Special Topics in Global Public Health: Infectious ...
Policy Brief
Infectious Diseases, HIV/AIDS in Russia
From: Ashley Roberts, Secretary of Health, Russia
To: Minister of Finance, Russia
Introduction:
Russia has a serious problem with HIV/AIDS. There are almost one million people living with HIV/AIDS in Russia. In 2008, 66 percent of newly reported cases of HIV worldwide were in Russia.[i] Although the number of people infected is a relatively small percentage of the entire population, the rate of infection has skyrocketed in the last few years. If this trend continues, Russia will have soon an epidemic of HIV/AIDS. The people most affected by this disease are intravenous drug users, sex workers, men having sex with men, prison populations and children born to HIV-positive women. The risk factors for the problem include non-sterile needles, no protection when having sex and lack of education regarding the dangers of HIV/AIDS, including how it is transmitted and treated. The economic and social consequences of the problem include loss of productivity and income and also the possibility that Russia will lose an entire age group if the spread of this disease is not stopped. In addition, people with HIV/AIDS are more susceptible to tuberculosis. The rapid spread of HIV/AIDS can be addressed through increased education campaigns and greater access to antiretroviral drugs for those affected by the disease.
Nature and Magnitude of the Problem:
Russia is experiencing a severe epidemic, which if left unchecked will grow to unmanageable proportions.[ii] There are approximately 940,000 people over the age of fifteen living with HIV in Russia.[iii] Conservative estimates project that if nothing is done to stop the spread of disease, by 2025 Russia could have 5 million cases of HIV. The highest estimates place this number at 19 million cases of HIV.[iv] The number of children born to HIV positive mothers reached 2,761 in 2002, marking a 144% increase since 2001.[v] The number of HIV cases is highest in the ten largest urban areas in Russia. Moscow had over 40,000 cases of HIV in 2003 and St. Petersburg had almost 30,000 cases of HIV in Russia.[vi] These urban centers account for approximately 60 percent of HIV cases.[vii] The virus is spread most effectively through infected blood products and dirty needles.[viii] As of right now, the HIV disease is a “concentrated epidemic” because about 1 percent of the population is infected. This disease can quickly grow into a “generalized epidemic” where 5 percent of the adult population is infected if the Russian government does not address this problem.[ix] This is clearly an issue that needs to be taken seriously.
Affected Populations:
The people most affected by the HIV/AIDS epidemic in Russia are intravenous drug users, street children, sex workers, prison populations, men having sex with men, and children born to women with HIV. In Russia, 83 percent of HIV cases resulted from injecting drug use.[x] In 2006, 66 percent of newly reported HIV cases resulted from intravenous drug users.[xi] Sex workers also make up a large number of new HIV cases. They made up 15 percent of HIV cases in Moscow, 48 percent in St. Petersburg, and 62 percent in Tolyatti.[xii] In addition, there is an overlap between sex workers and users of intravenous drugs.[xiii] Men between the ages of 15 and 30 account for 80 percent of the newly reported cases of HIV.[xiv] In addition, there is a 30 percent prevalence of HIV among young people living full or part-time on the street in St. Petersburg.[xv] In 2007, 10 percent of newly reported infections of HIV were found in prison populations.[xvi] This is because of the large number of intravenous drug users in prison. Men who have sex with men are also at risk for contracting the disease, but the share of HIV cases resulting from men who have sex with men has decreased since it was first reported in 1987. From 1987 to 2007, a total 1,613 men contracted HIV in this way.[xvii] In 2007, almost 60 percent of newly infected HIV cases resulted from intravenous drug users, and fewer than 40 percent resulted from heterosexual contact. The remaining cases resulted from mother to child transmission during pregnancy and birth.[xviii]
Risk Factors:
The risk factors for the problem of HIV in Russia are being an intravenous drug user, being a sex worker, and being a youth on the street. In addition, another risk factor is being a child born to a mother with HIV. Intravenous drug users are at risk for contracting the disease because they use non-sterile needles for drug injection[xix]. Men who have sex with men are at risk of contracting the disease because of unprotected sex. 31 percent of men in monogamous relationships reported using condoms regularly, while just 61 percent of men with casual sex partners used protection.[xx] Sex workers are at risk for becoming HIV positive because of practices such the use of a large number of partners without using protection and heavy alcohol and drug use. Street youth are at risk because of lack of education as well as behaviors such as heavy drug and alcohol use and not using protection when having sex. Finally, children born to mothers who are HIV positive at risk because the mothers may not know they have HIV, how it is transmitted and how it can be prevented. The largest risk factor of contracting HIV remains lack of knowledge about how the disease is transmitted and how it can be prevented. Just 34 percent of young people between the ages of 15 and 24 in 2007 correctly identified two ways of preventing sexual transmission of HIV.[xxi]
Economic and Social Consequences:
The economic and social consequences of this problem are vast and impact all of Russian society. The Russian population is already declining. If this problem is not addressed adequately, then HIV will kill an estimated 5 million people by 2025. This will negatively impact the Russian work force. If a family member has to care for someone with HIV, they will lose income. In addition, HIV makes people more susceptible to other diseases such as tuberculosis, thus increasing the number infected with TB and making that disease more prevalent. The growing epidemic will also negatively affect Russia’s defense forces, because young people comprise a large number of those newly infected. If this disease is not addressed, by 2030 the Russian population is expected to fall between 30 and 50 percent. If the disease is not controlled, it will also negatively impact Russia’s GDP. By 2010, Russia’s GDP will fall by 4 percent and by 2020 it will drop by 10 percent if the epidemic is not addressed.[xxii]
Priority Action Steps:
The most important step the Russian government can take is to increase awareness and education regarding the disease, how it is transmitted, and how it is prevented. To address the problem of intravenous drug users, the Russian government should increase the number of clean needle exchange programs. There are only 69 such programs in Russia, where there are 2 million intravenous drug users.[xxiii] The Russian government needs to promote 100 percent condom use for sex workers, and more needle exchanges programs to reach all intravenous drug users. Moreover, the Russian government should make it a priority to increase HIV-positive peoples’ access to anti-retroviral therapy (ARV). ARV therapy has not been able to keep pace with the increase in cases.[xxiv] The number treated with ARV has increased but the cost has also increased.[xxv] Studies have shown that it will be cost-effective to expand coverage of ARV in St. Petersburg because this will help stop the spread of the epidemic and make those with the disease more productive. In order to stop the spread of HIV via mother to child transmission, the Russian government should target pregnant women in urban areas with education campaigns. Finally, the Russian government must launch a campaign to educate street youth on the dangers of drug use and sexual behavior without proper protection in order to stop the HIV epidemic.
