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Newsletter, January-February 2017

Round Table on the Russian Orthodox Church's participation in prevention of HIV/AIDS

A Round Table on the Russian Orthodox Church's Participation in Preventing and Overcoming HIV/AIDS took place on January 26, 2017, as part of the XXV Christmas Readings, at the Moscow Patriarchate's department for external church relations. It was attended by some 40 clergy and laity of the Russian Orthodox Church from different dioceses, representatives of Protestant and Catholic communities as well as governmental and public organizations. The Round Table was chaired by Archpriest Maxim Pletnev, leader of the Coordinating center for overcoming drug and alcohol abuse, St. Petersburg diocesan Department for church charity and social service.

The participants have heard reports and studied problems of the HIV/AIDS epidemic in Russia; all-Russian events and actions aimed at preventing this disease; development of palliative care and work with HIV-positive drug addicts; experience in the implementation of primary prevention programs for risky behavior and HIV/AIDS among children and youth in different regions.

Larisa A. Dementyeva, deputy head of directorate for epidemiological monitoring, Russian Federal Service for Surveillance on Consumer Rights Protection, made a report on the present state of the HIV/AIDS epidemic in Russia.

She reported about some events of 2016, which are important for work in the field of HIV/AIDS prevention. In 2016 a meeting of the Government Commission on HIV was held, the Government developed and approved the Government Strategy for Counteracting the Spread of HIV in the Russian Federation for the period to 2020 and beyond. A plan for its implementation is being developed. In 2016, the Resolution of the Government of the Russian Federation (dated October 27, 2016 No. 1096, Moscow) was adopted "On approval of the list of socially beneficial services and criteria for assessing their quality," in which a list of socially beneficial services for NGOs, and criteria for assessing their quality were identified. In particular, it refers to services for prevention of socially significant diseases, organization and conduct of counseling, methodical, preventive and anti-epidemic measures to prevent the spread of HIV infection. In this regard, new opportunities are opening up for church related NGOs.

Changes were made into the procedure of rendering assistance to patients with HIV infection: from 2017 purchases of antiretroviral (ARV) drugs will be made by the Ministry of Health of the Russian Federation, which consistently insists on increasing the budget for the purchase of medicines.

Thanks to the program of import substitution of medicines, adopted a few years ago, today 19 generics are produced in Russia for the treatment of HIV infection. In 2017, producers plan to cover 50% of the demand with domestic generics, and by 2020 - 100%. This will reduce the cost of drugs and provide a greater number of patients with medicines.

The speaker noted that 38.8 million people live worldwide with HIV (2015), almost the same number of people have passed away during the epidemic (since late 1980s). This is comparable to the losses in the Great Patriotic War. Among the achievements in the fight against this disease is that over the past 5-6 years, the number of patients receiving antiretroviral therapy increased from 5-6 million to 17 million. This allowed to reduce the mortality and morbidity. Nevertheless, in general, the trend of an increase in the number of new HIV cases has been observed in the world: almost 5,500 new cases occur daily. 14 million children were orphaned by AIDS.

In Russia in the last few years, insufficient attention has been paid to HIV infection, which has resulted in negative consequences. In recent years, the annual increase in new cases of infection was approximately 10%, and in 2016 - by 5.4%, in absolute terms this is 103.438 new cases, in 2015 this figure was 95.000. In Russia about 300 people are infected every day. A total of 1.114.815 HIV cases were detected among Russians during the whole epidemic period. The number of PLWHA, registered at AIDS Centers, has increased: from the 870.000 PLWHA 675.000 people are registered. In 2016 285.920 people received ARV therapy in Russia (42,3% of those on dispensary supervision).

HIV infection affects different human body systems: cardiovascular, central nervous system, causes psychological problems, etc. "Living with this disease is difficult. Therefore, the help of religious organizations is very important, "she said.

