#3 - JRL 7244
Toronto Star
June 29, 2003
Russia's first city of art, culture, heroin
By MICHAEL MAINVILLE
SPECIAL TO THE STAR
Michael Mainville is a Canadian journalist based in Moscow.

ST. PETERSBURG—Far from the tourists admiring the tsarist-era Winter Palace or lining up outside the Hermitage, Oxana Kirilenko sits in a white van, handing out clean needles to heroin addicts at a teeming suburban housing project.

"We work six nights a week, every week of the year," says Kirilenko. "There are always new addicts for us to see."

St. Petersburg, which is celebrating its 300th birthday this year, has long been known as Russia's cultural capital, home to its greatest museums, its most stunning architecture, even its coolest rock bands.

With its smoky cafés, avant-garde artists and laid-back atmosphere, it's a hip sister to Moscow, which Petersburgers love to deride as a city without a soul.

But in recent years St. Petersburg has gained another, far more dubious reputation — as one of the cities worst hit by Russia's troubling heroin problem.

Russia is estimated to have 3 to 4 million illegal drug users, 20 times the figure of 10 years ago, and heroin accounts for up to 75 per cent of drug use in St. Petersburg. Doctors and social workers here say they are doing what they can to combat the problem but fear they are fighting a losing battle.

Kirilenko and her partner, Anatoly Fyodorov, are on the front lines. They work for the St. Petersburg chapter of Medécins du Monde, an international aid organization that has been trying to help the city's drug addicts since 1997.

The group operates three mobile units and a drop-in centre where addicts can obtain clean needles, condoms, HIV tests and counselling.

Tonight, Kirilenko and Fyodorov are running the organization's busiest operation — handing out needles and condoms to some of the thousands of young women who work as prostitutes on St. Petersburg's busy streets.

At 8 p.m., their first two clients are Valia, a 21-year-old redhead, and Oxana, a bleached-blonde 20-year-old with sores covering her face and arms.

Valia says she started working on the street five years ago, shortly after becoming addicted to heroin.

"I was young and stupid and now I have to do this," she says, motioning to the street. "I want to stop. I wish I could stop, but I'm not strong enough."

Valia and Oxana each have four or five clients a day, charging them 300 to 700 rubles ($13-$31) — just enough to pay for their daily fix.

After about five minutes in the van, the women head back to the sidewalk with plastic bags containing five clean needles, five gauze pads, five packs of sterilized water and five condoms.

"It's always the same story," says Kirilenko.

"They start by taking heroin and within a few months they're on the street, selling themselves for their next hit."

Over the next six hours, Kirilenko and Fyodorov follow the same routine with three dozen prostitutes.

The girls — few of them older than 22 — are almost always polite but show little interest in counselling or treatment.

"They never stop abusing drugs," says Fyodorov, "so we just do what we can to help them."

Drug abuse is not entirely new to Russia. Writer Nikolai Gogol described opium use in his 1835 short story about St. Petersburg's most famous street, Nevsky Prospekt.

But under the isolation and strict regimen of Soviet rule, Russians had little access to illegal drugs. Following the collapse of the Soviet Union, however, they suddenly found themselves with easy access to heroin at a time when they were most susceptible to using it.

"It wasn't only the new freedoms of 10 years ago but the disintegration of families, the economic and social hardships and the proliferation of the mafia that fuelled drug use," says Alexander Tsekhanovich, director of Medécins du Monde's St. Petersburg branch.

As a transit city for heroin heading west from Afghanistan, St. Petersburg was particularly hard hit.

Vladimir Musatov, the team's medical co-ordinator, says the number of heroin addicts in the city peaked in the late 1990s at about 70,000 and is now dropping because of increasing prices due to a government crackdown on traffickers.

But he estimates that St. Petersburg still has at least 55,000 intravenous drug users — a staggering number in a city of about 4 million.

And most worrisome, Musatov adds, is that about one in five of them is infected with HIV and the number of infections is growing every year.

Experts have warned that Russia is on the verge of an HIV crisis of horrendous proportions, with up to 7 million deaths from AIDS possible in the next 15 to 20 years.

Tsekhanovich, a muscled, tattooed man who looks more like an aging street thug than an aid worker, says his people pioneered harm-prevention programs for drug addicts in Russia but now focus on needle exchanges, HIV testing and information campaigns because they simply can't afford to go any further.

"I know that what we do is only the beginning, but we don't have the resources to do everything," he says.

At the equivalent of about $543,000 a year, the team's budget is already strained. And only a small part of that funding comes from the government, Tsekhanovich says, because the authorities are fiercely resistant to seeing drug users as anything but criminals.

The team's long-term goal is to raise enough money to open a detox centre that can provide free medical treatment to addicts.

Tsekhanovich has little hope the government will approve a methadone treatment program because "even mentioning methadone to the authorities is like committing a crime."

But other heroin-substitution programs may be feasible.

"We're looking into various options because the current detox centres are like prisons. (Addicts) suffer for days without any drug treatment and there is no counselling process."

The government centres also cost about $315 to enter, which Tsekhanovich says "is an impossible fee for the great majority of addicts."