HIV-Infection Epidemiological Control System

The HIV-infection epidemiological control system in the Russian Federation is characterized by:

• Unified state registration of all HIV-infection and AIDS cases, changes in the physical condition of HIV-infected people and all tests made for HIV antibodies;
• Vigorous steps being taken to detect HIV-infected persons, given the population’s massive obligatory or voluntary testing for HIV; 
• Obligatory epidemiological investigation to be conducted in each case of HIV infection.

Under Russian legislation, the persons who shall be subject to obligatory medical examination to detect whether or not they are HIV-infected are as follows:

• blood, biological fluid, organ and tissue donors, and
• the personnel in certain occupations and of the businesses, institutions and organizations whose work involves directly handling HIV-infected people (for example, medical examination and treatment) or the materials containing the human immunodeficiency virus.

In addition to that, the patients who show several clinical symptoms indicating that they may be HIV-infected and the patients suffering from various diseases (or being suspected ill) such as drug abuse, STDs, Kaposi’s sarcoma, pulmonary or non-pulmonary TB, hepatitis B and some other illnesses shall also be tested for HIV. The pregnant women shall also be subject, under legislation, to testing for HIV, should there be taking the abortion and placental blood that is used as raw materials for the manufacture of immunobiological medicines.

In actual fact, however, the legislation has been frequently violated towards enlarging the number of those to be tested. This was confirmed by health-care authorities themselves, as can be seen from the following quotation: «... there have been widespread practices when test for HIV is an obligatory condition for any person to be admitted to a hospital». Virtually all pregnant women are tested for HIV, and in some cases such tests are made repeatedly. The scale of testing the population of Russia for HIV can seen from Table 1.
 

Table 1. The results of testing Russia’s citizens for HIV antibodies in 2002

 

Tested subpopulations	Number of tested	Number of positive tests	HIV+ per 100,000 of tested
Drug abusers	331,112	10,298	3,110.1
STDs sufferers	1,690,507	3,408	201.6
MSMs / bisexuals	9,489	35	368.8
Donors	3,855,814	1,044	27.1
Pregnant women	2,922,008	3,353	114.7
Prison populations	739,989	7,542	1,019.2
Patients tested, as required by their clinical indications	6,205,937	9,306	150.0
Those contacted with HIV-infected persons	246,976	52	21.1
Those detected during epidemiological investigation	70,437	6,563	9,317.5
Others	7,987,531	8,777	109.9
Total	24,059,800	50,378	209.4

Special surveys of the population of Russia to estimate the HIV prevalence are carried on by the territorial centers for AIDS prevention and control, and by non-governmental organizations using routins of the first- and second-generation sentinel epidemiological surveillance. This kind of surveillance is not obligatory and is conducted at the initiative of individual organizations. In doing so, various methodology has been used in different regions, and studies have been made among various population groups, more often among injecting drug users and CSWs. The results of such studies are often not comparable and are not collected in a centralized way. As is known from the findings of the research conducted by North Carolina University in Chapel Hill and the Institute of Sociology, Russian Academy of Sciences, as part of the Russia Longitudinal Monitoring Survey (RLMS) 38% of the respondents aged between 14 and 49 were tested for HIV at least once and about a half of them - over the last 12 months.

The Russian system of recording and surveillance has its advantages to stand in bold relief against the appropriate systems in other countries, where HIV-related statistics gives mainly national estimates based on the results of the sentinel epidemiological surveillance conducted, as a rule, by some of the medical institutions. The number of tests for HIV per 1,000 of the population in Russia is generally much greater than in other countries (Table 2). 

Table 2. Number of tests for HIV in 2001, WHO Europe

No.	Country	Number of tests per 1,000 of the population	No.	Country	Number of tests per 1,000 of the population
1	Russia	135.1	15	Azerbaijan	16.4
2	San Marino	134.8	16	Slovakia	15.4
3	Austria	72.0	17	Moldova	15.1
4	Byelorussia	49.0	18	Malta	13.9
5	Kazakhstan	44.7	19	Uzbekistan	13.7
6	Norway	38.6	20	Turkey	12.5
7	Latvia	38.3	21	Slovenia	9.8
8	Luxemburg	37.6	22	Lithuania	7.6
9	Estonia	35.4	23	Croatia	5.3
10	Israel	31.7	24	Georgia	5.2
11	Czechia	28.3	25	Tadjikistan	2.1
12	Finland	28.0	26	Armenia	1.3
13	Denmark	24.2	27	Macedonia	1.2
14	Ukraine	22.7

Source: European Centre for the Epidemiological Monitoring of AIDS. HIV/AIDS Surveillance in Europe. End-year report 2001. Saint-Maurice: Institut de Veille Sanitaire, No. 66, Table 21.

Of the 27 countries given in Table 2, 13 are ex-Soviet republics and another 5 are the former «socialist countries». Some of the countries that have not provided testing data because they do not simply have them. Among these are, in particular, Spain, the Netherlands and France. It is believed that in some countries of Europe (Denmark, France and Great Britain) the underestimed number of HIV-infected people is nearly 1/3 and in Poland - 2/3. According to European Centre for the Epidemiological Monitoring of AIDS (Euro-HIV), this ratio is still higher in the countries that were formerly parts of the USSR.

In the USA, all 50 states report the cases diagnosed as AIDS to the Federal Center for Disease Control and Prevention (CDC), but only 39 states have legal grounds for the registration of and report on the case of anyone being infected with HIV. Despite the efforts made by CDC to have standardization in this sphere, data as to state to state are still hardly comparable. Nevertheless, the amount of recording HIV infection in the USA is estimated at 85%.