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The main trend of HIV epidemic development in Southern Russia is identical to Russia’s nationwide but less intense. High incidence rates are registered in such regions that have a saturated prevalence of HIV infection at the population level. During 1998–2018 an annual increase in HIV incidence has permanent vacillation ranging between +5 and +15%. This vacillation turned to be influenced by insufficient routine HIV testing coverage, which has always been lower than Russia’s nationwide rate and hardly ever reached 20% until 2017. The HIV incidence steadily biases into the age of 30–44 and elders. Sexual transmission of HIV predominates in the South since 2004. There are sustained agencies by which new HIV infections occur in Southern Russia and upward trajectory of HIV epidemic.

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