Global summary of the AIDS epidemic
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Source: 2008 Report on the Global AIDS epidemic
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Source: 2008 Report on the Global AIDS epidemic
UNAIDS publishes a new "Report on the global AIDS epidemic" every two years. The Report draws upon and publishes the best available data from countries and provides an overview and commentary on the epidemic and the international response.
Full text of the 2008 Report on the global AIDS epidemic and previous years can be downloaded at the UNAIDS global web-site: http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008
Status of HIV/AIDS epidemic in the Russian Federation
The HIV epidemic in the Russian Federationcontinues to grow, though not as rapidly as in the late 1990s. The annual number of newly registered HIV cases declined between 2001 and 2003 (from a peak of 87 000 to 34 000), but has risen again subsequently. In 2006, 39 000 new HIV diagnoses were officially recorded, bringing the total number of HIV cases registered in the Russian Federation to about 370 000 (AIDS Foundation East-West, 2007; EuroHIV, 2007).
Those officially documented HIV cases represent only those persons who have been in direct contact with the Russian Federation’s HIV reporting system.
According to the latest official statistics of the Federal AIDS Centre of the Russian Federation as of June 30 2008 there are 438,827 HIV cases registered in Russia among country citizens. (http://hivrussia.ru)
By the 2008 Report on the global AIDS epidemic the actual number of people living with HIV in Russia at the end of 2007 could be as high as 940 000 [estimated range from 630 000 to1,3 million]. (2008 Report on the Global AIDS Epidemic. UNAIDS)
Although the HIV epidemic is affecting all of the Russian Federation’s regions, it has been concentrated largely in urban and industrial centres. A large proportion (59%) of HIV cases reported to date have been in 10 major cities and regions: the cities of Saint Petersburg and Moscow, the regions of Chelyabinsk, Irkutsk, Leningrad, Moscow, Orenburg, Samara, Sverdlovsk and Khanty Mansiisk autonomous republic (AIDS Foundation East-West, 2007). Injecting drug use remains the main mode of HIV transmission in the Russian Federation.
Of the newly registered HIV cases in 2006 where the mode of transmission was known, two thirds (66%) were due to injecting drug use and about one third (32%) to unprotected heterosexual intercourse (Ladnaya, 2007). The latter proportion, though, has been increasing steadily since the late 1990s, especially in areas with comparatively mature epidemics. In Orenburg, for example, 64% of newly registered HIV cases in 2006 were attributed to sexual intercourse (Zebzeeva, 2007).
Overall, women comprised about 44% of newly registered HIV cases in 2006 (Russian Federal AIDS Centre, 2007). National HIV prevalence among pregnant women is still low and was estimated at 0.4% in 2005 and 2006 (Ladnaya, 2007), although prevalence of 1% or more has been recorded in some areas, including Saint Petersburg and Orenburg (Lazutkina, 2007; Volkova, 2007). Substantial proportions of HIV positive women - ranging from one in seven to one in two in a recent five-region study - have reported injecting drugs (WHO, 2007). Most other HIV-positive women are believed to have acquired HIV through unprotected sex with injecting drug users. It is estimated that between 1.5 million and 3 million (or 1%–2%) of the Russian Federation’s population (141.4 million) are injecting drug users (Rhodes et al., 2006), and that most of them (about two thirds or more, depending on the location) are male (DfID, 2006). Nevertheless, a significant percentage are female—about one third (34%) in Moscow and one quarter (24%) in Volgograd, according to various studies (DfID, 2006) .
Large proportions of injecting drug users use non-sterile injecting equipment, which carries a high risk of HIV transmission. In Saint Petersburg, 79% of the 900 injecting drug users enrolled in one study said they had used non-sterile needles (Kozlov et al., 2006). About 60% of the injecting drug users surveyed in Barnaul (Siberia), Moscow and Volgograd said they had injected drugs with previously used syringes or needles, and one in seven (14%) had done so in the previous four weeks. Most (84%) had used other non-sterile injecting paraphernalia in the previous month (DfID, 2006). In the Samara and Saratov oblasts, use of non-sterile injecting equipment was less frequent (about 15% of injecting drug users had used someone else’s equipment in the previous 12 months), but more than two thirds had used other non-sterile injecting equipment (such as filters and containers) (Population Services International, 2007a). Among 520 injecting drug users followed for 12 months in a study in Saint Petersburg, HIV incidence was 4.5% (Kozlov et al., 2006).
Estimated HIV prevalence varied from 3% in Volgograd to 9% in Barnaul and 14% in Moscow (DfID, 2006). Other studies have found HIV prevalence of 30% among injecting drug users in Saint Petersburg (Shaboltas et al., 2006) and more than 70% in Biysk (Pasteur Scientific and Research Institute of Epidemiology, 2005). Up to two thirds of the injecting drug users testing HIV-positive in such studies were unaware that they had been infected (Rhodes et al., 2006).
New research also highlights the importance of social relations within networks of injecting drug users. For example, all the new injecting drug users participating in another Saint Petersburg study had been recruited by older, long-term injecting drug users, many of whom were likely to have already been HIV-positive. Newcomers using non-sterile injecting equipment or having sex with their “mentors” faced very high risks of exposure to HIV (Stormer et al., 2006).
