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

On May 23, 2022 the Department for External Church Relations of Moscow Patriarchate hosted a Round Table on the Russian Orthodox Church's Participation in Preventing and Overcoming HIV/AIDS. The meeting was held as part of the XXX International Educational Christmas Readings. The event was attended by representatives of six dioceses of the Russian Orthodox Church, governmental and public organizations.

Archpriest Maxim Pletnev, head of the Coordinating center for overcoming drug and alcohol abuse, St. Petersburg diocesan Department for church charity and social service, was the moderator of the round table. The meeting was coordinated by the DECR staff member M. B. Nelyubova.

The meeting heard seven reports and discussed issues related to the current state of the HIV and AIDS epidemic in Russia, to the palliative care for HIV-infected people, rehabilitation of drug addicted people and codependents; to the experience of cooperation of governmental, public and FBOs in the field of prevention of risky behavior of children and youth in various regions.

A report on "The state of HIV infection and measures to counteract the epidemic in the Russian Federation" was made by N. N. Ladnaya, a senior researcher of the Scientific Center for the Prevention and Control of AIDS of the Central Research Institute of Epidemiology of Rospotrebnadzor. She noted that HIV infection is still a very serious problem all over the world. According to UNAIDS statistics for 2020, about 79.3 million people have been infected with HIV since the beginning of the epidemic and 36.3 million people have died from HIV-related diseases.

In 2020, 37.7 million people living with HIV lived worldwide; the number of new infections was 1.5 million; 680,000 people died from HIV-related diseases. The incidence and mortality from HIV is growing rapidly. The massive spread of HIV infection in the Russian Federation is considered as a threat to national security in the field of public health. In 2000-2020, a total of 1,433,019 new cases of HIV infection were registered in the Russian Federation. Despite the wide coverage of the Russian population by HIV testing, the proportion of representatives of vulnerable groups among the surveyed is small. In the EU, on the contrary, the focus of testing is shifted to risk groups.

According to UNAIDS, in the EU countries, the number of new HIV infections in 2020 decreased by 32% compared to the previous year; this happened against the background of a 19% decrease in the number of HIV tests in 2020 compared to 2019.

A significant decrease in the number of new HIV infections in Russia in 2020 (by 25% compared to 2019) does not reflect the true situation and is probably due to a reduction in the number of HIV tests (by 13%) and a decrease in the number of patients contacting medical organizations during the implementation of COVID prevention.

The highest rates of HIV incidence in the European region in 2020 were observed in the Russian Federation (40.8 prs. per 100 thousand population), followed by Ukraine (37.5), Kazakhstan (18.5), the Republic of Moldova (16.7), Malta (15.9) and Belarus (15.1). In the EU/EEA, the incidence of HIV is 3.7 prs. per 100 thousand population.

In 2020, HIV-infected Russians died at a young age - an average of 42 years. "Every case of death among HIV-positive people is 27 years shorter of life expectancy for men and 37 years for women," the speaker noted.

Since 2015, HIV infection has become the most common cause of death of Russians who died from infectious diseases, and one of the main causes of mortality of the working-age population. In 2021, 375,000 people infected with HIV died. Since 2016, heterosexual contacts have been the main route of HIV transmission in the Russian Federation (65% in 2020), although 60% of all HIV-infected people in the country registered since the beginning of the epidemic in 1987 were infected thorugh drug use (30% in 2020); most of them are men. 85% of women become infected with heterosexual contacts, and not with casual relationships, as it was ten years ago, but in marriage, and learn about their disease during medical registration for pregnancy.

According to the estimates of the Analytical Center under the Government of the Russian Federation, the total direct expenditures of the consolidated budgets of the Federation subjects for the implementation of measures to counter the spread of HIV infection (taking into account inter-budget transfers from the federal budget) increased from 20.3 billion rubles in 2010 to 63.4 billion rubles in 2019. In 2019, the structure of these expenditures was dominated by financing the procurement of antiretroviral (ARV) drugs (46.3%) and medical care (30.1%), the share of expenditures on HIV prevention was insignificant (0.7%).

