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The only regions in the world where the HIV epidemic continues to spread rapidly are Eastern Europe and Central Asia, according to a new UNAIDS report. Russia in these regions accounts for 80% of new HIV cases in 2015, the international organization notes. Another 15% of new diseases are in Belarus, Kazakhstan, Moldova, Tajikistan and Ukraine.
In terms of the spread of the epidemic, Russia has even surpassed the countries of South Africa, according to recent statistics on the incidence. Meanwhile, the Russian authorities not only do not increase funding for the purchase of medicines for patients, but, according to reports from the regions, they even increase the savings on this item.
Comparing published UNAIDS statistics on new HIV cases in different countries With the number of patients already in these countries, Gazeta.Ru became convinced that our country is the leader in terms of the spread of HIV not only in its region.
The share of new cases of HIV in 2015 in Russia is more than 11% of the total number of people living with HIV (95.5 thousand and 824 thousand, respectively, according to the Federal AIDS Center). In the vast majority of African countries, the number of new cases does not exceed 8%, in the largest countries South America this proportion in 2015 was about 5% of the total number of patients.
For example, in terms of the rate of growth of new cases in 2015, Russia overtakes African countries such as Zimbabwe, Mozambique, Tanzania, Kenya, Uganda, each of them has almost twice as many patients as in our country (1.4-1.5 million people ).
More new cases than in Russia now occur annually only in Nigeria - 250 thousand infections, however, the total number of carriers there is many times higher - 3.5 million people, therefore, in the share ratio, the incidence is lower - about 7.1%.
HIV epidemic in the world
In 2015, there were 36.7 million people living with HIV worldwide. Of these, 17 million received antiretroviral therapy. The number of new infections was 2.1 million. Last year, 1.1 million people died from AIDS worldwide.
The number of new HIV infections in Eastern Europe and Central Asia has increased by 57% since 2010. Over the same period, the Caribbean saw a 9% increase in new cases, the Middle East and North Africa- 4%, in Latin America - 2%.
The decrease was noted in Eastern and South Africa(by 4%), as well as in the Asia-Pacific region (by 3%). In Europe, North America, Western and Central Africa there was a slight decrease.
In the largest countries of Latin America - Venezuela, Brazil, Mexico - the proportion of new HIV infections remained at the level of 5% of the number of carriers. For example, in Brazil, where the number of people living with HIV is about the same as in Russia (830,000), 44,000 people were infected in 2015.
In the United States, where there are one and a half times more HIV patients than in Russia, about 50,000 people fall ill every year, according to the AVERT charity, which finances the fight against AIDS.
Russia can't cope on its own
UNAIDS experts see the main reason for the deterioration of the situation in the fact that Russia has lost international support for HIV programs and has not been able to replace it with adequate prevention at the expense of the budget.
In 2004-2013, the Global Fund remained the largest donor of HIV prevention in the region (Eastern Europe and Central Asia), but as a result of the classification of Russia as a high-income country, international support has disappeared, and domestic funding for HIV has not ensured adequate coverage of antiretroviral therapy (prevents the transition of HIV to AIDS and provides prevention of infection).
The amount of grants from the Global HIV Fund amounted to more than $200 million, the head of the Federal AIDS Center told Gazeta.Ru. “Many preventive and treatment programs were carried out with this money in the country. After the government returned this money to the Global Fund, it focused mainly on financing treatment, and there was no one to finance prevention programs, they stalled,” he complains.
Similar messages come from St. Petersburg, Perm Territory and other regions. At the same time, the total amount of funds provided in the federal budget for 2015 and 2016 for the purchase of antiretroviral drugs is approximately the same - the amount remains at the level of about 21 billion rubles, part of the funds from it is directed to purchases for federal medical institutions.
In the budget of 2015, 17.485 billion rubles were allocated directly to the regions, in 2016 the amount slightly decreased and amounted to 17.441 billion rubles. Information on whether the funds were brought to the regions in full or somehow redistributed or frozen, federal ministries kept secret. The Ministry of Finance and the Ministry of Health did not respond to the relevant requests from Gazeta.Ru.
According to the government report on the implementation of the anti-crisis plan, which Gazeta.Ru managed to get acquainted with, the money was transferred to the budgets of the regions in full, but they refused to confirm this information.
