Round Table on the Russian Orthodox Church's Participation in Preventing and Overcoming HIV/AIDS

On January 30, 2019 a Round Table on the Russian Orthodox Church's Participation in Preventing and Overcoming HIV/AIDS was held, as part of the XXVII Christmas Readings, at the Moscow Patriarchate's department for external church relations. It was attended by 45 clergy and laity of the Russian Orthodox Church from 10 dioceses, representatives of Protestant and Catholic communities as well as governmental organizations and NGOs. The Round Table was chaired by Archpriest Maxim Pletnev, head of the Coordinating center for overcoming drug and alcohol abuse, St. Petersburg diocesan Department for church charity and social service.

The participants have heard eleven reports and discussed problems of the HIV/AIDS epidemic in Russia and worldwide; "harm reduction" programs; psychological counseling of HIV-infected people using Internet technologies; cooperation between Church and government in palliative care; cooperation of state, public and religious organizations in the prevention of HIV infection in different regions.

Larisa A. Dementieva, expert on epidemiological issues of the Central Research Institute of Epidemiology of Rospotrebnadzor, made a report on "Situation of HIV infection in the Russian Federation, and the measures taken for its improvement". She noted that according to UNAIDS, since the beginning of the epidemic, the global number of people living with HIV and AIDS (PLWHA), amounted to 36.9 million (as of June 2017). In 2017 1,8 million people were infected, 940.000 died from AIDS associated diseases. Since the beginning of the epidemic 77,3 million people have been infected with HIV, 35,4 million died from AIDS associated diseases. Number of PLWHA having access to the therapy has increased (21,7 million).

In the Russian Federation, there has been a positive shift in the fight against HIV infection in many areas:

• A number of government ministries and departments have actively joint the fight against AIDS.
• HIV screening access outside of medical institutions increased, which resulted in 1,3 times raise in tests as compared to 2015, i.e. 38,39 million people (37% of the population) were tested in 2018. In the recent years over 30 million people were tested annually (over 20% of the country's population), 34,08 million people (23,1%) were tested in 2017.
• Antiretroviral therapy (ART) coverage of PLWHA has increased: 443.000 patients received ART in 2018 including those in detention, i.e. 58,9% of those at the dispensary (compare: in 2006 14.000 PLWHA received ART). In 2018 120.876 prs. started ART.
• More drugs for the treatment of HIV (more than 60%) are now produced in Russia, thereby reducing the cost of treatment; new factories for the production of ART drugs were built.
• The rate of increase in the incidence of HIV infection in the country went down from 13.4% in 2012 to 2.2% in 2017, in 2018, the growth rate was 2.0% (about 90,000 new cases).
• The proportion of people infected with HIV from injecting drug use decreased from 56.1% (2012) to 42.5% (2018), as well as the proportion of adolescents and young people (under 20) among newly diagnosed PLWHA went down to 1.1 %.

At the same time, the proportion of sexual transmission of the disease is increasing: among newly diagnosed cases in 2018, 54.8% of people were infected during heterosexual contacts (2017 - 53.5%, 2016 - 48.7%). In 2017, in 56 territories, sexual transmission prevailed. In the regions of the Siberian Federal District: the Republic of Khakassia, the Altai, Krasnoyarsk Territories, Kemerovo and Novosibirsk Regions, HIV transmission during drug use dominates.

HIV infection is responsible for more than half of all deaths from infectious diseases (in 2017, 57.2%); for various reasons, 29.3% of all registered PLWHA died (318.870 people); the average age of the dying is 38.9 years; the proportion of patients who died due to HIV infection itself is growing; the number of people infected with HIV / TB co-infection continues to grow; 24.8% of PLWHA died from tuberculosis, 3.4% from drug overdose.

The incidence rate (the number of PLWHA per 100,000 population) in Russia is 643.8, the prevalence rate (the number of newly diagnosed PLWHA per 100.00 population) is 71.2, i.e. in the country as a whole, more than 0.5% of the population aged 15 to 45 years are infected with HIV.

Since the beginning of HIV registration in Russia, 191.882 children have been born to HIV-infected mothers. Of these, the diagnosis of HIV infection was confirmed in 10.882 children. Every year more than 15,000 children are born with perinatal contact for HIV infection. Last year less children from this category were born - 14,400.

