HIV Epidemiology

According to data for 2006-2007, the ten countries with the largest number of HIV-infected people included: India (6.5 million), South Africa (5.5 million), Ethiopia (4.1 million), Nigeria (3.6 million ), Mozambique (1.8 million), Kenya (1.7 million), Zimbabwe (1.7 million), the United States (1.3 million), Russia (1 million) and China (1 million) ^[7] .

According to the report of the Joint United Nations Program on HIV / AIDS (December 2009 ), almost 60 million people have been infected with HIV since the start of the HIV epidemic, and 25 million people have died from HIV-related diseases ^[8] . In 2008, the number of people living with HIV was about 33.4 [31.1–35.8] million, the number of new infections was about 2.7 [2.4–3.0] million, and 2 [1, 7–2.4] million people died from AIDS-related illnesses. In 2008, approximately 430,000 [240,000–610,000] children were born with HIV, resulting in a total of 2.1 [1.2–2.9] million children under the age of 15 living with HIV. Worldwide, young people account for about 40% of all new HIV infections recorded among adults (over 15 years old) ^[8] . Less than 40% of young people have basic HIV information, and less than 40% of people living with HIV know their status. The number of new HIV infections is still ahead of the number of people receiving treatment: for every two people starting treatment, there are five new cases of HIV infection ^[8] .

Sub-Saharan Africa remains the most affected region: 67% of all people living with HIV live here, and 91% of all new infections among children are reported. As a result of the epidemic, more than 14 million children in sub-Saharan Africa have become orphans. ^[8] The HIV epidemic has led to a sharp decrease in life expectancy in many African countries (for example, in Botswana from 65 to 35 years old by 2006) ^[9] .

South and Southeast Asia are also significantly affected by HIV infection. In 2007, about 18% of all HIV-infected people lived in this region, and up to 300,000 AIDS deaths were recorded ^[8] .

In the United States, young African-Americans have an increased risk of contracting HIV infection ^[10] . African Americans make up 10% of the US population, but they account for up to half of HIV / AIDS cases ^[11] . Such a division can be explained, on the one hand, by less knowledge about HIV / AIDS, on the other hand, by the limited treatment options and, on the third, by a greater likelihood of sexual contact with young people at risk ^[12] .

In the United States, people living in rural areas and the southern states, in particular the Appalachian Mountains, in the Mississippi Delta and the border region with Mexico are more infected with HIV / ^{13 [13]} . By 2010, about 1.1 million people are infected with HIV / AIDS in the United States, more than 56,000 new patients are registered each year, with the last figure remaining virtually unchanged over the past ten years ^{[14] [15]} .

As there is an increase in transmission among sexual partners of drug users, the report of the Joint United Nations Program on HIV / AIDS (December 2009 ) notes that in many countries of the region there is a transition from an epidemic that is mainly concentrated among drug users to an epidemic characterized by increased sexual transmission ^[8] . In 2007, in Eastern Europe, 42% of new HIV infections were due to heterosexual intercourse. Sex between men accounts for a relatively small proportion of new infections in Eastern Europe and Central Asia. In 2007, only 0.4% of new HIV infections in Eastern Europe were due to sexual intercourse between men. However, HIV prevalence among men who have sex with men is 5.3% in Georgia, 6% in the Russian Federation, and 10-23% in Ukraine ^[8] (see HIV in Ukraine ). Approximately 25% of unprotected anal sex among seropositive gays is made up of the so-called “ barebackers ” (making up about 14% of all gays in the sample studied) - people who knowingly avoid using condoms, despite their awareness of the possibility of HIV infection ^{[16] [17] [ 18]} ; a small proportion of barebackers are “ bug chasers, ” people who deliberately seek to contract HIV and choose HIV-positive or potentially positive individuals called “gift-givers” as partners for sex ^{[19] [20]} .

In 2008, the estimated number of adults and children living with HIV in Eastern Europe and Central Asia increased to 1.5 [1.4–1.7] million, an increase of 66% compared to 2001, when amounted to 900,000 [800,000-1.1 million] people. In three countries of the region (the Russian Federation, Ukraine, and Estonia), HIV prevalence exceeds 1% ^[8] .

