Russia’s HIV epidemic is worsening despite official claims to the contrary. Here’s what the numbers really show.

In mid-October 2026, Moscow hosted a conference on HIV research and clinical practice. Doctors specializing in HIV discussed the situation in Russia.

The news, unfortunately, wasn’t good. Here are some of the points they raised:

Meanwhile, the Health Ministry regularly says Russia is doing exceptionally well on HIV and that reports of high incidence rates “do not reflect reality and are yet another propaganda stunt aimed at our country.”

The situation is worse than the Health Ministry makes it out to be.

In July 2026, Alexey Mazus, the Health Ministry’s chief external adviser on HIV, said the government’s strategy over the past 10 years had brought HIV incidence in Russia to a historic low.

Incidence — the number of newly diagnosed cases in a year — is indeed falling. But it remains high. Incidence is also different from the total number of people living with HIV. According to Rospotrebnadzor, Russia’s public health watchdog, 1.23 million people in Russia had a confirmed diagnosis at the end of 2025, or 0.8% of the population.

But Rospotrebnadzor and the Health Ministry count differently.

That leaves a gap of 385,555 people between the total number with a confirmed diagnosis (1.23 million, according to Rospotrebnadzor) and those receiving ongoing medical care (846,500, according to the Health Ministry).

The Health Ministry has begun testing people who are less likely to have HIV. That appears to explain the decline in incidence.

Over the past 10 years, the number of people tested for HIV has nearly doubled, from 28 million in 2014 to more than 54 million in 2024. But testing is becoming less effective. Vasily Akimkin, director of Rospotrebnadzor‘s Central Research Institute of Epidemiology, says people from key populations, the groups most at risk, need to make up a larger share of those tested. Their share of those tested has nearly halved, from 5.8% in 2014 to 3% in 2023.

More tests are being done, but they are increasingly directed away from the people most likely to have HIV. Yet models such as the Humanitarian Action foundation’s Cascade project show that it is possible to reach key populations and connect them with treatment through an anonymous, nonjudgmental approach.

A second reason to conclude that the situation isn’t improving is that the epidemic now affects the wider population as well as at-risk groups. A third is that mortality remains at a historic high. A fourth is that only half of people with HIV have a suppressed viral load, at least according to Rospotrebnadzor’s figures. In the United Kingdom, for example, that figure is 98%.

Globally, the epidemic is declining. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), 41 million people were living with HIV in 2025, including those in Russia. There were 1.2 million newly identified infections that year, and 570,000 people died. New infections were down 65% from their peak in 1994, while deaths had fallen 73% from their peak in 2004.

But new infections have increased over the past 15 years in three regions: Latin America; the Middle East and North Africa; and Eastern Europe and Central Asia, which includes Russia.

According to UNAIDS, Eastern Europe and Central Asia had 2.1 million people living with HIV in 2024, with 130,000 new infections (7% more than in 2010) and 48,000 deaths (48% more than in 2010). Only 43% of HIV-positive people had a suppressed viral load, the lowest share of any region in the world.

The latest available figures, for 2023, show that four countries — Russia, Ukraine, Uzbekistan, and Kazakhstan — accounted for 92% of all new HIV infections in the region. UNAIDS links this growth to stigma, criminalization, and underfunded prevention for at-risk groups: Sex work is punishable by law in every country in the region; 13 countries have specific criminal penalties for failing to disclose HIV status, exposing someone to the risk of infection, or transmitting the virus; and seven criminalize possession of small quantities of drugs for personal use.

In 2025, heterosexual sex accounted for 82.3% of new infections. But these statistics may not reflect the true picture: Rospotrebnadzor acknowledges that the share of infections acquired through same-sex contact and among other key populations is probably underestimated. This may be because people in these groups are tested less often and because stigma prevents them from reporting how they acquired HIV.

In any case, the risk of infection is higher for people who frequently have new sexual partners, use drugs (especially by injection), don’t know their partner’s HIV status, don’t use condoms with a partner whose HIV status they don’t know, or live in a region with a generalized epidemic.

Condoms offer excellent protection and are the first thing experts recommend. They reduce the risk of transmitting HIV as well as syphilis, gonorrhea, hepatitis B and C, and other sexually transmitted infections.

It’s also important to know your own HIV status and your partner’s. You can read about how to discuss this with a partner in our other explainers.

Another option is pre-exposure prophylaxis: A person who doesn’t have HIV takes specific medications to prevent infection. It is available as daily pills. In Russia, a combination of tenofovir and emtricitabine is used. Prevention is explicitly listed among the approved uses for the original brand-name drug, Truvada, but this approach is not included in the Health Ministry’s clinical guidelines. There are also new long-acting injections — lenacapavir, given once every six months, and cabotegravir, given once every two months — but as of October 2026, they are unavailable in Russia.

For people who use drugs, harm reduction measures — such as using sterile equipment for every injection — are effective. However, needle and syringe distribution programs are limited in Russia, even though they have been proven to reduce HIV transmission. Opioid substitution therapy is banned altogether.

