SEXUALLY TRANSMITTED DISEASES IN RUSSIA
Russia has high rates of sexually transmitted diseases such as syphilis and gonorrhea. Igor S. Kon wrote in the International Encyclopedia of Sexuality: “There is an increase in sexually transmitted disease, particularly among young people. People are becoming infected at a younger age. A sharp increase in the incidence of syphylis began in 1988, followed by gonorrhea in 1991. In large cities, such as Moscow, these diseases have already reached epidemic proportions. Virtually half of that increase is accounted for by children and adolescents. According to the U.S.S.R. Health Ministry figures for 1985-87, the number of under-17 women infected by STDs increased by virtually a third throughout the country. In the early 1980s, physicians noted a substantial rise, especially among young people, in the so-called minor venereal diseases that often occur without symptoms. Russians had practically no knowledge of genital herpes or chlamydia until they encountered it in their own experience. [Source: Igor S. Kon, Ph.D. International Encyclopedia of Sexuality ^^]
“The overall STD picture is still not as bad as it is in many other countries. According to Russian statistics, the rate of syphilis infection is on the increase, with 9,873 cases in 1991 and 7,178 cases in the first six months of 1992. The gonorrhea rate has fallen slightly, from 180,883 in 1990, to 175,020 in 1991, and 87,724 in the first six months of 1992. These statistics do not take into account that many people use home treatment or seek help from a variety of private practitioners who are not part of the official statistical records. ^^
“A special epidemiological investigation by Olga Loseva shows that in 1991, the number of registered syphilis sufferers in Russia rose by almost 34 percent, in Moscow by 17 percent in 1991, and by another 50 percent in the first quarter of 1992 (Kon 1995, 277). This is due primarily to the rise in child and teenage prostitution that often begins between ages 10 and 12 for girls and age 14 for boys. No less than half of the infected go to unregistered medics for treatment.” ^^
Policy Towards Sexually Transmitted Diseases in Russia
Igor S. Kon wrote in the International Encyclopedia of Sexuality: “ The customary hypocrisy did not allow the Soviet people to talk openly about STDs. STDs have been consistently regarded throughout the century as shameful. This attitude has hampered health education, especially when new infections are confronted (Kon 1995, 229-231). Nonetheless, free state medicine provided treatment in special dermatological and venereological clinics with mandatory official registration identifying the source of infection, and doctors assisted by police endeavored to follow the entire chain of dangerous contacts. Treatment was compulsory, and any infringement of that, or willful infecton of anyone with an STD, was punishable under the Russian Criminal Code. This policy enabled the state to confine the danger within certain limits. [Source: Igor S. Kon, Ph.D. International Encyclopedia of Sexuality ^^]
“The demise of the Soviet system has acutely affected the epidemeological situation for the worse. Extensive sexual contacts with different partners, given the ignorance and lack of observance of elementary safety and hygiene rules, is dangerous in itself. State medicine is now debilitated, and in some areas collapsed, because of lack of funds, medicine, and equipment. Private medicine is not available to all, and, when available, it is less effective, especially when it comes to maladies requiring lengthy treatment with subsequent supervision. Administrative supervision is now worse, and official statistics have become even less reliable. ^^
“What is to be done? There are two competing strategies. The first demands more stringent administrative measures, namely enforcement of the law prohibiting private doctors from treating STDs. The second strategy would take the social and psychological reality into account. Patients should have the right to choose whether to go to a private doctor or use the state medical system. But the private doctor must report disease cases to the epidemeological services so the epidemeological situation can be correctly evaluated, trends forecast, and preparation made for future needs.” ^^
Syphilis in Russia
Russia has one of the world's highest and fastest growing syphilis rates. In 1996, there were 217 syphilis cases per 100,000 compared to just 5 per 100,000 in 1990—a rate 50 to 100 times that Western Europe and the United States. Prostitution is blamed for the spread of the disease.
A typical syphilis patient in Russia has had 10 sexual partner in the previous year, doesn't use condoms and does have a clue who he or she picked up the disease from. Explaining why wasn’t planning to change her sexual activity even though she spent hundreds of dollars for syphilis medicine, one Russian woman told Newsweek, "We have one life to live, and we all inevitably get sick at various points in our life—that's the way it goes."
The rate of syphilis among young males between 10 and 14 increased 40 times in the 1990s. The high rate of syphilis and AIDS worries health officials because it represents risky sexual behavior which could spread the disease more and spread AIDS.
