According to the report announced at the Fifth International Conference on HIV, held in March 2016 in Moscow, the following ranking of 10 countries was compiled by the number of people infected with AIDS. The incidence of AIDS in these countries is so high that it has the status of an epidemic.

AIDS Acquired immune deficiency syndrome secondary to HIV infection. It is the last stage of the disease of an HIV-infected person, accompanied by the development of infection, tumor manifestations, general weakness, and ultimately leads to death.

1.2 million patients with 14 million population. Therefore, it is not surprising that the average life expectancy there is 38 years.

9th place. Russia

In 2016, the number of people infected with AIDS in Russia exceeded 1 million people according to Russian healthcare, 1.4 million according to the EECAAC-2016 report. Moreover, the number of infected in the last few years has been growing rapidly. For example: every 50th inhabitant of Yekaterinburg is HIV-positive.

In Russia, more than half of patients became infected through a needle while injecting a drug. This way of infection is not the main one for any country in the world. Why exactly in Russia such statistics? Many say it was driven by the move away from oral methadone as a substitute for injecting drugs.

Many mistakenly believe that the problem of infection of drug addicts is only their problem, it is not so scary if the "dregs of society" acquire diseases that lead to death. A person who uses drugs is not a monster that can be easily identified in a crowd. He leads a completely normal life for a long time. Therefore, spouses and children of drug addicts are often infected. There are cases when infection occurs in clinics, beauty salons after poor disinfection of instruments.

Until society realizes the real threat, until random partners stop assessing the presence of STDs “by eye”, until the government changes its attitude towards drug addicts, we will rapidly rise in this rating.

8th place. Kenya

6.7% of the population of this former English colony are HIV carriers, namely 1.4 million people. Moreover, among women, the infection is higher, since in Kenya the social level of the female population is low. Perhaps the rather free manners of Kenyan women also play a role - they easily approach sex here.

7th place. Tanzania

Of the 49 million people in this African country, just over 5% (1.5 million) have AIDS. There are areas in which the infection rate exceeds 10%: this is Njobe, far from the tourist routes, and the capital of Tanzania, Dar es Salaam.

6th place. Uganda

The government of this country is making great efforts to combat the problem of HIV. For example, if in 2011 there were 28 thousand children born with HIV, then in 2015 - 3.4 thousand. The number of new infections in the adult population has also decreased by 50%. The 24-year-old king of Toro (one of the regions of Uganda) took control of the epidemic into his own hands and promised to stop the epidemic by 2030. There are one and a half million cases in this country.

5th place. Mozambique

More than 10% of the population (1.5 million people) are infected with HIV, and the country does not have its own forces to fight the disease. About 0.6 million children in this country are orphans due to the death of their parents from AIDS.

4th place. Zimbabwe

1.6 million infected per 13 million inhabitants. Such figures have led to widespread prostitution, lack of basic knowledge about contraception and general poverty.

3rd place. India

Official figures are about 2 million patients, unofficial ones are much higher. Traditional Indian society is quite closed, many people ignore health problems. Educational work with young people is practically not carried out, it is unethical to talk about condoms in schools. Hence the almost complete illiteracy in matters of protection, which distinguishes this country from the countries of Africa, where getting condoms is not a problem. According to surveys, 60% of Indian women have never heard of AIDS.

2nd place. Nigeria

3.4 million HIV patients per 146 million population, less than 5% of the population. The number of infected women is higher than men. Since there is no free healthcare in the country, the most terrible situation is in the poor segments of the population.

1 place. South Africa

The country with the highest incidence of AIDS. Approximately 15% of the population is infected with the virus (6.3 million). About a quarter of high school girls already have HIV. Life expectancy is 45 years. Imagine a country where few people have grandparents. Scary? Although South Africa is recognized as the most economically developed country in Africa, most of the population lives below the poverty line. The government is doing a lot of work to stop the spread of AIDS, providing free condoms and testing. However, the poor are convinced that AIDS is a white invention, as are condoms, and therefore both should be avoided.

Bordering South Africa, Swaziland is a country of 1.2 million people, half of whom are HIV positive. The average resident of Swaziland does not live up to 37 years.

The topic of the article is not the most pleasant, but “forewarned is forearmed”, the problem exists and just turning a blind eye to it is unforgivable carelessness. Travelers and so often risk their health, fortunately, with lesser consequences, but it’s still not worth putting yourself in danger.

South Africa

Although the country is the most developed on the African continent, the number of HIV-infected people here is a record - 5.6 million. This is despite the fact that there are 34 million patients in the world, and the population of South Africa is about 53 million, that is, more than 15% live with the virus.

