10 Percent Russian Adults
May Have AIDS By 2010

Transatlantic Partners Against AIDS

Russia's HIV/AIDS Epidemic: Status And Outlook
Russia has recently emerged as a new epicenter in the global HIV/AIDS pandemic, with one of the world's highest rates of new infection. As of August 2003, there have been more than 245,000 officially diagnosed cases of HIV infection in Russia, over 80 percent of which were reported in the last three years. It is widely acknowledged, however, that Russia's official statistics represent only a fraction of the actual number of HIV-infected Russians; most experts estimate that the true number is somewhere between 1.5 million and 2 million citizens, or over 2 percent of the adult population.
Epidemiologists warn that up to 8 million Russians - over 10 percent of the adult population - could be infected by 2010, under worst-case scenarios. The epidemic is growing fastest among young people aged 15-30, the very same group that should be leading Russia into the 21st century. Figure 1 shows the dramatic growth of Russia's HIV epidemic between 1994 and mid-2003, as measured by official cases of HIV diagnosis registered with the Russian Federal AIDS Center.
Recent reports that the rate of new HIV infection in Russia is declining are almost certainly misleading. Since 2000, the number of people in high-risk groups tested for HIV has declined dramatically. According to official statistics compiled by the Russian Federal AIDS Center, the number of injecting drug users tested for HIV infection dropped from a high of 524,300 in 2001 to 331,100 in 2002; this may explain why there were only 10,298 cases of HIV infection registered among drug users in 2002, when almost three times that figure were diagnosed in 2001. Moreover, the federal government has recently stopped the supply of HIV test kits to the regions; for those regions that cannot afford to purchase their own test kits, the number of tests (and the number of officially diagnosed HIV-positive people) has therefore declined.
Although HIV infection has been reported in virtually all of Russia's 89 regions, there are a number of geographic "hot spots" where HIV prevalence rates are much higher than average. Russia's largest urban centers, Moscow and St. Petersburg, are epicenters for HIV/AIDS, as are the strategically important cities of Kaliningrad, Togliatti, Norilsk, and Khanty-Mansiysk. In Norilsk, over 1 percent of the adult male population is already officially diagnosed with HIV.
At the end of 2002, 11 regions of the Russian Federation reported HIV-prevalence rates above 300 cases per 100,000 citizens. Of greatest concern are six regions that have prevalence rates higher than 500 cases per 100,000: Sverdlovsk oblast (which includes Yekaterinburg); Leningrad oblast; St. Petersburg; Samara oblast; Irkutsk; and Orenburg oblast. According to the Russian Federal AIDS Center, 39 percent of the entire Russian population is now living in regions where between 0.2 percent and 0.6 percent of the population is officially diagnosed with HIV.
High-Risk Groups and Bridge Populations
Over the past decade, HIV transmission in Russia has been concentrated within a number of high-risk populations, among which there is considerable overlap: (1) injecting drug users (IDUs); (2) sex workers; and (3) prisoners. Men who have sex with men (MSM) and migrant workers, especially those from Central Asia, are additional populations with high concentrations of HIV. The future of Russia's HIV/AIDS epidemic will turn on the degree to which these high risk groups serve as "bridge populations" for transmitting the virus into the heterosexual, nondrug using population. Notable indicators that this shift is already underway include the rapid rise in curable sexually transmitted infections in the general population and the growing rate of new HIV infections among women over the last two years.
Injecting Drug Users
Since the early-1990s, drug use in Russia has exploded. Russia's Ministry of Health estimates that drug use soared by 400 percent between 1992 and 2002. According to numerous studies, drug users in Russia represent a larger share of the total population when compared to other countries.
There is a direct connection between injecting drug use and HIV. Given the widespread use of shared needles and other equipment, HIV has spread swiftly through Russia's drug subculture in the past five to seven years, representing over 80 percent of all reported cases of HIV infection with a known mode of transmission. HIV has already begun moving rapidly from that sub-culture to people who have no direct contact to drugs, often through unprotected sex.
Russia is wedged between opium-producing Afghanistan and major drug markets in Western Europe, making heroin and other opiates easily accessible. Russia's long and porous southern border, manned by underpaid and overworked customs inspectors, border guards, and Interior Ministry officers, is especially susceptible to drug trafficking and transport of illicit goods. The demand for illegal drugs has increased over the past decade, driven by a combination of factors, including the difficulties of Russia's ongoing economic and political transition, deteriorating education and healthcare systems, and a nationwide shortage of social services and recovery programs for drug users.
Illegal drug use is especially rife among Russia's youth. In May 2003, Russia's Minister of Education reported that 4 million young people between the ages of 11 and 24 were using illicit drugs, and that about a million of them were drug dependent; around the same time, an Education Ministry survey reported that 8 percent of Russian youths bought illegal drugs every day. Both statistical and anecdotal evidence indicate that drug use among young people in Russia continues to climb. This trend, together with a shortage of high-quality condoms and a lack of information about safer sex, suggests that conditions are ripe for the virus to spread rapidly among Russia's non-drug using youth.
Sex Workers
Sex workers constitute a second important high-risk group with the potential to spread HIV into the general population. Since the collapse of the Soviet Union, sex work in Russia has increased dramatically. In Moscow, the number of professional sex workers is believed to total between 13,000 and 30,000. In St. Petersburg, the number of full-time prostitutes is estimated at about 8,000.
But sex work is not confined to those two cities. Port communities, mining cities, and industrial centers are well-known for high concentrations of sex workers. A recent U.S. Centers for Disease Control and Prevention (CDC) study revealed high levels of epidemiological exposure to sex workers in a number of cities in Saratov oblast, for example. Depending upon the city under consideration, the researchers estimated the annual number of sex worker contacts per 100,000 persons in the general population to range from a low of 33,000 to a high of 730,000. If the pattern in Saratov mirrors other regions across Russia, the implications for the spread of HIV, as well as for other public health problems, are dire.