AIDS-HIV IN RUSSIA
Around 1.4 million people in Russia, Eastern Europe and Central Asia were living with HIV at the end of 2011, representing an HIV prevalence of 1 percent. Around 140,000 became infected in 2011 and 92,000 died from AIDS-related illnesses; there was a 21 percent increase in AIDS-related deaths between 2005 and 2011. It is estimated that over two-thirds of the area’s infected people live in Russia, and combined with Ukraine, these two countries account for almost 90 percent of the region's newly reported HIV diagnoses. Both countries also have the highest number of people living with HIV relative to the general population; adult HIV prevalence is 0.8 percent in Ukraine and between 0.8 and 1.4 percent in Russia. Significant numbers of people infected with HIV live in Belarus (20,000) and Kazakhstan (19,000). [Source: Avert, International AIDS-HIV charity website]
In 2006 Russia’s Federal AIDS (acquired immune deficiency syndrome) Center reported 1.5 million confirmed cases of human immunodeficiency virus (HIV), 341,000 of which were officially registered. In 2005 Russia had the most rapid rate of increase in HIV cases outside sub- Saharan Africa. By that time, sexual activity had overtaken narcotics use as the main avenue of HIV transmission, and the trafficking of Russian women for the sex industry in Europe made Russia’s high HIV rate an international concern. Poor health care in the prisons made them another major source of HIV-positive individuals. In 2006 the government allocated an estimated US$115 million to HIV and AIDS programs, but local administration and public education remained ineffective. [Source: Library of Congress, October 2006 **]
There were at least 1 million people with HIV/AIDS in Russia in the early 2000s. Some thought the true figure was 4 million. Official AIDS statistics are believed to represent about one tenth of the true number. As of 2004, there were 280,000 officially registered HIV/AIDS patients. The HIV infection rate in Russia is seven times higher than in Western Europe. There are more infected people in Russia than in the United States, which has more than twice the population of Russia and has a longer history with the disease.
The HIV-AIDS problem is currently concentrated among injecting drug users (IDUs), sex workers and their sexual partners. About 85 percent of Russia's AIDS/HIV cases are drug related. Only about 5 percent are related to homosexual activity, 5 percent with heterosexual activity, and around 5 percent with tainted blood. Young Russians take relatively few precautions when it comes to drug use and sex.
The HIV problem in Russia has been compared to a neutron bomb and been described as catastrophic. Tens of thousands of Russians die each year from AIDS. This is causing the population of Russia to shrink even faster than it already is. The problem is particularly acute in regards to the shrinking male population because most of those who die are young men.
Spread of HIV-AIDS in Russia
HIV-AIDS likely was brought to the Soviet Union by students from countries with high levels of incidence of the disease. In 1987, after the first case of AIDS was confirmed in Russia, the Supreme Soviet of the Soviet Union passed the strictest anti-AIDS law in the world, making the knowing transmittal of the infection a criminal offense punishable by up to eight years in jail. A 1995 law, which has been criticized vehemently for its human rights implications and the cost of its administration, stipulates that all visitors remaining more than three months must prove that they are not infected with the AIDS-causing human immunodeficiency virus (HIV). [Source: Library of Congress, July 1996 *]
In the 1990s HIV/AIDS is growing faster in Russia than anywhere else in the world. In 1990, there were 103 reported cases of HIV/AIDS in the entire Soviet Union. In the first ten months of 1996, confirmed cases of human immunodeficiency virus (HIV) were four times more numerous than in all of 1995, with drug addicts accounting for about 70 percent of cases. Although the official estimate of HIV cases was fewer than 2,000 in 1996, other estimates placed the number at ten times that many. The Ministry of Health reported that only 50,000 of Russia's estimated 2 million drug addicts were under treatment for their addiction in 1996.[Source: Glenn E. Curtis, Library of Congress, July 1996 *]
Official diagnoses of HIV increased 50 percent from 1993 to 1994. However, according to an official of the Imena AIDS support group, which is devoted to rehabilitation of HIV victims, the official statistics are understated at least tenfold because Russians in the groups most at risk — prostitutes, homosexuals, and drug users — have reason to fear that results will not remain confidential and so refuse AIDS testing. Although the 1990 Law on Prevention of AIDS mandates confidentiality of medical records, in practice jobs often are lost and social services denied after a positive diagnosis. The highest incidence of HIV is in Moscow, St. Petersburg, Rostov-na-Donu, Volgograd, and the Republic of Kalmykia, the last three of which have medical facilities where unsanitary procedures have resulted in mass transmission of the virus. The majority of reported HIV-positive individuals are drug users. *
HIV-AIDS spread very quickly in the late 1990s and early 2000s. The number of new cases doubled between 1997 and 1999 and then quintupled between 1999 and 2001. HIV spread first in the homosexual community and then to drug addicts who contacted the disease from infected needles. By the late 199os the disease was spreading among heterosexuals and there were worries the infection rate could reach levels like those found in Africa. .
