The Russian dictator fiddles while HIV rages his country, and his silence is deafening.

Russian President Vladimir Putin has little to say about HIV rates in his country, despite the fact that Russia has the highest growth rate of HIV in the world. The leader's denial appears to be the official state policy.

As of June 2017, AFEW International estimated there were 1,160,000 HIV cases in Russia, and at least 750,000 new diagnoses have occurred since the beginning of Putin’s third presidential term in 2012. Even more disturbing, at least two-thirds of the 340,000 deaths from HIV have occurred during his current term.

It was a different story during his first two terms from 2000 to 2008, however, when the former KGB officer-turned-politician repeatedly cited the urgency of the problem.

“This is a serious situation that requires us to take the appropriate action,” he said in a speech to the State Council in April 2016. “We need more than words; we need action, and the whole of Russian society must get involved.”

Since that time, his words have proved hollow as little official action follows. The country remains a bastion of ignorance when it comes to HIV prevention and treatment. New advances in the fight such as PrEP and Undetectable Equals Untransmittable (U=U) are not utilized or promoted.

Instead, students receive instruction that abstinence is the best tool: “The main weapon against HIV is love and fidelity” is an official government slogan.

Part of the problem is cultural as well. HIV is still viewed as a “gay disease” and, sadly, not considered a priority for large segments of the population. Fear and shame are also a factor, and many people living with HIV either don't know it or refuse treatment because of social stigma. These societal inhibitors are compounded by a lack of access to qualified medical services that can identify and provide life-saving treatment.

This head-in-the-sand approach is not limited to HIV, as other communicable diseases are overrepresented in the population as well. Tuberculosis and hepatitis infections remain disturbingly high compared to other developed countries.

Despite the severity of the problem, Putin remains mum on the issue.

His silence is not just emblematic of the government response but also responsible for it. Russia’s thousand-year history of dictatorial strongmen has led to society that often enacts policy by what it perceives is the desired wish of those in power rather than by any official edict.

By remaining silent on the issue, Putin is ensuring that the Russian HIV epidemic will only get worse. It's time to get loud.