Battling ignorance and saving lives

by Nathan Gray at 30/07/2012

The Moscow news

When HIV was first observed in the West in the beginning of the 1980s, medical professionals were baffled and blindsided by a rapidly spreading outbreak.

In the Soviet Union, however, political isolation contributed to a delay in the emergence of the virus, with the first diagnosis in a Soviet citizen not coming until 1987.

“We had very few conditions for the explosive rise of an epidemic: we had a very controlled society, we had little exposure with the rest of the world, and we had a relatively minor drug abuse problem,” said Alexei Bobrik, now the head of major medical equipment developer and supplier Becton Dickinson in Russia and the CIS.

Unlike in the West, where no one knew even what the virus was at its first appearance, the Soviet Union was able to institute a blood screening program based on the West’s experiences. Infections from transfusions were low, and apart from isolated outbreaks, the virus’s spread was controlled.

Use of homemade drugs

However, the social dislocation that began in 1991 and the easy availability of homemade opiates for injection, sold and distributed from large open containers, helped bring about the following decade’s spike in the occurrence of HIV, and overwhelmed the structures Soviet and Russian authorities had built to contain the virus.

“Drug users, when they bought the drug, they had to fill their syringes from a big jar,” Bobrik said. “So you can imagine, a 2-liter jar with homemade opiates, and a couple, well, several dozen drug users filling in their syringes from it.”

Bobrik was a doctor in his home city of Tver, specializing in dermatology and sexually transmitted diseases, when an HIV epidemic took hold there in the mid ’90s.

“I saw the first outbreak of HIV in my city in 1995, when, for the first month, we had the first eight cases, and it was out of the blue,” he said. “Next month, we had 20 cases, next month 100 cases, then 500 cases – it was like an explosion, so that’s how I learned about HIV. It was shocking, we were totally unprepared.”

A rural start

Bobrik had not always focused on infectious diseases. He graduated from Tver Medical Academy in 1993 and began work in a rural hospital in the Ryazan region, which he found a good basis for a medical career.

“Working in a rural hospital has a lot of advantages,” he said. “Basically, you have a very small referral base, so you have to make decisions on your own, and it’s a very good development of your independent thinking.”

Returning to Tver in 1995, Bobrik worked there for five years before embarking on a career change in 2000, when he enrolled in a master of public health program at Hebrew University in Jerusalem.

“I decided that I had to expand, to broaden my horizons,” he said. “Therefore I started looking for a kind of international exposure, and I found an opportunity to be trained abroad.”

He remembers his experience in Israel very fondly, despite the security threat of the second Intifada, which started around that time.

“I think it was one of the best years of my life,” Bobrik said. “We had people from Russia, from Kazakhstan, from Uruguay, from Canada,from Australia, a bunch of nations – we were very happy and grateful to the school.”

The school was apparently quite happy with him, as well, since it invited him to return as keynote speaker at the 2011 graduation.

Open Health

Upon returning to Russia, Bobrik began work in Moscow with the American NGO the Open Society Institute, whose public health program was spun off in 2002 to become the Open Health Institute. It was in the context of this job, which saw him taking charge of projects with total budgets of approximately $150 million, that he first worked alongside Becton Dickinson.

In 2011, the company hired him as country general manager. His professional experience and interests were a good fit for the post, especially in the protection of medical workers from accidental exposure to HIV and other bloodborne viruses.

“In response to HIV infections among health care workers, Becton Dickinson started working on safer medical instruments in the ’80s, and it produced its first safety devices on the market at the beginning of the ’90s,” he said.

HIV in Russia

While Bobrik feels that the conservatism of Russian society poses problems for people living with HIV, “I would say it’s quite possible right now for an HIV-infected person, regardless of income, regardless of social stratum, to have a pretty normal life and antiretroviral treatment generally in accordance with modern international standards,” he said.

The question of prevention, however, is still too sensitive for Russia to address openly, Bobrik said.

“For a politician or a decision maker to launch a condom promotion campaign in a Russian region, it will be political suicide,” he said. “Therefore the programs that are called prevention programs are mostly about educating about healthy choices, or whatever, but it has nothing about condoms, it has nothing about clean syringes.”

No danger from NGO laws

The political environment for NGOs, though, reflected in recently enacted laws requiring registration of groups receiving funds from foreign governments, does not inspire concern in Bobrik for public health work.

“I don’t think it’s really important, because in health care, in HIV, most NGOs that work in that area are very far from politics,” he said. “I think that Russia has certain peculiarities, but the unnecessary harshness of law here has often been compensated for by poor execution of those particular laws.”

“It’s quite possible to function in Russia, to do your business according to transparent Western standards, to enjoy sufficient freedom that, if you don’t break any taboos, it’s okay,” he added.

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