A rating of regions according to the level of HIV infection prevalence has been prepared

The annual ranking of regions by HIV prevalence was prepared by the analytical project “To Be Precise.” In 2022, the most difficult situation (rating E, the lowest) has developed in the regions of Siberia and the Urals – they have been anti-leaders for many years. Experts also note a new unexpected trend: in a number of regions, the incidence rate among rural residents has increased. At the same time, the number of regions where more than 1% of pregnant women are infected with HIV is growing. According to Kommersant’s interlocutors, these facts indicate the erosion of “traditional” risk groups.

To assess the scale of the HIV problem in the regions of the Russian Federation in 2022 (this is the last period for which statistics are available), analysts of the “To Be Precise” project compiled a rating based on five indicators: the number of new cases of the disease per 10 thousand examined; number of deaths from HIV-related causes per 100 thousand population; proportion of pregnant women with HIV; proportion of those receiving antiretroviral therapy (of all people with HIV); proportion of patients with undetectable viral load (of those receiving treatment).

The list of the most problematic regions does not change from year to year, experts emphasize. In 2022, the most difficult situation (rating E) developed in the regions of Siberia and the Urals: Kemerovo, Sverdlovsk, Chelyabinsk, Irkutsk and Tomsk regions, Altai, Krasnoyarsk and Perm territories. All of them previously had a rating of D or E, and the Kemerovo and Irkutsk regions have received an E rating for nine years in a row. These regions have the most people living with HIV per capita. The Kemerovo region is in the lead (2039 people with HIV per 100 thousand population), followed by the Irkutsk (1978) and Sverdlovsk regions (1910). The national average is 797 people.

In these regions, the percentage of those who use drugs is still high, says Alexey Lakhov, head of the committee of the Eurasian Harm Reduction Association: “Data from the state drug treatment service for 2021 show that the overall incidence of drug addiction disorders, in particular drug dependence syndrome, is highest as times in the Siberian Federal District (196.8 per 100 thousand population), the Far Eastern Federal District (189.2) and the Ural Federal District (167.2).” Siberian cities were often built around oil and gas sources, Mr. Lakhov recalls, and in the Urals and the Arctic – around mineral mines: “Such places attract migrant workers, and they are followed by an increase in the level of commercial sex, human trafficking (often from among migrants from heroin-producing countries) and the level of drug addiction.”

The most prosperous regions in terms of HIV are the Kirov, Lipetsk, Belgorod and Tambov regions, Kalmykia, Ingushetia and Mordovia (rating A). The lowest mortality rate is in the Lipetsk, Tambov and Orel regions, Karachay-Cherkess Republic, Tuva, Dagestan and Ingushetia (1 person per 100 thousand population). The fewest new cases are in Kalmykia (4.5 per 100 thousand), Chechnya (5.2), Ingushetia (6.7), Tuva (9) and Dagestan (10).

When the virus spreads beyond vulnerable groups and spreads throughout the population, they speak of a generalized epidemic. The stage of the epidemic is determined by the proportion of pregnant women with HIV, since an HIV test is mandatory for them. If their share remains consistently at 1% or higher for 2–3 years, the epidemic is considered generalized. On average in Russia in 2022, HIV was detected in 0.7% of pregnant women, experts report “To be precise.” However, in 19 regions in 2022 this share is above 1%. The largest number of pregnant women with HIV are in Kemerovo (2.2%), Tver (1.9%), Samara and Tomsk (1.8%) regions. The data does not take into account terminated pregnancies and cases where a woman was already diagnosed with HIV before she became pregnant, analysts point out. Such pregnancies are taken into account by the Federal AIDS Center, which estimates that the number of regions with a generalized epidemic is higher—27. In some regions, there is a high proportion of women with HIV among all those who terminated pregnancies. In the Tyumen region, 3.6% of abortions were performed by women with HIV, in the Samara region – 2.9%, in the Kemerovo region – 2.5%. In most regions this share does not exceed 1%.

The high proportion of pregnant women with HIV primarily indicates that transmission of the infection occurs through heterosexual means, says Vadim Pokrovsky, head of the department of epidemiology and AIDS prevention at the Central Research Institute of Epidemiology of Rospotrebnadzor. “If previously we observed mainly transmission among drug users and men who have sex with men, the high percentage of HIV among pregnant women suggests that the epidemic has spread beyond vulnerable groups, and it is necessary to expand measures to combat this infection,” comments Mr. Pokrovsky.

In some regions, the incidence has increased among the rural population, despite the fact that HIV is an urban disease, analysts point out “To be precise.” Rospotrebnadzor includes the Perm Territory, Novosibirsk, Kemerovo, Tomsk, Samara, Tyumen, Kurgan, Orenburg, Chelyabinsk regions, Chukotka Autonomous Okrug, Buryatia and Khakassia as such subjects. There, there are 60–97 cases per 100 thousand population – in most cases higher than the average population. The authors of the study conclude that the infection in these regions is “covering an increasingly wider segment of the population.”

Vadim Pokrovsky confirms that in general Russia has an “extraordinarily high” rate of HIV infection in rural areas. “There is only one explanation: if preventive measures are carried out, they are mainly in cities, and the countryside is practically not covered,” believes Mr. Pokrovsky. Alexey Lakhov points out that HIV infection (and associated mortality) first affects large cities, then urban settlements, and with a time lag of 2–4 years, the rural population. “Another alarm bell that says that the ‘traditional’ risk groups have blurred and now all people who have ever had sex without a condom with a partner whose HIV status is unknown to him or her are at risk,” he notes.

The chief freelance specialist on HIV infection, Alexey Mazus, told Kommersant that experts are recording a confident trend towards an annual decrease in the number of new patients – for example, in 2021 there were 59 thousand new cases, which is 2% lower than in 2020. Our country, he said, is a leader in the early detection model, which gives patients an unconditional opportunity to lead a full life after infection. The press service of the Ministry of Health added that Russia occupies a leading position in the world in HIV testing coverage. In 2022, it amounted to 32% of the population, which allows us to “reliably speak about the continuation of a confident trend towards an annual decrease in the number of new patients.”

The head of the monitoring department of the Zdravresurs expert group, Natalya Egorova, believes that such dynamics in HIV detection could be called positive if screening were carried out among key and vulnerable groups, but now it is “extremely limited, it can be carried out mainly by NGOs.” In those regions where the state and non-governmental organizations (namely, they have access to these closed groups) work together on the problem, says Mr. Lakhov – for example, in St. Petersburg, the Leningrad region, the Moscow region, Novosibirsk, Chelyabinsk – people succeed and test, and lead to treatment, and help maintain adherence to ARV therapy: “Now, against the backdrop of increasing pressure in case of receiving foreign funding (and it made up a significant part of the budgets of most HIV service NGOs), tightening legislation regarding LGBT people and the growth HIV-risky behavior associated with the difficult socio-political situation in Russia, the situation may worsen.”

Natalia Kostarnova