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The number of deaths from AIDS in the world. The spread of HIV in the world: the incidence rate in different countries

Statistics on HIV incidence and AIDS mortality vary widely across countries and continents. The indicators are influenced by the standard of living of the population, economic development, health and social security, youth policy and promotion of a healthy lifestyle. It would seem that backward third world countries are among the leaders in immunodeficiency. However, HIV in the Russian Federation is spreading at a rate that brings Russia to third place in the world ranking in terms of the rate of increase in incidence, behind only South Africa and Nigeria.

HIV statistics in Russia change from year to year for the worse. Since 1987, when they first started talking about a terrible diagnosis, and to the present, the number of cases has been increasing, and mortality has been increasing. The percentages of new cases of immunodeficiency and population bring the Russian Federation to the leading positions in the lists of the countries of the former USSR and the entire planet. Moreover, the main increase in deplorable statistics does not occur in the 90s, neither the change of power, nor the change in the way of thinking, nor the improvement in the quality of life affect - an increase in the rate of HIV spread is recorded every year. The mortality index (number of deaths per 1,000 people) has increased 10 times over the past ten years.

According to official data, there are about a million HIV patients in Russia, that is, approximately 0.7% of the country's inhabitants are infected with HIV. According to unofficial information from foreign agencies, the percentage in reality is exactly 2 times higher, and this indicates an epidemic of immunodeficiency in the Russian Federation.

In order not to cause panic and not take away the first place in AIDS from South Africa and Nigeria, in Russia the statistics are slightly corrected in the right direction. For example, a person with AIDS dies, but the cause of death is a secondary disease - heart failure or a malignant neoplasm, and the patient was not registered for immunodeficiency. This death is not reflected in HIV mortality. Also, the data on the total number of cases are not accurate enough - there is no mandatory procedure for testing for HIV. Thousands of people do not go to medical institutions for years and do not donate blood. Naturally, if they are infected, Rosstat and Rospotrebnadzor do not know about it. If a person is diagnosed with HIV, but does not undergo an examination and is not registered with an infectious disease specialist, then such a case is also not taken into account - the patients actually registered are taken into account. In Russia, most citizens need to be forced and persuaded to go to the hospital and get treated. Based on the above cases, the actual incidence of AIDS in the Russian Federation is clearly much higher.

Regions and cities are leaders in the number of HIV infections

Russia is a large country in terms of territory and, accordingly, statistical data varies by region. Sverdlovsk, Irkutsk, Kemerovo, Novosibirsk, Samara, Orenburg regions, Perm Territory, Khanty-Mansi Autonomous Okrug have become the most disadvantaged for HIV in recent years. In these regions, the highest rate of increase in the incidence and the highest percentage of HIV-infected people - more than 2% of the inhabitants are infected with a retrovirus, with a huge number of infected children and pregnant women (every 50th woman in labor is sick with immunodeficiency). Of the leading cities in terms of HIV, the geography remains identical to the regional one - Kemerovo, Yekaterinburg, Irkutsk, Novosibirsk.

HIV statistics by age

HIV statistics by age in Russia has not changed for many years - the majority of infected people are young people from 20 to 39 years old, accounting for approximately 80% of registered patients. Another 10% are from 40 to 60 years old, 9% are from newborns to 19 years old. The latter category of patients is more vulnerable in terms of diagnosing immunodeficiency. An HIV diagnosis is accurately established in children from 0 years of age, infected in utero, during childbirth from a sick mother. The rest of the children, among whom the peak of injection drug addiction is recorded at the age of 13-17, are not tested for retrovirus and remain unaccounted for.

Reasons for Russia's leadership in HIV infection

The UN has called Russia the epicenter of the global epidemic of secondary immunodeficiency. Inaccurate and underestimated statistics of immunodeficiency in the Russian Federation exceeds the scale of the disaster in other countries. For example, in Germany, the increase in the incidence is three times less than in Russia. And there, HIV is a national problem that is being fought and funds are allocated from the state budget. The HIV epidemic in Russia is not considered something global and serious, given the lack of a state program to combat AIDS. By the way, in the United States, the state wrestling program appeared in the late 1980s.

There are two main reasons for Russia's leadership in infection with immunodeficiency:

  • lack of fight against the disease at the state level - correction of statistics, lack of mandatory HIV testing of citizens without exception, lack of funding - propaganda and youth policy aimed at a healthy lifestyle;
  • HIV and drug addiction epidemics coincide geographically, that is, the main route of infection in Russia is injection drugs.

