The article presents an overview of the existing publications and the author’s several studies focusing on the need in strengthening HIV prevention in Russia. Based on the official data, the author attempted to provide an analysis of three stages of the Russian HIV epidemy (1987-2010) in terms of incidence levels, predominant transmission routes, involvement of various populations in the epidemy and prevention activities. The author describes social prevention projects implemented by AIDS Centres in 73 administrative territories across Russia in 2008-2009. There is a clear absence of unified approaches, with primary prevention focused on the general population and multiple projects targeting specific vulnerable groups such as IDUs, prisoners, migrants and SWs. The key partners in the projects were NGOs and international organizations. Most prevention projects were aimed at awareness-raising and information work. Long-term monitoring of prevention effect was problematic due to short lifespan of most projects. The vast experience of working with target groups is combined with the positive attitude to social surveys. Financial shortages are the key factor restricting prevention activities. The final section of the article contains discussion of highly active combined prevention which incorporates behavioural, structural and biomedical interventions as well as HAART. This approach, promoted as a standard by the international community, should be incorporated in the Russian concept of HIV prevention.