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5 Responding to HIV/AIDS and Tuberculosis in Rus­sia While having a dif­ fer­ ent history and po­ liti­ cal culture, by the 1980s Rus­ sia had joined Brazil, India, and China in confronting a series of public health threats, including HIV/AIDS and tuberculosis. In contrast to the other BRICS ­ nations, however, Rus­ sia’s negative geopo­ liti­ cal positioning generated few ­ incentives for the government to pursue a stronger policy response to­ these epidemics when confronted with international criticism and pressure. Given the government’s foreign policy legacy of positioning Rus­ sia as an in­ de­ pen­ dent geopo­ liti­ cal power and a leader in international diplomacy, it had ­ little interest in using such a response to bolster its international reputation in health. In this context, the government would begin to address HIV/AIDS—­ though not TB—­ more concretely only ­ after the disease began to pose a ­ national security threat. Even then, recognition of this threat did not lead to a strengthening of policy response. Moreover, while the government joined its BRICS counter­ parts in providing foreign aid assistance to other nations for HIV/AIDS and TB, the goal was always to improve Rus­ sia’s international ­ image as an influential global leader rather than a government committed to disease eradication in Rus­ sia and elsewhere. The government’s ability to improve its policy response was further complicated by the absence of strong bureaucratic–­ civil societal partnerships. With a president suspicious of in­ de­ pen­ dent civil societal organ­ izations that have linkages to international donors, the po­ liti­ cal environment has not been propitious for an improvement in ­ these partnerships or, ultimately, the possibility of ­ either a stronger or perhaps centrist policy response. 158   Geopolitics in Health Responding to HIV/AIDS Rus­ sia’s initial response to HIV/AIDS was marked by government denial, inaction , and discrimination. Initially, a combination of conservative moral and social beliefs, government pride, and putting blame on other nations ­ shaped the government’s perceptions. When HIV emerged, ­ toward the end of the Cold War, the Soviet government accused the United States of clandestinely planting the virus in Moscow (Williams, 1995). At the time, this made a lot of sense to the paranoid Soviet intelligence: HIV could easily have been a ploy to undermine the health of state officials. It took the government several years to realize that HIV/AIDS was not a CIA operation. The initial response underscored the deeply held belief, much as in China, that Rus­ sia’s socialist, conservative , pious moral beliefs, permeating the government and certain segments of society, could not possibly have allowed the emergence of HIV (Williams, 1995). Indeed, the historical infiltration of conservative moral beliefs within government helps to explain Rus­ sia’s delayed response to HIV/AIDS. In this re­ spect, Rus­ sia was perhaps most similar to China and India. A strong Orthodox Christian faith, institutionalized in the eigh­ teenth ­ century through the po­ liti­ cal appointment of individuals with such beliefs,1 and the creation of federal laws and regulations based on ­ these beliefs, engendered a state that was highly discriminatory ­ toward acts of immorality and crime (Williams, 1995). Beginning with Stalin, a host of federal laws banned homosexual activity—­ punishable by years of imprisonment (Williams, 1995)—­ and intravenous drug use; such activities ­ were deemed “morally defective” (W. E. Butler, 2003). While the Boris Yeltsin presidential administration (1991–99) successfully overturned the laws affecting the gay community, po­ liti­ cal and social discrimination persisted (Pape, 2014). Rus­ sian health officials also believed that, when compared with the myriad of health threats the nation confronted, the small number of HIV/AIDS cases did not pose a serious national health threat (Brown, 2006; Wallander, 2005).­ There simply was not enough credible epidemiological evidence pointing to a public health crisis (Wallander, 2005). Moreover, Twigg (2007) notes that in the 1980s, AIDS paled in comparison with the health threats mainly affecting working-­ age men, such as heart disease, diabetes, and high blood pressure. With so many health prob­ lems, the scarcity of infrastructural and ­ human resources , and the mysterious nature of the virus itself, ­ there was ­ little interest Responding to HIV/AIDS and Tuberculosis in Rus­ sia   159 and incentive for the government to aggressively respond. The increase in HIV/AIDS in Rus­ sia since the mid-1980s is shown in figure 5.1.­ Under the Soviet Union, the threat posed by HIV/AIDS to the military and thus to Rus­ sia’s national...


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