HIV/AIDS in Russia
Disease	HIV
Confirmed cases	1,528,300
Deaths	405,477

The situation with the spread of HIV/AIDS in Russia is described by some researchers as an epidemic. The first cases of human immunodeficiency virus infection were recorded in the USSR in 1985-1987. Patient zero is officially considered to be a military interpreter who worked in Tanzania in the early 1980s and was infected by a local man during sexual contact. After 1988—1989 Elista HIV outbreak [ru], the disease became known to the general public and the first AIDS centers were established.^[1][2] In 1995-1996, the virus spread among injecting drug users (IDUs) and soon expanded throughout the country. By 2006, HIV had spread beyond the vulnerable IDU group, endangering their heterosexual partners and potentially the entire population.^[3][4]

It is estimated that in 2017, the Russian Federation had the highest number of HIV-positive people of any country in Europe.^[5] In the following 5 years, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing annually estimated the number of new infections at 70,000-100,000. At the end of 2021 there were 1.137 million infected people in the country, accounting for 1.5% of the adult population; 424.9 thousand people died during the entire history of the epidemic.^{[6][7][8][9][10]} Nevertheless, most experts believe that the real number of HIV-positive people is significantly higher, since a noticeable part has not yet been identified.^[11][12]

First cases of infection

First cases

According to the Moscow Scientific and Practical Centre for Addiction Medicine, the first cases of human immunodeficiency virus (HIV) infection in the Soviet Union may have occurred as early as the 1970s through unprotected sexual contact with African students. But diagnosis was impossible at the time, as the first HIV screening was not carried out until 1987.^[13] Officially the first foreigner to die of AIDS in the USSR was in 1985. A thirty-year-old student of the Higher School of Trade Union Movement contracted HIV when he went to visit family in South Africa on holiday. He was later admitted to Moscow Infectious Diseases Hospital № 2 with pneumonia and died a month later. In the next two years, 219 infected foreigners were identified. In 1986, the first specialized unit to provide medical care for people living with HIV was opened at an infectious diseases hospital in Moscow. Initially, its patients were foreigners only; after a course of treatment, they were subject to deportation. By 1989, there were 485 HIV cases among foreigners in the country. Half of them were in Moscow and the rest in Odesa, Kyiv, Minsk, Leningrad, and other cities of the USSR.^[14] In Soviet state media outlets, incidents of HIV infection were explained as an attempt to discredit USSR relations with friendly African countries and spread false notions about the disease. For example, the newspaper Izvestia asserted in 1987 that AIDS had been "invented by the Pentagon in a laboratory of biological warfare methods". It was presented solely as a disease of capitalist society, which could not spread to the USSR, since homosexuality, drug use and prostitution were allegedly not practiced in the country.^[15] Although the carriers were subject to deportation, the virus began to spread gradually among Union citizens.^[16][17]

There are several versions of the spread of the disease within the country. The officially registered 'Patient Zero' was a Zaporizhzhia engineer and military translator, Vladimir Krasichkov, who was on assignment in Tanzania in 1981. During his service, he had sexual contact with a local carrier. When he returned to Moscow, where he worked in one of the military units, he had sexual intercourse with 25 conscript soldiers of the USSR who, after demobilisation, dispersed across the country. Five of them were later diagnosed with the disease. Krasichkov himself repeatedly sought medical attention and on 26 February 1987 he was diagnosed with HIV with AIDS as a result of an enzyme immunoassay. According to some media reports, the Ministry of Health tried to conceal the circumstances of his illness, allegedly taking a non-disclosure pledge from him in exchange for benign treatment.^[18] The patient died in the summer of 1991. Evidence of further spread of the virus varies. It is known that one of Krasichkov's five HIV-positive partners transmitted the virus to his wife and their child was born with HIV. He also donated blood to five other patients (according to epidemiologist Vadim Pokrovsky, three children were among them).^[19][20][21]

The first death from acquired immune deficiency syndrome in the country was registered in September 1988. The victim was Olga Gaevskaya, a 30-year-old evening student at the Leningrad branch of the Moscow Institute of Technology. She had contracted HIV between 1979 and 1985 when she had repeated sexual contacts with foreigners, in particular Africans. She received treatment in the following years, during which she was tested negative for HIV in 1988. Presumably no antibodies to the virus were found due to a poor diagnostic method. Doctors saved scarce test kits by mixing the blood of three to ten patients into one. A separate sample was taken from each patient only in case of a positive result. Gaevskaya was diagnosed with AIDS post-mortem, as antibodies to HIV were found in the blood. There is also evidence that the first death from AIDS in the USSR was recorded by Professor Andrey Kozlov in Odesa in 1988. His patient was a child who had been infected by his mother. After the incident, more children were tested for AIDS.^[13][14]

Number of HIV-positive people among Soviet citizens, 1985-1989^[14]

Territories	1987	1988	1989	Total 1985—1989
USSR citizens	34	85	322	441
RSFSR citizens	22	50	268	340
Residents of other Soviet republics	12	35	54	101

Kalmyk outbreak

The first major outbreak happened in Elista, the capital of the Kalmyk Autonomous Soviet Socialist Republic. The "zero patient" was a former enlisted sailor who was infected in the Congo by a local prostitute. He later transmitted the virus to his wife, and during her pregnancy their child became infected. Shortly after giving birth, the infant was hospitalized at the district pediatric hospital, where he died before the diagnosis was made.^[21] In 1988, the first patient from Elista was identified. She was a female donor who had been infected by her infant while breastfeeding. In December of that year, the program Vremya reported an outbreak of HIV infection in a children's clinic in Elista, where an infected infant was treated. A total of 75 children and 4 adult women were infected. A medical board headed by Vadim Pokrovsky was called to investigate in early 1989. The doctors found that the child was infected in the hospital due to negligence of the medical personnel, who used the same syringes several times, changing only the needles:

This was before hospitals began to actively use disposable syringes. This meant that all syringes had to be sterilized, and, in fact, not all of them were sterilized. We did a simple comparison between the number of injections given and the number of syringes sent for disinfection and found that the difference was about 30-40%^[22]

— Vadim Pokrovsky

Such practices were common throughout the country. Presumably, local outbreaks of HIV infection could have occurred before, but were not recorded. For example, in Kalmykia, the "Republican Center for the Prevention and Control of AIDS and Infectious Diseases" was established only a year before the Pokrovsky investigation.^[23] Doctors, journalists, and representatives of the RSFSR Ministry of Health also offered unofficial theories of infection: local sheep disease, some blamed recently discovered immunoglobulin.^[22][24] However, later research on the genome of the virus confirmed that it had spread from a single individual and corresponded to subtype G, which has only been recorded in the Congo.^[21]

