For more than thirty years, the world has been living with the problem of deadly AIDS. This disease is still incurable, difficult to diagnose and insidious. And how many myths there are around HIV and AIDS! For example, about “safe sex” with a condom and about the fact that HIV is not transmitted through saliva. AIDS Day, which is celebrated on December 1, is another reason to talk about this disease.
HIV terrorist caught in Moscow
December 1st marks World AIDS Day around the world. ohm What is the situation with HIV and AIDS in Russia? Here are just some of the figures prepared for the landmark date by the Federal Scientific and Methodological Center for the Prevention and Control of AIDS.
By the end of this year, the number of HIV-infected people will reach one million people, and the number of people infected in 2014, according to doctors, is 80 thousand. About two hundred people become infected with HIV every day- half of them are young women aged 25-35 years.
Injection drug addicts hold the top spot among the total number of people infected with HIV.- 57 percent. Almost all the rest are ordinary men and women leading promiscuous sex lives.
It may be noted that the head of the above-mentioned federal center, Academician of the Russian Academy of Sciences Pokrovsky, announced a change in the global strategy in the fight against AIDS. In short, the usual (and already slightly set on edge) preventive measures in the form of promoting the use of condoms in developed countries recede into the background.
Which is not surprising at all. If only because although despite many sites, dedicated to AIDS, the possibility of infection through the saliva of a patient is openly ridiculed - but the discoverer himself dangerous infection, Nobel laureate Luc Montagnier, had a completely different opinion on this matter.
And professional instructions for doctors, in case of saliva (or other biological fluids) of a patient getting into the eyes or mucous membranes, categorically require that they immediately be washed with disinfectant solutions. And then take antiretroviral drugs for several months - which is clearly done taking into account the by no means imaginary “safety” of the saliva of an HIV carrier.
When applied to ordinary lovers, this means that a condom only reduces the risk of a healthy partner contracting HIV from a sick one. But the same passionate kiss (and even with a bite, which often happens at the height of passion) can lead to a fatal outcome, from which “product number 1” cannot save, even if it wants to.
Returning to Professor Pokrovsky’s information, the world is now focusing on early diagnosis of HIV - and the earliest possible start of treatment for HIV-infected people.
In general, in the non-medical press and on forums, the terms HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome) are often used interchangeably. But this is not always the case.
HIV is simply a pathogen, and an HIV-infected person is a carrier of this virus. When clinically, this carriage practically does not manifest itself in any way - except perhaps for the presence in the blood of antibodies to the virus, which, alas, are unable to cope with it radically.
But when the virus begins its destructive work of destroying the immune system, then it manifests itself as AIDS. Which kills its victim sometimes within several years.
However, if you start taking antiretroviral drugs during the HIV carrier stage, AIDS may not develop at all. Or - in a very old age. Which, in general, is equivalent to the opportunity for a person to live an almost full life.
Small stop - early diagnosis HIV. And, alas, there are big problems with this in Russia.
Actually, there is only one main problem - HIV testing is entirely voluntary. Even in a hospital, when a patient from a “risk group” (the same drug addict, for example) is admitted, doctors formally do not have the right to test his blood for HIV without his consent. And in the absence of this, they themselves are at risk of contracting HIV, because they do not know what precautions to use when communicating with such patients.
But when dealing with drug addicts, caution is usually the default. But not every HIV-infected person is a drug addict - among them there are also people who are absolutely not involved in the addiction.
And take, for example, testing the most vulnerable groups - young people of marriageable age? So far, Chechnya and Ingushetia can boast of the best achievements, where All newlyweds are encouraged to take an HIV test before the wedding.
But there this initiative comes from the local clergy, and the local patriarchal traditions of respect for elders are incomparable with the rest of Russia. Try not to follow the “recommendation”. But in other Russian regions, even if such a practice is introduced, it will clearly not be generally accepted.
In this regard, it is appropriate to remember that in Soviet times, in skin and vein dispensaries, treatment of patients with much less dangerous syphilis began only when the patient honestly told the doctor about his sexual contacts: “when, with whom and where.”
Not because doctors suffered from excessive curiosity - it was simply that the earliest possible examination and preventive treatment of “contact objects” made it possible to “cut off” the spread of a real epidemic of sexually transmitted diseases.
But then glasnost, democracy, freedom, individual rights began, “anonymous treatment rooms” appeared - and the very effective fight against “diseases of love” almost came to naught. And the victorious walk of AIDS is the result of precisely this paradigm.
The tragedy of Russian society, including in terms of venereal diseases, was not least that “having left its native shore, it never came to another.”
In general, it is not for nothing that infectious disease doctors and dermato-venereologists ironically say that "the best remedy for AIDS - “Sleep alone” and “Sleep at home”. That is, either do not have sexual intercourse at all, or have one partner, a wife or girlfriend, and do not look for adventures on the side.
So, even during the war, German doctors examining Soviet girls deported to Germany for work noted that almost all of them were virgins!
Yes, in the West there is a different tradition, “free love”. But, for example, in the rather old American film “Love is like a deadly sexually transmitted disease,” the main characters, a guy and a girl in love, do not start having sex without a condom until they have been examined for sexually transmitted diseases.
Well, we have our own way. Marriage contracts and analyzes are vulgar Western rationalism, it’s unromantic for us. But maintaining virginity before marriage (and remaining faithful in marriage) is already “outdated.” As a result, we have what we have, the AIDS epidemic and not only...
It seems that the only measure capable of turning the situation around (except, alas, for the fantastic hope for the revival of morality) is introduction of mandatory periodic medical examination for HIV infection. With the preservation of "medical confidentiality" and everything attached, but nevertheless.
Other measures, such as “promoting safe sex” (which simply cannot be such in principle, even with the most reliable condom) are pounding water in a mortar. And they are unable to stop the spread of the “plague of the 21st century.” The sooner both legislators and society as a whole understand this simple thing, the sooner a turning point in the fight against AIDS can occur.
