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Newsletter, January 2018

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, 2018, as part of the XXVI 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 five reports and studied problems of the HIV/AIDS epidemic in Russia and worldwide; prevention of HIV infection among nurses and volunteers providing palliative care for HIV-infected people; evaluation of the effectiveness of primary prevention programs for risky behavior and HIV/AIDS among children and youth in different regions; attitude of the Church towards the movement of HIV-denials; experience of cooperation of state, public and religious organizations in the prevention of HIV infection.

Larisa A. Dementieva, deputy head of directorate for epidemiological monitoring, Russian Federal Service for Surveillance on Consumer Rights Protection, made a report on "The epidemiological situation of HIV infection and the measures taken in the Russian Federation to prevent the spread of HIV infection".

She noted that according to UNAIDS, since the beginning of the epidemic, more than 78 million people have been infected with HIV worldwide, about 50% of them have died from complications associated with the disease. However, since 2005, the number of deaths has almost halved. The number of new HIV infections compared to 2010 decreased by 11%, and among children - by 47%. The leading cause of death among people living with HIV (PLHIV) remains tuberculosis (about 30%). Of the 36.9 million PLHIV in 2017, 21.5 million people received access to therapy.

In the Russian Federation at the end of 2017, the total number of HIV-infected people was 1 million 219 thousand people. The number of new HIV infections continues to grow (about 100,000 people in 2017), but the incidence rate is declining: in 2011-2015, the annual growth was on average 10%, in 2016 - 5.3% and in 2017 - 0.9%.

The speaker noted some positive trends in this area:

  • Population screening increased: compared to 2016, the coverage of the population by HIV testing has increased by 10.7% (34.08 million Russian citizens were tested). At the end of 2017, 724,415 PLHIV (75.5% of the total number of cases) were registered in specialized medical organizations for regular medical check-up, 674,209 received prophylactic medical examination.
  • Therapy coverage of PLHIV on dispensary registration - from 37% in 2015, 42.3% in 2016 to 47.8% (346,132 patients) in 2017.
  • Decrease of the proportion of adolescents and young people of 15-20 y.o. among newly detected cases of HIV infection to 1%, of youth of 20-30 y.o. - to 20%.

At the same time, there are also alarming signs of the epidemic:

  • Only one third (36.7%) of PLHIV received ARVT, which is significantly lower than the rates recommended by WHO.
  • The drug resistance of the virus to the effect of ARVT is increasing, and reaches 10% in some regions. This entails the need to change treatment regimens and use more expensive drugs.
  • The number of regions with HIV infection incidence of more than 0.5% of the population is increasing: from 22 in 2014 to 34 in 2017. In these regions, 50.6% of the country's population live in these regions.
  • The increase in deaths among PLHIV continues to be recorded: 277 thousand people died during the whole observation period, including 31,898 in 2017 (an increase of 4.4% compared to 2016).
  • The proportion of rural residents among newly diagnosed PLHIV is increasing (in 2015 - 27.8%, in 2016 - 28.3%). At the same time, the share of rural residents among adolescents of 15-17 y.o. is higher than in urban areas (28.4%).
  • The HIV incidence tends to shift to older age groups: among newly detected cases in the group of 30-40 y.o. - 47%, 40-50 y.o. - up to 22%. The highest incidents rates among men are registered in the age group of 35-39 y.o. (2.9%), among women - in the group of 30-34 y.o. (1.6%).

The problem of providing medical care to children and adolescents living with HIV, especially orphans, requires an individual, non-discriminatory approach. From 1987 to 2016 there were 172 thousand children born to HIV-infected mothers (as of September 1, 2017) in the Russian Federation; 29,122 HIV-infected children aged 0-17 were registered. In 2016, 10,943 HIV-positive children lived in the Russian Federation.

The community of biological parents of HIV-infected children and adoptive parents is actively developing. Such organizations as the Charity "Help Children Affected by HIV Infection "Children Plus"" contribute to family adoption of orphans, organize clubs for HIV-positive teenagers aged 12-17, assist in trainings for adoptive parents and support their community through forums, etc.

Along with the positive moments in the parental community, AIDS-dissident ideas continue to spread, which results in dropping therapy and death of children.

The prevention of further spread of HIV requires modern prevention technologies, including electronic software, like "Life4me +", Russia's first free mobile app with many different functions: permanent communication between doctor and patient, remote real time control of drug intake and adherence to treatment, most relevant news from the world of HIV, scientific discoveries, research, etc.

