The return of a grievous epidemic: rising HIV/AIDs infections in the post-Soviet states6 min read

On December 1st, dozens of countries and organizations around the world observed World AIDS Day, an opportunity to mourn those lost to a disease that the United Nations once hoped to eradicate by 2030. Statements of solidarity were issued by leaders like Prime Minister Justin Trudeau of Canada, and thousands of individuals marched to raise awareness in countries such as South Africa, where 7.5 million people live with HIV. However, one state actor remained conspicuously silent. The Russian Federation, a country that bears the highest rate of HIV diagnoses in Europe, made no comments to commemorate or acknowledge World AIDS Day, except to deny the critical findings of a World Health Organization (WHO) HIV report the day before.   

2018 marks the 30th anniversary of the original declaration by WHO of World AIDS Day. This announcement came in the midst of a national scramble in the United States and many Western European countries to counter the rapid spread of HIV/AIDs. By the end of 1989, AIDs cases in the United States totaled 100,000, a shocking number of diagnoses for a disease that had only been given an official name seven years earlier. As much of the West rushed to respond to the HIV/AIDs tragedy, the Soviet Union was disintegrating, leading to a chaos that masked the new HIV outbreaks detected in the former Soviet Union in the 1990’s.

In 2013, UNAIDS announced that AIDS-related deaths had fallen 30 percent since their peak in 2005, a step in the right direction for most of the global community. However, while many countries around the world continued to tackle HIV/AIDs head-on, the former Soviet states started to show signs of crisis; the number of people living with HIV in Russia had topped one million in 2016, a number that has only continued to surge.

Overview of HIV and AIDs prevalence in the former Soviet Union. Source: Avert

Russia, unfortunately, is not alone in confronting the rising rates. Many Eastern European states, such as Belarus, Ukraine, and Moldova, are dealing with a shocking number of new HIV diagnoses: 160,000 in 2017 alone, according to a report by the European Centre for Disease Prevention and Control. The infection rates in countries formerly under Soviet influence that are now part of the European Union, with the exception of the Baltics, tend to run much lower compared to their Eastern European neighbors. In Russia specifically, infections are increasing by 10-15 percent each year, and the broad-brush regional picture is no better. AIDs deaths in Eastern Europe have jumped 38 percent in the past ten years, worsened often by the fact that many people do not realize they have HIV until the disease advances to debilitating stages. Simultaneously, Avert reported that the former Soviet states show a 30 percent increase in annual HIV infections between 2010 and 2017.

Despite the fact that HIV is a wholly manageable and preventable condition, rates continue to rise, the result of education failures, paralyzing stigma, and a lack of proper and accessible medical treatment. Two calamitous problems stand out above the other challenges: increasing injection drug use and the introduction of restrictive conservative legislation. These two trends are on a collision course that has left the region unprepared to face this new health crisis.

Not only is the production and availability of illegal drugs accelerating and reinforcing dangerous underground black markets, but recently Europe has witnessed the appearance of entirely new synthetic and highly potent substances. In Eastern Europe, opiates are particularly popular, part of the reason that the area has the highest regional prevalence of injection drug use in the world. The high prevalence of injection drug use, compounded by the depressingly lax efforts across the former Soviet Union to implement clean-needle exchanges, has induced the quick spread of HIV in Ukraine, Belarus, and Russia.

In the 2013 journal article “Addressing injecting drug use in Asia and Eastern Europe,” researchers compared efforts in Asia and Eastern Europe to decrease drug injection use in preventing HIV. While China, for instance, aggressively implemented harm reduction strategies and was rewarded with a great decline in the prevalence of HIV among those that inject drugs, Eastern Europe has taken very little action to inform and support drug users to prevent the spread of HIV.

Some governments, especially Moscow, have passed legislation that cuts healthcare funding or disrupts the supply of life-saving medicines, crippling communities struggling to combat HIV. The Russian Ministry of Health, for instance, has often failed to procure medical supplies despite the rising rates, a testament to how little the government prioritizes the treatment of HIV/AIDs. In 2016, The Moscow Times published a story explaining that regions throughout the country had received “10 to 30 percent less funding for HIV medication than planned,” generating a funding shortfall and medicine shortage that forced hospitals to switch to cheaper, less effective treatments. In Belarus, there have been reports of increased criminalization of those with HIV, especially based on the state’s 1993 public health law, while some experts say that Ukraine’s belligerent war on drugs has aggravated the HIV epidemic there.

Some of the former Soviet states use indirect methods to isolate and marginalize populations with HIV/AIDs. For instance, the region possesses much lower numbers of prevention programs, and many governments do not support or endorse free condom distribution schemes. Regardless, the spread of the virus has corresponded with the more forceful spread of discrimination and misunderstanding.  

One last thing that cannot be ignored, especially in the context of the recently-released WHO report, is the over reliance of the most victimized states on funding from international donors and NGOs. According to The Atlantic, in the post-Soviet countries “at least 60 percent of HIV funding still comes from external donors and NGOs.” As of 2013, only 15 percent of funding for harm reduction programs in Eastern Europe are from domestic sources, evidence that governments are insufficiently invested in solving the connection between injection drug use and HIV rates. The dependence on external financial support is even more worrying given how Russia, as USA Today writes, has persecuted and chased away nonprofits that provide preventive programs or treatment. Not only does the dearth of support for HIV prevention and treatment programs show the governments to either be ignorant or inactive, but it also exposes greater cracks within the general healthcare systems of the post-Soviet countries.

Even with the introduction of the WHO’s 3×5 program, the use of more accurate HIV testing, the initiative of President George W. Bush’s PEPFAR program, and the discovery of effective antiretroviral treatments, HIV/AIDs still poses an unyielding danger for many parts of the world. As the virus threatens the stability of healthcare systems and the vitality of certain communities, the former Soviet states cannot afford a sluggish and sedentary approach to the increasing challenges presented by the grievous epidemic.

Anna Blue graduated with honors from the International Relations program at Stanford University in Palo Alto, California. After working for a small think tank in Los Angeles for two years, she arrived in Tartu, Estonia to pursue her Fulbright grant for a year. As a Fulbright researcher, she studies and investigates the policy and security impacts of Estonian e-residency.