Since 2001, HIV prevalence in Russia, Eastern Europe and Central Asia has increased by 250 percent, making the region home to the world’s most rapidly expanding epidemic. In contrast, over the same period, prevalence in sub-Saharan Africa fell from 5.8 percent to 5 percent, and stabilised in South and Southeast Asia at 0.3 percent. [Source: Avert, International AIDS-HIV charity website]
Places with high rates of AIDS-HIV include the central European enclave of Kaliningrad, the Siberia city of Irkutsk and the Ural city of Chelyabinsk. All of these places have high rates of drug use. In the early 2000s, Chelyabinsk was getting 15 to 30 news cases of the disease every day. In Irkutsk at that time, 8 percent of the people between 15 and 25 have AIDS-HIV. The AIDS-HIV rate is also high the Khanty-Mansi region of Siberia and in the former Soviet republic of Estonia, Ukraine, Latvia and Belarus.
Ignorance About AIDS
As in the Soviet period, the public receives little information about precautions against AIDS or the identity of the high-risk categories in society, and AIDS sufferers meet much intolerance in Russian society. Because the disease has been associated with foreigners, government officials and the public have ignored the need for preventive measures among Russians. AIDS transmittal is increased by a chronic shortage of condoms (which Soviet medical officials euphemistically called "Article Number 2") and by the lack of disposable hypodermic syringes in hospitals and clinics, which results in the repeated use of unsterilized needles. [Source: Library of Congress, July 1996 *]
Ignorance and caviler attitudes about AIDS are problems in Russia. The majority of people with AIDS/HIV in early 2000s didn't even know they had it. Even though 80 percent of the homosexual interviewed in one survey said they were aware of the dangers with AIDS only 32 percent used condoms.
Some HIV victims believe they got the diseases from heroin spiked with the ground up bones of African AIDS victims. One young Russian man, who was infected with HIV along with his 18-year-old wife and baby, told the Washington Post, "HIV is like a cough. I'm not expecting any help. We will die here, and our kids will die here." He said he doesn't take medicine, or fear death.
Russians don’t like to talk about AIDS. One official told Foreign Policy magazine: “It is officially prohibited to talk about HIV. Neither people nor specialists nor politicians are ready.” People “can not take any words beyond ‘bodily fluids,’ and you expect them to be comfortable talking about heroin addiction and intravenous infections, condoms and sex?” Many don’t regarded it as a serious problem. There are undoubtably some that see it as blessing—a way to rid their country of drug addicts, homosexuals, prostitutes and lowlifes.”
AIDS and Drug Use in the Former Soviet Union
HIV-AIDS spread quickly through the drug community in the 1990s. In 1994, there were no positive HIV test results among drug users. In 1996, there 190 positive out of 45,507 intravenous drug users tested. A typical HIV victim at that time was 17, also has hepatitis, and started using opium at 15 and heroin at 16.
Drug related HIV spread across Russia and the former Soviet Union from the Ukraine, southern Russian cities like Krasnodar and the Baltic port of Kaliningrad. In some cities in Belarus it is estimated that half the intravenous drug uses in the 1990s carried the HIV virus.
By the mid 1990s, there were large number of addicts in place like Chelyabinsk, a city in the southern Urals and transfer point for opium and heroin, making its way from Afghanistan through Central Asia to Europe. The infection rate really took off in Siberian cities like Irkutsk. when large quantities of ready-to-inject liquid Afghan heroin hit the country in the spring of 1999.
Doctors have admit they do not want to waste scarce anti-AIDS drug on addicts because they probably won’t stick the strict regime that is required. One junkie told Newsweek, "Why does it matter what you die of, AIDS or drugs? One of them will kill you, but there' no reason to live anyway. We spit on society, and we spit on ourselves."
