UNAIDS, an association of UN agencies designed to mount a well- coordinated global struggle against the spread of HIV and AIDS and their consequences, was founded on July 26, 1994. For 25 years, UNAIDS has been providing assistance in building up support for large-scale operations to stop the spread of HIV / AIDS, consolidating efforts of various sectors and partners from government agencies and civil groups alike in combating the epidemic. In addition, it has set itself the task of eradicating AIDS by 2030. Vinay Saldanha, UNAIDS Regional Support Team Director for Eastern Europe and Central Asia, gives a detailed account of UNAIDS activities in Russia and elsewhere the world in a special interview with International Affairs.
International Affairs: Vinay, you first found yourself in Russia in 1994, when very little was known about HIV, both in Russia and elsewhere. Has the attitude to AIDS changed over the years in the world and in Russia?
Vinay Saldanha: I first visited Russia, then the Soviet Union in 1991, when only separate cases of HIV were reported. Should we have known then what we know now, probably, it would have been possible to prevent the spread of HIV infection. Therefore, when in 1994 I came to St. Petersburg to help one of the first local public organizations in Russia dealing with HIV, we hoped that Russia would not repeat the same mistakes that had been made by the West. By that time, I had gained both professional and personal experience in having met people afflicte3d with HIV. I had friends living with HIV, acquaintances who had died of AIDS. The world already knew a lot about the virus, but the fight against AIDS was yet to be coordinated at the global level. At that time, about 100 people with HIV infection were registered in St. Petersburg. In those days, I sincerely and naively believed that if everything was done on time and in the right way, we could avoid repeating the mistakes of other countries and prevent the epidemic. Of course, back then we could not even imagine that 25 years later we would talk about more than one and a half million people infected with HIV in Eastern Europe and Central Asia, including about a million living with Russia.
In more than 30 years of fighting against AIDS, the world has seen a lot of chages. At present, we know everything about HIV infection: we know how to prevent infection, we know about effective preventive measures. We also know that for any person diagnosed with HIV infection, it is very important, if thyey want the treatment to be successful, to start it without delay and continue to undergo treatment for the rest of their life. We have not yet been able to create a vaccine or an effective remedy that completely cures of HIV infection (although there have been two confirmed clinical cases of recovery, they require further scrutiny). However, given timely, proper and high-quality treatment, the concentration of the virus in the body is so low that its effect is reductged to the minimum and a person with HIV can live as long as a healthy one. Moreover, an HIV-infected person runs no risk of infecting their partner.
Thanks to all these achievements, the situation is improving, slowly but surely. Fewer cases of HIV and deaths of AIDS have been reported of late, while antiretroviral therapy is covering ever more patients. According to the latest UNAIDS global report, published on July 16, 2019, a record number of people worldwide – over 23 million - are receiving antiretroviral therapy (ART). At present, the entire world is able to observe the effects of anti-AIDS struggle in some countries of Africa, which were particularly hit by the epidemic.
In South Africa alone, the Department of Health is providing access to HIV treatment for more than 500,000 new patients per year — more than 4.5 million people are currently getting ART therapy in South Africa in what is described as the most extensive national HIV treatment program in the world.
Yes, even though they started late, when every tenth, and in some countries, every fifth person, was HIV-infected, today, according to the latest reports, the AIDS epidemic in the worst-hit countries of this continent is declining.
In our region, in countries of Eastern Europe and Central Asia, including the Russian Federation, the epidemic is spreading - since 2010, the number of reports of new HIV infections has increased by 60%, and the death rate from AIDS is increasing. So there is yet a lot to be done to reverse the situation.
International Affairs: What is the main agenda of the Regional Office of the United Nations Joint Program on HIV / AIDS? In which countries do you operate?
Vinay Saldanha: We work in all countries of Eastern Europe and Central Asia, although we do not have offices everywhere. The agenda of the Regional Office is the same as UNAIDS — to mobilize the society, the government and the private sector, including health care workers, journalists and people living with HIV, with a view to beat AIDS by 2030 — a task to this effect was set by the UN General Assembly at the 2016 Special Session on AIDS. To this end, we need coordinated multi-sectoral efforts, at the federal and local levels, and not only the efforts of the healthcare services.
