Categories
Health HIV Medicine Russia State

Communicating Disease: The Silenced Epidemic in Russia

Photo by Klaus Nielsen from Pexels

By Ksenia Kogler, BA

HIV/AIDS represents a major global health issue. According to the World Health Organization (WHO) about 38 million people in the world were diagnosed with HIV at the end of 2019. By June 2020, already 26 million of them had access to the antiretroviral therapy (ART), but unfortunately due to the COVID-19 pandemic there is a decrease in the progress of providing the therapy to people.[1]

In the Russian Federation, the number of infections is increasing since the beginning of the epidemic. By the end of 2019, the total number of Russians living with HIV reached 1.1 million according to the statistical data provided by the Federal Research and Methodological Centre for AIDS Prevention and Control. The HIV prevalence in the population increased accordingly, approaching 0.75% of the general population and 1.42% of the population aged 15-49 years[2], the highest number in Eurasia.

Mass media often uses the term “silenced epidemic.” The problem of communicating the disease lies also in the statistics. Officially, the term epidemic is used only when the amount of infected people is over 1% of the population, but in Russia, only in 13 regions more than 1% of residents are infected and in general in 35 regions HIV prevalence is above 0.5%, which makes it more difficult to use this term. However, in official documents the term epidemic has been used more often over the past years.

There is no doubt that one of the main steps for defeating the disease is to inform the population. In Russia, not only public awareness is insufficient, but also the state is reluctant to include the issue on the national agenda. Mass media, on the other hand, frequently uses misleading clichés, such as “plague of the 20th (21st) century” and “at-risk groups,” as well as discriminatory labels such as “homosexuals,” “drug addicts,” etc.

This negative framing has a history. In the second half of the 1980s and early 1990s, the common stereotype was that AIDS was a threat coming from the United States and Western countries as “a focus of the evils of the capitalist system.” In the headlines of articles from 1986 to 1994, the expressions “American syndrome,” “AIDS truck” and “plague from the West” were used. This representation of the disease has formed the opinion in the society that people with HIV/AIDS are very contagious, dangerous and dirty, which has entailed a certain “AIDSophobia,” as well as discrimination against people at risk and people living with HIV as well as their isolation. There is still a lack of awareness in the population about what HIV is, how the latter is different from AIDS and how the HIV virus can be transmitted. Furthermore, it is still little known that it is not a problem limited to homosexuals, drug users or sex workers.

In 2016 the Government of the Russian Federation approved the “State Strategy 2016: Countering the spread of HIV in the Russian Federation for the period until 2020 and beyond”[3], which declared HIV outreach a priority for primary HIV prevention. This strategy contained a specialized federal information resource to counteract the spread of HIV, which included large-scale communication campaigns, comprehensive communication projects, nationwide events, annual specialist forums, and the operation of a specialized information online portal on HIV and AIDS. Unfortunately, there is still no official data available about the results.

Vadim Pokrovsky, head of the Federal Research and Methodological Centre for AIDS Prevention and Control, commented in an interview in 2019 on another important problem that makes government officials reluctant to conduct extensive information campaigns. He explained: “The bet is on the religiosity of the population. The rules of behaviour should be in line with Christian traditions, which in itself, as some believe, should reduce the spread of HIV infection. But, as we can see, the epidemic does not depend on the fact that the so-called spirituality and ideology are promoted in Russia. Not a single official in our country has yet uttered the word “condom” in public. And condoms, by the way, are unaffordable for many in Russia. If it costs the same as a bottle of beer, then there is no telling what people will be more willing to buy with that money. It is necessary to lower the price and increase their availability to low-income people.”[4] The lack of sex education in Russia is one of the reasons why it is difficult to discuss the issue. Even within families, parents often avoid talking to their children about sex, hoping that the child will somehow find out on his or her own.

An excellent example to see the strong difference in discourse across different media platforms were two films on HIV released in 2020. The first film was released on 11 February on the YouTube channel of the well-known Russian journalist Yury Dud, who has become popular with his interviews with celebrities from various fields. The film features the stories of real people, explores the problem of stigmatization, and discusses not only preventive measures, but also testing and treatment methods. In addition, the contact details of the responsible centres and a strategy for dealing with a positive test result are given. In the documentary, accessible, simple, precise, and open vocabulary is used. The film went viral and has been watched by almost 20 million people. What is more, the film inspired a panel discussion on HIV prevention and treatment in Russia that was held in the State Duma on 21 February.