Several patients were transferred from the Elista hospital to large medical centers in Volgograd, Stavropol, Rostov-on-Don, and Shakhty, so the virus began to spread in these regions. By 1989 there were a total of 270 infected people^[24] The news about the spread of the HIV virus caused a very negative reaction in society. Pickets were held outside the Elista hospital, local residents began harassing the victims and their families, and demanded that the infected be placed in isolation wards.^[16][21] USSR citizens began to refuse donation and medical procedures on a mass scale, and in some hospitals doctors allowed patients to bring their own syringes.^[25][26] At the direction of Soviet Health Minister Yevgeniy Chazov, AIDS centers were established across the country.^[19][20][27]

Children infected in hospitals in southern Russia, by 1996^[14]

Region	Number of infected children	Total number of deaths	Number of AIDS deaths
Rostov Oblast	98	41	40
Kalmykia	74	43	37
Volgograd Oblast	52	29	25
Stavropol Krai	15	7	6
Chechnya	6	4	3
Dagestan	5	4	4
Astrakhan Oblast	2	1	1
Other regions	13	5	4

Virus spreading

1990-2019

The WHO classifies the HIV epidemic in three stages. In the first stage, less than 1% of the general population and less than 5% in vulnerable groups are infected. When more than 5% are infected in one vulnerable group, the disease moves to the concentration stage. In the third, generalized stage, HIV infection extends beyond one group, the epidemic spreads to the general population,^[28] and the proportion of HIV-infected pregnant women reaches 1%.^[29] While in the 1980s there were sporadic outbreaks of infection in the USSR, the next decade saw a new phase in the spread of HIV, when the disease was most often transmitted through blood by injecting drugs.^[1]

According to the WHO, by the 1990s, there were 494 infected people (307 adults and 187 children).^[13][21] Nevertheless, the actual figures may differ. Before 1990, patients had to provide passport data for HIV testing. Those found to be HIV-positive were required to make a list of their sexual contacts, and the principle of medical confidentiality did not apply to them. For this reason young people preferred not to be tested for HIV or did it using false documents.^[16] Between 1987 and 1995, only 1,096 carriers were identified among the 160 million surveyed people.^[30] At the same time, diagnostic laboratories did not provide complete testing: only preliminary tests were performed at blood transfusion stations and AIDS diagnostic laboratories. The results were confirmed at the only AIDS diagnostic laboratory at the Central Research Institute of Epidemiology of the USSR Ministry of Health. The Ministry of Health of the RSFSR admitted tardiness in the deployment of preventive measures. Hospitals did not comply with the anti-epidemic regimen and did not conduct explanatory work among the population satisfactorily. Research institutes of the Ministry of Health of the RSFSR paid little attention to virus research. The work of scientists was not coordinated, there was no republican program of scientific research, no clear system of surveillance and preventive measures.^[26][27]

Researchers call 1996 the beginning of a new phase in the spread of HIV in Russia.^[1] It was preceded by an outbreak in the Ukrainian port city of Odesa, where the HIV strain was introduced from Central Africa in 1993. While in 1994 only 3 cases were diagnosed in the city, by 1995 the number had risen to 1021. The virus spread rapidly among injecting drug users (IDUs) in the former Soviet Union. After just one year, their share in the total number of Russian infected was 30.7%.^[31][3][32] During the first 10 months of 1996, the official number of persons infected with AIDS in Russia increased by 4.5 times; within one year, the total number of those infected almost doubled (from 1,090 to 1,925 carriers). The rapid growth in the number of infected people was attributed to high unemployment, the development of a shadow economy and a low level of living, which led to an increase in the number of drug addicts. HIV prevention measures were mainly aimed at the sexual channel of the virus spread. Special commissions at state AIDS centers distributed medications and determined which infected people to treat.^[11][33] The largest epicenters during this period were major agglomerations, as well as single-industry towns that experienced an economic crisis after the collapse of the Soviet Union.^[2][3]

Since 1999 the virus began to spread more and more frequently among people who engage in unprotected sex (both homosexual and heterosexual). Experts attribute this to the fact that HIV has reached saturation point in IDU communities, as well as to a decrease in the overall number of drug users. In 2003, for example, 17% fewer new IDUs were registered than in 2002. Large segments of the population were at risk, as injecting drug users (estimated by WHO at 1-2% of the population by 2005) were putting their sexual partners at risk. During the first decade of the 21st century, the proportion of this mode of HIV transmission became comparable to that of injecting drug use. Between 2000 and 2005, the share of newly reported cases of infection through non-sterile injecting needles fell from more than 90 percent to 66 percent. Experts noted the critical situation: by 2001, cases of HIV had already been registered in all regions of the country.^[19][34] Nevertheless, in the following years the rate of spread of the virus generally began to decrease, since parenteral drug use with an unsterile needle has a much higher chance of infection than unprotected sexual intercourse.^{[35][36][2][1]} While in 2001 the primary incidence rate was 55 cases per 100,000 people, five years later it was 20-23 cases per 100,000. Part of the reason for this decrease in the number of HIV diagnoses is that fewer tests were conducted in some high risk groups, such as injecting drug users and prisoners. From 2000-2004, there were 51% fewer tests among IDUs and 30% fewer tests among prisoners. This distorted the overall picture of the HIV epidemic in Russia. Starting in the middle of the first decade of the 21st century, the number of infected people resumed growing. By the end of 2006, 0.5% of the Russian population between the ages of 15 and 49 were officially registered as HIV-positive. Between 2006 and 2017, the incidence rate tripled, reaching 60 cases per 100,000 inhabitants.^[37][38][33]

The exact number of carriers in the country is difficult to determine, since health services have not kept up with the spread of the virus, and vulnerable groups are often reluctant to be tested.^[39] In addition, HIV infection can be asymptomatic for 8–10 years.^[40] For the most accurate calculation of the infected population, several estimation systems have been developed that give different results. If according to official data, the number of HIV-positive citizens in 2003 was only 235,000, then epidemiologist Vadim Pokrovsky testified about more than 700,000 infected people. The media called his estimates deliberately exaggerated, and the proposed "soft methods" of HIV prevention - "softening the brains of the population and preparing the ground for further colonization of the Third World". Antiviral prophylaxis was given a moral dimension: journalists emphasized marital fidelity and family values.^[41] State bodies did not support Methadone maintenance and Harm reduction programs, including syringe distribution to HIV-infected people. Since 2006, the Federal Drug Control Service of Russia have lobbied for a system of HIV prevention based on repressive methods requiring carriers to give up drugs entirely. A misguided belief spread among officials that high moral standards of citizens would help stop the AIDS epidemic, and the federal media silenced the problem.^[42][43] Chief Narcologist of the Ministry of Health Eugene Brun [ru] commented that “The medical community is generally skeptical about handing out syringes on the street, because by handing out materials, we draw attention to this area to those citizens who have never even thought about it. It's a kind of "drug propaganda".”^[44] Those non-profit charitable foundations that criticized the country's current HIV legislation, educated the population, and distributed condoms and disposable syringes to at-risk groups were often labeled as foreign agents. Their activities contradicted the state policy in the sphere of drug addiction and AIDS prevention and fell under the principles of post-liberal ideology. For example, in 2016, during the trial over the status of the Saratov-based NGO ‘Socium’, which received foreign funding, a guest expert described it as "a participant in a hybrid war waged against Russia.^[45]