At the moment, in Russian Federation The AIDS epidemic is growing at the highest rate in the world. An article by Anna Banken, published in the San Francisco Chronicle, analyzes the social reasons for the current situation in Russia. This material, intended for publication outside Russia, allows you to assess the situation through the eyes of an outside observer, and, first of all, to see those features of the attitude of Russian society to the problem that prevent the formation of an effective policy regarding AIDS. Namely, that ignorance and inaction contribute to the AIDS epidemic. According to experts, the AIDS epidemic in Russia could reach proportions not found outside Central and Southern Africa. The government, however, continues to fail to act. At the moment, according to a UNAIDS report, Russia has the highest rate of epidemic in the world. At the same time, the heterosexual route of transmission increases sharply.
If HIV continues to spread at the same rate, more than 5 million Russians will become HIV-positive by the end of 2011. According to Vadim Pokrovsky, director Federal Center AIDS, the $5 million allocated annually to fight AIDS is a ridiculously small amount. For comparison, in the United States, $5 billion is allocated annually for such purposes. Pokrovsky said that $65 million is urgently needed for programs to prevent and treat HIV infection.
But it is not only the government that is inactive. Throughout the country, the AIDS problem is being denied.
In the beginning, the AIDS epidemic in Russia affected gay men in the late eighties. Sex between men was then considered a criminal offense, and any talk about it was taboo. But even when the epidemic among intravenous drug users began to explode in the mid-1990s, few people paid attention. When President Vladimir Putin addressed the nation in January 2002 about the crisis in the health care system, he did not say a word about HIV/AIDS. Official statistics look ominous. If by 2000, 87,000 cases of HIV infection were registered, now this figure is 201,000. Since 1997, the number of HIV-positive people in Russia has increased by more than 500%. The real numbers could be much higher. UNAIDS estimates this at approximately 700,000 cases of HIV infection. Pokrovsky suggests that there may be 1.4 million.
At this rate of the epidemic, 5 to 10 million people could die from AIDS by 2015, according to an estimate by the Washington Center for Strategy and International Studies.
At the same time, government funding is extremely insufficient. The healthcare system spends $45 per year per HIV-positive person, while in the United States this figure is $10-15 thousand per year. Preventive work on AIDS is carried out mainly by low-budget non-governmental organizations with the support of charitable foundations.
A year ago, Russia turned down $150 million from the World Bank to help prevent and treat HIV, AIDS and tuberculosis, which kill 30,000 Russians every year. The reason for the refusal was a sense of pride and confidence that the country could cope with the situation on its own. As Alexander Goliusov, head of the HIV/AIDS prevention department of the Russian Ministry of Health, said, Russia will not ask for help on its knees. Part of the reason for the government's lack of interest is that intravenous drug users have been hit hardest by the epidemic since 1996. Representatives of this group in Russian society are treated with contempt and fear; no one cares about their fate. According to Goliusov, the main problem is that most people continue to believe that AIDS is a disease of the scum of society.
Since the epidemic began in Russia relatively recently, only a few people developed HIV infection into the AIDS stage. According to official statistics, only 2,095 people have died from AIDS so far. “In Moscow, more people died in shootings,” says Pokrovsky, adding that it is time to take the problem seriously. The fact that the epidemic was quietly spreading among drug users was immediately reflected in a sharp increase in cases of HIV transmission through unprotected heterosexual contacts. It is the heterosexual route that is the main route of HIV transmission in African countries, where the number of HIV-positive people can account for 30% of the population.
"Either the epidemic is spreading like an explosion, or it is just being noticed," says Dr. Jay Levy, a recognized AIDS expert and professor of medicine in San Francisco. According to Aza Rakhmanova, one of the main AIDS specialists in St. Petersburg, the greatest concern is people's belief in their immunity to the epidemic.
In Russia they do not help those affected by AIDS. Fear and ignorance limit patient care.
This is also stubborn ignorance, which, according to experts, will maintain the epidemic in Russia for another twenty years. At the moment, the pace of the epidemic in Russia is the highest in the world.
The impending disaster was faced by a government spending $45 per patient per year, insufficiently trained health care workers, and a society that turned a blind eye to the problem, which is common even to those called upon to care for the most vulnerable victims of the epidemic.
“The problem is that people whose profession obliges them to take care of patients are so afraid of infection that they refuse to provide care,” says Nikolai Nedzelsky, director of the Moscow Educational Center INFO-Plus. According to Vedmed, Russian orphanages are reluctant to accept HIV-negative children born to HIV-positive mothers, but refuse to deal with children living with HIV. Little patients of Vedmed are delayed in development by at least a year and a half due to lack of love and care from adults.
Despite all the efforts of organizations to combat AIDS, the majority of Russian residents, even doctors working with HIV-positive people, treat people living with HIV as outcasts from society. “Instead of trying to treat HIV-positive people, they would rather have them all die and take the infection with them,” says Nikolai Panchenko, president of the St. Petersburg Society of People Living with HIV/AIDS.
According to Alexander Goliusov, HIV-positive people are illegally expelled from schools and institutes, fired and driven out of dental offices. Discrimination is rarely carried out openly, under various pretexts, and it goes unnoticed by the public. “People living with HIV/AIDS are isolated in Russia,” says Nedzelsky, whose center runs an HIV/AIDS hotline. - “They don’t have any rights, sometimes they don’t even know about their rights.”
AIDS took Russia by surprise. Low-budget charity groups are fighting to educate the public.
How many people know that unsafe sex can lead to HIV infection? Like most HIV-positive people in Russia, they simply don’t think about it.
HIV is spreading faster in Russia than anywhere else in the world, but the government is failing to educate the population. Even as government health officials worry about an uncontrolled epidemic, only $3 million has been allocated for antiviral therapy this year. This is barely enough to treat 500 of the 201,000 registered HIV-positive people.
