Are people aware of their HIV status?
We’re seeing slight improvements here. Among the 1.4 million people living with HIV in the region at the end of 2017, 73 percent were aware of their HIV status, an four percent increase from 2016. Late HIV diagnosis also remains a major challenge in the region: in the Russian Federation, almost 69 percent of patients who started treatment in 2016 already had very low CD4 cell counts.
Even when people know their status, treatment are slow to scale up. Coverage remains among the lowest in the world. Only about 36 percent of all people living with HIV in the region are accessing ARVs. The region needs to test and treat 635,000 people living with HIV by 2020.
Which countries are doing better, which countries worse?
The Russian Federation accounts for the highest HIV infection rates at 71 percent, followed by Ukraine.
Several countries—Belarus, Kazakhstan, the Republic of Moldova, the Russian Federation and Ukraine—have successfully reduced the cost of first-line treatment regimens in recent years, in some cases to as little as US$78 per person per year.
Score cards for this region on laws and policies show that Turkmenistan and Uzbekistan criminalize same sex sexual acts. Russian Federation, Ukraine, Serbia, Moldova, Bosnia and Herzegovina, Tajikistan punish sex work. Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan and Uzbekistan criminalize drug use or consumption or possession of drugs for personal use. Azerbaijan, the Russian Federation and Turkmenistan restrict entry, stay and residence of people living with HIV.
This legal and societal stigmatization and criminalization hinders safe behaviours, rates of HIV testing and proper treatments.
What are the most encouraging trends?
In the region, cities are proving to be dynamic. At the end of 2017, harm reduction programmes were still operating in 17 cities in the Russian Federation. The city of Saint Petersburg, for example, has achieved a consistent decrease in new HIV infections thanks to city authorities collaborating with CSOs. But there are limited options to sustain these types of projects in the future.
Several countries have maintained and scaled up harm reduction programmes with government resources, leading to reductions in new HIV infections among people who inject drugs. The coverage of opioid substitution therapy has proven to be efficacious and cost-effective, but still remains suboptimal throughout the region.