From Russia with love

President Putin has insisted that Russia’s new ban on “homosexual agendas,” which allows for the arrest and detention of foreign nationals who express pro-gay sentiment or “appear to be gay,” will not apply to foreign athletes competing in the Sochi Games. This pledge has not failed to allay fears about the treatment of LGBT Russians, nor should it: Putin’s anti-homosexuality agenda is only one part of a much larger problem. Not all Russian citizens are entitled to the same level of civil liberties, social benefits, and welfare.

Among the most harshly affected by this disparity are injection drug users – the overwhelmingly majority of whom are men – and men who have contracted HIV due to having sex with other men who are HIV-positive. These two groups make up more 80 percent of Russia’s one million HIV/AIDS cases. Russia has a growing HIV epidemic due to male same-sex sexual transmission, though a portion of these individuals may also be injecting drugs and engaging in sex work. The World Bank estimates that by 2020, 20,000 Russians will die from AIDS every month.

But a man who has contracted HIV due to having sex with another man (regardless of how he self-identifies as himself as heterosexual, bisexual, or gay) is highly unlikely to come forward to seek treatment, due to fear of legal repercussions – including imprisonment. Like HIV-infected men who have sex with men, injection drug users are not eligible for medical treatment of any kind; it is illegal for the state or for private doctors to provide such treatment. In private conversations, my Russian colleagues would observe that the official government sentiment is that these two groups of Russian citizens suffer from these ailments because they have no moral fibre, and are thus not entitled to or able to benefit from rehabilitation or treatment.

Such assertions fly in the face of empirical evidence. There is unequivocal scientific evidence that individuals receiving methadone treatment for their injection drug use habits can reduce their own health risks, and minimize the health risks of others who might have intimate contact or relationships with them. For many years, China’s policy toward injection drug users was similar to Russia’s current policy, but in the last decade, China has decided to take a realistic public health approach by promoting methadone treatment programs for injection drug users.

The results are nothing short of amazing. When the pilot project was first launched in 2004 it only had eight sites. Now, it is a national program with more than 680 sites in 27 out of 31 provinces serving a clientele of more than 242,000. Certainly, negative attitudes towards people who inject drugs are still common in China. But the courageous action of the government sent a strong message to the society in general and to the injection drug users in particular: HIV is a public health problem, not a moral failing. 

Likewise, in many countries – China, South Africa, Tanzania, and Thailand, to name just a few – men who have become infected with HIV as a result of having sex with other men who are HIV-positive have benefited from antiretroviral treatment. These nations recognise that having a healthy population is an asset; a less than healthy populace would inevitably drain national resources. 

Prejudice and stereotyping are not limited to Russia. For many people, including educated and learned professionals, such as doctors and lawyers, there remains an underlying misconception that men who have sex with men and injection drug users cannot be productive or moral citizens – even in the “developed” world. Once, an American medical doctor asked me if “promiscuous” gay men could really stick to their HIV treatment regimes. 

Russia used to be a recipient of the UNAIDS’s Global Funds for HIV Prevention and Treatment, where education is a key ingredient. Russia has decided to forfeit this international-financed contribution to public health, because it considers UNAIDS’s requirement to adhere to international standards and practices to be “foreign interference.” Obviously, the immediate consequences of this refusal are that Russians who are living with HIV/AIDS will not benefit from the global scale-up of anti-retroviral treatment. Also, the disengagement may isolate Russian scientists and researchers, as well as health care providers benefiting from the intellectual, financial, and human resources in the international community.

Ensuring that people are treated for HIV and AIDS isn’t simply a public health issue, but a question of human rights. As we watch in dismay as Russia denies the basic humanity of its LGBT citizens and visitors, we must also consider its other abuses of human rights – in this case, its unwillingness to treat those with a terminal illness. One of the greatest accomplishments of medical science in the last quarter century is that HIV and AIDS are, with the right treatment, no longer a death sentence. Who is Russia to condemn its citizens to death, and then to claim that they brought it on themselves?

Frank Y. Wong, Ph.D., trained in social psychology, is an Associate Professor in the Rollins School of Public Health, Emory University, Atlanta, GA, United States. He is a Fellow of the American Psychological Association. Also, he is an Op Ed Project Public Voices Fellow. His research focuses on HIV and other non-HIV sexually transmitted diseases (e.g., syphilis) among marginalized (e.g., migrants) and sexual minorities. In addition to the United States, he has worked in China, South Africa, and Russia.