Some countries of the former Soviet Union, the so-called CIS countries, are facing difficult challenges to achieve the HIV/tuberculosis-related Millennium Development Goal (MDG 6) by 2015. The continuing growth of new HIV cases, insufficient access to prevention services and treatment for people living with HIV, combined with the severity of region’s tuberculosis (TB) epidemic (particularly multi-drug resistant TB) are major challenges.
On October 10-12, 2011, the Russian government, along with UNAIDS, the Global Fund, and the World Bank, is hosting in Moscow a high-level forum to discuss these challenges and ways to reach MDG 6 in the CIS. (Click here for a video, a presentation, and more from the forum.)
Unless concerted action is taken, sustained political commitment mobilized, new public/private and civil society partnerships established, and a sharp improvement in the effectiveness of HIV and TB programs realized, MDG 6 risks not being achieved. So, what to do?
International experience suggests that CIS countries must target prevention efforts to people who inject drugs, sex workers and their clients, and men who have sex with men, as well as prisoners and migrants who lack or have limited access to needed services. The priority focus on these vulnerable groups is critical to better align resource allocation in accordance to the nature and characteristics of the dual HIV/TB epidemics.
This calls for a major rethinking of strategies that have criminalized risky behaviors and driven the HIV epidemic underground. Scientific evidence clearly supports needle exchange and substitution therapies as part of broader social support and health programs as the most cost-effective strategies to arrest the spread of HIV among intravenous drug users—a risky behavior that is driving the epidemic in the CIS countries.
A concerted focus on bridging the gap between HIV treatment need and access is essential. This would require lowering the cost of diagnostic tests and anti-retroviral drugs, so that the promise of universal access to HIV treatment can be met for the infected population in need. The full-scale implementation of the Stop TB Strategy also needs priority attention, particularly to deal with the escalation of multi-drug resistant TB—ten of the 14 most affected countries in the world are in Europe and Central Asia.
Strengthening the CIS health systems to increase efficiency and effectiveness of prevention and treatment is critical as they are mutually complementary and reinforcing. The World Bank-funded Russia TB and AIDS Control Project, implemented by the Russian government with technical support from WHO over 2004-09, is a good example of this. It supported the modernization of the public health laboratory network and health surveillance systems, and improved knowledge and skills of health personnel in both the prison and civilian health systems across the country as critical investments for scaling up diagnosis and treatment (http://go.worldbank.org/15TL3FROX0).
Controlling blood transfusion-transmitted communicable diseases such as HIV, and Hepatitis B and C is still a major public health issue in Central Asia, as documented in a World Bank report done with the U.S. Centers for Disease Prevention and Control and WHO. This merits utmost attention as part of health system strengthening efforts.
There is high hope that the Moscow Forum will catalyze a reinvigorated response. The challenge and options in the CIS countries are clear, and the time for MDG 6-related action is now, since tomorrow will not wait.