Lyudmila Aleksandrovna Ruzaeva, Chief Physician of the Krasnoyarsk Kray Center

1. PUBLIC HEARING “AIDS and Drug Addiction: Myths, Reality, Actions” Krasnoyarsk, July 4, 2005 Overview of the Current Status of HIV/AIDS Epidemic in Krasnoyarsk Kray Lyudmila Aleksandrovna Ruzaeva, Chief Physician of the Krasnoyarsk Kray Center forPrevention and Fight Against AIDS and STDs

2. Current HIV/AIDS Situation • 5847 cases of HIV infection have been officially registered in Krasnoyarsk Kray as of June 1,2005. Expert estimates suggest that the real number of people with HIV/AIDS is 17,000 to23,000people (0.6% – 0.8% of the region’s population). • In 2004 there were 11,548 people with diagnoses of “drug addiction” and “sporadic drug use” in Krasnoyarsk Kray. • 96% of all the registered HIV infection cases were revealed within last five years. • Territories adversely affected by HIV: Norilsk – 2,471 cases; Krasnoyarsk – 2,233 случая; Lesosibirsk – 264 cases andYeniseysk Region– 145 cases.

3. Current Situation Assessment • Young people are prevalent among PLWHA and drug users; more than 80% are people at the age of 15 to 29. • Since 2004, there has been an increase in HIV-infection transmitted through unprotected sexual contacts (50% of all the newly revealed cases). • Proportion of women with HIV increases (47.3%in2004). Number of children born to HIV-positive mothers grows. • Total of 508 children were born to HIV-positive women in Krasnoyarsk Kray. 90 became orphans as a result of death of HIV-infection of one of their parents.

4. Correlation of Drug Use and HIV/AIDS • HIV/AIDS epidemics is closely linked with the problem of the use of narcotic substances • In 73.5% cases HIV is transmitted through injection drug use

5. Tendencies and Consequences of the Epidemic Development • Women comprise a steadily increasing proportion of HIV cases • Sexual transmission of HIV is becoming more common in the region • Cumulative number of HIV cases continues to grow • Epidemic has spread beyond vulnerable groups and starts to affect the general population, i.e. transfers from a concentrated to a generalized phase

6. Tendencies and Consequences of the Epidemic Development • Since the start of the epidemic in Krasnoyarsk Kray 268 HIV-positive died before the age of 30. PLWHAare citizens in their prime economic and reproductive age • Spread of HIV threatens to aggravate a demographic crisis and affects productive members of society • The epidemic negatively affects labor productivity and the region’s economic potential and causes increase in budget expenditures • HIV causes biological and social orphanages • HIV/AIDS undermines the military security. 128 young people were rejected from the military service, and 35 HIV-positive members of the military were dismissed.

7. Overview of Measures Taken in Krasnoyarsk Kray • A Regional Interagency Commission to Address Drug Use, Alcoholism and AIDS operates in Krasnoyarsk Kray (created on 09/28/2004). The Commission has adopted the “Program of Comprehensive Measures to Address the Spread of Drug Use, Alcoholism and HIV Infection in Krasnoyarsk Kray for 2005” • Since 1998special programs to fight HIV/AIDS have been implemented in Krasnoyarsk Kray • 65.5 million rubles (29% of the special program budget) were allocated for the sub-program “Anti-HIV/AIDS” within the framework of the program “Prevention of the Spreadand Fight Against Socially Important Diseases” for 2005-2007

8. Overview of Measures Taken in Krasnoyarsk Kray Off-Budget Sources of Funding Since 1999 projects supported by international charity organizations have been implemented in Krasnoyarsk Kray. Main directions of activities: • HIV/AIDS prevention; • Programs targeted at vulnerable groups; • Support to public initiatives (including those involving PLWHA). The total of 34.9 million rubles of grant funding was raised. Since 2005 Krasnoyarsk Kray participates in the GLOBUS Project: Global Efforts Against AIDS.It is important to secure sustainable funding for response to HIV/AIDS from the Krasnoyarsk Kray budget after the completion of the project.

9. Priorities in Addressing HIV/AIDS Two equally important aspects in fighting HIV/AIDS are: PREVENTION and TREATMENT. • Prevention measures must be targeted not only at the general population at large, but also at vulnerable groups. • Among the main causes of the epidemic growth are insufficient awareness in general population, and absence of a system to motivate people for a healthy lifestyle. • Raising HIV/AIDS awareness remains the most effective measure to control the epidemic.

10. Priorities in Addressing HIV/AIDS PREVENTION and TREATMENT • Harm Reduction Programs are a real opportunity to reduce the risk of HIV transmission among IDUs • Anti-retroviral (ARV) therapy is a life-long treatment, if stopped – HIV progresses • Access to ARV therapy positively affects the effectiveness of HIV prevention measures.

11. Main Conclusions • HIV/AIDS epidemic and its consequences affect all the major groups of society. • Measures taken today can in many respects define the further character of problems related to HIV infection and drug use for many years ahead. • It is only possible to achieve significant results in fighting the epidemic under the condition of broad interagency and intersector collaboration, combining efforts of state authorities, business, political forces and civic organizaions.

12. THANK YOU! Krasnoyarsk Kray Center forPrevention and Fight Against Aids and STDs 45, Ulitsa Karla Marxa, Krasnoyarsk г. Tel.:(3912)27-24-13 (Reception) (3912) 22-22-19 (HIV Infection Prevention Department) Fax: (3912) 22-16-38 E-mail: aids@ktk.ru Internet: www.aids.krsn.ru