Russian Federation has the "National Action Strategy for Children for 2012-2017," which resulted in a 2-fold decrease in the number of orphans; 40% of HIV-infected children live in foster or guardian families, 10% - in full families. The institution of adoptive parents and guardians is actively developing. "Schools for adoptive parents" were organized.

The HIV incidence tends to shift to older age groups: in 2001 among newly detected cases youth of 15-29 y.o. made 87%, in 2018 82% were people older than 30 years. The highest incidents rates were registered in the group of 30-40 y.o., 3,3% of men of 35-39 y.o. are HIV-infected. "This is due to the lifestyle, established habits," - said the speaker. Increasingly, HIV infection is detected in pre-retirement and older people, whereby the disease is in advanced stages. This means that such patients avoid contacting specialized medical organizations fearing of discrimination, which is dangerous for themselves and for those with whom he or she has sexual relations. "In connection with this trend immeasurably increases the role of the Russian Orthodox Church and the priests in that should motivate people to go to health institutions," she said.

L.A. Dementieva emphasized that due to therapy, HIV-infected people began to live longer, therefore, the importance of palliative medicine increases, providing comprehensive care to patients and ensuring their decent death. The development of palliative medicine has become a national task. ROC is doing a lot in this field. This was emphasized at the conference "Palliative care. Modern experience of the Russian Orthodox Church" in December 2018. There is also an acute shortage of medical palliative care centers in the Russian Federation, including those that provide care for PLWHA. Every year several cases of nosocomial HIV infection are registered. To solve this problem it is necessary to improve the education of nurses. Important work in this area is carried out by the social services of the Russian Orthodox Church.

In recent years, awareness raising and HIV prevention has been intensified, three large-scale STOP HIV / AIDS information campaigns have been conducted focusing on students, prevention work among the working population in large industrial enterprises has been intensified, HIV testing outside medical organizations was offered on a broader scale: during large prevention events and actions, at railway stations and in trains, at the workplace.

In particular, 9,8 million people took part in the STOP HIV / AIDS events organized by the Social and Cultural Initiatives Fund. Rospotbernadzor organized more than 1.100 hotlines and held more than 19.000 counseling sessions for citizens on HIV issues. Among the most pressing problems, the speaker identified insufficient prevention work with risk groups, including drug users.

In conclusion L.A. Dementieva expressed her hope for continued mutually beneficial cooperation between state and religious organisations in the prevention of HIV-infection and in care for people affected by the disease.

Contributions of representatives of three confessions were devoted to the discussion of "harm reduction" programs: Bishop Mefody of Kamensk and Kamyshlov, the head of the Coordination Center for Counteracting Drug Addiction at the Synodal Department for Church charity and social service, Bishop Konstantin V. Bendas, first deputy of Senior Bishop of Russian Union of Christians of Evangelical Faith and priest Kirill Gorbunov, Vicar General of the Roman Catholic Archdiocese of the Mother of God in Moscow.

Bishop Mefody reported that "substitution therapy" does not motivate drug addicts to abandon drugs and, in fact, is a way to support drug abuse. Popular mentality shares a widespread misconception about a dependent person. Because of this, the prevention programs do not work, and the assistance offered is a system of punishment. Being rejected by the society, drug addicts are looking not for help, but for asylum, where they could hide. A lot of harmful myths have been created around "substitution therapy", one of which is that if a legal drug is offered, a dependent person will not commit crimes in order to raise money for a "dose". However, all crimes are committed just in a state of altered consciousness, i.e. under the influence of a drug, in this case it can be a "substitution therapy" drug. At the same time, a drug addict committing a crime will have "protection" from law enforcement agencies - after all, he is undergoing alternative treatment!