Reason for the High AIDS Rates Among Russian Drug Users
The rise of HIV in the region is closely linked with increasing rates of injecting drug use that developed in the mid-1990s during the socioeconomic crisis that followed the break-up of the Soviet Union. At this time, nearby Afghanistan became the world’s largest producer of opium, from which heroin is derived, and drug trafficking increased throughout the region. Initial outbreaks were detected in Ukraine, Russia, Belarus and Moldova. [Source: Avert, International AIDS-HIV charity website -]
Sharing of contaminated drug taking equipment is a highly efficient HIV transmission route. In Eastern Europe and Central Asia around 3.7 million people inject drugs; this represents a quarter of injecting drug users across the world. An estimated one quarter of IDUs (intravenous drug users) in this region are living with HIV. Many countries in the region have experienced rapid increases in the number of new HIV infections among IDU’s, and now 40 percent of all new HIV infections are transmitted via injecting drug use. -
In Estonia, HIV prevalence among IDUs is estimated at 50 percent, and at 20 percent in Ukraine. Whilst the most recent HIV prevalence is lower among IDUs in Russia, at 16 percent in 2009, the overall number of injecting drug users is extremely high at around 2 million. 12 Therefore, despite the lower HIV prevalence of 16 percent in Russia, compared to 50 percent in Estonia, a much greater number of people are living with HIV in Russia (2 million) than in Estonia (9,900).
AIDS and Unsafe Drug-Taking Methods
One of the most popular drugs among hard drug users in Russia and the Ukraine in the 1990s and early 2000s was Hykma, a cheap but powerful, home-brewed, liquid opiate. The intravenously-injected drug is blamed for the rapid spread of the HIV virus in the Ukraine and western Russia. In another HIV epicenter, Irkutsk in Siberia, the drug of choice is liquid heroin from Afghanistan.
The way home-made drugs are prepared is also blamed for the spread of HIV/AIDS. When a drug preparation has cooled drug dealers check the pH using a primitive method based on whether or not blood has coagulated (something that can cause instant death in a drug user). Drug users use the same technique to check if drugs are safe to use. A Russian doctor told AP, "one of them cuts a vein and drops blood into the liquid. If the mixture does not coagulate, it's okay, but if it does then they have to add acid to balance the pH indicator and then the procedure is repeated again...As far as I know Russia is the only country where such a barbaric technique is used by drug addicts."
Explaining why he shared needles and engaged in other risky practices, one drug addict told the New York Times, "You don’t care, when you need a dose. The fear of remaining sober and in pain overwhelms any fear of sickness." One junkie told Newsweek, "When you get the drugs, you don't have a clean syringe. Sometimes you just don't have the money, other times the pharmacy is closed."
Another told the Washington Post he shared a needle with another addict who warned him that he might have AIDS. “All I could think about was the needle,” the addict said, “I had to have it.” If the blood donor has HIV, thousand of drugs users could potential get the disease.
AIDS and Sex in Russia
There is a very real danger that AIDS-HIV could spread through the general public through heterosexual sex, beginning with drug users giving it to their lovers. According to one study in the early 2000s, 60 percent of drug users had sexual relations with non-drug suers. There is also a concern that prostitutes will give it to their customers and they in turn t will give it to their wives and girlfriends. The number of cases attributed to homosexual sex is relatively low. In Kaliningrad AIDS-HIV spread by sexual contact at an alarming trend. In 2001, 30 percent of the those who contacted the virus got it through sexual contact, compare to only small percentage in 1996.
In the 1990s, about 40 percent of Russian prostitutes surveyed who often use drugs were HIV positive. About 85 percent of the prostitutes tested in one survey in Kaliningrad in 1997 had HIV. A year before less than 5 percent had the virus. In the early 2000s, there were an estimated 3,000 prostitutes in Kaliningrad. On the streets of Kaliningrad at that time you could find strung out teenagers willing to sell themselves for as little as $7.
