Spring 2008

 Vol. 16, No. 2

 Russia’s Growing HIV Epidemic

The terms HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome), typically first call to mind Africa. But increasingly the public is coming to realize that HIV infection rates are also soaring in countries like Russia, Ukraine, India, and China. In fact, HIV is spreading more rapidly in Russia than in any other country in Europe.1

A Brief Overview of the Epidemic in Russia

 In the early 1990s, HIV rates in Russia were negligible. As late as 1996, there were less than 300 reported HIV-infected persons in the entire country, but only five years later, in 2001, that number had skyrocketed to 90,000. Currently, around one percent of the population of Russia is HIV-infected, which places Russia third among countries with the highest number of HIV cases outside Africa.2

The epidemic in Russia has spread consistently through unclean needles in the drug culture.3 According to 2006 data from the U.S. government’s Centers for Disease Control, HIV sero-prevalence (the percent of a population testing positive for infection in a blood test) among injection drug users in Russia runs as high as 78 percent, whereas rates among those engaged in commercial sex are at a comparatively low 14 percent. Over 80 percent of AIDS cases in Russia occur among people between the ages of 15 and 30.4 Within that age group, injection drug users, orphans and street children, and commercial sex workers are at the greatest risk of contracting HIV.5

Each of these at-risk groups requires careful attention, but a relationship between HIV/AIDS and orphans has been largely overlooked and warrants special mention. While the global community has been aware for years of the devastating effect of HIV/AIDS on children, making orphans of countless numbers of them, it has failed to realize the drastic impact the orphan crisis can have on the HIV/AIDS epidemic. The situation in Russia presents a picture of the synergy of HIV/AIDS and the orphan problem. In Russia, street children who have lived in orphanages are two times more likely to be HIV positive than those who grew up in homes.6 Strategies to fight HIV/AIDS around the world must take into account the importance of the modern orphan crisis because many of today’s orphans will be tomorrow’s AIDS patients. Due to the magnitude of the HIV problem in Russia, a concentrated effort is required to effectively combat it. Everyone from government leaders to Sunday school teachers has a valuable role in the fight against this epidemic by stepping up and taking action.

Government Attempts to Curb the Epidemic

The Russian government is now taking positive steps in the fight against HIV/AIDS. Government spending on HIV/AIDS and hepatitis increased from $140 million in 2006 to $300 million in 2007, and the state has established a federal AIDS center, as well as 88 regional AIDS centers. In April 2006, President Vladimir Putin stated, “Carrying out preventive work among the groups most at risk of HIV infection is of vital importance.”7 Particular progress has been made in the area of mother-to-child HIV transmission. Through the government prevention program, overall transmission rates from mother-to-child have been reduced from approximately 35 percent to 5 percent.8

Additionally, the government has committed to providing anti-retroviral (ARV) treatment for everyone infected with HIV in Russia. Unfortunately, the reality is that ARV treatments often do not reach the people for whom they are intended.9 ARVs have a short shelf life and frequently sit in storage past their expiration date while officials deal with red tape. Another obstacle is the failure of lower-level officials to distribute the drugs. Recently, administrators of a large rehabilitation center not far from one of Russia’s major cities revealed that while over half of their program participants are HIV positive, not a single one of them had been receiving ARVs from the state. Rehabilitation center staff had visited the city AIDS center many times only to be repeatedly turned away. Tanya, a single mother of two children and a patient at the rehab center, was in the advanced stages of AIDS. Staff were concerned that she would not live much longer, and they could not afford the medications she needed. Thankfully, international leaders were able to intervene on Tanya’s behalf with the city AIDS center to get ARVs, not only for her, but also for all of the other HIV-positive residents of that particular rehabilitation center.10

The Response of NGOs and Government Agencies

Other governmental and non-governmental organizations (NGOs) from around the world are also increasingly active in combating HIV in Russia. The United States Agency for International Development (USAID) has been working very closely with both the Russian government and NGOs, such as Assistance to Russian Orphans (ARO), to fight the epidemic. The Joint United Nations Program on HIV/AIDS (UNAIDS) and The United Nations Children’s Fund (UNICEF) also continue to provide critical funding to a variety of NGOs in Russia to stem the HIV tide. In addition to large global groups like UNICEF and UNAIDS, many smaller NGOs are playing key roles in the fight against AIDS. One such group is

Doctors of the World, based in St. Petersburg. This organization operates a drop-in center where street children are able to receive medical care as well as a friendly hug and a cup of tea. Outreach workers also spend three days a week getting to know street children where they live and educating these young people about their health-care options. Recently, Doctors of the World has been collaborating with the Centers for Disease Control to provide voluntary, free HIV testing for street children.11 Those who are HIV positive receive ongoing counseling and are connected to clinics around St. Petersburg where they can receive anti-retroviral treatment.12 It is critical to have groups such as Doctors of the World that can provide the medical care and treatment that the church and some Christian organizations are generally less equipped to offer.

