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BACKGROUND : An increased incidence of communicable diseases, especially HIV-infection, has since the mid 1990ies been observed in Northwest Russia and the Baltic countries. Injecting drug use has until now been the most important factor in the spread of HIV in the area. RESULTS AND INTERPRETATION : In Northwest Russia and the Baltic countries, a sharp rise of newly diagnosed HIV-cases started in 1998 and a peak was observed in 2001. The reduction of reported cases observed during the last few years is mainly caused by fewer newly diagnosed HIV-cases in intravenous drug users. An increasing proportion of the newly diagnosed cases of HIV occur among women. It is uncertain if this reflects sexual spread to drug users' partners, or if it is the beginning of a heterosexual epidemic in the general population. Men who have sex with men do currently not account for a large proportion of total cases in Northwest Russia and the Baltic countries, but stigmatisation of this group may cause underreporting of this transmission route. The epidemiological situation in the neighbouring countries has had little effect on the HIV epidemic in Norway. This is probably because HIV in Northwest Russia until now has been limited to social groups that have little contact with Norway or Norwegians visiting Russia. MATERIAL AND METHODS : This paper is based on surveillance data published by EuroHIV, Epi North and the Norwegian notification system for communicable diseases, and on personal experience. We present an overview of the epidemiological HIV situation in Northwest Russia and the countries of the Baltic Sea area, and the effect this has on the HIV-epidemic in Norway.

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