Russia plans to step up its international role in fighting infectious disease across eastern Europe and central Asia, in what some observers see as the latest effort by the Kremlin to reassert its political influence over its former Soviet neighbours. The move offers prospects for extra funding to tackle HIV in a region with the fastest continued growth in HIV anywhere in the world, where infections have risen threefold over the past decade to affect 1.4m people. However it also raises concerns that Russia could export its own restrictive policies on HIV prevention methods to its neighbours. At a conference for Russian and international health specialists hosted by the Russian authorities in Moscow last week, Arkady Dvorkovich, economic aide to President Dmitry Medvedev, pledged money for a new international development agency to support programmes against HIV and tuberculosis. The pledge could provide fresh political commitment and resources to boost prevention and treatment programmes at a time when the economic downturn is threatening both domestic and donor government funding to respond to infectious diseases. But some observers fear a growth in bilateral funding would also allow Russia to impose conditions on its neighbours’ HIV programmes. This has raised concerns that it would export its own hardline attitude towards drug users, which has undermined efforts to slow the growth of the epidemic. At the meeting – called the Millennium Development Goal 6 Forum – Gennady Onishchenko, head of the Russian federal service on protection of consumer rights and human well-being, reiterated his government’s opposition to the provision of methadone pills to heroin injecting drug users. Such “substitution therapy” has been identified by the UN’ Aids agency (Unaids) and other specialist bodies as pivotal in reducing HIV transmission through the sharing of infected syringes among drug users, the largest group at risk in Russia and its neighbours. While outlawed in Russia, the therapy is used in other countries in the region, including Tajikistan, Armenia and Kyrgyzstan. Sergei Lavrov, Russia’s foreign minister, said prevention of HIV among drug users should start with the coalition forces in Afghanistan bombing poppy fields to cut heroin supplies. An analysis by the World Bank has suggested just 11 per cent of spending on HIV in the region is targeted at drug users and other groups in which the infection is spreading the fastest. Michel Sidibé, head of Unaids, said: “I have a strong feeling Russia wants to play a leadership role in the region. People are afraid there will be less donor money. But it could be worse if Russia does not change its policies on substitution and needle exchange.” Participants at the Moscow meeting also expressed concern that Russia’s own aid efforts could be accompanied by efforts to encourage the use of locally produced drugs and diagnostics, adding to the costs of prevention and treatment. Russia already has extremely high treatment costs, at an average of $2,500 per patient per year compared with $560 in other upper middle income countries, according to figures from the Global Fund to fight Aids, TB and Malaria. One health specialist who attended the meeting said: “Russia’s idea is for tied aid based on the models in the west used in the 1960s and 1970s. It’s clear it wants to be able to increase its influence in the former Soviet Union.” Others stressed the symbolic importance of Russia agreeing to host a meeting as a sign of fresh political will to act to tackle HIV. The country has already stepped up treatment programmes significantly in recent years.