Russia and some former Soviet Union countries risk developing out-of-control HIV epidemics, experts said, after data showed a record number of new cases last year.
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 Organization (WHO) and the European Center for Disease Prevention and Control.
The increased rate of new diagnoses in the region since 2012 comes amid a global decline and Masoud Dara, HIV specialist at the WHO, said it could be an indication of overspill in the general population.
"HIV starts (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, "Dara told the Thomson Reuters Foundation.
"We do not have enough medication, we do not treat every patient," said Nikolay Lunchenkov, a doctor at the Moscow Regional AIDS Center. "We are increasing the number of people who receive antiretroviral therapy, but it's still not enough."
The number of HIV treatment courses by the Russian government rose 37% to about 360,000 last year, according to the Treatment Preparedness Coalition, an NGO. But methadone, which research has been shown to prevent injecting drug users from 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.
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 organizations working with groups vulnerable to HIV, said Oli Stevens, an HIV researcher based in Britain.
In the rest of the former Soviet Union, new cases of infected drug users have fallen 45% to 6,218 a year in a decade, while new cases of heterosexual transmission increased 59 percent 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. "State-sponsored homophobia and transphobia (have become) a crucial issue," said Yuri Yoursky of the Eurasian Coalition on Male Health, which supports men with HIV/AIDS in the region.
"In many of the states, governments are not accepting (the) LGBT community as it is, even though MSM are a vulnerable group," he said. "Where human rights for LGBT (people) are not accepted, and are not free and protected for everyone, there cannot be efficient HIV prevention," Yoursky said.
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 dropped 20% between 2015 and 2017 among men having sex with men in the region, according to the WHO data.