How the world is fighting HIV
Measures to combat HIV are generally the same all over the world: prevention includes informing the population, identifying the most vulnerable groups of citizens, distributing contraceptives and syringes, active measures are antiretroviral therapy that maintains the standard of living of those who are already sick and does not allow the patient to infect others. However, each country has its own regional peculiarities.
Governments in the United States primarily fund social campaigns against the taboo of AIDS. Also, with the help of social actions, Americans are called for regular testing, especially if a person belongs to one of the most vulnerable groups - black citizens, men who have had homosexual contacts, and others.
Another way to combat the spread of HIV and AIDS is sex education. In 2013, HIV was taught in 85% of American schools. In 1997, these programs were taught in 92% of American schools, but due to the resistance of religious groups of citizens, the enrollment rate has declined.
From 1996 to 2009, more than $1.5 billion was spent promoting abstinence as the only way to fight HIV in the United States. But since 2009, funding for "orthodox" methods has been declining, more funds have been allocated to bring comprehensive information.
However, according to the Kaiser Family Foundation, only 15 states so far mandate contraception when talking to schoolchildren about HIV prevention, despite the fact that, according to statistics, 47% of high school students have had a sexual experience. HIV education remains optional in 15 states, as is sex education, and in two more states only sex education is included in the program.
In China, according to 2013 data, 780 thousand people live with the immunodeficiency virus, of which more than a quarter receive antiretroviral therapy. The most vulnerable populations are gays and bisexuals, young Chinese under 24, drug addicts who inject themselves, and there is a high proportion of infections from mother to child. In the PRC, infection most often occurs through unprotected sex, so preventing sexual transmission of the virus accounts for the bulk of the effort. Among the measures are treatment for couples in which one of the partners is infected with HIV, distribution of free condoms, popularization of testing for the virus, and informing children and adults about the disease.
A separate category of efforts is the fight against the illegal market for donated blood, which flourished after the ban in the 1980s on imported blood products. Entrepreneurial Chinese, according to Avert, were looking for plasma donors in rural areas, completely unconcerned about the safety of the procedure. Since 2010, China has begun testing all donated blood for HIV.
In India, the world's second largest country, 2.1 million people were living with HIV in 2015, one of the highest rates in the world. Of the patients, 36% received treatment.
Hindus distinguish four risk groups. These are sex workers, illegal immigrants, men who have had homosexual contacts, drug addicts and the hijra caste (one of the untouchable castes, which includes transgenders, bisexuals, hermaphrodites, castrates).
As in many other countries, the fight against HIV in India is carried out through reaching out to the most vulnerable, awareness raising, distribution of condoms, syringes and needles, and methadone substitution therapy. The epidemic in the country is on the decline: in 2015, according to UNAIDS, fewer people were infected here than in Russia - 86 thousand people.
In Latin and Central America, 1.6 million people were living with HIV in 2014, 44% of whom received the necessary treatment. Among the measures taken by the countries of the region to combat the epidemic are social campaigns explaining what HIV is and why those who are sick cannot be discriminated against. Such actions were held, in particular, in Peru, Colombia, Brazil, and Mexico. Five countries—Argentina, Brazil, Mexico, Paraguay, and Uruguay—had needle and syringe programs, and substitution therapy was used in select cities in Colombia and Mexico. In some countries of the region, sick people receive cash benefits.
Australia, which has one of the lowest incidences in the world, has achieved this by implementing comprehensive prevention programs and by never stopping them. She also started the fight against HIV earlier than others, draws the attention of Pokrovsky from the AIDS Center. “For example, back in 1989, I got acquainted with the work of the Australian Prostitutes Collective, which was engaged in the prevention of HIV among sex workers. This and dozens of similar projects have been constantly funded by the government,” he emphasizes.
Irkutsk and Samara region with 1.7 and 1.6% of HIV-infected, respectively. Next come: Sverdlovsk region (1,6%), Kemerovo region(1.5%), Orenburg region (1.2%), Leningrad region (1,2%), Chelyabinsk region(1%), St. Petersburg (1%), Tyumen region (1%; including autonomous regions).