The second example is the HIV/AIDS prevention film, “AGAINST AIDS: The View of Two Generations. A value-based navigation” produced by the Moscow City Health Department on 1 December 2020. This film is aimed more at parents as it calls on them to talk more to their children about the issue in question. However, although the usual stereotypes are explained in the film, they still remain a focus. It also remains unclear, which role the state structures will play in providing this information to more parents, as this film was shown for discussion within universities.

Overall, a positive development can be seen in the provision of reliable information about HIV in Russia. Unfortunately, so far only outbreaks of public outcry have forced representatives of the authorities to pay more attention to the problem. In the meantime, much of the outreach work is done by NGOs in the Russian Federation, which actively use Instagram accounts as well as other social media to educate young people about the disease and its prevention, and to inform them about news and upcoming events related to the topic.

Bibliography:

AGAINST AIDS: The View of Two Generations. A value-based navigation. 2020 URL: https://youtu.be/_vcXKC0KJvA [Accessed: 07.02.2021]

Barysheva. E., Deutsche Welle. Why HIV-related deaths are on the rise in Russia. 2019. URL: https://p.dw.com/p/3NG65 [Accessed: 29.01.2021]

Federal Scientific and Methodological Centre for AIDS Prevention and Control., (2020) “HIV-INFECTION.” Information bulletin No 45. Moscow.

Government of the Russian Federation (2016). No 2203-r, Moscow. “State Strategy 2016: Countering the spread of HIV in the Russian Federation for the period until 2020 and beyond”

HIV in Russia (Eng & Rus subtitles). 2020. URL: https://youtu.be/GTRAEpllGZo [Accessed: 07.02.2021]

World Health Organization. HIV/AIDS. 2020. URL: https://www.who.int/news-room/fact-sheets/detail/hiv-aids [Accessed: 28.01.2021]

Yasaveev I.G., (2006) “The media and the HIV/AIDS situation in Russia.” Sociological Studies no. 12, pp. 89-94


[1] World Health Organization. HIV/AIDS. 2020. URL: https://www.who.int/news-room/factsheets/detail/hiv-aids [Accessed: 28.01.2021]

[2] Federal Scientific and Methodological Centre for AIDS Prevention and Control., (2020) “HIV-INFECTION.” Information bulletin No 45. Moscow.

[3] Government of the Russian Federation (2016). No 2203-r, Moscow. “State Strategy 2016: Countering the spread of HIV in the Russian Federation for the period until 2020 and beyond”

[4] Barysheva. E., Deutsche Welle. Why HIV-related deaths are on the rise in Russia. 2019. URL: https://p.dw.com/p/3NG65 [Accessed: 29.01.2021]

Categories
COVID-19 Diplomacy Geopolitics Health Humanitarianism International Health Latin America Medicine United States

Internationalizing Cuban Medical Internationalism

A doctor’s surgery in Jaimanitas, Cuba. Source: Soydcuba, CC BY-SA 3.0, Wikimedia Commons

By Nicolas Friden, BA

As many different countries choose many different approaches in order to fight the virus, it still remains a huge task, even for the majority of countries in the developed world. As countries with a functioning health care system like France or even Germany struggle to contain the outbreak of the virus.

If the Covid-19 epidemic has shown one thing, it might well be that despite our belief we cannot control any and every disease. While somehow most Western countries might come through this pandemic relatively unharmed, it has still shown us that we have a lot to learn about our approach to a functioning medical system.

One country that frequently eclipses the rest of the World when it comes to medical expertise and a functioning heath care system is Cuba. While many are aware that Cuban doctors are sent to a lot of different countries, especially poorer ones, the proportions of this aid and cooperation system are less known.

However, if this system of health cooperation is functioning so well, why don’t any of the major countries in the World aspire to imitate some of its aspects in order to improve their own health diplomacy? Is the capitalist world too stubborn to adopt good ideas from other systems?

