1 Million Russians Are HIV-Positive, but Only a Third Get Treatment

Judy Woodruff:

Now we continue our series on the AIDS epidemic, returning again to Russia.

Last night, we looked at how injection drug use initially drove the epidemic there, where it’s estimated that one million people are HIV-positive.

Tonight, correspondent William Brangham and producer Jason Kane return to look at the other factors behind the continued growth of this epidemic, and how the Russian government is responding.

This series was produced in partnership with the Pulitzer Center.

William Brangham:

Pavel Lobkov is one of the top news anchors in Russia, a celebrity of sorts here.

But one night three years ago, he became the news, revealing to the country that he had HIV.

Pavel Lobkov (through translator):

Well, I went to the infectionist. He had a thick file crossed with a red marker, HIV-positive.

William Brangham:

This was news because Lobkov is one of the only well-known figures in all of Russia who has gone public about his HIV status.

Lobkov says he wanted Russians to know that HIV wasn’t a death sentence, something that much of the world learned decades ago.

Pavel Lobkov (through translator):

You look at me, you don’t see that I’m exhausted. You don’t see spots on my cheeks. You couldn’t distinguish that I’m HIV-positive, if I don’t tell about it.

William Brangham:

Public health officials say it’s hard to believe that such a wealthy, educated nation still treats HIV/AIDS with so much stigma and denial.

Pavel Lobkov (through translator):

It’s because we are still Soviet.

William Brangham:

What does it mean to be Soviet?

Pavel Lobkov (through translator):

Soviet means to be very shy, not to share problems, keep everything with himself. If you cry, do it alone, please.

William Brangham:

Critics say these attitudes are partly why Russia is one of the few places on Earth where HIV’s spread continues to increase at a rate of 10 percent every year, higher than in the hardest-hit countries in sub-Saharan Africa.

Over the last decade, the science has shown that there are certain things you can do that will definitely slow the spread of HIV:

You give clean needles to injection drug users. You aggressively test and treat people with HIV, so that they don’t spread the virus to others. And you target these interventions at people who are at risk.

These things have been shown to work. And yet, oftentimes, those tools are not being used here in Russia.

This young woman, who we will just call Katia, gives a glimpse of how outdated HIV care can be in Russia. She asked that we not show her face.

A few years ago, after a breakup, she started feeling sick.

Katia (through translator):

He liked alcohol, and loved to sleep around. Then, when we split up, I started to get sick.

William Brangham:

Her doctors wouldn’t test her for HIV. The idea that a drug-free heterosexual woman could contract the virus seemed unlikely, despite the fact that heterosexual sex is now becoming the top driver of HIV transmission in Russia.

But Katia insisted. Then, when her test came back positive, she was told she didn’t need to start antiretroviral drugs, the standard care for HIV.

Katia (through translator):

They told me, pills are not necessary. There’s no need to start anything.

William Brangham:

According to Jon Cohen, who’s been covering HIV/AIDS for more than 25 years for “Science” magazine, the advice Katia received runs counter to every tenet of modern HIV care.

Cohen is our reporting partner on this series.

Jon Cohen:

Back in the bad old days, when there weren’t enough drugs for everyone, the recommendations were that you wait to start treatment, until your immune system declined.

But the evidence has become overwhelmingly clear. Start everyone on treatment immediately. In most of the world right now, anyone who receives an HIV diagnosis is offered medication right away.

William Brangham:

Katia then told her doctors that she and her new husband, who’s in the military, were trying to have a baby, and she’d read online that she should definitely take antiretrovirals to prevent transmitting the virus to her husband and her baby.

Katia (through translator):

The doctor told me that the virus is small. You won’t likely infect him. And I said, what? How can that be? I sat and argued with her because I had already researched online.

Jon Cohen:

It’s startling to me that there was a woman in Russia in 2017 who’s trying to get pregnant and goes to the doctor and says, hey, I need antiretrovirals, and the doctor says, well, you know, your immune system’s doing well, your viral load isn’t that high, you don’t really need it.

She knew better. She had been reading on the Internet. And she said, no.

What it says is that there’s something broken.

Vadim Pokrovsky:

It seems that, at the present moment, there are no real attempts to overcome the epidemic.

William Brangham:

Vadim Pokrovsky is the longtime head of Russia’s Federal AIDS Center. And, yes, such a senior official has a bleak view of his country’s efforts.

He says Russian society is shaped in large part by the hugely influential Russian Orthodox Church, which argues against key HIV prevention, like comprehensive sex education, condoms and needle exchange.

Vadim Pokrovsky:

In many situations, the arguments from science are not so effective as arguments from the church. But we think that it’s better first to save life, and then to save soul.

