Russia's AIDS epidemic

One of the most disturbing aspects of Russia's HIV/AIDS epidemic is not only how rapidly it is spreading. It is also how many children from HIV-infected mothers have been abandoned and left to be cared for by the state. Efforts by the authorities to place them in kindergartens or schools are in most cases unsuccessful. They have become the children nobody wants, a sad reflection of attitudes in a naturally caring society.

Russian law states that abandoned children should spend their first three years in "baby houses," or orphanages that serve as kindergartens where children are taught to talk, walk and interact with other children.

However, because many of those places refuse to take children born from HIV-infected mothers, the children remain in hospitals, growing up in isolation from other children. Under these conditions, they are at high risk for developmental problems.

The Russian government's reaction to the level of threat posed by HIV/AIDS has so far been inadequate, particularly in dealing with the stigma and the care for orphan children.

The Russian government could learn from the slow and inadequate U.S. response to the epidemic, in which, initially, people with AIDS were made scapegoats and stigmatized.

Although the first case of AIDS was reported in 1981, President Ronald Reagan, who at the time had just recently come into office, refused to countenance the epidemic and made no official mention of the disease until 1987, when he finally named a commission on the problem. To Reagan's and many other people's surprise, that mostly conservative commission recommended passing anti-bias laws to protect HIV-positive people, the speeding of AIDS research, and on-demand treatment for drug addicts. That commission's recommendations would pave the way for a more appropriate response to the epidemic in later years.

It is now known that children of HIV-positive mothers can be infected during pregnancy, delivery or breast-feeding. Most infections can be prevented by adequate and timely treatment. But the way it all too often works out in Russia is this: Many mothers, particularly if they have not been treated, fear that their children will be born infected. Unable to deal with their care - either because they are too sick or poor or both - many mothers abandon their babies, who are then placed in maternity or infectious-diseases wards in hospitals.

To date, 21,000 babies have been born to HIV-positive mothers in Russia, of whom approximately 1,500 have been abandoned. More women of childbearing age are now becoming infected through sexual contact. As their number increases, so does the risk of even more babies being born infected by mother-to-child transmission. Many HIV-positive women hide their situation from family and coworkers and live in virtual isolation.

In recent years, Russia's HIV/AIDS epidemic has spread at dramatic speed, making its rate of infection one of the fastest-growing in the world. Several experts estimate that more than 1.5 million Russians are infected. According to World Bank estimates, that number could reach between 5.4 million and 14.5 million by 2020.

The American experience can serve as a guide to the Russian experience in this regard: It teaches us that AIDS is a problem that bridges social attitudes and public health. Experience in other countries has shown that major gains can be achieved through strong government leadership; by partnering with business, labor and religious leaders; and by coordinating the efforts of people living with HIV/AIDS.

Prejudice against the HIV-infected persists in Russian society. What is needed is a massive education campaign throughout the country aimed at the most vulnerable and disadvantaged. The campaign should include sex and HIV-AIDS education in the schools, lessons on safe sex and harm-reduction strategies, and education aimed at reducing the stigma and discrimination associated with HIV/AIDS.

A system should be developed to prevent as many cases of HIV transmission from mother to child as possible (indeed, such efforts should be part of maternal and child health services) and to disseminate the best practices. More pediatricians should be trained in antiretroviral therapy and in caring for HIV-positive children.

To prevent painful discrimination, the government should prioritize the fight against HIV/AIDS as public policy and prosecute violations of the federal AIDS law. HIV-positive mothers still face punishing discrimination. Both they and their children suffer.