The UN says more than one million people or about one in every 100 people are living with HIV – the virus that causes AIDS – in Russia.
The latest official figures show that about 200 new cases are being recorded every single day.
The main source for 60 percent of new infections is dirty needles used to inject drugs. Russia has one of the worst heroin problems in the world.
HIV is spreading five times faster in Russia than the global average, with Ukraine and Russia accounting for 90 percent of the region's cases.
"If you look at the post-Soviet history of the Russian federation you see very, very uneven industrial development, you see the collapse of old industrial areas, and you see a spread of hopelessness which means that people in small rural communities, in old urban decaying communities, they have little else to do. And it's a major drug route through Russia, from Afghanistan and that part of the world where the drugs are produced, so drugs are used and used widely…"
- Tony Barnett, a social scientist
Between January and October 2012 nearly 63,000 people tested positive for HIV in Russia, and has recorded nearly 4,400 children infected with HIV in 2012, and 529 deaths.
But it has also resisted so-called harm reduction strategies including funding needle exchange programmes, angering health workers and global HIV prevention groups.
Activists say social stigma is impeding the fight against HIV in Russia.
Critics say Russia's budget for HIV is misplaced despite seeing an increase. UN funding for awareness training and medication has also stopped.
In many parts of the world the number of HIV and AIDS-related deaths is falling, with HIV cases being stable for the past four years.
The UN says the number of HIV-positive people is estimated at 34.2 million. In 2011, about 1.7 million people died from AIDS-related causes worldwide.
Inside Story asks: So how does Russia plan to stem the rise in HIV?
Joining the discussion with presenter Adrian Finighan are guests: Tony Barnett, a professor at the London School of Economics and Political Science, specialising in infectious diseases and HIV/AIDS; and Dr Jens Lundgren, the co-founder of HIV in Europe – an initiative promoting early diagnosis and care of HIV.
"The management of and care for people who are dependent on heroin [in Russia] is very poor [and] the same goes for sexual contacts … The solution is very simple, very evidence based because we have a lot of experience from other regions on how to handle both challenges, the needle-mediated and sexual transmissions. But it requires that the knowledge and evidence that we have from other regions are actually used and implemented."
Dr Jens Lundgren, the co-founder of HIV in Europe
New HIV cases in Russia:
- The public health office says more than 60,000 people tested positive for HIV in the first 10 months of 2012 – up 12.5 percent on the previous year
- Almost 2/3 of those who tested positive were male – the overall sickness rate was highest in the 30-40 age group
- The mortality rate in this same period grew by 14 percent
Fewer HIV/AIDS-related deaths worldwide:
- The latest UN figures show 1.7 million people died from AIDS-related causes worldwide in 2011 – 24 percent fewer than in 2005
- In the same period the number of deaths in sub-Saharan Africa dropped by nearly 1/3, and by almost half in the Caribbean
- But two regions saw significant increases – AIDS-related deaths went up by 17 percent in the Middle East and North Africa, and by more than 20 percent across Eastern Europe and Central Asia