Prevention and educational programs are virtually non-existent. Of the 2 million the government allocates for prevention, each person receives one cent per year. According to Vadim Pokrovsky, this is 10 times less than what is needed to create an effective preventive program. A possible reason for the government's refusal to acknowledge the problem lies in fear of scaring off Western investors, and a lack of resources allocated to more pressing issues such as the war in Chechnya and army reform. However, the government has allocated about $2 billion to celebrate St. Petersburg's 300th anniversary. “Apparently, the government is not taking the problem of AIDS prevention seriously,” Pokrovsky notes dryly.
Prevention programs have encountered unexpected resistance. Medical professionals, most of whom were trained under the Soviet system, continue to view drug use as a law enforcement problem only.
The same situation has developed in education. Although recent surveys show that 95% of Russian residents know about the routes of HIV transmission, this knowledge is not applied in practice. “The problem is that people don’t trust what they know,” says Alexander Goliusov. Efforts to introduce sex education in high schools have been met with opposition from parents who fear such classes will lead children to have sex and the conservative Russian Orthodox Church.
According to Nikolai Panchenko, private AIDS organizations are barely making ends meet. On television they only rarely talk about HIV-positive people, mentioning only the injection route of transmission. AIDS experts argue that television programs are not aimed at people who do not use drugs, and such people are becoming more and more common among HIV-positive people.
According to Pokrovsky, Russia's failure to create a long-term prevention program now will lead to huge complications in the future. “The government will only start to worry when people with HIV become a significant part of society,” says Panchenko. “Unfortunately, it seems that this will only happen when there is an HIV-positive person in every Russian family.”
A deterioration in the HIV situation in Russia has been noted since mid-1996. The epidemic began its movement from the port city of Kaliningrad, spreading among injection drug users. During the year, 2.8 times more infected people were detected and 1.6 times more than during all previous ten-year observation periods. In 1998, 3,607 people were affected by the epidemic, which is 21% less than in 1997. In just four years, the epidemic spread to more than 30 cities across the country. In 1999-2000, there were several new outbreaks of HIV infection among injection drug users in large cities, particularly in Moscow, St. Petersburg and Irkutsk.
According to official data from the Russian Scientific and Methodological Center for the Prevention and Control of AIDS, in total, for the period from January 1, 1987 to August 1, 1999, 17,000 HIV-infected Russian citizens were registered, of which 533 were children, 175 children infected from mothers during pregnancy and childbirth. 377 patients were diagnosed with AIDS, including 126 children. To date, 101 children in Russia have already died from AIDS.
Among those who fell ill in 1999, 70% were young people aged 15 to 29 years. A third of all those infected in Russia are women, 98% of them are of childbearing age. Of the total number of HIV-infected people in 1999, 1.6% of children were found infected. The ratio of sick people to women since 1996 in Russia has been consistently 3:1.
The total number of administrative territories where HIV infection is registered has reached 83. Almost a quarter of all HIV-infected people (more than 2,700 people) are in correctional institutions, 90% of them are drug users. In 1997, 58 HIV-infected adolescents were serving sentences in the penitentiary system of the Ministry of Internal Affairs of Russia; by the end of 2000, their number had almost doubled.
The HIV epidemic, which began in Russia in mid-1996, is due to the development of another, no less terrible social problem - drug addiction. According to expert estimates, there are more than 2 million drug users in Russia. Today in Russia there is a unique situation - several socially determined epidemics are developing: the epidemic of HIV infection, drug addiction, STDs, and viral hepatitis with a parenteral transmission mechanism.
Due to the fact that HIV infection first appeared in Russia ten years ago, the incidence of HIV/AIDS is characterized by the following stages:
Appearance and initial outbreak of nosocomial infection among children in 1987-1990;
- “pseudo-quiet” period (1991-1995), when a small number of cases were diagnosed;
The period of escalation, when the rapid spread of HIV infection among intravenous drug users began in 1996 and continues to this day;
The spread of HIV infection among drug addicts, against the background of promiscuity, leads to the spread of the epidemic to other groups of the population, mainly through heterosexual contacts.
Experts from the Russian Scientific and Methodological Center for the Prevention and Control of AIDS believe that Russia has already passed the first initial stage and enters another - the stage of a “concentrated” HIV epidemic, which is characterized by a high susceptibility of risk groups and an increase in morbidity among the rest of the population. The third and final stage of the “generalized” epidemic will not take long to arrive.
Thus: Considering the variability, versatility and multi-sectorality of the problem of HIV/AIDS, countering the spread of this infection in Russia should be based on an integrated approach with the involvement of all interested ministries and departments, as well as international and non-governmental organizations and structures.
Russia is on the verge of an AIDS pandemic and its further spread on the territory of Russian regions “will sharply weaken not only the economic, but also the international position of our country.” The spread of AIDS will affect “all aspects of our relations with the world,” Karaganov believes. The political scientist announced the intention of the constructive forces to “promote an information and political lobbying campaign to force our society and government agencies to seriously address this problem.” In his opinion, the problem of AIDS “should become a topic of public debate, as well as central in the activities of Russian parliamentarians.
Today in our country the number of HIV-infected people exceeds one percent of the total population. Most of those infected are young people between 20 and 30 years old. In terms of the growth of HIV infection, Russia is second only to Ukraine: even Africa and Southeast Asia are left behind. The cost of treatment that prevents HIV infection from developing into AIDS is approximately $9,000 per year. In our country, 1 ruble is spent on the prevention and treatment of AIDS. 50 kopecks per year per person. At the same time, Russia transfers millions of dollars to international funds that fight AIDS. The combination of these facts cannot but amaze. It is obvious that Russia is far from the richest country in the world; it is well known that underfunding of even the most important programs is our sad tradition.
But in this case, it would seem that elementary logic dictates that if the situation does not change radically, a national catastrophe awaits us.
Various scenario developments are possible. Under an optimistic scenario, another million Russians will become infected, and then the epidemic will begin to subside, that is, several tens of thousands will become infected per year. In a pessimistic scenario, according to the African version, if the disease actively spreads sexually, we can talk about several tens of millions of infected people.
