AS HIV SPREADS, OFFICIALS ARE STILL LOOKING THE OTHER WAY

MOSCOW - Since she began using heroin at 12, Oksana Mitrofanova has been to
drug-abuse clinics twice - once before she was told she was infected with
the virus that causes AIDS, once afterward. Each time they flushed the drug
out of her body but not the craving for it.

"As far as counseling, they said, 'Here, take this medicine,' " said
Mitrofanova, now 19. "And they suggested I see a psychologist. That's all."

Nowhere in the world is HIV spreading faster than in the former Soviet
Union, an ominous trend that so far has been driven almost exclusively by
the young embracing experimentation.

And yet Russia has devoted little if any attention to the prevention and
treatment of drug abuse, AIDS experts say. Now, as Russia begins to see the
first signs that transmission among non-drug-using heterosexuals is on the
rise, experts worry that the nation once again will react far too slowly to
a health crisis that threatens to explode.

At a global AIDS conference in July in Barcelona, Spain, the director of
the Russian Federation AIDS Center, Dr. Vadim Pokrovsky, said the
proportion of Russia's new HIV cases linked to heterosexual transmission
jumped from 4 percent in 2001 to 8.4 percent during the first three months
of this year.

About 200,000 Russians are registered as HIV-positive, but Pokrovsky and
other leading AIDS researchers in Russia estimate the actual number is
closer to 1 million. The figure is expected to grow to 5 million by 2005.

Pokrovsky has said as much as $65 million is needed immediately to slow the
spread of HIV infection in Russia and to treat the thousands of infected
people who soon will begin suffering the symptoms of AIDS. This year, the
Russian government budgeted just $5.1 million to combat the disease, Health
Ministry officials said.

The government could have tapped into a new global fund for nations facing
huge increases in AIDS cases in coming years but did not submit a proposal.
That fund could have produced as much as $27 million for Russia this year,
experts believe. Ukraine, which is facing a crisis of its own with 1
percent of the population HIV-positive, was awarded $9 million from the
fund this year and is to receive $92 million over 10 years.

Alexander Goliusov, head of the Russian Health Ministry's HIV infection and
treatment department, said Russia contributed $20 million to the fund but
chose not to request aid like Ukraine, "which like a beggar has stretched
out a hand for help."

AIDS experts believe that behind Russia's reluctance to employ even basic
preventive measures such as drug-abuse counseling and needle exchanges is a
glaring underestimation of how severe the crisis could become.

Ninety percent of the Russians infected by HIV are intravenous drug users.
More worrisome, though, are estimates from researchers that two out of
every five intravenous drug users already are infected with HIV, said
Andrei Kozlov, director of the Biomedical Center in St. Petersburg and one
of Russia's leading AIDS researchers.

And in cities such as Rostov-on-Don, Krasnodar and Kaliningrad, experts are
seeing evidence that the spread of HIV is beginning to take hold in the
general heterosexual population, said Arkadiusz Majszyk, the Russian
Federation's representative to the United Nations Program on HIV and AIDS.

"We are going from this high-risk group, intravenous drug users, to the
general population," Majszyk said. "The young generation is experimenting
with everything, including sex and drugs. Having these two combined, the
danger is much higher."

Other former Soviet republics faced with rapid increases in the spread of
HIV, including Kyrgyzstan and Belarus, have begun methadone programs to
help reduce the incidence of intravenous drug use. In Russia, however,
methadone is illegal.

Needle-exchange programs benefit about 5 percent of the country's
intravenous drug users, Majszyk said. But to make a significant dent in the
spread of HIV among that group, at least 60 percent coverage is needed.

Russia has had myriad other problems to confront, from an ailing economy to
the ongoing civil war in Chechnya, but experts argue that the explanation
for the country's inaction toward the AIDS crisis goes beyond priority-setting.

"In Russia there has been a lack of understanding of new social problems
and a tendency to look at drug users as a marginalized group," Majszyk
said. "And today, that drug user could be your son, or the son of a
government leader. For now, however, the average Russian citizen is saying,
'No, it will not come to me.' "

That denial courses through every tier of Russian society, experts say.
Foundations that fund AIDS prevention and treatment programs have begun to
spring up in Moscow and throughout Russia, but they are largely
foreign-based groups, Kozlov said.

"We have so many rich people in Russia now. Why don't we have an AIDS
foundation here?" Kozlov said. "This means society doesn't understand the
scope of the problem yet."

Support groups for people who are HIV-infected exist, but on a shoestring.
Mitrofanova's group meets in the basement of a large, dilapidated apartment
building in Moscow's industrial northeast sector.

Heroin users in the group say they realize their predicament is the product
of their own actions. But they recount how when they sought help at Russian
drug-abuse clinics, the experience was impersonal, almost mechanical. The
sole purpose was detoxification, and it usually was carried out through a
daily regimen of vitamins and painkillers.

Mitrofanova said that before her diagnosis, she and 19 other teenagers
spent their evenings huddled around a small spoon of heroin outside an
apartment building. They shared syringes. Her two visits to drug-abuse
clinics ended the same way: She walked out the door and began using again
later that day. "It was of no help," she said.

She said when she learned she was HIV-positive, "there was no fear of being
ill or doomed to die. What really frightened me was the fact that I knew
people were going to turn their backs on me."