Russia is facing a serious deterioration in the epidemic situation related to HIV, with the number of newly infected among military personnel increasing by more than 40 times since the start of the war in Ukraine. According to data from the Russian Ministry of Defense, by the end of 2022 there was a 13-fold increase in new cases, and by the beginning of 2023 it was already more than 40 times compared to pre-war levels. Later that year, the spread of HIV among the military was 20 times higher than usual, the opposition publication The Moscow Times reported, News.bg reports.
Globally, HIV is in decline, but in Russia the disease continues to grow. More than 1 million Russians have been living with the virus since 2016, almost 1% of the population and between 1.5 and 2% of people of working age. Between 50,000 and 100,000 new cases are registered each year. According to UN data, Russia is among the top five countries in the world in terms of the number of new infections, along with South Africa, Mozambique, Nigeria and India - the latter two with many times larger populations.
The reasons for this epidemic are both medical and political. Military actions contribute to the uncontrolled spread of the virus: there is no access to regular antiretroviral therapy (ART) on the front lines, which suppresses the virus and prevents its transmission. Treatment interruptions lead to the emergence of resistant strains that spread easily. In addition, in field conditions, syringes are often reused or blood transfusions are performed with questionable sterility.
The classic routes of transmission of the virus - unprotected sexual contact, including with prostitutes, and injection drug use - have also not disappeared.
Even before the war, the Russian healthcare system did not provide treatment for all those in need. Only the richest regions financed full therapy, and the switch to cheap local generics often led to shortages. After the invasion began, the situation worsened even more: for the first time in years, less than 50% of those diagnosed with HIV in Russia receive treatment.
In parallel, repressions against civil society organizations seriously hinder prevention. Foundations such as the Elton John AIDS Foundation were declared “undesirable”, and local NGOs broke off cooperation with them. The declaration of the LGBT+ community as an “extremist organization” further hinders access to help and reinforces stigma.
Although by law HIV-positive individuals are unfit for military service, these rules are often ignored. There are cases in which commanders refuse to release seriously ill soldiers due to a shortage of personnel. At the same time, the practice of falsifying diagnoses in order to avoid mobilization continues at draft boards.
The epidemic is now also affecting the civilian population. In 14 Russian regions, more than 1% of pregnant women test positive for HIV. A threshold that, according to the WHO, marks the transition to a generalized epidemic. This means that the virus is no longer concentrated among risk groups, but is spreading widely in society.
Despite the alarming data, the Russian Ministry of Health rejects international assessments and accuses UNAIDS of “propaganda“. Meanwhile, the rest of the world is making significant progress: in the US, clinical trials of a vaccine with over 90% effectiveness are progressing, and new therapies allow for administration by injection only a few times a year.
The international strategy “90-90-90“ - 90% diagnosed, 90% on therapy, 90% with suppressed virus - is already showing results in many countries, including Africa, where new cases have decreased by 20% and deaths by 40% over the past decade.
In Russia, however, health decisions remain in the shadow of politics. The country refuses to implement substitution therapy for drug addicts (such as methadone), despite its proven effectiveness. There is a lack of sex education in schools, which limits young people's awareness of protective equipment and testing.
Those infected during the war will need lifelong, expensive therapy, not only for their own health, but also to interrupt transmission of the virus. This will place a serious strain on the Russian healthcare system, budget, and labor market, with consequences that will be felt long after the end of the war and Vladimir Putin's rule.