In recent years the number of regions increased with incidence of disease of more than 0,5%: in 2014 - 23 regions, in the middle of 2016 - 28, at the end of 2016 - 30. These are the most important regions, where about 50% of the Russian population lives. The highest rates of incidence of disease (per 100 000 people) are registered in the industrialized regions: in the regions of Irkutsk (1 618,6), Sverdlovsk (1 583,9), Kemerovo (1 553,0), Samara (1 396,9), Tyumen (1 308,0), Khanty-Mansi autonomous region (1 251,6), Orenburg (1 198,2), Chelyabinsk (1 068,5), Leningrad (1 138,2), Novosibirsk (991,5), Perm (986,8), Republic of Crimea (969,3), Ulyanovsk (914,0), St. Petersburg (852,6), Altai (819,0), Krasnoyarsk (761,3). In some areas up to 1,5% of the population is affected by HIV infection, generalization of the epidemiological process takes place. The total incidence (the number of new cases per 100 000 population) in Russia is 70 people, and in some areas, for example, in Kemerovo - 288, Irkutsk - 163, Samara - 161. It is alarming that there is an increase in morbidity in previously quiet areas, for example, In Karachaevo-Cherkessia - by 86%, Yaroslavl - 61%, in Sevastopol - 70%.

The coverage of the population by HIV surveillance increased by 5%, in some regions up to 20%. In 2016, 30.787.882 people were tested for HIV in the Russian Federation, which is 7,4% more than in 2015. Not many countries in the world have such high rates.

The causes of HIV infection in 2016 were: drug use - 48,85% (in 2015 - more than 51%), heterosexual way - 48,7%, homosexual - 1,5%, from mother to child - 0,8% . It is known that with proper medical support children of HIV-infected women are born healthy. In the Russian Federation, 16.000 deliveries are registered annually from women living with HIV. Unfortunately, the number of HIV-positive children is increasing every year due to the fact that women do not turn to health facilities for treatment.

The high rate of HIV infection in the Russian Federation increases the risk of infection of health workers in emergencies at workplaces. There has been an increase in reported cases of trauma of health workers providing assistance to PLWHA. In 2015, 3 cases of infection of nurses were registered. Post-exposure prophylaxis can stop the development of the disease. In 2015, 3.462 health workers received such preventive treatment.

"Those who provide palliative care for HIV-infected people, especially Orthodox sisters of mercy, need to be well educated in matters of anti-epidemic regime in the provision of medical care in medical facilities, outpatient clinics and at home," - said the speaker.

Currently the laws are being softened on the undesirability of staying on the territory of the Russian Federation of persons, who have been diagnosed with a disease that poses a danger to others. Previously, a migrant, even after being cured, could no longer enter the territory of the Russian Federation. Today, the Constitutional Court marked certain laws as unreasonably stringent, and the government of the Russian Federation instructed all interested federal ministries to amend federal legislation, in particular the Federal Law on entry and exit to the Russian Federation and Decree No. 99 specifying, which federal services and ministries can decide about undesirability of a migrant's stay in Russia. This makes it possible to suspend the decision on expulsion or to abstain from such decision if a person, after learning about his illness, has been treated at home or in the Russian Federation.

In 2016, 49,4% of the total number of decisions on undesirability of stay in the Russian Federation was taken against citizens of Uzbekistan, 24,1% - Tajikistan, 2,0% - Moldova, 6,3% - Azerbaijan, 2,0% - Armenia.

Almost all migrants receiving a patent are tested for HIV infection, TB and STI. In 2016, 2,3 million migrant workers were examined, of which 1.916 (21,6%) were HIV-infected, 2.370 (27,0%) had tuberculosis, 4.369 (50,4%) - STIs, 1 - leprosy. HIV rates are declining among migrants, TB rates remain at a high level. The incidence of STIs is rapidly increasing.

In 2016, two documents were issued, which are important, in particular, for the work of religious organizations:

  • Changes were made in Sanitary rules and regulations 3.1.5.2826-10 "Prevention of HIV infection" (registration No. 44101 of October 20, 2016);
  • The methodological instructions "Epidemiological surveillance of HIV infection" have been approved, including, in particular, a detailed section on the organization of epidemiological investigation for suspected HIV infection of February 26, 2016.

The Program of the Russian Federation to Assist the Countries of the Region (2016-2018) in the fight against HIV continues: technical assistance is provided, joint scientific research is conducted; the genetic variability of HIV circulating in adjacent territories is studied; a reference center for countries of the region has been established to monitor the resistance of HIV to antiretroviral drugs.

A project operates since 2015, under which the Russian Federation has provided equipment for 6 countries of the region. In particular, 6 mobile complexes were delivered (in February 2017 another one will be delivered), which are used in remote mountain regions to survey the population, especially women for HIV, TB, STIs, and for medical care. Specialists of these countries are trained. Since 2016, scientific research has been carried out aimed at identifying the causes of highly resistant forms of the disease in the region.