While Cuba is a relatively poor country compared to most of the Western World, this has never been an excuse for not providing medical aid and medical assistance to those most in need in any part of the World. For example, as Hurricane George devastated Haiti in 1998, Cuba immediately sent a force of 200 medical staff to help the local population. But the Cuban model doesn’t stop at immediate medical relief. This is actually only the beginning. After the initial damage is more or less under control, Cuban doctors and medical staff usually stay there and begin to train and treat the patients in the devastated country so as to provide development assistance to the local health authorities. This includes the process of transmitting knowledge to the local population by either training staff on the ground, or, more importantly even, by providing local students with the chance to acquire a medical degree in Cuba. This allows fully trained medical personnel to come back and be able to help the local population where it is most needed.[1]

This feat is even more impressive if you consider that every single step of the way is free of charge. This is seen by some as a true act of solidarity to the ones that are most in need. This is particularly astonishing as Cuba didn’t have a lot of support and of trading partners after the Soviet Union collapsed. In the early 1990s, male body weight in Cuba fell by 20-25 pound on average and public transportation was cut by 80%. Still, even in these difficult times for the country, its foreign policy regarding health remained the same, and Cuba continued assisting others where and when they needed it. [2]

So why is it that Western countries are neither discussing nor adopting the Cuban model to some extent?

The two parts of this question might well be closely linked to each other, as the West and in particular the United States have always had a hard time accepting Cuba’s existence in the first place. Since Cuba has a socialist government, it was always viewed as a possible threat in Washington, which imposed a trade embargo on the country, already in 1958. Writing this in 2021, when the Soviet Union is long gone, and an East West divide is not so visible anymore, it is astonishing that this embargo remains in place.

This might be one reason why Western media and policy-makers remain reluctant to fully acknowledge the real role Cuba plays when it comes to global medical relief. This whole situation really is an indictment on most powerful Western governments, as they remain unable to even acknowledge that their way of thinking might not be the best or even the only way.

As the Covid-19 pandemic rages on stronger than ever (especially in the United States, the one country that will not in any case acknowledge Cuba’s know-how or accept its existence), the Cuban situation compared to the rest of the World remains under control for the moment and Cuba is only waiting for the opportunity to help its neighbours[3].

It remains difficult to see a change of course for the United States, when it comes to its relationship with Cuba and its reluctance to accept any kind of help or advice coming from this country, but maybe if the rest of the World starts implementing some Cuban medical policies, the US eventually could follow the same path.


[1] John M. Kirk, “Cuban Medical Internationalism and Its Role in Cuban Foreign Policy,” Diplomacy & Statecraft 20, no. 2 (August 5, 2009): 275–90.

[2] Ibid.

[3] Worldometers.info/coronavirus

Categories
COVID-19 Health Medicine Security State Surveillance

Podcast: COVID-19 in the history of biopolitics

By Nicolas Friden BA & Carlos Solsona Ribes BA & Camilla Wallner BA

This podcast episode discusses COVID-19 and the vaccination debate in the context of the history of biopolitics.

Categories
Class Ethnicity Health Medicine United States Vulnerability

Social vulnerabilities and determinants of health

By Victoria Frohnhofer, BA

“Drawing attention to the central role of human freedoms in health is a statement of philosophical position and a call to social action. ”[1](Marmot)

Ethnic minorities, socially vulnerable people or marginalized groups are terms, which are often associated with struggle. The struggle to find housing, the struggle to vote (if the possibility exists) or the struggle to receive appropriate health care to name a few of these. This struggle has continued into the global COVID-19 pandemic, making it more threatening to certain groups of people than others. 75% of people who died of COVID-19 in Washington D.C. up until June 2020 were of African American descent.[2] This reality within the capital shows just how different realities can be, depending on how much melanin your skin contains. Different reasons have led to this palpable scenario. However, these reasons have been apparent long before the year 2020.

The Crux of Health and Wealth

One may think that health is solely determined by wealth, however this conclusion is a bit too linear. The complexity behind linkage of health and wealth comes with the addition of political or socio-economic progress as well as inequities. Because progress is not produced homogeneously, inequities are a side effect of it. Inequity is therefore what determines health perhaps even to a much greater extent than just wealth does,[3] even though wealth is one of the biggest forms in which inequity can be seen. For this reason, the gaps of health within even wealthy countries can be seen in crisis much more clearly. It is the amount of inequity within a country, which determines the health of its citizens, not how large its GDP (gross domestic product) is. Crisis such as the Covid-19 Pandemic have made this painfully apparent.           

