How UNAIDS “90-90-90” target looks in Russia today

Natalya Ladnaya, a senior researcher from the Federal Scientific and Methodological Center for AIDS Prevention and Control, told about the specifics of HIV epidemic in Russia at the St. Petersburg forum on HIV.

Ladnaya reminded that as of mid-2017, in Russia there were registered more than 1,160,000 HIV cases. However, the scientist hopes that by the number of new cases the country has reached the maximum: last year, the growth was 5%, in the first half of 2017 — 3%, which means that the growth rate declined. Nevertheless, counting the absolute number of new cases, we continue to remain the world leader.

The incidence of HIV infection in Russia is more than 70 per 100 thousand, in the EU — 6 per 100 thousand.

People with HIV infection continue to be concentrated in the Ural Federal District and the Siberian Federal District, but in 2016 in these regions, as well as in the North-West Federal District, the incidence declined slightly. Nevertheless, the researcher interprets this as stabilization, and not as an improvement of the situation. At the same time, in other federal districts there is an increase of epidemics, and large and economically successful regions are being affected by HIV infection: the most affected are 30 regions, where the half of Russian population live.

Ladnaya noted that 21% of the population on average is tested on HIV per year. 35% of the new cases are detected with immunodeficiency (less than CD4 350 cells per μL), but even they are not immediately taken for the treatment. Among those starting ARV in 2016, only 27% of patients had more than 350 CD4 cells per μL.

While the number of AIDS-related deaths has decreased by 48% since 2005 worldwide, in Russia it continues to grow, and the increase in the total number of deaths from infectious diseases is due to HIV infection. For example, in 2014 among women who died at the age of 30-35 years, 21% were diagnosed as «HIV-infected» (although not all of these deaths are directly related to HIV).

There are deaths of patients on ARV, which is primarily due to the late onset of treatment: most of those who die on ARV die within the first six months of treatment.

Ladnaya pointed out the prevalence of HIV infection among the key groups: among drug users about 24% were HIV-positive, MSM — 14-15%, and sex workers — about 12%.

Among pregnant women, the average prevalence in Russia is about 0.8%, but 22 regions have more than 1% of pregnant women with HIV, that is according to WHO classification is already a generalized stage of the epidemic.

In 2016, the heterosexual contacts were the first way of HIV transmission; the number of new HIV cases among MSM is also increasing. As in other countries, new registered cases are moved to older age groups, up to the age group of 80+ and 90+. The fact of «growing up» of HIV infection is important to record and analyze in terms of age-related diseases and possible more serious side effects of ARV.

At the same time, women in Russia are getting infected at a younger age than men. Every year, 20,000 pregnancies and 16,000 births are registered among HIV-positive women, which is significantly more than in European countries.

According to the estimates from the Federal AIDS Center, the total number of HIV-infected people in Russia is about 1.3 million. Only 64% of them know about their HIV infection, and 46% ow them are linked to care. Only 21% of the estimated number of all PLWH are on ARV, and only 16% of patients have an undetectable viral load — which is very far from the UNAIDS goal «90-90-90».

Ladnaya concluded that the available data indicate a worsening of the HIV problem in Russia in 2016: the prevalence and the number of new HIV cases have increased, the number of HIV related deaths has increased, and the number of people who need ART is constantly increasing. All these facts demonstrate the need to strengthen and optimize measures to counteract the HIV epidemic.