In the Russian Federation, in 2016 a number of prevention programs was carried out, in which 1.700 participants of various forums underwent voluntary anonymous testing, 19.000 information materials were distributed.

Sergey Smirnov, Deputy Director of the Foundation for Socio-Cultural Initiatives, reported about the All-Russian action "Stop HIV/AIDS".

He noted that according to the Ministry of Health, preventive and educational work reduces the level of HIV infection by up to 20%. Therefore, the Foundation for Social and Cultural Initiatives saw its task in uniting the efforts of state funds and NGOs in educating youth. The organizing committee consisted of representatives of various agencies and organizations, including Russian Orthodox Church, they paid attention to the ethical aspect in the preventive work with the youth.

Through the efforts of the Fund in 2016 the All-Russian action "Stop HIV / AIDS" was organized, dedicated to May 15 - World Remembrance Day of AIDS Victims.

Within this Action various training seminars, psychological trainings, anonymous HIV testing, student flash mobs, and many other activities were held in federal universities and medical institutions of the country. The key event of the Action was the Open Student Forum, which was held in 200 federal universities, major events were held at MGIMO and Moscow State University in Moscow and were broadcasted on the Internet. "Of course, this event did not become some kind of revelation, however, it allowed to look at the problem of HIV infection from different sides. This was an open dialogue, during which the students themselves, with the support of specialists, talked about the HIV problem, "S.A. Smirnov said.

From November 28 to December 4, 2016 the All-Russian action "Stop HIV/AIDS", dedicated to December 1 - World AIDS Day, was held. During these days, awareness raising activities were organized throughout the country, one of which was a thematic Open lesson, prepared by university students and health professionals. An open lesson was held in schools, colleges, universities, in correctional facilities for juveniles. About 10 million children were involved. Within the open lesson with "Russia 24" TV channel, a 15-minute film about HIV infection was prepared and methodological recommendations were developed for it. The website http: //. displays presents all the main materials of this Action.

"For our Foundation, high school students, young people are a priority group, we will continue to work in this direction," he said. "In May 2017, the third All-Russian action" Stop HIV / AIDS "will take place, during which an open space will operate in a public park in Moscow. We will continue the preventive education work in the format "children-to-children", "students-to-students".

Shahgildyan Vasiliy Iosifovich, a senior researcher at the Federal Research and Methodological Center for Prevention and Control of AIDS, made a presentation on the organization of palliative care for PLWHA.

He noted that Eastern Europe is the only region in the world, where the HIV epidemic continues to grow, and mortality due to AIDS increases. In Russia every day about 300 people are infected with HIV, about 70 people die, that is every 5 minutes 1 person is infected, every 20 minutes - 1 person dies of HIV.

In Russia (as of 1.11.2016) 51.601 AIDS patients were registered, 42.661 prs. died with the diagnosis of AIDS (82,7%). Similar indicators among children: total of 508 AIDS cases, 373 children died (73,4%).

The total number of HIV-infected citizens in Russia (from 01.01.1987) as of 30.09.2016 (Federal Research and Methodological Center for Prevention and Control of AIDS, 2016) is 1.087.339. The annual increase in new HIV cases is as follows:

2010 - 58,298 new HIV cases;

2011 - 62.385 (+ 6,5%);

2012 - 70.744 (+ 11,8%);

2013 - 79.728 (+ 11,3%);

2014 - 89.342 (+ 10,8%);

2015 - 95.475 (+ 6,5%);

During the first 9 months of 2016 - 75.962 (+ 1,9%).

The incidence is 51,8 per 100.000 of the population of the Russian Federation, the prevalence is 582,9 per 100.000. Speaking about the relevance of palliative care, Shahgildyan V.I. Noted an increase in the numbers of patients with HIV, who need care.

The percentage of HIV-infected people, newly diagnosed in the late stages of the disease and in need of palliative care, has more than doubled in the last 6 years. In 2005, the share of those diagnosed at the stage of opportunistic diseases was 11,1%, in 2011 - 24,4%, in 2015 - 28%. Almost 30% of the newly diagnosed patients were already at an advanced stage of HIV.