In fact, the appearance of UNAIDS demonstrates that HIV infection is not a purely medical problem. This is a social, economic, financial and political issue that requires undivided attention and incessant monitoring on the part of political leaders.
At present, we are working on reaching the 90-90-90 target by 2020: 90% of people living with HIV should know about their HIV status, 90% of people who know they are HIV-positive must receive treatment, and 90% people receiving treatment should reach reduced viral load. This ambitious agenda was supported by all UN member states to be achieved by the end of 2020. According to a recent UNAIDS report, approximately 79% of people living with HIV knew about their HIV status in 2018, 78% of those who know they are HIV-positive got access to treatment, and 86% of people living with HIV and receiving treatment, developed a suppressed viral load, which contributed to their life and health and prevented the transmission of the virus. In our region, 72% of people living with HIV knew about their HIV status in 2018, but only 53% of them had access to treatment. Limited access to treatment is one of the most pressing issues in Russia. The organizations concerned have already invested a lot of effort to identify HIV infection in nearly one million Russians, and now, in accordance with WHO recommendations, everyone afflicted should have immediate access to treatment.
Therefore, one of the most important points on our agenda today is to assist countries in ensuring uninterrupted access to high-quality antiretroviral drugs. 20 years ago, the treatment for HIV infection cost about 10 thousand dollars per patient yearly. Given the high cost, far from everyone could afford it. Thanks to coordination with partners, including the World Health Organization, which is a co-sponsor of UNAIDS, the cost of an annual treatment for one person living with HIV has been reduced in many countries to less than $ 100 a year. Thus, the number of people receiving this kind of therapy today has reached record levels. The same process has been reported to be under way in Russia, where the cost of treatment has dropped significantly following a decision of the Healthcare Ministry to centralize the purchase of drugs for the whole country. We hope that the recent measures taken by the government and public organizations in expanding access to anti-AIDS treatment will guarantee the achievement of the 90-90-90 agenda in 2020 on the territory of Russia and throughout Eastern Europe and Central Asia.
International Affairs: What are the global statistics on the anti-AIDS campaign?
Vinay Saldanha: On July 16, 2019, UNAIDS pubished a report on the global AIDS epidemic. The report presents the latest data received by UNAIDS from UN member states. At present, about 38 million people live with HIV. In 2018, there were about 1.7 million new HIV infections, which is 16% less than in 2010. This is mainly the result of consistent progress of anti-AIDS campaigns in most countries of eastern and southern Africa. For example, South Africa has cut the number of new HIV infections by more than 40% since 2010, and deaths from AIDS dropped by about 40%.
Deaths from AIDS continue to decline also due to greater access to anti-AIDS treatment - since 2010, the death rate from AIDS worldwide has decreased by 33%, to 770,000 cases. Meanwhile, in Eastern Europe and Central Asia, there has been an alarming increase in new HIV infections by 29% and AIDS mortality rate has gone up by 5%.
International Affairs: What is the role of Russia in the global and regional response to the epidemic and what should be done here, in Russia, to hit the main target - the victory over AIDS by 2030?
Vinay Saldanha: Russia plays an exceptionally important role in combating AIDS at three levels. First, as a UN member state, the Russian Federation practices an ever constructive position at negotiations on the Political Declaration on AIDS at the UN General Assembly. In addition, being one of two representatives of Eastern Europe on the UNAIDS Program Coordinating Council, Russia has a special responsibility to put into effect international decisions and the approach to HIV infection which it helped to form at the global level. Russia has all the resources needed for this: scientific achievements, qualified and dedicated specialists, experienced non-governmental organizations, a clear understanding of the nature of the epidemic.
Undoubtedly, an increase in HIV cases in Russia over the past few years, though testifying to an improvement in diagnostic practices, also speaks of a continuing spread of HIV. The Russian authorities are currently taking a lot of preventive measures but at the moment these measures are not enough where the frequency of new cases is the highest and where the epidemic is the worst, that is, in the midst of groups which are highly vulnerable to the infection. It is also vitally important to ensure access to antiretroviral treatment for all HIV-infected. This will make it possible to not only save thousands of lives, but will also help to stop the spread of the virus, because given proper treatment, the concentration of the virus in the blood decreases to a level at which the risk of transmission is reduced to minimum.