When in 2008 the number of carriers reached 444,000, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing acknowledged the state significance of the problem.^[46] A year later, according to estimates by various international and Russian experts, the real number of Russians living with HIV ranged from 800,000 to 1.5 million (1-2% of the country's adult population).^[28] In 2010, the Federal AIDS Research Center reported over 516,000 HIV-positive citizens. By that time, since the beginning of the epidemic, more than 60,000 HIV-positive people had died for various reasons.^[1] There was an increase in the number of infected pregnant women (from 0.3% in 2003 to 0.62% in 2011), which indicates a concentrated epidemic stage according to the WHO classification. Eight regions of Russia recorded over 1% of HIV-positive pregnant women as early as 2008.^[4] In contrast, the proportion of infected adolescents decreased from 24.7% to 1.5% between 2000 and 2012. Presumably, the reasons were prevention programs in the country's educational institutions and an increase in the age at which risky behavior begins to be practiced.^[47]

In 2005, of the more than 1.4 million people infected with HIV in Europe and Central Asia, about 61% were Russian citizens.^[48] In 2005, of the more than 1.4 million people living with HIV in Europe and Central Asia, about 61% were Russian citizens.^[33] One year later, 90 percent of all HIV-positive people in Eastern Europe and Central Asia lived in Russia and Ukraine. The most affected regions of the Russian Federation were Samara, Irkutsk, Leningrad, Orenburg, Sverdlovsk, Tyumen, Ulyanovsk, Chelyabinsk, Kemerovo and Kaliningrad oblasts, the city of St. Petersburg, and the Khanty-Mansiisk Autonomous District. A large cluster of drug users had formed there, and by the end of 2009 between 0.5% and 1.2% of the population in these regions were officially registered as carriers. HIV predominantly affected the young population of the country: 70.5% were diagnosed before the age of 30.^[30] Experts feared that this would soon lead to an increase in the dependency ratio, as well as affect the rate of long-term economic growth. According to various estimates, by 2025-2035 the population loss due to AIDS will reach 20-30 million people.^[48] During the next decade, the annual increase in HIV-positive people in Russia was 5-10%.^[49] The number of deaths from HIV was increasing by about 20% annually. According to Rospotrebnadzor, by early 2013, 140,000 HIV-infected people had died for various reasons.^[50] A year later, the number of carriers in the country exceeded 900 thousand people, 80% of whom were under 30 years old. At the same time, the deputy prime minister of the Russian government Olga Golodets stated that the total number of carriers exceeded one million, with more than 6,000 new infections daily.^[51] About 40% of all carriers were female. One in twenty men aged 30–35 years old was a carrier of HIV.^[33][13][43]

In 2015, the Federal AIDS Center officially registered 1 million HIV-positive people. Of these, approximately 53% of infections were related to drug use, 43% to sexual contact between men and women, and 1.5% to homosexual contact.^[52] Despite the relatively high number of surveys (10-19.3% in 2006-2015,^[29][53] epidemiologists assumed that the real number of carriers was 7 times greater.^[54] Half of the new HIV cases were attributed to 22 regions.^[55] The most critical situation with the spread of HIV was observed in regions where drug trafficking took place. Thus, Rospotrebnadzor considered Irkutsk (1.7% of the population infected with HIV) and Samara (1.6%) Sverdlovsk (1.6%), Kemerovo (1.5%), Orenburg (1.2%), Leningrad (1.2%), Chelyabinsk (1%) problem regions. Tyumen (1%) regions, St. Petersburg (1%).^[56] In November 2016, the press service of the Yekaterinburg Health Department reported that every 50th resident of the city is infected with HIV. In 15 regions, more than one percent of pregnant women were infected. In many cases, they found out about their status when they were registered at the maternity clinic.^[42][49][54]

By 2017, according to WHO data, Russia became the leader in the number of HIV-infected people in Europe (1.16 million people). This year alone 104 thousand new cases of HIV were registered, of which 53% were detected at the last stage, for 55% the routes of infection were not identified. Approximately 2.8% of the country's most economically active population, men aged 30–39, were HIV-positive. Women under 30 years of age were more frequently infected, as they had more sexual contact with older men.^[57][49][58] Russian Health Minister Veronika Skvortsova reported different figures: 998,500 identified HIV carriers, 81% of whom did not know their status. An American-Swedish research group in the journal PLOS Medicine pointed out that there are actually more than 2 million infected people in Russia.^[5][59]

By the end of 2021, there were 1.137 million people living with HIV in the country, and 70.5% of them were registered for medical care. According to Academician Vadim Pokrovsky, this figure is about 70% of the real number of people living with HIV.^[60] The number of regions with high HIV rates (more than 0.5% of the population) increased from 22 to 36. More than half of the country's total population (60.1%) and 82.8% of those infected with HIV resided in these regions. The most acute situation was observed in 22 regions (more than 1% of the population).^[61]

Most-affected regions in Russia^[62]

Federal subject	Per 100,000	Total cases
Kemerovo Oblast	2,211	58,218
Irkutsk Oblast	2,068	49,118
Sverdlovsk Oblast	1,907	81,807
Samara Oblast	1,818	57,343
Orenburg Oblast	1,588	30,862
Chelyabinsk Oblast	1,410	48,547
Khanty-Mansi A.O.	1,344	22,687
Novosibirsk Oblast	1,337	37,256
Leningrad Oblast	1,329	25,163
Tyumen Oblast	1,266	19,546
Perm Krai	1,263	32,570
Republic of Crimea	1,191	22,650
Krasnoyarsk Krai	1,155	32,972
Kurgan Oblast	1,145	9,373
Altai Krai	1,136	26,089
Ulyanovsk Oblast	1,108	13,501
Tomsk Oblast	1,097	11,745
Saint Petersburg	1,082	58,282

Since the beginning of the 21st century, the portrait of the average HIV-infected person has changed markedly. While in 2001, 87% of carriers were diagnosed at the age of 15-29, in 2019, 84% were first diagnosed at the age of over 30. According to statistics from the AIDS Center, 71% of those infected were economically active adults 30 to 50 years old. One of the reasons cited by epidemiologists was the high cost of condoms and lack of risk awareness.^[59][12] A new trend in the spread of the virus was its spread from Russia and Ukraine to Central Asian countries due to work migration.^[63]

