Newsday - November 4, 1997
Laurie Garrett - Staff Correspondent

Nonetheless, he's been at the forefront of a battle by local citizens of this small Bohemian village to control prostitution in the area - a battle that so far has been unwinnable under a new Czech constitution that views any attempt to ban the practice as an illegal violation of human rights.

Dubi is about 7 miles from the German border, not far from Dresden. It is one of many small towns strung along highway I-55 that have, over five years, become host to hundreds of brothels and strip joints, thousands of streetwalkers and parklands littered with discarded underwear and sex leaflets written in German.

Jirasek is not bothered so much by the morality of the situation, he says, but rather by hard-core medical issues. "We're seeing big increases in syphilis, gonorrhea, and soon HIV will follow," Jirasek said. "In 1989 it started with pimps that had two, maybe three, girls in a car. And later they bought houses on the highway. By a year ago, there were girls lined all along the side of the highway in a huge line.

"They're all over the Czech Republic, all over eastern Europe, in fact,'" he said, "and when one [prostitute] gets ill they just replace her. That's it."

Since the waging of the "Velvet Revolution" in Czechoslovakia in 1989, the fall of the Berlin Wall in 1990, and the collapse of the Soviet Union in 1991, prostitution has been transformed in this vast region. It has gone from being a tightly controlled cottage industry into a multibillion-dollar, multinational enterprise run by sophisticated gangsters who transport tens of thousands of women - and sometimes girls and boys - from the poorest areas in the former Communist world to places like Dubi, areas that share borders with better-off western European and Middle Eastern countries.

The trafficking of women in these networks is so massive and expanding so rapidly, according to the International Organization of Migration, that the agency can provide only ballpark estimates.

"It is following exactly the model we've seen in India," the organization's Marco Gramegna said. "These women are given a phony contract for a job in western Europe. The trafficker charges her bank account or debits her future earnings for plane tickets and lodging. When she reaches the destination, the trafficker seizes her passport and tells her she must work as a prostitute until she earns back her debt. Of course, she never does."

In this manner, about half a million women from the former Soviet Union were smuggled into western Europe and forced into prostitution by 1995, Gramegna said. The scale of the operation has escalated since then, with up to 300,000 more women trafficked into western Europe annually, most from Russia and Ukraine, he said.

But this is only part of the equation driving up the rate of sexually transmitted diseases (STDs) in the region, experts say. For many, prostitution has gained strong acceptance as the industry of last resort in an economy in which millions have lost jobs since 1991.

In Moscow and Odessa, Tbilisi, Novosibirsk and Irkutsk, local street-level prostitution can be tantamount to survival, Newsday found during its year-long examination of public health in the former Soviet world, and the results are clearly seen in the region's health-care statistics.

In Russia, for instance, demographers point out that the line plotting the country's syphilis rate has been progressing upward at a sharp angle. In 1994 the incidence nationally was 81.7 per 100,000; in 1995 it was 172, and last year it reached 221.9. If the trend holds, this year should see syphilis top 330, experts say, making Russia's syphilis rate one of the top 10 worldwide, joining the ranks of AIDS-plagued nations in sub-Saharan Africa.

And while this infection isn't nearly as frightening as HIV, it can be extremely dangerous. Usually marked by small genital sores, syphilis often goes unnoticed in women and, untreated, can lapse into a latent stage that can persist for years. Then, secondary syphilis can appear in the form of severe damage to the central nervous system, lesions of the heart, skin or bones and eventually death, usually due to brain damage.

Gramegna said the crime syndicates most involved in the trafficking of women are, essentially, beyond police control. In Dubi, for example, two of about 20 brothels are next to a police station.

"We tried to contact the German press to discourage clients, but there was a threat of international complications," Jirasek said. "The clients are foreigners, so they can't be arrested here. They can be charged, but we can't throw ten Germans in jail in one night or we would have a German invasion."

At Central Hospital in Usti And Labem, about a 20-minute drive from Dubi, "we have seen a thousand-fold increase in syphilis since 1985," said Dr. Alesander Moroc. "Sixty-eight percent of it is among 15to 24-year-old females. And often we see syphilis in late-pregnancy women."

The other major STD, gonorrhea, also is on the rise, he said, though the statistics aren't as clear. "The paradox," he explained, "is that rates appear to be decreasing as syphilis rises. But this is because general practitioners treat the gonorrhea and don't report the cases."

Gonorrhea usually produces obvious urinary discharge in men within a week after infection and is easily treated with a single dose of appropriate antibiotics. Infection in women, however, often goes unnoticed until pelvic inflammatory disease appears, leading to ectopic pregnancies and sterility.

A Czech government survey five years ago of Usti prostitutes showed that 30 percent carried either syphilis or gonorrhea. Rates are believed to have doubled since then, Moroc said, but the pimps are not allowing their prostitutes to participate in new studies.

