Hiv/aids

Main article: HIV/AIDS in Russia

HIV/AIDS, virtually non-existent in the Soviet era, rapidly spread following the collapse, mainly through the explosive growth of intravenous drug use.^[21] According to a 2008 report by UNAIDS, the HIV epidemic in Russia continues to grow, but at a slower pace than in the late 1990s. At the end of December 2007 the number of registered HIV cases in Russia was 416,113, with 42,770 new registered cases that year. The actual number of people living with HIV in Russia is estimated to be about 940,000.^[22] In 2007, 83% of HIV infections in Russia were registered among injecting drug users, 6% among sex workers, and 5% among prisoners.^[23] However, there is clear evidence of a significant rise in heterosexual transmission. In 2007, 93.19% of adults and children with advanced HIV infection were receiving antiretroviral therapy.^[22][24]

The Russian Federation has demonstrated a high-level commitment in response to the AIDS epidemic. In April 2006, the State Council met with the Russian President to set goals for developing a strategy for responding to AIDS; improving coordination, through the creation of a high-level multisectoral governmental commission on AIDS; and establishing a unified monitoring and evaluation system. A new Federal AIDS Program for 2007 - 2011 was also developed and adopted. Federal funding for the national AIDS response in 2006 had increased more than twentyfold compared to 2005, and the 2007 budget doubled that of 2006, adding to the already substantial funds provided by the main donor organizations.^[24]

Coordination of activities in responding to AIDS remains a challenge for Russia, despite increased efforts. In 2006, treatment for some patients was interrupted due to delays in tender procedures and unexpected difficulties with customs. Additionally, lack of full commitment to an in-depth program for education on sex and drugs in schools hinders effective prevention programs for children.^[24]

Suicide

In 2008, suicide claimed 38,406 lives in Russia.^[25] With a rate of 27.1 suicides per 100,000 people, Russia has one of the highest suicide rates in the world, although it has been steadily decreasing since it peaked at around 40 per 100,000 in the mid-late 90s,^[26] including a 30% drop from 2001 to 2006. In 2007 about 22% of all suicides were committed by people aged 40–49, and almost six times as many Russian males commit suicide than females.^[27] Heavy alcohol use is a significant factor in the suicide rate, with an estimated half of all suicides a result of alcohol abuse. This is evident by the fact that Russia's suicide rate since the mid-90s has declined along-side per capita alcohol consumption, despite the economic crises since then; alcohol consumption is more of a factor than economic conditions.^[28]

Health care reform

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Pre-reform health care

Pre-1990s Soviet Russia had a totally socialist model of health care with a centralised, integrated, hierarchically organised with the government providing free health care to all citizens. All health personnel were state employees. Control of communicable diseases had priority over non-communicable ones. There was over provision of hospital beds, which contributed over time to an imbalance in the overall structure of the health care system. On the whole, the Soviet system tended to neglect primary care, and placed too much emphasis on specialist and hospital care.

Despite weaknesses, the integrated model achieved considerable success in dealing with infectious diseases such as tuberculosis, typhoid fever and typhus. The effectiveness of the model declined with underinvestment. Despite a doubling in the number of hospital beds and doctors per capita between 1950 and 1980, the quality of care began to decline by the early 1980s and medical care and health outcomes were below western standards. The lack of money that had been going into health was patently obvious. Many small district hospitals had no more than 4–5 m2 per bed, and some of the smallest hospitals had no radiology services, and inadequate heating or water. A 1989 survey found that 20% of Russian hospitals did not have piped hot water and 3% did not even have piped cold water. 17% lacked adequate sanitation facilities. Every seventh hospital and polyclinic needed basic reconstruction. Five years after the reforms described below per capital spending on health care was still a meagre US$158 per year (about 8 times less than the average European social models in Spain, the UK and Finland, and 26 times that of the U.S. which spent US$4,187 at that time).^[29]