Science Magazine
6/11/18
UNAIDS calculates that between 2010 and 2015, Russia accounted for more than 80% of the new HIV infections in the entire Eastern European and the Central Asian region. By Russia’s own estimates, the epidemic grew 10% per year during that period, with the new infections roughly split between people who inject drugs and heterosexual transmission. At about the same time, new infections in the rest of Europe and North America dropped by 9%. By the end of 2017, the Russian Ministry of Health estimates, just shy of 1 million people were living with HIV. Even official accounts acknowledge that only one-third of those receive ARVs (antiretroviral drugs). Many people, even within the government, think those estimates understate the epidemic. HIV took off in Russia in the mid-1990s, later than in Western European countries, and at first the spread was limited mainly to heroin users sharing needles and syringes. No program yet provides ARVs to high-risk uninfected people, a prevention strategy called pre-exposure prophylaxis (PrEP) that has had remarkable success, particularly with MSM in Western Europe, Australia, and the United States. On top of all those challenges, Russia has a dysfunctional medical system, says Olga Bogolyubova, a psychologist who did HIV/AIDS research in St. Petersburg but, fed up, moved to the United States in 2015.
St. Petersburg is often out of step with Moscow and has made solid headway against HIV/AIDS. The most westernized city in the country, St. Petersburg “is kind of an oasis,” says Gregory Vergus, who works with an HIV/AIDS NGO called the International Treatment Preparedness Coalition. As a federal city, St. Petersburg directly receives funding from Moscow for HIV prevention, and Vergus says it invests the money wisely, focusing on vulnerable groups. “Most regions spend their HIV prevention money on balloons, songs, and working with grannies,” he says. In 2016, new infections in the city dropped below 2000 people a year for the first time since the epidemic took off, according to the city’s AIDS center. Of the 36,000 residents who know they are living with HIV, about half now receive ARVs, and 82% of that group have undetectable levels of virus in their blood, meaning they are adhering to their treatment regimens. “We’re doing something right,” says Tatiana Vinogradova, deputy director of the St. Petersburg AIDS Center. In 2016, new infections in the city dropped below 2000 people a year for the first time since the epidemic took off, according to the city’s AIDS center. Of the 36,000 residents who know they are living with HIV, about half now receive ARVs, and 82% of that group have undetectable levels of virus in their blood, meaning they are adhering to their treatment regimens. “We’re doing something right,” says Tatiana Vinogradova, deputy director of the St. Petersburg AIDS Center. But St. Petersburg is only one city in a highly populated, geographically expansive country. They have a treatment coverage level that is half what it is in Zimbabwe. This epidemic is not going to go away on its own.