Health

A LOOMING TRAGEDY

Canadian scientists are helping Russia battle the growing scourge of AIDS

PAUL WEBSTER March 29 2004
Health

A LOOMING TRAGEDY

Canadian scientists are helping Russia battle the growing scourge of AIDS

PAUL WEBSTER March 29 2004

A LOOMING TRAGEDY

Health

Canadian scientists are helping Russia battle the growing scourge of AIDS

PAUL WEBSTER

LATE ONE AFTERNOON, Vinay Saldanha of Mississauga, Ont., finishes up another day at the Russian Federal AIDS Centre— a sprawling compound of concrete walls and towers ringed with barbed wire that houses the majority of Moscow’s AIDS patients. The task this day was simple enough: with a spreadsheet listing 15 types of pharmaceuticals, Saldanha and a group of hospital staff sorted $250,000 worth of drugs into boxes for shipment to clinics in Altay, Krasnoyarsk, Saratov and Tver, regions where clinical trials have begun under the direction of a team of Canadian scientists. More than a decade after Saldanha moved here to help tackle what was then a small HIV problem, his job has become a race: he’s now working fast to have these treatments tested and ready before a full-blown AIDS epidemic hits.

When it comes to HIV in Russia, the numbers—and the disputes surrounding them— say it all. Officially, the country’s health ministry reports that 268,000 Russians have HIV. But the head of the ministry’s HIV department admits the real figure could be double that, while the top HIV scientist in the country believes it should be quadrupled. Either way, Russia’s HIV growth rate is among the fastest in the world, surpassing even Africa’s. “Whichever of those figures is right, AIDS in Russia is a looming, massive tragedy,” says Saldanha, the 33-yearold project coordinator of the non-profit Canada AIDS Russia Project (CARP), which is currently spearheading a $2.3-million, three-year initiative to prepare Russian health workers for the epidemic. “It will soon hit this country with explosive force.”

Eight time zones away at Toronto General Hospital, Carol Major, CARP’s research coordinator and a laboratory diagnostics specialist, waits for Saldanha’s results. Along with an infectious diseases specialist at Toronto’s Hospital for Sick Children, an immunodeficiency specialist at Toronto General Hospital, and an epidemiologist at the University of Toronto—as well as dozens of researchers in Russia—Major analyzes Russian HIV infection and the application of various drug combinations. The collective aim is to increase education and improve access to treatment for massive numbers of patients. “The Russians need to make decisions in a hurry on how to treat these people, and they need to base those decisions on evidence they’ve gathered,” says Major, also a research coordinator for the Ontario HIV Treatment Network, Ontario’s largest HIV treatment binding agency. “We’re there to show them how to do it.” And all that before the government even acknowledges that any such programs will be needed.

HIV’s sudden spread in Russia has garnered little attention among the country’s politicians. Until the late 1990s, Russia was thought to have been spared the scourge of AIDS, which was then sweeping across subSaharan Africa. But HIV began to hit when the number of heroin addicts boomed as a result of cheap and plentiful narcotics that flooded in from Central Asia. The disease then began seeping into the mainstream population through unprotected sex. According to Saldanha, Russian leaders proceeded to make the same mistakes that fuelled Africa’s nightmare: campaigns promoting safe sex and risk reduction for drug addicts were rejected by politicians and Orthodox religious leaders, even as the number of HIV infections started to skyrocket.

Making matters worse, international efforts to help Russia address the emerging disaster came at a time when the government was coping with severe cash problems. Many initiatives—including a US$50-million World Bank loan offered in 1999—were delayed. Physicians and scientists warned that, without treatment, at least 100,000 Russians with HIV would require hospitalization begindag in 2007, and by 2015 over one million Russians could die of AIDS—but those words went unheeded.

Vadim Pokrovsky, the soft-spoken director of Russia’s federal AIDS centre, was among the first to publicly demand government action. A medical researcher by training, Pokrovsky has gathered data on HIV infection cases across Russia since 1987. Since then, he has built Russia’s only database charting the scale and nature of the burgeoning epidemic, in the process creating a powerful tool to challenge dubiously low government figures and political indifference.

‘GETTING the Russian government to buy into this in time to confront the crisis remains the challenge’

When Russian President Vladimir Putin recognized AIDS as a national concern in his annual address to the nation last year, many people credited Pokrovsky for the symbolic step forward. So far, though, confronting the plague remains a low priority for the Putin government, which earmarked a mere $6 million for HIV control in 2004. “My worry is that we’ll be stacking bodies in the streets before the government finally acts,” Pokrovsky told Maclean’s at the clinic where he works alongside Saldanha.

The two began their partnership in 2001 after Saldanha had spent six years campaigning across Russia to introduce HIV and AIDS control models based on Canadian approaches. At the suggestion of Russian health officials, Saldanha eventually decided to pursue the idea of linking Canadian AIDS control experts with Pokrovsky’s research team. “Numerous officials told us they would only consider adopting the Canadian approaches we were promoting if Dr. Pokrovsky approved of them,” Saldanha explains. “When we asked him to get involved, he recommended we work together to establish clinical trials to demonstrate to the government that Canadian methods are sound and appropriate.”

With Pokrovsky on board, Saldanha persuaded the Canadian International Development Agency to back the three-year project linking CARP with the Russian Federal AIDS Centre, the Russian ministry of health’s HIV/AIDS department, and a private Russian non-profit group called AIDS Infoshare. The core focus of the project is to build a consensus among Russian clinicians on “best practice guidelines” for HIV clinical care, epidemiological surveillance and laboratory procedures. As well, Russian physicians and researchers will gain experience evaluating HIV and AIDS patients under the guidance of Canadian experts. At the Russian Federal AIDS Centre, Saldanha notes with pride that many patients are now getting treatment thanks to the Canadian effort. But whether the programs can be extended remains to be seen. “Getting the Russian government to buy into this in time to confront the crisis remains the challenge,” Saldanha says. “To succeed, we may have to persuade a lot of officials this was all their idea in the first place.” lí1]