A popular theory with little evidence

Several Georgian doctors have linked the country’s recent HIV spike to migration from Russia and Ukraine. What does the data show?

Since the start of Russia’s full-scale invasion of Ukraine, more than 62,000 Russians and 20,000 Ukrainians have relocated to Georgia. Meanwhile, Georgia itself has seen a rise in HIV infections, with almost 400 new cases reported in the first eight months of 2023, despite having been lauded among European countries for its effective HIV and AIDS policies in recent years. This has led some Georgian doctors and media outlets to attribute the worsening HIV situation to the wartime influx of Russian and Ukrainian migrants — the latest iteration of a theory that’s found resonance in a number of countries, particularly among conservative politicians. Meduza takes a look at the reasons behind the widespread popularity of this dubious hypothesis.

A lack of evidence

In late June, Professor Maya Butsashvili, an infectious disease specialist who works at Tbilisi’s NEOLAB clinic, expressed concern on Facebook regarding the large number of Russians entering the country. Arguing that Russia was grappling with an HIV epidemic and that unprotected sexual encounters between local residents and migrants could lead to an increase in HIV infections in Georgia, she urged officials to remind citizens about safe practices to avoid sexually transmitted infections.

Shortly after, Tengiz Tsertsvadze, the director of Georgia's main infectious disease hospital, said that Butsashvili's theory “had some truth to it” but suggested that the increase in cases might have “less to do with the influx of migrants and more to do with the end of the COVID-19 pandemic, the lifting of restrictions, and an increase in testing.” He noted that since the wartime migration of Russian and Ukrainian citizens had begun, Georgia’s HIV and AIDS Control Service had intensified its surveillance and implemented measures for prevention and treatment. Tsertsvadze also emphasized the importance of only using sterile medical instruments and avoiding unprotected sexual contact, encouraging those with suspected infections to seek medical assistance.

Nonetheless, Butsashvili remained firm in her stance, insisting that migrants were a “high-risk group.” In August, she recommended a policy of mandatory HIV testing for people entering the country and urged local residents to “abstain from unprotected sexual contact.”

Butsashvili, whose Facebook page has some 7,000 followers, has been widely quoted in the Georgian media for her statements, especially during the COVID-19 pandemic. Her opinions on the role of migrants in HIV transmission have sparked huge debates across social media platforms. According to her profile, she studied epidemiology at the State University of New York and is currently a faculty member at the University of Georgia.

Skewed by the pandemic

Georgia was seeing record spikes in HIV rates well before the recent influx of migrants from Russia began. In 2018, for instance, the country identified 672 new HIV cases, while it saw 719 in 2016, which remains the highest year on record. In 2022, 617 new cases were recorded, and in the first eight months of this year, 393 cases were confirmed.

In August 2023, the total number of HIV infections in Georgia reached 10,170, with the majority of cases in Tbilisi (3,830). According to the Georgian Center for Research of Infectious Diseases and AIDS, the virus is transmitted primarily through heterosexual contact (51.4%) and intravenous drug use (32.6%). HIV prevalence in Georgia, at 0.27% of the total population, is substantially lower than in Russia (0.8%) and Ukraine (approximately 0.55%).

Georgia's HIV and AIDS policy, according to WHO estimates, has been one of the most effective in Europe. The country introduced antiretroviral therapy (ARV therapy) in the 1990s and ensured universal access in the 2000s, significantly reducing AIDS-related mortality. In 2011, Georgia established a national AIDS information system, creating a comprehensive database of demographic, epidemiological, clinical and laboratory data on all AIDS patients. The government also actively promotes ARV therapy and health services for all, regardless of gender, ethnicity, or viral load.

Despite these efforts, Georgia fell short of its goal to provide ARV therapy to 90% of the infected population by 2020, with only 76% of virus carriers knowing their status and only 65% receiving ARV therapy. Even fewer individuals (65% of those on therapy) have managed to suppress the virus's activity.

