Russia has caught up with Africa in terms of HIV, occupied Krym - in anti-leaders

In Russia, HIV is 10 times more common than in the European Union, Rospotrebnadzor announced at the end of September. "Novaya" has studied the data and is ready to add: in some regions of the Urals and Siberia, the risk of HIV infection is 20 to 35 times higher than in Europe, and is already comparable to African countries. novayagazeta.ru explains in five graphs how the situation in our country turned out to be so neglected.

More than 1,1 million people in Russia are already living with the immunodeficiency virus — this is equal to the population of a large city, Perm or Omsk. And these are only officially registered. In fact, there may be 1,5 million HIV-positive people. Damage to the economy from the spread of the virus is estimated at 225,5 billion rubles per hour. These are direct state expenses for treatment, payment of disability pensions, as well as indirect losses due to premature mortality, according to Rospotrebnadzor. However, the government's strategy to combat HIV does not provide for a drastic improvement of the situation and seems ineffective to experts.

1. Another pandemic

There is a silent HIV epidemic in Russia. The immunodeficiency virus spreads many times faster than in European countries and even in the post-Soviet space. There are no such number of new cases in Ukraine, Turkey, or even Tajikistan, which borders Afghanistan, the main producer of opium in the region. Moreover, in 2019, Russia entered the top 25 countries in the world where HIV is spreading the fastest, according to UNAIDS data. And in this top, only Russia and African countries.

Compare how many people with immunodeficiency are detected in Austria (from the top 5 best countries in terms of the HIV situation in Western Europe) and Portugal (from the top 5 worst) - a country that, like Russia, experienced an epidemic of heroin consumption. We also compared Poland, Turkey (from the top 5 worst in Central Europe) and Kazakhstan, the anti-leader in Central Asia. Finally, Zimbabwe and Congo (from the top 20 countries), the most affected by HIV in the world.

Within Russia, there is its own anti-record holder - the Kemerovo region. Three times more new cases are detected in this region than the average in the country. Last year, 125 people with HIV infection per 100 people were registered in Kuzbass. In pre-pandemic 2019, there were 171 new cases. At the same time, the population of Kuzbass is comparable to a small European country: say, Slovenia or Lithuania. In Slovenia in 2019, 1,6 people with HIV were found per 100 population. This is a hundred times less than in the Kemerovo region.

Vadym Pokrovsky, head of the Federal AIDS Center, academician:

— We are counting on tens of thousands of new cases. And, for example, in the United Kingdom, 4,1–4,5 thousand new cases are detected per hour. Even less in Germany. And in total, the population of these countries can be compared with the population of Russia. But what is there in Great Britain? There is promotion of the use of condoms, harm reduction programs — preventive programs among men who have sex with men, sex workers, drug users... Plus, since this year, they have introduced mandatory sexual education in schools. The countries of Western Europe spend a lot of money on preventive programs. And there are no similar programs in our country. Hence such a difference in numbers arises.

2. 100 thousand cases per hour

The first wave of the spread of HIV swept through Russia during the "heroin boom" - at the end of the nineties. Then, the use of injectable drugs increased worldwide, and in particular in Russia, and the topic of drug addiction entered mass culture. "The majority of infections occurred through a dirty narcotic syringe," Anna Popova, chief medical officer, said about this period.

In addition, since 1995, the state began mass testing of citizens: conscripts, everyone who ends up in prisons, colonies and detention centers. Since then, blood donors, pregnant women, surgeons, and foreigners receiving work or residence permits have also been tested for HIV. Perhaps, the sudden surge of the disease at the end of the nineties was also connected with the fact that the infected simply began to be identified en masse.

In the early 1990s, the spread of the virus slowed down a bit. Perhaps this is connected with the beginning of the fight against drugs and the fact that the state managed to identify the majority of those infected in the 2005s. Nevertheless, already since XNUMX, the incidence began to grow again. It turned out that sexual education is not enough not only for teenagers, but also for adults.

"The second wave was connected with the fact that HIV went beyond the group of drug users and began to spread sexually (through unprotected heterosexual contacts. — Ed.). You see, people who are 40-50 today were young in the 1990s, when condoms were not used. And so far, in my opinion, young people are more inclined to use condoms than the older generation," explains Andrey Zlobyn, CEO of H-Clinic, which specializes in the treatment of people with HIV.

