Za Zdorovie!

We shift back to reality in Russia, as D'Adesky depicts a depressing scene on the Russian AIDS front. Having lived and worked at an AIDS center in Kazakhstan, this chapter sounded very familiar....Russia has the fastest growing rates of HIV in the world, which are running rampant in the drug user population and unfortunately making the transition to heterosexual contact.

The government response has been minimal and that seems unlikely to change given the cultural context of the country. The remnants of communism is guiding the much of the HIV response. Under the paternalistic nature of the Soviet regime, citizens were taught to obey, not question authorities. This has led to difficulties cultivating HIV advocacy groups, as stigma is widespread, little regard for individual rights exists (people are often testing unknowingly for HIV when they go for regular checkups (!!)), and ARVs are not affordable to the average Russian.

Harm reductions programs, namely distribution of clean needles to drug users, is the primary response by NGO's yet this has only contributed to increasing stigmatization of these groups.

For me the most interesting, and terrifying, part of this chapter was D'Adesky's description of the treatment of orphans. HIV positive infants who are orphaned (or abandoned) are housed at Children's hospitals. These hospitals, like much of Russia, are understaffed and underfunded. Increasing the problem, is the government's mandate to keep these infants in the hospital until they test negative for HIV. (Oftentimes, newborns carry passive maternal HIV antibodies that are shed within 18 months.) These infants stay in hospitals wards for months and many show signs of delayed development-which is common for institutionalized youth.

Like Tonya Thurman mentioned in her lecture, there is a growing movement away from orphanages and other institutionalized settings. Again, given the cultural context and stigma associated with HIV in Russia it seems unlikely that the government will shift to a model of community-based care. Which come to think of it is rather ironic given the underlying concept of communism.