“The number of people infected with HIV in the Urals is not something out of the ordinary,” confirms Vadim Pokrovsky, director of the federal AIDS Center, who first reported on the HIV epidemic in Russia in May 2015. In his opinion, in the 1990s, large quantities of injecting drugs were brought into "relatively prosperous" cities, which led to an outbreak of HIV infection among drug addicts. Later, the infection spread to the rest of the population, the expert explains. The expert includes Irkutsk, Samara, Togliatti (in this city, according to Pokrovsky, 3% of the population is infected), Chelyabinsk and St. Petersburg.
Regions with megacities are the most problematic, agrees Andrei Skvortsov, coordinator of the Patient Control movement. Official data for some cities, for example, for St. Petersburg, can be underestimated by a factor of three, RBC's interlocutor is sure (according to official data, there are 53.3 thousand HIV-infected people out of 5.2 million people in the city).
It is difficult to say in which region official statistics are hidden and in which not, Maxim Malyshev, coordinator of street social work at the Andrey Rylkov Foundation for Health Protection and Social Justice, notes. “The situation is bad in all regions – somewhere more, somewhere less. However, there are historically established places where the statistics are always higher - Yekaterinburg, Kurgan, other Siberian cities, ”he points out.
At risk
Today, the narcotic mode of HIV transmission is gradually fading away, says Pokrovsky. According to the Federal AIDS Center, 48% of infections occur in heterosexual relationships. “It has to do with serial monogamy. People do not live long with one person, but constantly change partners. If at least one HIV-infected person gets into this chain, then everyone becomes infected, ”Pokrovsky believes.
The main methods of fighting the epidemic: effective prevention programs, the introduction of sex education in schools and substitution therapy for drug addicts. “In France or Germany, substitution therapy is legal and there are dozens of times less infected. As long as we have a conservative approach, whose supporters raise a terrible howl and urge to go their own way, the number of infected people will grow. First you need to stop the epidemic and only then promote a healthy lifestyle,” the expert sums up.
Prevention measures
Russia will be saved by condoms, modern drugs for the treatment of HIV, public information, free tests to determine one's status and harm reduction programs for drug addicts, lists Skvortsov from Patient Control. “For a long time, the problem of the spread of HIV as a shameful disease was hushed up. Only this year, some campaigns for free HIV testing began. The situation needs to be corrected urgently,” he points out.
First of all, Skvortsov believes, it is necessary to provide 100% of registered patients with HIV with antiretroviral therapy - lifelong maintenance therapy for people with human immunodeficiency virus, blocking the spread of infection. For the convenience of patients, the state should purchase combined drugs containing several active ingredients at once. This reduces the chances that an HIV-infected person will stop taking therapy due to a large number tablets, Skvortsov points out.
Secondly, Russia needs to introduce harm reduction programs for drug addicts. “Russian officials believe that such programs are just distributing methadone among drug addicts. But it's not. Harm reduction programs are a set of measures aimed at identifying an injecting drug user, giving him the opportunity to pass all the tests, provide legal support and help rehabilitation,” says the expert.
First of all, prevention should be introduced among risk groups, Malyshev from the Rylkov Foundation believes. “Now there is almost no street work - there is no distribution of either syringes or condoms. In Russia, only 26 organizations are engaged in real prevention, and several of them are recognized as foreign agents and they are not allowed to work at all, ”he said.
Today, five non-profit organizations specializing in HIV infection in Russia are recognized as foreign agents, RBC found out. These are the Perm NPO "Sibalt", the Saratov "Socium", the Penza "Panacea" and two Moscow organizations - "Esvero" and the Andrei Rylkov Foundation.
In 2016, the Russian government sent an additional 2.3 billion rubles to the Ministry of Health. for the purchase of antiviral drugs for the prevention and treatment of HIV-infected people. The corresponding order was signed by Prime Minister Dmitry Medvedev. According to him, the Sverdlovsk region will receive the most a large sum among the regions - 260.6 million rubles. On October 25, a government in which money to counter the spread of HIV has not yet been provided.
TASS-DOSIER. From May 15 to May 21, 2017, the All-Russian Action "Stop HIV/AIDS" will be held in Russia for the third time. It is organized by the Foundation for Social and Cultural Initiatives (the President of the Foundation is the wife of the Prime Minister of the Russian Federation Svetlana Medvedeva). The action is supported by the Ministry of Health, the Ministry of Education and Science, the Ministry of Communications of Russia, Rosmolodezh, Rospotrebnadzor, as well as the Union of Rectors of Russia, leading state universities of the Russian Federation and the Russian Orthodox Church.