A country or other socio-economic community exposed to the combined influence of factors that increase the likelihood of the spread of infection is defined as a risk environment. When an infection spreads through the general population, it can be argued that the entire community represents a risk environment.
The consequences of the epidemic will be associated with the fact that those infected are mainly people who are at the most demographically, economically and socially productive age, that is, bearing a greater share of responsibility for financial support and care for others. The significance of the failure of these people extends far beyond the family, manifesting itself in the depletion of labor resources in economic sectors, in a decrease in labor productivity and savings necessary for investment, in demographic consequences, which will be all the more painful the unfavorable the initial economic and demographic situation in the country.
Regarding the consequences of the epidemic, it must be taken into account that once the virus has spread through the population, the consequences of its spread will be felt in subsequent generations. Since stopping the spread of the virus in modern conditions unrealistically, the economic, social, demographic, psychological and other consequences of the epidemic will unfold for decades after it has reached the general population. They will be felt for a long time even after the virus has completely stopped circulating.
The duration of the consequences of the epidemic is influenced by the social, economic and cultural characteristics of the country or regions, population groups involved in the epidemic process, as well as the timeliness and effectiveness of measures aimed at preventing the spread of HIV.
UNAIDS experts studying the consequences of the HIV/AIDS epidemic in the countries most affected by the epidemic have come to the conclusion that they have a wavy nature. Let's consider this issue in more detail.
At the epicenter of the chain of consequences is the transmission of the virus from person to person. Over time, the consequences of this transmission spread widely.
The first wave of the consequences of HIV/AIDS “draws in” individuals and follows directly the spread of the virus: those who are now infected will, after some time, begin to get sick and die. The first ripple effect is on the infected individuals and, consequently, their families, partners and caregivers. It includes the trauma of the diagnosis, societal reaction (acceptance or discrimination), economic and emotional impact on families, health care provider response, illness, and death.
As the number of cases increases, family incomes decrease. Children's school fees and food costs can become overwhelming.
Using savings in a vain search for a cure can drive even a fairly wealthy family into poverty.
Often, national consensus on the urgency of prevention is reached only when a significant number of people are already infected and many are developing AIDS or AIDS-related diseases, such as tuberculosis. It is usually only at this stage that the voices of healthcare leaders, healthcare workers, those infected and their families begin to be heard at the highest levels of management.
The second wave of consequences occurs as more and more patients die and more and more children and elderly people are left without support. In this wave of the epidemic, poverty, which has engulfed a significant part of the population, may intensify. The second wave has a destructive effect on the family, since the majority of those infected, being at the stage of life, have the maximum number of people economically dependent on them: children, parents and other persons who need support. When those infected begin to get sick and die, the people who depend on them will be left without a livelihood. For every adult who dies, there is usually an average of one or two people who depend on them. The most significant feature of this wave is its psychological impact with the loss of a large number of lives of parents, brothers and sisters, friends, children, colleagues, neighbors.
The third wave of consequences reaches the level of regions and economic sectors.
It occurs because those infected are in the most economically productive and active period of their lives. There is a loss of significant volumes of population and labor resources, and human resources, as is known, are a key factor determining the ability of any country to resist the epidemic. The country is experiencing difficulties in this regard. They are caused by the aging of the population, which causes a high economic burden on the able-bodied to be disabled. The epidemic will worsen this situation. It affects the quantity and quality of labor resources employed in all sectors of the economy. The loss of labor input caused by HIV/AIDS will jeopardize not only the standard of living of families and other communities, but also the efficiency of the functioning of economic sectors. Increasing morbidity can ultimately affect all sectors of the economy and the overall results of its functioning, that is, affect the productivity of the national economy.
The pattern of supply and demand for labor resources will change. In this case, the determining factor will be professional and geographical differentiation of the level of infection spread. The most vulnerable types of regional economies will be those focused on a small number of industries.
This group will also include industries that require a significant number of trained personnel for whom it is difficult to quickly find replacements. There will be a decrease in savings and a change in patterns of their use. And they influence the growth rate of gross national product. The decrease in the level of savings will occur in parallel with the increase in direct and indirect costs associated with the epidemic. With growing numbers of people falling ill and dying and those caring for the sick, people will have less and less time to care for and socialize their children, engage in manufacturing, or become self-employed.
Thus, the consequences of the epidemic are cumulative losses of human resources, erosion of development opportunities and deepening poverty.
The fourth wave is the long-term potential consequences. It is directly related to the failure of previous interventions. If the spread of the virus is not slowed as soon as possible and those affected by the epidemic are not given adequate support, then the very survival of various populations and even nations may be at risk. The need to support needy orphans left without supervision and care, the weakening of basic public and utility services, rising prices, deterioration in the quality of services can lead to discontent and social tension.
The scale and nature of the fourth wave of consequences are determined by the following two main circumstances:
By society's response to the infected and those caring for them (it is very important whether they remain an active part of society and whether it provides support and care for them), if the infected are pushed out of society, the damage will be even greater;
Differentiation of the level of infection spread in professions and regions.
The experience of countries affected by the epidemic suggests that at this stage the consequences can be so devastating that even external interventions to prevent the disintegration of society may be too late. The epidemic is already undermining the progressive achievements of recent decades in many affected countries. Its destructive impact is observed on households, industries and agriculture, entrepreneurship, social infrastructure, healthcare, as well as on structures whose activities are related to ensuring the country’s security, including the police and army.
In severely affected regions of the world, the virus caused enormous demographic damage: life expectancy dropped significantly and until 2010, the epidemic doubled child mortality, negating the gains made in reducing infant and child mortality over the past ten years. These long-term consequences of the epidemic are not entirely inevitable.
Their scale and severity will depend directly on the timeliness and effectiveness of behavior change programs and policies that can respond to the needs of those infected, sick and survivors. Timely, adequate and effective actions based on an integrated approach to the problem can significantly reduce these consequences. All these waves, naturally, do not exist separately, but are superimposed on one another. The mentioned waves of the epidemic correspond to the levels of its influence - individual, family, regional, sectoral, national.