Bishop Mefody calls this strategy "alternative drug abuse" - it not only does not help a person to get rid of dependence, but also closes for him the very possibility of treatment and healing, he is offered to "live out his days" more comfortably in an increasing dependence. Although the "substitution therapy" somewhat reduces the percentage of those who become infected with HIV through drugs, but in general it does not reduce drug use: it is known that after receiving a dose of a substitute drug, addicts always add "street drugs" afterwards. The alternative offered by Bishop Mefody, and the concept developed by the Coordination Center he heads, is a "difficult long-term rehabilitation, with a non-guaranteed result, with lifestyle changes and repentance", however, it has already shown good fruits. "As long as a person is alive, he can always change, there are no hopeless people" - this is the starting point of those who in the Orthodox Church helps people with chemical addiction to get rid of it.

Konstantin V. Bendas emphasized in his contribution that lobbyists of the substitution therapy are based on the idea that drug addiction cannot be cured, their main argument is that if a person cannot be helped to cure, then at least we can protect society from crime associated with drugs. However, such expectations are not met in those countries where this method is used: the drug trafficking does not disappear; the dependence of the patients of the program is aggravated. More than twenty years of social work experience of the Russian Union of Christians of Evangelical Faith shows that drug addicts can be cured, that the drug users who have gone through rehabilitation are returning to normal life.

Priest Kirill Gorbunov presented the position of the Roman Catholic Church, which is formulated in the Charter for Catholic Health Care Workers (1995). The document emphasizes that drug use is contrary to the "vocation for life", from a moral point of view, it is "a refusal to think, to desire and act as a free person." It is also noted that "harm reduction" programs force other people to pay for the choice of drug addicts (in the truest sense of the word, through the redistribution of budget funds). In 1999, the Congregation for the Doctrine of the Faith gave an opinion on the use of the methadone program in one of the medical centers. The risk of overdose was 36 times higher than on the street, because drug addicts exceed the dose, expecting to receive immediate medical help in case of overdose; drug addicts in this center made only one in 35 injections with a "clean needle", adding more drugs in other conditions. The Congregation concluded that such a program is nothing else than "material accessory in the serious evil of drug use."

Pontifices also clearly spoke out on this topic. "On cannot beat drugs with drugs," - the words of Pope John Paul II. Pope Francis clearly shares the same position: "Drug substitutes are not adequate therapy, but in a veiled way of surrender to this phenomenon ... We must say no to any drug use." Father Kirill also recalled that there are many rehabilitation programs in the world, functioning under the auspices of the Catholic Church, for example, the "Fazenda of Hope" network, which unites more than 80 rehabilitation centers for drug dependent people. Representatives of the Holy See spoke on many occasions in various UN agencies, stating that the main problem of "harm reduction" programs is that they do not take into account the dignity of those they are trying to help, and do not even consider the prospect of real healing. Addicted people should be provided with the possibility of real spiritual, psychological and social rehabilitation in order to overcome addiction.

The Round Table participants unanimously spoke out against "substitution therapy" programs and noted that the specialists working in this area are lacking an official opinion of the Church on this issue. A proposal was made to include in the work plan of the Christian Interconfessional Advisory Committee for 2019 a meeting to develop a joint document of Christian confessions on this issue.

Alexandra Imasheva, head of the Christian psychological service "Candle", said that the service provides free psychological counseling and informational support to PLWHA and their families: in form of face-to-face psychological counseling, an average of 8-10 sessions per client (since 2006) and in the format of online text counseling (since 2009). The service employs 5 people. "When we started text consulting in 2009, it wasn't known either in Russia or in western countries, it didn't even have a name. At first we called it 'online consultation' and experimented with the format for a while. Now it has a name - 'text counseling', this is a dynamically developing area of psychotherapy all over the world. In the USA, for example, there is already an Association of text psychotherapists and consultants. This kind of service develops also in Russia. This is a fairly effective method of counseling. Our format is a personal online correspondence in the social network 'VKontakte' in real time, the duration of a counseling session depends on the desire of the client; the consultants are available almost every day, "said the speaker.

Text counseling has several advantages over the face-to-face counseling: it provides full anonymity, the "hidden face" of the client, the availability of psychological assistance at any time of the day, independence from geographic distance, the possibility to quickly redirect to other specialists, for example, to a doctor, lawyer, etc.