What you need to know: Most HIV-infected people are blacks from disadvantaged suburbs. It is this group that is in the worst social conditions with all the ensuing consequences: drug addiction, promiscuous sex, unsanitary conditions. Most of the patients were recorded in the provinces of KwaZulu-Natal (the capital is Durban), Mpumalanga (Nelspraid), Freestate (Blomfontien), North-West (Mafikeng) and Gauteng (Johannesburg).

Nigeria

Here, there are 3.3 million carriers of HIV infection, although this is less than 5% of the population: Nigeria recently displaced Russia, taking 7th place in the world - 173.5 million people. In big cities, the disease spreads due to antisocial behavior, and in rural areas due to constant labor migration and "free" customs and traditions.

What you need to know: Nigeria is not the most hospitable country and the Nigerians themselves are well aware of this. Therefore, the receiving party will certainly take care of safety and warn against dangerous contacts.

Kenya

The country accounts for 1.6 million infected, just over 6% of the population. At the same time, women are more likely to suffer from the disease - about 8% of Kenyans are infected. As in many African countries, the status of a woman, and hence her level of security and education, is still very low.

What you need to know: a safari in a national park or a beach and hotel vacation in Mombasa are quite safe activities, unless, of course, you specifically look for illegal entertainment.

Tanzania

A country quite friendly for tourists with a bunch of interesting places is also dangerous in terms of HIV infection, although not like many other states in Africa. According to recent studies, the HIV/AIDS incidence rate in Tanzania is 5.1%. There are fewer infected men, but the gap is not as large as, for example, in Kenya.

What you need to know: Tanzania is a fairly prosperous country by African standards, so if you follow the obvious rules, the threat of infection is minimal. High, more than 10, the percentage of infected people in the Njobe region and the capital Dar es Salaam. Fortunately, both of them are far from the tourist routes, unlike Kilimanjaro or the island of Zanzibar.

Mozambique

The country is deprived not only of sights, but also of elementary infrastructure from hospitals to roads and water supply. In addition, many of the consequences of the civil war are still unresolved. Of course, an African country in this state could not avoid an epidemic: according to various estimates, from 1.6 to 5.7 people are infected - conditions simply do not allow an accurate study. Due to the widespread spread of the immunodeficiency virus, foci of tuberculosis, malaria and cholera often break out.

Uganda

A country with good potential for classic safari tourism, which it has been actively developing lately. Plus, Uganda has been and remains one of the most progressive countries in terms of HIV prevention and diagnosis in Africa. The first specialized clinic was opened here, and disease testing centers operate throughout the country.

What you need to know: risk groups are the same as everywhere else: drug addicts, former prisoners - it will not be difficult for a sane tourist not to intersect with them.

Zambia and Zimbabwe

These countries are similar in many ways, even the main attraction, they have one for two: it is located right on the border - tourists can come to it from both sides. In terms of living standards and the incidence of AIDS, the countries are also not far from each other - in Zambia there are almost a million infected, in Zimbabwe - 1.2. This is an average figure for Southern Africa - from 5% to 15% of the population.

What you need to know: there are problems with the provision of medicines, in addition, in rural areas, many self-medicate and practice useless rituals. Therefore, the disease, typical for cities, has also reached remote areas.

India

There are 2.4 million HIV-infected people here, although against the background of 1.2 billion people this does not look so frightening - less than 1%. The main risk group is sex workers. 55% of Indians with HIV-positive status live in four southern states - Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu. In Goa, the incidence rate is far from the highest for - 0.6% of men and 0.4% of women.

What you need to know: Fortunately, HIV infection, unlike many other tropical diseases, depends indirectly on unsanitary conditions. Outright filth and tightness is a normal condition for India. The main thing, as, by the way, in any country, is to try not to appear in public places if there are wounds and cuts on the body, not to wear open shoes in the city, and we are not even talking about dubious entertainment.

Ukraine

Eastern Europe, unfortunately, over the past decades has shown a positive trend in the incidence of HIV / AIDS, and Ukraine consistently tops this sad list. Today, slightly more than 1% of people in the country are HIV-infected.

What you need to know: a few years ago, unprotected sex became a way to spread the disease, overtaking injections with dirty syringes. Dnepropetrovsk, Donetsk, Odessa and Nikolaev regions are unfavorable. There are 600-700 infected per 100 thousand inhabitants. Kyiv, where tourists most often come, has an average level, and Transcarpathia has the lowest rate in the country.

