Department of Health Policy, London School of Economics and Political Science, London, UK.
University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
AIDS. 2023 Mar 15;37(4):637-645. doi: 10.1097/QAD.0000000000003441. Epub 2022 Dec 6.
Although HIV infection in the Russian Federation was historically concentrated among marginalized populations (people who inject drugs, sex workers, MSM, and the prison population), recent evidence suggests that it has become a more generalized epidemic. The objective of our research was to explore how these trends in HIV prevalence and HIV-related mortality compare across Russia.
We calculated HIV-associated mortality for both male and female individuals in each region (oblast) of the Russian Federation using data from the Russian Fertility and Mortality Database (RusFMD). Using current data on HIV prevalence, we computed the correlation between HIV prevalence and HIV-associated mortality. We also used oblast-level data to examine the associations between HIV prevalence and the risk factors most commonly associated with HIV infection.
Over the past 20 years, the Russian Federation has experienced a rapid increase in HIV-associated mortality in both male and female individuals. Our findings revealed significant heterogeneity, with higher rates of HIV-associated mortality reported in oblasts in the Siberian and Ural Federal Districts. There is a strong correlation (0.8) between HIV-associated mortality and virus prevalence. These findings confirm that there are regional disparities in access and adherence to antiretroviral therapy (ART), as indicated by the low correlation (-0.4) between virus prevalence and access to ART coverage. The results from our modeling analysis revealed that, in addition to the factors most commonly associated with this disease (e.g. intravenous drug use), knowledge about sexual transmission of HIV in the general population has a broad impact on its prevalence at the oblast level.
Interventions that reduce HIV prevalence, for example, opioid substitution therapy and needle-sharing programs for people who inject drugs, as well as the increased availability of educational and preventive programs may halt the spread of HIV across the Russian Federation. Similarly, increased access to treatment could help in reducing HIV-related mortality.
尽管在俄罗斯联邦，艾滋病毒感染历史上集中在边缘化人群（注射毒品者、性工作者、男男性接触者和监狱人口）中，但最近的证据表明，艾滋病毒感染已成为更为普遍的流行。我们研究的目的是探讨俄罗斯各地区艾滋病毒流行率和与艾滋病毒相关的死亡率趋势的异同。
我们使用俄罗斯生育和死亡率数据库（RusFMD）的数据，计算了俄罗斯联邦每个地区（州）男性和女性的艾滋病毒相关死亡率。利用当前艾滋病毒流行率数据，我们计算了艾滋病毒流行率与艾滋病毒相关死亡率之间的相关性。我们还使用地区一级的数据，研究了艾滋病毒流行率与与艾滋病毒感染最常见相关的风险因素之间的关联。
在过去的 20 年中，俄罗斯联邦男性和女性的艾滋病毒相关死亡率均迅速上升。我们的研究结果显示存在显著的异质性，西伯利亚和乌拉尔联邦区的州报告的艾滋病毒相关死亡率较高。艾滋病毒相关死亡率与病毒流行率之间存在很强的相关性（0.8）。这些发现证实，由于获得和坚持抗逆转录病毒疗法（ART）方面存在区域差异，因此病毒流行率与接受 ART 覆盖之间的相关性较低（-0.4）。我们的模型分析结果表明，除了与该疾病最常见相关的因素（例如静脉注射吸毒）外，普通人群中对艾滋病毒性传播的了解也对该疾病在地区一级的流行率产生广泛影响。
减少艾滋病毒流行率的干预措施，例如针对注射吸毒者的阿片类药物替代疗法和共用注射器方案，以及增加教育和预防方案的普及，可能会阻止艾滋病毒在俄罗斯联邦的传播。同样，增加治疗的可及性也有助于降低与艾滋病毒相关的死亡率。
