Investing, Transitions, and Disease Control in Russia

This chapter unpacks the dynamics of science, politics, and controversies around investing in tuberculosis (TB) and HIV/AIDS control in the Russian Federation, following its emergence from the Soviet era. The challenge was to successfully negotiate with Russia an agreement to combine technical guidelines from the World Health Organization (WHO) with financing from an external multilateral development financier — the World Bank — for a large program to curb the dual epidemics of TB and HIV/AIDS. The chapter begins with an overview of the context of political and economic transition from the Soviet Union to the Russian Federation and an overview of TB and HIV/AIDS in Russia. This is followed by deeper dives into the logic of development assistance for the health sector — and specifically for disease control — in Russia and a closer examination of the HIV/AIDS problem. Attention then turns to the challenges of learning, adapting, and scaling. This is followed by an exploration of how the impasse around foreign investment in the program was resolved through complex transactions and bargaining that informed the agreement between Russia and international institutions.