Purpose of review: To explore the consequences of policies implemented in the Russian Federation in response to syndemic of HIV-1 and opioid use disorder and compare the responses to the concomitant syndemic in rural America.
Recent findings: The syndemic spread has not been reduced by policies implemented by the Russian government, which continues to underfund harm reduction efforts to reduce HIV transmission, refuses to approve evidence-based opioid agonist treatments for opioid use disorder, and relies on criminal justice and abstinence approaches to control illicit opioids. When effective measures have been undertaken locally, the lessons learned have not been transferred to other parts of the country and local programs have been allowed to wither. As in many parts of rural America, Russia has experienced intertwined epidemics of opioid misuse and HIV-1 that continue to expand. The expansion has been facilitated by adoption of policies that run contrary to medical and public health evidence.
Keywords: HIV-1; Harm reduction; Injection drug use; Opioid addiction treatment; Russia.