#2 - JRL 7214
June 8, 2003
AIDS Spreading Rapidly in Russia
By Liam Pleven
Kaliningrad, Russia - Bottle-blond with sorrowful eyes, Lena has this in common with her motherland: She's lived with the AIDS virus for several years - but it's hurting now in new ways.
A 29-year-old resident of this western Russian city, Lena tested positive for HIV after being sent to prison in a robbery case in 1997. But, she said, "I put up with it." Her parents were supportive, and when she got out she found a job and a new boyfriend.
Lena, who declined to give her last name, learned this year she was pregnant. She wanted the child, though her unafflicted companion feared the risk of an HIV-infected infant. Many friends of hers with the virus have had babies, she said.
But Lena had an abortion.
AIDS is wreaking similar human havoc across Russia. The plague arrived late - by the end of 1998, only about 11,000 cases of HIV were registered, fewer than there are now in some boroughs of New York City - and some Russians figured the cold climate or a genetic quirk might be protecting the country from bearing the disease's full brunt.
Yet just more than four years later, official figures have skyrocketed almost 22 times higher, and unofficial estimates reach loftier still, to 700,000 cases or more of HIV and AIDS in a population of roughly 145 million people. It is one of the fastest-growing AIDS epidemics in the world.
Once confined almost exclusively to drug addicts, HIV is increasingly spread here through sex. More than half the Russian babies ever born to HIV-infected mothers were delivered last year. And though only a relative handful of Russians with HIV have died so far, a World Bank study last year predicted that 500 to 760 could be succumbing monthly two years from now.
"We expect the deaths of hundreds of thousands of people. This is inevitable," said Vadim Pokrovsky, Russia's top AIDS doctor and a co-author of the report.
This will not merely mean giving the global tragedy another address, according to alarmed officials and experts. Russia is a nuclear-armed power that borders NATO member states, one that is reeling already from a post-Soviet health crisis and a declining population.
"I would liken HIV/AIDS [in Russia] to a punch on a bruise," said Nick Eberstadt, a researcher with the American Enterprise Institute, in Washington, D.C., who has written about AIDS in Russia.
Underscoring U.S. concern, Secretary of State Colin Powell warned of a "pending crisis" in an article last month in a Russian newspaper. The danger AIDS poses for Russia is increasingly portrayed by Russians and Americans not just as a humanitarian concern but as a potential peril for the rest of the world, comparable to international terrorism.
"Security is not only a fight against proliferation of nuclear weapons, not only nuclear deterrence, not only a fight against al-Qaida. Security is also a fight against such diseases as AIDS," said Mikhail Margelov, a key Russian legislator who co-chairs a U.S.-Russian citizens' committee on the disease.
The severity of the problem in Russia has become clear only in the past several years. Just less than 1 percent of Russians aged 15 to 49 carry HIV, a slightly higher proportion than in the United States and Western Europe, but well below the 9 percent rate in sub-Saharan Africa, according to UNAIDS, an arm of the United Nations. But one projection from the World Bank study of how HIV might spread if not countered would give Russia an infection rate of about 6 percent by 2010.
Compared with Africa, "the medical health service here is at a higher level. The opportunities for education are also wider," Pokrovsky said. "But nevertheless, rather many people might get infected heterosexually."
That's precisely what seems to be happening in Kaliningrad, a Baltic Sea port captured from Nazi Germany in World War II. It is the capital of Russia's westernmost region, and one of the first cities to be hit hard by HIV. The number of new cases reported in Kaliningrad province has dropped in recent years, but the infection rate is still almost three times higher than the rest of Russia, officials said.
In Kaliningrad, as across Russia, a drug-use explosion is largely to blame for the rapid spread; more than three of every four Kaliningraders registered with HIV - about 4,000 in a population of nearly 1 million - got it from injecting drugs with infected needles, officials said.
But almost half the new cases last year were linked to sex, according to the Kaliningrad AIDS center.
The number of young women who linger near a bridge over the Pregolya River downtown helps explain why, according to locals, who say Kaliningrad's prostitutes are frequently drug users. On a recent afternoon, a woman with an unsteady gait ducked into the shadows after consulting with a male passerby. Another woman said of her fellow street-walkers "the only thing they worry about is getting money for an injection, and then getting an injection;" the interview was interrupted while she chatted with the driver of a car that pulled up to the curb.
Local men who use prostitutes rarely wear condoms. "It's like Russian roulette," said Yelena Parshina, a psychotherapist who works at a clinic up the hill from where the prostitutes work. "It increases the adrenaline in their blood." Yet for such men, their wives and girlfriends, that often means HIV gets into theirs.
At Kaliningrad's AIDS center, a poster of a baby bears the legend "I don't want to get AIDS." More than half of the 118 pregnant women treated at the center last year had abortions, like Lena.
Still, Russia is facing a rapid rise in children born to HIV-infected mothers. The 2,777 born last year were more than 10 times the number three years earlier. In almost 20 percent of such births, mothers pass the virus to their infants, according to Russia's AIDS center. The transmission rate can be reduced to 1 percent with proper treatment, according to the U.S.Centers for Disease Control and Prevention.
But drug treatments can be costly, and Russia's budget for AIDS is a tiny fraction of America's. The United States government spends about $15 billion annually to fight AIDS domestically, and a few weeks ago, President George W. Bush authorized another $15 billion over five years on combating the plague globally, mostly in Africa and the Caribbean.
The Russian government is spending approximately $5 million domestically this year, about the amount the United States spends at home every three hours.
The disease is costing Russia in other ways. In a speech last month, President Vladimir Putin cited Russia's falling life expectancy, and said drug addiction and AIDS were making it worse.
"HIV is becoming a geopolitical problem," Pokrovsky said. "We should start thinking of the threat HIV infection is posing to our country."
Russia's AIDS Crisis
Russia has one of the fastest-growing AIDS and HIV epidemics in the world. According to statistics, as recently as five years ago there were fewer AIDS cases in all of Russia than in some boroughs of New York City.
Below is the number of reported cases of HIV infection in Russia in each of the past five years and the number of new cases registered by Russian health authorities in those years:
1998 New cases 4,058 Total HIV cases 11,020
1999 New cases 19,953 Total HIV cases 30,791
2000 New cases 59,257 Total HIV cases 90,193
2001 New cases 88,422 Total HIV cases 178,538
2002 New cases 50,378 Total HIV cases 228,971
SOURCE: Russian federal AIDS center
Tracking the Epidemic:
Unlike the United States Russia Keeps an official register of every case in which a person tests postive for HIV. But experts believe the real figure is far higher because many people who carry the virus have not been tested. Estimates of the number of cases of HIV infection in Russia and other countries among adults ages 15 to 49, as of Dec. 31, 2001:
Country No. with HIV % with HIV
China 850,000 0.1%
France 100,000 0.3%
Spain 130,000 0.5%
United States 890,000 0.6%
Brazil 600,000 0.7%
India 3,800,000 0.8%
Russia 700,000 0.9%
Thailand 650,000 1.8%
Haiti 240,000 6.1%
South Africa 4,700,000 20.1%