African countries, where at some time every second citizen was infected with HIV, were able to suppress the epidemic and began to fight the spread of infection. An economically and socially developed state should all the more recognize and accept the problem. Otherwise, according to experts, in the next 5 years Russia will come out on top in the world in terms of HIV, and the death rate from AIDS in the country will increase exponentially.

Key Facts

  • HIV remains a major global public health problem, with more than 39 million deaths to date. In 2014, 1.2 million people worldwide died from HIV-related causes.
  • At the end of 2014, there were approximately 36.9 million people living with HIV in the world, and 2 million people in the world acquired HIV infection in 2014.
  • Sub-Saharan Africa is the most affected region, with 25.8 million people living with HIV in 2014. The region also accounts for almost 70% of the global total of new HIV infections.
  • HIV infection is often diagnosed using rapid diagnostic tests (RDTs), which detect the presence or absence of antibodies to HIV. In most cases, test results can be obtained on the same day; this is important for same-day diagnosis and early treatment and care.
  • There is no cure for HIV infection. However, with effective treatment with antiretroviral drugs (ARVs), the virus can be controlled and people with HIV can lead healthy and productive lives.
  • It is currently estimated that only 51% of people with HIV know their status. In 2014, approximately 150 million children and adults in 129 low- and middle-income countries received HIV testing services.
  • Globally, 14.9 million people with HIV were receiving antiretroviral therapy (ART) in 2014, of which 13.5 million lived in low- and middle-income countries. These 14.9 million people on ART represent 40% of the 36.9 million people with HIV worldwide.
  • The coverage of children is still insufficient. In 2014, 3 out of 10 children with HIV had access to ART compared to one in four among adults.

Human Immunodeficiency Virus (HIV)) affects the immune system and weakens people's systems to control and protect against infections and some types of cancer. The virus destroys and weakens the function of immune cells, so infected people gradually develop immunodeficiency. Immune function is usually measured by the number of CD4 cells. Immunodeficiency leads to increased susceptibility to a wide range of infections and diseases that people with healthy immune systems can resist. The most advanced stage of HIV infection is Acquired Immune Deficiency Syndrome (AIDS), which can take 2-15 years for different people to develop. AIDS is characterized by the development of certain types of cancer, infections, or other severe clinical manifestations.

Signs and symptoms

The symptoms of HIV vary depending on the stage of the infection. During the first few months, people with HIV tend to be most contagious, but many of them do not know their status until later. During the first few weeks after infection, people may have no symptoms or develop a flu-like illness, including fever, headache, rash, or sore throat.

As the infection gradually weakens the immune system, people may develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhea, and cough. If left untreated, they can develop serious diseases such as tuberculosis, cryptococcal meningitis, cancers such as lymphomas and Kaposi's sarcoma, and others.

Transmission

HIV can be transmitted through various body fluids of infected people, such as blood, breast milk, semen, and vaginal secretions. People cannot become infected through normal everyday contact, such as kissing, hugging, and shaking hands, or by sharing personal items and drinking food or water.

Risk factors

Behaviors and conditions that increase people's risk of contracting HIV include the following:

  • unprotected anal or vaginal sex;
  • having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhea, and bacterial vaginosis
  • sharing contaminated needles, syringes and other injecting equipment and drug solutions while injecting drugs;
  • unsafe injections, blood transfusions, medical procedures involving unsterile incisions or punctures;
  • accidental needle stick injuries, including among healthcare workers.

Diagnosis

Serological tests such as RDT or enzyme immunoassay (ELISA) detect the presence or absence of antibodies to HIV-1/2 and/or HIV-p24 antigens. Conducting such tests as part of a testing strategy in accordance with an approved testing algorithm makes it possible to detect HIV infection with a high degree of accuracy. It is important to note that serological tests do not directly detect HIV itself, but detect antibodies produced by the human body as its immune system fights foreign pathogens.

In most people, antibodies to HIV-1/2 are produced within 28 days, and therefore, during the early stage of infection, during the so-called seronegative window period, antibodies are not detected. This early period of infection is the period of greatest infectivity, but HIV transmission can occur at all stages of infection.

It is good practice to retest all people initially diagnosed as HIV positive prior to enrollment in care and/or treatment programs to rule out any potential errors in testing or reporting.

Testing and counseling

HIV testing should be voluntary and the right to refuse testing should be recognized. Mandatory or coercive testing at the instigation of a healthcare professional, health authority, partner or family member is not acceptable as it undermines good public health practice and violates human rights.

