HIV/AIDS situation in Armenia

Statistics and commentary

Unless otherwise stated (or provided with the specific link), most HIV/AIDS statistics in this post are via National Centre for AIDS Prevention in Armenia 

Incidence and prevalence

From 1988 to 1 December 2007, 528 HIV cases had been registered in the Republic of Armenia among its citizens. 66 new cases of HIV infection were registered in 2006; and 99 - in 2007. Males constitute a majority in the total number of HIV cases - 396 cases (75.0%), females make up 132 cases (25.0%). 528 reported cases include 11 cases of HIV infection among children (2.1%).

AIDS diagnosis was made to 206 patients with HIV, of whom 40 are women and 6 are children. From the beginning of the epidemic, 119 death cases have been registered among HIV/AIDS patients (the cases include 19 women and 3 children).

Age groups

The overwhelming majority of the HIV-positive individuals (72.3%) belong to the age group of 20-39.

Modes of transmission

The main modes of HIV transmission are through injecting drug use (47.9%) and heterosexual practices (45.1%). Besides, there are also registered cases of mother-to-child HIV transmission as well as through blood transfusions and homosexual practices

Transmission through injecting drug usage	47.9 %
Transmission through heterosexual practices	45.1 %
Mother-to-child transmission	1.9 %
Transmission through blood	1.5 %
Transmission through homosexual practices	0.4 %
Unknown	3.2 %

 

All the individuals infected via injecting drug use were men. Some of them temporarily inhabited in Russia (Moscow, St. Petersburg, Irkoutsk, Rostov, Surgut etc.) and Ukraine (Odessa, Kiev, Mareupol etc.) and were most likely infected there, where HIV prevalence is much higher. In addition, the majority of all the HIV-infected males (64.7%) are individuals who practice injecting drug usage, whereas the majority of women were infected through sexual contacts (98.4%).

Geography

The maximum number of HIV cases was reported in Yerevan, the capital: 254 cases, which constitute 48.1% of all the registered cases. Shirak Marz follows next - 52 cases, which constitute 9.8% of all the registered cases.

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However, while interpreting these statistics, one must bare in mind under-registration of cases. As WHO advises, whereas the above figures represent reported cases, it is estimated that the actual number of people living with HIV/AIDS in Armenia is about 2800-3000.

As to the HIV transmission "via homosexual practices", on one hand, it seems to be not high. On the other hand, under-reporting/under-registration, which is true for both straight and gay people, would be certainly higher for gays -  in case of gay people there is not only stigma associated with HIV/AIDS but also fear of disclosure of their sexual orientation.

High proportion of HIV among straight people is not surprising due to lack of proper sexual education and still prevalent attitude of being engaged in unprotected sex. Also, according to second-generation HIV surveillance data collected in 2002, HIV prevalence among injecting drug users is about 15% and less than 3% among female sex workers. In 2006 there was no registered opioid substitution programme for injecting drug users in Armenia.

That's not to say that the situation in relation to sexual education is rosy among gay Armenians. Sure, they may be more aware of risks as compared to general population. However, one relatively recent survey among MSM (men having sex with men) revealed disturbing lack of knowledge especially among younger groups which constituted 56% of surveyed 70 MSM. Only around half of the youngest group of participants (18-30 yrs old) mentioned "unprotected sexual intercourse" as a mode of HIV transmission, while almost all of the older age groups indicated it. And slightly lower proportion of the youngest age group (51%) still believed that one may get HIV through "shaking hands."

Below are the distribution of answers concerning HIV transmission:

• By unprotected sexual intercourse: I group (18-30 yrs old) – 56%, II group (30-45 yrs old) – 92% and III group (45-62 yrs old) – 100%
• By drug injection: I group – 82%, II group – 83% and III group – 85%
• By blood transfusion - I group – 44%, II group –75% and III group – 100%
• From pregnant mother to a child: I group – 33%, II group –67% and III group – 85%
• By relating with HIV infected people, for example, shaking hands while greeting: I group – 51%, II group –33% and III group – 14%

Another anonymous survey among LGBT Armenians conducted by gay rights group WFCE confirmed lack of proper knowledge on HIV/AIDS. While most of them indicated that HIV can be transmitted through unprotected sex, majority (67%) did not use condom when they last had anal sex. The most frequent reasons cited for not using condoms were "no condom" (31%), "partner was against" (18%), "reduces pleasure" (15%), and "feel embarrassed to buy/purchase" (11%).

On the other hand, back to the previous survey, the prejudice towards HIV-positive people was prevalent in all age groups, being higher (again!) among the youngest:

26% from I group (18-30 yrs old), 33% from II group (30-45 yrs old) and 57% from III group (45-62 yrs old) have mentioned that they would limit their mutual relations with HIV infected person (it is not clear whether the question referred to sexual or general contacts). Respectively, 51%, 29% and 14% have mentioned that they would completely cut their mutual relations with HIV infected person, and 21%, 25% and 0% have mentioned that they would not only completely cut their mutual relations with HIV infected, but also actively prevent their relatives and friends from any relation with HIV infected person. And respectively only 3%, 13% and 29% of the survey participants have mentioned that they would continue their relations with HIV infected people.

I am not aware of the exact methodology of these surveys to judge more properly their reliability, however, my guess is that the convenient sampling  was used which is a  common practice to recruit participants for surveys dealing with sensitive matters. It means that it was not a random and thus more representative sample but possibly conducted by recruiting survey participants, say, through friends, or with the help of a particular social group etc. However, this is the best available evidence we have to get an indication of the state of knowledge and behaviour in this case among MSM or LGBT people in Armenia.

These surveys and HIV/AIDS statistics highlight the urgent need for proper sexual education among our population (younger generation is of particular concern!), which is as relevant for straight majority, as for gays. Relatively low rates of HIV in Armenia doesn't mean anyone could relax. Moreover, it should be a basis for more active actions to prevent its spread.

 

WHO Regional Office for Europe:

HIV testing is free of charge in Armenia and 29 facilities across the country provide testing. Systematic tests are performed in connection with pregnancy, in IDUs, in nationals returning home from long-term residency abroad and in blood donors. Nearly 50 000 people were tested for HIV in Armenia during 2006; 66 were found to be positive.

Armenia has one treatment facility providing medical care to people living with HIV. 170 people received medical care for their condition in 2006. By April 2007, 52 were receiving HAART [Combination of several (typically three or four) antiretroviral drugs is known as Highly Active Anti-Retroviral Therapy (HAART).] of which 61% are current or former injecting drug users. About 2/3 of the people living with HIV and who attended care were tested for coinfections and TB and hepatitis C were diagnosed in half of these cases.

National Centre for AIDS Prevention in Armenia:

1988 - registration of the first HIV case; the transmission mode is heterosexual intercourse;
1988 - registration of the first AIDS case;
1989 - registration of the first death from AIDS;
1990 - registration of the first case of HIV infection through injecting drug use;
1996 - registration of the first HIV case among women;
2000 - registration of the first case of HIV transmission through homosexual practice;
2001 - registration of the first cases of HIV infection and AIDS among children.