On World AIDS Day in 2015, public health leaders from around the globe announced a series of initiatives designed to officially bring an end to HIV/AIDS as we know it, by 2030. Unfortunately, news out of Russia suggests that we may have a long way to go.
According to a Fox News report on November 3rd, the Russian city Yekaterinburg, the country’s fourth-largest metropolis, is currently experiencing a higher-than-normal incidence of confirmed cases of HIV, with 1 in 50 people there currently positive for the virus. In all, the city of 1.5 million inhabitants has 27,000 HIV-positive residents; meanwhile, roughly 800,000 Russians across the country are currently registered as positive for the virus (although researchers estimate that this may be as little as half of the total positive population), with 100,000 new cases reported in 2015 alone.
Sadly, experts say that they are not surprised by the numbers.
“Where much of the world has seen a decline or stabilization in number of new HIV infections, Eastern Europe and Central Asia has seen a 57% increase from 2010 through 2015,” Anita Raj, PhD, MS, professor of medicine and global public health and director of the Center on Gender Equity and Health at the University of California, San Diego told Contagion. “Eighty percent of this region’s new infections in 2015 were in the Russian Federation.”
Most HIV cases are concentrated in large, industrial cities in the remote Siberia region and along common drug trafficking routes through Asia, according to media reports. Experts, such as Dr. Raj, suggest that family planning counseling and contraceptives “need to be made more readily available to women living with HIV, and for women more broadly.”
According to Dr. Raj, who has authored several papers on HIV in Russia, “injection drug use is a key driver of HIV in the country.” She added that some estimates suggest that as many as 500,000 Russians are currently active injection drug users. According to an article in The Moscow Times, 57% of infection cases are due to injection drug use.
Unfortunately, the Russian government’s response to the injection drug use problem specifically, and the HIV epidemic in general, have likely compounded the problem. Dr. Raj said that, currently, the “country does not allow scientifically proven methods to curb injection drug use, such as opioid substitution therapy”—or methadone therapy. In general, awareness of the risks of HIV is low, and testing for the virus is rarely performed and not widely available.
In fact, Jeffrey H. Samet, MD, MA, MPH, chief, General Internal Medicine, and professor of medicine and community health sciences at the Boston University Schools of Medicine and Public Health, told Contagion that the public health response to HIV in Russia has been a “disaster,” with limited needle exchange programs and inadequate access to antiretroviral treatment for injection drug users. He added that the country’s government has largely failed to implement the World Health Organization’s HIV prevention recommendations for this population.
“Combine [that with] an environment that tolerates great stigma for using drugs [and you] propel the epidemic and high mortality among HIV-infected drug users,” said Dr. Samet, who has also published research on HIV in Russia.
However, while injection drug use and HIV are closely related in Russia—and elsewhere—heterosexual sex is rising as a source of transmission in the country, further highlighting its poor prevention infrastructure. In addition, Veronika Skvortsova, Russia’s health minister commented, “We’re not only talking homosexuals…We’re talking about wives contracting [HIV] from their husbands, and the number [of HIV patients] is growing among well-to-do women.”
“The public health response to HIV in Russia has broadly been inadequate, particularly because there can be very severe consequences for [people who engage] in behaviors placing them at risk for HIV, such as men having sex with men, sex trade, and injection drug use,” Dr. Raj said, referring to an editorial published earlier this year in the Lancet. “It is hard to reach and support these populations when disclosure of these behaviors can result in harsh punishments. I am also concerned that, in regard to mother to child transmission and a potential shift to a more generalized epidemic in some contexts of Russia, inadequate support for family planning programming also heightens the vulnerability of women and children to the epidemic.”
According to the Moscow Times article, “a historically high level” of new cases of HIV, a whopping 93,000, are expected to be registered in 2016.