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[i] “Eastern Europe and Central Asia AIDS Epidemic Update Regional Summary,” UNAIDS and World Health Organization, March 2008, p. 3.
[ii] Aids Epidemic Update 09. World Health Organization and UNAIDS. 2009.
[iii] “Epidemiological Fact Sheet on HIV and AIDS: Russian Federation,” UNAIDS. Geneva. 2008.
[iv] “The HIV/AIDS Epidemic in the Russian Federation,” Transatlantic Partners Against AIDS, Vol. 1, No. 1, September 2004.
[v] “The HIV/AIDS Epidemic in the Russian Federation,” Transatlantic Partners Against AIDS, Vol. 1, No. 1, September 2004.
[vi] “The HIV/AIDS Epidemic in the Russian Federation,” Transatlantic Partners Against AIDS, Vol. 1, No. 1, September 2004.
[vii] “Eastern Europe and Central Asia AIDS Epidemic Update Regional Summary,” UNAIDS and World Health Organization, March 2008, p. 2.
[viii] Richard Skolnik, Essentials of Global Heatlh. (Boston: Jones and Bartlett Publishers, 2008), p. 192
[ix] Richard Skolnik, Essentials of Global Heatlh. (Boston: Jones and Bartlett Publishers, 2008), p. 192
[x] “HIV/AIDS in Russia, Eastern Europe, and Central Asia,” , November 2009, .
[xi] “Eastern Europe and Central Asia AIDS Epidemic Update Regional Summary,” UNAIDS and World Health Organization, March 2008, p. 3.
[xii] “Country Progress Report of the Russian Federation on the Implementation of the Declaration of Commitment on HIV/AIDS,” UNAIDS, January 2006 – December 2007, p. 19.
[xiii] “HIV/AIDS in Russia, Eastern Europe, and Central Asia,” , November 2009, .
[xiv] Dmitry Kissan and Lauren Zapata, et al. “HIV seroprevelance in street youth, St Petersburg, Russia,” AIDS: Official Journal of the International AIDS Society,” Vol. 7, No. 21, August 2007, p. 2333.
[xv] Dmitry Kissan and Lauren Zapata, et al. “HIV seroprevelance in street youth, St Petersburg, Russia,” AIDS: Official Journal of the International AIDS Society,” Vol. 7, No. 21, August 2007, p. 2334.
[xvi] “HIV/AIDS in Russia, Eastern Europe, and Central Asia,” , November 2009, .
[xvii] “Country Progress Report of the Russian Federation on the Implementation of the Declaration of Commitment on HIV/AIDS,” UNAIDS, January 2006 – December 2007, p. 15.
[xviii] “Country Progress Report of the Russian Federation on the Implementation of the Declaration of Commitment on HIV/AIDS,” UNAIDS, January 2006 – December 2007, p. 15.
[xix] “Country Progress Report of the Russian Federation on the Implementation of the Declaration of Commitment on HIV/AIDS,” UNAIDS, January 2006 – December 2007, p. 18.
[xx] “HIV/AIDS in Russia, Eastern Europe, and Central Asia,” , November 2009, .
[xxi] “Epidemiological Fact Sheet on HIV and AIDS: Russian Federation,” UNAIDS. Geneva. 2008.
[xxii] “The HIV/AIDS Epidemic in the Russian Federation,” Transatlantic Partners Against AIDS, Vol. 1, No. 1, September 2004.
[xxiii] “HIV/AIDS in Russia, Eastern Europe, and Central Asia,” , November 2009, .
[xxiv] “HIV/AIDS in Russia, Eastern Europe, and Central Asia,” , November 2009, .
[xxv] Elisa Long and Margaret Brandeau et al., “Effectiveness and cost-effectiveness of strategies to expand antiretroviral therapy in St. Petersburg, Russia,” AIDS: International Journal of AIDS Community, September 2006, p. 2208.
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