1. Epidemiological situation on HIV and AI in the Kaliningrad Region
Inna Vyshemirskaya, NGO «YLA»

2. The most affected by HIV regions
of the Russian Federation (by )
Irkutsk (1478,8),
Samara (1369,9),
Sverdlovsk (1172,0),
Leningrad (1117,1),
Orenburg (1049,9) region),
St. Petersburg (1003,2),
Khanty-Mansiysk Autonomous Okrug (955,8),
Kemerovo (921,5),
Tyumen (791,8),
Ulyanovsk (KZT 752.2),
Chelyabinsk (762,8) region,
Perm region (607,5),
Tverskaya (571,8)
Ivanovo region (551,2),
the Altai territory (563,0),
Kaliningrad (547,1),
Novosibirsk (545,2),
Moscow (503,3),
Murmansk region (479,3)
Krasnoyarsk territory (473,5)
Kaliningrad region (KR) is sadly known in Russia as the region where the HIV epidemic started in For many years KR had sad leadership in HIV prevalence rate. But now the whole county is facing the epidemic. Kaliningrad region is still in the list of 20 most affected regions.
HIV prevalence in the Kaliningrad region is 547,1 per
Kaliningrad region is still in the list of 20
most affected regions
HIV prevalence in the Kaliningrad region
is 547,1 per
Informatsionnyiy byulleten 2013 2

3. Incidence of HIV in the Kaliningrad region and Russian Federation (per 100.000)
Here you can see HIV incidence for the entire period. Blue line is KR. Pink line is Russia. As you may see the highest incidence rate (142 per ) in KR was in 1997.

4. Incidence of HIV in the Kaliningrad region (per 100.000 among urban vs. rural areas population)
In this slide you may see the incidence rate among city and country-side population.
Blue line is city. Pink line is country-side. HIV incidence in rural areas is getting closer to the level in urban areas

5. HIV incidence (per )
In the last 5 or, more correctly to say, 10 years HIV incidence is more or less stable, staying between 43 and 50 per

6. Number of new HIV cases
In absolute figures it is between 430 to 480 new cases per year.

7. Number of new TB cases

8. HIV & AI incidence (per 100.000)
In the next slide you can see incidence rate of HIV, syphilis and Hepatitis C. Data on Hep C do not reflect the real situation. VHC treatment is not available and testing is not done.
Official incidence rates on Hepatitis B and C are very low. At the same time 49% of LTSP clients knew that they had chronicle hep C.

9. Distribution of HIV cases by transmission routes (%)
Transmission routes for the entire period. 50% of cases among PWID

10. Dynamics of main HIV transmission routes (%)
But transmission routes changed over years. In 2013 they are 77,1 vs 20,5. We have a generalized epidemic.

11. Distribution of HIV cases by age in 2011 (%)
Distribution of HIV cases by age in 2011 (%). More than one third are between years old. One third are between years old.

12. Distribution of HIV cases by age for the entire period and in 2012
2012 +- %
< 1 34
0,41 2
0,45
+ 9,75%
1-14 y.o. 61
0,74 3
0,68
- 8,2%
15-17 y.o.
252
3,09 5
1,13
- 2,73 р.
18-19 y.o.
608
7,46 4
0,91
- 8,19 р.
20-29 y.o.
4211
51,73
149
33,94
-34,4%
30-39 y.o.
2073
25,46
158
35,99
+ 41,35%
40-49 y.o.
626
7,69 73
16,62
+ 2,2 р.
> 50 лет
275
3,37 45
10,25
.+ 3,04 р.
Total
8140
100,0
439
3,17% of new cases are among people under 19 y.o.

13. Structure of HIV cases by age in the entire period and in 2011 (%)
In the have a look at the distribution of HIV cases in the entire period 52.7% is y.o. In the last years an increase of new HIV cases occurred in older age groups. In ,7% of new cases were among people y.o.
61.2% were over 30

14. Distribution of HIV cases by gender (%)
Gender structure for the entire period: 62% - male and 38 - female

15. Structure of HIV cases by gender (%)
But we can see feminization of the epidemic with time. In ,1% - male, 42,9 – female.

16. Some important epi figures
10 months of 2013
HIV cases detected
8498 persons or 897,6 per
362 persons or 38,1 per
People with HIV died
3260 persons or 38,3%
154 persons
incl. people died of HIV/AIDS
1174 persons or 37,7% of all who died
69 persons or 44,8% of all who died
Routes of transmission:
intravenous drug use
heterosexual contact
4066 or 53,0%
3497 or 45,6%
20,5%
77,1%
Children born from HIV+ mothers
Among them children with HIV
1000
77 (7,7%) 73
1 (1,4%)

17. Number of people receiving antiretroviral therapy (by 01.01.2013)
Number of patients
Among them
1750
- Children 60
- People who use drugs or ex PWUD
778
- in prisons
193

18. Structure of HIV cases by age for the entire epidemic and in 2012 among youth
Population on
HIV+
2012 abslute value
HIV incidence in 2012
% among new HIV cases 2012
Total period Absolute value in 2012
% among new cases total
+/-
15-17 years old
27 500 5
18,2
1,13
252
3,09
- 2,73 times
18-19 years old
23 058 4
17,3
0,91
608
7,46
- 8,19 times
20-29 years old
149
93,3
33,94
4211
51,73
-34,4%
TOTAL
158
5071

19. Adolescents and youth at high risk of getting HIV and AI
Adolescent graduates of children’s homes from 15 to 18 years old (and older), particularly those, who live in hostels of educational institutions.
Young convicts, particularly those, who use drugs.
300
1100
When moving to college hostels, girls and boys, who are not supervised by teachers any longer, get involved in sexual relationships without any knowledge about safe sex. The risk increases due to the lack of condoms and sexual exploitation / sexual violence (we don’t know how common it is, as it isn’t a topic for open discussion, but the problem exists).
Healthy young men may serve their sentence together with HIV-infected inmates. Sex between men does take place, while there are no condoms available. Over recent years the number of drug using convicts with longer sentences increased. In penal colonies for men it is possible to get drugs, but no syringes.

20. Legal/ethic issues that may influence research/intervention among youth
Educational institutions
Penitentiary Service
It’s the director, who is directly responsible for everything happening in his educational institution. He allows or prohibits research/prevention programmes based on approval from superior bodies, who in their turn get approval in the Experts’ Committee attached to the KR Ministry of Education or Drug Control Service. Another alternative is getting the approval from parents or guardians. New Russian laws about protection of children from harmful information and homosexual propaganda strengthen suspicion among directors.
Research and prevention interventions in penal colonies require an approval of the Educational Department of the KR Penitentiary Service. It should be considered that for inmates sex is forbidden and drug use is strictly forbidden. Though managers and regular staff unofficially admit that both are widely spread (they will never admit it officially). It is possible, although difficult, to arrange selling condoms in shops of penal colonies.
Moreover (!), HIV prevention with regard to MSM in the Kaliningrad Region can be perceived as propaganda of homosexuality and thus is prohibited by a regional law.