RUSSIA FIGHTS ONLY FEEBLY AS HIV MAKES ALARMING INROADS

KALININGRAD, Russia - Alexander Dreizin runs an AIDS cafe for drug addicts.
He serves up tea, sympathy and clean needles.

His is a one-doctor battle against an epidemic that is marching through
Russia on the back of a dramatic surge in drug use. From the Baltic Sea to
the Pacific Ocean, AIDS has made speedy inroads against the futile
resistance of underfunded hospitals and clinics. By year's end, officials at
the federal AIDS Prevention and Cure Center in Moscow predict, at least
500,000 Russians will be infected with human immunodeficiency virus (HIV),
which causes AIDS.

"The outbreak is horrifying," said Vadim Pokrovsky, director of the AIDS
center. "The epidemic is developing geometrically."

Nowhere has the alarm been sounded more desperately than in Kaliningrad. The
region, separated from the rest of Russia and surrounded by Poland,
Lithuania and the Baltic Sea, is Russia's per-capita AIDS leader.
Officially, the city of the same name is home to 2,621 people who have
tested positive for HIV. Local doctors resist the idea that Kaliningrad has
a higher AIDS rate than the rest of Russia. They point out that the province
has been quicker than most in testing residents.

Comparative rates of regional HIV infection are not fully reliable, given
uneven testing programs. But the difference in data between Kaliningrad and
its Baltic neighbors is astonishing. Estonia, Latvia and Lithuania, with a
combined population of almost 8 million people, report 421 HIV cases. That
is one-sixth the number in Kaliningrad, whose population is 1 million.

Drugs drawn from communal vat

Dreizin focuses on stopping the spread. Federal law prohibits handing out
clean needles, but officials often ignore the law.

But it is far from certain that clean needles can stem the tide of HIV,
given the habits of Russia's drug abusers. Kaliningrad addicts have taken to
a deadly variety of mixtures to provide a low-cost high. "Chyorny," or
"black," is a mixture of boiled opium and other chemicals. Another opium
cocktail called "khanka" costs as little as $1.50 a hit. Lately, injections
of veterinary anesthetics have become popular.

Often, these narcotics are sold from vats in which addicts dip their
syringes. It takes only one unclean needle to infect the "kompot," or
"stewed fruit," as it's called in drug-world slang.

Kaliningrad is far from alone in the HIV fight. Moscow has the
fastest-growing rate of new infection, according to Russian officials.

The small Ural Mountain town of Verkhnyaya Salda discovered its first AIDS
case in 1997, and for the next nine weeks, doctors diagnosed an average of
five new sufferers a week. Kemerovo, in Siberia, began testing last year
after an outbreak of youth drug usage. Doctors quickly found 156
HIV-infected addicts.

The central government has yet to finance an educational campaign against
AIDS. Doctors Without Borders, the international medical aid agency, has
initiated a safe-sex television and billboard campaign. Some schools have
begun sex-education classes, but they have been attacked by Russian Orthodox
groups.

Kaliningrad's alarming rise in AIDS cases created a search for quick
solutions. Officials sought to ban prostitution, then to simply monitor it,
to clear drug addicts off the streets and crack down on smuggling. Nothing
worked. Besides the AIDS epidemic, Kaliningrad is noted for porous borders
and corrupt policing.

`Catching up' with the West

Patients who have developed AIDS are treated in a small ward at a hospital.
Russia produces AZT, an anti-AIDs drug. However, only 6 percent of budget
funds earmarked for fighting AIDS was actually disbursed to the Health
Ministry last year, said Alexander Galiusov, a ministry official.

Russian officials say the first AIDS case appeared in Russia in 1987; the
first case in the United States was reported in 1981. Isolation provided by
the Iron Curtain accounted for the tardy arrival. As Russia and the rest of
the former Soviet Union opened to the outside world - and to drug
trafficking - a society that thought itself immune from Western evils became
a leading importer of AIDS.

"It is like the fulfillment of a curse. We wanted to catch up with
everything in the West, so the first thing we succeeded in was getting HIV,"
Dreizin said.