THE SIBERIAN SIDE OF AIDS

Relatively sheltered from the AIDS epidemic threatening the rest of
the country, the Irkutsk region had - until a year ago - less than 100
registered cases of HIV infection. Now the influx of heroin has led to
a dramatic rise in the spread of the deadly virus. New York Times
correspondent Michael Wines reports from Eastern Siberia.

Thirteen months ago, a young man from Irkutsk's rough-and-tumble north
side appeared at the government railroad workers' hospital complaining
of a head wound suffered in a family fight. A blood work-up soon
showed that it was the least of his problems: He was also infected
with HIV, the virus that causes AIDS.

This in itself was unusual for the Irkutsk region - a Siberian expanse
big enough to accommodate France and England in one gulp. Since health
officials started keeping AIDS statistics in 1991 - four years after
the country's first case was officially recorded - the region had seen
fewer than 200 HIV infections. But when a second north-side man
checked into another hospital for an operation a few days later, only
to test positive for HIV, the officials decided to
investigate.

What they found is still resounding through Irkutsk. The two men, it
turned out, attended Vocational School 44, a training institute for
river-transport workers. Further tests uncovered six more HIV cases
among their class mates. All eight shared another deadly trait: They
were addicted to heroin, which first appeared in the city's drug
subculture only six or seven months earlier.

Today, a region that had hardly heard of AIDS a year ago has recorded
5,000 new cases of HIV infection and registered more than 8,500 drug
addicts. Those are the official statistics: The true figures could be
10 times higher, officials say.

Why are the official statistics so much lower? Partly because many of
those in the high-risk groups are reluctant to be tested. They are not
only afraid of knowing the results, but of the consequences of being
targeted as a carrier of HIV. Anonymous testing centers are still few
and far between - with only 300 cites throughout the country. In many
cases those who obtained positive test results from less than
anonymous clinics have been reported to the local authorities.

THE FIRE IN IRKUTSK

Perhaps nowhere else throughout the country have HIV infections grown
as explosively as they have in Irkutsk. Heroin has proved to be the
deadly catalyst in this epidemic. It has fueled a sharp rise in drug
use and encouraged the needle sharing that helps to spread AIDS.

"It's a fire there," said Arkadiusz Majszyk, the UN AIDS
representative. "And nobody is paying attention."

If it is a fire, then the rest of the country is surely smoldering.
The number of HIV-infected people is small so far - 33,000 by official
estimates, perhaps 300,000 by international ones - but the potential
for growth is huge.

The United Nations says the virus' spread is accelerating and could
move beyond drug users if preventive measures are not taken. Already
40 percent of the country's prostitutes, who often use drugs, are
HIV-positive.

The growing prevalence of venereal diseases makes sexual transmission
of the virus even easier. "Our experience shows that a rise in the
infection rate of diseases such as gonorrhea and syphilis is usually
an indicator that a jump in HIV infection rates will follow," said one
Moscow doctor who treats prostitutes and their clients for sexually
transmitted diseases.

"Many clients are aware of the risk of getting AIDS, but they still
prefer not to use a condom when the seek they services of a
prostitute," he said. "And for a little extra cash, the women are
willing to engage in unsafe sex."

"In the regions where the outbreak of the epidemic among intravenous
drug users was registered earlier, a new stage of the epidemic is now
developing driven by the sexual transmission of the virus," said
Majszyk, explaining that commercial sex workers are the gateway
through which the virus that causes AIDS reaches the rest of the
population. "Clients, who are generally not drug users, come back home
and transmit the disease to their wives and partners."

AN OUNCE OF PREVENTION

The United Nations recently joined local counterparts to announce a
new effort to halt the epidemic. This June the U.N. will support a
conference bringing together regional and federal officials along with
potential foreign donors to tackle the problem.

"We try to help get people together to speak the same language and
attack the HIV-related problems without overlapping," said Majszyk. "A
two-tiered strategy is required, including systemic HIV prevention
measures and an adequate response to urgent needs. The most urgent
issue to address is the problem of prevention among intravenous drug
users and commercial sex workers," said Majszyk.

"The most effective means of avoiding an epidemic among drug users is
harm reduction," said Majszyk. This technology, which uses syringe
exchanges to protect and educate the high-risk population, has proven
to be a very effective means of prevention in other parts of the
world, said Majszyk.