She is dedicated to world day in memory of the victims of AIDS, which is held annually on the third Sunday of May. Its goal is to draw attention to this problem in Russia, to raise awareness of the population, especially young people, about the disease.
Campaign "Stop HIV/AIDS"
The all-Russian action "Stop HIV/AIDS" began to be held in Russia in 2016. The key event of the first action, which took place in May, was an open student forum. The second action was timed to the World AIDS Day (December 1) and took place at the end of November. It started at the II All-Russian Forum for specialists in the prevention and treatment of the disease (November 28).
As part of the action, an open lesson "Knowledge - Responsibility - Health" was held in senior classes of secondary schools, at which a film was shown on topical issues of combating HIV infection.
HIV/AIDS disease
The human immunodeficiency virus (HIV) attacks the immune system and weakens the body's defenses against a wide range of infections and diseases, including some types of cancer. HIV-infected people gradually develop immunodeficiency.
The last stage of the disease that develops when infected with the human immunodeficiency virus is AIDS (acquired immunodeficiency syndrome), when the human body loses the ability to defend itself against infections and tumors. In different people, AIDS can develop 2-15 years after HIV infection.
There is no cure for HIV infection. However, with antiretroviral treatment, the virus can be controlled and transmission prevented. This facilitates and prolongs the life of those infected with the infection.
Statistics for Russia
The epidemiological situation of HIV infection in Russia (the first case was detected in 1987) is unfavorable, cases of the disease have been identified in all regions of the Russian Federation.
According to Rospotrebnadzor, as of December 31, 2016, since 1987, 1 million 114 thousand 815 cases of HIV infection have been registered among citizens of the Russian Federation, of which 243 thousand 863 people have died. Thus, at the beginning of 2017, 870,952 Russians were living with HIV/AIDS in Russia, which is 0.59% of the total population of the country (146,804,372). As of December 31, 2016, the prevalence of HIV was 594.3 people with an established diagnosis per 100,000 of the country's population.
The number of newly diagnosed HIV infections in the country continues to rise. According to Rospotrebnadzor, in 2011-2016. the annual growth averaged 10%. In 2016, the territorial centers for the prevention and control of AIDS registered 103,438 new cases of HIV infection (excluding those identified anonymously and foreign citizens) - 5.3% more than in 2015 (95 thousand 475).
High prevalence of HIV is observed in the 30 largest subjects of the Russian Federation, where 45.3% of the country's population lives. The most unfavorable regions, where the number of people living with HIV exceeds 1 thousand people per 100 thousand population, are Sverdlovsk (1648 per 100 thousand population), Irkutsk (1636), Kemerovo (1583), Samara (1477), Orenburg (1217) region, Khanty-Mansiysk autonomous region(1202), Leningrad (1147), Tyumen (1085), Chelyabinsk (1079) and Novosibirsk (1022) regions.
A high level of HIV infection in the Russian Federation is observed in the age group from 30 to 39 years. Among young people (15-20 years old), more than 1.1 thousand people with HIV infection are registered annually. Cases of infection of children during breastfeeding continue to be detected: in 2014, 41 children were infected, in 2015 - 47 children, in 2016 - 59.
In 2016, 675,403 patients (77.5% of all those living with a diagnosis of HIV/AIDS) were registered at the dispensary in specialized medical organizations. Of these, 285,920 patients received antiretroviral therapy (42.3% of those registered).
HIV/AIDS in the world
Some scientists believe that HIV was transmitted from monkeys to humans as early as the 1920s. The first victim of this disease may have been a man who died in 1959 in the Congo. This conclusion was reached by doctors who later analyzed his medical history.
For the first time, the symptoms of the disease characteristic of HIV/AIDS were described in 1981 during examinations of several men of non-traditional sexual orientation in clinics in Los Angeles and New York. In 1983, researchers from the US and France described a virus capable of causing HIV/AIDS. Since 1985, blood tests for HIV have been available in clinical laboratories.
According to World Organization health care, at the end of 2015 there were from 34 to 39.8 million (on average - 36.7 million) HIV-infected people in the world. Sub-Saharan Africa is the most affected region, with an estimated 25.6 million people living with HIV in 2015 (about two-thirds of those infected). More than 35 million people have become victims of HIV/AIDS worldwide. In 2015 alone, approximately 1.1 million people died. As of June 2016, 18.2 million patients had access to antiretroviral treatment, including 910,000 children.
