VZCZCXRO3701
RR RUEHAST RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHTM
DE RUEHMO #1973/01 1921107
ZNR UUUUU ZZH
R 101107Z JUL 08
FM AMEMBASSY MOSCOW
TO RUEHC/SECSTATE WASHDC 8968
INFO RUEHYG/AMCONSUL YEKATERINBURG 3240
RUEHVK/AMCONSUL VLADIVOSTOK 2887
RUEHLN/AMCONSUL ST PETERSBURG 5002
RUEHZN/EST COLLECTIVE
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHPH/CDC ATLANTA GA
UNCLAS SECTION 01 OF 03 MOSCOW 001973
SENSITIVE
SIPDIS
DEPARTMENT FOR S/GAC (CLANGLEY), EUR/ACE
USAID FOR GH, E
HHS FOR OGHA
E.O. 12958: N/A
TAGS: KHIV EAID EINV EAGR ETRD PREL SOCI RS
SUBJECT: PEPFAR HIV/AIDS DISCUSSIONS IN RUSSIA
MOSCOW 00001973 001.2 OF 003
THIS CABLE IS SENSITIVE BUT UNCLASSIFIED. PLEASE PROTECT
ACCORDINGLY.
1. (SBU) SUMMARY: USAID's Assistant Administrator for Global Health,
Dr. Kent Hill, visited Moscow and St. Petersburg June 18 to 22 to
discuss President Bush's Emergency Plan for AIDS Relief (PEPFAR)
HIV/AIDS program in Russia with representatives of the Ministry of
Health and Social Development (MOHSD), the Global Fund for AIDS, TB
and Malaria (GFATM), UNAIDS and key NGO groups working on HIV/AIDS
prevention programs. While significant GOR resources are committed
to addressing the HIV epidemic, there are serious gaps in technical
expertise and experience. Post believes continued USG engagement is
essential to target and help mobilize these GOR resources. The HIV
epidemic remains a concentrated epidemic but without international
support providing access to international best practices, Russia is
at risk. Adequate USG funding is needed to enable USG to carry out
an effective program of targeted technical support through 2013
leading to a full transfer of the USG program in the sector by that
year. Dr. Hill's discussions highlighted areas for continued
USG-Russia cooperation on prevention and care efforts, particularly
in St. Petersburg where there is considerable potential for
deepening current US-Russian collaboration on HIV/AIDS.
-----------------------
AIDS Epidemic in Russia
-----------------------
2. (SBU) The HIV/AIDS epidemic in Russia continues to expand,
although there has been a marked decline in HIV transmission since
the peak in 2001. More than 440,000 people have been officially
registered with HIV/AIDS in Russia, although the unofficial estimate
is one million. Although injecting drug users (IDU) continue to
account for the majority of newly reported HIV/AIDS cases, a growing
number of these infections are attributable to heterosexual sex (one
third in 2007), linked to sex partners of IDUs. Women constitute an
increasing share of newly reported cases, 44% of cases registered
last year, up from 24% in 2001. This suggests that a window of
opportunity exists to contain the epidemic in Russia with
appropriate intensification of prevention and other activities. It
also suggests that there is a risk that the epidemic could expand
beyond the IDU or IDU-linked population. Continued USG technical
assistance to help the GOR target the growing resources that it is
committing to combat this scourge is essential and timely.
------------------------------
Meeting the Ministry of Health
------------------------------
3. (SBU) In Dr. Hill's meeting with Deputy Health and Social
Development Minister Ruslan Khalfin the Deputy Minister praised the
work of USG programs in Russia and stressed that MOHSD supported
efforts to disseminate nationwide the lessons learned in regional
HIV/AIDS programs. Khalfin expressed interest in continued
international, including USG, support for programs aimed at training
of health professionals and acknowledged the need for prevention
programs such as substance abuse programs for IDUs, including a
greater focus on life skills and prevention programs. Khalfin
reiterated that methadone treatment for IDUs remains illegal in
Russia, but noted that some forms of medication assisted therapy
could be considered. Khalfin noted that with the recent selection
of a new Director for the Federal Drug Control Service, there may be
opportunities to bring policy leaders and experts together to
discuss options for addressing the IDU-driven epidemic, including
programs that the USG could support such as study tours and training
on HIV-related issues - exposing Russian policy makers to
international experiences (and allowing them to share their own
experiences) on combating substance abuse.
