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The Russian Federation has demonstrated a necessary, high-levelcommitment in response to the AIDS epidemic. This country has more peopleliving with HIV/AIDS than any other country in Europe, and accounts foraround two-thirds of the known infections in Eastern Europe and Central Asia.Russia identified its first case of HIV in 1987 and until 1995 the prevalencerate remained low. In 1996, the infection rate exploded with 1,515 newcases. After reaching its highest level to date in 2001, the annual number of newly diagnosed cases of HIV/AIDS in Russia has remained relatively steady.At the end of 2005, there were approximately 350,000 registered cases of HIV/AIDS in Russia. However, these figures do not adequately represent thesituation, as many HIV/AIDS cases are not officially reported. The HIV epidemic in the Russian Federation continues to grow althoughnot as rapidly as it did in the late 1990s. The population of Russia isapproximately 141,377,752 as of July 2007. The annual number of newlyregistered HIV cases declined between 2001 and 2003, but has subsequentlystarted to increase again. This initial reduction could be due to fewer peoplebeing tested, or it could be that HIV prevalence rates have reached saturationpoint amongst intravenous drug users. In 2006, there were 39,000 new HIVdiagnoses officially registered with the Russian Federation’s HIV reportingsystem. Today, the number of registered cases is estimated to be about370,000, however that number has been estimated to be closer to one millionwhen unregistered cases are taken into consideration. Eighty percent of infected people in Russia are under the age of 30. The area once known as the Soviet Union is now comprised of 17different countries, one of which is the Russian Federation. In the 1980’smandatory HIV testing was instituted across the Soviet Union. There were noprivacy laws in Russia at that time and the results of these tests completewith names of the infected, were widely publicized via mass media.Prevention during this time consisted of fear-based advertising campaignsand persecution of people with positive test results. Privacy laws were not inexistence during that time and most often testing was done without theconsent or knowledge of the person being tested. To worsen matters,homosexuality was illegal at that time, further stigmatizing these men thattested positive for the infection. The political unrest that occurred in theSoviet Union in the 1990’s pushed the issue of HIV to the background. By1991, over 142 million people had been tested, practically none of who wereanonymous in nature. Further complicating the issue was the fact thatforeign prevention literature, which was once translated into Russian, was nolonger available. Russia was also witnessing a “sexual revolution” andanonymous sexual liaisons were common during this time. Safe-sexeducation was non-existent and IV drug use was on the rise resulting in ahuge increase in HIV and other sexually transmitted diseases.After the breakup of the Soviet Union and with the formation of newlyindependent Soviet states, HIV commanded little attention, importance andeven less funding. Until 1995, the infection primarily spread through sexualcontact, mainly through unprotected homosexual intercourse. At that time, asteady increase in the number of HIV-positive people occurred with 100-150new cases registered per year. (Russian Federation Country Progress Report,2006) A network of specialized HIV/AIDS facilities were established acrossRussia in response to these statistics, including comprehensive training to

educate medical professionals about HIV/AIDS prevention, diagnostics andtreatment. However HIV still remained a low-priority issue with the emphasison the newly independent Russian Federation. There were poor networkingamong the few HIV organizations that existed and an inadequate flow of information being transmitted between the agencies. From 1996 onward, theepidemiological situation worsened as the disease became prevalent amongdrug users. 87,000 people living with HIV were identified in Russia in 2001. This marked the peak of officially recorded annual HIV incidence in theRussian Federation. (Country Report of the Russian Federation On theImplementation of the Declaration of Commitment on HIV/AIDS, 2005) Therehas been some decline in the numbers of HIV cases registered annually,however incidence remains very high. The history of the epidemic is important in our understanding of howand why certain stereotypes have come to be associated with this disease. The prevailing mentality among Russian citizens is that HIV is a disease of thehomeless and drug user, but statistics have shown otherwise. Injection druguse remains the predominant means of transmission. There is, however,clear evidence of a significant rise in heterosexual transmission. Russia hastheir own circle of infection where different groups interact and intertwinewith one another to fuel the spread of HIV. The groups that make up themajority of infected persons are intravenous drug users, sex workers,homosexuals, prisoners/inmates, women, and people