HIV/AIDS and Russian society
This telling account of an NGO activist from Kaliningrad shows that HIV/AIDS policy-making in Russia is far from being a straightforward task. Although there is a broad consensus that the epidemic poses a serious threat to Russia’s demographic and economic development and calls for a stepped-up response, divergent opinions exist in Russian society on what should actually be done to confront the epidemic. Ideological struggles and deep disagreements on basic prevention strategies – such as the above-mentioned sex education and harm reduction programmes – dominate public discourses on HIV/AIDS and form a barrier to an effective response to the epidemic. In order to understand why it is so difficult to reach a common understanding on HIV/AIDS prevention strategies one needs not only to consider Russia’s health care system and government policies, but also take into account the social context of the epidemic. A promising starting point for this investigation is a study by Borodkina (2008) who examined the social characteristics of HIV/ AIDS in Russia. According to the author, the epidemic needs to be viewed as a social problem, as it both threatens the basic value of human life and has a negative impact on the country’s overall development (Borodkina 2008: 152-153). As a social problem, the spread of HIV/AIDS does not only affect individuals, but also Russian society as a whole. Moreover, individual risk behaviour takes place in a social context and is, as such, dependent on a number of contextual factors. In order to confront the epidemic, it is therefore necessary to
re-evaluate legal and societal norms in Russia, including, for instance, attitudes towards homosexuality or drug use, as well as perceptions of prevention strategies, such as sex education programmes at schools (ibid.: 154). An effective response to HIV/AIDS in Russia should approach the problem in a comprehensive way. In addition to changing individual risk behaviours and underlying group norms it should focus on the creation of social structures and norms, legal regulations as well as social-economic conditions that support practices of safe behaviour and thereby prevent a further spread of HIV/AIDS in Russia. State and society thereby share a joint responsibility and should work together in what the sociologist describes as the “social prevention of HIV/AIDS” (ibid.: 153). This understanding implies that societal disagreements on HIV/AIDS prevention need to be resolved in order to find a common strategy for successfully countering the epidemic’s devastating impact on Russia. While the previous chapter gave an overview of the development of Russia’s HIV/AIDS epidemic and examined the changes in the Russian government’s response over the past two decades, this chapter aims to contextualise Russia’s HIV/AIDS policies in a broader societal context. This will allow for a better understanding of the “ideological and moral barriers” – mentioned by the NGO representative in Kaliningrad – which today hamper an effective response to HIV/AIDS in Russia. By examining public discourses on HIV/AIDS and discussing societal reactions to the unfolding epidemic, the chapter aims to provide an overview of the social context of Russia’s HIV/AIDS epidemic and explain why the country has failed to adequately deal with the crisis. The chapter begins with an investigation of the mechanisms and consequences of HIV/AIDS-related stigma and discrimination, which in Russia – just as in many other societies – have had a huge impact on the response to the epidemic. Subsequently, the chapter discusses public discourses on HIV/AIDS by focusing on a number of influential factors, including the role of the media, the position of the Russian Orthodox Church and the growing impact of AIDS denialists in Russia. This overview is meant to show the reader how controversially the issue of HIV/AIDS is discussed in Russian society with different groups holding diverging – sometimes even opposing – views on how the epidemic should best be countered. The discussion also illustrates the difficulties of finding workable solutions to societal problems such as HIV/AIDS in a political context like Russia, where public space is restricted and common understandings of HIV/AIDS are influenced by misconceptions, myths and prejudices. The second part of the chapter focuses on three major problem areas which exemplify how and why societal and political controversies on HIV/AIDS hamper the response to the epidemic in Russia: (1) HIV/AIDS and Russia’s approach to drug policy, (2) sex education and HIV/AIDS prevention programmes at schools and (3) the respect for human rights of people living with HIV (PLWH) and their inclusion in the response to the epidemic. These three problem areas have been singled out for separate discussion, as they have frequently been mentioned as most problematic in Russia’s HIV/AIDS policies, both by NGO representatives and HIV/AIDS activists and by health experts
working for governmental agencies or international organisations. Two of the three problem areas – drug policies and sex education programmes – concern HIV/AIDS prevention. Russia’s drug policies are crucial for its response to HIV/ AIDS, since injecting drug users (IDUs) form one of the most vulnerable groups to HIV/AIDS in Russia. Sex education and HIV/AIDS prevention programmes at schools, on the other hand, deserve special attention, as the epidemic mainly affects young people in Russia, who can best be reached by general prevention programmes, aimed at creating awareness and behaviour change. The third problem area – respect for human rights of PLWH and their inclusion in the response to the epidemic – mainly concerns treatment, as access to antiretroviral therapy and other medical services is a central concern for PLWH. However, the issue of human rights protection is also closely linked to HIV/AIDS prevention. Access to treatment enhances the general willingness to undergo voluntary testing for HIV infection; stigma and discrimination against PLWH, on the other hand, fuels the spread of HIV/AIDS, as it drives vulnerable groups beyond the reach of social services. Therefore, respect for the human rights of PLWH and other vulnerable groups is a necessary precondition for an effective response to the epidemic. All three problem areas are controversially discussed in Russian society. They show that Russia faces serious societal barriers in its response to HIV/AIDS. Many prevention programmes which are necessary to confront HIV/AIDS in Russia are not implemented at all or take place on such a small scale that they do not have a real impact on the course of the epidemic. Often, it is not financial limitations that prevent the adoption of necessary prevention programmes, but prejudices, stigmatisation of vulnerable groups or lack of information. A thorough analysis of the problem areas is therefore needed in order to understand what really impedes the fight against HIV/AIDS in Russia. In many aspects, HIV/AIDS politics in Russia can be understood as a battle of opinions, whereby different societal actors argue with each other on the right interpretation of the epidemic and its response. The arguments of the different actors and their overall impact on HIV/AIDS policy-making in Russia will therefore be examined for all three problem areas. This will provide insight into the societal factors that form an obstacle to Russia’s response to HIV/AIDS. The chapter will conclude with an overview of these societal barriers to Russian HIV/AIDS policies and discuss their practical effect on the work of HIV/AIDS NGOs in Russia. Overall, the chapter deals with the following questions: (1) What has been the social context of the unfolding HIV/AIDS epidemic in Russia? (2) How has the issue of HIV/ AIDS been discussed in Russian society and what has been the reaction of different societal groups? and (3) What are the societal controversies that hamper an effective response to HIV/AIDS in Russia?