In 2017, special emphasis was placed on working with students, on the population working in large and small industrial companies, in social services. Numerous prevention activities and actions were carried out, during which, in particular, anonymous testing for HIV infection was organized for all comers. Only within the framework of the All-Russian campaign "STOP HIV/AIDS" from November 27 to December 8, 2017, the Hygienics and Epidemiology Centers in the regions of the Russian Federation held more than 1,100 "hotlines" and carried out 19,014 counseling sessions for the population.

L.A. Dementieva told that the VI International Conference on HIV/AIDS in Eastern Europe and Central Asia will be held in Moscow on April 18-20, 2018, in which up to 3,000 participants are expected: prominent scientists, politicians, public health officials, health professionals, leadership of international organizations and UN agencies (WHO, UNAIDS), representatives of civil society and private sector from Russia, CIS countries, BRICS, SCO, Europe, South and North America, and South-East Asia. The conference will provide an opportunity to assess the experience of the region in the fight against HIV/AIDS.

In conclusion the speaker expressed her hope for continued mutually beneficial cooperation between state and FBOs in the prevention of HIV infection and in care for people affected by the disease.

First deputy of the Bishop of the Russian Union of Christians of Evangelical Faith (Pentecostals) K.V. Bendas noted during the discussion that RUCEF has about 350 inpatient rehabilitation centers for drug addicts, where up to 30,000 people are treated at a time. They operate in almost all constituent territories of the Russian Federation and make a great contribution to the primary detection of socially dangerous diseases: testing, incl. for HIV infection is mandatory for admission to rehabilitation. Currently, a uniform certification system for all RUCEF rehabilitation centers has been submitted to Rosstandart for registration. The leadership of the Union is ready to include an agreement with the regional Ministry of Health structures concerning prevention, testing and therapy in the mandatory requirements for certification. This will be a significant contribution to the prevention of HIV infection and promotion of adherence to antiretroviral therapy.

Head of the Resource Center for Palliative Care of St. Dimitry Sisterhood (Moscow) O.Yu. Yegorova spoke about the role that nurses and volunteers play in the HIV prevention system in medical institutions, using the example of Infectious Disease Hospital No.2 (Moscow).

Sisters of mercy and volunteers in hospitals perform functions that are not part of the duties of the regular medical staff: they talk with adult patients, cut hair, and feed. Much work is being done with drug users and homeless people in the hospital, their number is growing (in 2016 - 128 prs., in 2017 - 169 prs.). "If a homeless person leaves the hospital and returns to an antisocial lifestyle, after a month of living on the street he would lose all the results of treatment," she said. Therefore, the sisters of mercy try to accommodate them in social institutions, help them find relatives, recover IDs.

Sisters of mercy and volunteers participate in various activities for primary prevention: in 2017, a round table on HIV prevention for students of seven city medical colleges was held on the basis of St. Dimitry orthodox college for medical nurses.

Sisters of Mercy organize activities for primary prevention for students of medical colleges, teach infectious safety in the college, and at schools for volunteers, as well as at various trainings.

The St. Dimitry Resource Center for Palliative Care published a training manual for medical colleges on the prevention of occupational infections: "HIV infection. Clinical manifestations and forms. Nursing. Prevention of occupational infections " (authors: Palatova N.M., Egorova O.Yu., publishing house: Lan', 2017, series "Textbooks for Universities"). The Resource Center has already published many HIV-related curriculum books, all of them include a section on infectious safety.

To ensure secondary prevention, nurses and volunteers strictly observe all the rules of the sanitary and epidemiological regime in medical institutions, including the mandatory wearing of a mask in all rooms to prevent contraction of TB; they regularly undergo medical checks, testing for TB, and vaccination.

Providing care to discharged patients at home and working with body fluids, debriding pressure sores, dressing wounds, etc. the sisters observe the same strict infectious regime as in the hospital. The regime is less strict if the patient has no TB; feeding, talking, working with clean linen can be done without gloves and masks. Sisters of mercy also organize legal counseling, social assistance, consultation, help to heel relations with the family, and to find relatives. "It often happens that the family is tired of an adult who lives his own difficult life. Sisters of mercy and volunteers take over some of the worries, reconnect family members, and families are recreated".

Sisters of mercy and volunteers work with the parents of HIV-positive children to provide support for kids. They also work with teachers of schools where they study, to ensure that the diagnosis will not be disclosed and psychological support would be provided.

"Sisters of mercy and volunteers, unlike medical staff of hospitals, can stay with a patient as long as necessary not being limited by a job description or time frames. They have great access to all spheres of his life, are trusted and have the opportunity to motivate for therapy. Patients trust them, and they are coping well with the task of prevention, "O.Yu. Egorova.

