Ever since the first paper was published in 1981 detailing the instance of a certain virus attacking the immune system and leading to fatal outcome, HIV has spread at an incredible pace throughout the world and is now classified as a pandemic by the World Health Organization. Despite worldwide distribution of HIV, the rate of spread and the effect on populations have been different for different nations. Third world countries have been especially hardest hit, with the largest numbers of HIV infections being reported in India and Nigeria. While HIV infection rate was generally low in second world countries, such as Russia and other Eastern European nations, more infections are now being reported there. The high infection rate in third world countries has been blamed mostly on poverty, illiteracy and poor healthcare. On the other hand, the spread of HIV in second world countries is attributed to other issues, such as drug abuse and alternative lifestyles (Godinho and World Bank, 78-80). HIV infection rate in second world countries is now among the highest in the world.
This study is an analysis of the HIV pandemic in Russia, a country with one the fastest growth rate of HIV infection, and Nigeria, a nation with the second largest HIV-positive population in the world. The history of the HIV pandemic in the two countries differs a great deal due to the differences in demographics. An analysis of the two countries would, therefore, be beneficial in determining the factors that lead to high rates of infection and ways of keeping them in check. The 2008 UNAIDS report estimated that there were about 33.4 million who were living with the HIV virus. Of the 33.4 million Nigeria was home to 9%, with 2.98% being infected (Ajayi 45-57). According to the 1997 UNAIDS report, Russia has about 0.94 million people diagnosed with the virus. This is a prevalence rate of 8% as compared to Nigeria’s 4.6%. The report went on to assert that while prevalence rates in other nations in Eurasia were dropping, Russia’s numbers had slowed down, but not at the same rate as that of other nations (Twigg 97).
The state of the HIV pandemic in Russia has for a long time been classified as a concentrated epidemic. Most of the infected people were intravenous drug users, prisoners and sex workers. As of 2007, drug users accounted for the largest share of HIV infections, their number reaching as high as 64% in some regions. Sex workers and prisoners had prevalence rates of 6% and 5% respectively. While HIV has traditionally been transmitted through concentrated populations, recent data has shown that there is an increase in prevalence rates among the general heterosexual population (Godinho and World Bank 123-126). Nigeria’s pandemic, on the other hand, has been spread evenly among the general population. Nigeria’s prevalence rate is, however, skewed towards women who account for 1.72% of the general infected population, while the prevalence rate among men stands at about 1.28%. HIV in Nigeria is thus more common among heterosexual populations, as opposed to the instances of gay relations in Russia. Recent data has shown that the prevalence rate among women in Nigeria continues to increase, unlike that of men. HIV prevalence in Nigeria stood at 1.8% in 1991, before rising to 5.8% in 2008, and then dropping to 4.6 % in 2010 (Umunna 101-8).
Overview of the HIV Epidemic
The 2010 report on the AIDS pandemic in Nigeria showed the prevalence rate in Nigeria to be higher in urban areas. Age is also an important factor, with more youth aged 18-24 having a prevalence rate of 2.3%. Education also played a critical role in that people with college education had a higher prevalence rate of 4.7% as opposed to high school education at 2.6%. Studies conducted in Nigeria in 2010 established that the high risk populations, such as sex workers, gays and intravenous drug users, are a potential driver in the spread of HIV in Nigeria (Adeyi, 56-89). Poverty was also found to be a key factor responsible for the HIV pandemic. The rural poor had a lesser prevalence rate of 5% as compared to the urban poor which had rates of up to 8%.
The Russian HIV pandemic, just like that of Nigeria, is driven by concentrated populations. Individuals engaging in same sex relations, especially men, are deemed to be at a higher risk of HIV exposure in Russia. Sex workers, prisoners, and intravenous drug users were also found to be high risk groups. The HIV pandemic in Russia is heavily skewed towards men who account for approximately 67% of the national HIV population. Male homosexuals have been found to run a greater risk of having HIV. 7% of the people who sought an HIV test after reporting to have had sexual relations with other men were found to be HIV positive as compared to the heterosexual population (Godinho and World Bank 34-45). UNAIDS data has shown that intravenous drug use has increased in the past decade in Russia, and thus this group has become more at risk. Sex workers in Russia are a high risk group due to failure to use condoms, as well as alcohol and drugs abuse. High HIV prevalence rate among the prison population is linked to infection by intravenous drugs prior to entering the penal system.
National Response to the HIV/AIDS Pandemic
Differences in policy and response to the pandemic have a significant effect on the prevalence and infection rates in Russia and Nigeria. Political decisions and policy play a great role in determining the effectiveness of the fight against HIV. The Russian government has been very active in this regard by enforcing different policies, such as the 2006 program “On Urgent Measures for Controlling the Spread of HIV Infection in the Russian Federation” which was developed by academics, medical experts and line ministries. The Nigerian government has also been active in its response towards the AIDS pandemic by adopting the multispectral framework for action against HIV infection in 2008 (Ajayi 45-57). The Russian government has also adopted preventive programs against the pandemic. While the pandemic was not as severe as it is now, the Russian government adopted a number of preventive programs, such as the currently running “On Urgent Measures for Controlling the Spread of HIV Infection in the Russian Federation”, which is an extension of the original program (Twigg 178-190). The Nigerian government meanwhile established coordinating structures at both the national and state level to coordinate the fight against the pandemic. These structures were given autonomy and ratified by the Parliament in 2007 in order to give them more power.
