- The Russian Federation is experiencing one of the fastest-growing epidemics of HIV/AIDS in the world.
- The country accounts for some 70% of all HIV infections officially registered in the ECA region. An estimated 860,000 people were living with HIV in Russia at the end of 2003. These reported cases almost certainly underestimate the number of people living with the infection.
- Young people between 15 and 29 years make up some 80% of infected persons.
- Women account for more than 30% of infected persons. Reported cases of pregnant women with HIV in Russia have increased from just 125 in 1998 to 3531 in 2003. As a result, there is a sharp rise in mother- to-child transmission of the virus.
- The upheavals of transition have set the stage for the rapid spread of the disease, with economic and social dislocation, increased poverty, new freedoms including greater mobility, and a rise in premarital and extramarital sex, prostitution and drug use.
- Injecting drug use and unsafe sex drive the epidemic. Between 1.5 and 3 million Russians are believed to inject drugs (1% to 2% of the entire population), and an estimated 30% to 40% of injecting drug users use nonsterile needles or syringes, which massively boosts the chances of HIV transmission.
- HIV has been detected in 88 of the country's 89 administrative territories, but it is spreading unevenly across the country. In some places such as the Nizhny Novgorod region, interventions appear to have stabilized localized epidemics, but in at least 9 territories, serious epidemics are underway (UNAIDS).
- High growth rates of HIV/AIDS, combined with the country's declining population, could be an explosive mix with serious economic and social costs.
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Characteristics - 214,000 registered HIV - positive cases till 2002*.
- Rapid spread among high-risk groups, particularly high-risk youth
- Increasing evidence of spread into bridge populations
- Increasing heterosexual spread (6% in 2000,15% in 2001)
- Likely spread into general population
*Source: The Russian Federation AIDS Center. Note: Independent estimates suggest a much higher figure. UNAIDS estimated the number of carriers to be some 700,000 in 2001, whereas the Russian Academy of Medicine estimated it to be one million in mid-2002.
How Has it Spread ?
Sources of HIV Infection in the Russian Federation  Â Â Â Â Red: Intravenous Drug Users
    Blue: Unknown
| Injecting drug users | 53.9% | | Unknown | 40.9% | | Mother-to Child | 1.4% | | Heterosexual | 3.2% | | Men having sex with men | 0.4% | | Blood Transfusions (nosocomial) | 0.1% |
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Source: The Russian Federation AIDS Center.
Factors Fueling Spread
- Large numbers of injecting drug users sharing needles/syringes
- Prevalence of unsafe sex practices
- High prevalence of sexually transmitted infections
- Very weak prevention efforts
Potential Economic Costs
In May 2002, a study of the potential economic effects of an unchecked epidemic in the Russian Federation was conducted. The study entitled The Economic Consequences of HIV in Russia suggested that:
- Under some scenarios GDP would be some 4.15 percent lower in 2010. Without intervention the loss would rise to 10.5 percent by 2020.
- Investment would decline by more than production. In the pessimistic scenario, investment would decline by 5.5 percent in 2010 and 14.5 percent in 2020, indicating a growing impediment to growth.
- Effective labor supply would decline. High growth rates of HIV/AIDS, combined with a declining population, could be an explosive mix.
What Prevents Large Scale Programs?
- Inadequate attention to HIV/AIDS at the policy level, although this is improving.
- Legal and regulatory obstacles
- Social taboos preventing frank discussion about sex and drug use.
- Inadequate financing for large-scale programs
- Limited capacity to plan and implement large-scale programs.
What is Needed?
For Preventing Spread - Continued high-level political commitment
- Local ownership of all programs
- Targeted interventions for high risk groups - IDUs, sex workers, high-risk youths- to interrupt transmission among high risk core transmitters and prevent spread from them to bridge populations.
- Surveillance (epidemiological, behavioral, virological) and mapping
- Promotion of 100% condom use
- Better diagnosis and treatment of Sexually Transmitted Infections
- Provision of safe blood
- Prevention of Mother-to-Child transmission
- Reform of the prison system where overcrowding and lack of public health care fuel the spread of the disease, and where regular release of prisoners increases the spread into the general population
For Care and Support - Voluntary Counseling and Testing
- Diagnosis and treatment of opportunistic Infections
- Antiretroviral treatment with good laboratory support
- Social support
Russian Government Response
In 1995, the Russian Government adopted the Federal Law on the "Prevention of Spread of the Disease caused by the Human Immunodeficiency Virus (HIV)". The law was implemented through the Federal Anti-HIV/AIDS Program, which ran from 1996 to 2001. Building on the 1996-2001 Program, the Federal Government has introduced another Anti-HIV/AIDS Program which will last from 2002-2007. Its main components include the following: - Development and enforcement of legal and normative acts necessary for the implementation of the Program;
- Provision of more information on prevention of HIV ;
- Development of a surveillance system;
- Ensuring the safety of medical/surgical procedures, blood and blood products, bodily fluids and tissues;
- Development of services for HIV diagnosis and treatment ;
- Development of human resources for HIV diagnostics, clinical management, care, epidemiology and prevention;
- Social protection of individuals infected by HIV, and their families;
- Social protection of personnel exposed to risk of contracting HIV.
World Bank Assistance
The World Bank seeks to assist the Russian Government to protect its population and economy from uncontrolled epidemics of TB, HIV/AIDS and other epidemiologically important sexually transmitted infections (STIs).
On April 4, 2003, the World Bank approved a US$150 million loan to the Russian Federation for the Tuberculosis (TB) and AIDS Control Project, which will help Russia protect its population and economy from uncontrolled epidemics of TB, HIV/AIDS and other sexually transmitted infections. It will support the Government's Federal Program on "Prevention and Control of Social Diseases, 2002-2006." For more details, please click here.
The Economic Consequences of HIV/AIDS in the Russian Federation - A Computer-Based Model |
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