Who’s Infected
The prevailing thought among Russian citizens is that HIV is a disease of the homeless and drug user - but statistics say otherwise. HIV continues to grow throughout the Russian population. The following describes those groups that have been hardest hit.IV Drug Users (IVDU) – Russia has a very large IVDU population. Some estimates put the total at somewhere around 2 million people or two percent of the Russian population. Russia has outlawed the possession of needles and syringes, so sharing of those things is very common. In fact, Russian culture views it as being very rude if one refuses to share their needles and syringes.
Because of this, 40 percent of IVDUs utilize non-sterile needles and syringes. Compounding the problem is the fact that, because IV drug use is outlawed, users are very reluctant to use the healthcare system for any reason. All these factors combined has resulted in an HIV infection rate among IVDU to be about one in four, 80 percent of those being under the age of 30.
Sex Workers – Because of the prolific drug problem in Russia, sex for money is very commonplace. Women and men trade sex for drug money, meaning that a huge percentage of sex workers are IVDU, meaning many are HIV-infected as well.
To make matters worse, these sex workers go home to husbands, wives, girlfriends or boyfriends and have unprotected sex with them as well. Many partners don’t realize that their partner is a sex worker engaging in very risky behavior. The use of condoms is inconsistent among sex workers. In fact, even if condoms are used with their sex clients, they are not used with their regular sexual partners at home, meaning the partners of sex workers are often infected as well.
Prisoners/Inmates – Simply put, the prison system in Russia is deplorable. Prisons are very overcrowded, some having seven times more inmates than than the official capacity of the prison. This overcrowding results in very unsanitary prison conditions where disease and illness are common. Because IV drug use is illegal, a high percentage of inmates are IVDU. This, combined with the high incidence of unprotected sex between male inmates, results in a rapid spread of HIV across the prison population.
Women – Over the past several years, heterosexual transmission of HIV is on the rise. Between 2001 and 2003, heterosexual transmission rose from about five percent to 20 percent, and of those, 40 percent are women. As the number of infected women rises, so does the number of babies. Programs to curb infection between mother and baby (vertical transmission) are just now being put into place. Fortunately, Russia is seeing positive results, decreasing the vertical transmission rate from 27 percent to 12 percent over the course of 24 months.
Blood Transfusions – While the West has seen the transmission risk by blood transfusion all but eliminated, Russia still has a problem. The root of the problem may surprise you. In some cultural circles, blood transfusions are thought to be the key to a healthy life. Transfusions are done to "bless" the individual with good health. Often these transfusions are entirely unnecessary, especially among children.
Unfortunately, the blood supply is suspect at best with regard to HIV. This has led to an infection rate due to blood transfusions far above the world norm, and sadly many of those are in children. Many believe this is the primary reason Russia has the highest HIV rate among children in Europe.
The HIV Circle of Infection
Russia has a very interesting "circle of HIV infection" where different groups interact and intertwine with one another to fuel the spread of HIV. It can be a very complex series of twists and turns so I’ve summarized the interactions:- Sex workers have a high incidence of IVDU so they can infect those who they have sex with and those who they share needles with.
- IVDUs often go the jail, infecting prisoners they have unprotected sex with and share needles with.
- Former prisoners infect sex workers and loved ones at home.
- Customers of sex workers infect their loved ones at home as well as new partners they have when they enter into new relationships.
- Finally, IVDUs infect their loved ones at home after getting HIV from IVDU or sex workers.
As you can see, the groups with highest risk have a unique system of interaction with one another, fueling an HIV epidemic.
Page 3 looks at what is being done about the Russian HIV problem.