Issues most often discussed during the face-to-face counseling, are related to accepting a diagnosis of HIV infection, emotional state after receiving a diagnosis (shock, fear, anger, depression), problems of status disclosure, existential aspects, affective disorders (depression, anxiety, panic attacks), family relations, start of ART. In text counseling additional requests come for information about HIV infection, risk of HIV infection and prevention, and numerous problems associated with therapy. Compared with face-to-face counseling, where clients turn mostly with acute problems, in text counseling they often address minor issues. Clients of the service are people of different ages, incl. the elderly. "A lot of people turn to our service for help. In 2018 we consulted about 300 people in text format," said A. Imasheva.

A number of contributions during the Round Table were dedicated to programs of primary prevention of HIV / AIDS among children and youth. Participants from Chelyabinsk - priest Georgiy Artaryan, rector of the Holy Trinity Church in Dolgoderevenskoe village, Chelyabinsk region; Abalmazova S.F., psychologist in the Chelyabinsk Regional Social Protection Center 'Family'; Akhlyustin I.A,, staff member of the Chelyabinsk Regional AIDS Center, - they spoke about the experience of setting up the club 'Family Nest' at the Holy Trinity Church to assist parents in raising their children, in overcoming the crisis in relations between spouses. A group of psychologists has been working in Chelyabinsk for a number of years under the guidance of priest Georgiy Artaryan. These specialists work in schools with children and young people on the programs of prevention of risky behavior "Living Water", "Ladya" and "Way to Home". According to Father Georgiy, while working with youth, the specialists understood that some forms of risky behavior are laid in the family by the parents. Therefore, starting in 2014, Chelyabinsk specialists created the 'Family Nest' club, in which classes for families are conducted using the "Way to Home" program, to which on the participants' request, classes for adoptive and substitute families were also added. "Classes are held in the premises of an Orthodox parish, but people from other religions, of different ages, including young people preparing for marriage, come to the group. Families that managed to overcome a crisis in relationships share their experiences. Those who could not cope with the crisis, receive support and advice, how to live, how to restore relationships, etc. There were examples when, thanks to classes at the club, families were restored or new ones were created, families in difficult life situations, for example, with disabled children, received assistance in finding employment, training, etc.," said Father Georgiy.

Thanks to the collaboration with AIDS Center experts, who help conduct classes, the club members began to be aware of the value of health. The work on the topic "My Family" helps participants to value their connection with previous and future generations and to understand their responsibility for the future of their children. In 2014-2018, the club "released" 4 groups, a total of 76 people. The speakers noted that most of the club members are people over 30, i.e. representatives of the age group in which in recent years the largest number of new HIV infections has been registered. Among the participants there are discordant couples.

Priest Vyacheslav Inyushkin, rector of the Intercession of Mother of God Church and Zerkaliy N.G, project supervisor from the city of Zarechny, Sverdlovsk region, presented their network project "School of Strong Family" as an example of prevention of risky behavior in children and youth through spiritual and moral education. The project is organized by an Orthodox school in the name of the Holy Royal Martyrs, all schools in the city participate in it: teachers of all schools were trained to work with 3 prevention programs (Ladia, Living Water, Way to Home); in 2018-2019, lessons for children in these programs are held during "class hours" in 70 classes (from grade 3 to grade 11) for a total of 1.500 schoolchildren.

Following the project's completion last year, it received the support of the governor of the Sverdlovsk region, Metropolitan Kirill of Ekaterinburg and Verkhoturye, head of the Zarechny city government, the Department of Education, and school directors, where the programs were taught. It is important that the project takes into account the interests of all participants: for teachers and schoolchildren it is important that the process itself is useful, exciting and interesting. The programs mentioned above fully meet this challenge: schoolchildren like the lessons; the programs help teachers develop the skills necessary for modern education, and even prevent professional burnout. Parents believe that these activities help them in raising their children, help to improve family relations. "It was important for the authorities, society and benefactors to find the idea of a project targeting a pressing social problem. The city administration sees in this project assistance in the implementation of family policy, a socially significant initiative. From the point of view of society, this project contributes to strengthening families, enhancing morality and the level of happiness. And for the donors that support the project, this is strengthening their image of a socially responsible organizations and increasing the responsibility of their employees," said Father Vyacheslav.

The publicity is of great importance for the project: reports, articles, presentations, videos about the project make it possible to inform the public and show the results of the work.

