Russia has unveiled plans to ban state procurement of imported condoms, prompting a wave of risque jokes in the country’s media. But for anyone following the alarming rise in HIV infections in Russia the proposal was hardly a laughing matter.

Russia is one of the few places in the world where the HIV virus is still rapidly spreading, driven mainly by intravenous drug use and unprotected sex.

Within five years at least two million people are expected to be officially registered as HIV-positive, while three million – or 2 per cent of the total population – will be carrying the virus, according to Dr Vadim Pokrovsky, the head of the Russian Federal Aids Centre.

In most cases infection is an avoidable tragedy. However at “an adult level there are hardly any information campaigns to warn the public to take steps to protect themselves against the virus. We need to attend to these problems very urgently,” Dr Pokrovsky told The Irish Times.

Russia’s ministry of industry and trade proposed new legislation last week that would bar state procurement of a wide range of imported medical goods, from wheelchairs to orthopaedic footwear, from tampons to latex condoms.

Sanctions

Russian retailers will not be prohibited from selling imported condoms, but the government will no longer consider foreign latex brands when conducting state health tenders.

It is widely held in Russia that locally made condoms are no match for the likes of Durex or Trojan. However, Dr Gennady Onishchenko, Russia’s former chief sanitary inspector, who now serves as a government adviser, said a shortage of condoms could boost both public morality and the birth rate.

“Latex goods are not related to health” and their scarcity would “force people to be more disciplined, stricter, and pickier when choosing partners and might bring some benefits to our society in solving the demographic problem”, he told Ria-Novosti news agency last week.

HIV appeared in Russia only in the late 1980s as the country began opening up to the outside world after decades of Soviet isolation. The official tally of people in Russia living with the virus has almost doubled since 2010, to reach 930,000 cases, and it is snowballing year by year.

Intravenous drug users sharing infected needles accounted for the majority of new HIV cases registered in 2014. Men having sex with men accounted for less than 2 per cent, although the growing stigma associated with homosexuality after recent anti-gay legislation may have discouraged some HIV sufferers from reporting to the health authorities.

Heterosexual transmission

Russia cannot be accused of turning a blind eye to HIV. State funding for antiretroviral therapies that can suppress the progress of the virus towards full-blown Aids has been stepped up this year despite budget constraints. But little attention is being given to preventative measures.

Russia flatly refuses to consider the use of opioid substitution in treating drug addiction that has had huge impact in reducing the spread of HIV by infected needles in western countries. The use of heroin substitutes like methadone is punishable by up to 15 years in prison.

Dr Onishchenko won respect in the past for breaching an official wall of denial and publicly admitting that Russia was facing a looming Aids epidemic. But his comments on condoms last week have made him a target for media ridicule.

‘Official madness’

Novaya Gazeta Anthony Beevor

Vladimir Putin focused on Aids as a threat to national security in a speech to the state Duma during his first presidential term in 2003. But discussion of the problem has gradually dropped away.

The picture of a country in the grip of a potentially deadly epidemic does not fit well with the Kremlin’s promotion of Russia as a resurgent power confidently re-embracing traditional values.

Dr Pokrovsky says HIV prevention should begin with an overturning of restrictions on sex education in schools and a move to draw business and trade unions into campaigns to raise awareness.

It does not help that the increasingly influential Russian Orthodox Christian church opposes the distribution of clean needles and condoms to drug-users as legitimisation of sin. Church leaders discourage sexual relations outside matrimony and even designate days of the year when couples are permitted to indulge in love-making.

“Monogamy would of course help slow the spread of HIV,” says Dr Pokrovsky, “But as a health policy it’s not very realistic.”