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A closing window of opportunity - DCA report on HIV/AIDS in Russia

Since HIV/AIDS appeared in the Russian Federation in the early 90s, and particularly since 2001, the epidemic has increased rapidly. For a few years in the end of the last decade the country, together with Ukraine, accounted for the fastest increase in newly reported cases worldwide ?far more than in Sub-Saharan Africa, for example.

As shown in the DCA report a closing window of opportunity, extensive research indicates that the reliability of HIV/AIDS data from the Russian Federation is low, and the real number of infections may be as high as three times the official statistics and even higher in certain regions of the country.

Nevertheless, even with a much higher number of people living with HIV/AIDS, the situation is not yet critical for the country as a whole. The characteristics of HIV prevalence in the Russian Federation are clear, and the vast majority of the infected people may be found within certain groups, e.g. injecting drug users and their sexual partners, many of whom are also sex workers.

Furthermore, the epidemic is concentrated to a limited number of regions. A concentrated epidemic should be easier to control, and there is a wide range of well- documented evidence based on interventions on how to prevent and treat HIV within the groups affected.

Based on this information, a positive development with a decrease in the real incidence of HIV seems to be both realistic and plausible.

Epidemic is worsening

But a number of factors interfere, and the situation is not just critical– it is worsening.

Firstly, the concentration of HIV within certain groups may not last. Even though there is little evidence for onward spread to other groups, several risks are present and realistic. When HIV is spread to the broader population, through sexual transmission, the epidemic may speed up, and both prevention and treatment will be much more difficult and expensive to implement.

Secondly, the lack of reliable data makes successful actions and responses difficult. When information about high risk groups is limited, they are even more difficult to reach, and HIV may spread further outside control.

Thirdly, stigmatization and discrimination of sex workers, drug users and people living with HIV/AIDS lead to violations of their rights and make actions even more difficult.

When infected people avoid, or are denied, official health care due to stigma and discrimination, prevention and treatment is impossible. Finally, a lack of political will and targeted actions to high-risk groups, from the Russian authorities hinders any full-scale, focused, nationwide initiative to be implemented.

© DanChurchAid

May affect other European countries

With a regional perspective, looking at the Russian Federation as a part of Eastern Europe and Central Asia, there are additional worrying observations. The Russian Federation, together with Ukraine, has the largest concentration of people living with HIV and AIDS in the World Health Organization (WHO) European Region, and the increase of HIV in the neighboring countries is often linked to these two countries. Migration and regional mobility thus make the situation in the Russian Federation relevant for all of the European and Central Asian countries.

HIV in Russia may in a longer perspective be a threat to other European countries, but it should be emphasized that the development already now is violating the rights of people in Russia.

Even if the spread to other groups can be limited and controlled, there is a steady increase of HIV within certain high risk groups. These people are often being stigmatized and discriminated against due to the various groups they are associated to, such as drug users, sex workers or people living with HIV or AIDS.

According to the International Covenant on Economic, Social and Cultural rights, ratified by Russia in 1976, everyone has a right to the highest attainable standard of health, and this right is not being fulfilled in the Russian Federation today.

The DCA report aims to highlight the HIV situation in the Russian Federation and to appeal for action - from the Russian authorities, but also action from other European governments.

The present momentum, where the development may still be turned and the epidemic may come under control, is about to be lost. If HIV in the Russian Federation is dealt with now, it is possible to make a difference, but there is a closing window of opportunity.