Russia's HIV/AIDS Epidemic Enters New and More Dangerous Phase

Yesterday, Gennady Onishchenko, Russia's chief public health official, said that the total number of HIV-infected people in his country since the first infection in 1987 amounts to 467,016, a figure that most other Russian experts and the World Health Organization say is far too low (medportal.ru/mednovosti/news/2009/02/17/hiv/). In the last year alone, Onishchenko continued, the number of new infections, identified in the course of some 24 million HIV tests, rose by 50,670. And he said that of those whose infections had developed into full-blown AIDS since 1987, 31,636 had died prematurely, again a number many experts say is too low given the propensity of doctors to underreport such deaths. According to the public health chief, the places with the highest rates of HIV infections are St. Petersburg and Leningrad oblast, Moscow and Moscow oblast, and Sverdlovsk, Samara, Irkutsk, Chelyabinsk, Orenburg, and Kemerovo oblasts and the Khanty-Mansiisk Autonomous District, whose population is overwhelmingly ethnic Russian. In his briefing yesterday, Onishchenko did not provide much context for the numbers he reported. But in an interview with "Nauka i zhizn'," Boris Denisov, a demographer at Moscow State University, suggested that figures like those Onishchenko provides are more disturbing than the public health chief in fact suggested (www.nkj.ru/archive/articles/15097/). Russia is only just now entering what he called "the mature phase" of the HIV/AIDS epidemic, Denisov said. Compared to Western countries, the first infections occurred in Russia later and after an initial upsurge increased relatively slowly from the mid-1990s until 2002, when things stabilized. But since 2006, he noted, the epidemic in Russia has "again accelerated." The Moscow State researcher pointed to three aspects of the situation which suggest Russia has reached the tipping point regarding HIV/AIDS and that the epidemic is likely to result in an increasingly large number of deaths, something that will have a serious impact on the over-all demographic picture of that country. First and foremost, 63 percent of the new cases in the Russian Federation last year were the result of sexual contact rather than intravenous drug use, a pattern that means the disease has now passed into the general population where it may spread more slowly but could potentially touch far more people and where an increasing share of its victims will be women. Second, Denisov continued, although this epidemic began in Russia later than in Europe, it started long enough ago in the Russian Federation that many of those infected are approaching the time at which, absent radical medical intervention, an increasing fraction of them are likely to die. And third, as he and others have reported, the Russian government has decided against the use of some of the more expensive treatment regimes now being employed successfully in Western Europe and the United States, a decision that the current economic crisis means the government is unlikely to reverse anytime soon. But unless Moscow makes a serious investment in this area, it will soon discover that the impact of the HIV/AIDS epidemic will cost it any of the small gains that its pro-natalist policies have achieved. And it will find that the costs of treating those who come down with full-blown AIDS will far exceed the costs of treating those whose infection has not reached that point.