The high prevalence of syphilis and other sexually transmitted infections found in injecting drug users suggests that unprotected sex is commonplace. In Barnaul, Moscow and Volgograd, between one half and two thirds of injecting drug users participating in studies had had more than two sexual partners in the previous 12 months. Between one half and three quarters of them had not consistently used condoms with non-paying sexual partners in the previous month. Sex between persons who inject drugs and those who do not is common, which underlines the possibility of HIV transmission from injecting drug users to the wider population (DfID, 2006).
The sexual transmission of HIV from male injecting drug users to their female partners is especially evident in Moscow, Saint Petersburg, the Sverdlovsk region of the Urals and in the central Russian Federation. Indeed, there is a substantial overlap between sex work and injecting drug use in this country’s HIV epidemic. Four in 10 (39%) female sex workers in Samara oblast said that they had injected drugs (Population Services International, 2007b), as did 37% in a Saint Petersburg study (Benotsch et al., 2004), and up to 30% of sex workers participating in other studies (Rhodes et al., 2004). Sex with a non-regular partner was common. Almost half the sex workers who were injecting drug users in the Saint Petersburg study said that they had used injecting equipment with others (Benostch et al., 2004); also, among the Samara sex workers, only two thirds (67%) said that they had consistently used condoms during paid sex, and only one quarter (24%) had done so with non-paying partners (Population Services International, 2007b).
There have been moves to develop prevention and treatment programmes inside the country’s correctional system, where a large proportion of the prison population are current or former injecting drug users (DfID, 2006). A study in Moscow has identified high HIV prevalence among prisoners,and found that a history of imprisonment was significantly associated with increased risk of HIV infection (DfID, 2006). Nationally, HIV prevalence among prisoners reached an estimated 4.3% in 2006 (Ladnaya, 2007). In 2006, fewer than 1% of newly registered HIV cases in which the mode of transmission was known were attributed to unsafe sex between men (EuroHIV, 2007), but this possibly underestimates the extent to which HIV has been transmitted among men who have sex with men in the Russian Federation’s epidemic.
Research among men who have sex with men has revealed significant risk-taking that can increase the chances of acquiring HIV. In a survey carried out in nine regions of the country among men who have sex with men, 22% had bought sex, 10% had exchanged sex for some form of compensation and 2% had injected drugs. Condom use was relatively infrequent: more than one in three men (38%) did not use condoms with permanent partners, and four in ten (42%) did not use them with commercial partners (Population Services International, 2007c). An earlier survey in Saint Petersburg among men visiting nightclubs for homosexuals found that more than one in five of the men had bought or sold sex, yet fewer than half (46%) of them regularly used condoms (Amirkhanian et al., 2001, 2004).
HIV prevalence among men who have sex with men varies from place to place. In Nizhni Novgorod, about one in ten (9%) men who have sex with men were found to be HIV-positive in 2006 (Ladnaya, 2007), but lower HIV prevalence has been found in Yekaterinburg (4.6%), Saint Petersburg (3.8%) and Moscow (0.9%) (Smolskaya et al., 2004; Smolskaya, 2006). The lack of sexual behavior information for the general population in the Russian Federationmakes it difficult to gauge the extent to which sexual transmission of HIV might progress, independent of HIV spread among injecting drug users and their partners. The likely evolution of the overall epidemic is therefore difficult to predict. The Russian Longitudinal Monitoring Survey conducted among more than 6000 Russians between 1992 and 2003 found low rates of HIV-related risky sexual behaviours in the general population. Only 5% of participants reported having had sex without a condom with two or more partners in the previous 12 months, and although 2% said they had injected drugs at some point in their lives, only 0.2% said they had done so in the previous month. The study also suggests that younger population groups might be adopting safer sexual behaviour, compared with 30–40-year-olds (DfID, 2006). However, other evidence indicates that young people are becoming sexually active at earlier ages, and that they rarely use condoms. On average, 14–20-year-olds began having sex before their 16th birthday; whereas, on average, 30–40-year-olds had not had sex until they were 18 years old. In addition, almost two thirds (63%) of sexually active 14–20-year-olds said they had not used a condom the last time they had sex (Vannappagari & Ryder, 2004).
Source: Eastern Europe and Central Asia: AIDS epidemic update: regional summary, UNAIDS, WHO, 2008
The AIDS Epidemic Update is a joint UNAIDS and WHO report published annually since 1998. It provides the most recent estimates of the epidemic's scope and explores new findings and trends in the epidemic's evolution at global and regional levels.
UNAIDS and WHO modify their estimates as new scientific data, research and analyses emerge. As advances are made to methodology, data collection and surveillance, the estimates of numbers of people living with HIV are revised to reflect these improvements.
Full text of the 2007 AIDS Epidemic update and for the previous years can be downloaded at the UNAIDS global web-site: http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2007/default.asp
Monitoring Progress on the Implementation of the Declaration of Commitment on HIV/AIDS
In adopting the 2001 Declaration of Commitment on HIV/AIDS, Member States committed themselves to regularly report on their progress in responding to HIV to the General Assembly. The UN Secretary-General entrusted the UNAIDS Secretariat with the responsibility for developing the reporting process, accepting reports from member States on his behalf, and preparing a report for the General Assembly. Member States are required to submit country progress reports to the UNAIDS Secretariat every two years.
In 2008, countries are reporting on 25 core indicators which are described in detail in the 2007 Guidelines on Construction of Core Indicators. The 2008 reports mark an important time point in assessing progress towards the Universal Access to HIV prevention, treatment, care and support, and the targets set in the Declaration of Commitment.
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