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Russian AIDS statistics hide epidemic
By Clara Ferreira-Marques
MOSCOW, Nov 28 (Reuters) - Tucked away behind Hospital No 2 for Infectious Diseases in Moscow's rundown northeastern outskirts, the white six-storey block bears no sign or plaque.
But the edginess of the reception staff and the gaunt faces of the young patients on the peeling green wards tell you this Russia's main centre for the treatment of AIDS.
Many of Russia's 163,000 officially registered HIV/AIDS patients are diagnosed and treated here, flying in from Russian cities thousands of miles (km) away.
German Salamov, one of a handful of doctors at the centre, says patients come from as far afield as the eastern port of Vladivostock to seek anonymous treatment in the capital.
"From Yakutia (in Russia's far north) they pay $300 for a one way ticket, but they don't want to see a doctor there, they are afraid," said Salamov, speaking in his small office papered with AIDS prevention pamphlets and brightly coloured posters.
"If they become registered there, they fear they may have problems."
Even high-ranking officials from the regions turn up at the centre, seeking treatment for themselves or their children, unknown to friends and colleagues at home.
Most HIV-positive Russians cannot afford the fare to Moscow, let alone the treatments that would allow them to live a little longer.
Though there is no cure for HIV, which attacks the immune system and leaves the body vulnerable to a host of life-threatening diseases, drugs can hold back the spread of the virus and prolong the lives of sufferers -- if they can afford them.
Basic treatment for a single patient can cost up to $1,000, an amount beyond the reach of most people in Russia's provinces.
A CATASTROPHIC EPIDEMIC
According to the government, the country of 147 million people has around 163,000 patients infected with HIV/AIDS -- a fraction of the four million cases registered, for example, in South Africa.
Experts say these statistics hide a catastrophic epidemic, with real figures up to five times those on government files.
A bigger problem is the number of young people affected by the disease. More than 80 percent of recorded cases affect people under 30.
Initially, HIV spread through Russia's homosexual community, though drug addicts contracting the disease from infected needles soon came to represent the vast majority of cases.
Salamov says HIV/AIDS is now spreading rapidly among heterosexuals.
"(Drug addicts) are not separate societies, they are part of a larger society, they have friends, boyfriends, wives," he said.
Many heterosexuals remain off the record books, their contamination with the virus registered only as "reason unknown." In the first six months of 2001, 41 percent of cases were recorded under category "no information."
FREE HEALTHCARE
Others, living in Moscow without official permission, sit patiently on the centre's plastic-wrapped benches in the hope of getting at least part of the treatment their semi-permanent status bars them from.
"Moscow is a big city, it has a lot of money and a good mayor that gives money to the city's patients," Salamov said. "But there are a lot of HIV positive people who live in the city and cannot get help."
Without an official Moscow residency permit, patients have no access to the free and comparatively luxurious healthcare of the capital.
"I can screen patients for free, but I cannot do biochemical blood analyses myself," Salamov said.
"But if they go back to where they are registered, they lose everything -- health, work, money. And this is a huge problem, first and foremost, psychologically."
And for many, going back home means faring worse. Most regional centres cannot afford either treatment or the immune system testing crucial to monitoring patients' well-being.
And, Salamov says, many doctors outside Moscow who are ill-informed about HIV/AIDS, simply refuse to take on HIV positive patients.
"So what happens if their teeth hurt? What happens if, in the case of women patients, they need to see a gynaecologist?"
With the scant 120 million roubles ($4 million) provided this year by the Russian government for the prevention and treatment of AIDS, it may be surprising many patients are treated at all.
At a news conference, a Health Ministry official simply shrugged his shoulders.
"If the number of HIV positive patients goes on increasing at this rate, the Health Ministry budget will not be enough to give them even basic assistance," he said.
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