Infectious Diseases Hospital No 2, located in a garden on the industrial outskirts of Moscow, seems like an oasis of calm.

But for Vadim Pokrovsky, the head of Russia’s Federal Aids Center, it is an ideological battleground over measures to contain the spread of HIV.

Russia has become the epicentre of the global HIV pandemic, even as infection rates plateau in the rest of the world.

The Kremlin has mobilised funds to combat the virus, citing Aids as a threat to national security. But while the budget for treatment is rising rapidly, there is no state support for prevention of the disease.

“We are taking a lopsided approach to HIV,” says Dr Pokrovsky. “Why spend a lot of money on medicine if there are no funds to control the epidemic?”

Official statistics put the number of cases in Russia at 565,000 out of a total population of about 142m. But independent experts estimate the real figure is twice as high. Last year alone, there were more than 58,000 new infections, raising fears that the epidemic could spin out of control.

“The figures are very chilling,” says Denis Broun, regional director for Europe and Central Asia at UNAids.

More than two-thirds of HIV patients in Russia are intravenous drug users – testimony to a surge in heroin addiction since the collapse of the Soviet Union. Reported cases are clustered in areas overlapping routes followed by drug traffickers carrying heroin from Afghanistan to Europe. HIV has also taken hold in affluent Russian cities and oil regions, as the virus spreads into the wider community.

After years of official denial, Aids appeared on the Kremlin’s public agenda for the first time in 2003, when Vladimir Putin, then the president, warned that the epidemic risked hastening population decline.

Dmitry Medvedev, who succeeded Mr Putin in 2008, has also acknowledged the threat posed by HIV, offering support for a campaign by Bono, the lead singer of rock band U2, to fight the global pandemic.

But, while Mr Medvedev has set a goal to raise health standards in Russia, government support for HIV prevention has faded during his presidency.

“There is zero money in the federal budget to fund focused HIV prevention and education,” says Anya Sarang, president of the Andrey Rylkov Foundation for Health and Social Justice, a non-governmental organisation that advocates harm reduction programmes.

Russia has poured funds into testing and treatment, allo­cating larger sums for imports of antiretroviral drugs each year. HIV patients have complained that medication is inefficiently distributed, but the programme has had success in some areas. Transmission of HIV from pregnant mothers to unborn children has been reduced to almost zero.

Meanwhile the government has faced down international pressure to sanction opiate substitution that has proved effective in reducing the spread of HIV among drug users in the west.

Speaking at a UN conference, Viktor Ivanov, the head of the Russian federal narcotics control agency, denied there was scientific evidence to prove that opiate substitution worked. “We will not ban it, but there will be no federal support for methadone substitution,” he said.

Programmes sponsored by the UN-backed Global Fund to Fight Aids, Tuberculosis and Malaria focused on sex education and needle exchanges are regarded as excessively progressive in Russia, but have helped kick-start HIV prevention campaigns in some regions.

However, even this limited effort is now under threat, as the Global Fund winds down its operations in Russia to comply with its mandate to work only in countries considered poor.

Hopes that the government would step in to fill the gap were dashed this year when the health ministry said the Global Fund measures were ineffective and that the HIV epidemic was under control.

Russia has entered a second phase of denial about HIV, says the Andrey Rylkov Foundation. “The Ministry of Health is manipulating virtual percentages and pseudoscientific facts. And in the meantime, real people are continuing to get infected and die,” it said in a letter to Vladimir Putin, the prime minister, this month.

Dr Pokrovsky says government officials and agencies disagree over how to tackle HIV. “One group is convinced harm reduction [related to drug use] could reduce the risk of infection, but others have ruled it out on scientific grounds,” he says. “They are against substitution therapy but cannot propose anything more effective.”

Conservative attitudes are also an obstacle. Talk of sex is taboo and drug users are regarded as pariahs. The Russian Orthodox Church opposes sex education and condoms on moral grounds and paints illness as retribution for sin.

Dr Pokrovsky says opposition by the religious lobby to sex education would hasten the spread of HIV beyond drug users to the wider community.

“It is happening slowly, but in 10 years the results will be very noticeable,” he says.

“HIV will develop like in Africa. In one or two years, it will be too late to halt it.”

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