Some countries have introduced self-testing or are considering introducing it as an option. HIV self-testing is a process in which a person who wishes to know their HIV status collects semen, performs the test, and interprets the results in confidence. Self-testing for HIV does not provide a definitive diagnosis; this is an initial test that requires further testing by a healthcare professional using a nationally approved testing algorithm.

All testing and counseling services should take into account the five components recommended by WHO: informed consent, confidentiality, counseling, correct test results, and communication with care and treatment and other services.

Prevention

The risk of HIV infection can be reduced by limiting exposure to risk factors. Key HIV prevention approaches often used in combination include the following:

1. Use of male and female condoms

Proper and consistent use of male and female condoms during vaginal or anal sex can protect against the spread of sexually transmitted infections, including HIV. Evidence suggests that male latex condoms protect 85% or more against the transmission of HIV and other sexually transmitted infections (STIs).

2. HIV and STI testing services

Testing for HIV and other STIs is strongly recommended for all people exposed to any risk factor so that they can know their infection status and have immediate access to necessary prevention and treatment services. WHO also recommends offering testing to partners or couples.

Tuberculosis is the most common disease among people with HIV. If not detected and treated, it is fatal and is the leading cause of death among people with HIV, with approximately one in four HIV-related deaths due to tuberculosis. Early detection of this infection and prompt provision of anti-TB drugs and ART can prevent these deaths. It is strongly recommended that TB screening be included in HIV testing services and prompt provision of ART to all people diagnosed with HIV and active TB.

3. Voluntary medical male circumcision

Medical male circumcision, when performed safely by properly trained healthcare professionals, reduces the risk of heterosexual men acquiring HIV infection by about 60%. It is one of the main interventions in epidemics with high HIV prevalence and low rates of male circumcision.

4. Use of antiretroviral therapy (ART) for prevention

4.1. Antiretroviral therapy (ART) as prevention

A 2011 trial showed that if an HIV-positive person adheres to an effective ART regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96%. For couples where one partner is HIV positive and the other HIV negative, WHO recommends that the HIV positive partner be offered ART regardless of his/her CD4 count.

4.2 Pre-exposure prophylaxis (PrEP) for the HIV-negative partner

Oral HIV PrEP is the daily use of ARVs by people who are not infected with HIV to prevent HIV infection. There have been over 10 randomized controlled trials demonstrating the effectiveness of PrEP in reducing HIV transmission rates in a range of populations, including serodiscordant heterosexual couples (couples in which one partner is infected and the other is not), men who have sex with men, women, gender reassignment, high-risk heterosexual couples and injecting drug users. WHO recommends that countries undertake projects to gain experience in using PrEP safely and effectively.

In July 2014, WHO released the Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations at Risk, recommending PrEP as an additional HIV prevention option as part of a comprehensive HIV prevention package for men with sex with men.

4.3 HIV Post-Exposure Prophylaxis (PEP)

Post-exposure prophylaxis (PEP) is the use of ARVs within 72 hours of exposure to HIV to prevent infection. PEP includes counseling, first aid, HIV testing, and a 28-day course of ARV treatment followed by medical care. In a new supplement released in December 2014, WHO recommends PEP for both work-related and non-work-related exposures, and for adults and children. The new recommendations contain simplified ARV regimens already used for treatment. Implementation of the new guidelines will simplify drug prescribing, improve compliance, and increase completion rates of PEP for HIV prevention in people who are accidentally exposed to HIV, such as healthcare workers, or in people exposed to HIV through unprotected sex or sexual assault .

5. Harm reduction for injecting drug users

People who inject drugs can take precautions to prevent HIV infection by using sterile injecting equipment, including needles and syringes, for each injection. A complete HIV prevention and treatment package includes:

  • needle and syringe programs
  • evidence-based opioid substitution therapy for drug users and treatment of dependence on other psychoactive drugs,
  • HIV testing and counseling,
  • HIV treatment and care,
  • providing access to condoms, and
  • management of STIs, tuberculosis and viral hepatitis.

6. Eliminate mother-to-child transmission of HIV

The transmission of HIV from an HIV-positive mother to her child during pregnancy, labour, childbirth, or breastfeeding is called vertical transmission or mother-to-child transmission (MTCT). In the absence of any intervention, rates of HIV transmission from metaria to child range from 15-45%. Such transmission can be almost completely prevented if both mother and child receive ARVs at stages where infection can occur.