The palliative care for PLWHA includes:

  • Relief of physical suffering of the patient with HIV infection, by relieving or alleviating the symptoms of the disease, as well as severe clinical side effects associated with the therapy (including ARV);
  • Psychological, emotional support of the patient at the advanced stage of disease, including the period of his passing away;
  • Help to the HIV infected person in his spiritual suffering;
  • Assistance in solving social and economic problems of a person with HIV infection, who has limited physical or mental capabilities;
  • Providing care for a patient with severe clinical manifestations of the disease or its consequences (for inpatient and outpatient care).

Speaking about the medical component of palliative care, Shakhgildyan V.I. noted that ARV therapy could solve many problems, in particular, the lethality of late cases of HIV infection. Studies show that of the 100% of HIV-infected patients, only 85% are registered for dispensary, 75% follow medical check-ups, 31% receive ARV, and 23% get better, and no viral load is detected. So we need to increase the number of patients taking ARVs. NGOs and religious organizations play an important role, explaining the need for adherence to ARV therapy.

The number of people with HIV, who need to be hospitalized, is constantly increasing. For example, the Infectious Clinical Hospital (ICH) #2 in Moscow in 2004 had 1.500 such patients, in 2006 - 2.664, and in 2013 - 6.236, in 2015 - 6.414 people. Half of the patients arrive already at the stage of AIDS and need active palliative care.

The following data illustrate the relevance of palliative care: in 2001, of all HIV cases only 1.100 patients were at the stage of AIDS, and in 2016 (November) - 51.601. In the structure of PLWHA mortality, the share of deaths in the AIDS stage is increasing: in 2001 - 6,4%, 2016 (November) - 25,4% of all cases.

As of September 30, 2016, there were 233.152 (21,4%) deceased patients with HIV infection, including 19.979 prs. within 9 months of 2016 (9,2% more than in 9 months of 2015).

The palliative care can not be reduced only to supporting dying patients: patients with HIV infection have secondary diseases and require intensive symptomatic therapy and care, many of these diseases lead to a decrease in capacity and severe disability.

Palliative care for HIV-infected people is increasingly confronted with the problems of aging patients and the need to address the problems inherent in this age: at the end of 2013 40-50 years old patients made up 7,9% (62.319 prs.), as of July 31, 2015 - 9,0% (81.582 prs.); over 60 years old - in 2013, 5.708 prs., in 2015 - 7.629. The age group of people over 40 years has increased from 87.951 prs. (2013) to 115.331 prs. (2015). The age of newly diagnosed HIV cases is increasing.

Patients with HIV are 5 times more likely to have oncological diseases; higher percentage of cardiovascular diseases, in some cases provoked by obsolete ARV drugs. Palliative care involves symptomatic therapy - treatment of ARV side effects - the main reason, why PLWHA refuse therapy.

Palliative care also includes active professional social support. Religious organizations play an important role in this. "Religious organizations, such as St. Dimitry's sisterhood, selflessly work, providing palliative, incl. social assistance to HIV-infected people. This service should be incorporated into the work of medical institutions, social service centers. Otherwise, you will leave, there will be no palliative care. " According to the speaker, this integration should be supported by the government with a special order regulating social assistance.

An important part of palliative aid is care. A remarkable example of the organization of such care is the work of the sisters of mercy of St. Dimitry's sisterhood in the ICH No. 2. Today mostly NGOs provide care, but medical nurses too need to be trained for this service. The administration of hospitals should take care of this.

An integral part of palliative care is the spiritual support provided by religious organizations. "Their help is also needed in the prevention of spiritual deficit, which we sometimes encounter in the regions - there are cases of deliberate infection of their loved ones for the sake of social material assistance. We observe these cases among socially disadvantaged groups of the population. It is among them that one needs to prevent the spiritual deficit, "he said. "It is necessary to monitor and evaluate the effectiveness of this work in order to understand what forms of work are most effective."

Palliative care is helping people with various diseases that experience prolonged physical and psychological suffering. In Russia, palliative care is regulated by the following documents:

  • Order of the Ministry of Health No. 610 of 17.09.2007 "On measures to organize palliative care for HIV-infected patients";
  • Order No. 187 of 14.04.2015 "On the approval of the procedure for the provision of palliative care to the adult population";
  • Order No. 689n of 8.11.2012 "On the approval of the procedure for providing medical care to the adult population in case of illness caused by the human immunodeficiency virus (HIV infection)";
  • Strategy to combat the spread of the disease caused by the human immunodeficiency virus (HIV) in the Russian Federation for 2014-2020.

