Comprehensive, up-to-date information on HIV/AIDS treatment, prevention, and policy from the University of California San Francisco

In Eastern Europe and Central Asia, the number of people living with HIV has almost tripled since 2000 and reached an estimated total of 1.4 million [1.3 million-1.6 million] in 2009 compared with 760,000 [670,000-890,000] in 2001. A rapid rise in HIV infections among people who inject drugs at the turn of the century caused the epidemic in this region to surge. Overall, the HIV prevalence is 1% or higher in two countries in this region, the Russian Federation and Ukraine, which together account for almost 90% of newly reported HIV diagnoses. At 1.1% [1.0%-1.3%], the adult HIV prevalence in Ukraine is higher than in any other country in Eastern Europe and Central Asia. Annual HIV diagnoses in Ukraine have more than doubled since 2001. The HIV epidemic in the Russian Federation also continues to grow, but at a slower pace than in the late 1990s. Newly reported HIV cases have increased in several of the countries in Central Asia, including Uzbekistan, which has the largest epidemic in Central Asia.

The HIV epidemics in Eastern Europe and Central Asia are concentrated mainly among people who inject drugs, sex workers, their sexual partners and, to a much lesser extent, men who have sex with men. An estimated one quarter of the 3.7 million people (most of whom are men) who inject drugs in the region are living with HIV. In the Russian Federation, more than one third (37%) of the country's estimated 1.8 million people who inject drugs are believed to be living with HIV, compared with between 39% and 50% in Ukraine. Surveys among people who inject drugs in 2007 found HIV prevalence as high as 88% (in the city of Kryvyi Rih). High HIV prevalence has also been found in prison populations, especially among incarcerated people who inject drugs. The interplay between sex work and injecting drug use is accelerating the spread of HIV in the region. At least 30% of sex workers in the Russian Federation, for example, have injected drugs, and the high HIV infection levels found among sex workers in Ukraine (14% to 31% in various studies) are almost certainly due to the overlap of paid sex with injecting drug use.

As the epidemic spreads from (predominantly male) people who inject drugs to their sexual partners, the proportion of women living with HIV is also growing. By 2009, an estimated 45% of the people living with HIV in Ukraine were women, compared with 41% in 2004 and 37% in 1999. Different people using the same contaminated injecting equipment within a short time frame remains a core driver of these epidemics. An estimated 35% of women living with HIV probably acquired HIV through injecting drug use, while an additional 50% were probably infected by partners who inject drugs.

Unprotected sex between men is responsible for a small share of new infections in the region - less than 1% of people newly diagnosed with HIV infection for whom the route of transmission was identified. Nevertheless, official data may underplay the actual extent of infection in this highly stigmatized population. In small surveys, the HIV prevalence among men who have sex with men has ranged from zero in Belarus, Lithuania and parts of Central Asia to 5% in Georgia, 6% in the Russian Federation and between 4% (in Kyiv) and 23% (in Odessa) in Ukraine.