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[ Recorded presentation ] Recorded presentation

Rationing at the policy and service delivery levels: Towards a more strategic and ethical response to HIV/AIDS in the Russian Federation

Jill Costello, MPH, Boston University, Center for International Health and Development, 85 E. Concord St., 5th Floor5th Floor, Boston, MA 02118, 617-414-1433, jcostell@bu.edu, Shona Schonning, MPH, Program Director, Community of PLWHA, 1st Neopolinovski Pereolok Bldg 11/22, Moscow, Russia, and Eltom A. Akram, MBBS, MPH, c/o WHO Pouch Office, WHO Moscow, 20 Avenue Appia, CH 1211, Geneva 27, Switzerland.

Still in its early stages, Russia's HIV/AIDS epidemic only requires treatment for a low proportion of the one-million Russians living with HIV. Nonetheless, fewer than 5% of those in need receive antiretroviral therapy. Without a national strategy, rationing and resource allocation decisions can be arbitrary and subjective, and thereby discriminatory against those with weak bargaining power. Until access to evidence-based interventions is improved, strategies for addressing Russia's concentrated epidemic will remain highly cost- ineffective and inequitable.

Russia's HIV epidemic is concentrated among marginalized groups (injecting drug users, sex workers, prisoners and MSM), yet HIV testing is overwhelmingly targeted at low-risk groups. At the service delivery level, misconceptions are used to justify the exclusion of marginalized groups from the limited HIV/AIDS services. Also, despite methodological concerns about data collection and analysis, it is feared that the reported increase in heterosexual transmission is being used as a policy level maneuver to continue discrimination of marginalized groups in favor of "socially preferable" groups like children and pregnant women.

This paper will examine rationing tendencies occurring at policy and service delivery levels in Russia, and present public health and ethical arguments for increasing access to services for groups among whom the epidemic is concentrated.

Learning Objectives:

Presenting author's disclosure statement:

Any relevant financial relationships? No

[ Recorded presentation ] Recorded presentation

Rationing, Human Rights, Money and Antiretrovirals: Observations from Lesotho, South Africa & Russia

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA