Father Alexander renders help to patients of the Volgograd Regional AIDS Centre. He is a Priest of the Parish Church dedicated to Saints Faith, Hope and Charity with their mother Sophia. And this is very symbolic because everyone who is struggling for his/her health does need faith, hope, charity and wisdom.

The initiative to invite a priest to help patients of the AIDS Centre came from the multi-professional teams (MPTs) operating under this health facility. The multi-professional approach is a new developing practice, which is trying to survive in the Russian health sector.

The work of MPTs is funded by the Russian Health Care Foundation as part of the GF project covering 22 Russian regions. A MPT consists of an infectionist, a nurse, a psychologist, a social work specialist and a peer consultant.

In the Volgograd Regional AIDS Centre, the first MPT was established in 2006.

In 2006, the MPT asked Father Alexander on behalf of several patients to help them. At that time, it was a patient dying of AIDS and his relatives who needed his help. In that situation, the support from Farther Alexander was incomparable with anything else. Subsequently, Father Alexander was blessed by Metropolitan German of Volgograd and Kamyshin to work with HIV patients of the AIDS Centre, and has been acting as a friendly specialist of the MPT - a spiritual care giver - almost for three years. Today, his involvement is no longer confined to his work in the MPT. Many patients under treatment seek his guidance and blessing. Some of them need a blessing to take ARV drugs; others want him to provide guidance concerning fasts for sick people or to help answer such questions What for? How to live further?

According to N. Morozova, Infectionist, MPT Project, in the beginning of this cooperation, Father Alexander came to the AIDS Centre on agreed days to talk to patients. Today, people living with HIV are frequent visitors to his parish.

The multi-professional approach includes cooperation of professionals from various fields to provide assistance to HIV-positive people in maintaining treatment adherence. Infectionists, psychologists, social work specialists, a peer consultant, a narcologist, a TB doctor, a priest are staff and friendly specialists of the Volgograd MPT Project. The main output of their joint efforts is saved human lives.


In November 2009, a workshop for multi-professional team (MPT) coordinators took place in St-Petersburg. It was arranged by the Return Regional NGO as part of a project designated to hold workshops for coordinators of MPTs and nursing bureaus, and staff from AIDS Centres to ensure effective support and management of poorly motivated HIV patients under or in need of antiretroviral therapy; the project has been implemented since 2006 under RHCF-led programs.

The MPT-based approach is a new developing practice which is trying to survive in the Russian health sector. A team of specialists, consisting of a doctor, a psychologist, a nurse, a social work specialist, a narcologist, a 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.

MPT coordinators, who participated in the November workshop, submitted a request to the RHCF to continue to implement and promote MPTs in the Russian Federation in view of their relevance and significance: The experience shows that treatment (administration of drugs) without preliminary adherence efforts leads either to treatment interruptions (20-30%) or the need for additional financial inputs (for additional diagnostic services, new regimens, treatment of opportunistic diseases developing due to refusals to take treatment). Judging by the four-year experience of MPTs in regions, the MPT approach is the most cost-effective method of adherence stimulation. It is important to remember that an adhering patient is a person who has managed to arrive at undetectable viral load (when the presence of the virus in the blood is minimised to a very low level) and restoration of the immune status. It means that the probability of HIV transmission to anther person is negligible 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 ones family, and have healthy children.

Another important issue discussed at the workshop was the opportunity of training in the MPT approach for specialists from various municipal facilities, institutions and agencies.
Most of MPTs have gained experience in this area and are willing to share their knowledge and skills with others. It should be noted that MPT specialists are convinced in the effectiveness of this team-based approach. And it is their conviction which generates the desire to share their experience, and train their colleagues in regions and rayons. It is of particular importance (to replicate MPT experience) for infectionists. According to Dmitriy Ostrovskiy, Workshop Facilitator, a physician who is convinced that it is necessary to work in partnership with a psychologist, social work specialist, and peer consultants, who believes that health care rests not only with drug administration, is a new generation physician.

Contacts: Dmitriy Ostrovskiy, Chairman, Return Regional NGO, Tel.: (812)233 53 17


HIV/AIDS Prevention in Workplaces in the Irkutsk Oblast

Over several years, the Irkutsk Oblast has been among the 10 Russian regions with the highest HIV prevalence. In the Siberian Federal Okrug, it is the leader in HIV prevalence, and its HIV incidence growth shows that it time to think hard about the situation.

