Social change and HIV in the former USSR: the making of a new epidemic

This paper describes the development of the recent HIV epidemic in countrie s of the former Soviet Union. It explores the socio-political and economic roots of an injection-drug-driven HIV epidemic associated with a drug cultu re that facilitates HIV transmission. This review, based on many unpublishe d reports, studies and field notes, discusses the new social and health con text in which the epidemic is developing. The evidence of a growing number of drug users in the region is discussed and drug injection behaviour descr ibed. The authors present selected data on the heterosexual transmission of HIV and linkages between the drug-linked HIV epidemic and its further spre ad into the non-injecting population. The potential overlap with the still uncontrolled syphilis epidemic that began in 1990 is probably a key factor in the future of HIV spread in the region. Until now, HIV infection among S TD patients has been extremely low. However, rapid changes in sexual norms and behaviours, the growing commercial sex industry, and increased mobility soon may affect the current situation. The huge economic and socio-politic al crises currently affecting the region have created a "risk situation" fo r the spread of HIV. Concerns are raised about the appropriateness and the scope of government and non-governmental approaches to the exploding HIV an d STD epidemics, (C) 2000 Elsevier Science Ltd. All rights reserved.