This report assesses the evidence on the extent and prospects of an HIV/AIDS epidemic in the countries of the former Soviet Union and the impact this will have on the economies of those countries. The main focus of the report is the Russian Federation.

The economic and demographic context against which the epidemic is developing is first discussed. All of the states of the FSU have suffered unprecedented falls in employment and output and a collapse in many of the state institutions that might determine or implement public health policy. Russia in particular is suffering from falling life expectancy and general declines in health that are untypical for countries with high HIV prevalence.

The epidemic is still largely confined to high-risk groups such as Intravenous Drug users (IDUs) in Russia and the Ukraine. Infectivity is high in such groups and concentration of HIV among IDUs is one of the reasons the disease is spreading so rapidly. There is evidence of high recruitment and casual drug use suggesting the lines between IDUs, Commercial Sex Workers (CSWs) and the general population are more blurred than in a western country. The epidemics in the other former Soviet republics are less developed than in Russia but they exhibit many of the same risk factors and the trade and migratory links between them and Russia suggest they will suffer epidemics of similar magnitude.