Conclusions

Did AIDS go out of control? In Russia 2010: And What it Means for the World, Daniel Yergin and Thane Gustafson described the devastating effect of a rampant HIV/AIDS epidemic in Russia. Before summarising the research findings, let us briefly return to this scenario which had marked the beginning of the investigation. In the nearly 20 years that followed the publication of Yergin and Gustafson’s book, HIV/AIDS in Russia has indeed turned into an epidemic of alarming proportions. The responsibility for this development lies with the Russian government, which during all those years has done far too little to effectively counter the spread of HIV/AIDS among its citizens. In 2010, the conditions for a constructive dialogue between civil society and the Russian state in the field of HIV/AIDS – regarded by many as a necessary precondition for developing effective prevention programmes – could hardly be worse. This becomes apparent when looking at international conferences devoted to the problem of HIV/AIDS in the region of Eastern Europe and Central Asia. In October 2009, the 3rd Eastern European and Central Asia AIDS Conference (EECAAC) took place in Moscow. As the most important regional conference on HIV/AIDS, it was the third in a row after two earlier meetings in 2006 and 2008. The purpose of EECAAC 2009 was to take stock of what had been achieved in the fight against HIV/AIDS in the region and to prepare for the International AIDS Conference in Vienna in July 2010 which was set as a deadline for achieving universal access to HIV/AIDS prevention, treatment, care and support. Although international guests such as Michel Sidibé, executive director of UNAIDS, expressed his gratitude to the conference organisers – the Russian state agency Rospotrebnadzor – and appreciated the “leadership and commitment of the Russian Federation,”1 the controversies on policy priorities in the fight against HIV/AIDS between international delegates, NGO activists and Russian state officials emerged clearly in the course of the conference. The Russian government was heavily criticised for not supporting prevention programmes for the region’s most-at-risk populations such as injecting drug users (IDUs), sex workers (SWs) and men who have sex with men (MSM). Particularly its neglect of harm reduction programmes as an essential element of HIV/AIDS prevention, Russia’s punitive drug laws and the exclusion of vulnerable groups from health care services were described as key

barriers to an effective response to HIV/AIDS.2 The conference delegates thus voiced a number of concerns that had been on the agenda of Russian HIV/ AIDS NGOs for a long time. There was, however, no one to listen. In contrast to the 2nd EECAAC meeting in 2008 when Russian Minister of Health and Social Development Tatiana Golikova addressed the delegates in person and promised to continue the implementation of all necessary prevention programmes in Russia, in 2009, members of the Russian government preferred not to speak at the conference. Instead it was left to Gennadii Onishenko, head of Rospotrebnadzor and Russia’s chief sanitary inspector, to bear the brunt of criticism by HIV/AIDS activists and conference delegates – a task which he as ever fulfilled while keeping a straight face and not moving one inch from fixed instructions. During EECAAC 2009, it became evident that the Russian government was not willing to reconsider its course on HIV/AIDS. When the 2010 International AIDS Conference was held in Vienna, Russia did not even send an official delegation. The Russian government’s refusal to engage in an open discussion on the best ways to counter the epidemic is a writing on the wall. Although political decision-makers started to pay greater attention to the problem of HIV/AIDS after 2006, when President Putin called the epidemic a threat to Russia’s national security, many of the government’s commitments remained empty words. A particularly controversial subject is that of harm reduction programmes which focus on prevention among IDUs: The majority of international organisations and Russian HIV/AIDS NGOs consider them cornerstones in the fight against the epidemic in Russia, as HIV transmission in the country is mainly associated with drug use. The Russian government, however, largely rejects harm reduction programmes and thereby misses the opportunity to reach those groups of its population which are particularly vulnerable to HIV/AIDS. As has been shown in the discussion of the case study findings, many NGOs in Russia have struggled to contribute to the fight against HIV/AIDS. They have conducted local prevention programmes, provided services to vulnerable groups, including harm reduction, and set up self-help initiatives for those directly affected by the epidemic. Many of these organisations follow the rationale that through cooperation with state institutions and advocacy it would be possible to introduce evidence-based interventions and improve Russian state policies in the field of HIV/AIDS. By engaging in a dialogue with state organisations and political decision-makers on the response to the epidemic, the NGOs thus strived to contribute to countering the spread of HIV/AIDS in Russia. In this approach, however, the organisations have faced many difficulties, as has become evident in this study. All in all, it seems that the Russian government has turned a deaf ear to the proposals, ideas and demands of HIV/AIDS NGOs. With its refusal to attend the 2010 International AIDS Conference in Vienna, relations between state and civil society regarding the problem of HIV/ AIDS in Russia have hit rock bottom. In order to understand how this development came into being, it is now time to recapitulate the case study findings and summarise the research results.