According to the report announced at the Fifth International Conference on HIV, held in March 2016 in Moscow, the following ranking of 10 countries was compiled by the number of people infected with AIDS. The incidence of AIDS in these countries is so high that it has the status of an epidemic.
AIDS Acquired immune deficiency syndrome secondary to HIV infection. It is the last stage of the disease of an HIV-infected person, accompanied by the development of infection, tumor manifestations, general weakness, and ultimately leads to death.
10th place. Zambia
1.2 million patients with 14 million population. Therefore, it is not surprising that the average life expectancy there is 38 years.
9th place. Russia
In 2016, the number of people infected with AIDS in Russia exceeded 1 million people according to Russian healthcare, 1.4 million according to the EECAAC-2016 report. Moreover, the number of infected in the last few years has been growing rapidly. For example: every 50th inhabitant of Yekaterinburg is HIV-positive.
In Russia, more than half of patients became infected through a needle while injecting a drug. This way of infection is not the main one for any country in the world. Why exactly in Russia such statistics? Many say it was driven by the move away from oral methadone as a substitute for injecting drugs.
Many mistakenly believe that the problem of infection of drug addicts is only their problem, it is not so scary if the "dregs of society" acquire diseases that lead to death. A person who uses drugs is not a monster that can be easily identified in a crowd. He leads a completely normal life for a long time. Therefore, spouses and children of drug addicts are often infected. There are cases when infection occurs in clinics, beauty salons after poor disinfection of instruments.
Until society realizes the real threat, until random partners stop assessing the presence of STDs “by eye”, until the government changes its attitude towards drug addicts, we will rapidly rise in this rating.
8th place. Kenya
6.7% of the population of this former English colony are HIV carriers, namely 1.4 million people. Moreover, among women, the infection is higher, since in Kenya the social level of the female population is low. Perhaps the rather free manners of Kenyan women also play a role - they easily approach sex here.
7th place. Tanzania
Of the 49 million people in this African country, just over 5% (1.5 million) have AIDS. There are areas where the infection rate exceeds 10%: this is far from tourist routes Njobe and the capital of Tanzania - Dar es Salaam.
6th place. Uganda
The government of this country is making great efforts to combat the problem of HIV. For example, if in 2011 there were 28 thousand children born with HIV, then in 2015 - 3.4 thousand. The number of new infections in the adult population has also decreased by 50%. The 24-year-old king of Toro (one of the regions of Uganda) took control of the epidemic into his own hands and promised to stop the epidemic by 2030. There are one and a half million cases in this country.
5th place. Mozambique
More than 10% of the population (1.5 million people) are infected with HIV, and the country has no own forces to fight the disease. About 0.6 million children in this country are orphans due to the death of their parents from AIDS.
4th place. Zimbabwe
1.6 million infected per 13 million inhabitants. Such figures have led to widespread prostitution, lack of basic knowledge about contraception and general poverty.
3rd place. India
Official figures are about 2 million patients, unofficial ones are much higher. Traditional Indian society is quite closed, many people ignore health problems. Educational work with young people is practically not carried out, it is unethical to talk about condoms in schools. Hence the almost complete illiteracy in matters of protection, which distinguishes this country from the countries of Africa, where getting condoms is not a problem. According to surveys, 60% of Indian women have never heard of AIDS.
2nd place. Nigeria
3.4 million HIV patients per 146 million population, less than 5% of the population. The number of infected women is higher than men. Since there is no free medicine in the country, the most terrible situation is in the poor segments of the population.
1 place. South Africa
The country with the highest incidence of AIDS. Approximately 15% of the population is infected with the virus (6.3 million). About a quarter of high school girls already have HIV. Life expectancy is 45 years. Imagine a country where few people have grandparents. Scary? Although South Africa is recognized as the most economically developed country in Africa, most of the population lives below the poverty line. The government is doing a lot of work to stop the spread of AIDS, providing free condoms and testing. However, the poor are convinced that AIDS is a white invention, as are condoms, and therefore both should be avoided.
Bordering South Africa, Swaziland is a country of 1.2 million people, half of whom are HIV positive. The average resident of Swaziland does not live up to 37 years.
