On 1 September 2010, the Global Fund Board approved a continuity of services (COS) application from the Russian Federation for a Round 4 HIV grant, in the amount of $16,623,895, for the period from 1 September 2010 to 31 August 2011.
The Board said that although the Russian Federation does not meet all of the eligibility criteria for Global Fund support for upper-middle-income countries, "there is a need for continuing ARV treatment for 12,258 patients currently on treatment" for the three month period (September - November 2010) who are being transitioned into the national treatment programme. The Board added that the Russian Federation requires additional time to finalise the transition of ARV treatment of 4,669 migrants and prisoners into the national programme.
The Board approved the funding "with the understanding" that by not later than 31 March 2011, the CCM will submit to the Global Fund a transition plan for migrants and prisoners describing how the patients on treatment will be funded from government and other sources after the period covered by the COS.
Since Round 6, the Russian Federation has been classified by the World Bank as an upper-middle-income country and has been eligible to apply to the Global Fund only for TB (in light of the high burden of TB in the country). It has not been eligible to apply for HIV or malaria. Prior to Round 6, the Russian Federation was classified as a lower-middle-income country.
In November 2009, the Global Fund Board approved 'on an extraordinary basis' an extension of a Round 3 HIV grant to Russia, which was due to expire on 31 August 2009. The extension is until 31 December 2011. The cost of the extension is $24 million. The grant includes the provision of ARVs as well as prevention services to vulnerable populations. In its decision, the Board noted that the Fund's income eligibility policies are under review, and that this review should be completed by late 2010. The Board also urged Russia to expand its investments in services to vulnerable populations.
Meanwhile, according to postings on the International Treatment Preparedness Coalition (ITPC) listserv, demonstrations were held in Moscow in mid-September 2010 to protest interruptions of treatment for people living with HIV. Activists said that the interruptions started in April 2010 and have affected at least a quarter of Russia's regions. Several activists were arrested and later released.
The website www.pereboi.ru, which was launched in 2010 specifically to record the absence of medicines, reports stockouts of ARVs in Ulyanovsk, Samara, Arkhangelsk, the Moscow Oblast, Vladimir, Kaliningrad, Saratov and other regions. Treatment interruptions in prisons are recorded in almost all regions of Russia. Stockouts have been a documented problem for four consecutive years. Legal proceedings against the government with regard to stockouts have already been initiated in three Russian cities. According to the Russian Health Care Foundation, less than 62,000 patients out of the 120,000 who need them will receive ARVs in 2010.
Activists are concerned that the situation will only get worse after money from international sources, such as the Global Fund, runs out because, in their view, the government of the Russian Federation is not taking adequate steps to replace the funding that will be lost and to improve treatment delivery.
Some of the information for this article was taken from Board Decision Point GF/B21/EDP/19, not yet posted on the Global Fund website; and Board Decision Point GF/B20/DP29, at www.theglobalfund.org/en/board/decisions.