USA

America is in 9th place in the world in terms of the number of carriers of HIV infection - 1.2 million people. Such a high rate in one of the most prosperous countries is due to the high level of drug addiction, unresolved social contradictions, and active migration. And the violent, dissolute 60s were not in vain for the health of the nation. Of course, the disease is concentrated on specific groups of people who most often live not only separately from everyone, but localized, in “bad” areas.

What you need to know: Here are ten cities where the percentage of HIV-positive patients is highest (in descending order): Miami, Baton Rouge, Jacksonville, New York, Washington, Columbia, Memphis, Orlando, New Orleans, Baltimore.

Photo: thinkstockphotos.com, flickr.com

TASS-DOSIER. From May 15 to May 21, 2017, the All-Russian Action "Stop HIV/AIDS" will be held in Russia for the third time. It is organized by the Foundation for Social and Cultural Initiatives (the President of the Foundation is the wife of the Prime Minister of the Russian Federation Svetlana Medvedeva). The action is supported by the Ministry of Health, the Ministry of Education and Science, the Ministry of Communications of Russia, Rosmolodezh, Rospotrebnadzor, as well as the Union of Rectors of Russia, leading state universities of the Russian Federation and the Russian Orthodox Church.

It is dedicated to the World AIDS Day of Remembrance, which is held annually on the third Sunday of May. Its goal is to draw attention to this problem in Russia, to raise awareness of the population, especially young people, about the disease.

Campaign "Stop HIV/AIDS"

The all-Russian action "Stop HIV/AIDS" began to be held in Russia in 2016. The key event of the first action, which took place in May, was an open student forum. The second action was timed to the World AIDS Day (December 1) and took place at the end of November. It started at the II All-Russian Forum for specialists in the prevention and treatment of the disease (November 28).

As part of the action, an open lesson "Knowledge - Responsibility - Health" was held in senior secondary schools, where a film was shown on topical issues of combating HIV infection.

HIV/AIDS disease

The human immunodeficiency virus (HIV) attacks the immune system and weakens the body's defenses against a wide range of infections and diseases, including some types of cancer. HIV-infected people gradually develop immunodeficiency.

The last stage of the disease that develops when infected with the human immunodeficiency virus is AIDS (acquired immunodeficiency syndrome), when the human body loses the ability to defend itself against infections and tumors. In different people, AIDS can develop 2-15 years after HIV infection.

There is no cure for HIV infection. However, with antiretroviral treatment, the virus can be controlled and transmission prevented. Thus, the life of those infected with the infection is facilitated and extended.

Statistics for Russia

The epidemiological situation of HIV infection in Russia (the first case was detected in 1987) is unfavorable, cases of the disease have been identified in all regions of the Russian Federation.

According to Rospotrebnadzor, as of December 31, 2016, since 1987, 1 million 114 thousand 815 cases of HIV infection have been registered among citizens of the Russian Federation, of which 243 thousand 863 people have died. Thus, at the beginning of 2017, 870,952 Russians were living with HIV/AIDS in Russia, which is 0.59% of the total population of the country (146,804,372). As of December 31, 2016, the prevalence of HIV was 594.3 people with an established diagnosis per 100,000 of the country's population.

The number of newly diagnosed HIV infections in the country continues to rise. According to Rospotrebnadzor, in 2011-2016. the annual growth averaged 10%. In 2016, the territorial centers for the prevention and control of AIDS registered 103,438 new cases of HIV infection (excluding those identified anonymously and foreign citizens) - 5.3% more than in 2015 (95,475).

High prevalence of HIV is observed in the 30 largest subjects of the Russian Federation, where 45.3% of the country's population lives. The most unfavorable regions, where the number of people living with HIV exceeds 1 thousand people per 100 thousand population, are Sverdlovsk (1648 per 100 thousand population), Irkutsk (1636), Kemerovo (1583), Samara (1477), Orenburg (1217) regions, Khanty-Mansi Autonomous Okrug (1202), Leningrad (1147), Tyumen (1085), Chelyabinsk (1079) and Novosibirsk (1022) regions.

A high level of HIV infection in the Russian Federation is observed in the age group from 30 to 39 years. Among young people (15-20 years old), more than 1.1 thousand people with HIV infection are registered annually. Cases of infection of children during breastfeeding continue to be detected: in 2014, 41 children were infected, in 2015 - 47 children, in 2016 - 59.