WHO recommends a range of options for preventing mother-to-child transmission of HIV, which include providing ARVs to mothers and children during pregnancy, childbirth and the postpartum period, or offering lifelong treatment to HIV-positive pregnant women regardless of their CD4 count.

In 2014, 73% of an estimated 1.5 million pregnant women with HIV in low- and middle-income countries received effective antiretroviral drugs to prevent transmission to their children.

Treatment

HIV can be attenuated with combination antiretroviral therapy (ART), consisting of three or more antiretroviral drugs (ARVs). ART does not cure HIV infection, but it controls the replication of the virus in the body and helps to strengthen the immune system and restore its ability to fight infections. Thanks to ART, people with HIV can have healthy and productive lives.

At the end of 2014, approximately 14.9 million people with HIV were receiving ART in low- and middle-income countries. About 823,000 of them are children. In 2014, the number of people on ART increased significantly, by 1.9 million in one year.

Coverage of children is still insufficient, with 30% of children receiving ART compared to 40% of HIV-infected adults.

WHO recommends starting ART at the stage when the CD4 count falls to 500 cells/mm³ or below. ART regardless of CD4 count is recommended for all people with HIV in serodiscordant couples, pregnant and lactating women with HIV, people with tuberculosis and HIV, and people co-infected with HIV and hepatitis B with severe chronic liver disease. Similarly, ART is recommended for all children with HIV under five years of age.

WHO activities

As humanity approaches the deadline for achieving the Millennium Development Goals, WHO is working with countries to implement the Global Health Sector Strategy on HIV/AIDS 2014-2015. WHO has set 6 operational targets for 2014-2015 to best support countries as they move towards the global HIV targets. They aim to support the following areas:

  • strategic use of ARVs for HIV treatment and prevention;
  • eliminating HIV among children and increasing access to treatment for children;
  • improved health sector response to HIV among key risk groups;
  • further innovation in HIV prevention, diagnosis, treatment and care;
  • strategic information for efficient scaling;
  • strengthening links between HIV and related health outcomes.

WHO is one of the sponsors of the Joint United Nations Program on AIDS (UNAIDS). Within UNAIDS, WHO leads work on HIV treatment and care and co-infection with HIV and TB, and is coordinating with UNICEF to eliminate mother-to-child transmission of HIV. WHO is currently developing a new strategy for the global health sector response to HIV 2016-2021.

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In Moscow, the number of newly infected with HIV increased by 20% over the year. The disease continues to spread due to insufficient actions of the authorities to prevent it, academician Vadim Pokrovsky believes

Growing regions

In Moscow in 2017, 20.4% more cases of infection with the human immunodeficiency virus were registered than in 2016, follows from the data published in the annual statistical collection of the Ministry of Health. ​

In 2016, 2.4 thousand cases of the disease were detected (.doc), and in 2017 - 2.9 thousand. The certificate does not contain statistics on the total number of people infected with HIV. RBC sent a request to the Ministry of Health with a request to provide it. The head of the health department, Aleksey Khripun, refused to talk to RBC and referred him to the head of the press service. RBC is awaiting a response from the press service of the Moscow Health Department.

According to the Federal Scientific and Methodological Center for the Prevention and Control of AIDS (AIDS Center) of Rospotrebnadzor, the total number of registered Russians with HIV has reached more than 1.22 million people (living and dead). At the end of 2017, more than 944,000 people living with HIV lived in the country.

In two regions, the increase in cases was more than 100%: 151.7 and 133.3% in the Chukotka Autonomous Okrug and the Republic of Tyva, respectively. In Chukotka, the number of newly infected people has increased from 29 to 73 people (the population of the region is less than 50 thousand people), and in Tuva - from nine to 21 (the population is about 310 thousand people). In the Tambov region, the republics of Mari El, Karelia and the Ivanovo region, the increase was from 50 to 66%. A serious increase in the incidence was recorded by the Ministry of Health in the Rostov (from 1.6 thousand to 2.1 thousand people), Irkutsk (from 3.5 thousand to 4.2 thousand) and Novosibirsk regions (from 3.5 thousand to 4 thousand people).


The number of HIV-infected people in the Perm Territory and the Moscow Region also increased by an average of 400 people: from 3.3 thousand to 3.7 thousand and from 2.6 thousand to 3 thousand people, respectively. In another region, the Sverdlovsk region, the number of new infections did not increase: in 2016 there were 6.3 thousand, and in 2017 - 6.2 thousand people.