AIDS Ministries of Churches and Christian Organizations

Many church programs serving those with HIV in Russia have, of necessity, had small beginnings, largely due to the stigma within society, churchgoers included, against those who are HIV positive. Nevertheless, some churches are responding to the crisis and caring for people with HIV/AIDS in a wide variety of ways. One church outreach has been a visitation program to HIV/AIDS orphanages. This program, which includes holding babies, might appear to be a relatively small service, but in reality it is of great importance because it acts to break the pattern of prejudice, misinformation, and negative attitudes toward people living with HIV. It sends the message that one should not fear contracting HIV merely from touching an infant who is HIV positive.

Addressing the issue of HIV among injection drug users, Pentecostals, as well as other Christian groups, run a number of rehabilitation centers. Over 200 men and women participate in year-long rehabilitation programs in a facility at Kingisepp (Leningrad Region). Treatment includes character development, spiritual growth, job training, daily work on the center’s farm, and HIV/AIDS treatment for those who need it.13 This center has been a model which other drug rehabs across Russia have followed, including the well-known Betel and Ishod programs.

The Russian Orthodox Church began its anti-AIDS program in 2001, motivated in part by the alarming growth rate of HIV infection in Russia. The church focuses its efforts mainly in three areas: prevention of HIV in children and young people; spiritual, psychological, and social support services to individuals living with HIV; and hospice care. 14 The church’s work on behalf of those affected by HIV also includes campaigns to raise awareness and to counteract the social stigma and prejudice associated with people living with the disease. Presently, over 100 Russian Orthodox churches in Russia, Ukraine, and Belarus hold monthly prayer services for those affected by HIV. People who are HIV positive often attend these services, which in some churches are followed by support group meetings. The added benefit of these services is that they communicate to society that people affected by AIDS are welcomed, not turned away by the church. Speaking at the Global Summit on AIDS and the Church in November 2007, Sister Margarita Nelyubova said, “The [Russian Orthodox] Church became aware that increasingly people who learn about their positive status turn to God. So the Church must be ready and well-equipped to help a person living with HIV or AIDS to find in the Church a caring family.”15

In addition to churches, other Christian organizations working in Russia are engaged in the fight against HIV/AIDS. CrossRoads, a ministry of Campus Crusade for Christ, and Children’s Hope Chest, a leading international orphan-care ministry, have collaborated to develop the Life at the Cross Roads (LATC) curriculum specifically for the orphan population. This 30-lesson program uses “innovative methods to help youth develop character and make more positive and healthy choices, helping them to avoid devastating crises like HIV/AIDS.”16 More information about this cooperative effort is detailed in Matt Kavgian’s article, “An HIV/AIDS Ministry Partnership in Eastern Europe and Russia,” East-West Church and Ministry Report 15 (Fall 2007), 1-3.

Also working in partnership, Russian Ministries and its Moscow affiliate, the Association for Spiritual Renewal, joined with Tearfund (United Kingdom) to host the HIV/AIDS Forum of Good Practice and Networking in November 2006. This Moscow conference was attended by 153 individuals, representing 92 organizations from 13 countries. At the event, national evangelical leaders were equipped with training and resources, enabling them to more effectively address the HIV/AIDS crisis.17

Russian Ministries (RM) is actively responding to HIV/AIDS in other countries of the former Soviet Union as well. In Moldova, RM works with Pastor Vladimir Ubeivolc, founder of The Beginning of Life. Ubeivolc’s efforts include education in public schools and universities on the prevention of HIV/AIDS (reaching 15,000 students annually). This ministry also provides support to individuals who are infected with HIV. In 2007, Ubeivolc’s ministry held a first-ever summer camp in Moldova for people living with HIV/AIDS.18 At the camp, which was attended primarily by women and their children, staff shared the gospel message, and HIV-positive people, who typically face rejection by society, experienced acceptance and the love of Jesus.19 The Beginning of Life’s ministry model is being multiplied in Russia and Ukraine through Russian Ministries’ School Without Walls program, which includes an HIV/AIDS component in its training for future church leaders.20

AIDS Care Education Training (ACET), with ANPO as its Russian acronym, has over 300 HIV educators actively working in 90 cities and towns throughout the country.21 Trained volunteers raise awareness and present AIDS prevention programs in schools, universities, orphanages, drug rehabilitation centers, and prisons. ACET has also published two books in Russian on the topics of AIDS and sexual health, one of which, AIDS and You by Dr. Patrick Dixon, ACET international founder, contains case studies of Christian HIV/AIDS projects in Russia and Eastern Europe that have proven successful.

“The way of Jesus is clear,” Dr. Dixon maintains. “A Christian AIDS response means we are called to express the unconditional love of God to all in need, regardless of how they come to be so. This is fundamental to the call of the church to serve the world.”22 To that end, an important aspect of ACET’s work is to assist existing organizations in launching effective and compassionate AIDS ministries by providing training and resources.23 The organization is a member of the ACET International Alliance, a network of independent groups responding to the AIDS crisis worldwide. ACET International has affiliates in Ukraine, Czech Republic, Slovakia, Croatia, and Slovenia, and is beginning work in other parts of the former Soviet Union.24 Numerous other Christian organizations are developing AIDS ministries in Russia as they seek to bring the love and hope of Christ to those affected by the disease.

