HIV spreads first among the poor and the marginalized. They are the ones the virus hits hardest. Since epidemics are never merely biological, technological solutions cannot hold the complete answer.
Sergei is not so different from the average 24-year-old Russian: slight, dark-haired, with a gap between two teeth. But he is one of the very few, in this country of 145 million people, to admit that he is HIV-positive. ‘I’m not ashamed,’ says the former intravenous drug user, now a volunteer with a youth crisis group. ‘I have the virus and I want to stop as many people as I can from sharing the same fate. Ignoring the problem will only make it worse.’
These are brave words in a country that is in deep denial about a disease that could undermine its very future. According to the latest figures, 186,000 people like Sergei are registered with the health authorities as infected with the virus that causes AIDS. Experts say that is only a fraction of the real total which they estimate at nearly a million.
The time is long gone when AIDS was a ‘foreign disease’. It is now firmly entrenched in Russia, the product of tumultuous social change that left the country vulnerable to the dangers of both unimaginable new wealth and unthinkable new poverty. An estimated 100 young Russians a day are now diagnosed with HIV. But while the country has one of the highest rates of HIV increase in the world, its leaders and officials are largely turning a blind eye.
‘President Putin went to the G-8 summit in Genoa and for the first time said he was concerned about AIDS,’ says Dr Vadim Pokrovsky with a wry smile. ‘He pledged a million dollars to help fight AIDS in the Third World. It’s unfortunate he doesn’t do more in our own country.’
Pokrovsky, the head of the Russian Federal Aids Centre, works with a yearly budget of 190 million roubles, little more than $6 million, for programmes designed to curb the spread of the disease in this vast country. Soon, he says, the figure will be cut to 150 million roubles, just $5 million.
The combination of lack of interest among the country’s politicians, public disregard and a dearth of consciousness-raising campaigns has created a vicious circle that results in the premature death of thousands of people.
‘What we need is for the public to demand that something be done,’ says Pokrovsky. ‘But people just don’t want to think about it. So nothing is happening and the clock is ticking very fast.’
Drug abuse, once a minor concern, has become an epidemic. And prostitution as well as promiscuity is helping to spread the HIV virus throughout all strata of society.
‘In my group, there are a lot of drugs,’ explains Sergei. ‘I would say 90 per cent of the HIV cases are spread that way. But sex is also going to be a big problem in spreading the virus in the future, because so many people are infected and don’t take care.’
Ironically, HIV began to flare in Russia in the mid-1990s, just as advances in pharmaceutical research improved the prospects for people with AIDS in Western countries and brought a glimmer of hope to all AIDS sufferers.
In Russia the grim truth, as Sergei found out, is quite different.
‘Unless you have a lot of money, you don’t get these Western-style treatments,’ he says. ‘The official AIDS centre will help you if you pay $700 for each course of drugs. Otherwise you get some antibiotics and that’s it.’
Under Russian law, people with the HIV virus should receive free state medical care. But the quality of the care is far from certain. Many doctors, nurses and hospital employees refuse to deal with patients known to be infected. Those who are diagnosed with HIV often follow a nightmarish path through the medical establishment, from humiliation and rejection to neglect and early death.
‘If you have an accident and break a bone, ordinary hospitals won’t even give you an x-ray,’ says Sergei. ‘If you are bleeding, they’re terrified of touching you. Your medical record has a big ?HIV? on it and you’re forced to go to the AIDS centre or nothing.’
When Sergei discovered he was HIV positive, he immediately urged his wife to go to the centre for an examination. He said she was greeted by a doctor who told her glumly: ‘Why bother? You don’t have any money for treatment, so what’s the use?’
One of the problems for those already infected is that practitioners, even experts in the field, see AIDS (called ‘SPID’ in Russian and pronounced ‘speed’) as a disease of derelicts. Because most of the sufferers are drug users, they are often considered to be already doomed by their health-destroying habit.
