Russia and HIV: A Study in Failure

Kremlin Policies Fuel an Already Desperate Epidemic

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The Russian Federation, comprised of 17 different countries, is mired in an HIV epidemic which is taking its toll on the entire region from both a public health and economic perspective.

Geographically, Russia is approximately twice the size of the United States with less than half the population (roughly 143 million). From the perspective of HIV, Russia dramatically outpaces the U.S. in the rate of new infections, as well as most of its neighbors in Western Europe. While the official number of HIV cases are reported to be around 1.1 million, some experts believe that the figure may be closer to three million. If this were the case, the prevalence of HIV in Russia would be almost seven times that of the U.S. (which currently has a prevalence around 0.6 percent).

What we do know officially is that, based on Russia's own epidemiological statistics, the epidemic has exploded over the past 20 years, increasing by some 250 percent since 2001.

A Vulnerable Population

Putting the epidemic into context, one needs to examine Russia from the point of view of its at-risk population and its capacity to address the burgeoning HIV crisis.

From that perspective, Russia faces a serious demographic crisis as births lag far behind deaths. An aging population, combined with an increasing death rate of working-age males due to alcoholism, heart disease, and HIV, has contributed to the negative population growth rate. This negative growth is expected to cut the Russian population by 20 percent or more over the next 50 years.

Furthermore, Russia's response to the epidemic has been lagging, particularly in regards to key at-risk populations. Where the World Health Organization recommends that 90 percent of at-risk populations (injecting drugs users, men who have sex with men, commercial sex workers) receive HIV testing and counseling, most official reports half that. This is most true in countries like Tajikistan (54 percent), Kyrgyzstan (36 percent), and Uzbekistan (29 percent).

The History of HIV in Russia

HIV first emerged as a public health issue at the end of 1986. The first case was identified in a Russia man who has contracted the disease while in Africa. He then allegedly transmitted the infection to 15 Soviet soldiers with whom he had sex.

Because privacy laws did not exist in the then-Soviet Republic, these names of those infected were widely publicized via state media, which derided the men for living  "corrupt lifestyles" that led to their disease. The fact that homosexuality was illegal (and remains so under the county's Russian LGBT propaganda law) only served to stigmatize the men as well as the disease itself.

In the late 1980s, mandatory HIV testing was instituted across the Soviet Union, which was often performed without the consent or knowledge of the person being tested. By 1991, over 142 million people had been tested, practically none of which were anonymous.

Positive tests were dealt with harshly with aggressive efforts made to identify (and often publicize) the trail of infection from one person to the next.

The early 1990s saw the peak of political unrest in the Soviet Union, pushing the HIV crisis into the shadows. Foreign HIV prevention literature, once translated into Russian, could no longer be found in the country. Public prevention campaigns ceased to exist at a time that many considered to be the age of the Russian "sexual revolution." With concomitant rise in injecting drug use throughout the region, the HIV epidemic was essentially left unchecked, with the disease spreading like wildfire through even the most remote territories.

With the rise of the newly independent Russian Federation of States, AIDS agencies commanded little importance among legislative leaders and even less funding. Poor networking among the few HIV organizations that existed resulted in an inadequate flow of information to grassroots agencies and treaters on the ground.

Key At-Risk Populations in Russia

The epidemic in Russia is unlike that seen in the U.S. and Western Europe insofar as the populations being affected. It tends to mirror the crises in Central Asia and Eastern Europe, in which infections are spread along trafficking routes fueling the drug trade.

As a result of this, around 40 percent of all infection are among injecting drug users (IDUs), with estimates placing the total at somewhere between two and three million people (or roughly two to three percent of the Russian population). As a result of Russian laws banning the possession of needles and syringes, the sharing of these items is considered common.

Compounding the problem is the fact that, because injecting drug use is punishable by law, users are often reluctant to access the health system for even primary care. All these factors combined have resulted in an HIV infection rate among IDUs of about one in four, 80 percent of those being under the age of 30.

The problem in the prison system is believed to be even higher, both a result of shared needles and condomless sex among inmates. The situation is equally difficult among commercial sex workers (CSWs), with penalization driving both male and females CSWs from getting tested or treated.

Meanwhile, the epidemic among men who have sex with men (MSM) mirrors that of many countries with lack of preventive services fueling infection in this high-risk population. As a result, the rate of new infection among gay and bisexual men is often seen to be left unchecked, despite increases in MSM prevention programs in many urban centers.

Disappointingly, the access to antiretroviral therapy (ART) in these key populations continues to remain very low, particularly when compared to rises in other groups and regions (including Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Moldova, Russia, Tajikistan, Ukraine, and Uzbekistan).

The Way Ahead

Unlike even the most hard-hit parts of Africa, the number of new HIV infections in Russia continues to rise, bucking international trends. As a result, the scaling up of ART and other HIV prevention programs, particularly for key affected populations, is of urgent priority.

But, until Russian leadership under Vladimir Putin address economics equity, infrastructural healthcare shortcomings, and laws penalizing those with HIV, the road ahead looks incredibly bleak.

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