Russia is very close to its millionth registered HIV infection; 986,657 people have been registered as infected. Most experts believe that only half of all HIV cases are diagnosed and registered, meaning Russia now probably has two million inhabitants living with HIV. That is a staggering number, particularly for a middle-income country that is a donor to the Global Fund to Fight AIDS, TB, and Malaria. In comparison, the USA has a population more than twice as large as Russia, and approximately 1.2 million people living with HIV.

To make matters worse, infection rates are actually rising in Russia. From January to October, 73,000 new cases of HIV were officially diagnosed and registered. That’s a higher number than then first ten months of 2014. One must also remember that these are just the official numbers. The stigma against HIV in Russia is massive; many people avoid official diagnosis – and therefore fail to get treatment.

How has Russian reached this point? Stigma, mostly, combined with some failures of science. The HIV epidemic in Russia and Eastern Europe is different from HIV in the rest of the world. It’s not driven by sex. It’s driven by drugs, specifically, by shared needles. HIV, therefore is generally perceived as a problem that doesn’t affect “decent” people. The epidemic response is funded, and treated, in light of that stigma. This is compounded by anti-LGBT bias and recent anti-LGBT legislation. People living with HIV also live in fear, and rightly so. They get substandard care from doctors, harassed and arrested by the police, and ignored by their government officials.

In a drug-driven epidemic, risk reduction is a powerful tool. It enables people who inject drugs to reduce their likelihood of being infected with HIV. If infected, it helps them keep from spreading the infection. That’s the approach taken in most parts of the USA and in Europe. In Russia, that approach, in particular the use of medication regimens to enable drug users to quit illegal drugs, has been rejected. People who use drugs have very few options if they want to stop, and they don’t get the education or tools they need to avoid HIV infection.

If Russia wants to stop the expansion of HIV, the government needs to address the real needs of people living with HIV. Access to HIV medicines. Medical care not just for HIV but for all the health conditions that go with it. Help in ending addiction to drugs. And an end to police harassment of drug users.

Global health experts often talk about the need to “put people first.” Russian’s expanding HIV epidemic makes that necessity very, very clear.

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