Current state

According to UN estimates, in 2021, Russia ranked among the top five countries in terms of HIV prevalence, accounting for 3.9% of all newly diagnosed cases in the world.^[64] In the previous two years, the number of infections diagnosed in the Russian Federation decreased slightly (from 94,000 to 71,000), which was attributed to lower volumes of testing during and immediately after the covid-19 pandemic.^[6][65] The growth of the HIV epidemic in the country over 30 years has led to the situation that at the beginning of 2022, 1.137 million Russians were infected out of 144 million total population.^[6][66][67] Nevertheless, most experts believe that the real number of HIV-positive people is significantly higher, as a noticeable share has not yet been identified.^[11][12] This is reinforced by the ultra-conservative state policy promoted by the Russian Orthodox Church and the authorities since President Putin's return to his third term in 2012.^[68][69] Activists confirm that the 2013-2020 toughening of homosexual propaganda laws actually bans certain health and social services - HIV prevention in the LGBT community is now often equated with "propaganda."^[66][70] As a result, by 2021, government discrimination and police harassment of vulnerable populations hampered HIV prevention efforts.^[71][67] UNAIDS acknowledged that the "gay propaganda law" would undermine the Russian authorities' goal of eradicating AIDS by 2030 and called for its abolition.^[72]

In addition to the stigmatization towards people living with HIV, human rights activists and volunteers are concerned about the lack of funding. Despite the increase in the budget for the purchase of HIV drugs, in 2021 only slightly more than 30% of registered patients received them. This is due to the fact that the allocated budget did not cover the price increase: if in 2020 over 505 thousand annual courses were bought, in 2021 just over 391 thousand. Regional investments did not improve the situation - 72.2% of the 3.7 billion rubles of additional funding went to Moscow, the Moscow Region and St. Petersburg. As a result, therapy coverage declined by 11-15% annually.^[73] HIV-positive Russians reported that treatment was in fact only available in large cities, and that Russian AIDS centers recommended conjugal sex as prevention (which is not consistent with WHO recommendations). Foreign funding for WHO prevention measures threatens volunteer organizations with foreign agent status.^[74] For instance, the Andrey Rylkov Foundation [ru] which was a supplier of free clean needles and condoms to drug addicts in Moscow. In 2020, Russian deputy Vasily Piskarev accused the organization of promoting drugs in response to the foundation's assistance to drug addicts during the coronavirus lockdown.^[68][75]

The position of HIV-infected people worsened after the Russia invasion of Ukraine and the imposition of international sanctions. In 2021-2022, the Russian Ministry of Health reduced the share of unparalleled expensive foreign drugs for HIV treatment from 67.3% to 55% of the total volume of ARV procurement.^[76][77] Already in November, ‘Patient Control’ organization reported a shortage of Eviplera produced by Johnson & Johnson. Eviplera is one of the most expensive and popular combination drugs.^[78] Shortages were reported in 12 regions, of which the shortage was particularly acute in the Tver region, Komi Republic, and Crimea.^[79] Of the total number infected, a study by the British charity NAM estimated that in 2022 only 45% were receiving antiretroviral therapy.^[80] And in February 2023 the media reported that in some colonies prisoners began to be denied life-saving therapy.^[81] By December 2023, the HIV infection levels had reached 'epidemic proportions' in 19 regions with hot spots in the Kemerovo, Tver, Samara and Tomsk Oblasts, where more than 1.8% of all pregnant woman have been diagnosed with HIV. In Moscow, Crimea, Leningrad Oblast and Chechnya, less than 50% of patients were able to access therapy.^[82][83]

In 2022, the head of Rospotrebnadzor's Research Department for Epidemiology and AIDS Prevention estimated the total number of HIV-infected people to be 1.5 million (of whom 1.1 million were laboratory-confirmed cases). This figure diverges from the estimates of the Ministry of Health (about 850,000), which believes that the situation with HIV in the country has "stabilized".^[84][85]

Although officially most Russians with HIV/AIDS are exempt from military service, reports of such illegal conscriptions have surfaced since the partial mobilization was announced^[11] At the same time, the Ukrainian authorities confirmed that the Wagner Group was recruiting prisoners with infectious diseases, as there were people with hepatitis C and HIV infection among the Russian prisoners.^[86] Nevertheless, there have been multiple offers on the Internet to buy fake HIV certificates that allegedly allow one to avoid being drafted.^[87]

Statistics

Incidence

As the virus spread, the incidence rate grew geometrically. In 1987, it was 4.2 cases per 100,000 people; by the beginning of the 21st century, it was 157 cases. The main hotbeds of the spread were regions with a bad economic situation, where injecting drugs were spread. For example, in 1998 in Irkutsk Region alone, HIV was diagnosed in 32 people, a year later this figure increased almost 100-fold - up to 3157.^[89] According to the UNAIDS, total number of people infected in 2002 was four times higher than the official figures.^[90] Between 2007 and 2018, Russia was the world's third fastest-growing country in terms of HIV incidence, after South Africa and Nigeria.^[40] In 2013-15, average number of those infected increased by about 10% each year.^[91] In 2016-2017, the statistical handbook of the Ministry of Health fixed the average growth of HIV-infected people at 86 thousand nationwide. The incidence of HIV infection was 58.4 per 100 thousand people, the overall increase was about 1%.^[92][93] Although significant jumps were observed in some regions. In Moscow, the number of new infections rose from 2,400 to 2,900, an increase of 20%. In the Chukotka Autonomous District the increase was 151% (from 29 to 73 cases per 50,000 population), in Tyva - 133% (from 9 to 21 people per 310,000 population). But according to the ministry itself, it is incorrect to judge the percentage ratio based on these data, since a small number of carriers originally lived in these regions.^[94] By 2018, statistics showed that 10 people were infected with HIV every hour in Russia.^[89] In addition, in 2016-2018, the number of small towns with the number of infected people exceeding the national average by 2-4 times (Severouralsk, Kirovgrad, Togliatti, Verkhny Ufaley, Novotroitsk and others) has increased.^[26][56]

Officially the fact of epidemic is stated when more than 1% of the population is a carrier of the virus (for Russia - about 1.4 million).^[12][95][96] In November 2022, Rospotrebnadzor estimated the total number of infected people at 1.5 mln, by 2030 their number could reach 2 mln. The Ministry of Health, whose methodology is different, called these figures an estimate. According to the Ministry, the total number of HIV-positive people in the country was almost two times less - 850,000.^[97][98][99]

The Ministry of Health also denied the UNAIDS ranking in which Russia was among the five world leaders in the rate of HIV infection - according to its data, for 2019-2021 the incidence fell by 31.4% (from 58.6 to 40.2 per 100 thousand people).^{[100][101][102]} Rospotrebnadzor estimates, on the contrary, correspond to the data of the United Nations Joint Programme on HIV/AIDS - 48.7 per 100 thousand people or, roughly, 71 thousand new cases in 2021.^[6] In the WHO European Region, Russia led in the number of newly diagnosed HIV infections — it accounted for 55% of all cases, of which almost a third were diagnosed at a late stage.^[103] The most affected regions were the following 22 subjects of the Russian Federation