As officially reported, there are about 3,000 HIV-positive people in Angarsk. To get at the actual number of HIV cases, experts propose to multiply the reported figure by 3, or even by 5.

The HIV situation in Angarsk is very serious. HIV has reached older age groups. Whereas earlier, we worked with people aged 18-25, now we work with people at the age of 35, 39 and even 55, says Dr. N. Omelchenko, Head of the HIV Prevention Unit, Regional AIDS Centre.

This year, coherent activities to prevent HIV and viral hepatites in workplaces were mainstreamed into the National Priority Health Project; such activities were implemented in major enterprises in five Russian regions, including the Angarsk Oil Chemical Company. In Angarsk, the project was implemented by the Step Forward to Help You NGO, and financially supported by the Russian Health Care Foundation:

We selected an effective communication tool, says P. Tsikolin, part-time HIV and Drug Use Advisor to the Governor of the Irkutsk Oblast, - to arouse genuine interest among the audience rather than to force them to listen, which sometimes happens when similar efforts are made. The Angarsk Oil Chemical Company has an excellent training centre which is practically continuously used for training and retraining of its staff. We included HIV prevention events in the same program. In this way, we managed to address the most important issue: we made sure that the company management is really committed to help to ensure transformational change in the HIV situation and to enable its staff to obtain trustworthy HIV information. During the training of personnel, a no less important issue of HIV-associated discrimination was raised, and it was found out that most of respondents would prefer to refrain from working close to or contacting with an HIV-positive person. It is accounted for by lack of trustworthy information about the ways of HIV transmission though there are only three ways which are sexual contacts, injections and mother-to-child transmission. Another achievement of the project was the most efficient use of all information resources of the enterprise, including its newspaper, radio, and website to disseminate the information. Unexpectedly even for the project team, the coverage of employers with such prevention was 3 times greater compared with the target. As a result, almost 5,000 employers of the enterprise living in the city acquired HIV knowledge.

Upon training completion, people asked to be provided with additional information, says P. Tsikolin, - They understood that HIV was not something which was very far away from them, that it was quite near. Many people do not know that the epidemic reached its generalised stage more than six months ago, i.e. that, in essence, it has become uncontrollable. Now, everything depends on each individual, and his/her attitude to health plays a decisive role.

The country pays for HIV treatment US 1,000 per month per patient. As of today, 1,500 HIV patients are under such treatment in the Irkutsk Oblast. In view of the current HIV rates, or, to put it mildly, in view of the rapid growth in the number of HIV infected people, it will not take a long time to arrive at dozens of thousands of patients in need of HIV treatment.

I have prepared a proposal for the Governor, continues P. Tsikolin - to have such prevention activities implemented in all large enterprises in the region. They are not expensive, but we see, e.g., in the Angarsk Oil Chemical Company, that they are very effective. The Governor approved this proposal and it will be finalised to be mainstreamed into the Regional ANTI-AIDS Program. Some days ago, the Ministry of Health responded that the project would be continued under the Regional ANTI-AIDS Program.

Last week, the Angarsk project team presented their experience at an International HIV/AIDS Conference in Moscow (October 27 - 30, 2009).


On November 5, 2009, Vladivostok was visited by the Time to Live TV Marathon - the first Russian long-term socially oriented TV project to increase the visibility of HIV/AIDS problems.

It is not by chance that Vladivostok was selected to film the 40th program under this project.

According to the Federal AIDS Centre, the Primorsky Kray has been one of the 20 Russian regions with the highest HIV prevalence, for the recent five years. As of July 1, 2009, there were 8,281 registered HIV-positive people in the Primorsky Kray (0.32% of the population in the region). Since only a small share of the population is tested for HIV (21% in 2008), all official rates should be multiplied by 2 or 3 to arrive at actual rates.

Today, effective therapy is available to prevent mother-to-child transmission. But in 2008, only 64.2% of HIV-positive pregnant women were covered with such preventive therapy. Very poor coverage with vertical transmission chemoprevention has been recorded in this region for the recent five years, and this accounts for its persistent belonging to the 5 regions with the most unfavourable situation. As a result, in 2008, the rate of HIV transmission from mother to child reached 13.4% in the region versus 9.6% in Russia on the average.

