The present article treats the HIV/AIDS situations in Russian Federation and how Russia’s health authorities have been responding to it. It also tries to identify and analyze the various factors, particularly ideological, which determined this response. Those factors may explain the shortcomings, especially in prevention policies and in support provided to key populations. A special focus lies on HIV infection geography and on highly marked regional inequalities. In conclusion, the author promotes the need to better understand these disparities as well as the sociology of the epidemic, so that health policies can take them in account.