RUSSIA

Monitoting and Evaluation of HIV/AIDS programs

Irina Savchenko

Background

Russia has 147 million people. The first case of HIV/AIDS was reported in 1987 and the cumulative number of registered HIV infected is nearly 10,000. Initially, the epidemic was limited to men who have sex with men, but from 1996 a rapid increase occ urred among injecting drug users (IDU). There are an estimated 2 million IDU in Russia. The AIDS epidemic in Russia is now concentrated, with considerable variation within the country. A rapid increase of other STDs has been observed in recent years (e.g. syphilis).

National response

There is a united centralized system of 87 AIDS centers and more than 1,000 laboratories. Until 1995 there was mandatory and compulsory testing of 15 population groups. All HIV infected persons are registered and the initial response was contact traci ng for all HIV infected persons. During the early nineties counseling was increasingly integrated in the contact tracing. In 1995 a law was adopted that prohibited compulsory testing. Only blood donors and medical personnel are still subjected to compu lsory testing which meant to be conducted in conjunction with counseling.

In 1996 it became clear that the infection was spreading rapidly among IDUs. Training workshops were held for personnel of the AIDS centers and others to address this rapidly emerging problem. IEC materials for the general population have been develop ed and are disseminated on a modest scale. Condom promotion is also a relatively recent development.

There are more than 250 sites for anonymous testing and home test kits are also available. A Russian equivalent of AZT is used. Multi-drug anti-retroviral therapy is not available on a large scale because of cost.

Monitoring and evaluation

The mainstay of the monitoring and evaluation component of the AIDS programme has been the identification of HIV infection in special population groups. Data on HIV prevalence are collected at the country's AIDS centers. With the spread of HIV into IDU s and other population groups coverage of the AIDS centers is likely to be less complete. There are plans to revise the current HIV surveillance system.

There are very few studies about sexual behaviour or other risk behaviours such as injecting drug use. A telephone survey about AIDS knowledge was the first study related to AIDS, followed by a few studies on high risk behaviour among men who have sex with men, IDU and commercial sex workers.

Input, output and context

Information about the availability of condoms is limited. A study in Moscow in 1995 showed inadequate availability and accessibility of condoms. Studies among teenagers have been carried out in selected urban and rural areas to assess levels of knowled ge, attitudes and sexual behaviour. Although counseling with testing is mandated by law, an evaluation of counseling services has shown that only 2-10% of those tested were counseled according to the national protocol.

Proximate determinants

Only limited data are available on condom use and sexual practices.

HIV and STD

HIV prevalence data are generated by the AIDS centers and affiliated laboratories, but a national system of surveillance still needs to adapt to the changing face of the epidemic.

With regard to medical care-related transmission no case of infection has been registered during the last nine years. STD data are available from clinics and national and sub-national estimates of the incidence of syphilis and other STDs are available and have shown a rapid increase from 1989. The incidence of viral hepatitis (B and C) is also monitored and has shown a rapid increase among IDU during 1991-1997.

AIDS impact mitigation

Since 1996 there is a federal law that addresses the human rights of HIV infected individuals. Social support to HIV infected persons and their families is also guaranteed by law, but it is not known how operational this policy is or how "social s upport" is defined or measured.

Conclusion

The main strength of the monitoring and evaluation component of the AIDS programme is a united centralized system of AIDS centers throughout the country, which allows monitoring of the epidemic based on the annual reports of the centers. The surveilla nce system has yet to adapt to the changing face of the AIDS and STD epidemics. There is a lack of behavioural studies among the general and target population.