Preparing for a tidal wave

For decades the Iron Curtain limited personal freedoms within the Soviet Union and the Eastern Bloc, as well as social exchanges between East and West. Until it fell in the early 1990s, it also kept at bay the HIV/AIDS epidemic sweeping Western Europe. The number of new HIV infections in Russia hovered at only 200 a year. By 1996, however, largely due to injection-drug use, the number of cases rose to 1,546. Last year 18,140 new cases were reported in Russia, where health authorities expect that total HIV infections will reach a million by the year 2002.

“Russia is confronting what is a very early, but likely to be very massive HIV epidemic,” said Robert W. Ryder, M.D., John Rodman Paul Professor of Epidemiology and Medicine. He is also director of Training and Research in HIV Prevention in Russia, a training project for Russian physicians and scientists. Ryder and his Russian colleagues have established a multidisciplinary research center at St. Petersburg State University to develop, conduct and evaluate HIV prevention programs. “The most pressing need,” Ryder said, “is to establish a cadre of young Russian scientists trained in modern public health methods who are committed to returning to Russia to fill the enormous void in this area.”

Funded by the Fogarty AIDS International Training Program at the National Institutes of Health, the project has brought 10 Russian scientists and physicians to Yale for long-term training since 1998. In February of this year a four-day workshop brought top faculty from the university in St. Petersburg to Yale to learn about the institutional review board system that oversees many of the clinical trials conducted in this country.

Among the Russian scientists at Yale is Natalia Khaldeeva, M.D., Ph.D., who has treated patients with the disease since 1989. “Our experience here in the United States has been extremely valuable,” she said, noting that many resources available here, such as anti-retroviral drugs, are scarce in Russia. During her 18-month stay at the School of Public Health, Khaldeeva has been learning how to conduct clinical trials with new anti-retroviral regimens in HIV-infected patients and has been studying HIV treatment standards and research protocols. She also has received training in HIV prevention methods and studied at the Center for AIDS Intervention Research at the Medical College of Wisconsin, Yale’s partner in the program.

Prevention efforts, Ryder believes, can have a broad impact in Russia. “There are few other countries of similar size where one has such enormous possibilities for HIV prevention,” he said.

This year the project was extended to India and China and has begun short-term training of researchers who are involved in World Bank projects on HIV prevention. “In the next two years injection-drug use will be the major mode of transmission in China,” said Zunyou Wu, M.D., Ph.D., a research scientist at the Chinese Academy of Preventive Medicine. “We also expect that sexual transmission will increase dramatically.”

“We have seen what this epidemic has done in sub-Saharan Africa,” said Michael H. Merson, M.D., dean of public health and principal investigator of the Fogarty grant. “We hope that our efforts can help avoid a similar tragedy in Russia, India and China.”