In 2012, the draft of the order "Organization of social care system for HIV patients and their family members" was developed (not yet published).

Today a palliative care unit is operating in St. Aleksiy Hospital (Moscow); a department for HIV patients at advanced stages that provides palliative care in the City Center of St. Petersburg State University (head of the Department - Leonova O.N.); the department of intensive and palliative care for HIV patients in ICH #2 (Moscow).

There are several difficulties that hinder the organization of palliative care. The following can help to overcome them:

  • Count of HIV-infected patients in need of palliative care in the region;
  • Database (register) of patients who need palliative care in the region;
  • Determination of mandatory and priority types of assistance to meet the most urgent needs of HIV-infected patients requesting palliative care;
  • Assessment of the resources available in the region for the implementation of the tasks set for palliative care for PLWHA;
  • Development of a "roadmap" for palliative care to a patient with HIV infection;
  • Monitoring and evaluation of the effectiveness of the work.

Olga Yu. Yegorova, senior nurse of the St. Dimitry Sisterhood home-visiting service and head of the Re-source Center for Palliative Care for PLWHA, made a report on the experience of a socially oriented NGO in HIV prevention.

In October 2016, the State Strategy for Counteracting the Spread of HIV Infection in the Russian Federation for the period until 2020 was adopted, which places great emphasis on socially oriented NGOs and on combining their efforts with government and voluntary organizations in combating the spread of HIV. Their important role in prevention and care was noted, and provision was made for various forms of assistance, including financial assistance, including grants.

January 24, 2017 a meeting of the Council of RF Government on the issues of guardianship in the social sphere was held, at which the plan for implementing the Strategy was discussed. It is also important that according to the federal law (No. 442, Article 20) "On the Basics of Social Services for Citizens in the Russian Federation", socially oriented NGOs may be included in the register of social service providers, who provide: "welfare services aimed at maintaining life of recipients of social services in everyday life; social and medical services, aimed at maintaining and preserving the health of recipients of social services through the organization of care, assisting in the conduct of recreational activities, systematic observation of recipients of social services to identify abnormalities in their state of health; socio-psychological services, providing assistance in correcting the psychological state of the recipients of social services for adaptation in the social environment, including the provision of psychological assistance, anonymously using a telephone hotline. "

For these services Church related NGOs could enter the register. The St Dimitry sisterhood sets itself such a task.

The Resource Center for Palliative Care under St. Dimitry Sisterhood has two main areas of work. The first area is methodical, educational and trainings (courses for volunteers, care givers, training seminars for nurses and students of medical schools, social workers and sisters of mercy). Trainings are conducted on the basis of the St. Dimitry School in Moscow and in the regions. The resource center has been engaged in this work for many years, has long-term projects in the regions that yield good results. One example is Arkhangelsk, where a diocesan sisterhood is working, serving Arkhangelsk, Novodvinsk and Severodvinsk. On an ongoing basis, nurses help hospice patients, as well as nursing and palliative care departments of the City Clinical Hospital No. 1 in Arkhangelsk. In 2016, 60 patients with HIV were treated in different departments here. Another example is Khanty-Mansiysk, where the local government provided the sisterhood on a competitive basis with a subsidy for 2016-2017 in the field of "Philanthropy and volunteerism in the development of palliative care for HIV-infected".

In 2006-2016 the Resource Center organized trainings for 1.500 specialists from 80 organizations in different regions, issued methodical and educational manuals on the organization of nursing care.

The second area is practical activity on the basis of ICH No. 2 in Moscow, where in cooperation with the hospital administration a service for palliative care for PLWHA has been set up, that is run by sisters of mercy and volunteers. The hospital has 810 beds, which makes up 40% of adult infectious beds in Moscow. Out of these, 400 beds are occupied by PLWHA. In recent months, each hospital department has added 10-15 beds. The ICH complex includes the city AIDS Center with 3 adult patients units, in which sisters of mercy serve, as well as 3 units for children, where babies born from HIV + mothers stay. Many of them were abandoned by their mothers or belong to socially disadvantaged families. Many HIV-positive children from disadvantaged families did not receive ARV therapy and die at the age of 10-12 years. They need special care, which is provided by sisters of mercy.