Russian activists describe the situation as critical. In 2015, co-founder of AIDS.Center Anton Krasovsky described the situation in the country as the largest epidemic in the world.^[16][104] In 2019, Vadim Pokrovsky (epidemiologist) [ru] classified the situation in the most affected regions as a generalized epidemic stage, when the virus spreads beyond vulnerable groups.^[105] International experts also ascribe the status of the epidemic to the situation in Russia.^[106]

Mortality

In the early stages of the epidemic, key vulnerable groups were reluctant to be tested for HIV and refused therapy. As a result, health services could not track the spread of the virus promptly, and carriers found out about their diagnosis in the last stages of the disease. Between 2000 and 2007, the increase in the standardized HIV mortality rate was 54% for men and 69% for women. By the end of the period the rate reached 4.3 cases per 100 thousand inhabitants. In 2007 alone the number of deaths exceeded 3.5 thousand people.^[39]

The HIV incidence rate increased from 187.3 to 472 cases per 100,000 people between 2007 and 2017. The increase in the number of carriers indicated delayed diagnosis, low treatment coverage, and late initiation of therapy. As a result, the mortality rate from HIV increased 5.5 times during the same period, most of those infected died in the working age (from 20 to 59 years old). In ten years, the share of HIV-positive people in the total number of deaths from infectious and parasitic diseases increased from 11% to 57%. The mortality rate varied greatly across the country, forming clusters of high mortality (more than 21 cases per 100 thousand population): Middle Volga and Ural (Samara, Ulyanovsk, Orenburg, Sverdlovsk, Chelyabinsk, and Tyumen regions); southern Western Siberia (Kemerovo and Novosibirsk regions, Altai Krai); Baikal region (Irkutsk region, Buryatia). The head of the Federal Center for AIDS Prevention and Control Vadim Pokrovsky believes that if such trends persist, by 2031 the mortality rate from HIV infection will exceed the mortality rate from tumors.^{[39][107][108]}

During the first two decades of the 21st century, there was a rapid increase in mortality from HIV infection in both men and women. The highest rates were registered in the regions of the Siberian and Ural Federal Districts.^[109] The COVID-19 pandemic had a negative impact on mortality statistics among HIV-positive people. They were more severely affected by the new virus, and, presumably, as a result, the number of deaths among them in the first 10 months of 2021 increased by 5.4% compared to 2020.^[65] Over the entire period of observation, 424,900 people, or 27.2% of all detected cases, had died of HIV in Russia by the beginning of 2022. Meanwhile, 15% of this number died in the last two years-about 32,000 in 2020 and 34,000 in 2021.^{[7][8][6][39]}

Increase in the cumulative number of registered cases of HIV infection among Russian citizens in 1987-2021^[88][110][6]

Graphs are unavailable due to technical issues. There is more info on Phabricator and on MediaWiki.org.

Calculation methods and their limitations

Government bodies and researchers cite conflicting statistics about the incidence of HIV due to different methods of counting.

• The Ministry of Health counts the number of people who applied for medical care and presented a passport and SNILS. The press service of the Russian Ministry of Health calls its own data "the only official and most accurate source of information about the situation with HIV infection in the country," since all other counting systems are of an estimative nature.^[111]
• Rospotrebnadzor counts the percentage of HIV-positive results in the total number of blood tests performed. As of 2018, Russia was the only country in the world that practiced polyclinic registration of patients with HIV. A number of experts criticized the current system. According to Academician Vadim Pokrovsky, this practice leads to a difference between the recorded and real numbers.^[112]
• The predictive estimation system takes into account data from medical examinations of pregnant women, population health surveys (at the household level) and populations at high risk of HIV infection, data from the registration of detected cases, as well as data from all other types of monitoring. On this basis, scientists determine the estimated number of HIV-positive people and the margin of error of the calculations.^[12][104]

Vulnerable groups and spread routes

Under natural conditions, the immunodeficiency virus is transmitted from person to person horizontally (through sexual intercourse, blood transfusions, use of non-sterile injecting equipment) and vertically (from mother to child during pregnancy, childbirth, or breastfeeding). There have been cases of HIV infection through organ transplants and artificial insemination using contaminated donor materials. As a result, the entire population of the country is potentially at risk of infection. But the main transmission channels are defined by the most vulnerable groups: commercial sex workers (CSWs), injecting drug users (IDUs) and men who have sex with men (MSM). Over time, their ratio in the total number of HIV-positive people has changed.^{[3][113][114]}

Horizontal channel of spread

In the early stage of the epidemic in 1996-1999, the virus was most commonly transmitted through injecting drug use (78.6% of all known cases).^[3][114] Since the beginning of the new century, their share among newly diagnosed cases has gradually declined: from 95.6% in 2000 to 61.3% in 2007. But this mode of infection remained dominant. By 2009 in 46 regions of Russia the infection rate among IDUs exceeded 5%, in 13 regions it reached 20% (Chechen Republic and Republic of Buryatia, Kaliningrad, Leningrad, Tver, Ryazan, Orlovo, Chelyabinsk, Sverdlovsk, Irkutsk, Ulyanovsk and Chita, and Saint Petersburg. By 2012, IDUs were the most affected group of HIV-vulnerable people, ranging from 6.4% to 58.5% of carriers in different regions. The nature of the HIV epidemic among this population group was distinctly territorial. Critical HIV situations were typically observed in regions where homemade drugs were produced. At the same time, the number of HIV-positive CSWs ranged from 3.8% to 11.6% in different regions, and from 5.2% to 14.8% among MSM.^[50][113]

In the 2000s, transmission through sexual contact began to increase. Already since 2004, in 43 regions of the country there have been more HIV-positive people infected sexually than those who received the virus through injecting drug use.^[28] A year later, the sexual route of infection prevailed in half of Russia's regions, and the proportions of men and women who were infected became comparable. While in 1987-2001 the proportion of HIV-positive women was 22%, in 2004-2006 they accounted for 42-44% of new cases.^[113][38] In subsequent years, it was the sexual route of infection that remained the most common among HIV-positive women. At the end of 2009, it accounted for 61.8% of new cases. For men, the parenteral route of infection remained the leading one. During the same period, it accounted for 76.1% of first-time male carriers and 78.0% of all persons with known causes of infection.^{[92][115][30]} This indicated the dominance of men in the gender composition of carriers. The trend continued in the following years: in 2017, men prevailed both in the overall structure of carriers — 61.5%, and among first-time HIV-positive patients — 56.3%.^[92]