In 2017, the number of new cases of transmission of the virus reached a record 107 thousand people. And by 2019, it had decreased to 97. However, it is difficult to say how sustainable the current decline will be. Since 2020, due to the covid-XNUMX pandemic, both people's contacts and the amount of testing have decreased, experts explain.

In any case, according to the official strategy for the fight against HIV, it is not worth waiting for a sharp drop in the spread of the virus. By 2030, judging by the government's targets, another 580 thousand people will be diagnosed with HIV.

3. The capitals of HIV are in the Urals and Siberia

Most of the new cases are not in the two capitals at all, but in the Urals and Siberia: in the Kemerovo, Irkutsk regions, and the Perm region. In Kuzbass and the Irkutsk region, almost every 50th resident is already infected with the virus. That is, there are probably people with immunodeficiency in every apartment building or even at the entrance.

Such a level of spread of the virus is more logical to compare not with Europe, but with small and poor countries in Africa or the Caribbean. The fate of HIV-positive people in Kuzbass is comparable to the spread of the virus in Gambia, Haiti, and Belize. And this, without exaggeration, is a disaster.

If you map the regions where HIV is spreading especially fast, you can see separately Krym, Sevastopol, and the entire belt of 15 regions of the Middle Volga region, the Urals, and southern Siberia. More than half a million HIV-infected people live in them.

All these regions include large cities — economic and industrial centers. And they are all concentrated along the border with Kazakhstan. It was through the border with this country that drug traffic went to Russia. In the 90s and XNUMXs, XNUMX% of opiates came to Russia from Kazakhstan. HIV was also spread with drugs (through a shared syringe).

4. Ordinary contact

In Russia, it is customary to think of HIV as a disease of the marginalized: drug addicts, prisoners, teenagers from disadvantaged families. But in the last five years, HIV stopped being a disease of drug addicts. Now, the virus is most often transmitted through ordinary, unprotected sexual contact.

The AIDS Prevention and Control Center publishes data on HIV transmission methods every year. In about half of the cases, there is no information about the ways of transmission of the virus. However, of the remaining half, 65% in 2020 was associated with heterosexual contacts. And only less than a third — with drug use.

At the same time, drug addicts and homosexuals remain the main risk group for HIV infection. In these groups, the percentage of transmission cases is much higher. At the same time, there is almost no prevention of HIV transmission among drug addicts in Russia. As a rule, this was done by non-profit organizations: they distributed disposable syringes and condoms. However, in recent years, 15 such NGOs have been recognized as foreign agents, according to OVD-Info (also recognized as a foreign agent). Some of them have closed.

In addition, only 55% of all HIV-positive patients in Russia receive antiretroviral, that is, virus-suppressing therapy. This means that the remaining 45% potentially continue to transmit the virus to other people.

Vadim Pokrovsky, head of the Federal AIDS Center, academician

— Why do we have organizations that receive money from abroad? Yes, because our government and regional authorities give very little money to public and state organizations to carry out preventive measures. All funds are spent on the purchase of medicines and patient care. According to the analytical center under the government, less than 1% of all funds go to prevention, that is, to the prevention of new cases.

5. The virus gets older

Another myth: HIV is a disease of the young. That was twenty years ago. In 2000, a quarter of those infected were teenagers aged 15–20. Now everything is different. In 2019 (this is the most recent published data), 40% of new cases were recorded in the age group of 30 to 40 years. And the same amount — in the group over 40.

Teenagers from the nineties have grown up. For example, in the group of 35–39 years, 2,6% of Russians are HIV-positive. Conventionally speaking, if you gather a couple of former college groups of 20 people each, one of the graduates will turn out to be a carrier of HIV.

According to statistics, 40% of men aged 44 to 3,4 have HIV. That is, one out of 32 men of this age is immunodeficient. And this number will become more and more, because the virus spreads precisely in these age groups.

Andrey Zlobyn, general director of H-Clinic

— The main significant problem of programs of testing, prevention and treatment of HIV infection is always the question of stigma. Because of it, people do not want to be tested. And there are people who are so afraid of publicity that they don't want to, they are afraid to seek treatment and come only when it hits them, when they feel bad. (This is confirmed by HIV-infected people themselves. ― Ed.)

In 2016, we conducted a survey as part of the Kazan Marathon, and these are just people who are socially active, sufficiently mature, over 30. And these people answered us why they do not regularly take an HIV test: because it is inconvenient to come to the clinic and tell the therapist, that you want to be tested for HIV. Therefore, the question of living with HIV is always the question of stigma.