Standard forms of HIV protection a not used. People rely on abortion more than contraception. Sex workers are at risk of HIV because of the overlap with injecting drug use as well as unsafe sexual behaviours including low consistent condom use and multiple sexual partners. The HIV prevalence among sex workers in Eastern Europe is 11 percent. In Russia, it is estimated that almost a third of sex workers have injected drugs. In Ukraine, HIV prevalence among female commercial sex workers who also inject drugs is 43 percent, compared to 8.5 percent among female sex workers who do not inject drugs. [Source: Avert, International AIDS-HIV charity website -]
Partners of IDUs and sex workers are at risk of becoming infected with HIV through sexual transmission. An estimated 50 percent of women living with HIV in the region have acquired the infection through a sexual partner who injects drugs. Heterosexual contact, which accounts for nearly two-thirds of infections among women in Russia, accounts for an ever-growing proportion of new infections. In 2000, women comprised just over 20 percent of new infections, and in 2012 close to half of HIV infections are among women in many countries in this region. UNAIDS has stated that it is unlikely the regional epidemic will spread independently of transmission among injecting drug users and sex workers. However, one study has concluded that the HIV epidemic in Russia may be transitioning from one fuelled by injected drug use to an epidemic spreading through heterosexual sex. -
Men who have sex with men (MSM) comprise a relatively small proportion of total HIV cases in the region in comparison to Western European and North American nations. It is believed that the epidemic is thriving among this group but is being kept hidden and underreported due to a reluctance by MSM to reveal the cause of their infection for fear of stigmatisation. Small surveys among MSM in Russia have identified a prevalence of 6 percent. It is believed by some that the underground epidemic among MSM has been allowed to escalate due to very little funds targeting this group:
Children and Young Adults with HIV-AIDS
The number of children under fifteen living with HIV in Eastern Europe and Central Asia rose five-fold between 2001 and 2010, but then proceeded to decline by 13 percent between 2009 and 2011. HIV prevalence among young people aged 15-24 in the region increased by 20 percent between 2001 and 2011. Young women are particularly affected; among the 20-24 age group, women accounted for around two-thirds of new diagnoses in Eastern Europe in 2009. It has been argued that this increase has been compounded by the lack of HIV prevention programmes targeting young people. Many HIV/AIDS organisations are afraid to work with younger people due to legal or other repercussions. [Source: Avert, International AIDS-HIV charity website -]
Igor S. Kon wrote in the International Encyclopedia of Sexuality in the mid 1990s: “The major high-risk group in Russia turned out not to be gays, drug addicts, or prostitutes, but newborn children infected in maternity homes through lack of disposable syringes and the negligence of medical staff. Now the children and their families have become victims, not only of this terrible disease, but also of an AIDS-phobia. Medical personnel are scared of treating them, coworkers do not want to work with members of their families, and some schools are demanding their removal. [Source: Igor S. Kon, Ph.D. International Encyclopedia of Sexuality]
A significant proportion of sex workers are young people, with about 20 percent of females selling sex in Ukraine believed to be younger than nineteen years. Younger children are also affected in the region. A recent study, conducted across three cities, of Ukrainian street youth who were both orphaned and homeless found that HIV prevalence reached as high as 28 percent. The study showed that providing care and housing can be a method of preventing HIV within this population, and recommended practices such as extending foster care through to twenty-one year olds, conditional cash transfers and alternative family initiatives for orphans. -
Children and young adults in Eastern Europe are also suffering from the knock-on effects of the region's epidemic. Children born to HIV positive mothers, for example, are more likely to be abandoned than other children. In the Russian Federation and Ukraine, between 6 to 10 percent of children with HIV positive mothers are abandoned in paediatric hospitals, maternity wards and residential institutions. Mother-to-child transmission of HIV has played a relatively small part in the region’s epidemic. However, there is potential for this to change as heterosexual HIV transmission increases. -
AIDS and Prisoners in Russia
AIDS-HIV spread quicky among prisoners in Russia’s prisons in the late 1990s and early 2000s. Kresty prison in St. Petersburg had fewer than 10 inmates with the disease in 1997. By 2003, more than 1,000 out of around 8,000 prisoners carried the virus. Drugs are widely used in Russian prisons and AIDS-HIV spread by the sharing of needles and sexual contact. In a study by Doctors Without Borders 8 percent or prisoners admitted using drugs in prison and two thirds of them admitted sharing needles.
Usually prisoners are tested for HIV only when they enter prison and if they get sick. If they contact the disease in prison they may not known it and then unwittingly pass it on to others. There is also the danger that after contacting the disease in prison will spread it after they are released form prison.
Experts believe the situation would be improved if prisoners were given condoms (condoms are not allowed because sex is technically not allowed), clean needles or least bleach to clean needles. The primary strategy to halt the spread of HIV-AIDS is keeping infected and non-infected prisoners separated. This is fine except that are many prisoners have the disease but don’t know it.