At the individual level, as already noted, the greatest damage will be caused by the epidemic to the young, working-age population. Despite the fact that older people become infected with HIV relatively rarely, the consequences for them will be the damage to their families - a source of support and assistance. Children will suffer to a certain extent both from the epidemic, mainly due to the infection of mothers, and due to orphanhood as a result of the death of mothers from AIDS. People with low incomes are likely to make up the majority of the epidemic's victims. With regard to the vulnerability of families to HIV/AIDS, it is necessary to take into account both their composition and socio-economic status. Particularly vulnerable families include:
Insufficiently wealthy elderly couples (due to the possible death of children - a potential source of financial assistance and emotional support in old age);
Families with a low level of education of the married couple (due to less wealth);
Large families (due to possible disease children);
Single-child families, especially in old age of a married couple (due to the possible loss of the only child, with whom support in old age is associated);
Single-parent families (due to the possible loss of a breadwinner).
The impact of the epidemic on families will be especially strong when the losses it brings begin to affect the living conditions of dependent family members (children, elderly people). The number of low-income families will increase as the number of orphans and dependent elderly people increases. At this level, the main economic impacts will be loss of income and changes in budget allocation. At the regional level, the socio-economic consequences of the epidemic begin to be especially acutely felt when labor resources are depleted, labor productivity and production efficiency decrease, and, consequently, tax revenues decrease.
When there is a reduction in traditional industries in industrial regions, problems such as
High unemployment (often of more than one family member at a time);
Alcohol and drug abuse;
Intrafamily violence;
Labor migration (sometimes for a very long period).
All this favors the formation of “bridges” for the spread of infection to the general population, that is, an increase in susceptibility, and therefore vulnerability. At the national level, the consequences of the epidemic will be a drop in social productivity and production, which will cause a decrease in GDP, a decrease in tax revenues, budget cuts, a decrease in spending on social needs and social infrastructure, a decrease in savings and investments, and a decrease in export earnings. The scope and severity of the economic consequences will depend on factors such as the development of waves of the epidemic; the prevalence of HIV infection, its territorial, social, professional and sectoral differences; the structure of the economy and the relative vulnerability of its sectors to the epidemic; development of adequate, effective and timely programs.
The medical, social and economic consequences of HIV infection are as follows:
Defeat of the most able-bodied part of the population;
A sharp decline in population health indicators;
Economic damage to society;
Difficulty in organizing patient care due to diversity clinical manifestations;
High treatment costs (treatment of an AIDS patient for a year is measured in tens of thousands of dollars);
Possible discrimination against patients and HIV-infected people.
On the territory of the Republic of Belarus, all problems related to AIDS are solved by the Republican AIDS Center. The CIA included Russia on a list of five countries where the AIDS epidemic is developing most dynamically. In this ranking, Russia took place after Nigeria, India, Ethiopia and China. The CIA report states that by 2011 in these countries the total number of AIDS patients and HIV-infected people will be from 50 to 75 million. Human.
American experts are right in many ways. According to Vadim Pokrovsky, “if in the near future it is not possible to change the attitude of the government, and most importantly, in society, to this problem, in the next decade the country will lose hundreds of thousands of mostly young citizens from AIDS, and therefore the children they could give birth." In the Samara region, for example, from 20 to 35 thousand people are infected, or 5-7% of the young male population, and this number will grow. They are unlikely to start families, which will have a negative impact on the demography of the region. They will hardly be able to work fully, and in 7-10 years those who became infected today will die. For the country's economy, the progressive loss of men aged 25-35 years can become very noticeable. The army will face even greater problems. In 2002, 5.5 thousand HIV-infected conscripts were exempted from conscription - the army was missing an infantry division.
Thus, according to experts, Russia has two paths the epidemic could take. If you take the necessary preventive measures, as they did in Europe, the epidemic will cover risk groups and their sexual partners. In this case, 2-3 million people will be infected in the next 5 years. If you miss the initiative, then the epidemic will follow the African type, where the predominant route of infection is heterosexual. In such a situation, in just 5 years we could have up to 7 million HIV-infected people. According to Pokrovsky, the epidemic can only be stopped with the help of daily and widespread propaganda healthy image life, including protected sex.
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Because HIV/AIDS is NOT a medical problem.
HIV/AIDS has consequences in many areas of social and economic life, and its effects are felt by all participants economic activity households, businesses, government. Modern society needs to understand the problems associated with HIV and AIDS, since timely planning and implementation as early as possible of the necessary measures to counter the HIV/AIDS epidemic will save resources and human lives, and minimize efforts to overcome and mitigate the consequences of the epidemic.
WHY TALK TO THE TOPIC OF HIV/AIDS?
Prejudice. Corruption. Orphans. Sex. Health. Globalization. Excess profits.
Poverty. Dissidents. Drugs. These are just a few of the reasons that motivate media professionals to become more aware of AIDS-related issues.
It is often said that HIV/AIDS is the major health story of our time. Around the world, AIDS kills more people than famine or war.
But the story of AIDS is not only death. After all, we are also talking about how people live with HIV.
Today, most Ukrainians know about HIV/AIDS only from the media, and not from personal experience communicating with HIV-positive people. This means that the media play a key role in shaping knowledge, behavioral practices and public opinion about HIV infection and AIDS.
The media can contribute to certain stereotypes that HIV and AIDS only affect small, isolated groups of people. Or, conversely, that all people are at equal risk of HIV and AIDS. Neither of these extremes is true. HIV/AIDS can affect anyone, however, using simple remedies prevention, it can be avoided. Certain factors associated with the conditions
life and standards of behavior are, to varying degrees, risk factors for infection with the human immunodeficiency virus.
The key to preventing infection is for everyone to have accurate, unbiased information about what these conditions and standards of behavior are. Prevention is impossible without treatment. This is why people living with HIV desperately need support and understanding instead of judgment. Also, the general public needs information about available personal protective equipment (prevention).