The Primorsky Kray has high lethality rates among HIV-infected people (as of July 1, 2009, 26.4% of people with HIV died in the region versus 12.6% in Russia on the average), the region ranks the 4th in this respect after the Republic of Kalmykia, Kaliningrad Oblast, and Krasnodar Kray, i.e. after the regions with the oldest HIV epidemic.

Far from all people in need of ARV treatment were provided with it as of the end of 2008 (592 patients or only 10.3% of people living with HIV in the region). At the same time, 32.4% of those who initiated treatment ceased it, primarily, due to their death (60.4%). Among both all HIV-infected patients and those covered with treatment, high lethality may be attributable to the poor coverage of patients in need and too late treatment initiation.


D.A. Goliaev, GF Project Director, Russian Health Care Foundation, told the audience about progress under the GF-financed Program: Strategic Response to HIV/AIDS and TB -- Treatment and Care for Vulnerable Populations in the Russian Federation. Noting a significant contribution of the Global Fund into improving the availability of antiviral drugs for Russian patients, he also pointed out that difficulties with ensuring universal access to treatment were likely to arise upon completion of the GF projects and in view of the on-going financial crisis in Russia.

Ludmila Rusayeva, Chief Physician, Krasnoyarsk AIDS Centre, spoke about harm reduction programs for vulnerable groups under the GLOBUS Project and noted that presently, there was no alternative financing for such programs, and their termination would impair the HIV epidemiological situation in Russia.

Evaluating the GF projects, Vadim Pokrovskiy, Director, Federal AIDS Centre, acknowledged that the Global Funds input was really enormous: it made it possible to meet the key goal - to trigger a response to the epidemic at the national level; the country coordinating mechanism was made operational. In addition, it helped to build up human resource capacity through training of specialists from non-governmental organisations and some programs for vulnerable groups, e.g. for prisoners, migrants, were funded almost exclusively by the Global Fund. Vadim Pokrovskiy expressed a concern about the risk to fail to ensure sustainability of the response to the HIV epidemic in Russia upon completion of the GF projects.


The 3rd Conference on HIV/AIDS in Eastern Europe and Central Asia is held in Moscow and focuses on discrimination of people living with HIV and the need to establish a comprehensive system of HIV prevention for risk groups.

In his presentation at the Conference, Michel Sidibe, Executive Director, UNAIDS, notes that though Russia is making substantial progress in the response to the epidemic and allocating unprecedented amounts of resources to address this goal, we have to keep on working towards universal access, and that it is of particular importance for risk groups - IDUs, CSWs and MSMs, because it is they that are the channel for the epidemic.

Michel Sidibe urges the Government of Russia to change its attitude to harm reduction programs which have proven to be an effective tool for halting the HIV/AIDS epidemic in Eastern Europe and Central Asia. Professor Jay A. Levy, Director, Laboratory for Tumour Virus and AIDS Research at the University of California, reminds the participants that treatment and prevention effectiveness is of paramount importance in view of the fact that, nowadays, every 6 seconds, one person gets infected with HIV, and every 9 seconds, one person dies of this disease.

According to Mikhail Grishankov, First Deputy Chairman of the State Dumas Security Committee, the 2010 federal budget contains no earmarked proceeds for HIV prevention in vulnerable groups, which is accounted for, among other things, by distorted and sometimes false data on effectiveness of harm reduction programs as presented to Russian authorities, MOHSD, and, in particular, to the authorities of the City of Moscow by a number of persons.

Commenting a recent idea put forward by Ms. L. Stebenkova, Chairperson of the Moscow City Dumas Health Care and Public Health Committee, to make the emphasis on moral education of those belonging to risk groups to prevent HIV, M. Grishankov noted that such intentions and information were dangerous. They would push the country back into stagnation, time for arresting the epidemic is being lost, instead of making effective efforts, they are looking for an external enemy, and instead of building upon best practices and interventions which have been proven effective in dozens of other countries, they declare the need to look for a special way for Russia, noted M. Grishankov. He does not deem it sensible to promote the idea of robust families among commercial sex workers (which was the essence of the strategy proposed by the Health Committee of the Moscow City Duma).

The most grievous thing is that Moscow advises Regional AIDS Centres that they should forget about programs, and medical people do not even discuss the actual situation. M. Grishankov thinks that it is difficulty for Rospotrebnadzor to fight alone against such trends though Gennady Onishchenko, Chief Sanitary Physician of the Russian Federation, pointed to the insufficient coverage of regions with harm reduction programs, in his report today.