Precise information on patterns of HIV in prisons is hard to obtain, especially from lower and middle-income countries which dominate the region. In Russia, over one in ten of all new HIV diagnoses during 2006-2007 were registered to prison populations. Overall HIV prevalence in Russian prisons is estimated at around 5 percent with the majority of inmates already infected before entering. [Source: Avert, International AIDS-HIV charity website]
AIDS Treatments in Russia
Most of registered HIV-AIDS patients are treated in Moscow. Many of these reside elsewhere and fly or take the train hundreds or thousands of kilometers to be treated in Moscow. Beginning in 2001, the government began providing HIV-infected babies with medication. As the number of AIDS cases increased there were worries they might overload the health care system.
Adequate supplies of HIV-fighting drugs are not available. As of 2004, only 2,000 Russians were receiving ant-retroviral medication. Many of these got less than the full treatment known as the triple cocktail, which, as of 2004, cost between $6,000 and $12,000 a year. Most Russians can't afford the $1,000 a month coast for the best treatments. Drugs available in the United States and Europe are unavailable anyway. The best they can hope for AZT.
Drug users are often denied access to best the treatments unless they have they have the money to pay for them. One health official told the Los Angeles Times, "The philosophy of our masters seems to be that the average drug addict dies within four or five years anyway, so what's the point of treating him for AIDS when there are normal people needing treatment?"
Combating AIDS in Russia
The Russian government has done very little to treat AIDS patients and prevent people from getting the HIV virus. There is little interest for AIDS programs. As of 2004, the Russian government spent less $1 million a year on AIDS prevention. About $45 million was spent by the national and local governments on treating the disease. More money than that was provided by foreign groups such as the Ford Foundation, the Red Cross, UNAIDS and the George Soros program. In many case they gave money to private groups., bypassing the Russian government.
The cost of effectively tackling the AIDS/HIV crisis in Russian is estimated at around $5.8 billion (the entire 1996 budget was $10.5 million). Programs have consisted of the distribution of clean needles and flyers urging HIV tests among drug uses. There has been a lot of resistance to offering clean needles. Local officials think that it encourages drug use.
The Russian government has established a diagnostic and screening infrastructure for AIDS prevention and control at the central and subnational levels. This system has been criticized heavily, however, because it tests only populations with little chance of infection, and because it fails to allocate scarce funds to root causes of AIDS transmittal such as infection from hospital procedures and reuse of hypodermic needles. [Source: Library of Congress, July 1996 *]
Igor S. Kon wrote in the International Encyclopedia of Sexuality in the mid 1990s: “Since AIDS-prevention politics are completely in the hands of epidemiologists, millions of rubles are spent on diagnostics, HIV-tests - 25 million were tested in 1993, and so on, but there is no money for prevention programs and sex education. Education and prevention programs are mainly in the hands of different voluntary organizations. Due to its relative social isolation in the past, the former Soviet Union, for a number of years, was spared the effects of the HIV-related diseases. However, this lead time on the HIV epidemic has been wasted by government authorities and medical professionals. Instead of preparing the country for the inevitable increase in infection rates, the Soviet Ministry of Health and government-sponsored mass media waged an ideological campaign in the early 1980s - even accusing the Pentagon and CIA of inventing the virus as a form of germ warfare! Next, the blame was put on homosexuals and drug addicts. Hopes for control of the disease were placed on the prisons (for homosexuals) and on moral exhortations in favor of monogamy (for the addicts and the remainder of the population). Unfortunately, this strategy continued even after the disease had claimed its first victims. As late as 1988, an appeal to explore the social and psychological aspects of the AIDS, including the dangers of an AIDS-induced public hysteria, brought violent attacks in the conservative media. [Source: Igor S. Kon, Ph.D. International Encyclopedia of Sexuality]
Given that injecting drug use accounts for the overwhelming majority of new HIV infections in the region, the availability of needle exchanges and drug substitution therapy is vital if HIV is to be effectively tackled. Additionally, information regarding safer sex is also necessary to ensure the epidemic does not bridge to wider populations. Services to prevent the spread of HIV among IDUs are inadequate and it is estimated that just 9 percent of injecting drug users at best utilise harm reduction programmes. [Source: Avert, International AIDS-HIV charity website]
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Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, U.S. government, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Foreign Policy, Wikipedia, BBC, CNN, and various books, websites and other publications.
Last updated May 2016