In 2016, 675,403 patients (77.5% of all those living with a diagnosis of HIV/AIDS) were registered at the dispensary in specialized medical organizations. Of these, 285,920 patients received antiretroviral therapy (42.3% of those registered).

HIV/AIDS in the world

Some scientists believe that HIV was transmitted from monkeys to humans as early as the 1920s. The first victim of this disease may have been a man who died in 1959 in the Congo. This conclusion was reached by doctors who later analyzed his medical history.

For the first time, the symptoms of the disease, characteristic of HIV/AIDS, were described in 1981 during a survey in clinics in Los Angeles and New York of several men of non-traditional sexual orientation. In 1983, researchers from the US and France described a virus capable of causing HIV/AIDS. Since 1985, blood tests for HIV have been available in clinical laboratories.

According to the World Health Organization, at the end of 2015, there were from 34 to 39.8 million (36.7 million on average) HIV-infected people in the world. Sub-Saharan Africa is the most affected region, with an estimated 25.6 million people living with HIV in 2015 (about two-thirds of those infected). More than 35 million people have become victims of HIV/AIDS worldwide. In 2015 alone, approximately 1.1 million people died. As of June 2016, 18.2 million patients had access to antiretroviral treatment, including 910,000 children.

Key Facts

• HIV remains a major global public health problem, with more than 39 million deaths to date. In 2014, 1.2 million people worldwide died from HIV-related causes.
• At the end of 2014, there were approximately 36.9 million people living with HIV in the world, and 2 million people in the world acquired HIV infection in 2014.
• Sub-Saharan Africa is the most affected region, with 25.8 million people living with HIV in 2014. The region also accounts for almost 70% of the global total of new HIV infections.
• HIV infection is often diagnosed using rapid diagnostic tests (RDTs), which detect the presence or absence of antibodies to HIV. In most cases, test results can be obtained on the same day; this is important for same-day diagnosis and early treatment and care.
• There is no cure for HIV infection. However, with effective treatment with antiretroviral drugs (ARVs), the virus can be controlled and people with HIV can lead healthy and productive lives.
• It is currently estimated that only 51% of people with HIV know their status. In 2014, approximately 150 million children and adults in 129 low- and middle-income countries received HIV testing services.
• Globally, 14.9 million people with HIV were receiving antiretroviral therapy (ART) in 2014, of whom 13.5 million lived in low- and middle-income countries. These 14.9 million people on ART represent 40% of the 36.9 million people with HIV worldwide.
• The coverage of children is still insufficient. In 2014, 3 out of 10 children with HIV had access to ART compared to one in four among adults.

Human Immunodeficiency Virus (HIV)) affects the immune system and weakens people's systems to control and protect against infections and some types of cancer. The virus destroys and weakens the function of immune cells, so infected people gradually develop immunodeficiency. Immune function is usually measured by the number of CD4 cells. Immunodeficiency leads to increased susceptibility to a wide range of infections and diseases that people with healthy immune systems can resist. The most advanced stage of HIV infection is Acquired Immune Deficiency Syndrome (AIDS), which can take 2-15 years for different people to develop. AIDS is characterized by the development of certain types of cancer, infections, or other severe clinical manifestations.

Signs and symptoms

The symptoms of HIV vary depending on the stage of the infection. During the first few months, people with HIV tend to be most contagious, but many of them do not know their status until later. During the first few weeks after infection, people may have no symptoms or develop a flu-like illness, including fever, headache, rash, or sore throat.

As the infection gradually weakens the immune system, people may develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhea, and cough. If left untreated, they can develop serious diseases such as tuberculosis, cryptococcal meningitis, cancers such as lymphomas and Kaposi's sarcoma, and others.

Transmission

HIV can be transmitted through various body fluids of infected people, such as blood, breast milk, semen, and vaginal secretions. People cannot become infected through normal everyday contact, such as kissing, hugging, and shaking hands, or by sharing personal items and drinking food or water.

Risk factors

Behaviors and conditions that increase people's risk of contracting HIV include the following:

• unprotected anal or vaginal sex;
• having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhea, and bacterial vaginosis
• sharing contaminated needles, syringes and other injecting equipment and drug solutions while injecting drugs;
• unsafe injections, blood transfusions, medical procedures involving unsterile incisions or punctures;
• accidental needle stick injuries, including among healthcare workers.

Diagnosis

Serological tests such as RDT or enzyme immunoassay (ELISA) detect the presence or absence of antibodies to HIV-1/2 and/or HIV-p24 antigens. Conducting such tests as part of a testing strategy in accordance with an approved testing algorithm makes it possible to detect HIV infection with a high degree of accuracy. It is important to note that serological tests do not directly detect HIV itself, but detect antibodies produced by the human body as its immune system fights foreign pathogens.