E.M. Severina, representing the Bryansk regional NGO Blago, presented a study of the effectiveness of the programs "Living Water" and "Ladya" on the example of educational institutions in Bryansk (in 2014-2017).

Bryansk specialists have been working with value-oriented programs for the prevention of risky behavior of children and youth "Ladya", "Living Water" and "Way to Home" for more than ten years.

The effectiveness of these programs is being studied for four years in 15 groups (12-14 children) in the supplementary education system. Various methods were applied. Surveys were made at the beginning of the program and at the end.

The program "Living Water" for younger schoolchildren (9-12 y.o.), which introduces children to the basic ethical concepts and values, has an inbuilt free association method diagnostics that tests, in how fare children are aware of the basic value concepts (friendship, family, nobility, honesty , freedom, love, kindness, etc.). The assessment proves that the level of knowledge and skills in children increases in all parameters.

In order to assess the extent, to which children actually implement their knowledge about these concepts in their behavior, methodologies were used as "Diagnostics of the level of moral self-esteem" (T.A. Fal'kovich), "Diagnostics of attitudes toward life values" (T.A. Fal'kovich ), "What is good and what is bad" (I.B. Dermanova), "Unfinished sentences" (N.E. Boguslavskaya) and others, which are focusing of specific aspects, for example, development of communication skills, decreasing anxiety and aggressiveness, improving emotional background.

The diagnostics of the moral self-assessment level shows how children themselves assess their ownership of these moral concepts and their implementation in their lives. The study showed that in the cause of the program the number of children with a high level of moral self-esteem (from 53% to 77%) increased, with an average level (from 42% to 23%) decreased, and no children with a low level were left.

Diagnostic of the attitude toward values show that within one academic year (52 hours, 2 hours a week) children's views on life and their perceptions of values are changing. If previously the children considered game, entertainment, recreation as basic values, then after completing the program they include in their life universal values: culture, nature etc.

The methodology "What is good and what is bad" suggests that children make a moral assessment of various actions related to friendship, honesty, nobility, dignity. According to test results, the group with high rates (from 73% to 97%) increased by 24%, and the average group (from 27% to 3%) decreased by the same present. At the beginning of the program almost all primary school children consider punishment applied to them personally to be unfair. At the check-up stage they, when assessing their actions, understand that the punishment was fair. This means that they not only get introduced to the values, but also learn to correlate them with their life experience, apply to themselves and to others.

For the assessment of personal maturity and social competence of older teenagers (14-17 y.o.) under the Ladya program, the free association method was used that is inbuilt into the program, but also the "Personal maturity test questionnaire" (Yu.Z. Gilbukh), "Scale of social competence" (A.M. Prikhozhan), "The methodology of self-analysis of personality" (O.I. Motkov), "Socialization assessment methodology (social adaptation, activity, autonomy, ethical formation) " (M.I. Rozhkov), the questionnaire "Student's civil position".

The personal maturity questionnaire examines the children's need for social and normative behavior: views and beliefs, the manifestation of conscience mechanisms that regulate behavior. According to this study, the number of children with a very high level increased by 3% (from 10% to 13%), with high level - by 5% (from 17% to 22%), with an average level decreased by - 3% (from 53% up to 50%), with very poor level decreased by - 5% (from 20% to 15%).

The speaker noted: "Of course, one cannot expect that the program will bring all children to the high level, since in addition to the program activities the teenagers are affected by many other factors.

It should also be taken into account that some children with a high level, responding well to the questionnaire, in practice can demonstrate quite a different behavior. In our study a high percentage of "average" answers is a positive sign as it indicates that children answer questions honestly".

The achievement motivation assessment shows, in how much children are trying to overcome difficult life situations, are oriented towards a proper level of self-esteem and self-respect and respect for others. According to these indicators, the average level has initially 47% of children, after the program - 52%. The percentage of children with a very poor level of achievement motivation decreases (from 23% to 10%) - those are the kids, who do not want anything, do not want to solve problems, "go with the flow".

Components of personal profile analysis include the attitude of teenagers towards one's self: awareness of their capabilities, individual potential ("what am I capable of"), choice of one's own development direction. Teenagers prone to risky behavior, i.e. leading to socially dangerous diseases, are children with problematic "self-concept": distorted understanding of one's inner world, of oneself, which leads to various forms of dependent behavior. Such children feel worthless, they have many complexes. Therefore, the indicator of attitude towards oneself is very important. Test results show positive changes: the number of very high-level children increases from 8% to 12%, high level - from 20% to 24%, the average level decreases from 47% to 53%, very poor - from 25% to 11%.