In this sense, all materials about HIV/AIDS are a form of educational activity in the field of health, and the duty of journalists is not to neglect this socially significant information.
But HIV/AIDS is much more than a health story.
The spread of HIV infection is influenced by social and economic factors, political indifference and incompetence, thirst for profit, and corruption of government officials. The media can explore and highlight these factors, thereby influencing governments, international and national organizations, and businesses to do everything in their power to prevent the further spread of HIV infection and support those whose lives it has already affected.
Often journalists do not see the difference between these concepts and use them as synonyms. But this is wrong. What's the difference?
HIV – human immunodeficiency virus.
It is a retrovirus (slow virus), which, penetrating the human body, gradually destroys the immune system and leads to AIDS. The virus has a spherical shape, consists of RNA, and is protected by an envelope that is well adapted to exist in the human body.
AIDS (acquired immunodeficiency syndrome)
– the final stage of HIV infection. At the last stage, called AIDS, the final destruction of the immune system occurs in the human body and it loses the ability to resist not only any external infections, but also conditionally pathogenic microbes that
always live in the human body and do not cause diseases in people with a normally functioning immune system.
People die not from HIV, but from opportunistic (concomitant) infections.
Thus, HIV and AIDS are different concepts. HIV is a virus that destroys the immune system, and AIDS is a complex of diseases (syndrome) that manifests itself in HIV-positive people against the background of the destruction of the immune system and decreased immunity.
HIV and causes of AIDS
For more than 20 years, scientific circles have believed that a necessary condition for the development of AIDS is HIV, which, according to the overwhelming majority of researchers, causes AIDS. But there are still experts (called HIV dissidents) who are not convinced that HIV is the cause of AIDS. Others believe that HIV can lead to the development of AIDS in the presence of some unknown concomitant factor.
Routes of HIV transmission
HIV is present in human biological fluids. In the concentration necessary for infection, HIV is found in the blood (including menstrual blood), semen and vaginal discharge infected people, as well as in breast milk. The virus can only be transmitted to other people if these fluids enter their bodies.
Thus, the main routes of HIV transmission are:
Unsafe anal, vaginal or oral sex(i.e. sex without a condom); HIV cannot pass through condoms high quality(made from latex or polyurethane).
Blood-blood contact. This usually occurs when drug injection equipment or piercing and tattoo equipment are used together. In the past, before mandatory testing of donated blood was introduced, this occurred through transfusions of blood or blood products, and through the transplantation of untested donor organs. Very rarely, HIV can be transmitted through occupational injuries to health care workers, such as being stuck with a contaminated needle or being cut by a scalpel.
Perinatal mother-to-child transmission during pregnancy, childbirth or breastfeeding, since HIV is contained in the mother's biological fluids - blood and milk.
HIV epidemic and AIDS epidemic. What's the difference?
When we talk about the HIV epidemic in Ukraine, we mean the number of new cases of infection. Ukraine occupies a leading place among European countries in terms of the growth rate of new cases of infection.
The AIDS epidemic suggests an increase in the number of deaths from AIDS in the fourth clinical stage of HIV infection.
The AIDS epidemic begins in the absence of treatment with drugs that suppress the development of HIV.
What are the stages of HIV infection?
The clinical picture of HIV infection is characterized by 4 stages:
1. Asymptomatic stage. No symptoms of the disease are observed. This period lasts from 3 to 15 years. A person is clinically healthy, but due to the presence of HIV in the body, he is able to infect other people almost immediately (a week) after infection.
2. Disease of the type of generalized lymphadenopathy. There is a steady, at least 3 months, increase lymph glands in different places.
3. AIDS-associated complex. Body weight decreases, chronic drowsiness, fatigue, night sweats, diarrhea, fever, itching, lymphadenopathy, enlarged spleen appear, damage to the eyes and mucous membranes by opportunistic microorganisms is observed.
4. AIDS itself. With the gradual destruction of the body's immune system, extensive damage to all vital human systems occurs by opportunistic (concomitant) infections. Affected gastrointestinal tract, respiratory and cardiovascular system, central and peripheral nervous system, malignant tumors can develop. If treatment is not started in time, this stage ends in death.
In Ukraine, people most often die at the AIDS stage from tuberculosis, pneumonia and cancer.
Even if an HIV-positive person feels well, having HIV in his or her body means that he or she will eventually become vulnerable to common infections that people with an intact immune system can easily fight off. Therefore, it is vital for HIV-positive people to take care of their own health: avoid substances that suppress the immune system (tobacco, alcohol/drugs), avoid stress, exercise, eat well, lead a balanced lifestyle, regularly see a doctor at the local AIDS center, and also start taking ARV drugs on time.
What does HIV “do” in the human body?
When HIV enters the human body, it attaches to certain blood cells, on the surface of which there are CD4 molecules, on T-lymphocytes.
Lymphocytes play an important role as “sentinel systems” in the body. They “call for help” T-killer cells, which fight poisons, viruses and microorganisms. HIV “deceives” the body’s guard system, setting up a factory inside the lymphocytes to produce “spare parts” for future viruses. HIV needs 72 hours to “pick up the key” to the lymphocyte and penetrate inside it. The virus needs another 12 hours to get out of the lymphocyte and begin to bring itself to an “adult state.”
After some time, the infected cell becomes filled with virus particles, explodes, and dies. When this happens en masse, the number of T cells in the blood drops dramatically and the number of copies of the virus increases. The immune system ceases to cope with opportunistic infections, microorganisms and viruses - a person develops AIDS.
HIV can also penetrate long-lived cells, the so-called HIV reservoirs, neurons of the central nervous system, retina (macrocytes and macrophages), and “hide” in them for a long time, until the time when HIV can no longer be detected in the blood, and several years later, after any stress, it can appear again. Since HIV belongs to the category of “slow” viruses, it can remain in the body for a long time, showing practically nothing. Sometimes representatives of religious sects claim that they allegedly “cure” those suffering from AIDS. It should be borne in mind that the most powerful immunosuppressant is a person’s severe psycho-emotional state. Some people really benefit from prayer or meditation to maintain harmony with themselves and the world. However
It is important to understand the nature of HIV in order to draw the right conclusions about the next “miracle of St. Jorgen.”
