Population declines in the Russian Federation are being exacerbated by mortality caused by HIV/AIDS, tuberculosis and opioid use disorders. These illnesses work synergistically to create a syndemic – an aggregation of multiple diseases in a population in which positive biological interaction exacerbates their negative health effects – that is felt most heavily among the young adult, working age population. The roots of the syndemic go back to drug use resulting from the Afghan War of the late 1980s, and the HIV epidemic first blossomed in 2000-02, but Russia is now experiencing a second wave of the epidemic. My talk will explore the epidemic trends, attempts at epidemic control, structural reasons for the failure of these efforts, and end with possible causes for optimism.