The abandoned children stay in the hospital for a long time - until the guardianship authorities decide on placing them in an orphanage. Sisters of mercy organize their free time and education.

Sisters and volunteers now work in 4 departments for PLWHA. Their work is to provide comprehensive medical, psychological, social and spiritual assistance, they aim to increase motivation and adherence to treatment, improve the quality of life of patients. Their help is addressed to patients who cannot serve themselves and patients at the stage of AIDS. Sisters provide assistance to 700 patients a year, i.e. 58-60 prs. a month.

Social assistance is one of the most complex areas. Many hospital patients are homeless, asocial people who need help in restoring their IDs, buying tickets to return home, establishing contacts with relatives; they need to be placed in social adaptation centers, shelters and rehabilitation centers, need legal assistance.

The sisters see the main task of nursing care in the formation of patient's adherence to treatment, this entails the need to change his habits and values. Sisters of mercy with medical training answer patient's questions, which the medical staff has no time to answer. "The unity between patient and nurse is the basis for the empathic therapy or therapy by nurse's participation in the life of the patient. It requires trust, individual approach, a lot of time and inner energy, " noted Olga Egorova.

Medico-social assistance involves close cooperation between the nurse and the social worker. "Our achievements may seem small, but behind them is the life situation of each person, explored with him individually," the spokeswoman said. Olga Egorova named the following problems that sisters of mercy have to address while providing social assistance to the patients:

  • Accommodation of patients that can't take care of themselves, after they leave the hospital;
  • Permanent accommodation in a governmental institution for disabled;
  • Accommodation of migrants - citizens of Ukraine, Moldova, Georgia after discharge from the hospital;
  • Deportation of foreign citizens;
  • Preparation of documents and registration in a social institution, social shelter;
  • Organization of medical care for HIV-infected patients; no possibility to obtain ARVs at the place of patient's actual residence;
  • Individual accompaniment to AIDS centers.

Sisters of mercy also care for the spiritual state of patients, which significantly affects their physical and emotional state. A survey with 220 patients showed, that attending church worship and inchurching of patients effects very positively their physical condition. Many patients stated that the HIV infection caused them to turn to God.

Kuprik Valeriy Nikolaevich, the head of the rehabilitation center for drug addicts, the Antinarcotics Service of Shakhty Diocese 'Chance', made a presentation on "Rehabilitation of drug users and HIV-infected in the church community on the basis of the Governmental Institution" Narcological Dispensary ".

The rehabilitation program of the center is implemented within the agreement between NGO "Center of St. John of Kronstadt" (Shakhty Diocese of the Russian Orthodox Church) and the Narcological Dispensary. It is complex and includes the whole range of services: detoxification, motivation and rehabilitation, based on the Methodology of rehabilitation in church communities. The main stage of rehabilitation is realized jointly by the narcological dispensary that provides accommodation and technical facilities, and the diocese, which provides the content related component of the rehabilitation process.

The most important aspects in the organization of the main stage in the rehabilitation program are:

  • Organization of the atmosphere and everyday life in the rehabilitation center;
  • Rehabilitation work;
  • Training for labor and social skills;
  • Inchurching;
  • Treatment of associated diseases (including HIV and hepatitis C).

30-40% of the rehabilitants have a positive HIV status, of which only about 10% received ARV therapy and were registered with an AIDS center. Specialized care for patients is organized by the Ark-Anti-AIDS Foundation, the Regional AIDS Center and the Southern District AIDS Center.

Upon admission to the center, all patients without exception undergo a medical examination (fluorography, blood test for HIV, hepatitis B and C, syphilis, general analysis and biochemistry) in the laboratory of the Shakhty branch of the Narcological Dispensary. The examination is accompanied by pre- and post-test counseling by narcologists and peer-to-peer counselors in the rehabilitation center.

If HIV is confirmed or detected, patients with ELISA results are registered in the regional AIDS and ISC center, where they regularly check for viral load, opportunistic diseases, make immunograms, receive all necessary medical consultations and, if necessary, ARV drugs. This became possible after the problem of temporary registration of non-residents in the rehabilitation center for the entire period of treatment was solved. Consultants help the patients to form a responsible attitude to taking therapy. The Center carries out secondary prevention (classes with HIV-negative rehabilitants) and tertiary ("Patient's School" for HIV-infected rehabilitants on life with HIV and adaptation in the community).