In most people, antibodies to HIV-1/2 are produced within 28 days, and therefore, during the early stage of infection, during the so-called seronegative window period, antibodies are not detected. This early period of infection is the period of greatest infectivity, but HIV transmission can occur at all stages of infection.

It is good practice to retest all people initially diagnosed as HIV positive prior to enrollment in care and/or treatment programs to rule out any potential errors in testing or reporting.

Testing and counseling

HIV testing should be voluntary and the right to refuse testing should be recognized. Mandatory or coercive testing at the instigation of a healthcare professional, health authority, partner or family member is not acceptable as it undermines good public health practice and violates human rights.

Some countries have introduced self-testing or are considering introducing it as an option. HIV self-testing is a process in which a person who wishes to know their HIV status collects semen, performs the test, and interprets the results in confidence. Self-testing for HIV does not provide a definitive diagnosis; this is an initial test that requires further testing by a healthcare professional using a nationally approved testing algorithm.

All testing and counseling services should take into account the five components recommended by WHO: informed consent, confidentiality, counseling, correct test results, and communication with care and treatment and other services.

Prevention

The risk of HIV infection can be reduced by limiting exposure to risk factors. Key HIV prevention approaches often used in combination include the following:

1. Use of male and female condoms

Proper and consistent use of male and female condoms during vaginal or anal sex can protect against the spread of sexually transmitted infections, including HIV. Evidence suggests that male latex condoms are 85% or more protective against transmission of HIV and other sexually transmitted infections (STIs).

2. HIV and STI testing services

Testing for HIV and other STIs is strongly recommended for all people exposed to any risk factor so that they can know their infection status and have immediate access to necessary prevention and treatment services. WHO also recommends offering testing to partners or couples.

Tuberculosis is the most common disease among people with HIV. Left undiagnosed and treated, it is fatal and is the leading cause of death among people with HIV, with approximately one in four HIV-related deaths due to tuberculosis. Early detection of this infection and prompt provision of anti-TB drugs and ART can prevent these deaths. It is strongly recommended that TB screening be included in HIV testing services and prompt provision of ART to all people diagnosed with HIV and active TB.

3. Voluntary medical male circumcision

Medical male circumcision, when performed safely by properly trained healthcare professionals, reduces the risk of heterosexual men acquiring HIV infection by about 60%. It is one of the key interventions in epidemic settings with high HIV prevalence and low rates of male circumcision.

4. Use of antiretroviral therapy (ART) for prevention

4.1. Antiretroviral therapy (ART) as prevention

A 2011 trial showed that if an HIV-positive person adheres to an effective ART regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96%. For couples where one partner is HIV positive and the other HIV negative, WHO recommends that the HIV positive partner be offered ART regardless of his/her CD4 count.

4.2 Pre-exposure prophylaxis (PrEP) for the HIV-negative partner

Oral HIV PrEP is the daily use of ARVs by people who are not infected with HIV to prevent HIV infection. There have been over 10 randomized controlled trials demonstrating the effectiveness of PrEP in reducing HIV transmission rates in a range of populations, including serodiscordant heterosexual couples (couples in which one partner is infected and the other is not), men who have sex with men, women, gender reassignment, high-risk heterosexual couples and injecting drug users. WHO recommends that countries undertake projects to gain experience in using PrEP safely and effectively.

In July 2014, WHO released the Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations at Risk, recommending PrEP as an additional HIV prevention option as part of a comprehensive HIV prevention package for men with sex with men.

4.3 HIV Post-Exposure Prophylaxis (PEP)

Post-exposure prophylaxis (PEP) is the use of ARVs within 72 hours of exposure to HIV to prevent infection. PEP includes counseling, first aid, HIV testing, and a 28-day course of ARV treatment followed by medical care. In a new supplement released in December 2014, WHO recommends PEP for both work-related and non-work-related exposures, and for adults and children. The new recommendations contain simplified ARV regimens already used for treatment. Implementation of the new guidelines will simplify drug prescribing, improve compliance, and increase completion rates of PEP for HIV prevention in people who are accidentally exposed to HIV, such as healthcare workers, or in people exposed to HIV through unprotected sex or sexual assault .

