Vadim Pokrovsky, head of the federal Aids centre in Moscow, predicted this month that at least two million Russians are likely to be officially registered as HIV-positive within five years, and a total of three million will have the virus.
All pretty worrying, except when we stop to consider that he also said the following – in 2002:
We’re talking about one-to-two million infected now, and in 2005, we could be talking about five-million being infected, and these are realistic, even conservative figures.
In reality, as of 2015, around 0.6% of the Russian population is officially registered as HIV positive. This is probably fairly comprehensive, since around 20-25 million people (one sixth of the population) are tested for it every year; though it should be noted that the unofficial figure is estimated to be around 50-100% higher. Even so, while that’s pretty bad by industrialized country standards, of course – about 3-10x higher per capita than in West European countries, twice higher than in the US, and about the same as in Ukraine and Estonia – but is nowhere close to the cataclysmic levels you see in Sub-Saharan Africa. The alarmist articles that you see and have been seeing in the press since about 2000 about millions and even tens of millions of Russians succumbing to AIDS in the next X years are fantastic in the literal sense of the word.
The reality is that in Russia, as in the rest of the ex-Soviet world, AIDS is primarily driven by injecting drug users (IDUs). This is unlike in Sub-Saharan Africa (SSA), where transmission is primarily sexual, whose particular virulence there is probably due to its specific environment (cultural acceptance of soft polygamy, widespread malnourishment/compromised immune systems, and states too fiscally weak to support mass antiretroviral therapy). Hence the complete failure of models that relied on applying SSA HIV dynamics to Russia at predicting the course of the epidemic there. The graph below is from a 2006 report (pp.56) that collated all of the most high profile projections. The most pessimistic projection, that by Ruhl et al., featured Pokrovsky as a coauthor, incidentally, while the other highly pessimistic estimate came from Nicholas Eberstadt, an AEI demographer who has always been extremely bearish on Russia’s demographic prospects.
I copied down the most important graphs from that report in this old post. In short, more realistic modeling that treats IDUs as the main driver and doesn’t foresee any major deviations from current sexual and drug usage preferences from today’s norms sees a rapid rise in infection rates throughout the 2010s, peaking around 2020, but never reaching much more than 1% of the population even at its peak, followed by a steady decline reaching an asymptote at around 0.5% of the population (note that this assumes no decline of Russia’s huge problems with injecting drug usage which is likely very pessimistic).
This process has “momentum,” on account of the relatively huge numbers of IDUs in Russia, and is very difficult to stop. But the chances it will spread to the general population to any degree – i.e., to people who don’t have first-order sexual relations with IDUs – is all but zero. And this is indeed what we are seeing happen.
The actual trends are closely tracking another model, the TFRI, as well as of an original model to the cited report (pp.78):
This is not to say that Russia’s “conservative” approach to fighting AIDS is without fault, nor that people like Pokrovsky have no right to make a din over it in the media (as he has in fact been doing for the past two decades). It is virtually certain that avoiding the government funding needle exchanges causes more harm than good, though its worth noting that syringes can be freely bought at any well-stocked pharmacy (though, of course, heroin addicts are not known for their high future time orientations). Methadone treatment is a much more questionable case, there being a legitimate debate over its efficacy; it is more addictive even than heroin. Treatment isn’t a problem, even if prevention is. There is near universal access to anti-retrorival therapy amongst registered HIV positive people.
The Orthodox Church’s “malign” influence on this issue is typically exaggerated; for instance, it does not oppose condom use. It is not at all clear to me to what extent progressive attacks on the “conservative” approach are merited. One of the root problems is that so many people feel so despondent or reckless that they are getting addicted to hard drugs. Religion and/or sports – the current emphasis – can indeed in many cases offer an alternative. Society has indeed become less favorably disposed to homosexuality in the past decade, in large part due to state policy. One can say this promotes “ignorance.” But it’s also a fact that HIV spreads much more easily via anal sex, and if it becomes less accepted as a result of changes in social mores, well, that statistically means fewer infections. Both at the national level (in Russia, as well as in Ukraine) and at the international level (they might take the anti-progressiveness a notch to far but the prevalence of AIDS is near zero in the Arab world) it is pretty clear that all else equal – i.e. adjusting for human capital, etc. – it is the more conservative/religious regions that have fewer problems with AIDS in the first place.
And I’m sure it’s possible to come up with plenty of counter-arguments to the above. But that’s not the main point, which is that at the end of the day, what we are ultimately dealing with here is not some kind of runaway pandemic that will result in SSA-level infections rates “in a few years” but a very much epidemic that will burn fiercely in affected communities (primarily IDUs and their close sexual partners) but remains contained in the IDU-sphere and peaks around 2020 and then declines. Likewise the real debate is not about how long it is before Russia collapses from AIDS (and brain drain, and Eurabia, and the Yellow Peril, and…) but whether the epidemic peaks at, say, 1% of the population, or 1.5% of the population, and whether it happens in 2018 or 2022. It’s a lot less fun than constructing apocalyptic scenarios, sure, but it’s also more realistic.