CONSEQUENCES OF THE HIV/AIDS EPIDEMIC FOR UKRAINE
Impact on the demographic structure of the population
The total number of HIV-infected Ukrainians and Ukrainian women, according to expert estimates, will reach 479–820 thousand in 2014, with another 29–94 thousand people becoming infected every year. The HIV prevalence rate among adults by 2014 could reach 1.9–3.5 percent, and the number of people who need ART - 130 thousand people (77 thousand according to the optimistic scenario). It is estimated that AIDS will cause 35,000–65,000 deaths each year, and a similar number of people will develop the disease each year. AIDS in 2014 will account for almost a third of all deaths among men and 60 (!) percent of deaths among women aged 15 to 49 years. Life expectancy for men will be reduced by 2–4 years, and for women by 3–5 years. The spread of HIV/AIDS will exacerbate the already unfavorable demographic situation in Ukraine. Without AIDS, low fertility rates would have driven the country's population down to 44.2 million in 2014; Another 300–500 thousand will be lost to AIDS, due to which the total population in 2014 will decrease to 43.9–43.7 million people.
The healthcare system is already feeling the negative consequences of the AIDS epidemic; the population’s need for medical services. But an increasing number of people of working age will need medical care, those people who, in the absence of an epidemic, were not active consumers of medical services.
Costs will increase for the diagnosis of HIV infection, treatment and maintenance of HIV-infected and AIDS patients, for the treatment of opportunistic diseases, and the prevention of vertical transmission (transmission of HIV from mother to child). The need for specialized medical personnel, blood testing laboratories, test systems, anonymous examination rooms, hospitals, etc. will increase.
Additional burden on the social sphere*
Due to the increase in the number of infected adults and children, as well as orphans, the burden on the social sphere increases due to the AIDS epidemic. Support for these population groups and social support for families with HIV-positive members will require additional resources. The loss of a breadwinner forces the state to increase the cost of maintaining such families. People who could act as labor find themselves supported prematurely, produce nothing and need help. Families appear that consist exclusively of disabled people. The population's needs for social services, psychological assistance and rehabilitation services will increase.
Impact of AIDS on children*
The negative attitude of society towards people living with HIV also extends to children. The issues of maintaining and raising children who are HIV-positive are not resolved. Some parents abandon such children, as well as children with AIDS. Siblings may become separated due to the loss of parents. Children who remain orphans and half-orphans will have significantly fewer opportunities to receive parental attention and care, as well as adequate upbringing and education. Taking into account the above, it is possible to foresee the emergence of preconditions regarding the formation of social inequality for children who grew up in families and children whose parents died of AIDS.
Implications for the labor market*
The catastrophic consequences of the AIDS epidemic include a reduction in the country's workforce, redistribution of labor between sectors, loss of working time (direct and collateral), decreased labor productivity, and limited ability to work of part of the workforce. There will also be a change in the quality of the workforce. AIDS will slow down the reproduction process and
accumulation of knowledge, significantly reducing the time young people use the acquired knowledge and professional skills, reducing the efficiency of education costs.
Implications at enterprise level*
Enterprises become vulnerable due to infection (loss) of management personnel and qualified specialists, and the costs of searching, recruiting, training and gaining experience increase. The number of employees at enterprises is decreasing. Tensions may arise in the workplace due to intolerant attitudes (stigma and discrimination) towards HIV-positive employees.
Consequences of the epidemic: conclusions*
The optimistic scenario for the development of the epidemic provides for the successful implementation of the activities of the National Program for Combating HIV/AIDS.
In 2014:
according to the optimistic scenario, the total number of HIV-infected people will be 479 thousand people (1.9% of the population aged 15 to 49 years);
according to the pessimistic scenario, the total number of HIV-infected people will be 820 thousand people (3.5% of the population aged 15 to 49 years).
The immediate results of the HIV/AIDS epidemic will be as follows.
The life expectancy of the population will decrease, economic activity will decrease, and labor efficiency will become low. Mortality and disability will increase. The economic structure will change active population(depending on the most affected sex and age groups). The birth rate will decrease and the number of orphans will increase. Tax revenues to the budget will decrease, spending on the social sphere and healthcare will increase.
The epidemic also has a long-term impact on the country's economy - a reduction in bank deposits and investments, a drop in motivation to invest in human resources - in education and health. Financial risks will increase and the trade balance will change.
State policy and counteraction to the HIV/AIDS epidemic
When we talk about HIV and AIDS, we must understand that first of all we are talking about all aspects of human rights, indivisible and inalienable: political, economic, cultural, social, reproductive, etc. The HIV/AIDS epidemic is not a problem of a single group of people, it is a problem of the entire society as a whole. And the state must take an active part in ensuring and maintaining the rights of its citizens, regardless of their HIV status, social status, ethnic origin, religion, religious, political, sexual or any other preferences. Improving the epidemiological situation in Ukraine is impossible without political decisions. The state's efforts should be aimed at developing both political and legislative mechanisms that would ensure fundamental human rights for HIV-positive citizens of Ukraine: non-interference in personal life, freedom from discrimination, the right to engage in socio-economic activities, stable funding for HIV programs /AIDS. HIV infection is completely controllable social problem. But this is a problem, first of all, a political one, which concerns both the rights of Ukrainian citizens and the state’s policy towards its citizens. Looking at HIV infection from the point of view of fundamental humanistic values allows us not to divide the single human essence into departments of “law”, “economics”, “politics”, etc., but to consider all these matters as a whole. For, contrary to the claims of traditional political theory, the human person, family, reproduction and sexuality must be included in political analysis of the problem of HIV/AIDS. The personal is political! No state that claims to take the needs of HIV-positive citizens seriously can ignore this thesis.