5. Harm reduction for injecting drug users

People who inject drugs can take precautions to prevent HIV infection by using sterile injecting equipment, including needles and syringes, for each injection. A complete HIV prevention and treatment package includes:

• needle and syringe programs
• evidence-based opioid substitution therapy for drug users and treatment of dependence on other psychoactive drugs,
• HIV testing and counseling,
• HIV treatment and care,
• providing access to condoms, and
• management of STIs, tuberculosis and viral hepatitis.

6. Eliminate mother-to-child transmission of HIV

Transmission of HIV from an HIV-positive mother to her child during pregnancy, labour, childbirth, or breastfeeding is called vertical transmission, or mother-to-child transmission (MTCT). In the absence of any intervention, rates of HIV transmission from metaria to child range from 15-45%. Such transmission can be almost completely prevented if both mother and child receive ARVs at stages where infection can occur.

WHO recommends a range of options for preventing mother-to-child transmission of HIV, which include providing ARVs to mothers and children during pregnancy, childbirth and the postpartum period, or offering lifelong treatment to HIV-positive pregnant women regardless of their CD4 count.

In 2014, 73% of an estimated 1.5 million pregnant women with HIV in low- and middle-income countries received effective antiretroviral drugs to prevent transmission to their children.

Treatment

HIV can be attenuated with combination antiretroviral therapy (ART), consisting of three or more antiretroviral drugs (ARVs). ART does not cure HIV infection, but it controls the replication of the virus in the body and helps to strengthen the immune system and restore its ability to fight infections. Thanks to ART, people with HIV can have healthy and productive lives.

At the end of 2014, approximately 14.9 million people with HIV were receiving ART in low- and middle-income countries. About 823,000 of them are children. In 2014, the number of people on ART increased significantly, by 1.9 million in one year.

Coverage of children is still insufficient, with 30% of children receiving ART compared to 40% of HIV-infected adults.

WHO recommends starting ART at the stage when the CD4 cell count is reduced to 500 cells/mm³ or below. ART regardless of CD4 count is recommended for all people with HIV in serodiscordant couples, pregnant and lactating women with HIV, people with tuberculosis and HIV, and people co-infected with HIV and hepatitis B with severe chronic liver disease. Similarly, ART is recommended for all children with HIV under five years of age.

WHO activities

As humanity approaches the deadline for achieving the Millennium Development Goals, WHO is working with countries to implement the Global Health Sector Strategy on HIV/AIDS 2014-2015. WHO has set 6 operational targets for 2014-2015 to best support countries as they move towards the global HIV targets. They aim to support the following areas:

• strategic use of ARVs for HIV treatment and prevention;
• eliminating HIV among children and increasing access to treatment for children;
• improved health sector response to HIV among key risk groups;
• further innovation in HIV prevention, diagnosis, treatment and care;
• strategic information for efficient scaling;
• strengthening links between HIV and related health outcomes.

WHO is one of the sponsors of the Joint United Nations Program on AIDS (UNAIDS). Within UNAIDS, WHO leads work on HIV treatment and care and co-infection with HIV and TB, and is coordinating with UNICEF to eliminate mother-to-child transmission of HIV. WHO is currently developing a new strategy for the global health sector response to HIV 2016-2021.

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Of all countries in the world, the highest growth rate in the number of new cases of HIV infection (human immunodeficiency virus) was recorded in Russia. Deborah Burks, coordinator of global AIDS programs, said this in her speech at the US State Department on the occasion of World AIDS Day celebrated annually on December 1. She said that "the largest increase in the number of new HIV infections worldwide is observed in Russia due to the lack of response in the fight against the breadth and depth of the epidemic in the country."

She did not provide any figures or data to support her words. However, official statistics confirm these words of the representative of the US State Department. At the beginning of 2017, there were about 36.7 million people living with HIV in the world, mostly in developing countries, including countries in Africa. Russia accounts for about 900,000 of them, according to official statistics. The real figures in the Russian Federation, according to domestic experts,.

In 2016, 1.8 million new infections were recorded worldwide, in other words, about five thousand people are infected with HIV every day on the planet - one every 17 seconds. In Russia, the annual increase in the number of new cases of infection with the virus is on average 10%: in 2014 - 89,808 cases of new infections, in 2015 - 98,232 people newly infected, in 2016 - 103,438 cases. And this year will be no exception. Mortality from HIV infection, according to Rosstat, in Russia is also growing annually: in 2014 - 12540 deaths, in 2015 - 15520, in 2016 - 18575 deaths.

The World Health Organization (WHO), which has kept HIV statistics by region since the 1980s, when data collection and analysis began, reports that the total number of people infected in the European Region has reached 2,167,684, including 1,114,815 cases registered in Russia.

