We are writing to express deep concern about your government’s treatment of Vasily Aleksanyan. Mr Aleksanyan is a pretrial detainee whose life is at immediate risk due to advanced stage AIDS unless he is urgently transferred to a specialized hospital. As you may know, the European Court of Human Rights (ECtHR) has issued an interim measure ordering Russia to facilitate such a transfer but this binding injunction has not been implemented.
In April 2006, Mr Aleksanyan, then the executive vice president of Yukos Oil Company, was detained on charges of embezzlement and money laundering. During medical examination at the prison in November 2006, doctors diagnosed Mr. Aleksanyan as being infected with HIV and recommended that he be given antiretroviral treatment. According to his lawyers, at that time Mr. Aleksanyan had less than 200 CD4 cells per cubic millimeter of blood—the standard threshold which the World Health Organization recommends that all HIV infected persons be offered antiretroviral treatment; doctors in many countries, including some AIDS centers in Russia, however, begin offering treatment to people with CD4 counts under 350. (A healthy person has at least 800 CD4 cells per cubic millimeter of blood).
Despite doctors’ recommendations, Mr. Aleksanyan has yet to receive the required antiretroviral treatment. Russian authorities have claimed both publicly and in submissions to the ECtHR that Mr. Aleksanyan has refused treatment. His lawyers, however, have provided Human Rights Watch with a copy of an official consent form to start antiretroviral treatment as well as with copies of various documents in which their client complained about the lack of treatment.
Since October 2007, Mr. Aleksanyan’s health condition has precipitously deteriorated. In documents submitted to the ECtHR on November 22, 2007, his lawyers list numerous health conditions that their client is suffering from, including many that are common in patients with advanced stage AIDS like anemia, weight loss, unexplained fevers, shingles, and swellings in lymph glands. According to his lawyers, Mr. Aleksanyan currently has fewer than 50 CD4 cells per cubic millimeter, meaning that his cell-mediated immune system has essentially stopped functioning.
In December 2007, doctors at the Moscow AIDS Center examined Mr. Aleksanyan and concluded that he had most likely contracted both pulmonary and lymphatic tuberculosis (TB) while in prison. TB is endemic in Russian prisons and a major cause of death for people living with HIV and AIDS in Russia. Although the diagnosis has yet to be formally confirmed, doctors recently prescribed Mr. Aleksanyan TB treatment. In February 2008, Mr. Aleksanyan was diagnosed with non-Hodgkins lymphoma, a cancer that—like TB—is associated with the advanced stages of AIDS.
As you may know, the ECtHR has repeatedly ordered the Russian government to transfer Mr Aleksanyan to a hospital that specializes in providing care and treatment for HIV. On November 28, 2007, the court invoked an interim measure indicating that Russia must “secure immediately…the in-patient treatment of the applicant [Mr. Aleksanyan] in a hospital specialized in the treatment of AIDS and concomitant diseases.” On December 6, 2007, it expressed concern that the interim measure had not been fully executed and added that “if necessary the Government can take security measures in order to guarantee proper proceedings in the conduct of the applicant’s case and secure his appearance at trial.” On December 21, 2007, the court again reminded the government that interim measures are binding and warned that should Mr. Aleksanyan die in custody or his health deteriorate further because of a lack of proper treatment, the ECtHR might hold Russia accountable for a violation of the right to life or for inhuman and degrading treatment. In late January 2008, the ECtHR again reminded your government of the interim measure. But Mr. Aleksanyan remains in a pretrial detention center.
Your government’s treatment of Mr. Aleksanyan has shown an absolute disregard for his life. It has deliberately put his health in grave danger, knowing full well its failure to provide treatment would cause needless suffering and could lead to his premature death. Had Mr. Aleksanyan been given access to antiretroviral medications in November 2006, as doctors recommended, the prospects of successful treatment would likely have been good and he might have avoided contracting active tuberculosis or developing lymphoma. In his current condition, treatment with antiretroviral drugs has become far more complex and far less likely to succeed at restoring his health and saving his life.
Every day that passes without Mr. Aleksanyan receiving specialized medical care increases the likelihood of both further irreparable damages to his health and his death. We therefore urge you to use your influence to ensure that Mr. Aleksanyan is immediately transferred to a hospital specialized in treating AIDS and concomitant diseases, that an investigation be launched into the deliberate denial of HIV treatment to him, and that those found to be responsible are held accountable.
Joseph Amon, PhD, MSPH
Europe and Central Asia Division