The Virus that Could Kill a Nation: An Analysis of the Impact of HIV/AIDS on the Russian Population and Factors Preventing Successful Intervention and Control

The dissolution of the Soviet Union in December of 1991 sparked the largest collapse in public health in the history of the industrialized world during peacetime, and is only rivaled in the Euro-Slavic world by the Black Death. Predictions indicated that the Russian population could plummet to as low as 80-90 million people by 2050 – which would be the smallest population the Russian Federation has seen in more the two centuries. If true, the Russian population would shrink more in 60 years than any country in the Northern Hemisphere had in all of recorded human history, including during wartime. The profound impact of the collapse of the Soviet healthcare system combined with the uncertainties of the post-Soviet era sparked one of the fastest-spreading HIV epidemics in history. The Russian Federation is one of the only countries in the world where the rate of HIV infection is increasing, rising by a predicted 10-15% each year. The country plays a prominent role in the epidemiology of HIV on a global scale, and is estimated to account for 69% of the total number of people living with HIV globally. The first case of HIV was officially reported in 1987, but the rapid spread of HIV did not begin until 1995 when Ukrainian injection drug users migrated to industrialized regions of the Russian Federation looking for work after the dissolution of the Soviet Union – bringing along the scourge of injection drug use and HIV with them. Injection drug use quickly became the primary means by which the virus spread throughout the country. HIV then spread to commercial sex workers, men who have sex with men, prisoners, and the heterosexual population – largely due to individual identification or close interaction with one or more of these groups. Each of these groups faces stigmatization and discrimination by Russian society at-large, making accessing prevention services and treatment extremely difficult, as well as generating detrimental effects on the mental health of these individuals. Additionally, the Russian government has shown both an inability and an unwillingness to address the epidemic in accordance with the recommendations of the international health community thereby inadvertently promoting the spread of HIV throughout the country. When these factors are considered together, it is clear that the Russian Federation has a bleak future if appropriate actions are not taken to mitigate the spread of HIV and to provide treatment and prevention services to those in need.