In Russia, HIV is primarily transmitted through heterosexual contact

In Russia, HIV is increasingly being transmitted through heterosexual contact—at least according to official statistics. And in the conservative Vologda Region, the number of pregnant women with the virus has doubled in a year.

December 1, on World AIDS Day, there has been renewed talk in Russia about the HIV epidemic, which, according to the authorities, affects more than one million people. However, the exact figures remain a subject of debate: different agencies provide conflicting estimates, and data on mortality from the virus have not been published at all since 2025. New analysis From the project “To Be Precise” pours sheds light on the situation, showing how the virus is spreading across Russia and highlighting gaps in the official statistics. We summarize the key findings with additional information.

Discrepancies in the Statistics: How Many People with HIV Are There Actually in Russia?

Oofficial data Estimates of the prevalence of HIV in Russia are conflicting. Rospotrebnadzor estimates that 1.2 million people will be living with the virus by the end of 2024. The Ministry of Health gives a more conservative figure—863,000, which is one-third less. Rosstat, relying on data from organizations under the Ministry of Health’s jurisdiction, reports a figure of 928,000. These discrepancies reflect systemic problems in data collection, where different agencies use different methodologies.

There is even greater uncertainty regarding mortality. Since 2025, Russian authorities have stopped publishing data on HIV-related deaths, as well as many other demographic indicators. This makes it impossible to fully assess the scale of the epidemic. Furthermore, reports on new cases are now released annually rather than monthly, which slows down monitoring and response efforts.

Foreigners in the Crosshairs: Deportation and Testing

Russia remains one of the few countries where foreigners living with HIV are deported—a similar policy is also in place in Egypt, Syria, Iraq, Oman, Kuwait, and Turkmenistan. Foreigners who wish to stay in Russia for more than 90 days, work, or obtain a residence permit are required to undergo testing. This applies even to refugees and those who are merely applying for refugee status.

In 2024, authorities collected 3.2 million blood samples from foreign nationals, with 88 positive results per 100,000. Among Russians, this rate is higher — 139 per 100,000. However, this comparison may not be accurate: nearly all foreigners living in the country are tested, while only 37% of citizens are tested — mainly those who have symptoms, pregnant women, or those who are getting tested voluntarily.

Transmission Routes: The Official Version vs. Reality

According to official data, HIV in Russia is primarily transmitted through heterosexual contact — in 81% of cases. Homosexual contact accounts for only 4%, while injection drug use — 14%. This stands in stark contrast to the European Union, where heterosexual and homosexual transmission rates are roughly equal (46% and 47%, respectively).

Analysts from "To Be Precise" attribute this difference to the fact that in the EU, the epidemic is concentrated among vulnerable groups, where the prevalence of the virus is lower (5 new cases per 100,000 versus 37.5 in Russia in 2023). Prevention and testing programs there are specifically targeted at these groups: men who have sex with men, sex workers, and people who inject drugs.

In Russia, however, testing of these groups has declined: they account for only 2% of those tested. At the same time, the detection rate is higher in these categories — For example, among men who have sex with men, there were 20,807 cases per 100,000 in 2023. In the general population, upon hospitalization or during routine screenings, — A total of 138 per 100,000.

Rospotrebnadzor acknowledges that the proportion of infections resulting from homosexual contact and drug use may be underestimated due to stigma: people often conceal the actual routes of transmission. Furthermore, the focus on the general population distorts the picture.

Regional Hotspots: The Urals and Siberia Lead the Way, with the Vologda Region as an Unexpected Leader

To assess the geographic spread of the epidemic, analysts examined several indicators. The situation is worst in the Kemerovo, Tomsk, and Chelyabinsk regions; the Altai and Krasnoyarsk territories; the Leningrad region; the Komi Republic; the Irkutsk and Perm territories; and the Chukotka Autonomous Okrug.

Testing of pregnant women is of particular interest; it is recommended for everyone in Russia and serves as an indicator of the virus’s spread beyond vulnerable groups. If more than 1% of pregnant women are infected for three consecutive years, this signals a widespread epidemic. On average across the country — 0.6%, but in 14 regions it exceeds 1%, and in 11 regions it has remained at that level for years. These include the Samara, Orenburg, Sverdlovsk, and Tyumen regions.

The Vologda Region was unexpectedly added to the list — a region where Governor Roman Filimonov promotes “conservative values,” including restrictions on abortion. In 2024, 2% of pregnant women tested positive for HIV — twice as high as in 2023 (1%) and 12 times higher than in 2022 (0.17%). This highlights how social policies may fail to address the real challenges facing public health.

On World AIDS Day, these figures serve as a reminder of the need for transparency and a focus on prevention. As long as the authorities continue to withhold statistics, the epidemic risks spiraling out of control.