Nevertheless, the GDP is important for tracking the growth and development of wealth of a country. The GDP is able to show the income of a nation as well as the proportion of its productivity within one year[4]. It is certainly a limited form of measurement for a country’s wealth since many factors are left out of the calculation or are up for interpretation. The reason for this is that wealth is defined within the GDP only in an economic way. However, other factors such as the environmental wealth of a nation, the wealth of education, health or diversity within a nation are neglected. As explained below, this is especially interesting when observing the United States of America for the reason of its ethnic diversity. However, by using the GDP, it is possible to examine the relationship between wealth and health to a certain degree and enable us to analyze how and were these two aspects of life seem to relate.

Disparity in Diversity

Socioeconomic differences and the social gradient in health[5] are, amongst other things, determining health in most countries. The social gradient in health is a concept which recognizes the correlation between inequities between social classes and population health.[6] The United States makes for a compelling example because of its ethnic diversity and its use of statistical measurements on the basis of these multiple ethnic groups. It is in this country with the highest GDP globally[7] in 2019, that ethnicity still plays perhaps the largest role in one’s health. Being of African American descent in the United States automatically places your life expectancy on the lowest scale[8] compared to other ethnicities. With ethnicity as the major determinants of health within this exceedingly wealthy nation, it is clear that the overall economic wealth of a nation does not automatically produce health in all of its citizens.                                       

It must be said that ethnicity, economic wealth and therefore health are nevertheless interconnected. Even though the economic wealth of a nation may not automatically produce health in its citizens, the lack of personal financial wealth can very well be the cause of a lack in health. An example is the African American community, for whom the poverty rate was more than 10% higher in 2010 than for other US Americans.[9] Reasons for this high amount of African Americans living below the poverty line are that many African Americans work in the low wage sector and in general, earn lower wages than Americans of other ethnicities, regardless of their workplace.[10] This increases the chance of falling below the poverty line. Thus, by understanding that there is an interconnection between low income and low health,[11] it becomes clear that the African American community faces a much greater struggle in obtaining and preserving their health. The most recent health crisis in the United States, the COVID-19 Pandemic, has made this inequity once more exceedingly visible through a death toll that was different for specific ethnic groups.

Feasibility vs. Possibility 

Considering the knowledge we have in todays global world regarding the correlation between health, wealth as well as ethnicity, the inequity within a nation such as the United States of America is logical and at the same time disheartening. Therefore, it is necessary to view the possibilities that a nation with the largest GDP has to implement political and economic changes in order to produce a shift in this inequity. The fact that this inequity has been a known issue for decades, makes it even more confounding as to why this predicament has not yet been tackled in a sustainable way. One may even hypothesize that it has suited successive governments not to eliminate the factor of ethnicity as a determinant of health. As a result, the possibilities of advancement in health for African Americans are limited, making social vulnerability a continued determinant of health.

References

Bloom, David E. “The Health and Wealth of Nations” American Society for the Advancement of Science, vol. 336 (18th February 2000), pp. 1207-1209.

Deaton, Angus “The Great Escape – Health, Wealth, and the Origins of Inequality”. Princeton: Princeton University Press, 2013.

Kosteniuk, Julie G, and Harley D. Dickinson. “Tracing the social gradient in the health of Canadians: primary and secondary determinants. Social Science & Medicine vol. 57;2 (July 2003), pp. 263-276.

Marmot, Michael “Health in an unequal world: social circumstances, biology, and disease”. The Lancet, vol. 336 (9th December 2006), pp. 2081-94.


Websites:                    

https://coronavirus.dc.gov/release/coronavirus-data-june-5-2020 (5.12.2020)

https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US&most_recent_value_desc=true (2.1.2021)


[1] Michael Marmot “Health in an unequal world: social circumstances, biology, and disease” The Lancet, vol. 336 (9th December 2006), 2081-94.

[2] https://coronavirus.dc.gov/release/coronavirus-data-june-5-2020 (5.12.2020).

[3] Angus Deaton The Great Escape – Health, Wealth, and the Origins of Inequality. Princeton, Universtiy Press, 2013.

[4] Ibid.

[5] Marmot, 2006.

[6] Julie Kosteniuk and Harley D. Dickinson “Tracing the social gradient in the health of Canadians: primary and secondary determinants” Social Science & Medicine vol. 57;2 (July 2003), 263-276.

[7] https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US&most_recent_value_desc=true (2.1.2021)

[8] Deaton, 2013.

[9] Ibid. (see Figure on p.180)

[10] Ibid.

[11] David E. Bloom “The Health and Wealth of Nations”. American Society for the Advancement of Science, vol. 336 (18th Febuary 2000), 1207-1209