X HIV/AIDS Prevention and Care in Resource-Constrained Settings

years combined. HIV prevalencevaries from fewer than two percentof IDUs registered officially inRussia, to about 30 percent in sentinelsurveys in Ukraine andRussia, and more than 60 percentin Svetlogorsk in Belarus and indrug-injecting CSWs inKaliningrad. HIV prevalenceamong other population groupsseems to have remained low so far.While about 130,000 Russiansare believed already to be livingwith HIV, the Russian Ministry ofHealth estimates the number ofIDUs in Russia at about threemillion—two percent of the totalpopulation—providing a largepool of highly vulnerable but notyet infected persons. Although notconfirmed in scientific studies,similarly high estimates also havebeen made for Ukraine and otherNewly Independent States. Withthe deteriorating economic situationof women, the number ofwomen engaging in sex work andpotentially at high risk of infection is believed to haveincreased considerably.At the same time, large epidemics of syphilis andother STDs have been reported from these countries.In Russia alone, between 200,000 and 400,000 newcases of syphilis have been reported annually in thepast few years. This may be only the tip of the iceberg,as under-reporting is believed to be high. Althoughmajor spread of HIV via heterosexual transmission inthe population at large has not yet been confirmed,the massive increase in STDs in the populations ofEastern European countries proves the potential formore widespread HIV/AIDS epidemics.F igure 8Annual Number of Newly Registered HIVInfections, Russia, 1993–1999161412106420Number of HIV infections (thousands)93 94 95 96 97 98 99Year of registrationSource: Russian Federal AIDS Centre, Moscow.■■■The epidemics in this region feature:An estimated 420,000 adults and children livingwith HIV in Eastern Europe and in the countriesof the former Soviet Union by the end of 1999.Only a year later that number was estimated to bemore than 700,000, with the Russian Federation,Ukraine, Belarus, Kazakhstan and Moldova themost severely affected.Most HIV infections in this region are due toIDU, with HIV prevalence rates greater than 60percent in some cities, including Odessa andNikolaev in the Ukraine, Svetlogorsk in Belarusand Kaliningrad in the Russian Federation.Men account for three-quarters of all HIV infectionsregistered in the region, with as many as 60percent of infected persons between the ages of 15and 24.HIV/AIDS Prevention and Care in Resource-Constrained Settings XV