Prostitutes, too, are shunned. Although, paradoxically, increasing numbers of young women from ‘middle class’ families have turned to selling their bodies as a way of making what they think will be quick and easy money.
In the mid-1990s, a survey at a St Petersburg school startled teachers and parents with the finding that prostitution was one of the most desired future professions for female teenage students. Since the fall of communism many young recruits to the sex trade have succumbed to the powerful wave of advertising that swept into Russia, featuring women in semi-pornographic poses, scantily dressed in luxurious designer clothes and jewelery.
The increase in drug-taking can also be traced to the influx of new wealth and lifestyle choices, as well as to the growth of the Russian mafia. With hard drugs now easily obtainable, even impoverished wanabee millionaires can shell out a few roubles on a tiny dose of heroin that lets them escape the confusing and frustrating real world for a few hours. Bored with the past, uncertain about the future, Russia’s directionless young adults are living for the moment.
The increasing population of street people, many of them teenagers, have also been hooked on hard drugs, sharing needles as they lie on steaming grates to keep from freezing in winter. And drug use has spread to Russia’s outposts, like the southern region of Tyumen, near Kazakhstan, where new oil money has attracted dealers as a picnic draws ants. In St Petersburg, a leader in drug abuse, HIV is spreading like wildfire among impoverished young people, who shuttle between the streets and jail.
An estimated 100 young Russians a day are now diagnosed with HIV - and officials are turning a blind eye
‘It’s a terrible dilemma,’ admits a Petersburg social worker. ‘When we know kids have the virus we have to get them off the streets somehow. The few hostels won’t accept HIV-infected people, so we pretend they’re healthy. But of course there’s the chance they might infect more kids once they’re there.’ The lack of adequate medical care for HIV-infected people is even more severe when people develop AIDS and the disease progresses to its final stages.
‘Russia hasn’t developed hospices,’ says Dmitri Blagovo, who heads the charity Return to Life, which helps young people in crisis. ‘It’s really frightening to think what the outlook will be in the next few years. No hospital will take them and I have no idea where they will be able to go. Soon there will be hundreds of thousands of them.’
With such a horrifying scenario for the future, one would expect the Russian authorities to be nervous, if not actually panicky, about AIDS.
But, says Blagovo, a psychologist, they are mainly trying to avoid dealing with the unpopular problem — one of hundreds of devastating health and environmental issues that need attention and money. His own organization is an example of the general lack of interest. One of 300 NGOs in Russia that help people with AIDS, it may be shut down because a grant from a foreign organization has expired and there is no new Russian money to pay for the modest basement office and drop-in centre based in Moscow’s rundown east end.
‘NGOs from outside the country believe that it’s time Russia looked after its own problems,’ Blagovo says wryly. ‘But clearly it isn’t happening.’
He and his 20 volunteers — including Sergei — regularly visit Moscow’s highest-risk districts where prostitutes and young drug users congregate. They explain the dangers of AIDS, and distribute condoms and pamphlets. But experts understand that getting the message into schools is most critical. And it’s an uphill struggle.
‘There’s no official sex education in schools,’ says Pokrovsky. ‘There has been a big debate about it for years. But parents, teachers and the church are all involved, and nothing is solved. Meanwhile opportunities dwindle.’
Psychologists are at a loss to explain why Russians, who have become increasingly promiscuous since the fall of the Soviet Union, remain almost as conservative as their parents in discussing sex openly.
By default, some schools are offering their own sex-education classes. Blagovo has been asked to give talks to students, but he has little time either to lecture or to campaign for public awareness. Those who work with AIDS issues are chronically overstretched and underpaid.
As another day draws to a close in Moscow’s bleak, smoggy east end, Sergei and his fellow battlers prepare for another counselling session with their drop-in clients.
‘Most of the time they find out they don’t have much of a chance, their families reject them, they take more drugs and die,’ he says. ‘We’re here to help break that cycle. We don’t have a lot of resources but we can help them fight their fear.’
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