To date some 30 syringe exchanges have sprung up throughout the
country providing information about avoiding HIV infection along with
clean needles and syringes - but these efforts have not been able to
reach the masses.

"Take the St. Petersburg bus," said Majszyk, referring to one of the
first syringe exchange programs implemented. "Some 150 drug users come
to the bus every day, but there are 70,000 people injecting drugs
daily throughout the city. Over the next few years we want to reach 60
percent of the drug user population with prevention programs and
information."

But in order for these prevention programs to work, Majszyk says, they
take time. And time is in short supply in Irkutsk. Heroin and HIV have
already penetrated virtually every corner of this vast region, a
hodgepodge of pristine forest and permafrost, dying company towns and
smoky industrial cities.

Heroin has surfaced in Bodaibo, a mountain-ringed gold-mining outpost
reachable only by small plane, and in Ust-Kut, a northern river port
whose shipping business has all but dried up. There is HIV in Mama, a
moribund mica-mining village some 640 kilometers north of here, and in
Bratsk, a good-sized manufacturing center far down the north-flowing
Angara River.

The Irkutsk region is home to about 2 million people. Simple math says
the rate of HIV infection is somewhere between one in 40 and one in
400. "But you really have to measure it against the number of youth,"
because drug use and HIV are largely confined to the young, said
Yelena A. Lyustritskaya, who heads a government commission on drug
abuse. "And in the Irkutsk region there are 300,000 people between the
ages of 14 and 28. So it turns out that every third or fourth young
man at age 18 or 20 takes drugs."

No one knows the infection rate among those users. But Dr. Maxim
Medvedev, who screens addicts for a private rehabilitation program
called Siberia Without Drugs, says roughly three of every 10 people he
examines have the AIDS virus.

At the government's principal rehabilitation center, 40 of the 62
inpatients are infected with HIV. Talk to some of the current and
reformed addicts at that center, a tidy but rundown and cheerless
place, and those numbers do not seem so outlandish.

"We used to be the department for glue sniffers," one of the center's
doctors said. "There is only one sniffer here now. There are no
alcoholics. They are all drug addicts."

THE NEW DRUG IN TOWN

A buzz-cut 16-year-old who switched from opium to heroin said he
believed that he had gotten HIV by sharing his needle late last year.
He may understand how the virus is transmitted, but there are many
outlandish theories circulating among the infected - a sign that AIDS
prevention programs have a long way to go before they reach the
high-risk groups. One common theory explaining the rise of the
epidemic, said one 17-year-old with HIV and hepatitis, is that
outsiders salted the heroin with the ground-up bones of African AIDS
victims.

"The countries that supply us don't have anything, only fruits," he
said. "Siberia's rich, and they want everybody here to die."

Natalya Kozhevnikova, a 27-year-old from a small diamond-mining town,
said many addicts there began using drugs at age 12 or 13. "There is
nothing to do - no movie theaters, no discos, nothing," she said.

Lelia Starodumova, 23, was a swimming champion and model before she
started taking opium four years ago. Now she and her husband are
heroin addicts, and she carries HIV. "Ninety-nine percent of drug
addicts have HIV," she said blandly. "The only ones who aren't sick
are the ones who haven't had their blood tested."

In a bleak two-room apartment across town, opposite the ramshackle
factory that produces the country's top fighter jet, the Su-30, Andrei
Kurnosov, a 30-year-old addict, said he had been on drugs for nine
years. When he began, he said, he was among the top five in his law
class, hoping for a chance to study in the United States. Now he
practices petty thievery and rolls small-time drug sellers for the 150
rubles - about $5 - he needs daily to finance his habit. Kurnosov says
he has avoided HIV through blind luck. He has shared needles with
other addicts, the last time three months ago, although he knows the
dangers. "You don't care, when you need a dose," he said. "The fear of
remaining sober and in pain overwhelms any fear of sickness."

Heroin's death grip on its victims offers some explanation of why HIV
has raced through Irkutsk's addict population. Opium, whose less
insistent craving grants a user some time to find a clean syringe,
once was the drug of choice. But unlike heroin, which needs only water
for it to be injected, opium must be carefully cooked and mixed.

