The countries of the former USSR present some of the most dramatic trends in the worldwide AIDS epidemic. Fuelled by injecting drug use, the epidemic unfolds against a complicated backdrop of economic crisis, rapid social change, increased poverty and unemployment, growing prostitution and changes in sexual norms. Previously characterized by very low prevalence rates, the region now faces an extremely steep increase in the number of new infections, up from 420,000 at end-1999 to at least 700,000 one year later. In 2000 alone, more new infections were registered in the Russian Federation than in all previous years combined.

Studies in Russian cities conducted between 1997 and 2002 found a wide range of HIV prevalence rates among IVDUs ranging from 0% - 65% (UNDP 2004; Rhodeset al. 2004). Although only 52% of registered infections are among IVDUs, the Russian Federal AIDS Centre has estimated that in 2002 over 90% of actual infections are among IVDUs (Rhodes et al. 2004). A large part of this increase is among sex workers (many of whom are also IVDUs and/or are sexual partners of IVDUs): One study estimated that 80% of HIV-positive women were involved in both injecting drug use and sex work (Smolskaya et al. 2000 quoted in Rhodes et al. 2004). Young people throughout the region are particularly and increasingly vulnerable. HIV is concentrated largely among 18- to 30 year-olds, the average HIV-infected IDU is 24 years old, with up to 5% of young people in Moscow being HIV-positive (Burrows and Sarang 2005).

It is estimated that 1 million people are already injecting opiates in Russia, which is also vulnerable to large-scale importation of heroin from Afghanistan and Turkey. The sharing of injecting equipment is becoming more and more common because syringes of any sort are in very short supply. All syringes now have to be imported into the former Soviet Union, but supply is dependent on the availability of foreign currency to pay for the goods. Drug dealers will offer injections from ready loaded syringes, or will squirt a prepared dose from a larger syringe, which may have been used for prior injecting and contaminated with HIV-infected blood, into another syringe.

In Russia a unique form of home made opiate distilled from poppy straw has become widely disseminated. Mini–laboratories exist in virtually every neighbourhood, and Russian methods of producing opiates carry a particular risk - the use of human blood in the production process. Blood is used to neutralise toxins present in the opiate liquid derived from poppy straw because acetic anhydride, the chemical used in larger laboratories, is too expensive. On average, one glass of liquid will require 5ml of blood, virtually guaranteeing that HIV could be transmitted.

References

Burrows and Sarang. Mixed Signals: Responses to HIV/AIDS in the Russian Federation, 2005.

National Intelligence Council. The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China, Document ICA 2002-04D, Washington DC, November 2002.
Rhodes T,  Sarang A et al.  Review: HIV Transmission and HIV Prevention Associated with Injecting Drug Use in the Russian Federation. International Journal of Drug Policy, 15: 1–16, 2004.