HIV in the Russian Federation: mortality, prevalence, risk factors, and current understanding of sexual transmission

Abstract

Background:Although HIV infection in the Russian Federation was historically concentrated among marginalized populations (people who inject drugs, sex workers, MSM, and the prison population), recent evidence suggests that it has become a more generalized epidemic. The objective of our research was to explore how these trends in HIV prevalence and HIV-related mortality compare across Russia.Methods:We calculated HIV-associated mortality for both male and female individuals in each region (oblast) of the Russian Federation using data from the Russian Fertility and Mortality Database (RusFMD). Using current data on HIV prevalence, we computed the correlation between HIV prevalence and HIV-associated mortality. We also used oblast-level data to examine the associations between HIV prevalence and the risk factors most commonly associated with HIV infection.Results:Over the past 20 years, the Russian Federation has experienced a rapid increase in HIV-associated mortality in both male and female individuals. Our findings revealed significant heterogeneity, with higher rates of HIV-associated mortality reported in oblasts in the Siberian and Ural Federal Districts. There is a strong correlation (0.8) between HIV-associated mortality and virus prevalence. These findings confirm that there are regional disparities in access and adherence to antiretroviral therapy (ART), as indicated by the low correlation (−0.4) between virus prevalence and access to ART coverage. The results from our modeling analysis revealed that, in addition to the factors most commonly associated with this disease (e.g. intravenous drug use), knowledge about sexual transmission of HIV in the general population has a broad impact on its prevalence at the oblast level.Conclusion:Interventions that reduce HIV prevalence, for example, opioid substitution therapy and needle-sharing programs for people who inject drugs, as well as the increased availability of educational and preventive programs may halt the spread of HIV across the Russian Federation. Similarly, increased access to treatment could help in reducing HIV-related mortality.

Preventable mortality in the Russian Federation: a retrospective, regional level study

“…By contrast, whilst the HIV epidemic had been concentrated in a few marginalised groups in previous years, it has recently spread to the general population, with heterosexual transmission emerging as the predominant source of new infections. 49 , 50 …”

Sparse data obscure an unchecked Russian HIV epidemic

“…Can the current regime directing the Russian Federation government even be trusted to collect such sensitive information and not use it to continue to abuse marginalized populations within Russia and other former Soviet Bloc nations? The recent analysis of pre-COVID Russia by Nikoloski et al [1] does not inspire confidence in Russian authorities' abilities to effectively help vulnerable people within and near Russia.…”

“…The recent analysis of pre-COVID Russia by Nikoloski et al . [1] does not inspire confidence in Russian authorities’ abilities to effectively help vulnerable people within and near Russia.…”

“…This 'Russian aggression' should not be misunderstood as being universal and immutable across all people within Russia and of Russian ancestry. There have been good actors too, such as those maintaining any information about populations affected by HIV in Russia, including courageous community members, state workers, and NGOs with integrity [1]. This aggression seems to be disseminated and will require nuanced effort to mitigate while supporting stability and healing.…”

“…Although almost every other country in the world has made significant strides to control the spread of HIV/AIDS, and while Russian national protocol approximates testing for HIV and treating HIV as soon as possible [15], the picture that Nikoloski et al [1] paints is as bleak as pre-treatment era for most Russians. The authors reported that the areas hardest hit by HIV include areas with the lowest HIV knowledge and access to antiretroviral therapy.…”