In the second decade of the 21st century, the proportion of registered HIV-positive drug users began to decline. While in 2015 there were 203.6 IDUs with HIV per 100,000 people, a year later there were only 151.3.^[92][115] From 2012 to 2018, the number of people infected through infectious drug use decreased from 56% to 33%. In 2019, more than half of newly diagnosed carriers were infected through heterosexual contact (62.7%), only 33.6% through drug use, and 2.5% — through homosexual contact.^[61] Epidemiologists distinguish people who regularly have sex (sex workers, young people, migrant workers and those prone to promiscuity) as an independent vulnerable group. But the widespread public opinion that only people with a large number of sexual partners are at risk of infection is wrong. By 2014, 1.5% of men and women in the sexually active age group (25–35 years) were carriers of HIV, indicating a high chance of infection even with a single partner.^[50][55] Young people (15–29 years old), who for various reasons are often unable to protect themselves from the virus, are particularly at risk. For example, population surveys in 2009 showed that a large proportion of young people engaged in risky sexual behavior, even though most of those surveyed were aware of the real risk of infection. Increasing rates of sexually transmitted infections required the implementation of personal hygiene education programs and the education of young people.^[28]

Sex workers are subject to mandatory testing when detained by police. At the same time, in Russia there is criminal prosecution for the spread of HIV infection. As a result, members of this vulnerable group are reluctant to get tested themselves and take HAART.^[116] According to surveys, in 2005, 64% of sex workers aged 20–24 tested positive for HIV.^{[1][36][2][35]} After four years, the percentage of CSWs in the total number of HIV-infected people ranged from 4.5% in Moscow to 20% in Irkutsk.^[30] Commercial sex workers, like IDUs, are prone to marginalized behavior and crime. As a result, convicts and detainees are also a vulnerable group. A survey conducted in Russian penitentiary institutions in the early 2000s showed that only 10% to 15% of inmates had no sexual contact (voluntary or forcible) during their incarceration.^[117] According to the Red Cross, at the beginning of the 21st century, the concentration of HIV-positive people in the general prison population was 26 times higher than in the general population. The number of cases of HIV infection registered in the Russian penitentiary system rose from 7,500 in 1999 to 32,000 in 2005.^[55][34][33] By the end of 2009, there were 55,964 HIV-positive in Federal Penitentiary Service facilities (about 11% of the total number of carriers in the country).^[118] Prisoners' HIV status constitutes no grounds for parole.^[119] At the same time, conditions of detention and treatment may not meet the necessary standards. For example, in 2018, a riot broke out in one of the colonies in the Murmansk region, in particular, because of the lack of proper medical treatment.^[120] The European Court of Human Rights has repeatedly received lawsuits from relatives of prisoners who died of HIV as a result of lack of treatment.^[121][122] Poor condition of Russian penitentiary institutions in 2020 threatened an epidemic of COVID-19, deaths from which could be disguised as deaths from secondary HIV diseases.^[123]

The first identified HIV-positive individuals in the country were men who have sex with men. But the scale of HIV prevalence among Russian MSM is poorly researched. In 1995-1996, the percentage of new infections through homosexual contacts fell drastically from 55% to 7%.^[13] But, according to some epidemiologists, MSM put themselves at greater risk, as they relatively often change sexual partners and places of residence, which can lead to an increase in the number of carriers. While in 2000 0.2% of HIV-positive MSM were officially registered, in 2004 they were already 0.5%, and almost 2% in 2016.^[50][33] For the entire period of observation in 2009, 2,289 MSM with HIV were identified. Nonetheless, Academician Vadim Pokrovsky noted a high degree of awareness among MSM, who often use additional protective measures.^[63]

Vertical transmission channel

Vertical transmission of HIV (from mother to child) was common in the early stage of the epidemic. Thanks to the development of antiretroviral therapy, it has been possible to reduce the number of such infections. Without preventive measures, the risk of vertical transmission during childbirth is 25% to 50% (this rate depends on viral load and the health of the mother).^[50] If patients receive therapy, the risk is drastically reduced. Between 1987 and 2015, only 6% of children born to HIV-positive mothers were found to have antibodies to the virus. By 2015, the rate had dropped to 2.2%, one of the best levels in the world.^[55] This result was achieved by developing a system to prevent perinatal HIV transmission. By 2018, 93% of HIV-infected women in labor were under observation. Of these, about 2/3 already knew they were infected before they became pregnant. Children with HIV infection were 99% covered by outpatient care, and antiretroviral therapy coverage was 91%. Data from 2019 indicated that with timely therapy, the risk could be reduced to 1.2%. Only 165 children out of 13747 born to HIV-positive mothers were infected with the virus in the first year of life. Another 63 children became infected with HIV during breastfeeding. Over the entire surveillance period, 205,675 live children were born to HIV-positive mothers in Russia by the end of 2019, antibodies to the virus were detected for 11,322.^[61][92]

Medical prevention of vertical HIV transmission consists of testing pregnant women and prescribing antiretroviral drugs to the mother and the baby. If a woman has no indication for ongoing ART, she is prescribed treatment from 26–28 weeks of pregnancy, at delivery, and to her baby after birth. Sanitary regulations permit delivery if the mother has a viral load of more than 1,000 copies of HIV RNA per milliliter of plasma. If the viral load is unknown, a cesarean section is practiced (after the 38th week of pregnancy). Mothers are motivated to avoid breastfeeding. Chemical prophylaxis for children of HIV-positive mothers is started from the first hours of life, but no later than three days after birth or from the last feeding of breast milk with mother's milk (subject to its further withdrawal).^[124]

In Russia, double HIV testing of all pregnant women applying to antenatal clinics is enshrined by law; HIV testing of spouses and sexual partners of pregnant women has been introduced in regions highly affected by HIV.^[92] Despite the mandatory nature of testing, as of 2011 in some regions testing was conducted on a fee basis.^[91]

HIV Infection Rate in Russia by Known Factors of Infection, 1987-2018^[88]

Graphs are unavailable due to technical issues. There is more info on Phabricator and on MediaWiki.org.

HIV prevalence by federal districts

HIV prevalence statistics vary from region to region of the country, as they depend on a number of geographic, social and economic factors. The most affected areas are characterized by pronounced social inequality. HIV infection aggravates the economic and social status, affecting the demographics situation, as well as the age and sex structure of the population.^[125] In 2006, about 60% of all registered cases of HIV infection belonged to 10 regions: Sverdlovsk Oblast, Moscow Oblast, Samara Oblast, Irkutsk Oblast, Chelyabinsk Oblast, Orenburg Oblast, Leningrad Oblast, Saint Petersburg, Moscow, Khanty-Mansi Autonomous District.^{[126][61][63][127]} In subsequent years, there was an increase in the number of regions where more than 0.5% of the population was infected. In 2014 there were 22 such territories, while in 2018 there were 35. The most affected areas included: Ivanovo Oblast, Irkutsk, Kemerovo region, Kurgan Oblast, Leningrad region, Moscow, Murmansk Oblast, Novosibirsk Oblast, Omsk Oblast, Orenburg, Samara, Sverdlovsk, Tver region, Tomsk region, Tyumen region, Ulyanovsk region and Chelyabinsk region, St. Petersburg, Khanty-Mansi Autonomous Okrug, Republic of Crimea, Perm Oblast, Krasnoyarsk region, and Altai. The highest rates of HIV incidence were noted in Siberian Federal District and Ural Federal District, the lowest — in North Caucasian Federal District.^{[128][129][130][131]}

Dynamics of HIV incidence in federal regions, 2000-2020^{[132][133][134]}

Graphs are unavailable due to technical issues. There is more info on Phabricator and on MediaWiki.org.

