Defending the Human Right to Health in Brazil & Russia

Check out Felipe de Carvalho’s report on his peer to peer travel to Russia, his impressions of the country and his views on HIV patents, drugs and treatment.

*By Felipe de Carvalho – GTPI communication coordinator

A week in Russia is sufficient only to begin to glimpse the many paradoxes of this Asian giant, with no clue as to how to decipher them.On behalf of Rebrip I was able to visit two of its main cities, Moscow and St. Petersburg, and see the contradictions of  a country that has opened to globalization without relinquishing an anti-Western attitude, a global power which often watches its own people more than its borders, a developed country that frequently works to undermine its democracy.

With a rich past that saw tyrannical tsars and the revolutionaries who overthrew them, Russia today still seems to be uncertain about the benefits of its own historical process.

My visit received great support from the Oxfam Russia staff who welcomed me with open arms.The staff gave me a good overview of the local political situation, with an emphasis on the health field. Through meetings organized by the Oxfam office itself, I was able to obtain more information on GCAP, an informal coalition of 40 Russian NGOs that work in various areas.With regard to health, the GCAP focus has been on access to and quality of services.

There is currently a great challenge in the country due to tension between the public and the private sector in health.The funding that supports the public system comes from mandatory contributions of the working population, but only 42% currently contribute, while close to 35% of the population is not officially employed.Supposedly as a reaction to this situation of insufficient financing, the government has promoted Public-Private partnerships to manage health services.But this strategy has only benefitted those able to pay for the expensive health plans.The main hospital in Moscow, for example, is targeted for a PPP and after completion of the reforms, only 20% of the beds will be reserved for those who do not have a health plan.In addition, the new hospital structure will eliminate what was the largest center for palliative care in the country and replace it with a plastic surgery unit.The PPP policy is above all a major focus of corruption.

In 2015, the policy initiative that has received most attention is the process called civil BRICS, a platform for participation created by the Russian government to involve NGOs in discussions on themes that will be central in the next summit meeting of BRICS presidents to be held in July, in Ufa, Russia.This discussion platform was an initiative of the Russian Ministry of Foreign Affairs and is intended to become a precedent for civil society participation in the BRICS decision-making process.It is still early to evaluate how much autonomy will be given to BRICS NGOs that get involved in the process, but at least for the Russians, this is an important framework, if only for the greater clarity it provides on issues for which the Russian government is seeking greater dialogue with NGOs.

After two days in Moscow, I packed my bags and left by train for St. Petersburg.My memories of Moscow included the coldest weather I have ever felt in my life (12 degrees below zero), a rich culinary experience of flavors of neighboring countries and the experience of being stuck in the hotel elevator for almost an hour without understanding a bit of what was happening since all those involved spoke only Russian.

St. Petersburg is vibrant at any time of day and exudes culture.Just as vibrant as the city are the NGOs that operate in the field of AIDS, especially focused on trying to remove the virus of social exclusion from the most hidden parts of the city.

I had a chance to get to know the work of four of these NGOs: Humanitarian Action, EVA, Candle and ITPCru.Humanitarian Action is one of the oldest in operation in St. Petersburg.The organization’s work focus is on information and prevention for drug users and sex workers who, due to the great stigma they suffer, do not reach the health services and end up starting HIV/AIDS treatment too late.Humanitarian Action has three buses that conduct testing and provide counseling to these populations.I had a chance to accompany the bus focused on drug users.I met the multidisciplinary team (a doctor, a social assistant and a psychologist) and I followed the routine of the bus, which was parked in a neighborhood on the outskirts of the city, a place frequented by intravenous drug users.The buses have been in operation since 2001.

Candle is a community-based organization that acts in various ways to expand access to health services and reduce the stigma against people living with HIV/AIDS.EVA is a women’s network that advocates for access to HIV/AIDS, tuberculosis and hepatitis services.  One of this organization’s great achievements was to convince the government to reverse a prohibition on offering artificial insemination to people living with HIV/AIDS.

My last meetings were with ITPCru, which engages in very organized work to monitor the purchase of AIDS drugs.This is difficult work in light of the fact that this purchase is decentralized in Russia and there are close to 3,500 tenders per year, with wide ranges in prices between the regions.ITPC also engages in pioneering work in monitoring shortages, allowing patients themselves to complain to the authorities.Like my organization (ABIA), ITPC also pursues strategies to reduce the prices of drugs, including by means of overcoming barriers resulting from pharmaceutical patents.

I also had a chance to visit an HIV/AIDs center of excellence, where numerous services are offered in an integrated manner, from X-rays with immediate results to dental treatment.According to the hospital director, 50% of those taking HIV tests do not return and of the 50% who return, 20% test positive.The hospital attends close to 500 patients per day.

All these visits contributed significantly to my understanding of the advances and setback in the response to AIDS in Russia.The lack of sustainable investment in specialized centers, the stigma suffered by the most vulnerable populations and the difficulty of dialogue between civil society and the government are points shared by the Brazilian context.

The trip was without doubt very worthwhile and, to a certain extent, motivating, since it provided more evidence of an unending truth:regardless of the difficulty of conditions imposed by governments or economic circumstances, those defending basic rights will always find ways to maintain the hope of building a fairer world.

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