There is an unfair piece in this week’s Lancet about the mismatch between Russia as a donor and its willingness to accept responsibility for its own national HIV problem. The piece is unfair for two reasons: it ignores the history of wildly inaccurate predictions of doom (not surprising since many appeared in the Lancet) and it ignores Russia’s legitimate concerns about spying.

There was ludicrous international hysteria over AIDS about ten years ago. Then, Dr Richard Feachem (at the time head of the Global Fund), the CIA and others were warning that Russia had reached “a tipping point”, that HIV would “spiral out of control” and that, by 2005, 1.5 million Russians would have contracted HIV. In 2000, the (US) National Intelligence Council  released a report on the HIV/AIDS pandemic in five of the world’s most populous states: China, India, Ethiopia, Nigeria, and Russia. The report predicted that, in those five countries alone, between 50 and 75 million people would be HIV-positive in 2010. (According to this 2002 report from the Center for Strategic and International Studies). The World Bank — in 2002 — said that, “if Russia does not tackle the HIV/AIDS epidemic, it is not likely to achieve sustained and rapid economic growth in the future.” It was, of course, all rubbish. The HIV epidemic was already in decline and it looks as if the Global Fund had good information that this was so in the first years of this century — it just chose to ignore it. Even if AIDS really is on the rise in Russia, who can blame Russian policymakers for taking today’s warnings about HIV with a pinch of salt?

Russia is a bit paranoid about international organisations but it may have a rational basis for worrying. In 2006, the British press poked endless fun at Russian TV for claiming that the UK had planted a fake rock in a Moscow park to spy on Russia’s electronic communications. Every stereotype was re-played in stories about deluded Russian spies. In 2012, a former Blair adviser admitted that the UK had – in fact — placed a fake rock in the middle of Moscow to receive and transmit information. Who can forget the recent pictures of the CIA station chief arrested complete with several wigs and disguises? I’m not suggesting that AIDS NGOs are foreign spies; I’m just saying that the idea is not as silly as it might at first sound.

Still, there’s no doubt that Russia should do more for people with HIV, Hepatitis C and other diseases that occur mostly among marginalised people. Actually, like most middle income countries, it should probably just spend more of its overall resources on health