Father Vyacheslav emphasized: "Our experience shows that what matters, is not only what you do, but also how we do it! The atmosphere that prevails at all the project activities, is very valuable for us and for all parties involved in the project: it is friendliness, sincerity, benevolence, emotional involvement in the project. It is important that after our trainings, teachers take away warm feelings, which they then convey to their students. "

Afonina V.G., director of the Bryansk regional public organization "Blago" said that in 2018 her organization together with the Bryansk State University implemented the project "Family - the unity of thoughts and deeds. Formation and preservation of family values ", which was attended by 200 prs. - schoolchildren, students and young couples. The main objective of the project is to expand the youth's perception of family values, the basic patterns of family relations. In the city of Vladimir in 2018, "Blago" trained more than 80 employees of orphanages on the use of "Ladya" program, and also conducted methodological seminars on the development of skills for training in teenagers' groups. In Moscow, Bryansk specialists continued to work on training teachers in coaching skills and educated more than 70 people. A unique work was carried out in the city of Zarechny, Sverdlovsk region, where the skills of work on three prevention programs were taught to teachers of all schools in the city. At the Russia volunteer's forum Dobrograd-2018 in Arkhyz village, Zelenchuksky district of Karachay-Cherkessia, where volunteers from all over the Stavropol region gathered, "Blago" conducted a training on Ladya program.

The speaker noted that new "Ladya" sessions have been developed on the prevention of "bullying" (harassment), which is often found in schools. She also showed videos on the prevention of "bullying", created by students of Bryansk State University as a tool for social advertisement.

Olga Yegorova, senior nurse of the home care service of St. Dimitry sisterhood, head of the Palliative Care Resource Center, in her report "Palliative care for PLWHA - collaboration of secular and church organizations" noted that palliative care as a medical field has been recognized in the Russian Federation only in 2012. The Russian Orthodox Church has always provided assistance to incurable patients, and in contemporary times, for more than 25 years, it has provided palliative support to patients with various diseases, including HIV infection.

In recent years, significant results have been achieved in this church ministry: palliative care training for nurses and volunteers has been established and is implemented on a systematic basis; cooperation agreements have been signed with public health institutions. In Moscow today, in 12 public hospitals, palliative care is provided mainly by Orthodox sisterhoods. The attitude of the medical community to the work of sisters of mercy has changed: if earlier they were "tolerated" in hospitals, now the role of sisters of mercy and Church related NGOs is recognized, their ministry is integrated in the work of medical institutions. Over the past 2 years, the number of palliative departments in Moscow hospitals has increased: from 2 in 2016 to 15 in 2018, the Palliative Care Center was opened. 2 hospitals are basic health care institutions for the development of palliative care: the St. Alexis hospital, where the palliative department with 60 beds has been functioning for 3 years, and in February 2019 it is planned to open one more department with 30 beds; and Infectious Clinical Hospital No. 2, in which out of 900 patients 400 have HIV infection. The palliative care church service, which has been working in this hospital for many years, employs 30 volunteers and 7 sisters of mercy, it is built into the hospital structure and works in 4 HIV-specialized units for a total of 200 beds.

On December 14-15, 2018, the conference "Palliative care. The Modern Experience of the Russian Orthodox Church" took place in Moscow, which evaluated the results of almost three decades of church palliative activity. The conference was held at the Central Clinical Hospital of St. Alexiy and was dedicated to the 115th anniversary of the clinic. It was organized jointly by the Hospital, the Resource Center for Palliative Care of St. Dimitriy Sisterhood, the Synodal Department for Church charity and social service, and the Russia Round Table at the DECR. The conference was addressed by the heads of public health institutions, ministries and agencies, representatives of the dioceses of the Russian Orthodox Church - the spiritual fathers of sisterhoods, heads of social diocesan departments. Among the participants were sisters of mercy from different regions of Russia, mostly from those who are actively developing palliative care for HIV-infected people: Moscow, Khabarovsk, St. Petersburg, Ufa, Arkhangelsk. Among the participants were also members of the Union of Orthodox sisterhoods of Belarus. The conference was attended by 160 prs.