Resources for Responding to the Crisis

In November 2007 more than 1,700 people gathered at Saddleback Church, Lake Forest, California, for the third annual Global Summit on AIDS and the Church, at which over 90 international speakers addressed attendees. The event called for cooperation among government agencies, the private sector, and religious communities in combating HIV/AIDS and emphasized how and why the church’s involvement, in particular, is critical. Speaking at the Summit, Kay Warren, Executive Director of the HIV/AIDS Initiative at Saddleback Church, said, “People with HIV/AIDS need to have the invisible God made visible to them–that is our purpose. There are many things we don’t know about this epidemic, but what we do know is that individuals living with this disease need at least six things: acceptance, hope, support, to know people care, a family, and our presence.”25

Churches can be very effective in combating AIDS. When pastors lead the way in showing Christ-like compassion to those with HIV/AIDS, church members are more likely to become engaged as well. This principle is central to Pastor Rick and Kay Warren’s “local church-based” strategy for mobilizing congregations worldwide to respond to the HIV crisis.26 Valuable resources to assist churches in raising awareness and launching effective AIDS ministries are available at www.purposedriven.net/hiv.

It is important to carefully consider the synergy of HIV/AIDS and the orphan crisis when formulating a response to the epidemic in Russia. The two are so inextricably linked that caring for orphans can also help avert the HIV crisis. Because young people in Russia are the most at-risk group for HIV, and the rates among orphans soar above those for children raised in homes, additional outreach to institutionalized children and those living on the streets can have a significant impact in preventing the spread of this disease.

Two networks, the U.S.-based CoMission for Children at Risk and its sister organization in Moscow, The Russian National Network for Children at Risk (www.risknetwork.ru), assist churches, Christian organizations, and individuals in beginning or developing ministries to orphans. In addition to coordinating training and networking events, both groups maintain comprehensive websites that include profiles of hundreds of organizations serving at-risk children in the region, ministry materials in several languages, partnership opportunities, articles, statistics, and events calendars. The sites also contain useful information related to HIV/AIDS in Russia. Profiles of Christian organizations responding to Russia’s HIV crisis, including those highlighted in this article, and resources to help individuals and groups begin or grow AIDS ministries are readily accessible at www.comission.org/go/hiv.

Conclusion

There are positive signs of action by governments, NGOs, churches, and ministries in response to HIV in Russia, but much remains to be done to stem the flood of the country’s rising AIDS epidemic. The vital importance of Christians in this battle cannot be overstated. Those affected by HIV need the compassionate care and support of Christians, and the church is uniquely equipped to deliver the message of hope that can both prevent the spread of AIDS and give strength to those who are suffering.

Notes:

1 UNAIDS, 2006 Report on the Global AIDS Epidemic (New York: UNAIDS, 2006).

2 Ibid.

3 UNAIDS, Country Situation Report: Russian Federation, 2007; http://www.unaids.org/en/Country/Responses/Countries/Russian_federation.asp.

4 Dr. Susan Hillis, Centers for Disease Control, Personal Interview, 3 February 2008.

5 Dmitry M. Kissin et al., HIV Sero-prevalence in Street Youth in St. Petersburg, Russia (Atlanta: Centers for Disease Control and Prevention, 2007).

6 Ibid.

7 Opening Remarks at State Council Presidium Meeting on Urgent Measures to Combat the Spread of HIV/AIDS in the Russian Federation; www.kremlin.ru/eng/text/themes/2006/04/211932_104794.shtml, 21 April 2006.

8 Dr. Susan Hillis, Centers for Disease Control, Personal Interview, 3 February 2008.

9 UNAIDS, Country Situation Report: Russian Federation, 2007; www.unaids.org/en/Country Responses/Countries/Russian_federation.asp.

10 Cristi Hillis interview with Tanya, 24 April 2007.

11 Kissin, HIV Sero-prevalence.

12 “Russia: Access to HIV Testing, Prevention, and Care Services for Street Youth”; www.dowusa.org/wher-we-work/Russia/Russia-youth-hiv, 12 February 2008.

13 Pastor Mikhail Kozitsky, personal interview, 20 April 2007

14 Sister Margarita Nelyubova, “Church Models of Leadership in HIV,” Presentation at the Global Summit on AIDS and the Church, 28 November 2007.

15 Ibid. See also http://www.rondtb.msk.ru.

16 Crossroads, www.crossroadslink.org, 12 February 2008.

17 Combating HIV/AIDS, Russian Ministries, December 2006.

18 Pastor Vladimir Ubeivolc, “Excellence in Global Leadership,” Presentation at the Global Summit on AIDS and the Church, 29 November 2007.

19 Russian Ministries, www.russian-ministries.org, 3 December 2007.

20 Ubeivolc, “Excellence in Global Leadership.”

 21 ACET International, www.acet-international.org/Russia.htm, 18 February 2008.

22 “AIDS: Christian Action and Compassion,” http://www.globalchange.com/craids.htm, 18 February 2008.

23 ACET International, www.acet-international.org, 12 February 2008.

24 Ibid.

25 Saddleback Church’s HIV/AIDS Initiative, www.purposedriven.net/hiv, 1 December 2007.

26 Ibid.