Evolution of the HIV epidemic in Kaliningrad, Russia.

Abstract

Our earlier epidemiological and virological analysis made in 1997 suggested that in the Kaliningrad region of Russia a rapidly spreading human immunodeficiency virus (HIV)-epidemic among injecting drug users had recently started and that it was caused by an unusual A/B subtype recombinant strain of HIV. Furthermore, it was evident that the societal and health care structures necessary to combat the spread of the infection were not well developed. Since June 1996 more than 2400 HIV-infections have been detected in the region with a population of less than 1 million. Here we report the current situation concerning the epidemic and its risk factors. The information is based on information collected during several visits and from written reports. Whereas almost all cases in the earliest phase of the epidemic have occurred among injecting drug users (IDU), sexual transmission may soon become more common and spread the epidemic into the non-IDU population. We describe here the recent evolution of the epidemic and the various risk factors that seem to contribute to the outbreak. We also describe the current resources that are used for prevention. Information complementing earlier studies were collected during visits to Kaliningrad from direct observations, interviews with local authorities and official bulletins and written reports by local and national experts. Local resource building with the aid of international help is urgently needed to alleviate the forthcoming crisis due to clinical consequences of AIDS. Both prevention and patient management require resources that are not available at present. Also, more virological studies should be undertaken to identify the present and future pattern of the epidemic.