Last week, a Russian Nation-Wide Meeting of Directors of Prison Health Services was held. It was attended by D.A. Goliaev, Director, GF R4 Program: Strategic Response to HIV/AIDS and TB -- Treatment and Care for Vulnerable Populations in the Russian Federation, who made a presentation there. (In October 2005, the Federal Prison Service of Russia entered into an agreement with the Russian Health Care Foundation for joint implementation of the above referred Program. The program implementation period is up to the end of 2010).

Since 2005, the R4 TB Program has trained 438 prison staff, supplied laboratory equipment to 86 facilities, vehicles to 88 facilities, office equipment to 170 facilities, refurbished bacteriological laboratories in 37 facilities; supplied infection control equipment to 110 facilities; and provided 204 facilities with consumables.

The total input of the R4 TB Program unto the Russian prison sector has reached RUR 333,668,097.

The HIV/AIDS activities were implemented under the following three projects: the National Priority Health Project, R4 Program: Strategic Response to HIV/AIDS -- Treatment and Care for Vulnerable Populations in the Russian Federation, and the UNDP (on behalf of the UN Office on Drugs and Crime).

Trainings in VCT, HAART and adherence covered 1,674 persons; and the trained personnel provided individual and group counselling services to over 10,000 prisoners. The following information products were developed, printed and disseminated to regions:

HIV Test: 41,000 copies
Life with HIV: 20,000 copies
Comprehensible information about AIDS: 10,000 copies
AIDS: Questions and Answers: 10,000 copies
AIDS Glossary: 10,000 copies
Freedom to Learn the Truth: 80,000 copies
HIV Treatment in Prison: 600 copies
Safety and Security Measures for Non-Medical Prison Staff: 600 copies
Handbooks for People Living with HIV/AIDS: 1,000 copies
Posters: 9,000 copies.

A collection of 8 audio lectures was prepared, with guidelines for their use in prison developed. Six Social Bureaus for HIV-positive ex-prisoners were put in place and successfully operate.

Under the R4 Program, ARV treatment is provided to 5,337 patients in 142 prisons.


Invitation to bid: A bidding process is initiated to procure rapid test systems for standard post-exposure testing in regional health facilities and in prisons.


The day before, the region was visited by experts from the Global Business Coalition against HIV/AIDS, TB and Malaria (GBC). The visit included their meeting with Mr. N. Cherepanov, Deputy Governor of the Altai Kray, Ms. E. Vaigel, Deputy Director, Health and Pharmaceutical Department, and Mr. L. Sultanov, Chief Physician, Altai Kray AIDS Centre.

The meeting participants discussed a possibility to have a training course delivered for senior officials from regional executive authorities, civil and municipal servants in how to develop and implement programs to arrest the spread of HIV and other socially significant communicable diseases. According to the Regional AIDS Centre, the region has gained enormous experience in addressing various issues to halt the HIV/AIDS epidemic; and such a training course would help to ensure sustainability of prevention programs in the Altai Kray.

The training will be supported by the Russian Health Care Foundation as part of the Program: Strategic Response to HIV/AIDS -- Treatment and Care for Vulnerable Populations in the Russian Federation.

It is noteworthy that the curriculum and the contents of the training course were developed with inputs from the Ministry of Economic Development, Federal AIDS Centre, Higher School of Business under the Moscow State University named after M.V. Lomonosov, National Association of Charity Organisations, Russian Nation-Wide Association of Private and Privatised Enterprises, Association of Russian Managers, and UNAIDS.

The training course was presented at an expanded meeting of the all-party parliamentary working group on HIV/AIDS and other socially significant communicable disease prevention and control in the State Duma of the Federation Council. Participants of the meeting deemed the project very relevant and approved it.



Dear Colleagues,

This is to inform you that the budget of the Program is limited to the amount of the grant made available and in view of the need to finance the coherent HIV/AIDS activities as approved by the Global Fund.

In 2008-2009, owing to efforts to save as much money as possible and its reallocations, the Russian Health Care Foundation could supply 35 additional Russian regions with ARV-drugs worth of over US$ 1 million.

By now, the 4th Round Program of the Global Fund has fully exhausted its resources for additional drug supply.

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