Are Former Soviet Nations Plodding Down Wrong Path? Experts Lack Optimism for the Region

Instead of supporting needle exchanges and other harm reduction strategies that have been proven to reduce the spread of HIV, Russia and some neighboring countries are arresting drug users, in some cases apprehending users at needle exchanges sponsored by international organizations, said Kasia Malinowska-Sempruch of the Open Society in New York City.

Between 1987 and 1996, Russia had 1,000 cases of HIV, most transmitted within hospital settings or among MSM, said Robert Heimer, Ph.D., of the Yale School of Medicine. In 1996, 1,500 more cases appeared, most from IDU transmission. Heimer said a worsening socioeconomic climate resulted in youth alienation, increasing risk behaviors, increases in crime, drug use and STDs.

By 1997, HIV cases had risen to 4,300; in 2001, cases numbered 88,000 and now there are nearly 250,000 known cases in Russia. There could be four to six times as many HIV-positive people undiagnosed, Heimer noted.

In some Eastern European cities, the infection rate among IDUs is greater than 60 percent, said Malinowska-Sempruch. The Open Society supports 200 harm reduction programs in the region, but those efforts are just a drop in the bucket.

"Between 3 percent and 6 percent of IDUs are receiving HIV-prevention services, so obviously, the epidemic we're seeing now is not going to stop," she commented.

Although only 15 percent of Russians with HIV got it through non-IDU transmission, the trend is unlikely to continue because the average age of Russian IDUs is mid-20s, and they are likely to practice unsafe sex. Experts predict a generalized heterosexual epidemic possibly within the next five to seven years, which could leave around 10 million to 20 million infected.

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