Chronology and problems of the evolution of HIV infection in the Vologda Region in the structure of the North-West of the Russian Federation

Aim. To determine the general patterns and distinctive features of the formation of the HIV epidemic in chronology in various administrative territories of the Vologda Region. Materials and methods. The data of the epidemiological survey maps of HIV infection foci, reports «Causes of mortality of HIV-infected», statistical observations were analyzed: form No. 61 «Information on the contingent of HIV-infected patients», form No. 4 of the Federal State Statistical Observation, forms of the Vologda Regional Center for the Prevention and Control of AIDS and Infectious Diseases, materials of the North-Western District Center for the Prevention and Control of AIDS. Dynamic monitoring of the HIV epidemic in the Vologda Region (since 1995) and evaluation of the effectiveness of the national project to combat HIV infections were carried out. Results and discussion . On the territory of the Vologda Region, the trend of stability of the indicator of HIV infection remains. The prevalence of the population is increasing, accompanied by the identification of patients at late stages with the manifestation of secondary diseases. In the region, the HIV epidemic corresponds to the main trends of the epidemic process in the North-Western Federal District (NWFD) with some differences. The dominant transmission routes are parenteral (39.9% in 2021) and heterosexual. Over the past 5 years, there has been an upward trend in homosexual transmission of infection among men who have sex with a men (MSM), the share of which increased in 2021 by 2 times compared to 2017 and amounted to 3.1%. The detection rate in 2021, calculated for 100 thousand surveyed, in the Vologda Region was 111.3 (in the NWFD — 160.1). The highest detection rate of HIV infection was observed among MSM — 14.3% (in the NWFD — 4.1%), among injecting drug users (IDUs) — 1.0% (in the NWFD — 1.1%), among persons in prison — 1.8% (in the NWFD — 1.8%). One of the main causes of death in HIV-infected patients is the late detection of the disease and the initiation of antiretroviral therapy (ART). During the entire period of observation, the epidemic was most intense in Cherepovets and Vologda, since 2000 there has been a gradual spread of infection with involvement in the process in rural areas. Conclusion . The results obtained demonstrate the importance of implementing different models of the main stages of diagnosis, prevention and treatment of people in urban and rural areas, which is included in the developing concept of personalized HIV medicine. It is necessary to carry out additional measures for the active identification and registration of dispensary patients, the formation of adherence to dispensary monitoring and therapy, the timely appointment of ART, the introduction of new approaches to providing medical care to HIV-infected patients in the districts of the region.