In the centre of Russian HIV/AIDS politics: HIV/AIDS NGOs in Moscow
The fourth case study takes us to the Russian capital Moscow. In contrast to the previous three chapters which focused on local HIV/AIDS NGOs in Russia’s regions, this chapter discusses those organisations that work at the federal level. They differ from their local counterparts in terms of the size of their organisations and the budget they can spend on HIV/AIDS programmes. The most important difference, however, is that they act as a link between the global governance of HIV/AIDS, Russia’s national policy-making, and the local realisation of HIV/AIDS prevention programmes. In contrast to HIV/AIDS organisations in Russia’s regions, Moscow-based NGOs have – at least to a certain extent – access to Russian political decision-makers, inter-governmental organisations and transnational NGO networks. This creates far greater opportunities for them to engage in agenda-setting and advocacy work. Moreover, these central HIV/ AIDS NGOs implement country-wide prevention programmes which have a strong impact on regional responses and enable them to create networks with local partner organisations. In the development of Russia’s response to HIV/ AIDS, Moscow-based NGOs have thus played a crucial role. A salient example of NGO action in the field of HIV/AIDS in Russia is the GLOBUS project which started in 2004. The five foreign and Russian NGOs that have united in the GLOBUS consortium formulated their objective to “stimulate an effective national response to HIV/AIDS in Russia” (OHI 2006: 3). The NGOs thus explicitly aimed to influence Russian HIV/AIDS policymaking and enhance the country’s capacities in dealing with the epidemic. Based on partnerships in ten project regions, the five NGOs wanted to set an example of successful prevention programmes and thereby convince the Russian government to invest in policy development and better coordination. The GLOBUS project was thus meant “to function as a catalyst” for improving Russia’s response to HIV/AIDS (GFATM). GLOBUS was the first NGO-led HIV/AIDS programme in Russia that received substantial funding from the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM). In the following years, two similar projects followed. The Global Fund’s financial support strengthened the position of NGOs as policy actors in the fight against HIV/AIDS in Russia. Moreover, it provided the participating organisations with the unique opportunity to realise a broad, multi-year HIV/AIDS programme and
thereby demonstrate to Russian decision-makers what an effective response to the epidemic could look like. According to the overview of the organisational landscape of HIV/AIDS NGOs in Russia provided in Chapter 6, Moscow-based NGOs can be divided into three groups: policy/advocacy NGOs, government-affiliates and NGO networks. Policy/advocacy organisations focus on policy development and/or advocacy and seek to influence national HIV/AIDS policies in Russia. Examples are the NGOs that constitute the consortium of the GLOBUS project and the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC). The second category – government affiliates – consists of only one organisation: the Russian Health Care Foundation. It was established in 1996 with the support of the Russian government and can thus be characterised as a government-affiliated NGO. Similar to the GLOBUS consortium, the Russian Health Care Foundation received a grant from the Global Fund for the implementation of a country-wide HIV/AIDS programme, called “Promoting a Strategic Response to HIV/AIDS Treatment and Care for Vulnerable Populations in the Russian Federation”. The third group of Moscow HIV/AIDS NGOs are network organisations which unite local NGOs and/or individual members. NGO networks facilitate an exchange of information between Russia’s regions and combine service delivery with advocacy. Examples include the Russian Harm Reduction Network and the AllRussian Association of People Living with HIV. What is common to all Moscow-based HIV/AIDS NGOs is that they focus on the bigger picture of HIV/AIDS policy-making in Russia. Compared to local organisations in Russia’s regions, they have better access to information and more communication opportunities with Russian decision-makers, intergovernmental organisations such as UNAIDS and transnational NGO networks. Moreover, in contrast to their local counterparts which mainly focus on service delivery, HIV/AIDS NGOs in Moscow have a broader perspective on policy development, advocacy and empowerment. Generally speaking, the rationale of the organisations is based on the assumption that an effective response to Russia’s HIV/AIDS epidemic is only possible by combining the efforts of state and civil society. On the one hand, the NGOs want the Russian government to take responsibility for the fight against HIV/AIDS and create favourable conditions for integrating civil society actors in the response to the epidemic. On the other hand, they understand that Russia needs an active civil society (consisting not only of NGOs, but also of other stakeholders including religious communities, local initiatives, foundations, media actors, etc.) that is able to deal with the issue of HIV/AIDS and can negotiate between divergent societal views on prevention programmes.1 Moscow-based HIV/AIDS NGOs such as the GLOBUS consortium thus have very ambitious aims. Not only do they seek to raise HIV/AIDS awareness among Russian decision-makers, but they also intend to improve HIV/AIDS policies in a sustainable way in order to bring about an effective improvement of the country’s response to the epidemic. This chapter investigates whether the NGOs have actually lived up to these expectations. The question is thus whether they
succeeded in making use of the increased opportunities provided and achieve what they themselves have described as “stimulating an effective national strategy to HIV/AIDS in Russia” (OHI 2006: 3). The work of HIV/AIDS NGOs is thereby analysed from different perspectives: First, an overview of the organisational landscape in the Russian capital is given. Moscow-based NGOs that manage country-wide prevention programmes or organise country-wide advocacy networks take centre stage here. Moreover, the different perspectives on NGO action and the relationship between the central NGOs in Moscow and their local partner organisations in Russia’s regions will be discussed in order to show the impact central NGOs have on regional HIV/AIDS policies. As a second step of the analysis, the chapter will provide two examples that show how HIV/AIDS NGOs used their transnational links in order to exert influence on HIV/AIDS policy-making in Russia. The first example focuses on the interaction between NGOs in Russia and the Global Fund as the main international financing mechanism in the field of HIV/AIDS. The second example discusses the participation of Russian NGOs in the UNGASS reporting mechanism which monitors the progress of UN member states to achieve universal access to HIV/AIDS prevention, treatment, care and support as agreed upon in the 2001 UNGASS Declaration of Commitment on HIV/AIDS. These examples give insights into the ways Russian HIV/AIDS NGOs used transnational ties in order to pressure for policy changes in their own country. The chapter concludes with a summary that evaluates the role of NGOs in the fight against HIV/AIDS in Russia based on their different functions of service delivery, advocacy and empowerment. In contrast to the previous – regional – case studies, this chapter does not deal with the implementation of HIV/AIDS programmes nor the obstacles NGOs experience in their practical work (as this mainly takes place at the local level), but rather focuses on the opportunity structures and influence strategies of HIV/ AIDS NGOs with regard to other stakeholders at the local, national and international level. Overall, the chapter seeks to answer the following questions: (1) How did HIV/AIDS NGOs in Moscow interact with local, national and international actors? and (2) To what extent have they been able to influence domestic HIV/AIDS policy-making in Russia? The chapter draws upon different data: In addition to in-depth interviews with representatives from HIV/AIDS NGOs, Russian state organisations and health experts in general, information material, conference presentations, reports and project documentations of the organisations were analysed. Field work in Moscow extended over a longer period. After a pilot study in February 2007, further interviews were conducted in February and May 2008 and in November 2009. Moreover, participation in the Moscow conference “Civil Society and the Fight against HIV/AIDS in Russia” in January 2008 provided valuable information on the development of Russian HIV/AIDS policy-making and, in particular, on the role of civil society actors.