RBC sent inquiries to regions where an increase in the number of new cases was noted, asking them to explain how local authorities are fighting the spread of HIV.

Lack of prevention

The increase in the number of infected people can partly be explained by the improvement in the quality of testing of the population, academician Vadim Pokrovsky believes. But the main reason is that the preventive measures taken by the authorities are insufficient. “The government does not pay enough attention to regions where the situation has not yet reached a critical level. All forces are aimed at fighting the epidemic in large cities, which is fundamentally wrong, since it is easier to prevent than to fight another epidemic later,” he said.

To stop the epidemic, Pokrovsky will finance the purchase of anti-HIV drugs (now the state allocates an average of about 20 billion rubles a year for these purposes), improve the availability of condoms and inform the population about ways to protect against HIV.

How HIV is spread

The human immunodeficiency virus (HIV) is transmitted through unprotected sexual contact, when the blood of an HIV-infected person enters the body of a healthy person, including when it is transfused, and when non-sterile medical instruments are used. HIV infection is not transmitted by kissing, shaking hands, etc. There is, which, without completely destroying the virus, stops its development and makes the infected person harmless to others.

The Ministry of Health considers only those infected who turned to medical institutions subordinate to the ministry for help, Academician Pokrovsky explained the difference in the calculations.

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Last week it became known that every 50th inhabitant of Yekaterinburg is infected with HIV. Today, the Ministry of Health officially announced that an increased level of the spread of the disease is observed in 10 regions, including the Sverdlovsk region. Life found out which regions of the country are most likely to contract a deadly disease.

On November 2, Tatyana Savinova, First Deputy Head of the Health Department of the Administration of the City of Yekaterinburg, announced a pandemic of the immunodeficiency virus in the Ural capital. According to her, the disease is firmly rooted in all segments of the city's population and the spread of the disease no longer depends on risk groups. A total of 26,693 cases of HIV infection have been registered in Yekaterinburg, but this includes only officially known cases, so the actual incidence is much higher.

Later, the city health department informed about the epidemic, and the refutation was made by herself Savinova. According to her, on P press conference, journalists asked her a question about the situation in Yekaterinburg. And in response she just " voiced the data broadcast in the media."

Of course, for us, physicians, this has long been an HIV epidemic, since many people are sick in Yekaterinburg, the official said. - It didn't happen yesterday and nothing has been officially announced.

Today, the head of the Ministry of Health of the Russian Federation, Veronika Skvortsova, that an increased level of the spread of HIV disease has been recorded in 10 regions Russia.

In our country, 57% of all sources of HIV infection are the injection route, as a rule, among heroin addicts, she added.

Meanwhile, according to experts, it is really high time to declare the epidemic officially, moreover, on a national scale.

The epidemic is spreading throughout the country, and only one administrator had the courage (the administration of one region. - Approx. ed.) admit it. There is unevenness: the population of cities is more affected. And where the urban population is higher than the rural population, the percentage of those affected is higher there. This is the Volga region, the Urals, Siberia. These are signs of the general epidemic which at us goes, - Life reported. Director of the Federal Methodological Center for the Prevention and Control of AIDS, Deputy Director of the Central Institute of Epidemiology Vadim Pokrovsky.

To prove what was said, the head of the center cited figures.

Now we have 1% of the population infected with HIV, and in the age group of 30-40 years - 2.5%. On the day we register a total of 270 new cases of HIV infection in the country, every day 50-60 people die from AIDS. What else is needed to talk about the epidemic? asked Pokrovsky.

In Yekaterinburg, the situation with HIV is not even the worst. Every 50th inhabitant of the city (2% of the population) is infected there. But in Tolyatti (Samara region), as told by p Head of the Federal Scientific and Methodological Center for the Prevention and Control of AIDS Vadim Pokrovsky,already 3% of the population are HIV-positive.

On the Life map, you can find your region and see how many cases are among your fellow countrymen.

The share of HIV-infected people in the total number of inhabitants of the region

As you can see, the epidemic covered Russia unevenly. Half of all those infected live in 20 of the 85 regions. The worst situation is in the Irkutsk and Samara regions (1.8% of the inhabitants are infected with HIV). In third place is the Sverdlovsk region, the capital of which is Yekaterinburg (1.7% of the inhabitants are infected with HIV).

Slightly fewer infected in the Orenburg region (1.4%), the Leningrad region (1.3%), the Khanty-Mansi Autonomous Okrug (1.3%).

