Chicago Tribune - July 21, 2002
Alex Rodriguez, Tribune foreign correspondent

"As far as counseling, they said, 'Here, take this medicine,'" said Mitrofanova, now 19. "And they suggested I see a psychologist. That's all."

Nowhere in the world is HIV spreading faster than in the former Soviet Union, an ominous trend that so far has been driven almost exclusively by the young embracing experimentation.

And yet Russia has devoted little if any attention to the prevention and treatment of drug abuse, AIDS experts say. Now, as Russia begins to see the first signs that transmission among non-drug-using heterosexuals is on the rise, experts worry that the nation once again will react far too slowly to a health crisis that threatens to explode.

Growing menace

At a global AIDS conference this month in Barcelona, the director of the Russian Federation AIDS Center, Dr. Vadim Pokrovsky, said the proportion of Russia's new HIV cases linked to heterosexual transmission jumped from 4 percent in 2001 to 8.4 percent during the first three months of this year.

About 200,000 Russians are registered as HIV positive, but Pokrovsky and other leading AIDS researchers in Russia estimate the actual number is closer to 1million. The figure is expected to grow to 5 million by 2005.

Pokrovsky has said as much as $65 million is needed immediately to slow the spread of HIV infection in Russia and to treat the thousands of infected people who soon will begin suffering the symptoms of AIDS. This year, the Russian government budgeted just $5.1 million to combat the disease, Health Ministry officials said.

The government could have tapped into a new global fund for nations facing huge increases in AIDS cases in coming years but did not submit a proposal. That fund could have produced as much as $27 million for Russia this year, experts believe. Ukraine, which is facing a crisis of its own with 1 percent of the population HIV positive, was awarded $9 million from the fund this year and is to receive $92 million over 10 years.

Alexander Goliusov, head of the Russian Health Ministry's HIV infection and treatment department, said Russia contributed $20 million to the fund but chose not to request aid like Ukraine, "which like a beggar has stretched out a hand for help."

Problem underestimated?

AIDS experts believe that behind Russia's reluctance to combat what looms ahead with even basic preventive measures such as drug abuse counseling and needle exchanges is a glaring underestimation of how severe the crisis could become.

Ninety percent of the Russians infected by HIV are intravenous drug users. More worrisome, though, are estimates from researchers that two out of every five intravenous drug users already are infected with HIV, said Andrei Kozlov, director of the Biomedical Center in St. Petersburg and one of Russia's leading AIDS researchers.

And in cities such as Rostov-on-Don, Krasnodar and Kaliningrad, experts are seeing evidence that the spread of HIV is beginning to take hold in the general heterosexual population, said Arkadiusz Majszyk, the Russian Federation's representative to the United Nations Program on HIV and AIDS.

"We are going from this high-risk group, intravenous drug users, to the general population," Majszyk said. "The young generation is experimenting with everything, including sex and drugs. Having these two combined, the danger is much higher."

Other former Soviet republics faced with rapid increases in the spread of HIV, including Kyrgyzstan and Belarus, have begun methadone programs to help reduce the incidence of intravenous drug use. In Russia, however, methadone is illegal.

Needle exchange programs benefit about 5 percent of the country's intravenous drug users, Majszyk said. But to make a significant dent in the spread of HIV among intravenous drug users, at least 60 percent coverage is needed.

Russia has had myriad other problems to cope with, from an ailing economy to the ongoing civil war in Chechnya, but experts argue that the explanation for the country's inaction toward the AIDS crisis goes beyond priority-setting.

"In Russia there has been a lack of understanding of new social problems and a tendency to look at drug users as a marginalized group," Majszyk said. "And today, that drug user could be your son, or the son of a government leader."

That denial courses through every tier of Russian society, experts say. Foundations that fund AIDS prevention and treatment programs have begun to spring up in Moscow and throughout Russia, but they are largely foreign-based groups, Kozlov said.

"We have so many rich people in Russia now. Why don't we have an AIDS foundation here?" Kozlov said. "This means society doesn't understand the scope of the problem yet."

Support groups underfunded

Support groups for people who are HIV-infected exist, but on a shoestring. Mitrofanova's group meets in the basement of a large, dilapidated apartment building in Moscow's industrial northeast sector.

Heroin users in the group say they realize their predicament is the product of their own actions. But when they sought help at Russian drug abuse clinics, the experience was impersonal, almost mechanical. The sole purpose was detoxification, and it usually was carried out through a daily regimen of vitamins and painkillers.

Mitrofanova, waif-sized with tawny blond hair, said that before her diagnosis, she and 19 other teenagers spent their evenings huddled around a small spoon of heroin outside an apartment building. They shared syringes. Her two visits to drug abuse clinics ended the same way: She walked out the door and returned to using that day.

She said upon learning she was HIV positive, "there was no fear of being ill or doomed to die. What really frightened me was the fact that I knew people were going to turn their backs on me."

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