Sex workers are widely known to engage in high-risk behavior. Leaving aside the large number of sexual partners, condom use is erratic and there is considerable overlap among sex work and injecting drug use. Targeted interventions in this community are essential to an effective overall HIV strategy.
Prison Population
With nearly 900,000 people held in prisons and pre-detention centers, Russia has one of the world's highest ratios of inmates to total population: an estimated 1 percent of the population aged 20-64 is currently incarcerated. According to official Ministry of Justice data, as of early 2003, over 37,000 inmates in Russian prisons and pre-detention centers were HIV positive. This would mean that 4.1 percent of Russia's inmates are living with HIV - a rate nearly 30 times higher than registered for Russia's non-incarcerated population. But HIV infection rates among prisoners are certainly even higher than that; programs for testing Russian inmates for HIV are poorly run and coverage is inconsistent.
Russia's overcrowded prison system also harbors a myriad of risk factors that facilitate the spread of HIV. According to one survey, 20 percent of Russian prisoners acknowledged injecting drugs while incarcerated; another report, for Tyumen oblast, indicated that up to one-third of young drug-using prisoners began using drugs in jail. Sex is also a major risk factor for inmates: one survey of prisoners with 1.5- to 10-year sentences reported that 85 percent had sexual encounters while in prison. The vast majority of sexual encounters are unsafe, as condoms are generally unavailable to prisoners.
The conditions and policies under which prisoners live create a breeding ground for other infectious diseases, including drug-resistant tuberculosis. HIV and TB have high rates of co-infection, and when prisoners are released into the general population, they all too often carry both. Roughly one-tenth of Russia's inmates now test positive for tuberculosis. In short, the Russian prison system serves both as an incubator for the spread of HIV and other infectious diseases, and also as a vehicle for spreading HIV into the general population when inmates are released.
Worrisome Trends
In light of the dramatic rate of increase of HIV in recent years, the prognosis for the future development of the epidemic is grim. The total number of persons living with HIV in Russia will certainly continue to increase for several years - even if effective prevention programs were implemented today.
Although Russia's HIV epidemic has been largely concentrated among high-risk populations, there is mounting evidence that the virus has already begun to move beyond these groups into the general population. As recently as 2000, 90 percent of the country's new officially registered HIV cases were attributed to injecting drug use. By 2002, however, the percentage of HIV cases ascribed directly to drug use fell to 36 percent, while the number of cases attributed to heterosexual transmission rose to over 12 percent. Another indication that the epidemic has spread more widely into the general population is the sharp increase in the number of babies born to women with HIV. In 2002, there were over 2,700 babies born to HIV positive mothers, an increase of more than 230 percent over 2001.
Alarming trends in the incidence of curable sexually transmitted infections (STIs) also point to the potential for HIV to spread into the general population. STIs greatly increase the likelihood of HIV transmission, and their presence indicates that sexually active people are not using protection. In 2002, the reported incidence rates for a number of STIs were many times higher in Russia than comparable figures from Western European countries.
The prevalence of STIs in some ostensibly "low-risk" populations is also remarkably high. A survey recently conducted in St. Petersburg, for example, found that 15 percent of university students questioned had at least one sexually transmitted disease. These trends, especially against the background of high rates of injecting drug use among Russian young people, suggest a very dangerous mix of risky behavior.
Projections for Russia's HIV/AIDS Epidemic
In planning an effective strategy to confront Russia's HIV crisis, Russian policy makers must consider a range of possible medium- and longer-term scenarios.
Figures 2 and 3 demonstrate the impact of HIV on Russia's life expectancy and working age population, respectively, under three different, but reasonable scenarios for the epidemic. The "mild" scenario presumes that Russia's HIV prevalence peaks at 2 percent of the adult population by 2025; the "intermediate" scenario assumes a 6 percent prevalence rate; and the "severe" scenario assumes a 10 percent prevalence rate.
Under the "mild" scenario - which some experts suggest Russia has already reached or exceeded - Russia would have over 5 million cases of HIV infections by 2025, and over 3.4 million persons in Russia would have died of AIDS. All gains in life expectancy would be rolled back for 15 years, and life expectancy would be four years lower than it would have been without HIV.
Under the "intermediate" scenario, a cumulative total of 11 million people would have contracted HIV in Russia by 2025 - with 8.7 million deaths related to AIDS. The "severe" scenario is extraordinarily grim: by these calculations, over 7 million people in Russia would be living with HIV in 2025, and over 12 million would already have died of AIDS.
These projections illustrate the concrete challenges that HIV/AIDS represents for Russiaóchallenges that must be confronted with decisive action. Even under the "mild" scenario, HIV would be a horrendous humanitarian disaster for Russia, with an average of over 200,000 AIDS-related deaths each year beginning in 2010. In all cases, the impact of HIV on Russia's labor force is strong and negative.
The epidemic has much broader implications for Russia as well: by adversely impacting the health and the size of Russia's economically active population, the HIV epidemic will exact serious costs in terms of economic performance. Foregone productivity and economic growth due to HIV/AIDS will not only affect living standards. By negatively impacting the size of Russia's GDP, the epidemic will also limit Russia's economic power - and by extension, Russia's influence on the international stage. Even without considering the possibility of destabilizing social tensions unleashed by the epidemic, Russia will potentially face severe adverse consequences in the areas of national security and economic stability if it cannot successfully control its HIV/AIDS epidemic. The numerous, multifaceted, and complex policy implications of these trends will require a top-level, strategic commitment of resources for years to come.
Copyright © 2003 Transatlantic Partners Against AIDS. All rights reserved.




This Site Served by TheHostPros