William Brangham:

Russia’s national budget covers the treatment of only 300,000 HIV-positive Russians, nowhere near the estimated one million who are infected and need care.

For those who do get on treatment, it’s not always easy to find a ready, steady supply of medicine.

Alexander Chebin is something of an underground pharmacist.

So, this is a traveling pharmacy?

Alexander Chebin (through translator):

Yes.

William Brangham:

In the city of Yekaterinburg, he runs an informal, free, drug-sharing network for HIV-positive Russians in need.

In this box is a mix of various HIV medications, collected from people who don’t need them anymore, either because they have changed meds or because they died.

So this is AZT?

Alexander Chebin:

AZT.

William Brangham:

Chebin says, because no money changes hands, this is legal, but he still plays it safe, hiding medications in different places, like here in his couch.

Using a network of couriers, Chebin packs up and sends medicine anywhere in the country to patients who need them, all for free. This woman 1,300 hundred miles away in St. Petersburg is part of that network.

Russia has had repeated problems with so-called stock-outs, where different regions run short on these crucial HIV medications. This group is here to help fill the gap.

Keeping people on steady HIV medication is crucial, because people on treatment are much less likely to transmit the virus to others. But the fact that only a third of HIV-positive Russians are on treatment contributes to the 100,000 new infections that occur here every year.

President Putin’s government has been criticized for not forcefully addressing the crisis, but, in 2016, Prime Minister Dmitry Medvedev signed Russia’s strategic plan against HIV, which hopes to get many more people tested and treated in coming years.

Tereza Kasaeva:

We have a big number of cases, but the situation is quite different in different regions. There is no epidemics in our country.

William Brangham:

We met with officials from the Russian Ministry of Health. They reject the term epidemic and claim they are aggressively trying to get everyone who’s infected onto medication.

They say millions more Russians are being tested for HIV, and their treatment numbers are growing.

Tereza Kasaeva:

We didn’t say that we have no problem with HIV. We know that, in fact, we have problem. But we are trying to solve it.

William Brangham:

But this couple, which is part of that effort in St. Petersburg, says it’s too little, too late.

Andrey Skvortsov (through translator):

They give it more money. They give it more prevention programs. They say, we have a strategy. But the price for that is 20 years of death.

William Brangham:

Andrey Skvortsov works for an HIV patient advocacy group. His wife, Dr. Tatiana Vinogradova, is one of the nation’s top HIV doctors.

She helps run St. Petersburg’s AIDS Center, one of the longest-running centers in Russia. And St. Petersburg has made some progress locally against HIV using proven prevention and treatment strategies.

But there’s more to their story. Skvortsov is HIV-positive and on treatment, and Vinogradova is HIV-negative. In this public ad campaign, they tried to chip away at HIV stigma. This poster says, “HIV isn’t a barrier to starting a family. With HIV, it’s possible to live a long life.”

The idea is, if you know you’re infected, like this young man who just was diagnosed, regular treatment can not only save your life, but can prevent your partner from becoming infected as well.

But Vinogradova says the prejudice is still strong, even in the medical community.

Dr. Tatiana Vinogradova:

They are still afraid of HIV patients.

William Brangham:

Doctors are afraid today?

Dr. Tatiana Vinogradova:

Surgeons. Dentists. Nurses.

William Brangham:

In this day and age?

Dr. Tatiana Vinogradova:

In this, in this city, in this progressive Russian city.

Jon Cohen:

So, there’s a lot of frustration here as well from people who are at the front. These people that we’re meeting with, they’re really smart. This is not a place for people that are living in the Dark Ages.

You know? Look around. It’s — it is Europe.

William Brangham:

So, what is it? If the tools are at hand and everyone knows how to really address it, why is it not happening?

Jon Cohen:

You know, William, they’re telling us that it’s leadership. We have heard it again and again, that their leadership just isn’t embracing it aggressively.

And they have a lot of other problems.

William Brangham:

But Dr. Vinogradova is darkly optimistic. She says this growing epidemic will eventually make Russia pay attention.

Dr. Tatiana Vinogradova:

Actually, it’s Russian mentality.

William Brangham:

What, that it has to get worse?

Dr. Tatiana Vinogradova:

Something should happen. Something very bad should happen. After that, everybody will stand up and just go and do something.

William Brangham:

For now, though, people like Katia keep up a quieter fight, one foot in front of the other, even as her country’s epidemic moves in the wrong direction.

For the “PBS NewsHour,” I’m William Brangham in Yekaterinburg, Russia.

You can see all the reporting for this series "The End Of Aids: Far From Over" on our Web site, PBS.org/NewsHour.