risk factors impacting on the spread of hiv among pregnant women ...

RISK FACTORS IMPACTING ON THE SPREAD OF HIV AMONG PREGNANT WOMEN IN THE RUSSIAN FEDERATION
INTRODUCTION
The first HIV case in Russia was registered in 1987. Until 1996, only isolated cases of hetero- or
homosexual HIV transmission were registered, predominantly among males.
In 1996-1997, HIV spread explosively among IDUs in several regions. The number of regions
involved in the epidemic increased every year. The highest number of new HIV cases officially registered
nationwide was documented in 2001 (88,577 cases).
According to the data from the areas with the highest HIV prevalence, parenteral transmission predominated
in the first 3-4 years after the onset of the epidemic, which was mainly spreading among
men. At a later stage, heterosexual transmission had reached 30–50% in some areas by 2005
(Kaliningrad District, Tver District, Yekaterinburg, Krasnoyarsk Region, etc.).
The increase in the proportion of women in the HIV-positive population (feminization of the epidemic)
indicated that the epidemic had expanded and changed. Up to 30% of HIV-positive women
are pregnant. Most HIV tests are done and most HIV cases are discovered when women seek antenatal
care. The number of new HIV cases among pregnant women per 100,000 patients tested
nationwide has grown by 190.3 times between 1996 and 2003, with HIV prevalence in a number of
areas during certain times of the year approaching 1% (as per Statistical Form No.4).
According to international criteria based on investigations of epidemics in various continents, pregnant
women are regarded as members of the general population and HIV prevalence of above 1% in
this group indicates a generalized epidemic. In view of this, some Russian and international authors
refer to the HIV epidemic in certain regions of the RF as a “transition to a generalized epidemic”.
However, a number of <strong>factors</strong> indicate that such classification of the epidemic in Russia may be premature.
There are far more reasons to suggest that most infected people can blame their HIV status
on belonging to high <strong>risk</strong> groups (IDUs, SWs) or on their immediate social environment. This
assumption rests on the following grounds:
• Drug use, both experimental and regular, is practised by both men and women, but because of
stigmatization, women tend to seek specialist drug treatment less frequently than men.
Consequently, information about female IDUs is patchy, practically inaccessible for analysis and
often not officially registered.
• Some women report contracting HIV from their IDU sexual partners, which means that they may
have experimented with drugs and may have been infected parenterally.
• Some women deny both using drugs and the possibility of sexual transmission, suggesting that
they may have been infected in medical settings, which can not be proved even after epidemiological
tracing.
• Women identified as HIV-positive during pregnancy often mechanically define their transmission
route as sexual because they are pregnant.
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