Ukrainian live sex
Moldova (1%), Belarus (1.1%) and Ukraine (0.8-1.2%) also have significant numbers of this population.15 In Russia, roughly one in four (25.6%) people who inject drugs are living with HIV.16 However, there are significant geographical variations.
For example, a 2015 survey of people who inject drugs conducted in five Russian cities (Abakan, Barnaul, Volgograd, Naberezhnye Chelny, Perm) found that one in three people who inject drugs were living with HIV.17 HIV prevalence among people who inject drugs is also high in other countries, estimated at 30.8% in Belarus and 22.6% in Ukraine.18 HIV prevalence among women who inject drugs is higher than their male counterparts in Kazakhstan, Uzbekistan, Kyrgyzstan, Belarus, and Ukraine.19 Sex work is closely associated with injecting drug use in the region.
For example, in Russia in 2017, almost 69% of patients who started treatment in 2016 had CD4 cell counts below 350 cells per mm3.49 with late presentation rates as high as 60–80% reported in Georgia, and Albania.50 A 2018 analysis found overall percentages of late presentation and advanced disease in the region to be 40.3% and 25.4%, respectively.51 The main barriers to effective provision of HIV testing services in the region relate to a lack of community-based testing services and health professionals’ knowledge and attitudes.
In the same year, there were 38,000 AIDS-related deaths.3 By the end of 2018, 72% of people living with HIV were aware of their HIV status.4 The vast majority of people living with HIV in Eastern Europe and Central Asia live in Russia (70%), where new infections are on the rise, followed by Ukraine.New conservative legislation is placing additional restrictions on same-sex relationships, sex work and drug use, which could further prevent key populations accessing HIV services.Prevention programmes are under threat as international support for HIV responses decreases and domestic funding for HIV prevention fails to keep pace.10 38% of all people living with HIV were accessing ART in Eastern Europe and Central Asia at the end of 2018, one of the lowest coverage rates in the world.Among HIV positive men who have sex with men it ranges from 36% in Armenia to 69.7% in Azerbaijan.Among HIV positive people who inject drugs it ranges from 12.2% in Azerbaijan to 62.2% in Kazakhstan.48 Even where HIV testing is accessible, people are often diagnosed at a late stage of infection.
According to country progress reports in eight countries, from 2.0% (in Tajikistan) to 11% (in Kyrgyzstan) of surveyed young people (aged 15–24) had sex before the age of 15.45 Among the 1.4 million people living with HIV in the region at the end of 2017, 73% were aware of their HIV status, an increase from 69% in 2016.46 However, while the overall number of annual HIV tests continues to increase, the proportion of tests among key populations is shrinking, declining from 4.5% of all HIV tests conducted annually in 2010 to 3.2% in 2016.47 Testing coverage is generally higher among sex workers and men who have sex with men, and lower among people who inject drugs, although it is still below advised levels across all key affected populations.