that have had bloodtransfusions.Intravenous drug users (IVDU) make up about 2% of the Russianpopulation. A large number of people throughout this region are using drugsmore frequently and sharing needles. An estimated 30-40% of injecting drugusers in Russia use non-sterile needles or syringes. (UNAIDS) Sinceunauthorized possession of needles or syringes is illegal in the region, manydrug users are compelled to share. Additionally Russian culture considers itrude if you do not share needle while doing drugs. This, combined with poormedical care and fear amongst drug users of using available health careservices, has all led to the spread of HIV amongst intravenous drug users.Because of the prolific drug problem in Russia, sex for money is verycommonplace. A large percentage of sex workers are IVDU, meaning manyare HIV-infected as well. These men and women are engaging in sexualrelations on a regular basis and may or may not use protection. Condom useis inconsistent among sex workers. Even if they do use condoms with clients,they are not used with their regular sex partners at home, meaning thepartners of sex workers are often infected as well. A study done in Moscowfound that many sex workers also injected drugs using non-sterile needlesand of this group 45% were HIV-positive. (UNAIDS) According to the CIA factbook, Russia is a significant source of women trafficked to over 50 countriesfor commercial sexual exploitation.As the first case of HIV in the Russian Federation was identified amonghomosexual men, this group was the first one to be identified as vulnerableto HIV. Since 2004 the number of homosexual men tested for HIV hasincreased continuously, while the number of HIV cases reported for this groupincreased almost two-fold. The factors identified as risk factors in sexualbehavior of men having sex with men (MSM) are high number of sexualpartners, risky sexual practices including unprotected anal sex, bisexuality as

well as low motivation for safer sex and accessing STD treatment.Another group at high-risk are the prisoners/inmates in Russian jails. The prisons in this area are often very overcrowded, some having seventimes more inmates than the official capacity of the prison. Theovercrowding results in unsanitary conditions and increase the rate of diseaseand illness among prisoners. Many of those imprisoned are IDU’s who havebeen charged because they used illegal drugs. A majority of this groupcontinues to use drugs in prison and to share needles. This combined withthe high incidence of unprotected sex between male inmates, results in therapid spread of HIV across prison populations.Women comprise a steadily increasing proportion of HIV cases.Between 2001 and 2003, heterosexual transmission rose from about 5% to20%, of which 40% were women. According to the 2007 UNAIDS Update,women comprised about 44% of newly registered HIV cases in 2006 in theRussian Federation. Women in Russia are particularly vulnerable tocontracting the disease because they suffer from an overall lack of information of contraception options, STD prevention, and sexual issues ingeneral. Russian women suffer from a lack of sex and health education, and itis very difficult for them to discuss contraception with a partner.Furthermore, condom use is very unpopular. The economic dependence of women on their sexual partners often means they have little bargainingpower over condom use. Young women are particularly at risk because theirreproductive organs are immature and more likely to tear during intercourse,making infection more likely. Thus infected women find themselves isolatedwithout a support system and unable to control many important aspects of their lives. The HIV virus is easily transmitted through blood transfusions. Somecultures, such as Russia, believe that infusions of fresh blood can fortify ahealthy body and remedy diseases that are not blood-related. Transfusionsare often entirely unnecessary, especially those done among children. Whilethe West has seen the transmission risk by blood transfusion all buteliminated, the Russian Federation still faces considerable risk of transmissionof HIV through blood infusion. Blood products are used several times perpatient in this country and the tests to ensure that healthy blood is used arenot always accurate.Russia has a population that is getting older with declining birthrates.An aging population, combined with an increasing death rate of working-agemales due to alcoholism, heart disease and HIV, has contributed to thenegative population growth rate in Russia. The disease is spreadingpredominantly among young people aged 15–39. With more than 70% of allpeople living with HIV/AIDS in Russia being young men aged 15–39, it isestimated that GDP, investment and labor supply will all decline between nowand 2020 unless there is an increase in effective HIV prevention. (The WorldBank Group ‘Combatting HIV/AIDS in Europe and Central Asia, 2005) If leftunchecked, this trend is sure to will a significant economic impact on Russiaand worldwide. The epidemic most heavily affects young people who make up thelargest part of the labor force. HIV/AIDS reduces the proportion of