How much does it cost to treat HIV-positive migrants in Russia?
Among the countries of Eastern Europe and Central Asia (EECA), Russia remains the most common destination for migrants, especially labor migrants. Citizens of Uzbekistan, Tajikistan, Kyrgyzstan, Armenia, Ukraine, and other ex-Soviet countries come to Russia in search of jobs and better quality of life.
At the same time, HIV prevalence is the worst in Russia compared to other EECA countries. The HIV epidemics has entered its generalized stage. This means that it is no longer limited by the groups with high-risk behavior, rather, it is spreading among the general population.
HIV in Russia: numbers
According to Russian consumer protection agency Rospotrebnadzor, a total number of 770 thousand patients were actively followed-up in the third quarter of 2020. The proportion of patients receiving antiretroviral therapy was 52% (581 555 people) among all HIV-positive people, or 75.5% of all those who were followed-up.
We can assume that the actual number of HIV-infected in Russia is approximately two times higher than the number of patients under active observation. Estimates made by VV Pokrovskiy, Head of the Federal Scientific Center of AIDS control and prevention (a Rospotrebnadzor agency), in the beginning of 2020, suggest that about 1.5 million people in Russia were living with HIV. In addition, about a third of this estimated number of HIV-positive people in Russia are not aware of their serostatus.
On average, HIV is three times more prevalent among Russian citizens than among foreigners. According to the annual “HIV infection” newsletter published by Rospotrebnadzor, in 2019, the number of HIV tests performed reached 40 580 588 among Russian citizens and 2 550 422 foreign migrants. The test results obtained indicated that 294.2 per 100 thousand Russians and 94.4 per 100 thousand foreigners were HIV positive.
HIV treatment opportunities in Russia
Opportunities for Russian people living with HIV and international migrants with HIV are unequal.
Citizens of the Russian Federation have the right to diagnostic examination, medical care, and antiretroviral therapy (ART).
If HIV is detected in a foreign citizen or a stateless person, he or she may face deportation, entrance ban, or no chance of future legal residence in the Russian Federation. Detailed restrictions for HIV-positive migrants in Russia will be presented in the next article.
The number of HIV-positive migrants who hide their status due to the fear of deportation is growing. They do not seek medical care and do not receive treatment. Consequently, their health deteriorates, their immune function becomes weak, and may lead emergency care.
Thus, the consequence of these legal restriction is not limited to uncontrolled HIV spread. The healthcare system and regional budgets are spent in providing emergency care services for migrants living with HIV.
A group of investigators, including Ekaterina Zaiko, Anna Popova, Kirill Barskiy, and Daniel Kashnitsky, have studied the international experience in the efficacy and economic effects of ART and compared HIV detection in residents and migrants in different countries.
A review of the studies on international practice of HIV management helps understand societal and personal benefits of early and regular antiretroviral treatment among all HIV-positive people including foreigners. Several studies show that late HIV discovery is typical among migrants compared to locals.
The investigators have analyzed costs of HIV treatment for a foreigner in Russia. Two scenarios have been outlined:
- Outpatient treatment of a HIV-positive patient in the context of timely diagnostics or after several years of controlled disease.
- Inpatient treatment of a HIV-positive patient who does not receive antiretroviral therapy and thus has developed HIV-associated conditions.
The costs were calculated based on pricelists of private clinics and laboratories in 2021, i.e., on real market prices.
Modelling included two scenarios of HIV treatment among foreign citizens.
- An HIV-positive patient who annually receives services which include outpatient observation and ART. In this case, the total cost of services is approximately 6 924 RUR per month, or 83 084 RUR per year. This is the cost of medical care and antiretroviral treatment for a foreign citizen who does not have a National health insurance. It should be noted that these costs can be covered by mutual international transfers or privately.
- If a HIV-positive migrant did not receive antiretroviral therapy and has developed opportunistic infections, he or she will have to be hospitalized to receive inpatient treatment for 21 days. During the hospitalization, the patient will undergo diagnostics and receive the cheapest antiretroviral therapy (1 407 RUR). The total cost of this medical care is 228 572.6 RUR for 21 days. This option is being financed by the Russian Federation state budget.
The investigators did not account for non-medical costs of other agencies related to HIV-infected migrants deportation such as detention, translation service, hearing, transportation, time in retention center, and deportation per se. All these procedures represent additional costs for the governmental budget. Other social costs and out-of-pocket expenses of patients were also not included.
This is not the first time a study shows that an optimal approach includes opportunity for HIV-positive migrants to legally receive antiretroviral therapy and not be afraid of deportation.
The regularization of foreign migrants living with HIV is essential to control the spread of infection, decrease costs of high-tech medical care for the budget, as well as non-medical budget costs.
HIV control among migrants as a social group is an important step in the quest to control the HIV epidemic in the Russian Federation.
full text of the study is available in Russian. English version will be uploaded soon.
Based on: ES Zaiko, AA Popova, KA Barskiy, DS Kashnitskiy. Economic analysis of HIV care for foreign migrants in the Russian Federation. Regional Expert Group on Migration and Health.
This article was prepared with the support of Oxfam in the Russian Federation