About 90% of all HIV infections in Eastern Europe and Central Asia are in the Russian Federation and Ukraine (the region has the highest epidemic growth rates in the region ^[8] ), where the use of contaminated injecting equipment for drug use remains the main route of HIV transmission ^[21] . In 2007, 57% of newly diagnosed HIV cases in Eastern Europe were attributable to the use of contaminated injecting drug equipment ^[8] . An estimated 3.7 million people are now injecting drugs in the region, with approximately one fourth of them estimated to be infected with HIV ^[8] .

In Ukraine, according to 2005 data, 770 thousand were registered, of whom 238 thousand were still alive (see HIV in Ukraine ). In Belarus at the end of 2011, 13 thousand cases of HIV infection were registered. Most are between the ages of 15 and 29 ^[22] . In Germany, by the end of 2012, an estimated 78,000 people were infected with HIV ^[23] .

Access to antiretroviral therapy has been expanded in a number of countries in the region, although treatment coverage remains rather weak ^[8] . By December 2008, 22% of adults in need of such therapy received antiretroviral therapy, more than half the average global coverage in low- and middle-income countries (42%). Available evidence suggests that injecting drug users, the population most at risk of HIV infection in Eastern Europe and Central Asia, are often less likely to receive antiretroviral therapy ^[8] .

The first case of HIV infection in the USSR was discovered in 1986. The first cases of HIV infection among citizens of the USSR, as a rule, occurred as a result of unprotected sexual intercourse with African students in the late 70s of the XX century. Further epidemiological measures to study the prevalence of HIV infection in various groups living in the USSR showed that the largest percentage of infection at that time was among students from African countries, in particular from Ethiopia ^[25] . The outbreak of HIV infection in Elista in 1988 received wide resonance.

The collapse of the USSR led to the collapse of the unified epidemiological service of the USSR, but not the unified epidemiological space. A short outbreak of HIV infection in the early 90s among men who have sex with men did not spread further. In general, this period of the epidemic was characterized by an extremely low level of infection (for the entire USSR there are less than 1000 cases detected) of the population, short epidemic chains from infect to infected, sporadic drifts of HIV infection and, as a result, a wide genetic diversity of detected viruses. At that time, in Western countries the epidemic was already a significant cause of death in the age group of 20 to 40 years. This favorable epidemic situation has led to the curtailment of some broad anti-epidemic programs in the CIS countries, which are inadequate and extremely expensive. In 1993-1995, the epidemiological service of Ukraine was unable to timely locate two outbreaks of HIV infection that occurred among injecting drug users (IDUs) in Nikolaev and Odessa. As it turned out later, these outbreaks were independently caused by different viruses belonging to different subtypes of HIV-1. Moreover, the transfer of HIV-infected prisoners from Odessa to Donetsk, where they were released, only contributed to the spread of HIV infection ^[26] .

The marginalization of IDUs and the unwillingness of the authorities to carry out any effective preventive measures among them greatly contributed to the spread of HIV infection. In just two years (1994-1995), several thousand HIV-infected were detected in Odessa and Nikolaev, and in 90% of cases, IDUs. From this moment, the next stage of the HIV epidemic begins in the territory of the former USSR, the so-called concentrated stage, which continues to the present (2007). This stage is characterized by a level of HIV infection of 5 percent or more in a certain risk group (in the case of Ukraine and Russia it is IDU).

In 1995, there was an outbreak of HIV infection among IDUs in Kaliningrad, then successively in Moscow and St. Petersburg, then outbreaks among IDUs went one after another throughout Russia in a direction from west to east. The direction of movement of the concentrated epidemic and molecular-epidemiological analysis showed that 95% of all studied cases of HIV infection in Russia have their origin from the initial outbreaks in Nikolaev and Odessa.