There is also post-exposure prophylaxis: a 28-day course of medication that must begin within 72 hours of a potential exposure. Taking the medication for all four weeks, without stopping early, is essential for it to work. Within that 72-hour window, the sooner the better: Literally every hour counts.

There is no HIV vaccine yet.

The standard recommendation is at least once in your lifetime. For people at higher risk, it’s once a year or more often. This includes people from key populations and anyone whose risk is currently above average, for example, because they have many sexual partners and are casual about condom use.

Pregnant women are advised to get tested in the third trimester, which helps prevent transmission to the baby.

After a potential exposure — for example, sex without a condom with a partner whose HIV status you don’t know — when to test depends on the type of test. A modern fourth-generation laboratory test looks for both antibodies and a protein from the virus itself: A negative result 45 days after exposure is considered conclusive. A rapid test that detects only antibodies can take up to 90 days to give a conclusive result. If you have taken post-exposure prophylaxis, the timing changes; a doctor will determine your follow-up testing schedule.

HIV testing in Russia is voluntary, free, and anonymous. You can get tested at AIDS prevention and control centers (addresses are available at o-spide.ru), at many private clinics, or with a rapid test, either on your own or at nonprofits specializing in HIV. Your partner should also consider checking their status.

The earlier HIV is diagnosed, the easier it is to bring the infection under control and avoid passing it on.

People who test positive in Russia should register with an AIDS center. For Russian citizens, this provides access to free treatment. HIV has long been a manageable chronic condition. Starting treatment early can bring life expectancy close to normal and prevent transmission to a partner.

Registering requires documents, including proof of residence registration in the region where you live. This can be a barrier, as can stigma against HIV-positive people. But it is entirely possible to go from a diagnosis to a life without fear, and the first step is a doctor’s visit.

There are shortages. When a medication is unavailable, a person’s regimen may be changed abruptly, they may be given only some of the drugs they need, or they may be left without treatment altogether.

Pereboi.ru, a project run by the Patient Control movement, monitors these problems. In 2023, activists recorded medication shortages in at least 18 regions. In 2024, Pereboi.ru received 668 complaints from 65 regions, as well as from facilities run by the Federal Penitentiary Service and the Federal Medical-Biological Agency.

Shortages force doctors to put people back on regimens previously discontinued because of severe side effects or to dispense only some of the necessary drugs. Either approach risks allowing the virus to multiply unchecked, potentially leading to disease progression and drug resistance.

People also report being denied timely tests to measure their viral load and immune status. In 2025, limited access to viral load testing was reported in 16 regions.

The problem comes down to the budget for antiretroviral therapy (ART). Spending has risen in recent years as more people have registered for ongoing care. In 2024, spending on ART reached 36.76 billion rubles, 17% more than in 2023, enough to buy a record 610,000 yearlong courses of treatment. But that is still only enough for about 70% of registered patients and just half of all people living with HIV. The Zdravresurs project estimates that the budget would need to almost double, to 74.5 billion rubles a year, to cover everyone. Increasing it is difficult as government spending shifts toward the war. The federal healthcare budget is already set to be cut in 2027.

Government agencies and people living with HIV give different accounts of the situation. The Health Ministry says 90.5% of registered patients are receiving treatment, exceeding even the target set in the government’s HIV strategy. It also says funding rose by a quarter in 2025 and there will be no shortages. In December 2025, Patient Control also acknowledged that the situation had begun to improve for the first time in a long while: The budget had increased, purchases had been made in advance, and widespread shortages like those in 2023 and 2024 had been avoided. Even so, the movement received more than 300 requests for help in 2025 over medication shortages, refusals to change treatment regimens, and problems with diagnostic testing. These included reports of 28 prisoners with HIV who were being denied treatment.

Their condition changes gradually.

HIV makes imperfect copies of itself. When nothing is holding its replication in check, roughly 10 billion new viral particles form in the body each day. Effective treatment prevents this: Replication is suppressed, leaving almost no opportunity for new variants to emerge.

When someone stops taking their medication, the drugs don’t leave the bloodstream immediately, but the virus begins replicating. Viral particles that happen to be less susceptible to the drug because of random mutations gain an advantage at this point: The medication eliminates their competition, allowing a resistant variant of HIV to take over. This takes only a few weeks. As a result, the previous regimen no longer works if the person resumes it.

A single mutation is enough to make some drugs ineffective — this is the case with lamivudine, emtricitabine, and efavirenz. For others, such as dolutegravir, the virus must accumulate several changes before the drug loses its effectiveness. That is why the World Health Organization recommends regimens containing dolutegravir as first-line treatment.

The worst problems begin with repeated interruptions. The first mutation gives the virus resistance but makes it harder for it to replicate. If the person continues without medication, the usual form of the virus gradually displaces the altered variant, though this takes months. But if interruptions recur, the virus has time to acquire a second mutation that restores its ability to replicate without losing its resistance. It is then just as capable of replicating as the usual form and won’t go away on its own. New medications are needed.

That’s why, after an interruption, a person can’t simply go back to their previous treatment. Once the person has resumed taking medication, doctors must check the viral load and, if the previous regimen is no longer controlling the virus, order a drug resistance test.