Ergste regio's/steden

THE RUSSIAN FEDERATION is currently experiencing one of the fastest-growing injection drug use–associated HIV epidem- ics in the world. Since 1995, a series of rapidly occurring, explo- sive outbreaks of HIV infection have occurred among vulnerable populations of injection drug users (IDUs) in over 30 cities of the Federation, including Kaliningrad, Krasnodar, Nizniyi-Novgorod, Rostov, Tula, Tver, and more recently the Moscow region, where a massive new outbreak occurred in 1999, with almost 7000 newly reported cases.

Analysis of HIV case reports indicates that more than 70% of registered HIV cases in Russia are associated with injection drug use. In many cities, including in Rostov-Don, Volgograd, and Togliatti, this figure is higher than 90%.

Recorded HIV prevalence rates are 56% among a sample of community-recruited IDUs in Togliatti, Samara Oblast, and 33% among needle-exchange attenders in Rostov-Don.

In Moscow, the economic center of the Federation, it is estimated that there are between 30,000 and 150,000 female sex workers. As detailed by Aral et al, many different types of prostitution exist in Moscow, with women work- ing in a variety of locations, including railway stations, truck stops, streets, brothels, massage parlors, saunas, and hotels.

As would be expected, given the very high HIV prevalence rates among IDUs in Russia, the limited data available indicate that HIV prevalence among female IDU sex workers is also very high, ranging from 17% in St Petersburg to 61% in Togliatti and 65% in Kaliningrad. In Moscow, a small study of sex workers attend- ing outreach programs showed an HIV prevalence of 15%.

Among female IDUs themselves, data from Togliatti suggest that sex work is associated with a much higher frequency of STIs. (Sexually transmitted infection)

Kaliningrad, for example, the proportion of new cases of HIV infection associated with hetero- sexual transmission increased from approximately 10% in 1996 to approximately 35% in 2000, with a corresponding decrease in the proportion of new cases attributed to injection drug use, from approximately 90% to 65%

In a random-digit-dialing telephone survey in St. Petersburg, 7% of men aged 15 to 55 years reported having had sex with sex workers, and half of these said they had done so more than once.

One important aspect of the vulnerability of many sex workers in Moscow is their relationship with the police. In Russia, soliciting for money in exchange for sex is not a criminal offense but an administrative one. In Moscow, women are arrested under administrative codes for “petty hooli- ganism” or for not possessing the correct documents. This system is open to abuse by the police, who use the ambiguity of the legislation to enrich themselves financially through bribes or by taking sexual services.

http://journals.lww.com/stdjournal/Citation/2003/01000/Injection_Drug_Use,_Commercial_Sex_Work,_and_the.10.aspx