Looking back, Alexey believes he contracted HIV six years ago during a time when he was a heavy heroin user.

Unfortunately, Alexey's story is one of the exceptions in Russia. Even when people know their status, getting access to treatment can be a challenge. Before 2006, only 300 of the 25,000 patients in St. Petersburg who needed it could access free ARV treatment, says Dr Galina Volkova, Deputy Chief Physician at the St. Petersburg AIDS Center.

"There was a very large protest from patients about the lack of treatment," Dr Volkova says. A speech by Russian President Vladimir Putin during the G8 Summit that was held in St. Petersburg in 2006 changed things for the better. "This was only a municipal program before. Now it's a federal program," she says.

The AIDS Center is now providing free treatment to 1,400 patients, 800 of whom are receiving treatment with Global Fund support. Still, because of the high volume of drug users, it is very difficult to manage patients who have a tendency to stop treatment when the temptation to use drugs becomes too difficult to resist.

Nikita, 30, has come to the AIDS center to check whether he has become resistant to any of the ARVs that were part of his previous treatment regimen. This is the third time he is restarting treatment.

"This is a patient that requires the most attention. It is the most difficult patient for us, but it is also our target group," says Dr Natalya Badosova, head of the outpatient department at the AIDS Center. "[Nikita] is not a hopeless case. As long as he keeps coming to us, it gives us hope."