So when heroin suddenly appeared some 18 months ago, addicts switched
en masse. It first came in liquid form - in bottles or already-loaded
syringes - and groups of users filled their syringes from the same
bottle, raising the odds that one infected addict would contaminate
many others.

Today heroin comes as a powder wrapped in paper "checks," Russian
slang for the cash-register tapes that they resemble. Fifty-ruble and
100-ruble checks are sold almost brazenly, from newsstands and bread
kiosks and by loitering dealers, in any number of open-air drug
markets around town.

Addicts say many police officers have been bought off, and this may be
true. In one muddy north-side market named Trety Posyolok, or Third
Settlement, a militia jeep cruised past knots of dealers and addicts
twice in 10 minutes one recent afternoon.

Officially, of course, the police deny being on the take. They claim
the heroin trade is ballooning despite their best efforts to stop it.

THE ROUTE TO SIBERIA

The drug comes by truck from Afghanistan and Tajikistan, far to the
west of Irkutsk, and is distributed throughout Siberia from the
western Siberian city of Novosibirsk.

Irkutsk's militia seized about 180 kilograms of drugs last year, well
ahead of previous years but a pittance in comparison with the total
traffic. Smugglers vacuum-pack heroin or hide it in shipments of
rotting onions to deter drug sniffing dogs. More and more, the trade
has shifted from individual freelancers to organized crime.

"It's difficult to control the flow," said the deputy chief of the
eastern Siberia militia, Pyotr Kobalchok. "We've even arrested members
of the Tajikistan special services who were escorting the smugglers.
It's that well organized."

Beneath such frustration over Irkutsk's plight runs a subtle but
pointed undercurrent: This region never had such problems when the
Soviet Union existed. Addiction and AIDS are among the consequences of
freedom and capitalism that Westerners neglected to mention when
communist rule ended a decade ago.

Indeed, it is not just in Siberia where officials are blaming the
spread of AIDS on the country's open borders. The fear of HIV, which
is perceived to be an imported disease, led to the implementation of a
controversial law passed in 1995 requiring all foreigners requesting a
visa for longer than three months to take an AIDS test. Among the many
outspoken critics of the law were medical experts who accused
legislators of trying to shut the barn door after the horse was loose.

Law-enforcement officials unanimously blame the drug problem on the
opening of Soviet borders and the loosening of government control over
ordinary people.

"Back then, there were no charter flights," said Nikolai Pushkar,
chief of the eastern Siberia transport militia, which battles drug
smuggling. "Everything was state-owned, and it wasn't possible to
negotiate with the state. In the past only the president could have
his own plane. Now anyone with money can have a plane."

"No matter how much we criticize the Soviet system, there was a
certain ideology. We were educated in an absolutely different way,"
Pushkar added. "Of course, there were abuses when the state interfered
with family life.

"But there were standards then."

Irkutsk has declared its own war on both of its epidemics, hiring new
narcotics police, printing educational brochures and changing the
school curriculum to promote what officials call "the healthy way of
life." But beyond telling people to just say no to drugs, officials
have not done much to prevent the spread of HIV among addicts and have
no immediate plans to do so.

Proven AIDS-preventive measures, like providing drug addicts with
sterile needles or bottles of virus-killing bleach, remain on the
drawing board - in part, some critics say, because politicians believe
they amount to an endorsement of drug use.

Indeed, although prevention is the best method of battling the virus,
many regions throughout the country are reluctant to endorse public
AIDS awareness campaigns. "In many schools the theme [of sex and drug
use] is still taboo," said Irina Savchenko, the health ministry's
representative to the federal center for AIDS prevention. "They
believe that just discussing these subjects will result in greater
sexual activity and drug use among pupils."

"We had contact with different people last year, including people from
foreign countries where such programs are implemented," said Dmitry
Piven, the Irkutsk region's deputy head of health care. "Since there
are different schemes, we are choosing an optimal one for ourselves."
Piven said officials would try to put new preventive measures into
effect among addicts before year's end.

The addict Kurnosov - his gaunt, rheumy face a contrast to hands
swollen grotesquely by repeated injections - said that would be too
late for many addicts. For many others, it already is.

"The generation of the '70s is dying," he said. "The generation of the
'80s is already dead - not all, not 100 percent. But 50 percent are
killing themselves."