Central Federal District

The epidemiological situation in different regions of the Central Federal District (CFD) varies greatly. Thus, in 2009-2012 the average growth rate of HIV-infected people in the CFD was 32.5%. The maximum rates were observed in Lipetsk (56.1%), Smolensk (53.2%) and Voronezh (50.75%) regions, the minimum — in Tula (23.4%). At the same time, the district was in the top three in terms of the rate of primary disability due to HIV-related diseases. The growth of AIDS patients in the CFD was 86.6%,^[135] the increase in the number of deaths of people with HIV was 83.7%.^[136] By 2020, the total number of HIV-infected people reached 206.9 thousand, with the region traditionally among the leaders in terms of testing coverage (over 21-29% in 2013-2020).^{[137][138][139][140]}

Moscow was the leader in terms of the number of tests and detected cases in the federal district for 2019-2020 — about 10 thousand HIV-positive people were detected per almost 4 million examined sera. In comparison, in the second leading region — the Moscow region — only 1.7 million tests were conducted with positive results in 3.7 thousand people. The situation in the two subjects was still better than in most regions — for example, in the Kemerovo Region 3.6 thousand cases of HIV were detected per 600 thousand people tested.^[137] The relatively good statistics in the central regions are influenced by good regional funding and a higher standard of living. For example, in 2019 the Moscow region ranked second in the country in terms of the number of people receiving antiretroviral therapy.^{[88][136][139][140][141][142]} On the other hand, according to Vadim Pokrovsky, head of the Scientific Center for AIDS Prevention and Control at the Central Research Institute of Epidemiology of the Russian Federal Consumer Rights Protection and Human Health Control Service, Moscow's statistics on the incidence of HIV infection is affected by the specifics of data collection, which considers only people with a Moscow residence permit. Taking into account non-Moscow residents, the actual incidence of the virus could be much higher^[143]

Northwestern Federal District

The Northwestern Federal District as an administrative-territorial unit was formed by presidential decree in May 2000. The first cases of HIV infection on its territory were detected as early as 1987, when the epidemic began. At the beginning of the 21st century there was large-scale drug traffic passing through the Leningrad Region, which contributed to the rapid spread of the virus. In 2005 the incidence was 310.3 cases per 100 thousand examinees, in four years - 367.8. The most affected areas were St. Petersburg, where the index almost reached 1% of the total population, Leningrad Region - 0.7%, Kaliningrad Region - 0.5%, Murmansk Region - 0.45%.^{[144][145][56]} By 2015, the NWFD was in fifth place by the total number of carriers after Privolga, Siberian, Ural and Central federal districts. The average detection rate was 303.8 cases per every 100 thousand examinations. The lowest incidence rate was recorded in the regions of the Far North: in Nenets Autonomous District and Arkhangelsk Oblast. The leaders in terms of incidence were St. Petersburg, Leningrad, Kaliningrad and Murmansk regions. At the same time, the highest annual increase in the number of new HIV cases was registered in Komi Republic (80.7%), which is due to the proximity of the Urals Federal District.^{[146][128][147]}

By 2015, there were more than 109,000 HIV-positive people registered in the Northwestern Federal District, which accounted for 12% of the total number of carriers in the country. The incidence was 43.5 cases per every 100,000 inhabitants. In the next five years, the rate dropped to 33.7, but the total number of carriers continued to grow. In 2020, there were more than 115,000 people with HIV in the district.^{[146][128][147][137]}

Southern Federal District

Southern Federal District (SFD) is considered to be a territory with a stable HIV situation. Nonetheless, in 2010, despite a relatively high level of examinations among risk groups, insufficient detection rate was recorded in the district as a whole. In this period, the rate was 133.4 cases per 100,000 inhabitants. However, the high percentage of HIV-positive cases among tuberculosis patients (2172.9 per 100 thousand inhabitants) indirectly pointed to a higher prevalence in the region. This could be explained by the insufficient number of surveys. The Southern Federal District and the North Caucasus Federal District ranked last in terms of the total number of tests per inhabitant (0.156 and 0.094, respectively).^{[148][149][150]}

By 2020 the situation remained unchanged: 26.7% of every 100 thousand people in the Southern Federal District were tested against the national average of 27.7%. The total number of HIV-positive people was 83.3 thousand. The most problematic regions were the Russian-occupied Ukrainian Republic of Crimea and Krasnodar Krai, each with over 22,000 HIV-positive people. The most favorable situation in the district was observed in the Republic of Kalmykia, where only 292 carriers were registered.^{[128][137][151]}

North Caucasian Federal District

As of 2018, the North Caucasian Federal District was the region with the most positive figures. During the entire observation period since 1988, about 17 thousand carriers were registered on its territory, more than 5 thousand of them in the most affected Stavropol Krai. The rates were directly affected by the cultural peculiarities of the region. On the one hand, condemnation of premarital sex reduced their number, on the other hand, the taboo nature of the topic reduced the number of tests: in 2020, the percentage of those tested per 100,000 people was the lowest in the country (24.1%).^[152]

Volga Federal District

Since the beginning of the 21st century Volga Federal District is a territory with a high level of HIV infection and morbidity rates exceeding the national average. Population surveys in the first decade testified to poor preventive work in the region. For example, in 2009 only 25.5% of respondents in Tatarstan were aware of the risk of contracting HIV during sexual intercourse.^[28] By 2013, more than 65% of the territories of the Volga Federal District were characterized by high HIV prevalence. As of 2020, the Volga Federal District was the leader in the absolute number of registered HIV-positive people (over 244,000). The most affected region was Samara region, where more than 57 thousand carriers of HIV were registered. The Orenburg Oblast, the second highest in the ranking, had almost twice as few (30 thousand). The epidemiological situation in the Volga Federal District was complicated by the prevalence of ARV-resistant strains.^{[88][32][137] [153]}

