Yale and New Haven join in pilot program for treating HIV/AIDS in Russia

Russia today is where the United States was 20 years ago in dealing with HIV/ AIDS: denial and prejudice are almost as widespread as the disease itself.

In an effort to help, last July in St. Petersburg Health and Human Services Secretary Tommy G. Thompson announced a major grant to fight the AIDS epidemic. A Yale doctor and epidemiologist were by his side, and at an October news conference in New Haven’s City Hall, they announced their own role in the initiative. The School of Medicine was one of four U.S. organizations chosen to receive $320,000 each from the U.S. Agency for International Development to provide training in care, treatment and support services to people living with HIV/AIDS in Russia.

The School of Public Health, through its Center for Interdisciplinary Research on AIDS, has worked on training and prevention programs with colleagues in St. Petersburg since 1998. But this marks the first collaboration between the two cities to address HIV/AIDS care and treatment.

The 30-month program calls for Yale, along with state and city agencies, to share information and strategies with colleagues in St. Petersburg. The grant will fund four exchanges each year; the first group of Russian trainees arrived in New Haven in early October. Yale faculty and representatives from community-based HIV/AIDS organizations will also travel to St. Petersburg to train Russian health professionals and to observe how they are managing the epidemic.

In Russia, a major obstacle is the prejudice against HIV/AIDS patients, typically young, male intravenous drug users. As part of the program, Russian visitors will observe services provided by the Yale AIDS Program and organizations in New Haven, and they will visit a methadone clinic and needle exchange program. Krystn R. Wagner, Ph.D. ’89, M.D. ’96, assistant professor of medicine and project coordinator of the New Haven–St. Petersburg partnership, said she hopes that “observing drug treatment here will help catalyze new thinking about substance abuse management and the care of drug users.”

The problem in Russia, said Robert Heimer, Ph.D. ’88, associate professor of epidemiology and public health and co-coordinator of the project, is the lack of a multidisciplinary, integrated system for managing HIV/AIDS. “Someone walks into a hospital and is treated for HIV,” said Heimer, “but what about his drug addiction, or the fact that he has tuberculosis or that he’s homeless? There’s no coordination, no system that allows them to deal with the complexities of this illness in a way that crosses traditional medical boundaries.”

The impetus for this initiative is the soaring number of HIV infections in Russia. HIV/AIDS didn’t surface in the countries of the former Soviet Union until the early 1990s, but they now report some of the world’s fastest- growing rates of new infections. Although there are 300,000 reported cases in Russia, the United Nations and Russian AIDS officials put the number at 1 million or more. Wagner, medical director of the Nathan Smith Clinic, the HIV clinic affiliated with Yale-New Haven Hospital, said this is due to many factors, including relaxed border controls after the dissolution of the Soviet Union, rising unemployment and drug trafficking. Most new HIV cases were initially among IV drug users, but now cases caused by sexual transmission are on the rise.

Heimer called the collaboration “remarkably exciting. … If we can create and implement an integrated system on a pilot basis in one small region of St. Petersburg, and if it’s successful, it can be replicated elsewhere in Russia.” Russia today is where the United States was 20 years ago in dealing with HIV/ AIDS: denial and prejudice are almost as widespread as the disease itself.

In an effort to help, last July in St. Petersburg Health and Human Services Secretary Tommy G. Thompson announced a major grant to fight the AIDS epidemic. A Yale doctor and epidemiologist were by his side, and at an October news conference in New Haven’s City Hall, they announced their own role in the initiative. The School of Medicine was one of four U.S. organizations chosen to receive $320,000 each from the U.S. Agency for International Development to provide training in care, treatment and support services to people living with HIV/AIDS in Russia.

The School of Public Health, through its Center for Interdisciplinary Research on AIDS, has worked on training and prevention programs with colleagues in St. Petersburg since 1998. But this marks the first collaboration between the two cities to address HIV/AIDS care and treatment.

The 30-month program calls for Yale, along with state and city agencies, to share information and strategies with colleagues in St. Petersburg. The grant will fund four exchanges each year; the first group of Russian trainees arrived in New Haven in early October. Yale faculty and representatives from community-based HIV/AIDS organizations will also travel to St. Petersburg to train Russian health professionals and to observe how they are managing the epidemic.

In Russia, a major obstacle is the prejudice against HIV/AIDS patients, typically young, male intravenous drug users. As part of the program, Russian visitors will observe services provided by the Yale AIDS Program and organizations in New Haven, and they will visit a methadone clinic and needle exchange program. Krystn R. Wagner, Ph.D. ’89, M.D. ’96, assistant professor of medicine and project coordinator of the New Haven–St. Petersburg partnership, said she hopes that “observing drug treatment here will help catalyze new thinking about substance abuse management and the care of drug users.”

The problem in Russia, said Robert Heimer, Ph.D. ’88, associate professor of epidemiology and public health and co-coordinator of the project, is the lack of a multidisciplinary, integrated system for managing HIV/AIDS. “Someone walks into a hospital and is treated for HIV,” said Heimer, “but what about his drug addiction, or the fact that he has tuberculosis or that he’s homeless? There’s no coordination, no system that allows them to deal with the complexities of this illness in a way that crosses traditional medical boundaries.”

The impetus for this initiative is the soaring number of HIV infections in Russia. HIV/AIDS didn’t surface in the countries of the former Soviet Union until the early 1990s, but they now report some of the world’s fastest- growing rates of new infections. Although there are 300,000 reported cases in Russia, the United Nations and Russian AIDS officials put the number at 1 million or more. Wagner, medical director of the Nathan Smith Clinic, the HIV clinic affiliated with Yale-New Haven Hospital, said this is due to many factors, including relaxed border controls after the dissolution of the Soviet Union, rising unemployment and drug trafficking. Most new HIV cases were initially among IV drug users, but now cases caused by sexual transmission are on the rise.

Heimer called the collaboration “remarkably exciting. … If we can create and implement an integrated system on a pilot basis in one small region of St. Petersburg, and if it’s successful, it can be replicated elsewhere in Russia.”