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WHO World Health Organization |
20 years ago, the first five patients died from AIDS in the U.S. Since then, over 20 million people have become victims of the disease. And more than 30 million are now suffering from it. A WHO expert comments on today’s battle against HIV/AIDS in three dimensions: the World, Russia and one of Russia’s regions.
Addressing the World Health Assembly in May, 2001, UN Secretary-General Kofi Annan emphasized the five following objectives in the fight against HIV/AIDS:
– to ensure that people everywhere, particularly young people, know what to do to avoid infection;
– to stop HIV transmission from mother to child;
– to provide care and treatment for all those infected;
– to redouble the search for both a vaccine and a cure; and
– to care for all those whose lives have been devastated by AIDS, particularly the orphans.
On the same occasion, Mr Annan announced plans to set up an international fund to combat HIV/AIDS, tuberculosis, and malaria. Managed by an independent board made up of governments from both donor and developing countries, NGOs, the private sector and the UN, the fund could become a major tool for economic growth in the developing world, providing support for those people who need it most. The UN Secretary-General has called on governments and the private sector to contribute to the new fund.
Though Russia does not fall into the developing country category, the problem of HIV prevention and its financing, in view of the rapidly growing rate of infection in the country, remains acute. As of May 21, 2001, a total of 115,289 HIV-positive cases were reported to the Russian Federation Ministry of Health (as opposed to the 103,024 cases registered by April 1, 2001), indicating infection rates as high as 79.2 cases per 100,000 of the population and a 132-fold increase compared with the corresponding figures in 1996. An estimate from the Russian Federal Scientific and Methodological Centre for AIDS Prevention is approximately seven times higher. To succeed with HIV-prevention in such a deteriorating situation, the combined efforts of the local health authorities and the federal administration, as well as the community of donor nations, is essential.
In response to the UN Joint Initiative presented in Moscow in November 2000, the Finnish Government contributed $300,000 USD for the reinforcement of HIV preventive measures in the Republic of Karelia, through the World Health Organization.
Though the registered rates of HIV in Karelia still remain at a comparatively low level, new cases of the infection in the republic have been increasing exponentially. Furthermore, factors facilitating an explosive increase of new HIV cases, through both injection and sexual transmission, are currently at work in Karelia.
These factors include: the high-risk behaviour practices that are common among intravenous drug users, sex industry workers, their clients and other people; insufficient HIV-prevention; inadequate skills of medical and other professionals for counselling and HIV case management; and insufficient local institutional capacity for managing the problem.
As part of the planning phase of the project, the World Health Organization carried out a fact-finding and planning mission to the republic in February, 2001. In concert with the RF Ministry of Health, the Government of the Republic of Karelia, and municipal authorities, it has been decided to first concentrate their efforts on two main high-risk groups – intravenous drug users and sex industry workers – in three pilot areas of the republic: Petrozavodsk, Kostomuksha and Sortavala.
The project calls for the setting up of easily accessible units for counselling and voluntary HIV testing, outreach work, the training of relevant staff, and improving the systems for epidemiological control. These will be initiated simultaneously with the promotion of ways to avoid infection among the general population, and particularly among youth. The latter will be reached through the training of school teachers and medical personnel at state enterprises and penal institutions. Advice on safe sex will be conveyed to the clients of sex industry workers, including foreign tourists, through an informational campaign and via the mass media. All activities will be endorsed by a high-level working group on HIV, which will be set up as part of the project.
Through the project, the local staff will gain the knowledge and skills to proceed with HIV preventive work. The project is planned to last for 24 months. However, the infrastructure for prevention of HIV in the high-risk groups will lean on local manpower and will be locally funded, which will contribute to its sustainability.
It is envisaged that this WHO-implemented project will have catalytic and coordinative effects on other partners, including UNAIDS co-sponsors like UNFPA, UNODCCP, UNICEF and ILO. In addition, new funding opportunities through other donor agencies will be actively sought by WHO.
Dr Nikolai Mashkilleyson,
Coordinator on HIV/AIDS and STI Control, WHO
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The 54th World Health Assembly took place this year from
14 to 22 May at the United 
Nations
Palais des Nations in Geneva, Switzerland. The Assembly is the annual meeting
of the 191 Member States of the World Health Organization (WHO), and its highest
governing body.
The year 2001 has been designated as the World Mental Health Year with the global slogan "Stop Exclusion – Dare to Care". To highlight this vastly neglected health problem, a series of round-table discussions were organized on 15 May, when many ministries of health and their representatives provided their insights and debated the strategies for improving the situation in their countries. Professor Valery Krasnov, from the Moscow Research Institute of Psychiatry, represented the Russian Federation. This is what he said to the international community:
We are participating in an extremely important process: comprehension and statement of the fact of mental health’s special importance. In contemporary conditions, as a result of the high level information saturation and the psychological intensity of work, the mental health of the population has truly become a major factor in social development. Therefore, all state and public institutions should participate in solving the problems of mental health.
It is generally accepted, that poverty is, if not the reason, then a decisive precondition for the deterioration of the population’s mental health. Proceeding from this, we suppose that resources for overcoming poverty should be sought. However, the incidence of mental disorders is increasing around the world, both in the countries with low per-capita incomes and in countries with a high income levels - and also in countries in transitional period of social and economic development, such as Russia. In fact, the restoration of mental health is itself a true resource for overcoming poverty: by preserving mental health and preventing serious mental disorders, we thus prolong the high-quality, able-bodied life of the individual. It also prevents poverty from spreading farther.