Ural Federal District

Since the first decade of the 21st century, the Ural Federal District (UrFD) has had a difficult epidemiological situation. While in 1999-2001 in Russia as a whole the incidence of disease increased 2.4-fold (from 20.7 to 50.9 cases per 100,000 inhabitants), in the Urals Federal District it increased 15-fold (from 11.2 to 168.4). The leaders of the district were the Sverdlovsk, Chelyabinsk, and Tyumen regions, where a large number of IDUs lived. Thanks to preventive work among drug users in subsequent years, it was possible to slow down the rate of spread of the virus. In 2005, the incidence rate was 50.4 people per 100 thousand inhabitants; in 2010, the growth resumed and the rate reached 85.7. In 2008-2015, the largest number of tests was conducted in the least affected region - Yamalo-Nenets Autonomous District. The testing rate among IDUs in the Urals Federal District was higher than the national average: 1.38% compared to 0.9% of the total number of screenings. But in general, the district suffered under-detection, which affected the rate of spread of HIV. For example, in Kurgan region the incidence rate increased more than sixfold between 2008 and 2014. Although in 2015-2020 the incidence rate decreased markedly from 135.6 to 78.7 cases per 100 thousand people, but still exceeded the national average by more than one and a half times. By 2020 the total number of people registered with HIV in the Urals Federal District was 185,000, with 43% of them in the most affected Sverdlovsk Region.^[154][88]

Siberian Federal District

In the initial stage of the HIV epidemic in Russia, the Siberian Federal District (SFD) had a relatively low incidence rate. The first 2 cases were detected in 1989 and were due to Hospital-acquired infections of children. Up until 1996, only sporadic cases were recorded in the county, with the total number of infected reaching 44 people. In 1999 the virus began rapidly spreading among IDUs in Irkutsk Region, where over three thousand new carriers were registered during the year. In 1999, the number of infected people increased 28.8 times. Within four years the virus spread through Republic of Buryatia, Kemerovo region, Altai, and Krasnoyarsk region. The incidence in these regions ranged from 24.2 to 62.6 cases per 100,000 inhabitants. Since the beginning of the 21st century, SFD has been the leader in the number of IDUs, which was reflected in the rate of HIV spread. Already by 2005, the incidence rate in the district exceeded the national rate by 1.9 times.^[129] By 2012, the most unfavorable HIV situation was observed in the Irkutsk, Kemerovo, Novosibirsk, Altai, and Krasnoyarsk Krai.^[155][129] Against a backdrop of increasing incidence and a complex mix of carriers with a high percentage of IDUs across the county recombinant strains resistant to ART were spreading.^[156] By 2020, the total number of carriers in the SFD reached 237 thousand people, although the incidence dropped to 94.3 cases per 100 thousand population (from 127.5 in 2019). The most affected regions were Kemerovo, Irkutsk, and Novosibirsk regions, the least affected were Republic of Tyva.^[88][137]

Absolute number of first registered HIV cases in the Siberian Federal District, 1989-2012^[157]

Graphs are unavailable due to technical issues. There is more info on Phabricator and on MediaWiki.org.

Far Eastern Federal District

The HIV epidemic in Eastern Siberia and Far East has been studied less than in other parts of the country.^[158] In 2006-2018 in Far Eastern Federal District (FEFD), the average annual increase in the number of HIV-infected people amounted to 8.64%. As of 2010, more than 11 thousand people with HIV were registered in the FEFD, 72.4% of whom lived in Primorsky Krai. Within it, the distribution of carriers was uneven: Terneisky, Olginsky, Chuguevsky, Krasnoarmeisky, Lazovsky, and Anuchinsky districts recorded sporadic morbidity. This was explained by the inaccessibility of the territories, their remoteness from major foci of infection — Ussuriysk (73.94 cases per 100 thousand people), Dalnerechensk (70.11), Artem (55.19), Partizansk (48.37), Nakhodka (48.29).^[1]

By 2020, the incidence rate in the Far Eastern Federal District was almost half that of the national average and was approximately 39 cases per every 100,000 inhabitants. The most affected regions were Primorsky Krai, Buryatia, Zabaykalsky Krai, which accounted for about 70% of all HIV-infected people in the region.^[137][159]

HIV testing practices

According to the 1990 regulations, the standard groups for Disenfranchisement#Screening HIV testing were MSM and bisexuals, promiscuous persons, sex workers, recipients of blood products, Armed Forces personnel, citizens who traveled abroad for more than one month, or foreigners who arrived for more than three months. But the federal law on the prevention of the spread of HIV of 1995 made testing mandatory only for donors of any body fluids, tissues and organs; as well as for doctors and researchers whose work involved handling virus particles. In subsequent years, other vulnerable groups were added to the list: people in prison (1996), pregnant women (1997), personnel at Gynecology wards (1999), those entering military higher educational institutions and contract military service (1998), and those receiving Russian citizenship (2003). In addition, in accordance with FSIN regulations, all those entering prisons are tested for HIV.^[118]

Voluntary HIV testing is free for anyone. But in most cases the examination is carried out on the recommendation of a doctor, less often — on the initiative of the examinee.^[50] The main part of those examined are people aged 15–49 years, the older generation and children — most often with the relevant indications.^[30]

In Russia, the standard procedure for diagnosing HIV infection involves ELISA. It allows a large number of tests, but can give false-positive results. To make a definitive diagnosis, positive tests are confirmed using method of immune blotting with HIV antigens modified by Western blot. Since 2007, Polymerase chain reaction has also been used. Combined with data on epidemiological and clinical criteria it allows the diagnosis of HIV infection in persons who are false-positive, false-negative or of uncertain significance in other tests. For children under one year of age born to HIV-infected mothers, the methods used are aimed at detecting HIV-related genetic material (DNA or RNA). They can be taken off the registry only at 18 months of age after several tests, absence of significant hypogammaglobulinemia and clinical manifestations.

Effective therapy requires early testing, so the main WHO programs are aimed at increasing the availability of screening. In the USSR, 9.5 million people were tested for HIV in 1988 alone, 6.5 million a year later. In 1990-2006, 20-24 million people were tested. But as of 2006, representatives of vulnerable groups accounted for only 10% of the total number of people tested.^[38] By 2019, the trend remained unchanged: testing coverage in vulnerable groups was only 4.1%. At the same time, they accounted for 21% of new HIV infections.^[115] In all, more than 43 million blood samples were tested during the year (27.6 tests for every 100 people in the population).^[61] But according to activists, the authorities tried to artificially increase the number of people tested in order to bring the numbers closer to the WHO prescribed norms. For example, a year earlier it was suggested that children of HIV-positive parents be included in the list of mandatory annual examinations.^[89]

Zdroj:https://en.wikipedia.org?pojem=HIV/AIDS_in_Russia
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Scopes and results of HIV testing in Russia, according to the Federal Scientific and Methodological Center for AIDS Prevention and Control, 2001-2020

Year	Tests	HIV seropositive	Number of seropositive per 100,000 tests
2001[160]	23,996,849	89,548	373.2
2002[160]	24,298,575	52,930	217.8
2003[160]	21,900,300	40,021	182.7