In general, this stage of HIV infection in Russia and Ukraine is characterized by the concentration of HIV infection among IDUs, the low genetic diversity of the virus, and the gradual transition of the epidemic from risk groups to other populations. In Ukraine, in 2007, adult HIV prevalence was 1.6% [1.1–2.0%] - the highest level in Europe ^[8] . According to official statistics, in 2010, 360,000 HIV-infected people live in Ukraine ^[27] . However, it is worth considering that the actual number of HIV-infected people is almost five times higher than official statistics .

As of January 1, 2013, 719,445 HIV-infected people were registered in Russia, including 6306 children under 14 years of age. Due to the lack of HIV prevention, the number of Russians infected with HIV increased by 69,280 per year ^[28] . HIV prevalence among adults has reached ~ 1.1% ^[29] . In 2006, 19 347 people died from diseases related to HIV and AIDS, among them 353 children ^[30] . As of December 1, 2012, 125 thousand AIDS deaths were recorded in Russia ^[31] .

According to a 2006 study, HIV prevalence among injecting drug users ranged from 3% in Volgograd to 3.5–9% in Barnaul , 12–14% in Moscow , 30% in St. Petersburg, and more than 70% in Biysk ^[32] . According to the report of the Joint United Nations Program on HIV / AIDS (December 2009 ), the average HIV prevalence among injecting drug users is 37% in the Russian Federation and 38.5-50.3% in Ukraine ^[8] .

About 60% of HIV infections among Russians occur in 11 of 86 Russian regions ( Irkutsk , Saratov , Kaliningrad , Leningrad , Moscow , Orenburg , Samara , Sverdlovsk and Ulyanovsk regions , St. Petersburg and the Khanty-Mansi Autonomous Okrug ).

In 2005, 35,500 new cases of HIV infection were registered in Russia, in the first 6 months of 2006 , slightly less than 13,500 cases; thus, the total number of infected documented since the epidemic in Russia amounted to almost 350,000. However, official data only takes into account people who have had direct contact with the Russian HIV registration system. The actual number of people living with HIV at the end of 2005 is estimated to be much higher - from 560 thousand to 1.6 million. Most of them are young people: 80% are 15-30 years old ^[33] . According to the end of 2012: over the past 5 years, the number of HIV-infected people has doubled. But many people may not know that they are ill. According to different assessment methods, the actual number of HIV-infected people can range from 950 thousand to 1 million 300 thousand people ^[34] . According to the data at the end of 2013, the epidemic from vulnerable groups of the population to the general population intensified in Russia. The epidemic involves socially adapted people of working age. The maximum prevalence of HIV infection was registered among women in the age group of 25–34 years, among men - in the age group of 30–34 years. The main routes of infection: 58% - intravenous drug administration with non-sterile instruments, 40% - heterosexual contact ^{[35] [36]} .

Negative factors contributing to the spread of HIV infection in the former USSR are the social stigmatization of HIV-infected people ^[37] and homophobia . ^[38]

According to WHO data , in 2017, Russia led the list of countries in the number of new HIV cases: 104 thousand cases of virus infection, 71 cases per 100 thousand people. Second and third places: Ukraine - 37 per 100 thousand and Belarus - 26.1 per 100 thousand ^[39] . The Rospotrebnadzor called the WHO report unreliable ^[40] . The Minister of Health Veronika Skvortsova refers to the inaccuracy of the WHO data, according to her, the Ministry of Health has more accurate data: the number of new cases in 2017 is 85 thousand people. ^[41] . Rospotrebnadzor published a joint comment with the Ministry of Health, in which the information in the WHO report was called “extremely incorrect”, indicating that Russia has a broader population coverage when testing and when recalculating the values ​​according to coverage, the incidence rate in Russia will be lower than in some European countries , and that Russia did not transmit HIV statistics for 2017 to WHO. However, the WHO report indicated that the data for Russia were taken from official statistics published by the Russian Federal Scientific and Methodological Center for the Prevention and Control of AIDS. ^[42] . According to the Federal Center for the Prevention and Control of AIDS, Federal Center for the Prevention and Control of AIDS at the Central Research Institute of Epidemiology of Rospotrebnadzor, the number of new infections in 2017 was 104,402 ^[43] .