--------------------------------------------- ----
UNAIDS and Other Partners in the Fight against HIV
--------------------------------------------- -----
4. (SBU) In meetings with UNAIDS and GFATM representatives, Dr. Hill
discussed the status of the epidemic and the need for greater
emphasis on prevention programs. Both organizations noted that
currently over 200 NGOs work on HIV issues in Russia, a significant
increase in recent years primarily due to external support from
international donors such as the USG and the GFATM. While this is
impressive growth, the downward trajectory of external funds has the
potential to thwart progress made in this area. Programs receiving
support from USG and other external partners are still needed as
many barriers limiting NGO access to GOR support persist. These
MOSCOW 00001973 002.2 OF 003
barriers include limited funding opportunities from GOR federal and
regional budgets and complicated funding disbursement systems.
According to UNAIDS and the GFATM, 83 percent of NGOs rely on
international funding. GFATM representatives noted the success of
grants in reaching targeted goals and treatment levels, but
indicated that the future sustainability of these NGOs after phase
out of GFATM support is in doubt without a firm transition plan.
-----------------------------------
HIV/AIDS PROGRESS IN ST. PETERSBURG
-----------------------------------
5. (SBU) In St. Petersburg, Dr. Hill and U.S. Consul General Kruger
met with representatives from the city's Health Committee and Social
Services Administration, which signed a Memorandum of Understanding
(MOU) with the USG in July 2007 to fight HIV/AIDS. The USG team
presented city officials with a six-month progress report on
achievements under the MOU. City officials emphasized the positive
impact of the MOU on coordination of joint efforts and expressed
their willingness to strengthen such collaboration in the future.
The City Health Committee praised Russian-American cooperation for
its important contribution to successful implementation of the St.
Petersburg City Government HIV/AIDS Action Plan as well as the GOR's
National Priority Project on HIV/AIDS. Officials highlighted
achievements in significantly decreasing the HIV mother-to-child
transmission rate from 19 percent to 6 percent and increasing
fivefold the number of people living with AIDS (PLWA) receiving
anti-retroviral therapy (ART) as a result of targeted USG support
under the MOU.
6. (SBU) St. Petersburg City health officials expressed the need for
continued USG support in critical areas such as improving
effectiveness of prevention programs for injecting drug users(IDUs),
patient treatment adherence to HIV treatment, improved links with
social services, and outreach to youth and street children. Health
officials explained their readiness to work collaboratively under
the MOU to further advance HIV prevention among IDUs by launching a
program using naltrexone as a medication assisted therapy in drug
rehabilitation. This use of naltrexone is a positive first step in
a path that may lead to the introduction of other drugs such as
buprenorphine or methadone as an accepted drug therapy.
7. (SBU) Faith-Based Leaders and NGOs: USG partners from the
faith-based community and NGOs highlighted their role in preventing
the spread of HIV among most at risk populations (MARPS). St.
Petersburg City officials present acknowledged the catalytic role of
USG supported program in strengthening government-NGO cooperation.
Last year 9,000 MARPs received outreach and HIV prevention messages,
the largest number of outreach activities in any one city in Russia.
Faith-based organizations are increasingly engaged in promoting
behavioral changes among vulnerable youth, provision of care to
PLWA, and drug-free rehabilitation services for IDUs. St.
Petersburg is now planning to replicate successful drug-free
programs developed by NGOs into state-run facilities.
8. (SBU) The USG team also visited a unique USG-support street youth
drop-in center and met with the heads of the Municipal
Administration and the Social Services Administration, strong
supporters of the USG program. The Municipal Administration has
directed funds to cover rent and other recurrent costs of this youth
center. The center is the first municipal social services program
to introduce HIV/AIDS tested services for street children and youth,
especially important in St. Petersburg where HIV rates among street
kids reached 37% in 2006, according to a study by the U.S. Centers
for Disease Control and Prevention. Municipal authorities plan to
expand the program to other districts within St. Petersburg in
collaboration with a USG-funded partner.
9. (SBU) COMMENT: The GOR is increasingly prepared to commit
financial resources to combat HIV/AIDS in Russia, but faces serious
gaps in technical expertise and experience. USG engagement can play
a critical role in helping the GOR overcome this technical capacity
gap and contribute substantially to containing the HIV epidemic in
Russia. With the existing support and leadership of GOR
counterparts, the PEPFAR program in Russia is well positioned to
support a bilateral compact or compacts with national and regional
governments in Russia to bring collaboration on HIV/AIDS to a new
level, mobilize significant additional Russian resources, and ensure
an orderly transition of USG-supported program to the GOR. Such a
compact could serve as a model for other graduating countries on how
to solidify collaboration with host country governments and how to
leverage and target host government resources.
MOSCOW 00001973 003.2 OF 003
BEYRLE