The Union of Soviet Socialist Republics, also known as the U.S.S.R. or the Soviet Union, disintegrated at the end of 1991, splintering into 15 independent countries. These countries can be divided into five subregions: the gigantic Russian Federation, still the world's largest country; the three western countries of Ukraine, Belarus, and Moldova; the three Baltic states of Estonia, Latvia, and Lithuania; the three Transcaucasian nations of Georgia, Armenia, and Azerbaijan; and the five Central Asian republics of Uzbekistan, Turkmenistan, Kyrgyzstan, Tajikistan, and Kazakhstan. All of these countries except the three Baltic states later became members of the Commonwealth of Independent States, which is a loose alliance permitting each country far more independence than the Moscow-centered Soviet Union.
The collapse of the Soviet Union in 1991, largely as a result of massive political, economic, and ideological failures, followed in the wake of the overthrow of Soviet-dominated Communist regimes throughout eastern Europe. Among other things, the collapse brought further damage to an already inadequate public health system. As a result, many infectious diseases, including diphtheria, cholera, and hepatitis B, reached epidemic proportions. Rates of sexually transmitted diseases (STDs) skyrocketed in several of the former republics, with statistics indicating an increase of between 200 and 500 percent in syphilis and chlamydia. Price deregulation created a dramatic inflation in food prices, sparking widespread malnutrition. Prostitution increased as the local currency continued to decrease in value and foreign business people began arriving. Civil unrest in the countries of Central Asia and the Transcaucasian region, as well as unbearable economic conditions, has led to mass migration to large cities in Russia and Ukraine. High suicide rates, widespread alcoholism, and a shortened life span are further indications of the turmoil faced by the countries of the former Soviet Union.
AIDS-awareness campaigns in Russia tend to focus on scare tactics, as does the poster at top, which reads: "AIDS -- Come to Your Senses!!!"
The poster at bottom is unusual in that it conveys useful, if simplistic, information about AIDS; the text indicates that risk groups include narcotics users, bisexuals/homosexuals, and prostitutes.
Despite all these factors, the number of confirmed HIV infections has remained relatively low in the region. Prior to its dissolution, the Soviet Union was virtually isolated from the influences of the West. In the early years of the epidemic in the United States, news about the "Western problem" of AIDS was frequently in the Soviet press. Because homosexual activity and injecting drug use were illegal under Soviet law, officials were confident that HIV/AIDS would never be a problem in their country.
The 1987 discovery of almost 300 cases of HIV among children infected in medical settings in the cities of Elista, Volgograd, Krasnodar, and Rostov-na-Donu created shock waves among Soviet health officials. Universal precautions were immediately mandated by the ministry of health. The government of the Soviet Union developed the country's first national program for AIDS prevention and control. By 1989, the system consisted of a national center, seven regional centers, and 82 territorial or local centers. The main activity of these centers was surveillance of HIV infections and AIDS cases; from the beginning of the epidemic in the Soviet Union, emphasis was placed on testing as a preventive and control measure.
A number of categories of individuals have been subject to compulsory HIV-antibody testing, including drug users, known homosexuals and bisexuals, people with STDs, "individuals having casual sex," citizens returning from abroad, blood donors, pregnant women, recipients of blood products, soldiers, prisoners, and people with clinical indications of AIDS. Between 30,000 and 100,000 foreigners located in the countries of the former Soviet Union have been tested per year since testing began in 1987.
The total number of HIV-antibody tests performed in the Soviet Union (before 1991) and the Russian Federation (since 1991) is over 142 million. Only 0.4 percent of these tests (approximately 600,000) were reported as being voluntary and consensual; people are typically unaware that they are being tested. Historically, testing policy and procedures have been the domain of the State Committee on Epidemiology and Sanitary Surveillance, which functions independently from the ministry of health.
The practice of HIV-antibody testing in the former Soviet Union has ranged from the questionable to the outright unreliable. The standard practice has been to collect ten samples of blood, combine them, and test the pooled mixture. Not only does this practice greatly dilute each sample, but very often the samples are kept for days and/or transported to another place before being tested. The tests -- enzyme-linked immunosorbent assay (ELISA) tests made in St. Petersburg -- are claimed to demonstrate an approximate 60 percent specificity of sensitivity. There is no pre-test counseling, as most people do not know that they are being tested. If an individual has a positive test result, post-test counseling is in the form of a document that he or she is required to sign stating: "You are the carrier of a deadly disease and are criminally liable for any contact that would pass that disease to another person."
Strict specialization in the medical system has most likely resulted in many misdiagnoses of HIV/AIDS, as the most common HIV-related conditions go unrecognized by gynecologists, oncologists, pulmonary specialists, dermatologists, and other specialists. There is also a shortage of diagnostic equipment and medication, even for palliative care. The Soviet health model never placed emphasis on preventive medicine; thus, prophylactic treatment for opportunistic infection is rarely administered.
Because of the extremely centralized nature of the Soviet Union, the capital city of Moscow was historically the location of all government offices and structures. Even after the breakup of the Soviet Union, the documents and regulations in place in the former Soviet republics were very similar to those of Russia or were those that were adopted during the Soviet era.
Russia is by far the largest and most populous of the states of the former Soviet Union, with a population of more than 150 million. Predictably, Russia also has reported the greatest number of cases of HIV infection -- over 1,323 by the end of 1994. Of these, 460 were foreigners, who were deported. Of the Russian nationals who were infected, about one-fifth had died by the end of 1995. Of 139 deaths, 110 were owing to AIDS-related complications; the other 29 deaths were reported by the government as "unfortunate accidents or suicides."
