Russia faces HIV drug shortageDW 12/10/2023

Patients at the Moscow Center for HIV/AIDS Prevention and Control warned last month on a patient website that the antiretroviral drug dolutegravir is no longer available in pharmacies in the Russian capital.

It’s not the only HIV drug that’s unavailable.

“Patients have reported 400 cases of drug shortages to Disruptions, a website that monitors HIV and hepatitis treatment in Russia,” Novaya Gazeta Europe, an independent Russian news site, wrote in November.

The news site estimates that medical institutions have cut purchases of AIDS drugs by almost half and stopped supplying 13 drugs entirely.

The epidemic is out of control

More than 1.13 million people in Russia are thought to be infected with the human immunodeficiency virus (HIV), which can cause acquired immunodeficiency syndrome (AIDS).

Ekaterina Stepanova, a doctor at a private clinic in Russia, said the actual number is likely much higher.

“More than 27 regions are currently experiencing an HIV epidemic,” she said. “This means that more than 1% of pregnant women test positive for HIV. This is terrible. It shows how far the virus is spreading throughout Russia.”

Only about 52% of all registered patients receive free medication. In exchange, they must register their status as HIV-positive and have this recorded in a database.

Many people do not want to register because they fear discrimination and social exclusion. In Russia, AIDS remains a taboo subject.

This is due not only to a lack of information, but also to prejudices associated with the virus: many people believe that only homosexuals, sex workers and substance addicts are infected with HIV.

Socially, these groups are widely stigmatized and may be subject to criminal prosecution.

“That’s why it’s very difficult to work with these groups,” Dr. Stepanova told DW.

A clinic employee operates a machine at the Moscow Research Center for AIDS Prevention and Control
Not all people with HIV receive care. Those who are lucky enough to have access to medicine will try to share it.Image source: Sergei Bobylev/dpa/picture alliance

Prejudice and ignorance

Alexei is one of the few Russians willing to disclose his infection status. He lives in Moscow and still remembers the day he received his diagnosis.

“I was eight years old when I learned that I had been infected by my biological mother since birth. I spent a long time in the hospital. [something else], they discovered it by accident. I didn’t think too much about it at the time. I was just a kid with no preconceptions. “

He lived in several foster homes until he was 14 years old. At first, he did not notice any discrimination because of his infection. It wasn’t until later that he realized he was being treated differently.

“As a kid, I always wondered why my cutlery, plates and cups always followed me when I moved into foster care. I actually kind of liked it. It wasn’t until later that I realized it was because of my HIV diagnosis.”

However, he believes this was done not out of malice but because those in charge didn’t know much about the virus.

However, when Alexei experienced discrimination in his later years, he was deeply hurt.

“One time, I was in a bar with my friends and I told them that I had HIV,” he told DW. “They asked me which cup I was drinking from so they wouldn’t get confused. For some reason, it made me sad and brought tears to my eyes.”

HIV is not easily transmitted from one person to another. The virus is found in blood and some body fluids. In most cases, fluids from an HIV-infected person must enter the bloodstream directly, such as through an open wound or mucous membrane during unprotected sex.

How myths complicate the fight against HIV

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Drug shortage

Of course, there is also the option of receiving treatment in a private clinic. However, patients must pay for the medication out of pocket. This usually costs 4,000 to 9,000 Russian rubles ($44-98 or $40-90), and not everyone can afford it.

“Most of the time, my patients buy their own medications,” Stepanova said. “Those who receive free treatment or have money to purchase additional treatment can bring it so we can distribute it to those who don’t have treatment. We look out for each other.”

But why are medicines in such short supply? International sanctions against Russia specifically exclude the life-saving drug. There are also cheaper Russian generics. But even this is not enough to treat all people living with HIV in Russia.

One possible explanation is that Russia’s health ministry’s budget for acquiring HIV drugs has been stagnant for years despite rising infection numbers. Russia used funds earmarked for 2022 and 2023 to pay for the drugs in 2021, according to the International Treatment Readiness Alliance, a non-governmental organization working to make HIV treatment more accessible.

Much of Russia’s money is currently invested in the war in Ukraine, which will only exacerbate the situation.

To make matters worse, Russia’s population is growing, which means HIV infections are also rising. In September 2022, the illegally annexed areas of Kherson, Luhansk and Zaporozhye in eastern Ukraine were declared Russian territory, meaning Russia technically counts the 11 million people living there as part of the Russian health care system part.

By the end of 2023, Russia is expected to have approximately 60,000 new HIV infections.

This article was originally written in German.

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