And here are the statistics on the mortality of HIV-infected people by region (data from the Federal AIDS Center, dated 2014, no more recent statistics yet).

As of December 31, 2014 in Russia 148,713 HIV-positive adults and 683 children died. In 2014, 24.4 thousand HIV-positive people died.

Pokrovsky explained why HIV "selected" these regions:

These are the regions where drug trafficking took place, for example, the Orenburg region. As well as materially prosperous parts of the country where drugs were easier to sell (Irkutsk and Sverdlovsk regions).

Yekaterinburg Mayor Yevgeny Roizman also said that the majority of HIV-positive people became infected due to drugs.

I started talking about it in 1999,” he said. - Of those addicts who passed through my hands, the guys are heroin addicts, of which 40% were HIV-positive. The girls are heroin addicts, if without HIV infection, it was an event. Moreover, they were all, as a rule, also prostitutes. Then, when what was called a crocodile started, everyone there was HIV-infected. They could buy disposable syringes, but they recruited from one bowl. Now there is a sexual spread. Indeed, we are ahead of the whole of Russia. The situation in the Sverdlovsk region is worse than in Yekaterinburg. Ahead of all of Russia - this was due to drug addiction, - said Evgeny Roizman.

Vadim Pokrovsky stressed that among the main problems in this area is the lack of medicines.

Now we need to treat a little more than 800 thousand HIV-infected people. 220,000 have died, and, according to estimates, another 500,000 have not yet been diagnosed with us,” Pokrovsky noted.

Previously Pokrovsky, which is bad with prevention.

There are no strategic programs to fight AIDS in the regions, Vadim Pokrovsky says. - As a result, they will print and hang several posters and flyers. This is where prevention ends.

It turns out a vicious circle.

People do not even suspect how difficult the situation with HIV is in Russia, Vadim Pokrovsky notes. - Information is the main method of combating the spread of the disease. In addition, it is also cost savings, because the fewer people get infected, the less you will have to treat later.

Ten regions of Russia are in critical condition in terms of HIV prevalence. This was stated by the Minister of Health of the Russian Federation Veronika Skvortsova. The sad list is headed by the Sverdlovsk and Kemerovo regions.

“HIV is spread very unevenly across the country,” the head of the Ministry of Health noted. “The prevalence is significantly higher, several times higher, in those regions through which drug trafficking routes pass. Therefore, there are 10 critical regions out of 85. In the first place is the Sverdlovsk region, Yekaterinburg, which got (in connection with this) to the press," said Skvortsova.

According to the minister, "57% of all sources of HIV infection are injections, usually among heroin addicts." As for such a traditional risk group as homosexuals, this trend is less pronounced in Russia.

“40% of cases of sexually transmitted infections relate to heterosexual couples,” Skvortsova said, stressing that the increase in the number of infections is due to well-off women who have picked up the virus from their own husband.

According to the Federal Center for Prevention and Control of AIDS, at the end of last year the list of the most HIV-affected regions was as follows: areas.

During the year, anonymous testing was conducted in problem regions, which was passed by 23.5 thousand young people under 30 years old. Among them, 2.3% of HIV-infected people were identified.

In early November, the Ministry of Health of Yekaterinburg announced that every 50th inhabitant of the city had AIDS.

"Our infection rate is 1,826 people per hundred thousand, which is 1.8% of the city's population, 26,693 thousand infected," Tatyana Savinova, deputy head of the Yekaterinburg city health department, said. "And these are only known cases, the real incidence is even higher," she stressed.

But this situation in Yekaterinburg has been developing for decades, so doctors do not make announcements about the beginning of the epidemic, the city health department emphasized.

According to the criteria of WHO and the Joint United Nations Program on HIV, more than 1% of those infected means that the infection is firmly rooted in the population and its spread is practically independent of risk groups.

Meanwhile, the Federal Center for Prevention and Control of AIDS believes that Russia is now on the verge of transition to the third, last stage of the HIV epidemic.

"An epidemic is a relative concept. There are three stages of HIV. Initial - the first cases are imported from abroad. The second is concentrated, risk groups are affected. We now have 10% of men who have sex with men and 20% of drug addicts are infected. And when more than 1% of pregnant women are infected, then it is generalized. Here we are now at the stage of transition from the second to the third, "Vadim Pokrovsky, head of the center, academician of the Russian Academy of Medical Sciences, told the L!fe portal.