The Health Ministry says it spent 10 billion roubles ($320.5 million) on HIV/AIDS testing and treatment - mostly antiretroviral drugs - in 2010. But activists and health experts say this amount compares badly with other countries in the G20 and sufferers are routinely ignored.

In a 2010 report, the World Health Organization said just a fifth of Russians who needed AIDS drugs were receiving them. South Africa, which has the biggest HIV-positive population in the world - and whose government until recently was criticised as being in denial on AIDS - gives AIDS drugs at almost twice that rate.

“Appeals, trials and public action - nothing works,” says Alexandra Volgina, head of The Candle Foundation for HIV-positive people, a non-governmental organisationorganization in Saint Petersburg.

When asked why so many sick Russians lack access to AIDS drugs, the health ministry’s spokesman responds: “The amount spent was deemed sufficient.”

POPULATION PROBLEMS

Russians usually blame alcohol for their health problems. Official data shows the average Russian drinks 18 liters (38 pints) of pure alcohol every year, compared with 14 liters in France and eight in the United States.

Official campaigns against drinking have been pursued sporadically since Tsarist times, usually with little success. In September last year Russia banned night-time sales of heavy alcohol, following on from a proposal to double the minimum price of vodka over the next two years in an effort to curb drinking.

“They (the government) are nicer to alcoholics than they are to us,” says 32-year-old heroin addict and Tver resident Valera, whose scaly hands and face are covered in bright pink scabs from a decade of use. Like many drug addicts, Valera does not work and refuses to say how he funds his $300-a-day habit.

The Geneva-based International Aids Society Aids Society (IAS) warns that if Moscow continues to take no measures, the number of new HIV infections in Russia is likely to grow by 5-10 percent a year, pushing the problem to “an endemic level”, according to IAS president Elly Katabira: the rate will stay constant even without any additional infections from outside the country.

That would hit Russia’s already dwindling population - recently called a “demographic crisis” by President Medvedev. Heavy smoking, alcoholism, pollution, poverty, low birth rates in the years after the fall of Communism, as well as HIV/AIDS underpin UN projections that the population will shrink to 116 million by 2050 from 142 million now. Moscow - which now gives money to mothers bearing two or more children - targets a population of around 145 million by 2025, but concedes that it could fall to as low as 127 million by 2031.

DESPERATE FOR METHADONE

If one thing appals foreign health officials and activists more than anythappallsing else about Moscow’s response to its heroin problem, it’s the ban on methadone. The WHO regards methadone as essential in combating heroin dependence, but in Russia anyone caught using it or distributing it can face up to 20 years in prison - as harsh a sentence as that for heroin.

Called a replacement drug, methadone is taken by mouth - so reduces the risk of HIV infection by using shared needles - and is used around the world to treat opiate addiction. Russia is one of just three countries in Eastern Europe and Central Asia to ban the drug, alongside Turkmenistan and Uzbekistan, where heroin consumption is relatively low. China, which has over one million registered heroin addicts, with unofficial estimates running several times that, has more than 680 methadone sites.

Methadone is a potent synthetic opiate in its own right, but it can eliminate the agonizing withdrawal symptoms that addicts experience when they quit heroin. Its main advantages are that it has to come from a health-care source, in controlled doses and without needles. That gives addicts some chance, over months or sometimes years, to go clean for good.

In Tver, Yuri Ivanov, a doctor and the deputy head of the state-run Tver Regional Narcology Clinic, is dumbfounded by the ban. “Why do civil servants limit me from doing my work?” he asks in his dimly lit office in the crumbling grey clinic, which sits off an unpaved muddy lane in the center of the city. “All that they are trying to do is the opposite of what we need. It is hard for me to understand… The situation is going backward. When there is no real medicine, they go right back to drugs.”

Ivanov sometimes resorts to giving his patients tropicamide, a drug used by eye surgeons to dilate the pupils and which has a similar effect to heroin.