State strategy to counter the spread of HIV infection in the Russian Federation for the period up to 2030 was approved by the Decree of the Government of the Russian Federation on December 21, 2020 (No. 3468-r). The goal of the Strategy is to prevent the spread of HIV infection in the territory of the Russian Federation by achieving a permanent reduction in the number of new cases of HIV infection among the population and reducing mortality from diseases associated with HIV infection and AIDS, so that by 2030 this disease will cease to be a threat to public health.

Archpriest Maxim Pletnev, head of the Coordinating center for overcoming drug and alcohol abuse, St. Petersburg diocesan Department for church charity and social service , made a presentation on "The program of assistance to dependent people Favor: outpatient groups and remote rehabilitation groups".

Father Maxim began his report with a quote from the First Epistle of Apostle Peter: "Above all, love each other deeply, because love covers over a multitude of sins" (1 Peter 4:8), and noted that these words should become a motto in the fight against HIV infection and AIDS. "Unfortunately, people often come to addictions because of some difficult and forced life situations, because of a lack of love, because of problems in the family, childhood traumas. And these people need love, support, help and understanding," he said.

The main principle of the outpatient program "Favor" is voluntary participation; its employees try to create an environment in which there would be a minimum dropout of participants and to which people themselves would like to return every day voluntarily. The organization sets itself the tasks: to determine what needs and goals a person who has asked for help has; to create a spiritual and therapeutic environment in which the skills of sobriety, awareness, spirituality, social life, psychological health would be developed; to create an atmosphere of good human relations.

With the beginning of the CORONA virus pandemic, an outpatient rehabilitation program was organized via the Internet, thanks to which people from different regions of Russia and from other countries gained access to this program. After the end of the pandemic, some participants decided to stay in the program in the format of online conferences. This is a high-threshold program aimed at people with high rehabilitation potential. An important component of "Favor's" rehabilitation program is "soft churching". Most of its participants are believers who are experiencing a powerful spiritual crisis and need to rethink their church life. Non-church participants have the opportunity to join church life through the program.

Bogdanova V.V., coordinator of the project "Palliative Care Service for HIV-infected people" made a presentation "Palliative care for HIV-infected people: the interaction between the Russian Orthodox Church and the Moscow Department of Health". The Moscow Infectious Diseases Clinical Hospital No. 2 has successfully implemented a model of cooperation between the state institution of the Department of Health and the Russian Orthodox Church. Since 2008, the Sisters of Mercy of the St. Dimitry Sisterhood and volunteers have been working at the hospital. At the same time, cooperation with the Moscow City AIDS Center began. In 2013, a church was built on the territory of the hospital in honor of the Holy Great Martyr and healer Panteleimon.

The nursing and volunteer service consists of 9 sisters of mercy and 24 volunteers. They closely cooperate with the medical staff of the hospital, participate in the care of patients, providing them with medical, social and spiritual assistance. Divine services and other religious rites are held in the institution to meet the religious needs of patients, to realize the rights of patients to freedom of conscience and freedom of religion. Psychological and moral support of patients is provided, as well as assistance in creating optimal conditions for their free time. The volunteers work closely with the hospital's medical staff. Under the guidance of senior nurses of the departments, they provide free assistance in caring for seriously ill patients, patients in the terminal stage and people left without care of relatives in order to improve their quality of life.

Thanks to the help of volunteers and sisters of mercy, during the period from 2008 to 2021, 12,330 hospital patients received medical and social assistance and care; 500 patients were redirected to social adaptation and rehabilitation centers; 800 prs. reconnected with relatives and were sent home; 24 patients and their families currently continue to receive targeted assistance.

From 2014 to 2021, 3,300 patients visited the hospital church accompanied by volunteers; in 2020-2021, 435 patients with COVID 19 received volunteer assistance in preparing for a visit to a priest. The mission of the palliative care service is to provide comprehensive medical and social assistance and spiritual support to seriously ill patients diagnosed with HIV infection, patients in the terminal stage and patients left without care of relatives in order to increase motivation for treatment and improve the quality of life.

Savina E.A., director of the "Zebra and K" Rehabilitation Charity Foundation, spoke about the work on compiling a methodological manual for theological schools on the problems of alcoholism, drug addiction and other addictions. This project was started last year by the charity foundation "Diakonia" under the leadership of E.E. Rydalevskaya. The main sections of the manual are devoted to such issues as analysis of psychological, social and spiritual aspects of addiction; basic approaches to recovery from addiction; motivation to start recovery; medical care in acute conditions; information about rehabilitation centers; maintaining sobriety; failure in recovery and exit from it; destructive "rehabilitation methods"; basic recommendations to the priest on working with a person addicted to alcohol, drugs or gambling; recommendations to the priest on working with relatives of dependent persons, etc.

