H.I.V. IN RUSSIA

To the Editor:

Russian government reluctance to providing methadone treatment or
clean needles is only one of the fatal impediments to effectively
addressing H.I.V. in Russia ("Inadequate Fight Against Drugs Hampers
Russia's Ability to Curb H.I.V.," Memo From Russia, Jan. 17).

Access to antiretroviral treatment, despite government promises to
make it universally available, continues to be denied to injecting
drug users, who are the majority of those infected. A recent study in
19 cities found that in half, medical commissions used questions about
drug use as criteria for denying treatment.

An outdated Soviet-era system of linking health care to residence
means that thousands of internal migrants can't get care.
Organizations of people living with H.I.V. have also documented
consistent irregularities in how Russia procures H.I.V. medications
and prices paid for medications that are far above market value -
suggesting that while those most at risk are not benefiting from the
national AIDS program, corrupt officials may be.

Russia's increasing allocation of resources to stop its H.I.V.
epidemic is commendable. Yet these efforts will be in vain unless drug
users and other vulnerable groups who are most affected by H.I.V. are
placed at the core of the country's treatment and prevention strategy.

Maria Golovanevskaya

The writer is program officer for the Open Society Foundation's Public
Health Program.