Law professor founds 'HIV SWAT team'

By Ann Lukits
Local News - Tuesday, October 26, 2004 @ 07:00

A Kingston law professor has spent the last decade helping the people of Russia prepare for an epidemic of HIV and AIDS infections that many fear could decimate a country already on the brink of self-destruction.

Ten years ago, William Flanagan, a specialist in international law at Queen’s University, co-founded the Canada AIDS Russia Project, a non-profit organization of professional men and women – a Canadian “HIV SWAT team” – that has been helping Russians develop the expertise and tools to deal with the escalating public health crisis.

As the project comes to an end later this fall, Flanagan said he considers his team’s work a success, although he admits members had to work against considerable obstacles.

The team, he said, had to deal with ignorance, stigma, hostility and “a great deal of fatigue – [Russians] have been dealing with catastrophic failure for decades.

“It’s very hard to do anything,” he said. “It’s always been hard to do anything. People are very poorly motivated on a whole range of areas, not just health care and HIV.

“Getting people motivated to do things, to believe they can change things, that things can change, is very difficult in Russia. It’s a very poor country. It’s an extremely dysfunctional country.”

Russia is currently in the grips of a “quiet” epidemic. Between 750,000 and one million Russians are infected with HIV but most acquired the virus in the last three or four years so the disease hasn’t yet progressed into full-blown AIDS.

Soon the country will face a medical and social crisis. It’s projected that more than 600,000 Russians with HIV will require hospital treatment next year and more than one million people will die of acquired immune deficiency syndrome, or AIDS, by 2010.

Flanagan got involved in the Canada AIDS Russia Project through a fellow graduate of the University of Toronto, Vinay Saldanha, who was “doing HIV work” in Russia after the fall of the Soviet Union.

Although HIV wasn’t considered a serious problem at the time, a handful of individuals and organizations

believed it would become a serious health issue in the years ahead, in part because intravenous drug use soared after the breakup of the Soviet Union and Russia’s borders became more porous. Flanagan chaired the AIDS Committee of Toronto and the Ontario HIV Treatment Network when Saldanha approached him to help found the Canada AIDS Russia Project. Intrigued, Flanagan, who still heads the HIV treatment network, accepted and with Saldanha began assembling a team of professionals, most of whom were based in Toronto.

The project, which will wind down in December with a three-day conference in Russia, had two goals. One was to enhance the capabilities of key Russian governmental and nongovernmental organizations working in the HIV and AIDS field. The other was to develop a network of professionals who could respond more effectively to the spread of HIV and AIDS.

With funding from the Canadian International Development Agency, the team has carried out research, given lectures, conducted specialized training and dispensed policy advice in four regions of Russia.

Flanagan, who also directs the international law program at Queen’s Herstmonceaux Castle in southern England, said the Canada AIDS project also played a major role in helping Russia obtain $120 million from the Global Fund to help treat and care for people with AIDS.

The Global Fund was created to dramatically increase resources to fight AIDS, tuberculosis and malaria in countries that are ill equipped to deal with these diseases. The fund distributes money to different countries but relies on local experts to run the programs.

“We’ve helped Russia move to the next stage in dealing with its epidemic,” Flanagan said.

Flanagan said the Global Fund money is important because it will enable Russia to buy the expensive anti-retroviral drugs that have proved so effective in treating HIV in the western world. Only about 1,500 of the estimated 40,000 Russians who need them – or less than four per cent – are receiving HIV drugs. Global Fund money should allow at least 50,000 people to receive treatment, he said.

For the past three years, the Canada AIDS project has focused on “building capacity” by training the people who will be treating adults and children infected with AIDS.

“We’re doing training on how to treat children and how to treat adults in the hope they will get medication in the future,” Flanagan said. “Many [areas] don’t have the capacity to treat right now. They’re just not doing anything. There’s no drugs.”

Flanagan compared Russia’s reaction to the projected AIDS epidemic to “looking into an oncoming car [and] not doing anything.”

There is astounding ignorance in Russia about HIV and AIDS, despite an high rate of literacy in the country, according to a recent article in The New Yorker magazine. Most Russians believed HIV can be transmitted through kissing, coughing and mosquito bites, according to a survey carried out last year.

Flanagan said that when the Canada AIDS project began working in Russia “almost no one was being treated. Treatment wasn’t even on the horizon and it was completely unaffordable. There was very little experience in the treatment [of HIV] and once you left the cities there was none.”

The project started AIDS organizations in two of the four regions that it concentrated its efforts in and developed a training network in the other two, where there were existing non-governmental agencies in place to fight AIDS.

Queen’s law students also contributed to the Canada AIDS Russia Project.

Kirsty McHenry was in second year at Queen’s when she was hired by Flanagan to carry out research on the HIV epidemic and Russian women from a human-rights perspective. By the end of last year, there were an estimated 860,000 people living with HIV in Russia, 290,000 or 34 per cent of them women.

The proportion of women among new HIV cases is also increasing. In 2001, women accounted for one in every four new cases. The following year, one out of every three new HIV cases was diagnosed in a woman. Between 1998 and 2002, HIV infections among pregnant women underwent a tenfold increase.

McHenry spent several months conducting background research on the project in her home town of Kingston but in the summer of 2002, she spent two months in Moscow, working out of an office donated by AIDS Infoshare, an organization of professionals.

McHenry found that use of condoms was inconsistent and the high rate of abortions suggests that unprotected sex is common.

The country’s rigid residency laws also restrict women’s ability to move freely within their communities for fear of police harassment and detention. Generally, women are also poorly informed about HIV and AIDS in Russia, although women with sexually transmitted infections face more stigma than men in Russia, McHenry found.

“Vulnerable populations are more at risk of contracting HIV, I think that’s true in Canada as well as in Russia,” she said.

Her research also found that Russia wasn’t living up to its international human rights obligations. “One of the things we found was that there were some discrepancies between the law and what was happening [on the ground],” she said.

The Canada AIDS Russia Project’s upcoming conference will highlight the research, training and overall results.

Despite the obstacles, Flanagan said he was pleased with the work done so far. “We’ve got a great team. We’ve made some significant inroads. It was a lot of work and we may need a little bit of a break.”

Looking ahead, Flanagan said he’s thinking about launching AIDS projects in other parts of the world, possibly India and China.

“As a country, we’ve a lot to contribute to the international fight against HIV.”