Russia's HIV epidemic is no longer confined to high-risk groups. In 27 of the country's regions, the virus is now spreading through the general population, according to the Central Research Institute of Epidemiology of Rospotrebnadzor, the state consumer watchdog. Epidemiologists use the term "generalized epidemic" when more than 1% of pregnant women test positive for HIV — a threshold that has been crossed in those regions, with the most severe situations reported in Kemerovo, Irkutsk, and Sverdlovsk.
While the official number of new HIV cases in 2025 fell to 45,000 — a 13.4% drop from the previous year — the overall picture remains troubling. The number of people living with HIV continues to rise, and for every death there are roughly 1.5 new infections, notes Natalya Ladnaya, head of the AIDS prevention and control research department at the Central Research Institute. More than 1.232 million Russians have a confirmed HIV diagnosis, equivalent to 0.8% of the population, according to Vasily Akimkin, director of the institute and a Rospotrebnadzor academician.
Hospital-acquired infections at a 15-year high
Perhaps the most alarming trend is the surge in HIV and hepatitis infections acquired inside medical facilities. In 2025, Rospotrebnadzor recorded eight clusters of infection in healthcare settings, affecting 104 patients — the highest number in 15 years. Yelena Igonina, head of the department for epidemiological wellbeing at Rospotrebnadzor, says the clusters were dominated by viral hepatitis C and mixed HIV-hepatitis infections.
One of the largest confirmed clusters occurred in a sanatorium in Kabardino-Balkaria, where 82 people were infected, including 76 with hepatitis C and six with mixed infections. In oncology hospitals in Kamchatka Territory and Buryatia, 147 and 42 patients respectively contracted hepatitis. Dialysis centres in the Samara and Kursk regions saw three further clusters, affecting 26 people. In Moscow, an investigation is ongoing into a cluster of 22 hepatitis C cases.
Experts attribute these outbreaks to systemic violations of sanitary and epidemiological rules, including the reuse of single-use catheters and glucometers on multiple patients. The source of infection is often a patient with an undiagnosed infection, which means the virus can spread silently. Igonina describes these as "systemic and gross violations" that have become entrenched in today's Russia.
Testing gaps are compounding the problem. While blood, organ, and tissue donors are well screened for hepatitis C antibodies and RNA, testing is lagging for other high-risk groups — including dialysis, haematology, and transplant patients, contacts of hepatitis clusters, children under one born to HIV-positive mothers, and people with immunodeficiency. For the first time in six years, two cases of HIV transmission via blood transfusion were identified in 2026.
Aleksei Verter, an international HIV consultant, told Current Time that the presence of many undiagnosed infections in hospitals indicates that "the infectious process in the country is latent, hidden" — meaning a large number of people are unaware they carry the virus.
Mortality remains high despite recent declines
Although HIV incidence and mortality have fallen in recent years, the absolute numbers remain stark. Between 30,000 and 34,000 Russians die from HIV-related causes each year — a figure that Ladnaya calls "extremely high." Only 15 countries worldwide record more than 15,000 annual HIV deaths, and Russia is one of them. Akimkin notes that Russia, Ukraine, and North Macedonia have the highest HIV incidence rates per 100,000 people in the European region.
HIV has become the leading cause of death among Russians of working age. Among men aged 40 to 49, more than 3% are living with the virus. The average age of those infected has risen from 32 to 44 over the past 15 years, and two-thirds of new transmissions now occur through heterosexual contact.
If current prevention and treatment approaches remain unchanged, Rospotrebnadzor's mathematical model projects that the number of people living with HIV in Russia could reach 1.47 million by 2030, with annual new cases between 31,000 and 51,000 and deaths potentially rising to 51,000 per year, partly due to an ageing population.
The situation is also deteriorating for children. In 2025, mortality among HIV-positive children increased in all federal districts except the Central and Ural districts, a reversal of previous trends. The reasons for this rise are not yet fully understood, but experts point to gaps in testing and treatment coverage for vulnerable groups.
For Europe, the Russian epidemic is a reminder that HIV remains a continental challenge. While Western European countries have largely brought the virus under control, the high incidence in Russia, Ukraine, and North Macedonia — combined with the ongoing war in Ukraine and its impact on healthcare systems — means the region as a whole still faces significant risks. As Ladnaya cautions, there is no reason for complacency: "The dynamics can change rapidly."