Secondly, Russia is doing its utmost to support the efforts of different countries and UNAIDS to contain the epidemic at the regional level. Thanks to political and financial support from the government of the Russian Federation, UNAIDS is implementing the Technical Assistance Program for countries of Eastern Europe and Central Asia, which provides for the prevention, control and monitoring of HIV / AIDS and other infectious diseases. In 2019-2021, the program is under way in five countries: Armenia, Belarus, Kyrgyzstan, Tajikistan and Uzbekistan.
The technical assistance program envisages further development of national public health systems, the purchase of testing equipment, mobile clinics to provide first medical aid, including testing for HIV in out-of-reach areas, a constant exchange of experience and training of specialists, and extensive HIV-prevention programs for migrants.
Thirdly, Russia reports a considerable upsurge in anti-AIDS measures on the part of the government - it has introduced a centralized purchase of ARV drugs, it registers patients with HIV infection and has adopted the relevant strategy. But unfortunately, Russia has not yet made as impressive progress as other countries have: a sharp decline in new HIV cases and no deaths from AIDS. These achievements are possible on condition there is greater coordination between Russian government agencies and a closer cooperation between Russia and UNAIDS.
Another very important issue is that UNAIDS calls on Russia to lift the remaining restrictions on the entry of foreign HIV-infected citizens. I know that the Russian government and parliament have partially removed these barriers by allowing entry to those who have close relatives in the country. This demonstrates Russia’s fair attitude towards tourists and migrants and also to more than 160 countries that receive Russian citizens, regardless of their HIV status.
International Affairs: Do you personally believe that the idea of doing away with AIDS as a threat to public health by 2030 is realisticl? What gives you confidence that this is possible?
Vinay Saldanha: I have no doubt that we will be able to put an end to the AIDS epidemic by 2030. I proceed from what I see around the world as countries are taking the epidemic under control. Today, the most important question, from my point of view, is how many people we will lose as we move towards our target, how we could speed up the process to maximize the effect of our work by 2020 or 2025 and thereby save hundreds of thousands of lives - not only around the world, but also in Eastern Europe and Central Asia. The question is not whether we will win the battle against AIDS, but how to do it in the shortest period possible.
International Affairs: How do you think the humanity is coping with this challenge today? What did AIDS teach us?
Vinay Saldanha: In my opinion, the battle against the AIDS epidemic has taught mankind many important things. For now, I would like to point out one, extremely relevant aspect for our region.
Our recent report, whose title – Community in Focus - reflects the essence of the UNAIDS approach, emphasizes that people affected by HIV, living with HIV play a key role in the struggle against AIDS. First, they are vitally interested to receive high-quality and affordable prevention, treatment, care and support services. This is vital for them, so it was the community of people living with HIV that, in many countries and our region including, were at the forefront of efforts to cut drug prices. Secondly, it is the key communities (those groups of people who are most vulnerable to HIV infection) who know how and where to carry out preventive measures, they are trusted by patients, they succeed in leading the person through testing to the doctor. This practice has proved effective - the report cites research which was conducted in different countries and which proves that community involvement leads to a wider spread of HIV prevention and treatment services, guarantees reduction of stigma and discrimination and protection of human rights. And in the long run, it stops the spread of the virus.
Vinay Patrick SALDANHA, UNAIDS Regional Director for Eastern Europe and Central Asia, is a member of the international UN staff with over twenty years of experience in HIV policies and programs. In 1993, Mr. Saldanha arrived in St. Petersburg, Russia, to help with establishing one of the first public organizations to implement HIV prevention and support programs in Russia. In the mid-1990s, he led one of the first initiatives for international cooperation in dealing with HIV infection in Russia as part of the Canadian-Russian project to combat AIDS. Mr. Saldanha worked as a policy analyst for the G8 research group at the University of Toronto and focused on AIDS-related issues and the role of the Russian Federation during the G8 summit in Birmingham, United Kingdom, in May 1998. From 2009 to 2015, Mr. Saldanha served as Deputy Cabinet Chief of the Executive Director at UNAIDS headquarters in Geneva. Mr. Saldanha holds an honors degree from the University of Toronto in political science and English literature. Born in 1970, Mr. Saldanha holds Canadian citizenship. Fluent in English, French and Russian. He is married and has two daughters.