LBA

SS146 - Practice of Governance

Minerva University

Mar 17, 2024

 Introduction

HIV is a virus that attacks the body’s immune system and can be transmitted through
sexual contact, sharing needles to inject drugs, or during pregnancy and birth. There is no cure;
however, with proper care, it can be controlled, allowing people to live healthy and long lives
while protecting those around them (Centers for Disease Control and Prevention, 2022).
However, when not controlled and not treated properly, HIV can gradually destroy the immune
system, causing health decline and progressing into AIDS (HIV.gov, 2022).
According to UN estimates, Russia is ranked among the top 5 countries in terms of HIV
prevalence in 2021, with the number of infected people increasing significantly over time
(Gladkih, 2022). Over one million people in Russia are infected (Brangham & Kane, 2018), and
thousands are unaware of their diagnosis due to stigmatization, lack of sex education, and limited
recognition and partial denial of the problem by the government. For instance, Russia’s Health
Ministry considered the data indicating the extremely high rates of HIV cases as “yet another
propagandist provocation directed against our country” (Avilov, 2022). From this arises the first
governance problem.
According to Figure 1, the number of annual new infections is estimated to be between
70,000 and 150,000. As of the end of 2023, there are 1.6 million registered cases across Russia
(​​Isayev, 2023), with some regions having significantly higher positive case rates due to a lack of
financial budget allocated to fighting the epidemic and available facilities that can implement
and provide comprehensive HIV/AIDS prevention services.
 Figure 1: This graph illustrates the number of people diagnosed with HIV in Russia from 2016 to
2022.

The mortality data shows that HIV-related mortality had increased from 0.2 deaths per
100,000 people in 2000 to 18.5 per 100,000 (1 death per 5,405 men) in 2018 in men and 8.7 per
100,000 (1 death per 11,494 women). Russia’s mortality rate was almost 6 times higher than in
the UK, where there was one HIV-related death per 66 thousand people in the same year (Cairns,
2023). This report focuses on the reasons for HIV epidemics in Russia and explains the
government’s role in controlling this governance problem.
Analysis
Bevir defines state capacity as “state’s ability to overcome opposition in order to
accomplish its policy aims” (Bevir, 2009), and more narrowly state capacity often refers to the
ability of a state to provide public goods (Reiss, 2021). Next, let’s dive into the definition of
public goods and whether the programs and initiatives aitmed at prevention, treatment of
HIV/AIDS, and support fall into this category. Public goods are defined as goods that are
non-excludable meaning that individuals cannot be excluded from benefiting from them (Reiss,
2021). The efforts of HIV/AIDS-focused programs benefit society as a whole by reducing the
spread of the disease, improving the health and well-being of those affected, and potentially
decreasing healthcare costs in the long run. In the context of Russia’s fight against the spread of
HIV/AIDS, the main problem is the lack of capacity in terms of available financial resources to
help those infected.

Figure 2: This figure illustrates the trend in budget allocation for HIV treatment in Russia from
2016 to 2022, presented in millions of dollars. The data demonstrates fluctuations in funding over the
years, with notable peaks and declines in budget allocation

As demonstrated in Figure 2, there was a decline in budget allocation and funding to

provide treatment for infected individuals from 2016 to 2018. Although the allocated amount
increased after 2016, it did not keep pace with the rate at which the disease is spreading in
Russia. The peak in 2022 coincides with the year when the record number of infected people
surpassed 1.5 million in Russia (Figure 3).
 Figure 3: This figure illustrates the annual number of HIV cases in Russia from 2016 to 2022. The data
reveals trends and fluctuations in the prevalence of HIV over the years, providing insight into the
trajectory of the epidemic in the country.

The figure suggests that preventative measures in Russia may be failing drastically or
lacking resources. Access to antiretroviral therapy (ART) can be considered a preventative
measure, as studies suggest its effectiveness in halting HIV transmission and reducing morbidity
and mortality among HIV-positive individuals (Cohen et al., 2016).
 Figure 4: This figure depicts the per capita allocation of funding for antiretroviral therapy (ART) in
Russia from 2016 to 2022.

