interview over patiënten en zorg in st. petersburg

I have seen some of your photographs. The hospitals are difficult to find, I would think, if you don't know they exist. They don't have signs.

Absolutely. It's really quite interesting. In cities that have literally tens of thousands of HIV patients, all of the HIV hospitals and HIV clinics are unmarked. They do this on purpose, in large part because of the degree of stigma. So often the entrances to these clinics and facilities exist what seemingly looks like down a back alley, and certainly without significant signage. It speaks to the level of stigma and challenges that patients face, in terms of access and care.

Is the stigma also related to homosexuality or is that not an acknowledged issue?

It's largely an unacknowledged issue. But in terms of, let's say, cultural stigma, homosexuality is really not accepted in Russia. There are the very nascent beginnings of gay rights political movement, as well as rights for HIV-infected individuals. But these are not widely accepted. The educated person on the street in Russia will utter things about injection drug users, or gays, or HIV-infected patients that I think we have largely abandoned in the United States 20 years ago. The level of stigma in the general population is quite profound, even among the educated intelligentsia.

What percentage of people with HIV has access to meds in Russia?

Well, again, the statistics are often a bit fuzzy in terms of their accuracy. In St. Petersburg there are roughly 30,000 individuals known to have HIV, that is to say, registered with the federal government. Of those, fewer than 2,000 have access to continuous care. I think that that's the situation that my St. Petersburg colleagues will say needs to change.

Part of the difficulty is because of stigma. Part of the difficulty is because of the numbers of antiretroviral medications that are currently available. Part of the issue is the notion that injection drug users can't adhere and therefore are not really included in the nominator of the population that is theoretically eligible for antiretroviral therapy. So it's a situation that is in flux. There are ongoing and significant difficulties that are faced by the large majority of patients in the Russian Federation, in terms of access to care.

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