By Sultan Musayev | 2025-09-15

On the front lines of Russia's full-scale war in Ukraine, a second battle is raging, the one against a virus.

Within the first year of fighting, new HIV cases in the army spiked to 40 times prewar levels, according to Russian Defense Ministry data cited by the Carnegie Russia Eurasia Center in Berlin. By the end of 2023, the spread had eased somewhat, with growth dropping to 20 times higher than before the invasion.

Even though the epidemic has slowed slightly, infections remain staggeringly high, driven by battlefield exposure through blood and wounds as well as by unprotected sex and drug use.

The scale of the crisis is so severe that even pro-Kremlin voices have begun to speak out. In August, Anastasia Kashevarova, a nationalist commentator known for her outspoken support of Russia's invasion, warned on her Telegram channel that the front had become "a hotbed of disease and viruses," describing HIV as advancing alongside rats, lice and other wartime vectors.

She added that while authorities once sent only some prisoners with HIV or hepatitis to the front, now "they're taking all infected prisoners."

Crisis in the ranks

A Defense Ministry medical journal said many contract soldiers with HIV knowingly used fake certificates to hide their status and keep collecting military pay. The fraud is often uncovered too late.

Kashevarova said diseases spread quickly in the ranks because the army lacks prevention and treatment. She described infections arising from trench life, shared operating tables, blood transfusions and neglect by military medics.

Independent media also link the epidemic to sex work near the front. Verstka reported that hundreds of women travel from across Russia to serve soldiers "in the trenches, at roadblocks and in saunas." Many are drawn by pay ranging from 500,000 to 1.5 million RUB a month ($6,000-18,000), working either in brothels or on their own.

Sex workers told Verstka that nearly all their clients in the occupied territories are Russian soldiers. One said "civilians just don't make this kind of money," noting that the going "front-line" rate is 15,000 to 20,000 RUB an hour ($180-240), higher than in Moscow.

Russian troops fighting in what the Kremlin calls a "special military operation" earn far more than average citizens, with salaries up to 300,000 RUB ($3,700) a month plus a 400,000-RUB ($5,000) signing bonus.

Verstka reported that some sex workers agree to have unprotected sex with Russian soldiers for extra pay. Many troops appear unconcerned about the risk of HIV or other sexually transmitted diseases. One regular client told the outlet he sees himself as "a condemned man" and is "going wild one last time."

In August, UN investigators said Russian service members have also used sexual violence against Ukrainian civilians as a tool of intimidation in occupied territories.

“These were all highly sexualized assaults which included rapes, threats of rape and other depraved conduct," said Alice Jill Edwards, the UN's special rapporteur on torture.

Russian Defense Ministry physicians wrote that the epidemic is fueled in part by the reuse of syringes at the front, as well as drug use and homosexual relations.

Exacerbating the situation is the fact that the actual number of HIV cases among service members may be much higher because the statistics include only detected cases and cases confirmed through lab tests.

Beyond the battlefield

Experts say the HIV epidemic on the front is likely to keep growing.

Aigerim Zhakasheva, a primary care physician at the Central Family Clinic in Almaty, Kazakhstan, told Kontur the spread was predictable.

"Any war is a catalyst for infections: people are living in close quarters, without decent hygiene and healthcare, and any disease starts to spread much faster," she said. "Unprotected sexual contact guarantees there will be an outbreak of the HIV infection."

The United Nations in 2022 ranked Russia among the world's five countries with the highest HIV infection rates, behind only South Africa, Mozambique, Nigeria and India.

HIV cases in Russia continue to rise even as global infections have fallen for decades. The World Health Organization says new cases worldwide peaked in the mid-1990s and have since dropped by more than half, thanks to prevention programs and antiretroviral therapy.

Russia has the highest HIV rate in Europe, with 1.5% of the population infected, followed by Ukraine at 1.1%, according to the Carnegie Russia Eurasia Center. Considering the size of its population, Russia is playing a decisive role in the persistence of the HIV epidemic, the analysts wrote.

Zhakasheva warned that HIV does not respect borders and is not confined to the army.

"Today the virus is spreading on the front, but tomorrow it could infiltrate the families of the service members who go home, and it could become a problem for all of society," she said. "The war is accelerating the spread of infections that in peacetime could have been stemmed."