The diagnosis of HIV infection means the presence of the human immunodeficiency virus in the blood, which may not be accompanied by any changes in health status for many years, however, the very knowledge of the presence of HIV infection in the body almost always leads to changes in a person’s life. Currently, there are about 1 million HIV patients in Russia. The situation with the treatment of HIV-positive citizens in Russia is catastrophic. According to the World Health Organization, in Russia, out of 50 thousand people in need of HIV/AIDS treatment, 1,500 people (3%) receive therapy. The rest are doomed to death, although the use modern methods Antiretroviral therapy can prolong the life of HIV-infected patients by decades. In developed countries, the press conference participants emphasized, HIV is already considered a manageable chronic disease, not a fatal one. The peculiarity of this diagnosis is that it is associated with many social and psychological problems, internal crises, stress, difficulties in interpersonal relationships such as fear of transmitting the virus to a sexual partner; problems with the ability to have children, since there is a risk of transmission of the virus from mother to child; negative attitude towards HIV-infected people in society, etc. All this affects the quality of life, relationships with others and the attitude towards oneself and is not always clear to people who are not personally affected by the problem of HIV/AIDS.
Psychological problems
People living with HIV often have to deal with social and psychological problems long before they need medical help. It is very important to pay special attention to solving these problems. The emotional well-being of HIV-positive people requires no less serious approach than the physical well-being. Learning to live with HIV - difficult task, it requires a lot of strength, as well as support and help from loved ones and specialists.
Most people living with HIV go through difficult periods in their lives, characterized by depression, anxiety, fear, sleep disturbances, nightmares, difficulty concentrating, feelings of helplessness, hopelessness, and thoughts of death. These and other emotional crises interfere with taking care of your health and sometimes lead to mistakes that are difficult to correct. During a crisis, a person is faced with several problems at once and does not see a way out of the current situation. In this state it is difficult for him to understand even own feelings and desires. There are several periods during which people living with HIV are particularly vulnerable to crisis.
Getting a diagnosis. When most people first receive a diagnosis of HIV infection, they experience severe shock. Then they are faced with the question of how their future life will turn out, how long it will last and how all this will affect the people close to them. There is no “correct” reaction to this diagnosis: everyone perceives it differently. Many are overcome by anger, depression, despair, and fear for themselves and their loved ones. Some people think about suicide at first. Others, on the contrary, are absolutely calm. Often a person does not believe his diagnosis at first. Most people who learn about their HIV status are forced to reconsider their ideas about their own lives.
The appearance of the first painful symptoms. Often these manifestations are not related to HIV infection, but an HIV-infected person may perceive them as symptoms of the development of the disease. Until this moment, a person only knew about the presence of the virus, now HIV becomes visible to him, and the symptoms become proof of the diagnosis.
The need to take medications regularly. Most people with HIV infection are young people who have no previous experience of taking daily medications. Some of them are frightened by the thought of the inability of the immune system to fight the virus on its own, others are frightened by the complexity of taking medications and the possibility of side effects.
Serious painful symptoms. Painful symptoms in themselves are a difficult test for a person, and many HIV-infected people cannot get used to the fact that their lives will be associated with pain and medications, and constant seeking of medical help will force them to change or quit their job or stop studying.
Serious illness or death of an HIV-infected acquaintance. The loss of a loved one is always a hard blow. Death from AIDS is especially difficult for loved ones who themselves live with HIV infection. Thoughts about the possibility of approaching one's own death lead to serious emotional crises.
In addition, everyone may have their own crises depending on the values that are threatened due to HIV infection: study, career, personal relationships, creating or maintaining a family, favorite pastime. All these crisis situations are associated with emotional losses and deep negative experiences. A person experiences anger, despair, guilt, anxiety, and bitterness of loss. Many HIV-infected people are acutely aware of their own death and are afraid of losing physical attractiveness, health, independence, or losing friends and loved ones and being left alone. Therefore, during this period a person especially needs support, and the nature of this support determines how a person copes with his emotional state.
Social problems.
Many patients are forced to live in conditions of stigma and discrimination, even in countries with high HIV prevalence where the disease affects virtually everyone in the community.
Sick people are fired from their jobs and abandoned by their relatives and friends. For these reasons, patients begin to feel like outcasts from modern society.
A serious problem for HIV-infected people is discrimination from people around them. Thus, according to statistics, 46% of respondents believe that HIV patients should be isolated from society; 55% would transfer their child to another kindergarten (school) if they found out that there was an HIV-infected child there.
HIV carriage or AIDS have an obvious impact on the psyche and change the psychology of infected people due to the fact that today they are incurable, chronic diseases; proceed in a difficult to predict manner and for many years, are almost always accompanied by negative dependencies, and are perceived by almost any society as a negative and rejected phenomenon.
In families of HIV-infected and AIDS patients, psychological problems that are typical for any other families may arise, but at the same time, these problems acquire a certain specific coloring. It should be remembered that any person who is in close interaction with the carrier of a certain problem experiences its influence on their life and is codependent. Contacts with addicts force them to change habits, disrupt plans, cause fears about their loved ones with whom the addict interacts, and, finally, force them to plunge into the problem that was imposed on them. The main characteristics of codependent behavior are low self-esteem, excessive use of psychological defenses, and controlling behavior.
Lack of availability of quality medical care, discrimination against patients, the inability of the existing rights protection system to meet the real needs of people living with HIV/AIDS, insufficient funding for programs aimed at improving their quality of life.
Attention should be paid to the number of HIV-infected and AIDS-infected children, which is increasing every year. Taking into account the fact that today's HIV-infected children will not be able to ensure a healthy future for both our country and the world community as a whole, the importance preventive measures measures aimed at preventing the spread of HIV/AIDS among minors is increasing significantly.
Thus, the socio-psychological consequences of HIV infection manifest themselves at several levels: individual, family, society. infected hiv discrimination psychological