Kholodkova A.A., psychologist of the psychological assistance service "Consolation" of the Kazan Diocese under the organization "Mercy of Kazan" presented a report on the "Experience in teaching programs for the prevention of risky behavior and HIV/AIDS among children and youth: Barnaul and Kazan". She spoke about the work on the prevention of deviant behavior of children and youth using the Ladya program, which she taught in Barnaul, and how such activities can be established (after her moving to a new location) in Kazan. In addition to working with children, she conducts classes with their parents, since "the main work on the formation of spiritual and moral values should still be carried out with children in the family," the speaker noted. "A lot of work is planned in Kazan to train teaching staff to work on preventive programs. We are holding meetings with Sunday school teachers to gather a group of qualified specialists who are ready to participate in this work." The speaker also presented a collection of philosophical fairy tales for children and adults "Fish", compiled by Archpriest Sergiy Kholodkov, which can be used for classes with children. Each fairy tale is an interesting and instructive story about good and evil, mercy, determination, choice. In the video commentary to the book, the author noted: "These are fairy tales for the whole family - children should read them together with their parents and discuss them. On the basis of each fairy tale in Sunday school, you can make an interactive lesson for an hour and a half… I saw my task as helping the child to go deep into his own soul and feel the joy of goodness."

Afonina V.G., Executive Director of Briansk NGO "Blago" told about the peculiarities of conducting training on primary HIV /AIDS prevention programs during the pandemic in the regions of the Russian Federation. At the beginning of her speech, she emphasized that the teachers themselves, working with children on preventive programs, must certainly have in-depth knowledge about the HIV /AIDS, about the problems of addiction and codependency. Despite the pandemic, last year many regions held trainings for teachers on working with the prevention programs "Ladya", "Way to Home" and "Living Water".

On August 2-6, 2022, a training seminar on the "Living Water" program was held in Rostov-on-Don, where, since 2009, preventive programs have already been taught in many schools. In Cherepovets, training in working with the "Ladya" for school teachers has already been conducted. And now trainings on "Living Water" and "Way to Home" are being conducted, while the task is to analyze those delayed changes that occur in the behavior of children after training in these programs. Zarechny (Sverdlovsk region) has been teaching all three programs in all schools for 5 years with the blessing of Bishop Methodius of Kamensk and Kamyshlov. Citywide work is being carried out to support specialists working on these programs, parents and children. These programs are used even in kindergartens.

In a number of cities where training seminars on these programs were held, this work is carried out in close cooperation between educational institutions and local dioceses. This is the situation in Lipetsk, Barnaul, Penza and other cities. In total, about two dozen trainings for teachers and school psychologists were held in 2021. Victoria noted that "during the pandemic, when people were left alone with their fears, illnesses and worries, these programs helped many people: they gave support and hope for the future, helped specialists to prevent emotional burnout."

Potapova Yu.A., psychologist, head of the rehabilitation program of the center "Inextinguishable Hope" made a presentation on "Experience in the prevention of HIV infection and other socially relevant diseases in the rehabilitation of drug addicts on the basis of a rehabilitation center." At the beginning of her report, she spoke about her experience of using the Ladya program in Sunday schools, as well as in rehabilitation work with drug users.

Most drug users have associated diseases - HIV infection, hepatitis, tuberculosis, etc. These diseases are the result of uncontrolled risky behavior under the influence of drugs. Stigmatization of drug users and HIV-infected people in society and, most sadly, by medical personnel remains an important problem.

The rehabilitation center "Inextinguishable Hope" deals with secondary and tertiary prevention. Seminars on the prevention of socially significant infections, including HIV, are held for patients, their relatives and employees of the center. The seminars are aimed at correcting personal beliefs and attitudes related to the possibility of infection with socially dangerous diseases, awareness and change of their risky behavior. "We consider it our important task to motivate our HIV-infected patients for treatment: it is important to convince them that they can live with this disease, have a family and have children; they can have a decent, stable and high-quality life," Yulia Potapova emphasized.

DECR communication service