drug supply for them will exceed RUR 45 million a year. It is important to maximise the value of each rouble invested into treatment, or, in other words, into health of each individual and the nation as a whole. Certainly, much depends on the patient, on his/her responsible attitude to treatment. But to help patients develop such responsible attitude is a mission of physicians, psychologists, social work specialists and nurses. The MPT-based approach to HIV treatment is a most effective way to address this task.

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