NGOs, in particular the "Ark-Anti-AIDS" play a very important role at each stage of rehabilitation.

Tsunik Vyacheslav Konstantinovich, "Ark-Anti-AIDS" NGO reported about the possibility of obtaining governmental funds for socially-oriented NGOs for their social services for patients with HIV infection. This possibility is provided by Federal Law No. 442 "On the Basics of Social Services for Citizens in the Russian Federation". Orthodox sisterhoods in many regions, incl. Rostov-on-Don, that provide palliative care to HIV-positive people at home or in medical institutions for free, could receive public funds for their activities in accordance with Article 20 of the Federal Law. Regional laws that follow federal laws and regulate this activity, may differ from region to region. In order to receive such assistance, an organization needs to enter the register of state service providers (art. 25). For this some organizations will have to amend their statutes and include social services (see the Federal Law No. 442).

The law (Article 30) provides for various sources of financing of social services: budget funds, charitable contributions, income from business activities, etc. Article 15 sets up criteria for recognition a citizen as needing social services paid by the state. Article 14 states that "the basis for considering the issue of providing social services is a written or electronic application of a citizen or his legal representative for the provision of social services." This application is considered by social service authorities, but the services themselves can be provided by a large number of organizations, including those included in the register of social service providers in the respective region. Although the law does not mention palliative care, the services listed in it are part of this concept.

During the discussion, Dementieva L.A. recalled Decree No. 1096 of the Government of the Russian Federation of October 27, 2016 "On the approval of the list of socially useful services and criteria for assessing their quality," to which sisterhoods engaged in palliative care also can appeal. Article 17 of this decree refers to services of "medical and social support for persons suffering from serious diseases and those, who need medical palliative care, including organizing medical palliative care and assistance in obtaining it."

Representatives of different regions spoke to the theme "Primary prevention of HIV/AIDS - programs for children and youth".

Afonina Victoria Gennadievna, director of Bryansk NGO "Blago", presented new methodological materials for the "Living Water" program on prevention of risky behavior of primary school children. This program is taught in more than 50% of schools in Bryansk to 1.350 schoolchildren. Not always is it possible to engage two trainers during one session, as required by the program. The problem was solved with help of the Institute for Advanced Studies: its students after respective training accomplished "practicum" in schools as co-trainers in "Living Water". For those schools, where this was not possible, 26 short videos of 2-3 minutes each were shot - one for each lesson. Fairy-tale characters of the program address students from the screen, replacing the co-trainers.

Akhlyustin Ilya Anatolyevich, staff of the Chelyabinsk Regional AIDS Center, told that the prevention programs "Ladya", "Living Water " and "Way to Home" are spread in Chelyabinsk and the Chelyabinsk region in cooperation of church and secular education institutions, social services, AIDS Center. In some schools sessions on the program "Ladya" are included into the school timetable. Program participants and their parents actively discuss sessions in social networks, creating special groups. This allows teachers to get "feedback", i.e. from parents and assess the effectiveness of classes. The specific of the region is that several priests here received training on working with prevention programs, and teach these programs in schools. Practically in all cities of the Chelyabinsk region there are specialists, who have been trained and are teaching these programs in their schools. So far, 5.612 children have completed training on the "Ladya" program, 1.820 - in "Living Water" and 1.186 - in "Way to Home".

Balabanova Olga Vladimirovna, Moscow ROC Diocese, shared her observations on the possibility of spreading prevention programs in Nizhny Novgorod and Moscow, and also plans to begin teaching "Ladya" to students of the St. Dimitry Nursing College.

In agreement with the Head Department of the Ministry of Internal Affairs for Moscow, a pilot project was implemented with several sessions on "Ladya" program for children, who committed a crime, mainly drug sale and abuse. The sessions showed that the program is very effective for this population. The plans are to hold a training seminar for psychologists of the Department of Federal Penal Service on work with "Ladya".

Training seminars on "Living Water" and "Ladya" are also planned for the participants of the Mosgortur "School of Leaders" - students who work in the Moscow summer camps. Programs and church projects dealing with the prevention of alcoholism and drug addiction were also interested in the programs. "Ladya" has established itself as a universal tool that effectively works in a wide variety of public groups. And we are certainly happy to see that "Ladya" sailed from Kaliningrad to Magadan, "O.V. Balabanova noted.

