#20
Financial Times (UK)
May 17, 2003
Rising tide of Aids threatens to wash away Russia's young
By Rafael Behr

In an internet chat room, a Russian teenager calling himself Mul says of HIV/ Aids: " There's no such thing as Aids. It's all rubbish . . . Aids was a PR stunt thought up by the pharmaceutical companies to sell drugs."

Denis, who has just logged on, agrees: "Does anyone in this chat actually know anyone who's got Aids? I don't know anyone."

Denis may not know anyone with full-blown Aids, but if he is between 18 and 30 years old he has a good chance of knowing someone who is HIV positive.

Every day 133 more people in Russia are found to carry the virus. Along with neighbouring Ukraine, it has one of the highest growth rates for new cases in the world. There are an estimated five new infections every hour.

The United Nations predicts Russia's population of 143m will have shrunk to 104m by 2050. If infections continue at the current rate HIV will shave 4.15 per cent off Russian gross domestic product by 2010, a World Bank study showed. By 2020, HIV infection will account for an annual 1 per cent growth handicap.

HIV/Aids is an epidemic that threatens to assume catastrophic proportions in Russia. But health workers and international organisations say that the government is failing to address the problem.

"If there are now 230,000 registered cases, we can say there are up to 1.5m people actually infected, and they will die on average within 12 years," says Vadim Pokrovsky, head of the Russian Federation Aids Centre in Moscow. "But there's not much realisation of that. Sadly, in the society that we have now people don't even think ahead in terms of the next five or 10 years. Generally people think in terms of the next election."

The toll of HIV will be mainly within the young working population. More than 70 per cent of new HIV infections are among 15-30 year olds.

This generation is the first to have grown up without rigid Soviet social controls and in conditions of economic uncertainty, often in abject poverty. It has experienced an explosion of intravenous drug use. The opening of Russia's borders in the early 1990s led to ahuge influx of heroin from Central Asia.

An estimated third of Russia's 3m-4m registered drug users are aged 10-16. If drug use on the margins of society was the initial motor for HIV infection it is now crossing into the mainstream population. In the Baltic enclave of Kaliningrad, a border transit region and early flashpoint in the drugs and HIV epidemic, up to 40 per cent of cases are now sexually transmitted.

Only a quarter of HIV cases are getting treatment, with drugs prohibitively expensive. The basic facts about prevention are not widely publicised. With little access to anti-retroviral drugs, only embryonic support networks and widespread discrimination there is little incentive for people to find out if they are HIV positive.

Policymakers might be inclined to act when the economic dimension of the threat is made clear, says Mr Pokrovsky, who co-authored the World Bank study.

The message is slowly getting through. The government last month concluded talks on a $150m loan from the World Bank to fight the spread of HIV and tuberculosis, which is also a massive public health threat. The loan was first offered in 1999 but allocation terms took four years to negotiate.

The sums dwarf current government spending, and were seen by the Bank as a sign that Russia is finally taking the problem seriously. But no government official has yet publicly stated that Russia has an HIV problem. Health workers say the subject is taboo.

"Public attitudes towards HIV here are very like public attitudes in western Europe 20 years ago; they are characterised by ignorance and fear," says Rosemary McCreery, United Nations Children's Fund representative in Moscow.

The spread of the virus is particularly severe in overcrowded prisons. Tuberculosis is endemic and about 4 per cent of the incarcerated population is estimated to be HIV positive.

Testing of prisoners is often mandatory, and the practice is spreading to conscripts in the army and pregnant women.

In Sverdlovsk, for example, the region with the third highest infection rate in Russia, up to 13 per cent of births last year were to HIV positive mothers.