Care treatment and support are a fundamental aspect of the fight against HIV. Unlike Russia, Nigeria still has some weaknesses in its care treatment and support systems. The health and support systems in Nigeria are either substandard or non-existent, especially in the rural areas. Despite having superior facilities, the Russian Federation is hampered by negative attitudes, which makes it harder to provide support for those who need it. Funding is also what differentiates the two nations. Having superior financing, Russia can afford to conduct better treatment and research work, Nigeria largely depends on the UNAIDS and other development partners to finance its HIV programs. This makes it vulnerable to financial shocks, such as the recession of 2008. Public and private sector partnerships in Nigeria have, however, come to play a significant role in the fight against the pandemic in Nigeria by catering to previously unreached populations (Umunna 312-7).
Theories of Explaining the Differences in Government Response
Nigeria and Russia have exhibited differences in their responses to the HIV pandemic. These differences may be explained by various theories regarding HIV response. There have been various theories such as the political economic and epidemiological theories which have been put forward to explain differences in the reaction to HIV. Amartya Sen put forward the theory that democratic governments respond better to major life threatening issues as compared to authoritarian regimes. The growth of civil society and the promotion of democratic space in any nation would thus result to better responses in the fight against HIV and vice versa (Beyrer, & World Bank 2011). The notion of Democracy would in this instance be more than mere competition for political positions.
Another theory explaining the differences in responses between the two countries is the theory of institutional frameworks. The making of policy with regard to issues of national importance such as the HIV pandemic is tied to the institutional framework of a given nation. Some nations have the public health function placed under a health ministry and the actions of the ministry may be answerable to certain institutions such as parliament. In some institutions issues of public interest tare the preserve of the national government which may not be answerable to any other institutions for any of its actions. Issues of prioritization in the making of policy also play an important role in the fight against issues of concern (Kartikeyan, 2007). For instance nations which perceive themselves to be at risk of invasion would seek to strengthen institutions such as the military at the expense of investing in the fight against HIV.
Another very important theory that informs differences in the response towards the HIV pandemic is the theory of political community. The theory of political community asserts that the general public plays a very important part in determining the formation of policies with regard to issues of national concern. While the government may sometimes make unilateral decisions regarding issues of national importance, many a time governments usually make decisions after assessing the opinions of the general public. The public on the other hand develops its attitudes upon selfish attitudes. These attitudes and opinions shaping policy are based on how the public stands to benefit or lose by the policy undertaken by the government (DiClemente, Crosby, & Kegler, 2009).
The HIV response in Russia and Nigeria is as a result of other factors other than political community, democracy and institutional frameworks. A very plausible theory is the epidemiology theory. This theory states that the HIV virus is an epidemic like may others such as polio and the plague which have plagued mankind for millennia. Epidemics usually affect certain segments of the community for instance the plagues were most prominent in the ghettos which were unsanitary. Just like the epidemics of the Middle ages mainly affects people in same sex relationships and sex workers hence it is only when it affects other people outside these groups that government steps in to tackle the issue (Gibney, DiClemente, & Vermund, 2002).
Another very plausible theory to explain differences in the response to the HIV pandemic is the theory of differences in capacity between the different countries. It is a matter of common knowledge that different countries have different capacities installed to deal with issues of national concern. Different nations thus have different capacities in their health care sectors. These differences in capacity are not only evident in the area of financial capacity but also in other areas such as capacity and policy making. Nigeria and Russia have different capacities both in terms of research capacity and professional policy making capacity in the area of health that would make the requisite HIV policy (Beyrer, & World Bank 2011).
Leadership also plays a critical role in determining the policy making of a government towards issues of national importance. Governments with strong leaders that are driven by excellence or service delivery to the people are more likely to respond earlier or with more vigor towards issues of national concern such as the HIV pandemic. It is a fact that even with the best institutions in place without good leadership to make the institutions work it nothing will change for the better. The quality of leaders that are in power will determine the quality of policies that are adopted and implemented (Kartikeyan, 2007). A nation with a health minister that is knowledgeable in public health and who has a passion for his work is more likely to have better programs in place to tackle the epidemic.
THE Russian and Nigerian response give credence to the political theory and democracy theory in the differential response to HIV. The Nigerian response has become better coordinated since the coming to power of a democratic government in 2006. The Russian situation also became better since Vladimir Putin increased the political and democratic space in Russia. Nigeria has a less effective framework for fighting the HIV Pandemic since it has institutions that arte generally less coordinated. Russia on the other hand has very well coordinated institutions with a health framework which are highly supervised by the executive for achievement of targets.
Political community is tied to the theory of leadership that is prevalent in both countries. Russia has a HIV population that is generally restricted to certain groups such as men in same sex relationships and commercial sex workers. Russian public therefore plays little part in pushing their government into taking decisions towards addressing HIV. The Russian response to HIV is as a result of good leadership which has recognized the importance of tackling the pandemic before it blows over. The Nigerian response is however as a response of political community which has made the government adopt policies that the public deem to be in their interest (DiClemente, Crosby, & Kegler, 2009).
HIV in Nigeria may be attributed to a lack of capacity and epidemiology. Nigeria has relatively less international assistance in its fight against the HIV pandemic as compared to Russia. Nigeria has therefore less capacity to deal with the HIV pandemic as compared to Russia. The pandemic has also attained more epidemic proportions in Russia with rising rates that faster in a segment of a population as compared to Nigeria (Gibney, DiClemente, & Vermund, 2002). This therefore informs the Russian response as opposed to Nigeria which has declining rates of infection.
Russia and Nigeria are two nations that are faced with a very severe HIV pandemic. While the two countries have different demographics, there are also some similarities in certain areas which may be used in fighting the pandemic in other countries. The fight against HIV is slowly shifting with increased globalization, and as such nations, such as Russia, are becoming the new frontiers. It is now more important to take into consideration alternative lifestyles in the fight against HIV. In this regard, political community, democracy and improvement in political space remain fundamental aspects in assisting national and quasi-governmental bodies in funding, coordination, support and technical assistance in the fight against HIV.