A SOCIAL 'NEUTRON BOMB'

Russia Is The New Ground Zero Of The Aids Epidemic

Elena Yaskevich hunches over her desk and lights up another cigarette.
Her office phone, one of Moscow's few drug-addiction hot lines, rings
once again. She begins yet another round of questions, the same as the
last. "How old is your daughter?" Pause. "I see, 17. Vich?" the
Russian word for HIV. Solemnly, she nods as she gets the mother's
expected reply.

Even pros like Yaskevich have been blind-sided by the tidal wave of
HIV that's hit Russia over the past two years. "This is a serious
threat," she says, likening it to a "neutron bomb." That bomb has
already exploded among intravenous drug users. The question is when it
will go off in the general population. Officially, Russia has
diagnosed 129,261 new cases of HIV over the past year and a half,
including this July. That's the highest rate of infection in Europe,
making Russians seven times more likely than their Western
counterparts to contract the virus. And the real number of new cases
could be anywhere from five to 10 times higher, according to experts.
"This is a catastrophe," says Dr. Alex Gromyko, an HIV adviser to the
World Health Organization. "Within the space of two years, Russia has
gone from the bottom of the list to No. 1."

Infection rates are increasing almost exponentially. More than 63,000
cases have been counted during the first five months of this year,
three times the rate of two years ago and double the total for the 12
years between 1987 and 1999. That's modest compared with Africa, where
17 million people have already died. But Russia's HIV-watchers feel
like people preparing for a hurricane: they can close the shutters,
but that won't save their home. Dr. Gromyko makes no predictions,
except to say he is sure that within two or three years several
million Russians will be infected. "When the deaths will be counted in
the millions," he says, "then we will start to understand the tragedy."

HIV can quickly spread to the general population in a country like Russia,
where standard protections against the sexual transmission of the disease are
often not used and abortion is still a popular form of birth control. And
clearly, few of the dramatic steps needed to combat a general epidemic are
being
taken. This April, Russia refused a $150 million World Bank loan for treating
tuberculosis and AIDS. Reason: Health Ministry officials were reportedly "not
satisfied" with certain conditions of the loan. And while Russia plans to
commit
$5 million on the fight against AIDS this year, that's a pittance next to what
the United States and Europe spend to combat the disease--and utterly
inadequate
for the challenge. Russia has opened AIDS awareness centers in each of its 89
regions, and many hospitals now have AIDS wings. But few have adequate supplies
of the drugs needed to treat HIV, and their cost is beyond the means of most
patients. According to Dr. Gromyko, only about 500 are receiving effective
treatment. "Russia cannot afford to treat that many infected persons," he says.
"It's a generation lost."

Now comes the influx of heroin to the former Soviet Union. Ever since
the 1980s, the drug of choice in former republics like Belarus has
been cherny, a cheap form of raw opium. Shooting drugs into your arm
is still the best way to get a strong hit for the least amount of
money. Needle sharing has always been common, and remains so. Add to
this the general disregard for contraception and a surge in
drug-related prostitution and you've got a deadly recipe for an
epidemic. Just ask 26-year-old Lena, who walks the halls of the AIDS
ward at a hospital in Rostov, in southern Russia, a crumbling edifice
populated mostly by addicts with HIV. She wears blue pajamas and
clutches her stomach, not knowing why it hurts all the time. But she
knows she got her disease from sharing needles. "I never stole, I
never became a prostitute," she says. "Most narcomanki became
prostitutes for kopeks. They will serve clients right by the roadside.
They are the most lost of all."

At Rostov's Center for AIDS Prevention, heroin addicts Oleg and Vasily
wait to get their test results. The doctor has already told them they
are almost certainly HIV-positive, and the silence in the room
testifies to their nervousness. Oleg explains the deadly rules of the
game. It's almost a given, he says: "When you get the drugs, you don't
have a clean syringe. Sometimes you just don't have the money, other
times the pharmacy is closed." So you shoot up anyway. Vasily, too,
talks about the full-time job of obtaining the drugs, cooking them up,
injecting and keeping away from the cops. It gives him something to do
in what he sees as his otherwise useless existence. "Why does it
matter what you die of, AIDS or drugs? One of them will kill you, but
there's no reason to live anyway. We spit on society, and we spit on
ourselves." That attitude is surprisingly prevalent, in itself a
harbinger of worse to come.