At the Assembly’s plenary session, Gro Harlem Brundtland, the Director General of WHO, emphasized the need to draw up a long-term strategy to safeguard the health of the population by selecting the most promising lines of work. The strategy of safeguarding mental health should quite probably assume the greater integration of psychiatric services in the general health-care system and their interacting with other medical and non-medical institutions. This would involve not only specialists in different fields, but also non-professionals in the rendering of assistance to people with mental disorders, or at risk of developing such disorders. In particular, the former patients and their relatives have invaluable experience in how to overcome mental health problems, and this experience can be put to work in our common task.
The scale and content of the mental health problem are such that they can not be solved inside psychiatric establishments. The opportunities offered by our primary medical network should be used, first of all. In Russia, the traditional system of local outpatient clinics serving the population has substantial potential for the improvement of mental health services and bringing their help to the public, especially to those with non-psychotic, moderately manifested and short-term mental health problems. We in this country have solid experience in helping depressed patients through our primary medical network. We are ready to discuss this experience with the experts and managers of public health services from other countries, and to work together with WHO in creating new ways of helping people who suffer from depression.
We have had a suicide prevention service in Russia for many years now. However, its development under current conditions also requires the utilization of experience from other countries and the advisory support of WHO. We can not say for sure, whether the above-mentioned prevention service is actually helping to hold down the increasing suicide rate in this country, as suicide figures for Russia remain among the highest in the world in recent years. Taking into account WHO’s great experience in estimating the efficiency of the various mental health projects and programs, I would like to propose that they develop a selection of methods for estimating the long-term efficiency and economic profitability of various models of helping the public.
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"It is unusual for psychiatrists to get have their work acknowledged in such a positive and unusual way," said Professor Tatyana Dmitrieva, Head of the Serbsky National Research Centre for Social and Forensic Psychiatry. The Professor was speaking at the opening of a preview of the works of artist Ilya Komov, a special showing that featured portraits of prominent medical scientists. "We know that there is a a direct connection between colours, art, and mental well being. We also know that many world famous artists have suffered from mental disorders, thus reminding us of the importance of tolerance towards people who are ill," emphasized Prof. Dmitrieva, whose portrait was also exhibited.
With his preview, Ilya Komov highlighted the importance of
the World Health Day. He 
decided
to paint a series of psychiatrists, mental health workers and other health professionals
who aspire for better care and quality of life for people suffering from mental
illness. Mr Komov’s style of painting aims at bringing the inner spirit and
soul of the person to the canvas; colours play an important role. When asked
at the beginning of his exhibition about what it was like to paint these people
and chat with them as he worked, the artist said: "I have rarely met more interesting
and dedicated individuals. They are so devoted to their mission of alleviating
suffering among their fellow citizens."
Dr Mikko Vienonen, Special Representative of the WHO Director General in Russia, explained the double meaning of the name of the exhibition, "Healing People". "The portraits depict people who heal others; but on the other hand, all people can have a healing affect upon each other. We need to become more conscious of this important human characteristic," Dr Vienonen stressed.
The exhibition attracted wide interest among the media, particularly television. It did well in passing on the message: "Stop Exclusion – Dare to Care".
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The World Health Organization has proposed the introduction of a World Day (or Week) without Tobacco Smoke under the motto: "Passive smoking kills. Let's clear the air".
The problem of passive smoking is quite real for Russia. The increasing number of smokers among children and teenagers, and older girls and women, as well as the rise in morbidity and mortality rates from diseases caused by smoking, demand that the state take serious steps to educate the country’s population.
In light of this, the Russian Health Ministry has decided to organize a No-Smoking Week from May 31 to June 7, 2001. In April, public health officials in all of Russia’s 89 regions were sent materials from the World Health Organization on the observance of the Week across the nation.
In May, the nation-wide ORT TV channel, Radio Russia, Environment Magazine and other mass media actively discussed the problem of smoking. A responsive chord was struck by the May 16 and 27 airings of the TV show Court Is Now in Session, where defending the rights of non-smokers was debated by health-care experts and members of the general public.
Three medical research centres organized hot lines on May 31. All day long, doctors answered questions, and gave medical advice to those who wanted to quit smoking.
A number of drawing contests were held for children. One of these was dedicated to works by chronically ill boys and girls from Moscow’s children’s homes. They will receive their young laureate awards when they return to Moscow from their summer rehabilitation centres in September.
All 46 of the winners in the Russia’s first Internet Art Competition have already received their prizes. The grand prize, a computer, was awarded to a 10th grader for his computer graphic "Cigarettes Kill More Than Horses".
The Week’s final event was a press-conference titled "The Smoking Situation in Russia: Passive Smoking and the Treatment of Tobacco Dependency."
Taking part in the conference were Gennady Onishchenko, the First Deputy Minister of Health, academician Rafael Oganov, and other prominent scientists, and physicians, representatives of public organizations; and the Russian and foreign mass media. They expressed great interest in the topics under discussion, and in the special collection of informational materials published for the conference.
Galina Tkachenko,
Head of Coordination Centre on Overcoming Smoking,
Ministry of Health