In fact, per capita treatment funding fluctuates from year to year, reaching its minimum in
2018, resulting in an unstable availability of medications at health centers. Thus, it is true that as
years pass, the amount of available resources does not increase; instead, it roughly stays within
the previous range.
 Figure 5: This graph presents two line bars depicting the trends in registered HIV+ cases and the
availability of treatment in Russia from 2017 to 2023. The first line represents the number of registered
HIV+ cases reported annually, while the second line indicates the availability of treatment for
HIV-positive individuals over the same period.

The same conclusion can be drawn from the figure above, which demonstrates the ratio
of people receiving ART in Russia compared to the entire population of infected individuals.
Although the Russian Ministry of Health claims that more than 84% of HIV-positive individuals
receive treatment (Interfax, 2022), the collected data reveals that the actual numbers fall
significantly below this claim. For instance, in 2017, only roughly one-third of the 800 thousand
infected people had access to ART, while by 2022, this ratio had become even more alarming,
reaching just one-fifth. Unfortunately, only one in every five individuals who tested positive
could maintain a healthy life, thereby reducing the chance of transmitting the disease (RBC,
2022).
Figure 6: This graph displays the annual count of non-governmental organizations (NGOs) registered as
foreign agents in Russia from 2016 to 2023. The data illustrates the trend in the registration of NGOs
under this designation over time. Analyzing these trends can provide insights into the regulatory
environment for civil society organizations in Russia and its potential impact on NGO activities and
advocacy efforts.

A long-standing issue in Russia is the politicization of HIV, which is harmful because it

downplays the true scale of the epidemic. Information about HIV is often concealed, and
international experts believe that the officially reported numbers of cases are lower than the
actual figures (Toren, 2023). Additionally, institutions such as legislation pose a threat to the
existence of numerous NGOs and activists in Russia. The Russian foreign agent law requires all
organizations and individuals that receive support from outside of Russia to register themselves
as foreign agents (Moscow Times, 2022). As Figure 6 shows, more than 15 NGOs operating in
multiple regions of Russia simultaneously were added to the list, and some of them had to be
liquidated due to the increased bureaucratic burden resulting from the law. The peak of
registrations occurred in 2016 when 7 independent NGOs aimed to aid vulnerable populations in
accessing needed medications and support. Since 2016, 9 other NGOs have been included in the
list, and only 19 remain active throughout Russia (Humanitarian Project, n.d.). It is obvious that
there is no way to stop the process now. With the country banning LGBTQ+ propaganda and
passing punitive drug laws, it seems likely that the number will increase each year.

Figure 7: This chart illustrates the percentage of individuals receiving treatment for HIV/AIDS in each
oblast (region) of Russia in 2022
Figure 8: This graph depicts the number of HIV-related deaths per 100,000 people in each oblast (region)
of Russia in 2022

From the two figures above, it is clear that the distribution of infected people is not
uniform across different regions in Russia; instead, some regions have extremely low infection
rates, while others perform much worse. The average percentage of those receiving therapy is
71.47%. For example, in the first figure above, the states with an extreme shortage of ART
(based on how far their values are from the mean) therapies include Leningrad (42.10%), Tver
(54.10%), Kurgan (57.40%), Chelyabinsk (54.80%), Irkutsk (58.5%), and Astrakhan (53.80%).
Drugs for the treatment of HIV are purchased centrally by the Ministry of Health and distributed
among the subjects of the Russian Federation, but not all regions enjoy this right. In some
regions, the percentage of people receiving medications correlates with the number of diseased
people per annum. For instance, Irkutsk and Kurgan are among the top regions in terms of the
number of diseased people. If the country-wide average death rate is 10 thousand deaths per 100
thousand people, in those states it reaches 32.9 and 24.1 respectively. As Lakhov suggests, in
states where HIV/AIDS is highly stigmatized and tabooed among vulnerable populations, the
number of infected people will be lower than the actual number. As a result, they will not be able
to receive treatment due to social discrimination and may progress to AIDS (Babikhina &
Kokourovа, 2022).
In conclusion, the state's financial capacity and institutional factors have deepened the
problem of HIV in Russia. Insufficient financial resources allocated to HIV prevention,
treatment, and support services have hindered efforts to control the epidemic effectively.
Additionally, institutional barriers such as the politicization of HIV, restrictive legislation, and
the registration of NGOs as foreign agents have further compounded the challenges faced by
individuals and organizations working to address HIV/AIDS in the country. These systemic
issues have contributed to disparities in access to healthcare services, exacerbated stigma and
discrimination, and undermined the effectiveness of HIV control efforts.
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