The formation of life patterns test shows the development of children's positive ideals and ideas about norms and rules of behavior, the ability to self-assessment and self-regulation of behavior: the number of very high level children increased - from 8% to 12%, high level - from 12% to 18 %, the average level decreased from 43% to 46%, very poor - from 37% to 24%. This is an important indicator for the formation of a confident child, who would be able to solve his own problems.

The civic mind formation test shows, whether a child is able to assess justice and moral in actions and deeds, is ready for socially beneficial activities, for example, to become a volunteer, to interact with public organizations. As a result of the program, the number of children at a very high level has increased from 17% to 20%, at a high level - from 22% to 26%, on average level - from 41% to 48%, and on very poor level dripped from 20% to 6%.

Another test - for the ability to emotional bond with other people - assesses the ability to establish normal contact with other people. Without this relations with friends and family members are impossible. At the beginning of the program, 40% of children have a very poor level of emotional bond: they believe that friendship is an indicator of how others treat them, and they themselves can't affect anything. In fact, the ability to emotional bond speaks of the child's understanding that his relationships also depends on his participation, that he himself can be active in these relationships and give something to others. Here's how these indicators changed during the program: very high level - from 8% to 10%, high - from 8% to 16%, medium - from 44% to 48%, very poor - from 40% to 28%.

The teenagers' value assessment, where children have to determine what is the most important in the life, shows how their perceptions change. At the beginning of the program the first priority was the material security, the second one - successful education, the third - the well-being of the family and loved ones, the last one - fame. After the program the values changed places: in the first place was the well-being of the family and loved ones, on the second - health, on the third - the possibility to help people.

In general, the diagnosis of program effectiveness, conducted in Bryansk, helps to understand what exactly is changing in children. The report presented only those indicators that focus on the moral position of children, their attitude to the world, to life, to themselves. The results of the research may encourage other regions to also start using these programs.

During the discussion of the report, L.A. Dementieva noted that the Bryansk region for 20 years has remained relatively safe in the context of the HIV epidemic. This is obviously also, thanks to such teachers and organizations as Blago, who use the above-mentioned prevention programs.

The Chelyabinsk Regional AIDS Center representative I.A. Akhlyustin and social worker of the Holy Trinity Church in the village of Dolgoderevenskoye, Chelyabinsk region, A.V. Sherstobitov spoke about the experience of cooperation of governmental, public and religious organizations in the prevention of HIV infection among children and youth.

In the Chelyabinsk region (CHO), primary prevention of HIV infection is successfully implemented in close cooperation between governmental, public and religious organizations. Governmental organizations spend most of their resources for overcoming the spread of the epidemic, implementing various programs aimed at providing medical and social assistance to PLHIV. At the same time, the Russian Orthodox Church pays most attention to the causes of the spread of the disease, implementing primary prevention, education and ethical formation programs, making an invaluable contribution to overcoming the spread and consequences of this disease.

Governmental organizations provide information support for prevention: within 10 months in 2017, federal programs provided 78% of the population aged 19-49 with information materials. In Chelyabinsk region, annual preventive activities are organised: on AIDS Memorial Day (17,468 prs. participated, 4,310 prs. were tested for HIV); in "Day of Family, Love and Fidelity" (3,084 prs. participated, 1,148 prs. were tested for HIV); during the All-Russian action of Russian Railways (2,039 prs. tested for HIV).

In 2017, a survey was conducted in all educational and medical institutions to assess the level of awareness of the population about HIV infection. 67.8% of all respondents answered all questions correctly.

Thanks to cooperation with the Church, the focus of prevention campaigns of governmental institutions has shifted from advertising technical means of HIV protection to the promotion of ethical values; the

In December 2017, the seminar "Co-dependency. Overcoming " was organized jointly with the Russian Round table. It was conducted by S.P. Borzov and E.E. Rydalevskaya, and gathered a large number of teachers, incl. those from social services from different territories, and teachers who received training under "Ladya" program. The round table meeting on the occasion of the International AIDS Day on December 1 also gathered specialists from various government departments, NGOs and the Russian Orthodox Church. Thanks to such encounters there is an ongoing exchange of experience and coordination of responsibilities in joint work.

The Chelyabinsk AIDS Center has won two prizes at the All-Russian competition in 2017 "The Best AIDS Center": 1st place - for the best communication project " Forewarned, forearmed ", and 2nd place for the best joint project with socially oriented NGOs "Risk Zone". Thanks to cooperation NGOs the work of the AIDS Center with target groups has become more extensive and effective.

