EUROPE'S EAST SEES AIDS ON THE MARCH

DEBE, Poland, June 9 -- It did not seem pleasant for Krystyna Sokolowska to
put her life on display -- the youthful year of heroin addiction that led
to catching the virus that causes AIDS, to shuffling around homes for the
infected that were never popular with scared neighbors.

But she agreed to do so at a conference here as an early example of a trend
that is alarming health officials in the region: How intravenous drug use
is driving an epidemic of people becoming H.I.V. positive in Eastern
Europe, and especially in the countries that used to be part of the Soviet
Union. Nowhere else in the world is the virus that causes AIDS spreading so
quickly, and this is the only place where the sharing of needles during
drug use is the major route of infection, United Nations experts say.

When Ms. Sokolowska found out she was H.I.V. positive, in October 1989,
AIDS was hardly known in Eastern Europe, except as a disease of gay men in
the United States.

"Well, it definitely did not make me feel American," said Ms. Sokolowska,
now 32, who lived at the time in Silesia, in southwestern Poland.

But changes since the collapse of Communism -- say health officials who
gathered here, just outside Warsaw, at the first regional conference on
AIDS -- have created conditions ripe for the spread of the virus: Borders
opened, burrowing out nearby trade routes from the major supplier of
heroin, Afghanistan. Police control, which brutally curbed prostitution and
drug use in the past, receded. At the same time, the economic troubles in
the transition out of Communism have left many young people without jobs.

Now the number of people becoming H.I.V positive has been rising steeply.
Thought to be first in the region were two brothers in Ukraine, businessmen
who traveled and dabbled in drugs, health officials said. The first sizable
number of people found to be H.I.V. positive occurred in late 1995 in the
Ukrainian port cities of Odessa and Nikolayev.

Now, in Ukraine, there are 38,632 people registered as H.I.V. positive --
two thirds of them drug users -- while there were fewer than 300 before
1995. In Russia, 58,000 people were reported to be H.I.V. positive in 2000
- -- triple the number in 1999 and two times all the cases reported since
1987, according to Russian health officials here.

And while in some countries, like here in Poland, the numbers are
relatively flat, many others show similar increases.

"It looks much more like a regional pattern," said Dr. Karl L. Dehne, the
United Nations AIDS program's coordinator for Central and Eastern Europe.
"All regions in Ukraine are affected. Most regions in Russia. The Baltics
are affected. Now the first outbreaks are happening in central Asia.

"In intensity and geographic spread, it's evolving," he said. "It's
worrying." The overall rates of infection in the region are still low when
compared with Africa, where the AIDS epidemic is by far the worst,
according to United Nations officials. While the percentage of pregnant
women who test positive in some African countries is near 25 percent, the
number is less than 1 percent in Ukraine, one of the worst-hit former
Soviet states.

But people at the conference said the limited scope has, in some ways, made
containing the virus's spread more difficult, because the problem is
perceived to be confined to small groups of social outcasts, like drug
users. The H.I.V. rates have also been creeping up among prostitutes,
especially in Moscow, St. Petersburg and Kaliningrad. And drug use in
prisons is high.

"Intravenous drug users and commercial sex workers are blamed for spreading
the epidemic, so there is a backlash," said Robin Montgomery, an official
with AIDS Infoshare, a group in Russia that works with prostitutes, among
others.

But health officials here said there are early signs of the disease
spreading beyond drug addicts and prostitutes. Dr. Olena Purick, a
consultant with the International H.I.V./AIDS Alliance in Ukraine, said she
is seeing more cases of the virus being transmitted not by drug use but
through sexual contact -- from men who are drug users to wives or
girlfriends who are not.

"These were absolutely normal women," Dr. Purick said. "That was a new
phenomenon in Ukraine. In maybe Africa or Asia you have the same thing. But
it was new for us."

The conference, which attracted health officials from 27 countries in
Eastern Europe and the former Soviet states, was sponsored by several
groups that support containing the virus that causes AIDS through what is
known as "harm reduction." In theory, this approach aims less at law
enforcement than at finding ways to improve the health of people who use
drugs or are H.I.V. positive and to check the virus's spread.

Other countries, they said, do not support initiatives like needle exchange
or methadone treatment because such programs are perceived as helping drug
users in their habits.

"It's not about needles," argued Kasia Malinowska-Sempruch, director of the
International Harm Reduction Development Program, part of the Open Society
Institute, a sponsor of the conference. "Needles are part of a bigger
package to help incredibly mistreated, marginalized drug users."