Approximately one-third of confirmed cases of HIV in Russia were among children infected in medical settings. Another one-third of the cases were among homosexual men. No cases of HIV infection through injecting drug use had been reported by the end of 1995. However, subsequent reports have made clear that there has been considerable transmission owing to injecting drug use in Russia, particularly in the far western exclave of Kaliningrad Oblast. According to official statistics, as of 1994 there were 21 women who had contracted HIV "by nursing HIV-positive babies," although the actual route of transmission is almost certain to have been mother-to-child.
The vastness of the territory and the diversity of the population of Russia has made HIV/AIDS prevention and education difficult. Until recently, all prevention messages came from the government and were typically based on fear campaigns and discrimination against homosexuals. By the end of 1995, there were approximately 30 nongovernmental organizations (NGOs) involved in HIV/AIDS prevention, education, and support in Russia.
The first AIDS-related law, "On the Prevention and Spread in the Russian Federation of Disease Caused by Human Immunodeficiency Virus (HIV) Infection," was passed shortly before the collapse of the Soviet Union. A revised law went into effect in August 1995 in the Russian Federation. It was more specific on the rights of HIV-infected people and on the limits of compulsory testing, and it included provisions about prevention and the role of NGOs.
Ukraine, a Slavic nation that is the second most populous of the former Soviet republics, was the only country that had reported injecting drug use as its main mode of HIV transmission; the predominance of this mode of transmission can be explained, in part, by Ukraine's location on the drug trading route from Turkey to western Europe. According to Ukraine's ministry of health, by March 1994 there were 167 cases of HIV infection among Ukrainian nationals. In addition, 202 foreign nationals living in Ukraine had tested positive. The main law on HIV/AIDS in Ukraine is the "Law on the Prevention of AIDS and the Social Protection of the Population," which is a comprehensive law encompassing the rights of HIV-infected people, testing procedures, and certain protections for health professionals.
Health officials in the small Slavic nation of Belarus are still tackling the adverse health results of the 1986 nuclear station disaster at Chernobyl. Fallout from the explosion of the reactor in neighboring Ukraine fell mostly on Belarusan territory and is blamed by health authorities for weakening the immune systems of the area's residents, making them far more susceptible to infectious diseases. At the end of 1995, Belarus reported 109 HIV-positive residents, 15 of whom had progressed to AIDS. The small nation of Moldova, ethnically related to neighboring Romania, had an extremely low level of HIV infection, with fewer than ten cases confirmed by the end of 1995.
The Baltic states were the last to become members of the Soviet Union in 1940 and the first to declare independence. Because of their geographic proximity and cultural links to Scandinavia and the rest of western Europe, they have always been the least isolated of the former republics. As of August 1995, there were 57 confirmed HIV cases in Estonia; three of the patients had progressed to AIDS, and two had died. No transmission through injecting drug use had been identified. Almost half of the cases were the result of homosexual contact, and one-quarter were through heterosexual contact. Latvia followed in prevalence with just over 30 HIV-infected individuals. Lithuania had reported 20 cases of HIV among its citizens by the end of 1995. According to local activists, the strong Catholic majority in the country had placed restrictions on HIV-prevention messages in Lithuania and had limited discussion of condom use, homosexuality, and related issues.
Central Asia is often considered the poorest region of the former Soviet Union, and the economy has remained primarily based on agriculture. Over 80 percent of the population of this ethnically diverse region are Muslim. As of March 1994, the former Central Asian republics were still showing extremely low prevalences of HIV within their borders. Uzbekistan had the highest number of HIV infections, with just over 30 confirmed cases. The rest were as follows: Kazakhstan had 9 cases, Tajikistan, 2; and Turkmenistan, 1. Kyrgyzstan had not reported any HIV infections. A history of drug manufacture, use, and trafficking in the area remains cause for concern, however.
The Transcaucasian region has been embroiled in civil war and interethnic conflict since 1991. Attention to HIV/AIDS in the region has been minimal, owing to low numbers of infected individuals, an overburdened health system, an environment that is difficult for NGOs, and a general preoccupation with the demands of warfare. By the mid-1990s, Azerbaijan had reported 16 cases of HIV infection; Georgia, 8; and Armenia, 3.
Throughout the former Soviet Union, dramatic political and economic instability, flourishing organized crime, and epidemics of more acute infectious diseases have diverted attention from AIDS. As of the mid-1990s, HIV/AIDS had not yet become a priority for the citizens or governments of the former Soviet Union. With few exceptions, the average citizen still lacked the basic facts about HIV/AIDS, partly because of misinformation in the media and the lack of public discussion. Although the region is considered "low prevalence" by international experts, the official numbers of infected individuals have continued to grow steadily. Predicting the future of HIV/AIDS in the region is impossible without more accurate statistics and research in several areas.
Asia, East; Europe, Eastern; Europe, Northern; Middle East and North Africa
Baltic states, Central Asia, Commonwealth of Independent States, Slavic states, Soviet Union, Transcaucasia, U.S.S.R., [individual countries by name]
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The Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, Raymond A. Smith, Editor. Copyright © 1998, Raymond A. Smith. Carried by permission of Fitzroy Dearborn Publishers.
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