In Russia, the authorized bodies publish statistics on the incidence and mortality from HIV infection at the end of each year. Until 2011, the statistics were published by the Federal Scientific and Methodological Center for the Prevention and Control of AIDS. В его информационных бюллетенях информация доступна по России в целом и по каждому субъекту Российской Федерации в отдельности, а также выделены количество случаев заболевания у детей и количество случаев заболевания на стадии СПИД.

С 2012 года статистику публикует Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека : форма № 2 «Сведения об инфекционных и паразитарных заболеваниях» Федерального центра гигиены и эпидемиологии . В его статистике нет данных по каждому региону в отдельности, но доступны промежуточные кумулятивные данные (количество случаев, накопленное с начала года по текущий месяц включительно), а также отдельно выделены случаи заболеваемости у детей до 14 лет включительно и до 17 лет включительно. Данные по смертности по итогам года публикуются в отдельных пресс-релизах. Также Роспотребнадзор в своих информационных материалах специально указывает на отсутствие достоверных данных по Москве (поскольку территориальный орган по Москве несколько лет подряд не предоставляет статистические данные и их приходится рассчитывать косвенным путём).

В приведенной ниже таблице представлена по каждому году и в целом за всё время официальная статистика зарегистрированных случаев инфицирования, зарегистрированных смертей, а также рассчитано количество граждан, живущих с ВИЧ-инфекцией (разница между общим количеством зарегистрированных заболевших и смертей). В таблицу не включены официально зарегистрированные (на территории России) случаи ВИЧ-инфекции у иностранных граждан. Также следует учитывать, что количество выявленных в конкретном году заболевших зависит от количества проведенных тестирований, и не зависит от времени заражения. Следует учитывать, что персонифицированные данные о смертях ВИЧ-инфицированных граждан России поступают в уполномоченные органы с существенной задержкой ^[44] .

В России также проводится тестирование на ВИЧ иностранных граждан. За всё время наблюдения с 1985 года по 2014 год в России было официально зарегистрировано 23 840 случаев ВИЧ-инфекции у иностранных граждан ^[64] .

В декабре 2016 года на заседании президиума РАН руководитель Федерального научно-методического центра по борьбе и профилактике ВИЧ-инфекции Вадим Покровский сообщил, что носителями вируса ВИЧ являются примерно 1,5 млн россиян, а 240 тыс. человек умерли от СПИДа ^[71] .

В России из-за смешения ранее доминировавшего в РФ штамма A1 и нового агента AG, занесённого из Средней Азии, появился новый вирус A63, который гораздо опаснее родителей, сообщил в ходе заседания президиума РАН заведующий лабораторией иммунохимии Института вирусологии им. Д. И. Ивановского Эдуард Карамов ^[72] .

В 2016 году в России было зарегистрировано на 5,3 % больше новых случаев ВИЧ-инфекции, чем в 2015 году — 103,4 тысячи ^[73] . По данным заместителя генсека ООН, исполнительного директора объединённой программы Организации Объединённых Наций по ВИЧ/СПИД (UNAIDS) Мишеля Седибе по числу новых случаев заражения ВИЧ Россия заняла третье место в мире после ЮАР и Нигерии ^[74] . По темпам роста количества ВИЧ-инфицированных среди регионов России лидируют Кемеровская, Томская, Иркутская и Новосибирская области ^{[75] [76]} .

В 2017 году в России было зарегистрировано, по разным данным Роспотребнадзора, на 0,9 % больше заболевших, и на 2,2 % больше новых случаев ВИЧ-инфекции, чем в 2016 году ^{[43] [68] [69]} . Кроме того, ВИЧ-инфекция вышла за пределы уязвимых групп населения и активно распространяется в общей популяции, более половины больных в 2017 г. заразились при гетеросексуальных контактах (53,5 %) ^{[43] [69]} .

• ВИЧ на Украине
• СПИД в Бутане

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