Over the past year, according to WHO, in the European Region, 160 thousand new cases This is the maximum in the history of observations. The European region is the only one where the number of new infections is on the rise. But this does not mean that these threatening data refer to Europe. WHO statistics "for the European Region" unites 53 countries with a population of almost 900 million people - in addition to the countries of the European Economic Area (EU / EEA), this also includes Azerbaijan, Tajikistan, Turkmenistan, and Russia.

In the EU countries themselves, only 29,000 new HIV infections were recorded last year. Russia spoils the "European statistics", since out of the total regional figure of 160 thousand, more than 103 thousand cases fall precisely on our country.

A joint report by the WHO and the European Center for Disease Prevention and Control (ECDC) says this is the highest number of cases reported in a single year. "If the trend continues, we will miss our target of ending the spread of the HIV epidemic by 2030," says Zsuzsanna Jakab, WHO Regional Director for Europe.

In Russia, the highest incidence rates were also noted in 2016 - 70.6 cases per 100,000 population, in Ukraine this figure is 33.7 per 100 thousand, in Belarus - 25.2, in Moldova - 20.5. The number of newly diagnosed HIV infections in Russia and Ukraine is 73% of the number of infections in the European Region and 92% of the total in the east of the European Region.

In 2014, more than 142,000 new cases of HIV infection were recorded in the European Region (of which 89,808 cases were in the Russian Federation), in 2015 - 153,407 (of which 98,232 were in the Russian Federation). By the end of 2017, there will also be at least 100 thousand new infected people in Russia, Vadim Pokrovsky, head of the Federal Scientific and Methodological Center for the Prevention and Control of AIDS, is convinced.

According to him, the number of deaths due to HIV-positive status is also growing. "Last year, 18.5 thousand people, according to Rosstat, died precisely from AIDS (acquired immunodeficiency syndrome). In fact, more than 30 thousand people died with HIV, but why the remaining 15 thousand died is a question that needs to be studied," Pokrovsky said.

It cannot be said that the increase in the incidence rate is decreasing in Russia, one can only speak of a decrease in the increase in new cases. "We do not reduce growth, but as it was, it remains such, it is added," says Vadim Pokrovsky, head of the scientific and methodological Center for the Prevention and Control of AIDS.

Since 2016, the Ministry of Health has taken into account only non-anonymous infected people - those who have been tested in state medical institutions with a passport and an insurance certificate in their hands. There were 86,800 such people in 2016 compared to 100,000 in 2015. And taking into account anonymous analyzes, Rospotrebnadzor counted 125,000 new cases of laboratory confirmation of HIV infection in 2016. Thus, the Ministry of Health closed its eyes to at least 20% of those infected. And a large part of HIV-infected people is not yet aware of their diagnosis, since the latent form can last 10-20 years.

At the same time, there is not enough money in the state budget for the treatment of HIV / AIDS. WHO recommends immunodeficiency virus suppressive antiretroviral therapy (ARV) to all those diagnosed with HIV, while in Russia, ARV therapy coverage is 46% of 650,000 people with HIV registered by the Ministry of Health, or 33% of 900,000 living carriers of the virus registered by the Ministry of Health. Rospotrebnadzor as of the end of 2016.

State strategy of the Russian Federation to combat HIV: there is no prevention, only those who are already infected are identified

Recall that the state strategy to counter the spread of HIV, adopted by the Ministry of Health of the Russian Federation, set the task of bringing the coverage of antiretroviral therapy (ARV), which suppresses the immunodeficiency virus, to 90% of all infected by 2020 - this would stop the epidemic.

However, it is not easy for Russian citizens to receive such treatment, and in the countryside it is completely unrealistic, medicines given to patients are far from the most modern, with a large number of side effects and mostly generics - medicines that differ in composition from the original medicine both in the amount of active substance and by its quality.

In February 2015, in connection with the unfavorable dynamics of the spread of HIV infection in the Russian Federation, the Ministry of Health developed an AIDS response strategy until 2020. Officials planned to reduce prices for drugs vital to the infected through import substitution and the creation of cheaper Russian analogues.

But the Russian drug for the treatment of HIV will be registered at best only in 5-10 years, TASS reports. The development of the domestic gene therapy drug Dinavir, which is being developed by a group of scientists from the Central Research Institute of Epidemiology of Rospotrebnadzor, is now only at the stage of preclinical trials.