In Usti, Dr. Josef Trmal has found evidence that the Bohemian STD epidemic is moving "beyond the prostitution circle to all sexually active young adults. We've seen an increase in the numbers of people seeking STD counseling and treatment, and most of them are teenagers and very young adults."

From 1995 to 1996 there was a 59 percent increase in the number of adults and teens who sought STD checkups in Bohemia, Trmal said. And judging by the numbers who visited during the first quarter of 1997, this year will see a 140 percent increase over last year.

A similar industry is blooming in the region's Baltic states, where young women are recruited to service comparatively wealthy customers from Finland, Norway and Sweden.

Health officials estimate there are 2,000 Estonians who work as prostitutes in Helsinki, often going back and forth across the border on a weekly or monthly basis. The Deaconess Institute of Helsinki, a government-financed medical research facility, recently estimated that syphilis rates among Estonian prostitutes had increased 16-fold from 1990 to 1995, when the rate reached 852 cases per 100,000. And the gonorrhea rate doubled, to more than 3,000 cases per 100,000.

So it's no wonder, health experts say, that the country's overall syphilis rate is high - 205 per 100,000 in 1995, according to the World Health Organization. To put that in perspective, about one out of every 480 Estonians had syphilis in 1995, compared with one out of every 3,800 Americans.

Russia's figures are similar. In 1988, Russia had a total of 5,704 registered syphilis cases, according to the Ministry of Health; last year 386,935 cases were registered, a 68-fold increase in eight years. Overall, the national syphilis rate was 221.9 cases per 100,000.

And this figure is most certainly underreported, says a study published this summer in the medical journal Lancet by Dr. Adrian Renton of Westminster Medical School in London. First, the old Soviet system of tracking down and forcibly registering sex partners of identified syphilis cases has collapsed, and no sustained education effort has developed in its stead. Further, in many parts of Russia, government facilities now charge patients up to $300 for a 28-day course of syphilis treatment.

Watching all of this nervously are officials with UNAIDS in Geneva.

"What we see tells us that the rate of multiple-partner sex is already very, very high," said epidemiologist Luis Loures of UNAIDS in Geneva. "And what we want to watch for is the spread from lower-class prostitutes to their clients, those men turning up in STD clinics and then spreading [the disease] to their wives and the general population."

In Ukraine, Newsday found, the STD epidemic is being driven by activities of young people ages 13 to 21. While the syphilis rate for Ukrainians over age 30 has grown at a steady rate since 1990, it's still well below 180 cases per 100,000, according to the Ukrainian Ministry of Health. Girls 14 and younger have about 600 syphilis cases per 100,000; the rate for 15to 16-year-old girls has fluctuated between 1,550 and 2,000 cases per 100,000 since 1993.

And since the rates for boys are much lower, health experts say it clearly suggests the girls are getting the disease in ways that have nothing to do with normal precociousness.

A girl who said she is 14, and certainly looked it, trolled for customers in front of Odessa's Philharmonic Hall, dressed in hot pants, knee-high boots and a fur bolero jacket. "I always make my customers use condoms," she said, but followed the claim with a derisive laugh and a knowing wink at a second, similarly dressed teen standing nearby.

Indeed, several girls interviewed at the same site claimed to use condoms. But the truth, experts say, is that they merely charge more when customers won't use them.

The 14-year-old, who declined to give her name, is part of a well-organized contingent of 50 prostitutes who solicit customers in front of the stately Philharmonic Hall, charging $50 for a "quickie" or $100 for an all-night session. On the complex hierarchical scale of Odessa's sex industry, the Philharmonic girls are middle-class, according to psychologist Valeri Kiunov, who has mapped out the sex trade for UNAIDS and Odessa State University.

During Odessa's cold winter months, about 2,000 girls work as prostitutes. But in the summer, when the beachside city is a popular vacation spot, the prostitute population more than doubles.

Kiunov has found six distinct social strata of prostitutes. Most of the youngest girls - ages 11 to 17 - work as what he calls "chaotic prostitutes," flagging down customers on the streets after school two or three times a week. They typically earn $39 to $50 a week and use condoms.

A second group, averaging 26 years of age, works through female pimps and tends to have steady customers. Kiunov says two-thirds of these women have had at least one STD during the past three years.

Members of the most promiscuous groups, called "The Pacifiers," tend to congregate around factories and large workplaces, where they service 20 to 40 clients a week. The mean age of the group is 19, and they account for more than half of Odessa's sex workers. "They can't afford condoms [which cost 25 cents each], and when you talk to them about `safe sex' they think it means avoiding beatings," Kiunov said.

Half of that group also injects local opiate concoctions, and in recent years the average age of these prostitutes has been dropping, Kiunov added: "Last summer I saw 9and 10-year-olds working in this group."
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