Russia and some former Soviet Union countries are at risk of out-of-control HIV epidemics following a record number of new cases, say experts, The Mirror reports.
There were more than 104,000 new HIV diagnoses in Russia in 2017, taking total cases to more than 1.2million, but the number of infected people is believed to be higher.
The situation has concerned experts – who marked World Aids Day on Saturday – as Russia and Ukraine account for 75 per cent of all new infections in Europe amid a global decline.
Russia faces an escalating crisis with a rate – 71.1 new infections per 100,000 people – that is more than 10 times that of Western Europe (6.4 infections per 100,000 people).
Most new cases in the former Soviet Union in 2017 were from heterosexual sex as the disease spreads beyond high-risk groups, according to research by the World Health Organisation (WHO) and the European Centre for Disease Prevention and Control.
The increased rate of new diagnoses in the region since 2012 comes amid a global decline. Masoud Dara, HIV specialist at the WHO, said it could be “an early indication of overspill in the general population”.
He told the Thomson Reuters Foundation: “HIV starts off (in) key populations – meaning drug users, commercial sex workers and men having sex with men – but after that it (increases) exponentially … if there is no more intervention.”
Russia’s figures are probably an understatement, said experts.
Nikolay Lunchenkov, a doctor at the Moscow Regional Aids Centre, said: “We don’t have enough medication, we don’t treat every patient.
“We are increasing the number of people who receive antiretroviral therapy, but it’s still not enough.”
The number of HIV treatment courses bought by the Russian government rose 37 per cent to about 360,000 last year, according to the Treatment Preparedness Coalition, an NGO.
But methadone, which research has shown helps to prevent injecting drug users passing on HIV, is banned in Russia.
Cases have increased in Crimea since it was annexed from Ukraine in 2014, according to the Moscow Times.
Mr Lunchenkov said: “We also don’t have enough data about men who have sex with other men, because of high levels of stigma.”
The number of Russian men who were infected with HIV through having sex with another man more than doubled to 695 between 2008 and 2015, according to official data.
Discrimination against LGBT+ people means those at risk of HIV/Aids are afraid to seek out testing and treatment, experts say.
Russia was ranked Europe’s second least LGBT-friendly nation in 2016 by ILGA-Europe, a network of European LGBT groups.
A requirement introduced in 2012 for some international NGOs working in Russia to register as “foreign agents” led to a decrease in organisations working with groups vulnerable to HIV, said Oli Stevens, a HIV researcher based in Britain.
He said: “The message was very clear, MSM (men having sex with men) are not us, they are the other, they are not part of society we’re trying to build.”
President Vladimir Putin has pushed “traditional values”, and under his rule the Orthodox Church has become an even greater influence.
Boris Shapiro, professor and head of the psychology department at the Moscow School of Social and Economic Sciences, said in two-thirds of Russian families, parents don’t discuss sex with their children.
Attempts to introduce sex education into the curriculum have failed, he told US News & World Report.
Daria Rakhmaninova, a biology teacher who organises sex education seminars in Moscow, said Russian teens know little about safe sex.
She added: “They don’t know about birth control, they don’t know about sexually transmitted diseases.
“Some heard about HIV, but that’s about it.”
In the rest of the former Soviet Union, new cases of infected drug users have fallen 45 per cent to 6,218 a year in a decade, while new cases of heterosexual transmission increased 59 per cent to almost 18,000.
Activists blame widespread discrimination against LGBT+ people for an eight-fold rise in transmission among men having sex with men, to more than 1,000 cases annually.
HIV diagnoses are falling in the European Union and European Economic Area, thanks to more widespread testing, fast treatment and the roll-out of pre-exposure prophylaxis.
Transmission rates fell 20 per cent between 2015 and 2017 among men having sex with men in the region, according to the WHO data.
Nonetheless, experts warned against complacency.
Matthew Hodson, executive director of NAM, a British HIV/Aids information charity, said: “If you look at the late diagnosis rates, which are still quite high, that tells us that there’s still much more to be done.”
The theme of World Aids Day 2018 is Know Your Status.
This is the 30th anniversary of the international event. Some 37 million people live with HIV around the world, according to the Joint United Nations Programme on HIV/Aids. Death from Aids have fallen to the lowest level this century, with fewer than one million people dying from Aids-related illnesses last year, it said.
But a funding crisis, prevention services not reaching vulnerable populations and discrimination remain worrying issues.
More than 77million people around the world have become infected with HIV since the epidemic emerged in the 1980s.
Just under half, or 35.4million people, have died from Aids-related illnesses.