During the conference, workshops were held on training sisters of mercy to provide palliative care to bed ridden patients. One of them - on the use of innovative methods, so-called. sliding equipment - was conducted by Norwegian specialist Per Halvor Lunde.

The conference evaluated the achievements and the current state of palliative care provided by Church specialists, Orthodox sisterhoods of mercy and volunteers; informed the public health organizations - partners in palliative care - about the achievements of the ROC in this ministry (using the example of Moscow and regional sisterhoods); and thereby contributed to strengthening the credibility of the Church and expanding cooperation with public health institutions.

Conference participants formulated proposals for further development of palliative ministry. In particular, they noted that in order to establish interaction among the Russian sisterhoods, on the one hand, and between church and state organizations, on the other, it is necessary to intensify the work of the Sisterhoods Association (established in 2015). They proposed to increase governmental support of the motivation of sisters of mercy and volunteers towards participate in this work; to include the position of a "hospital chaplain" into the staff of hospitals and palliative care units; to support the promotion of the "nurse of mercy" profession, which is already included in the All-Russian Occupational Classification (Order of Rosstandart from 12.12.2014, No. 2020); to conduct training activities on palliative care for sisters of mercy at the base of the Training Center of the Central Clinical Hospital of St. Alexis and the Resource Center for Palliative Care of the St. Dimitriy Sisterhood.

V.N. Kuprik, a chemical dependency consultant in the Kovcheg Anti-AIDS Rostov regional NGO, presented the work of the Center for the Prevention of Dependent Behavior in PLWHA in Novocherkassk. The Center provides comprehensive assistance to drug and alcohol-dependent PLWHA, which includes the social rehabilitation of addicts and the full range of support for PLWHA. The program is based on the methodology of social rehabilitation of drug addicts, developed at the Coordination Center for Counteracting Drug Abuse, ROC Social department, and implemented in partnership with the Rostov-on-Don diocese, the State Narcological Service of the Rostov Region, the Research Institute of Parasitology and Infectious Diseases.

The speaker spoke in detail about the range of services provided in primary counseling, at the motivational and main stage of social rehabilitation, as well as during the period of adaptation and re-socialization. He noted that since May 2015, 132 prs. received rehabilitation services in this program. Of these, 78 prs. currently do not use drugs, 12 prs. started treatment of HIV infection, more than 15 prs. started treatment of hepatitis C.

M.B. Nelyubova, DECR staff member, spoke about the participation of religious communities in the preparation and conducting of the VI International Conference on HIV / AIDS in Eastern Europe and Central Asia (EECAAC), which was held on April 18-20, 2018 in Moscow under the moto "Mobilizing Resources: experience, investment, innovation. " About 3.000 delegates from 63 countries of the world, including a delegation of Christian, Muslim and Jewish religious communities from Russia, Belarus, Moldova, Ukraine and Armenia, took part in the forum - about 80 representatives of different religious traditions actively participated in plenary and satellite sessions, seminars and in the media coverage of the conference.

At the opening of the conference on April 18, the hierarch of the Russian Orthodox Church, Bishop Mefody of Kamensk and Alapaevsk, delivered a welcoming speech. The conference program included the session "The Role of Religious Denominations in HIV Prevention," co-chaired by Bishop Mefody of Kamensk and Alapaevsk, Chief Prison Rabbi of Russia Aron Gurevich, and the representative of the Central Spiritual Board of Muslims of Russia in the Tyumen Region imam-muhtasib Ildar Ziganshin. Members of the interreligious delegation also spoke at other sessions: at the panel discussion "Prevention of HIV infection among adolescents and youth", at the session "Issues that require advanced training of medical workers in organizing care for HIV patients".

The event was widely covered in many confessional media. As a result of the conference, the Final Statement was adopted, which confirmed the commitment of the countries of the region to achieving one of the goals of the Sustainable Development Goals - putting an end to the HIV epidemic by 2030. The statement also noted the important role of religious organisations in the progress achieved since the Fifth Conference in 2016 in countries of the region in combating the HIV / AIDS epidemic in a number of areas that are crucial in the fight against the disease. Among the tasks for the near future, the document encourages to "support and facilitate the involvement of religious communities of different faiths in the implementation of activities to prevent the spread of HIV infection."

DECR Communication Service