ALARMING PORTENTS ON FRONTIER OF RUSSIA'S AIDS CRISIS

KALININGRAD, Russia, July 14 - As the cafes and clubs began to course with
night life one recent evening, Andrei V. Bykovsky and Yuliya B. Sokolova
cruised around in a white van, patrolling the newest front of Russia's AIDS
epidemic.

They stopped first near the Mother of Russia statue, then along Moskovski
Prospect, then beneath the Cosmonauts Memorial. They easily found what they
were looking for: young women, many in their teens, most racked by drugs or
desperation, selling themselves on the street for a trifle - less than $7.

Mr. Bykovsky and Ms. Sokolova passed out condoms from a green backpack and
tried to coax the women to visit their basement clinic, which offers exams
and advice to slow the spread of H.I.V., the virus that causes AIDS.

In Kaliningrad, as in all of Russia, the virus has spread almost entirely
through the use of intravenous drugs. But the next step in the disease's
march across Russia, which has one of the fastest-growing AIDS epidemics in
the world, is starting to be documented here: a sharp increase in H.I.V.
infections through sex.

"The figures began to grow in the last year," said Yelena Y. Kozhenkova, a
doctor who rides along in the van on its nightly missions. "But we could
see it coming even earlier."

What makes Kaliningrad's experience significant is what it forebodes for
Russia as a whole. This region of more than 900,000 people, isolated from
the Russian mainland and plagued by the social and economic ills that came
with the Soviet Union's collapse, was the first hit hard by an explosion of
cases among drug addicts and has been a harbinger of the disease's spread
ever since.

In 2001, the percentage of new H.I.V. infections in Kaliningrad attributed
to sexual contact jumped to nearly 30 percent of the total, compared with
only 4 percent when the epidemic struck here with a vengeance in 1996,
regional officials said. Prostitution appears to have been the primary
source of these infections, but officials now fear that the trend signals
the spread of H.I.V. beyond the shadowy world of drugs and criminality.

Tatyana N. Nikitina, the director of the Kaliningrad region's government
AIDS center, attributed the increasing numbers to men contracting the virus
from prostitutes and then spreading it to their wives and girlfriends.

"The disease has reached beyond the circle of the consumers of sexual
services," she said.

In all of Russia, sexually transmitted H.I.V. infections accounted for a
little more than 5 percent of new cases last year. But if previous patterns
hold, officials warn, the number will rise, as it has here.

"The processes under way in Russia now could be observed in the Kaliningrad
region five years ago," said Vadim V. Pokrovsky, the country's leading AIDS
expert.

AIDS came belatedly to Russia, a fact attributed to the Soviet Union's
nearly closed society. The first case was reported in 1987, but infections
did not reach epidemic proportions until the mid-1990's, with an explosion
of intravenous drug use.

In the last year alone, the total number of registered H.I.V. infections
more than doubled to 177,354, from 87,177 in 2000. With screening still
fairly limited, officials estimate that the total number of Russians
actually infected may have already reached one million.

Dr. Pokrovsky has begun to warn, with some alarm, that AIDS could spread in
Russia the way it has in Africa, infecting broad swaths of the population.

For now, drugs remain the leading cause of H.I.V. infections, particularly
in Russia's notoriously overcrowded, drug-infested prisons. Some estimates
suggest that the country has more than a million hardened drug users, most
of them young men, but increasingly young women, as well.

They are also among the most sexually active age group, in which rates of
other sexually transmitted diseases, like syphilis, are also high.

"Given the high odds of transmission through needle sharing, the fact that
young people are also sexually active, and the high levels of sexually
transmitted infections in the wider population, a huge epidemic may be
imminent," a report by the United Nations program on H.I.V. and AIDS, or
Unaids, warned in December.

In Kaliningrad, the spike in infections through sex has overshadowed some
of the progress the region has made in slowing the disease's spread.

The number of new cases each year has dropped from a high of 1,109 in 1997
to 491 last year and only 215 in the first six months of this year,
according to the region's AIDS center. To date, there have been 3,763 cases
of H.I.V. infection.

Although its rate of infections per capita is higher than in Western
Europe, Kaliningrad no longer has the highest rates in Russia, having been
surpassed by the regions of Irkutsk and Khanty-Mansi, in Siberia. Officials
here have attributed the slowing of the growth to greater awareness of the
risks, stricter policing of drugs and to one of the unintended consequences
of the United States campaign in Afghanistan: a drop in drug exports that
has driven up prices for heroin.

Officials also cite the increased use of clean disposable syringes, which
are distributed by the basement clinic, run by a psychologist named
Aleksandr A. Dreizin, that sends out the van teams each night.

With the number of cases involving sexual contact increasing, the clinic's
mission has evolved from an exclusive focus on addicts, although drugs and
prostitution are inseparably intertwined.

Dr. Dreizin has hired a gynecologist to offer women free exams. With money
from the World Health Organization and private donors, the center also
distributes condoms and pamphlets on safe sex.

An estimated 3,000 women work as prostitutes in Kaliningrad. Dr. Dreizin
noted that new clusters of prostitution have appeared on Kaliningrad's
borders with Poland and Lithuania, where they serve long lines of motorists
waiting to cross. A French organization has donated a bus to help the
clinic reach those women more easily.

Of the prostitutes who are reached, Dr. Kozhenkova said, many remain wary
even of health authorities. "It's a complex of guilt and shame," she said.
"They are afraid even of a gynecological clinic."