A more plausible explanation

One epidemiologist, who asked to remain anonymous for security reasons, acknowledged that Russia and Ukraine have significant HIV epidemics and that migrants are a particularly vulnerable group. But at the same time, he said, Georgia’s rise in infections cannot be unequivocally attributed to the influx in migrants without a comprehensive analysis of the epidemiological data.

The Georgian Center for Infectious Diseases and AIDS Research reported more HIV cases in 2022 than in 2020 and 2021. However, this increase could be attributed at least in part to reduced testing during the COVID-19 pandemic, when resources were diverted to coronavirus prevention efforts.

The epidemiologist further explained that there’s little to no evidence that compulsory testing, entry restrictions, or deportation are effective public health measures. In fact, such measures may even hinder HIV prevention and treatment as they make individuals more likely to hide their status, avoid seeking help, and then propagate the virus as a result.

The U.N.’s note on HIV/AIDS and the Protection of Refugees states:

Detention or restrictions on the freedom of movement of persons living with HIV and AIDS would be in violation of the fundamental rights to liberty and security of the person, as well as the right to freedom of movement, if carried out solely on the basis of a person’s actual or suspected HIV status. There is no public health justification for restrictions of these rights due to a person’s HIV status alone. Moreover such restrictions would be discriminatory.

In Russia, however, it remains legally permissible to deport migrants based solely on their HIV status. In 2021, Fedot Tumusov, a deputy from the political party “A Just Russia — For Truth,” proposed a bill to abolish these measures due to their lack of effectiveness, but the State Duma ignored his proposal. According to the head of one public organization that works with individuals affected by HIV in Eastern Europe and Central Asia, who asked to remain anonymous, there’s no reasonable basis for a country to deport foreigners with HIV. Many developed countries have already repealed such laws.

An easy scapegoat

One human rights activist who specialises in HIV issues and wished to maintain anonymity told Meduza that the practice of blaming migrants, a vulnerable group, for various societal problems is not unique to Georgia; it’s a common rhetorical move employed by conservative political figures worldwide. In Georgia, she argued, negative sentiments regarding migrants may have been exacerbated by the strain on public health and the surge in migration caused by the war, leading to concerns and frustrations among local residents that politicians can exploit for political gain.

Georgian political scientist Gela Vasadze has also suggested that accusing migrants of spreading HIV may be an element of the political campaigns of right-wing opposition parties in the upcoming 2024 elections. He told the outlet Paper Kartuli that the Georgian authorities should address the migration crisis by reducing the stay period of visitors with uncertain legal status and making it easier for migrants to obtain residence permits.

According to the anonymous human rights activist, migrants are a vulnerable group with limited political and civil rights, which makes them easy scapegoats for various social problems. This phenomenon is not unique to Georgia but is a broader issue tied to policies and levels of tension within countries.

Russia is no exception: it, too, has a long history of public figures making public health-related xenophobic statements. In 2009, for example, the country’s then-Chief Health Inspector, Gennady Onishchenko, alleged that migrants “contribute significantly to the HIV and AIDS epidemic.” Similar sentiments were echoed in 2012, when the chairman of the Moscow City Duma’s healthcare commission, Lyudmila Stebenkova, proposed putting out public service announcements to warn Muscovites about the risk of contracting HIV from migrants.

Over the past two decades, however, Georgia has been decidedly receptive to international recommendations, focusing on testing and treatment while avoiding discriminatory policies. Anyone who’s in the country legally has the right to receive assistance, including refugees, who can access ARV treatment while their asylum requests are being processed.

At the same time, the activist said, there’s no question that the Georgian healthcare system was unprepared for the influx of migrants. While Georgia has been proactive in HIV prevention, migrants have encountered difficulties in accessing HIV treatment.

According to the experts who spoke to Meduza, effectively addressing Georgia’s HIV problem will require ensuring equal access to healthcare, repealing discriminatory laws, and prioritizing prevention programs and HIV awareness campaigns. Providing free counselling, testing, and treatment to all individuals living with HIV, regardless of their legal status, is paramount.

Story by Ivanna Leontyeva

Abridged English-language version by Cameron Manley