As for existing medicines, Vadim Pokrovsky, head of the Scientific and Methodological Center for the Prevention and Control of AIDS, says that only a quarter of patients receive them.

Despite the fact that the government of the Russian Federation in April announced an increase in spending on the fight against AIDS, only 60,000 people will feel the positive effect - "a drop of water on a hot stone," Pokrovsky believes.

In general, according to him, there are no pre-exposure prophylaxis programs (PrEP) in Russia, when antiretroviral drugs are taken by people with a potentially high risk of contracting HIV. There are no funds for this, because there are not enough medicines even for already infected citizens. Against this background, the only concept that works and is officially approved in Russia is the “test and treat” strategy, recalls Medvestnik. “Prevention should prevent infection, and we are identifying those who are already infected, and every year more and more. At the same time, next year the State Duma is going to reduce the budget for the treatment of HIV infection from 17.5 to 16.5 billion rubles. Therefore, it is not surprising that that our epidemic is on the rise," Pokrovsky said.

“The Russian state does not stand on ceremony with those who criticize it. As soon as Pokrovsky complained about the insufficiently active fight against the epidemic, the Ministry of Health deprived the Federal AIDS Center in June of this year of state funds under a far-fetched pretext. Non-governmental organizations also face an increased number of obstacles. Many of them are forced to curtail their work, since, according to the law that came out in 2012, they are required to register as "foreign agents," recalls the Swiss newspaper Neue Zuercher Zeitung... By the way, in Switzerland the situation is almost stable - in 2016, the virus was detected in 539 people there, in 2015 - 537.

Sex between men remains a major mode of HIV transmission

Despite the existence of specialized prevention programs in many European countries, sex between men continues to be the predominant mode of HIV transmission in the European Economic Area (EU/EEA).

In all previous years, cases of diagnosing HIV infection among men who have sex with men have grown there at an alarming rate - from 30% in 2005 to 42% in 2014.

According to acting Director of the European Center for Disease Prevention and Control (ECDC) Andrea Ammon, to reduce these statistics, it is necessary to adopt new strategies, such as pre-exposure prophylaxis for HIV infection (PrEP) and access to health care for EU citizens living in other countries.

In Russia, the official statistics are different: 40% of all HIV-infected people are people of traditional sexual orientation, from 55% to 60% of those infected were infected as a result of drug use, and only less than 2% were infected through homosexual contacts.

However, these figures are again far from reality due to the fact that in Russia, due to the high level of condemnation, gays cannot even tell doctors that they had same-sex contacts. “In AIDS centers there is a system of codes that are assigned to different groups. For men who have sex with men, this is 103. But they are given other codes, for example 105 (persons with promiscuity). And in this way gays replenish the statistics of the heterosexual path But according to studies by public organizations, every sixth gay person in Russia is already infected,” Yevgeny Pisemsky, head of the Phoenix Plus NGO in Oryol, told Radio Liberty.

"Specialists in AIDS centers are well aware of such underestimated statistics. But they are always under the sword of Damocles of the law on the so-called propaganda among minors and interpret it in such a way that "just in case, we will not even mention it, otherwise we will be accused of propaganda homosexuality. But only real numbers could convince society that the problem exists," says Pisemsky.

According to the Open Institutes of Health Foundation, the results of a 2017 biobehavioral study show that the average prevalence of HIV infection among gay men in Russia is 18% (in Moscow - 13%, in St. Petersburg - 24%, in Yekaterinburg - 16%).

According to Pisemsky, the state will not be able to fight HIV without recognizing that it is in this risk group that it spreads very quickly. This means that no prevention is carried out in this environment, and gays themselves receive a deceptive confidence that the HIV problem does not concern them.

Every second HIV-infected person is diagnosed at a late stage

Nearly half of HIV infections across the European Region, which includes Russia, are diagnosed at a late stage, increasing the risk of ill health, death and HIV transmission.

The large number of AIDS cases in Russia and other Eastern European countries is evidence that late diagnosis, late initiation of antiretroviral therapy and low treatment coverage contribute to the development of the disease, the World Health Organization notes.

HIV/AIDS surveillance data from 2016 suggests that the likelihood of late diagnosis increases with age. For example, 65% (63% in the EU/EEA) of people over 50 in the European Region were diagnosed with HIV at a late stage.

Testing for HIV infection for certain diseases, such as other sexually transmitted infections, viral hepatitis, tuberculosis and some types of cancer, can improve the quality of diagnosis.

According to Russian statistics, more than half (51%) of registered cases of HIV infection are diagnosed at a late stage of the disease.