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Russia Sits on the Edge of an Epidemic

Health: The former Soviet state's social ills go hand in hand with its soaring HIV rate.


RYAZAN, Russia — Out of work and separated from his wife, Yuri takes the only job he can find--chauffeuring prostitutes in this provincial city. The women are all using heroin. He becomes close to one, has an affair with her, and one evening while drunk accepts her challenge to shoot up "just once."

In a matter of days, Yuri is addicted. Months later, he learns he is HIV-positive. He contemplates suicide.

Yet the shock of realizing he might die of AIDS gets him off drugs. He goes through two weeks of gut-wrenching withdrawal and stays off the stuff.

And his wife, in an act of love and pity he considers miraculous, agrees to take him back even knowing of his infection. It would be a happy ending, if not for the ticking time bomb in his system--and Russia's.

Dismissed by the former Communist authorities barely a decade ago as a phenomenon of Western decadence that would never spread widely here, AIDS is making its mark on the new Russia. Disturbingly, it arrived virtually overnight, with the number of people with the human immunodeficiency virus exploding in just the last three years.

The coming together of a poor economy, a burgeoning plague of intravenous drug use, an overreaction to the country's new freedoms and Slavic fatalism has landed Russia on the cusp of an epidemic.

The face of HIV infection today in Russia is a young man, unemployed, who is using or has used intravenous drugs--and who has caught the disease from injecting himself with a dirty needle. So far, comparatively few people seem to have been infected by homosexual or heterosexual contact. Assuming, however, that the young man is sexually active, officials fear that this will inevitably change.

At least 201,000 Russians are HIV-positive, and the country's top AIDS fighter warns that the number of people infected but not registered with authorities could be four to six times higher.

Across the former Soviet Union, there are more than 1 million cases of HIV infection, participants at the International AIDS Conference in Barcelona, Spain, were told this summer. From a very small number of HIV/AIDS cases in 1995, the former Soviet states have zoomed ahead of the United States, which is roughly equal in population but has endured the epidemic for far longer.

The former Soviet states now face the fastest-growing AIDS epidemic in the world, the United Nations says, and international AIDS officials consider it vital that more resources go to oppose the disease here.

The epidemic in Russia is so young that cases of AIDS are rare. And it is still unclear whether there is a chance to staunch Russia's HIV crisis before it mushrooms into a human and demographic catastrophe.

There is one glimmer of hope: The number of newly registered cases of HIV infection has actually been dropping in the last year.

But Vadim Pokrovsky, director of Russia's federal AIDS center, argues that the recent drop-off makes the situation no less alarming. "Last year, about 88,000 new cases were registered. In the first six months of this year, we registered about 26,000 new cases--which may seem to some analysts as a slowdown," he said. "But the number of new cases in which the virus was transmitted heterosexually rose to 7% compared with 4.3% last year, which demonstrates the epidemic is spreading over the majority sector of the population.

"And thus it begins to develop according to the African scenario, where the majority of the HIV patients contracted it heterosexually."

In Pokrovsky's view, if just half of the HIV-infected population spreads the virus to one sexual partner per year--which he considers conservative based on the African experience--Russia could have as many as 5 million HIV cases by 2010 and will have suffered 500,000 AIDS deaths.

"This will be very grave for the country's demographics, because 80% of the infected people are between 15 and 30. They will die, and they will not produce children. And this is very frightening indeed for Russia," he said.

Already troubled by their country's declining influence since the dissolution of the Soviet Union, many Russians tend to look with dread on demographic projections that show their population declining from its current level of 144 million to around 110 million by 2050.

AIDS could accelerate that decline, and discussion of the epidemic often is seen here almost as a matter of long-term national survival.

The HIV/AIDS crisis in Russia has been a slow train wreck. Experts saw it coming but found themselves powerless to stop it. Tatyana N. Nikitina, the director of the Kaliningrad regional AIDS center, said the scenarios for the spread of AIDS in Russia turned out to be all wrong.

Officials who were concerned about the disease as early as the 1980s and early 1990s expected it to be primarily a sexually transmitted illness that would build gradually over a long period. They were caught by surprise when it instead soared in 1999 and 2000 among intravenous drug users.

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