Russia HIV/AIDS Situation Analysis : Russia HIV/AIDS Situation Analysis December 2005 Dr Akram Eltom, 3x5 Country Program Officer, Russian Federation World Health Organization,


Russia Country HIV/AIDS Facts: As of 12/2005: Russia Country HIV/AIDS Facts: As of 12/2005 Population: 142.4 million (UN; 2004) HIV prevalence: 0.6-1.9% (2003 UNAIDS/WHO) Reported PLHIV: Over 340,000 (12/2005 FAC) Estimated PLHIV: 860,000 PLHIV (0.4-1.4 million; UNAIDS/WHO) In need of ART: 92,000 PLHIV by Dec 2005 (05/2005; FAC) National target: Not yet established Currently on ART: Less than 3000 PLHIV (FAC; 12/2005) Epidemic burden: Largest number of PLHIV in Europe Epidemic trajectory: 2nd fastest globally and in Europe European standing: Only RUS + TRK have 'poor ART access' Country context: Middle/high income, sufficient HRH + facilities, reasonable int’l funding of ART + prevention effort, healthy level of UN/donor coordination.


Burden among Russia’s marginalized groups: Burden among Russia’s marginalized groups Total IDU: 1.5 - 3.5 million persons; highest in EURO, EURO is highest in world, IDU % of PLHIV: Over 85% (WHO EURO; 12/2004) IDU % of ART patients: Less than 10% (see RUS bar next chart) HIV among IDU: Almost 65% in some cities IDU/CSW overlap: 5 - 15% of CSW have HIV; up to 48% among CSW who are also IDU HIV among prisoners: Estimated at 2 - 4%; 42,000 prisoners (Min. of Justice 11/2004). PMTCT: Small but potentially important part of overall burden


Russia’s key challenges in scaling-up ART: A very slow response vs. a very fast HIV transmission rate: Russia’s key challenges in scaling-up ART: A very slow response vs. a very fast HIV transmission rate Stigma andamp; Legal Barriers: Pervasive and deep among officials, healthy providers indifferent and/or discriminatory, public is deeply prejudiced towards marginalized groups. Treatment entry and mutually-dependent preventive services: e.g. VCT, harm reduction (including needle exchange), focused IEC and public awareness interventions among marginalized groups, education: Are all either completely absent or of negligible scale and very poor quality Service delivery organization: Vertical regional health services; weak/non-existent referral links among health care facilities andamp; with community-based outreach; no HIV services below oblast/city levels (rayon level). Civil society: weak service delivery capacity and currently facing fundamental challenges in advocacy; (civil society is crucial to accelerating prevention andamp; generating effective ART demand) Human resource preparedness: Weak patient focus, evidence-based intervention concept, inter-disciplinary collaboration. Cost of ART: still too high for PLWHA + health system.


Estimated ART need in Russia (Source: WHO – Regional Office for Europe): Estimated ART need in Russia (Source: WHO – Regional Office for Europe)


IDU and access to ART – 07/05* WHO EURO countries reporting for 31/12/2004 or later, other for 30/06/2004: IDU and access to ART – 07/05 * WHO EURO countries reporting for 31/12/2004 or later, other for 30/06/2004


4 key take-home messages: 4 key take-home messages Concentrated Epidemic: IDU, CSW, prisons, MSM Trajectory: Increasing heterosexual ‘spill-over’ through CSW, MTCT; but not yet 'bridged’ to be called a 'generalized' epidemic. Extreme inequity in access to services; especially IDU. Critical to further speed up action to scale up ART + accelerate prevention if Government is to succeed in reversing HIV epidemic in time before the (already closing) window of opportunity completely shuts down.