Kholodkova Aleksandra Aleksandrovna, "Blagoveschenie" NGO, Barnaul ROC Diocese, said that prevention programs are being taught in 32 schools in Barnaul today. Trainings for teachers and school psychologists on work with prevention programs are held at the request of the city's Department of Public Education. In September 2016, a large conference on prevention was held in the city, where these programs were presented. "It is important that there are three programs for different age groups. This allows to involve whole schools in the work: from the first to the eleventh class, "- said Alexandra. In some schools, at the request of children, who have completed training on "Ladya", the cycle of this program is repeated, but in a modified form (modifications are provided in the program curriculum).

The teachers of "Living Water" in Barnaul, likewise in Bryansk, faced the problem finding a co-trainer. So they invited the participants themselves to act as fairy-tale characters: the children were given a text in advance to memorize it for the next lesson. Such lessons were more vivid, emotional, were better remembered.

Once in 2-3 months, master classes are held for teachers, who have completed training and for beginners - on specific topics. This allows to share methodological findings and to involve new teachers.

Sechina Irina, the chief editor of the web-site of the ROC Eastern Vicariate of Moscow, shared her ideas on how to organize media coverage of HIV / AIDS related issues.

On the territory of the vicariate is located the ICH No. 2 and a boarding school for children with HIV infection. In December 2016, Irina prepared a series of materials on the work of the nurses in ICH No 2. These publications were timed to the World AIDS Day.

In order to use the mass media as a tool for educating the public about HIV / AIDS, media events are necessary, i.e. events that the media could talk about, and also "speakers", i.e. people living with HIV, who would participate in TV talk shows, arrange their blogs in social networks, give interviews. "Given the delicacy of the topic, the press needs a very sensitive approach in its coverage, which can be found in high-level professionals," Irina believes.

Seminar on the Ladya program

From January 20 to 24, 2017, the St. John of Kronstadt Charitable Foundation held at the St. Nicholas of Ugresha Patriarchal Monastery a seminar on the work under the Ladya program designed for prevention of risk behaviours among teenagers. Teachers, psychologists and social workers, who deal both with troubled and sound teenagers, explained this program developed with the support of the Russian Orthodox Church. The lessons according to the Ladya program can be conducted in general secondary schools and boarding schools, vocational colleges and universities, as well as used in out-of-school forms of work - youth clubs, Sunday schools and summer camps.

According to its authors' design, the Ladya program is called not just to inform teenagers about problems involved in risk behaviours, such as HIV/AIDS infection, development of dependencies, etc., but also to help them develop spiritual and moral guidelines, which will enable them to refrain from hasty actions. It consists of 23 lessons one hour and a half each. The themes are the prevention of drug addiction, search for love and happiness, overcoming problems, the goal and meaning of life, etc. The program is designed for teenagers from 14 to 17 years of age, irrespective of their religion and level of social adaptation.

The seminar was attended by some 30 prs. including psychologists, social workers and members of parish temperance societies. 'The information was given in diverse forms, such as debates and discussions and role-playing games, which make it possible to play out the received knowledge and to understand what you should pay attention to in your preventive work with children', psychologist Natalia Ischenko of the St. John of Kronstadt charity said, 'the value of the Ladya program lies in its universality and flexibility, as it is a practical instrument to be used depending on a particular audience, on the children with whom a specialist is working'.

The seminar was conducted by psychologists Victoria Afonina and Yelena Severina. They presented to attendees not only the theoretical foundation of the program, but also gave recommendations on how to use it in practice. In particular, they recommended to involve in the work not only teenagers, but also their parents and school administration.

The teachers, psychologists and social workers who attended the seminar will introduce the Ladya program to the Moscow Region towns, including Dzerzhinsk, Kolomna, Podolsk and Khimki.

From February 23 to 27, 2017, in the same monastery of St. Nicholas of Ugresha there was a training seminar for teaching to work under the Living Water, a program for the primary prevention of risk behaviours among junior schoolchildren. It was organized by the Developmental Center 'The Sun's Circle' at the town of Dzerzhinsk, Moscow Region.

From www.diakonia.ru

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