A stigma surrounding homosexuality and drug use means that Russia and some countries of the former Soviet Union risk developing epidemics outside of HIV epidemics, experts said after a record number of new cases last year.
Most new cases in the former Soviet Union in 2017 came from heterosexual sex because, according to the World Health Organization (WHO) and the European Center for Disease Prevention and Control, the disease spreads outside high-risk groups.
The increased rate of new diagnoses in the region since 2012 is against the global downturn, and Masoud Dara, an HIV expert at the WHO, said it could be an "early indicator of over-population."
"HIV begins [in] the key population – meaning drug users, commercial sex workers and men who have sex with men – but after that [increases] exponentially … if there is no intervention, "Dara said.
In Russia, official data show that in 2017 more than 104,000 new HIV diagnoses were diagnosed in 2017, with total cases reaching more than 1.2 million. Experts have indicated that this is likely to be undervalued.
"We do not have enough medication, we do not care for every patient," said Nikolay Lunchenkov, a doctor at the Moscow Regional AIDS Center. "We are increasing the number of people receiving antiretroviral therapy, but it is still not enough."
The number of HIV treatment courses bought by the Russian government last year increased by 37% to around 360,000, as reported by the coalition for preparedness for treatment of non-profit organizations.
Methadone, which has shown research to help prevent injecting drug users from transmission of HIV, is banned in Russia.
"We do not have enough data on men who have sex with other men because of a high degree of stigma," said Lunchenkov, who is openly gay.
The number of Russian men sexually sexually sexually sexually affected by another sex has more than doubled to 695 between 2008 and 2015, according to official data.
Discrimination against LGBTI people means that people at risk of HIV / AIDS are afraid to seek testing and treatment, experts say.
Russia was ranked the second most European country in 2016, which is the least favorable for LGBT, the network of European LGBT groups ILGA-Europe.
The requirement introduced in 2012 by some international non-governmental organizations operating in Russia to register as "foreign agents" has led to a reduction in organizations working with HIV-sensitive groups, said Oli Stevens, an HIV researcher in Britain.
"The report was very clear, MSM (Men with Men and Men) are not us, they are the rest, they are not part of the company we are trying to build," said Stevens.
In the rest of the former Soviet Union, new cases of infected drug users dropped by 45% to 6,218 per year over a decade, while new cases of heterosexual transmission increased by 59% to almost 18,000.
Activists accuse widespread discrimination against LGBTI people for an eight-fold increase in transmission rates between men who have sex with men to more than 1,000 cases a year.
"State-sponsored homophobia and transfobia [have become] the crucial question, "said Yuri Youska of the Eurasian Men's Health Coalition, which supports people living with HIV / AIDS in the region.