The main platform for cooperation with the regional center "Family", the AIDS Center, the charity "Family +", other socially oriented NGOs is the St George church in Dolgoderevenskoye village near Chelyabinsk. Trainings are conducted here on the programs "Ladya", "Living Water" and "Way to Home" for specialists from all over Chelyabinsk regions, Khanty-Mansiysk autonomous okrug and other areas. Trainings are funded by the Presidential Grant. One of the leading trainers is Archpriest George Artartian, and many priests attend these trainings. With the support of the Sverdlovsk AIDS Center, Chelyabinsk trainers held a seminar in Yekaterinburg (for more than 30 participants).

The first training on "Ladya" took place in Chelyabinsk in 2009, for "Living Water" - in 2011, for "Way to Home" - in 2013. During this period, 380 specialists were trained on the "Ladya" program, 165 on "Living Water" and 147 on "Way to Home".

These programs are "working" in Chelyabinsk region up to now: during the webinar organized by the regional Ministry of Education in late 2017, in which about 200 school principals directors, 96 schools said that they teach "Ladya" program, 9,730 children were fully trained. The "Living Water" is taught mainly in kindergartens - 43 institutions, 2,920 children trained, "Way to Home" is taught in 22 institutions, 1,184 prs. have been trained.

Speakers noted that Chelyabinsk specialists invent new elements for the programs. So, the lesson on the topic "Homeland" (the program "Living Water") are supplemented with practical homework tasks: to make bird feeders and to feed "feathered co-citizens" during the winter. For each group of teenagers studying on "Ladya", a group is created in the social network "VKontakte": communication with children is maintained for 2-3 years after the program completion - trainers place links to useful materials or films that they recommend for children to watch and reflect upon themes of the lessons, receive their feedback.

Thanks to close cooperation with the Ministry of Education and Science of the Chelyabinsk region, there are no organizational problems with the invitation of school teachers to trainings: for the period of training, their salaries at their main working place are payed. There are many positive responses about the program from different organizations, most recently - from the "Parents' Committee". Many schools began to include "Ladya" in the school.

The main thing is that the program enables children to form a "backbone", which helps them to resist threats and avoid risky behavior. Many children, who have been trained by these programs, become volunteers: in 2018, which has been declared the "Year of the Volunteer", "Ladya" is preparing the 5th team of its special volunteers in Chelyabinsk.

In conclusion the speakers noted: "It is necessary to further develop the cooperation of the Russian Orthodox Church with governmental structures and NGOs in the sphere of moral formation and education of children and youth; to strengthen educational work in prevention of HIV and risk behavior among children and teenagers; with the support of public and state organizations to include the unique training programs on HIV/AIDS prevention - "Living Water", "Ladya", "Way to Home" into the educational process; constantly train new interested and enthusiastic specialists for the high-quality implementation of these programs. "

Archpriest George Pimenov, member of the Coordination Center for Counteracting Drug Addiction and Alcoholism of the St. Petersburg Diocese of the Russian Orthodox Church, spoke about "HIV Dissidence and the Church. The attitude of the Church towards the movement for the denial of HIV/AIDS. "

He noted: in spite of the fact that the Concept of the Russian Orthodox Church's participation in the fight against the spread of HIV/AIDS was adopted back in 2004, and hundreds of church rehabilitation centers for drug addicts successfully work with people living with HIV/AIDS, hospital chapels were opened, medical institutions and NGOs conduct joint conferences and activities, there is a semi-underground movement of HIV-dissidence in the church. If this movement were a harmless private opinion of individual lay people and priests, it would not be scary and would not have a public resonance. But a priest is especially responsible for the way of thinking that he professes. People often judge about the Church on the clergy's statements. It is time to say that some church people fell into a kind of heresy, akin to Gnosticism, a heresy of HIV-denial. Behind this sermon is not life eternal, but the real death of people affected by a serious disease, who gulls relentlessly of a difficult but life-giving medical treatment.

Among HIV-dissidents there are also doctors-narcologists, heads of NGOs and rehabilitation centers. Often they also advocate that HIV doesn't exist, using medical terminology, coupled with a set of church texts. He noted that it would be useful to give a formal explanation of the church's position on HIV-dissidence with a clear indication that such anti-HIV preaching is a personal error of speakers leading to the death of listeners or their children.

In the final discussion, the participants noted that the information presented in the reports would be useful for religious communities and church related NGOs working in the field of prevention and overcoming the spread of HIV/AIDS.

DECR Communication Service

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