Background The annual numbers of registered HIV cases in Russia continue to grow. The epidemic is driven by use of contaminated illicit injection equipment. In 2006 HIV prevalence in Barnaul was 9% and Hep C 54%. We sought to understand the epidemic trend and risk factors for HIV transmission in Barnaul.

Methods A cross-sectional survey PWID using RDS was conducted between August and October 2012 in Barnaul. PWID were recruited by 5 PWID seeds. Socio-behavioural, HIV and HCV results, and the proportion of previously undiagnosed HIV infections were calculated using RDSAT.

Results 500 PWID responded; they were predominantly: male (67.4%, 95% CI 62.3, 72.7), 30–39 years old (54.7%, 95% CI 49.1, 60.1), single (53.3%, 95% CI 48.0, 59.4), unemployed (67.3%, 95% 62.1, 72.5), used alcohol in the last month (81.6%, 95% CI 76.3, 86.2). More than half of them injected in the last month (55.9%, 95% CI 50.4, 61.5) from ≥ 2 to ≤ 9 (74.5%, 95% CI 66.9, 84.0) times a day and 55.9% (95% CI 52.1, 73.8) every day. Predominant drugs during the last month were heroin, marijuana (38.5%, 95% CI 26.0, 47.9) and desomorphine (19.0%, 95% CI 10.9, 23.8). 80.6% of PIWD injected in a group with 1–5 injectors in the past one month (95% CI 75.0, 88.3) with > 10 non-sterile injections (59.1%, 95% CI 46.7, 73.6) on average. 85.3% (95% CI 80.5, 92.3) share paraphernalia. Prevalence of HIV was 30.3% (95% CI 25.3, 35.2) and Hep C 72.7% (95% CI 67.5, 77.7). Among those recently tested for HIV, 20% (95% CI 8.8, 28.8) were unaware they were HIV+.

Conclusions HIV prevalence more than tripled and Hep C has increased by 25% between 2006 and 2012. Increased prevalence may be attributed to high risk behaviours. Effective essential HIV prevention interventions must be introduced and/or scaled up rapidly to slow the epidemic.